Neuroanatomical substrates of nociception in the spinal cord

Disentangling the spinal mechanisms of illusory heat and burning sensations in the thermal grill illusion

ABSTRACT

The thermal grill illusion (TGI), a phenomenon in which the juxtaposition of innocuous warm and cold temperatures on the skin elicits a burning sensation, offers a unique perspective to how pain occurs in response to harmless stimuli. We investigated the role of the spinal cord in the generation of the TGI across 2 experiments (total n = 80). We applied heat and cold stimuli to dermatomes, areas of skin innervated by a single spinal nerve, that mapped onto adjacent or nonadjacent spinal segments. Enhanced warm and burning ratings during the TGI were observed when cold and warm stimuli were confined within the same dermatome. Furthermore, we found the spatial organisation of warm and cold stimuli within and across dermatomes affected TGI perception. Perceived warmth and burning intensity increased when the cold stimulus projected to the segment more caudal to the warm stimulus, whereas perceived cold during the TGI decreased compared with the opposite spatial arrangement. This suggests that the perception of TGI is enhanced when cold afferents are projected to spinal segments positioned caudally in relation to those receiving warm afferents. Our results indicate distinct interaction of sensory pathways based on the segmental arrangement of afferent fibres and are consistent with current interpretations of the spread and integration of thermosensory information along the spinal cord.

Electroacupuncture improves allodynia and central sensitization via modulation of microglial activation associated P2X4R and inflammation in a rat model of migraine

Background: Recent studies have demonstrated that activated microglia were involved in the pathogenesis of central sensitization characterized by cutaneous allodynia in migraine. Activation of microglia is accompanied by increased expression of its receptors and release of inflammatory mediators. Acupuncture and its developed electroacupuncture (EA) have been recommended as an alternative therapy for migraine and are widely used for relieving migraine-associated pain. However, it remains rare studies that show whether EA exerts anti-migraine effects via inhibiting microglial activation related to a release of microglial receptors and the inflammatory pathway. Therefore, this study aimed to investigate EA' ability to ameliorate central sensitization via modulation of microglial activation, microglial receptor, and inflammatory response using a rat model of migraine induced by repeated epidural chemical stimulation. Methods: In the present study, a rat model of migraine was established by epidural repeated inflammatory soup (IS) stimulation and treated with EA at Fengchi (GB20) and Yanglingquan (GB34) and acupuncture at sham-acupoints. Pain hypersensitivity was further determined by measuring the mechanical withdrawal threshold using the von-Frey filament. The changes in c-Fos and ionized calcium binding adaptor molecule 1 (Ibal-1) labeled microglia in the trigeminal nucleus caudalis (TNC) were examined by immunflurescence to assess the central sensitization and whether accompanied with microglia activation. In addition, the expression of Ibal-1, microglial purinoceptor P2X4, and its associated inflammatory signaling pathway mediators, including interleukin (IL)-1β, NOD-like receptor protein 3 (NLRP3), and Caspase-1 in the TNC were investigated by western blot and real-time polymerase chain reaction analysis. Results: Allodynia increased of c-Fos, and activated microglia were observed after repeated IS stimulation. EA alleviated the decrease in mechanical withdrawal thresholds, reduced the activation of c-Fos and microglia labeled with Ibal-1, downregulated the level of microglial purinoceptor P2X4, and limited the inflammatory response (NLRP3/Caspase-1/IL-1β signaling pathway) in the TNC of migraine rat model. Conclusions: Our results indicate that the anti-hyperalgesia effects of EA ameliorate central sensitization in IS-induced migraine by regulating microglial activation related to P2X4R and NLRP3/IL-1β inflammatory pathway.

Neurosurgical Treatment of Pain

The aim of this review is to draw attention to neurosurgical approaches for treating chronic and opioid-resistant pain. In a first chapter, an up-to-date overview of the main pathophysiological mechanisms of pain has been carried out, with special emphasis on the details in which the surgical treatment is based. In a second part, the principal indications and results of different surgical approaches are reviewed. Cordotomy, Myelotomy, DREZ lesions, Trigeminal Nucleotomy, Mesencephalotomy, and Cingulotomy are revisited. Ablative procedures have a limited role in the management of chronic non-cancer pain, but they continues to help patients with refractory cancer-related pain. Another ablation lesion has been named and excluded, due to lack of current relevance. Peripheral Nerve, Spine Cord, and the principal possibilities of Deep Brain and Motor Cortex Stimulation are also revisited. Regarding electrical neuromodulation, patient selection remains a challenge.

