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Block transmission in nerves?

NEUROTRANSMITTER SUBSTANCES

Evidence based on both human and animal studies has shown that an endogenous system, lying within the central nervous system can induce a degree of analgesia. Electrical stimulation of certain sites, such as the periaqueductal grey matter, can inhibit pain perception.

Receptor sites for endogenous opiates have been found in the posterior horns and thalamus as well as at several other sites. The endogenous substances which bind to these sites are called encephalitis or endorphins.

Substance P, a polypeptide, found predominantly around free nerve ending receptors and in the spinal cord posterior horns, is the likely primary transmitter of pain.

DRUG TREATMENT

Sites of potential drug action:

Block transmission in nerves?

Block pain transmission centrally;

Block receptors at ~

periphery, e.g. aspirin, non-steroidal anti-inflammatory drugs

Drug selection in pain treatment depends on the severity, cause and the expected duration of the pain, i.e. acute pain - less than 2 weeks duration, e.g. postoperative, post-traumatic, renal colic.

chronic pain - benign origin, e.g. postherpetic neuralgia phantom limb pain chronic back pain.

— malignant origin.

1. In acute pain, drug therapy ranges from mild analgesics - aspirin, paracetamol - to narcotic agents - morphine, heroin. Tranquillisers may also help.

2. In chronic pain of benign origin, narcotics and sedatives must be avoided. In these patients, depression usually plays a role and the clinician must not underestimate the value of antidepressants.

Anticonvulsants - carbamazepine appears to benefit many patients, probably due to its membrane stabilizing effect.

Topical treatment - capsicin blocks substance P and inhibits pain transmission in the skin. Used for postherpetic neuralgia.

3. In chronic pain from terminal malignancy, patients often require strong narcotics -morphine, heroin. Frequent administration of small doses provides the greatest effect.

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