Post Thoracotomy Pain Management

Introduction The pathway of a pain impulse starts with the primary afferent nerve fibers (C and Aδ) whose axons end in the dorsal horn of the spinal cord. Nociceptive information is passed to the contralateral side of the spinal cord and, after synapsing, ascends in the anterolateral system as spinothalamic tracts. The primary areas of the brain that respond to pain stimuli are the somatosensory corticies, the insular cortex, the anterior cingulate cortex, the prefrontal cortex and several thalamic nuclei. (BoyetteDavis). The insular and anterior cingulate corticies are part of the limbic system, which contribute to the affective or emotional aspect of pain. There is also an elaborate array of pro-nociceptive mediators, which may potentiate the pain, as well as anti-nociceptive chemicals that are released following a tissue insult that leads to pain.