A Cancer Pain Tutorial

A Comprehensive Visual Short Course
on Cancer Pain Management

The Spinal Cord, Brain and Pain Transmission
illustration of parts of a spinal cord illustration of pain transmission in nerve fibers illustration of pain and temperatire pathways

The dorsal (rear) root is the sensory root. The ventral (front) root is the motor root. The dorsal root ganglion contains cell bodies of general somatic afferent (inbound) neurons, mediates pain and temperature and synapse in the dorsal horn of the spinal cord.

A-delta fibers are myelinated (insulated with a myelin sheath). The pain is fast and well localized, like the initial prick or stinging sensation following an injury.

C fibers are nonmyelinated and smaller than A-delta fibers. They transmit pain much slower. The pain is more lasting, generalized and described as a dull ache.

Dorsal Root
Ventral Root
Synonym:
back
front
Role:
sensation
movement
Nerve Diameter:
0.25 - 1.5 µm
1.00 - 5.0 µm
Signal Rate:
0.25-1.5 m/s
6 - 10 m/s
Diameter:
0.25 - 1.5 µm
1.00 - 5.0 µm
Sensation Speed:
Slow
Pain
Fast Pain
Duration:
Lasting
Stinging
Sensation Region:
Generalized
Localized
Sensation Type:
Dull Ache
Prick
Fiber Type:
non-
myelinated
myelinated
Thalamocortical fibers from neurons in the thalamic nuclei relay pain information to the cerebral cortex. 

Painful stimuli originating in the periphery decussate (cross) and ascend in the contralateral (opposite side) spinal thalamic tract.

The lateral spinal thalamic tract is the main tract carrying general somatic afferent fibers to their central nervous connections.

Peripheral receptors are terminals of pain pathway fibers. (A-delta and C nerve fibers.)

This process is referred to as nociception.

Synaptic Transmission of Nerve Signals
Synaptic Transmission
Synaptic Inhibition
Synaptic Hyperexcitation
illustration of synaptic transmisison
illustration of synaptic inhibition
illustration of synaptic hyperexcitation
Pain Neurotransmitters
Histamine
Dopamine
Serotonin



Bradykinin
Substance P
Calcitonin Gene-Related Peptide



Last Updated 10/2013 LVW