Somatotopic organization of the human spinothalamic tract: in vivo computed tomography-guided mapping in awake patients undergoing cordotomy

OBJECTIVE

The location of the human spinothalamic tract (STT) in the anterolateral spinal cord has been known for more than a century. The exact nature of the neuronal fiber lamination within the STT, however, remains controversial. After correlating in vivo macrostimulation-induced pain/temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, the authors present a modern description of the somatotopy of the human cervical STT.

METHODS

Twenty patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation (0.01-0.1 V, 50 Hz, 1 msec) were recorded and the electrode location for each response was documented with a contemporaneous CT scan. In a post hoc analysis of the data, the location for each patient's response(s) was measured and drawn on a diagram of their cord. Positive responses were represented only when the lowest possible voltage (≤ 0.02 V) elicited a response. Negative responses were recorded if there was no clinical response at 0.1 V.

RESULTS

Clinically, patients did well with an average reduction in opiates of 75% at 1 week, and 67% were able to leave the palliative care unit. The size of the cervical cord varied between patients, with an average lateral extent (width) of 11 mm and a height of 9 mm. Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially, but also posteriorly.

CONCLUSIONS

In this study, the somatotopic organization of the human STT was elucidated for the first time using in vivo macrostimulation and contemporaneous CT imaging during cordotomy. In this cohort of patients, the STT from the lower-limb region was located superficially and posteriorly in the anterolateral quadrant of the cervical cord, with the STT from the upper-limb region surrounding it primarily anteriorly and medially (deep) but also posteriorly. The authors discuss how the previous methods of cordotomy may have biased the earlier versions of STT lamination. They suggest that an ideal spinal cord entry site for cordotomy of either the upper- or lower-limb pain fibers is halfway between the equator and anterior pole of the cord.

Organization of the Thermal Grill Illusion by Spinal Segments

Objective

A common symptom of neuropathy is the misperception of heat and pain from cold stimuli. Similar cold allodynic sensations can be experimentally induced using the thermal grill illusion (TGI) in humans. It is currently unclear whether this interaction between thermosensory and nociceptive signals depends on spinal or supraspinal integration mechanisms. To address this issue, we developed a noninvasive protocol to assess thermosensory integration across spinal segments.

Methods

We leveraged anatomical knowledge regarding dermatomes and their spinal projections to investigate potential contributions of spinal integration to the TGI. We simultaneously stimulated a pair of skin locations on the arm or lower back using 1 cold (∼20°C) and 1 warm thermode (∼40°C). The 2 thermodes were always separated by a fixed physical distance on the skin, but elicited neural activity across a varying number of spinal segments, depending on which dermatomal boundaries the 2 stimuli spanned.

Results

Participants consistently overestimated the actual cold temperature on the skin during combined cold and warm stimulation, confirming the TGI effect. The TGI was present when cold and warm stimuli were delivered within the same dermatome, or across dermatomes corresponding to adjacent spinal segments. In striking contrast, no TGI effect was found when cold and warm stimuli projected to nonadjacent spinal segments.

Interpretation

These results demonstrate that the strength of the illusion is modulated by the segmental distance between cold and warm afferents. This suggests that both temperature perception and thermal–nociceptive interactions depend upon low‐level convergence mechanisms operating within a single spinal segment and its immediate neighbors. Ann Neurol 2018;84:463–472

PAIN MECHANISMS - A REVIEW: II. Afferent pain pathways

This paper reviews some major advances in our understanding of the organization of afferent pain pathways, and relates these and other findings to the limited success rate achieved by various surgical interventions used in the treatment of chronic intractable pain. First-order pain afferents, many of which use the transmitter substance P, may enter the spinal cord via both the dorsal and ventral roots. After terminating superficially in the dorsal horn, information may apparently ascend to higher centres via numerous pathways, some of which are contralateral some ipsilateral. The preferred route to the primary somatosensory cortex appears to be the contralateral spinothalamic tract, but alternate pathways may be recruited following anterolateral cordotomy or thalamotomy. In addition to divergence of the central pain pathways and the presence of ventral root afferents, other factors considered that may contribute to surgical failure include denervation supersensitivity, the occurrence of prolonged spontaneous injury discharge, and divergence of the peripheral branches of nociceptive fibres.

Pain, referred sensations, and involuntary muscle movements in brachial plexus injury

OBJECTIVES

Examination of the relationship between pain, sensory hypersensitivity, referred sensations and involuntary muscle jerks in patients with brachial plexus injury.

