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"Pain ladder", or analgesic ladder, was created by the World Health Organization (WHO) as a guideline for the use of drugs in the management of pain. Originally published in 1986 for the management of cancer pain , it is now widely used by medical professionals for the management of all types of pain .
The anterolateral system (ALS) is an ascending bundle of fibers in the spinal cord, carried in three main pathways or tracts. [1] The tracts convey pain, [6] temperature (protopathic sensation), and crude touch from the periphery to the brain. The most important of these is the spinothalamic tract. [2]
The second-order neurons ascend to the brain stem and thalamus in the ventrolateral, or anterolateral, quadrant of the contralateral half of the spinal cord, forming the spinothalamic tract. [1] The spinothalamic tract is the main pathway associated with pain and temperature perception, which immediately crosses the spinal cord laterally. [1]
The tract transmits slow nociceptive/pain information (but thermal, and crude touch information as well) from the spinal cord to reticular formation which in turn relays the information to the thalamus via reticulothalamic fibers as well as to other parts of the brain (as opposed to the spinothalamic tract - the direct pathway of the ...
Diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM) refers to an endogenous pain modulatory pathway which has often been described as "pain inhibits pain". [1] It occurs when response from a painful stimulus is inhibited by another, often spatially distant, noxious stimulus.
An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics. [1]
The exact medications recommended will vary by country and the individual treatment center, but the following gives an example of the WHO approach to treating chronic pain with medications. If, at any point, treatment fails to provide adequate pain relief, then the doctor and patient move onto the next step.
Cordotomy is performed as for patients with severe intractable pain, usually but not always due to cancer.Being irreversible and relatively invasive, cordotomy is used exclusively for pain where treatment to level 3 of the World Health Organization pain ladder (i.e., use of major opiates such as morphine) has proved inadequate.