It is perhaps fortuitous that the dorsal horn, the important site of pain transmission, is in the superficial layers of

Figure 21.3 Blood/cerebrospinal fluid-brain barrier. 1, cerebrospinal fluid-brain barrier, chorioidal part; 2, cerebrospinal fluid-brain barrier, extrachoroidal part; 3, blood-brain barrier.

Figure 21.4 Central nervous system distribution of systemic and spinal analgesics: (a) spinal; (b) systemic.

the spinal cord, enabling drugs reaching the cerebrospinal fluid to more readily exert their effects (Figure 21.5).

Spinal opioids exert their analgesic effect at the spinal cord pre- and postsynaptically by reducing neurotransmitter release and by hyperpolarizing the membrane of dorsal horn neurons.8

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