From Periphery to Perception: The Pathway to Pain

Sarah Mouton Dowdy

In explaining how a noxious stimulus in the periphery becomes an electrical impulse in the cerebral cortex, veterinary anaesthesiologist Dr. Mike Barletta ultimately makes a case for multimodal pain management.

Physiologic pain, or acute adaptive pain—the kind that prompts you to pull your hand away when you touch a hot stove, can prevent injury and even promote healing after injury.

Pathologic pain refers to chronic, maladaptive pain, which Dr. Barletta described as “an expression of the pathologic operation of the nervous system that can follow acute pain if not prevented or treated.”

Pain versus nociception

“Nociception is everything that happens before a noxious stimulus reaches the cerebral cortex,” explained Dr. Barletta. “It includes the periphery, nerves, and spinal cord—everything up to the cortex. Once that stimulus is processed by the cortex and the organism becomes aware of it, we start calling it pain.” Transduction, transmission, modulation, and projection are thus part of nociception

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