To provide a review of chronic pain states, focusing on neuroanatomic pathways and their influence on treatment strategies (part 2 of a two-part series).
A thorough literature review of published articles available in Medline from 1966 to 1996 on the topic of pain management, including diagnosis, pathophysiology, interventions, and treatment.
Understanding the pathophysiology of chronic pain and the role of chemical mediators, such as enkephalins, norepinephrine, serotonin, and substance P, may improve pain management. As a result, pain control measures can target inhibition of the descending pain modulation pathways of the spinal cord, in addition to the peripheral or central actions of traditional analgesics. Fewer ablative surgical interventions are performed for pain control, because they often provide only temporary relief at the expense of significant permanent neurological deficits. However, there are more augmentative procedures now available for the patient with intractable and unresponsive pain, although referral to specialized pain clinics may benefit particularly difficult cases.