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In these regions, somatosensory information is processed and associated with previous experiences that are related to pain. Inhibitory neurons in the spinal cord are activated by descending pathways from the brain. Here the transmitters are GABA and enkephalin. Enkephalin is one of the endogenous endorphins, which are natural opioids. Enkephalin reduces the release of substance P at the sensory neuron terminals in the spinal cord. It is also released in areas of the midbrain and medulla where it enhances the descending inhibitory pathways, which terminate in the spinal cord.


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Supplementary prescribing may only commence following assessment and diagnosis by the independent prescriber and the development of a written CMP agreed between the independent prescriber, the supplementary prescriber and the patient.

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