The field of Pain Medicine has evolved over the last 20 years to include an
increasing array of sophisticated and technologically complex diagnostic and therapeutic
procedures. Concurrent to this advancement has been the development of a
battery of pharmacological options to treat pain, from extended-release formulations
of analgesics to antidepressants and anticonvulsants designed to treat specific types of
The Spinal Cord and Referred Pain
The axons of primary afferent nociceptors enter the spinal cord via the dorsal root. They terminate in the dorsal horn of the spinal gray matter (Fig. 12-3). The terminals of primary afferent axons contact spinal neurons that transmit the pain signal to brain sites involved in pain perception. When primary afferents are activated by noxious stimuli, they release neurotransmitters from their terminals that excite the spinal cord neurons. The major neurotransmitter they release is glutamate, which rapidly excites dorsal horn neurons.
Why can some athletes seemingly play through
injuries but succumb to incredible pain
immediately after the competition ends? The
explanation is thought to be related to the
intense motivational states that may interfere
with the perception of pain. The effects of
emotional states may also explain why individuals
with clinical depression report more pain than
their counterparts without depression, and why
anxiety increases pain perception.
Aesthetic feelings are distinguished from sensory feelings, now, by the fact that the former
are related to the content of a presentation, the latter to the act itself.
Thus sensory feelings, but
not aesthetic feelings, are directly sensitive to the quality and intensity of the act, and all
sensations are, above a certain intensity, painful. Further, the sensory feeling disappears or is at
least reduced to an almost unnoticeable intensity in the passage from sensation (perception) to a
reproduced presentation in memory. ...
Fourth, our analysis of consultation patterns for the management of specific pregnancy-
related conditions suggests pregnant women are making discretionary decisions regarding
whom to consult depending on their immediate health concerns. Chiropractors are frequently
consulted for back pain and sciatica, massage therapists consulted more commonly for neck
pain, and naturopaths and acupuncturists more likely to be consulted for pregnancy-related
nausea. Women are consulting with CAM practitioners most commonly for management of