Pain? It’s Complicated.
Pain is complex. Briefly, painful stimuli arising in the periphery are received by nociceptors that respond to a range of aversive stimuli (eg, temperature, pressure). Peripheral nociceptive input is transmitted through the dorsal horn of the spinal column where interneurons project signals to central nervous system (CNS) structures. Pain is experienced through descending signals arising from both the periphery and from the brain.
Transmission of pain and modulatory signaling involves multiple pathways of excitatory and inhibitory receptors and neurotransmitters, which are targets for the treatment of pain. Drug treatment for chronic pain can target several sites, including neuroreceptors (eg, opioid receptors), ion channels (eg, calcium and sodium channels), and neurotransmitters (eg, norepinephrine and serotonin). Non-drug treatments targeting mostly peripherally-acting
mechanisms include acupuncture, dry needling, manipulation, and transcutaneous and peripheral nerve stimulation, among others. Non-drug treatments that are mostly centrally-acting include cognitive-behavioral therapies, and sleep hygiene. Non-pharmacologic treatments that target both peripheral and central pain processes include exercise, and yoga, among others. The dedicated providers at The Manhattan Center for Headache and Neurology are well-versed in drug and non-drug treatments for pain. Please call for an appointment to discuss a comprehensive treatment plan.
–Alice Wong, NP
https://www.uptodate.com/contents/approach-to-the-management-of-chronic-non-cancer-pain-in-adults