Pain Assessment and Management, 2nd Edition _ _________________________________________________
THE PAIN PATHWAY
Source: From Lennertz, R. (2020).
Figure 1
However, not all pain is localized to the area of injury, and the pain a client feels may seem to be in a location that is different from the site of the actual tissue damage; this phenomenon is called referred pain. For example, a heart attack can pro- duce pain in the jaw, neck, or left arm or may manifest as a toothache or even sinusitis. Referred pain is commonly seen in clinics; however, there are few studies specific to this topic, making management of referred pain clinically challenging (Jin et al., 2023). Many factors can alter the transmission of nerve impulses to the brain, including the actions of neurotransmitters, neuromodu- lators, and opioid receptors (Bán, 2020). Neurotransmitters are the chemical messengers that send a message from one nerve cell to another. The neurotransmitters include norepinephrine,
epinephrine, serotonin, and acetylcholine. Neurotransmitters are able to produce pain on their own. Neuromodulators act to enhance or dampen neuronal activities; examples of neuromodulators are endorphins and enkephalins, which act to depress pain by interfering with neural transmission (Bán, 2020). Opioid receptors are usually located in the brain and the superficial dorsal horn of the spinal cord regions, where the sensory nerve fibers are found. Certain types of opioid receptors have a high affinity for natural enkephalins and endorphins, and they also bind with medications such as morphine and codeine to diminish the pain response.
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