By Harry J. Gould III MD PhD
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Extra resources for Understanding Pain: What It Is, Why It Happens, and How It's Managed
Repetitive firing of C-fibers produces a gradual increase in the perception of a stimulus irrespective of an increase in its intensity (see Fig. 4-7). This phenomenon, called wind-up, effectively increases the likelihood that a stimulus will be relayed to levels of cognitive perception through a sensitization of relay neurons in the dorsal horn of the spinal 36 CHAPTER 4 • The Anatomy of Pain FIGURE 4-6 Descending systems modify pain signals as they enter the dorsal horn of the spinal cord. Ascending pain pathways conveying noxious information to the thalamus are depicted in gray.
The specialized nerve endings are associated with specific axon types, whose diameter and myelin sheath determine the rate of signal transmission. Ia afferent (A, most rapid conductor), A-␤ (B, C, and D), A-␤ A-␦ (F and G), and C-fibers (E and H, slowest conductor) are illustrated in association with their specialized nerve endings. 27 Understanding Pain in the arm, are optimally constructed to detect fine differences in muscle stretch. Signals generated in those nerves having these specialized endings are responsible for the corrective contraction of the stretched muscle so that the appropriate muscle length and tension is maintained.
These chemicals stimulate increases in blood flow to the injured area, which brings cells that engulf and destroy nonviable tissues and infectious agents; increases levels of oxygen and nutrients necessary for repair; sequesters particulate byproducts of the clean-up; and removes the byproducts of metabolism in the form of carbon dioxide. This process of clean-up and repair is called inflammation. The chemical agents released during inflammation also serve to diminish further injury by lowering the threshold of nerve cells for generating a pain signal, thus making it easier to send a protective warning to the spinal cord and brain.
Understanding Pain: What It Is, Why It Happens, and How It's Managed by Harry J. Gould III MD PhD