I recently returned from the 20th Annual Napa Pain Conference where I was fortunate to attend and present at a pre-conference meeting entitled, “Intraspinal Therapies: Enhancing Clinical Practices and Improving Patient Safety.” The pre-conference was held for Allied Health Professionals directly involved with the care of chronic pain patients. Gail McGlothlen chaired this pre-conference, and I greatly appreciated all of her efforts.

One of the first speakers was Dr. Elliott Krames with a presentation entitled, “Neurobiology of the Spinal Cord.” I previously mentioned this topic upon my return from the Targeted Drug Delivery Conference in May of this year, but it was great to hear Dr. Krames give this presentation a second time because I was able to recall points of interest that I had previously forgotten.

Dr. Krames began his presentation by discussing that the neurobiology of pain is broken down into two areas: one simple and complex. Additionally, there are five parameters involved with the biology of pain: transduction, transmission, pain processing, perception and modulations. The first of these parameters, transduction, is the process of converting noxious stimuli into electrical energy. Next there is a transmission of this electrical energy to the brain for processing and perception and modulation. Dr. Krames expressed that in every step of pain processing, our bodies function chemically and electrically; therefore, modulation constantly occurs. Very interesting!

Dr. Krames also stated nociceptive receptors are ubiquitous in all tissues except neural and that ninety-five percent of our skin contains nociceptive receptors. He explained that transmission velocity of nociceptive impulses are determined by the degree of myelination … the greater the myelination, the faster the transmission. For example, C fibers transmit very slowly due to being poorly myelinated.

During his presentation, Dr. Krames presented a slide showing the Rexed Laminae, which was identified in the early 1950s by Bror Rexed. This area is a system of 10 layers of gray matter within the spinal cord and these areas are defined by their cellular structure rather than by their location; however, the location still remains consistent throughout the spinal cord. In regards to the transmission and sensory of pain, the primary focus on the spinal cord relates to the substantia gelatinosa – an area that provides a wide dynamic of pain sensory and modulation. This is a topic that I am very interested in and will continue to research, and I will update as new information is gained.