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.