MATERIALS AND METHODS

Fourteen patients with brachial plexus lesions were included. Spontaneous background and paroxysmal pain and mechanically and thermally evoked pain were recorded. Areas with sensory hypersensitivity and referred pain were mapped on a body chart. This was supplemented by electrophysiological analysis in three patients.

RESULTS

Sensory hypersensitivity and areas with pinprick-induced referred phantom sensations were present in adjacent dermatomes. There was no clear relationship between chronic neuropathic pain and referred sensations, but there was a correlation between pain paroxysms and sensory hypersensitivity in dermatomes adjacent to deafferented areas. In three patients, simultaneous referred sensations and short latency motor action potentials ipsilateral to the denervated side suggested origin at subcortical sites.

CONCLUSION

The study suggests a possible role of a spinal generator for sensory hypersensitivity and referred sensations following denervation.

Cancer pain (classification and pain syndromes)

Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.

HISTOLOGICAL DISTRIBUTION AND ULTRASTRUCTURAL FEATURES OF IMMUNOREACTIVE TERMINALS AGAINST RT97, A MONOCLONAL ANTIBODY TO A 200 kD NEUROFILAMENT, IN THE SPINAL DORSAL HORN OF A RAT

Localization and ultrastructural features of immunoreactive fibers and terminals against RT-97, a mouse monoclonal antibody that recognizes subunit of a 200-kD neurofilament, were examined in the spinal dorsal horn of adult rats. Under a light-microscope, many RT-97 immunoreactive fibers were detected in the dorsal root, collaterals of the dorsal root in the dorsal funiculus, and laminae III and IV in the dorsal horn. Few immunoreactive fibers were found in laminae I and II. Electron microscopic observation demonstrated that almost all RT-97 immunoreactive fibers in the dorsal root were myelinated, and unmyelinated fibers immunonegative. The immunoreactive fibers entered into the dorsal horn passing through the collaterals of the dorsal root along the superficial gray lamina. In the dorsal horn, these fibers ascended into and then terminated in lamina II. RT-97 immunoreactive central terminals were semicircular or ellipsoid in appearance and contained many flat-type presynaptic vesicles. Some terminals made synaptic contact with dendritic profiles in lamina II. Our present results indicate that RT-97 is a useful marker for ultrastructural examination of terminals served by non-nociceptive A-fibers.

Cancer pain: Neurosurgical management

The management of cancer pain represents a difficult diagnostic and therapeutic problem for the clinician. In a multidisciplinary approach to the management of cancer pain, neurosurgical methods are an essential part of the therapy. Frequently, patients with advanced cancer suffer from an increasing pain, requesting ever higher dosage of narcotics, and finally seeming to respond only to high dosage of intravenous narcotics. Gradually, the opioids produce less satisfactory analgetics effects an more serious side manifestations. These patients can be considered for surgical management of pain. Historically, surgery for cancer pain began with destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative. In past two decades, with the help of the current knowledge of cancer pain mechanisms and some of the technological developments, such as microsurgical and stereotactic techniques, computerized tomography and magnetic resonance imaging, the majority of ablative procedures have been replaced by new methods. Among them a few are selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone operation, limited midline myelotomy) and the others ones are neuroaugumentative operations ( deep brain structures and spinal cord stimulation, drugdelivery systems).

beta3, a novel auxiliary subunit for the voltage-gated sodium channel, is expressed preferentially in sensory neurons and is upregulated in the chronic constriction injury model of neuropathic pain

Adult dorsal root ganglia (DRG) have been shown to express a wide range of voltage-gated sodium channel alpha-subunits. However, of the auxiliary subunits, beta1 is expressed preferentially in only large- and medium-diameter neurons of the DRG while beta2 is absent in all DRG cells. In view of this, we have compared the distribution of beta1 in rat DRG and spinal cord with a novel, recently cloned beta1-like subunit, beta3. In situ hybridization studies demonstrated high levels of beta3 mRNA in small-diameter c-fibres, while beta1 mRNA was virtually absent in these cell types but was expressed in 100% of large-diameter neurons. In the spinal cord, beta3 transcript was present specifically in layers I/II (substantia gelatinosa) and layer X, while beta1 mRNA was expressed in all laminae throughout the grey matter. Since the pattern of beta3 expression in DRG appears to correlate with the TTX-resistant voltage-gated sodium channel subunit PN3, we co-expressed the two subunits in Xenopus oocytes. In this system, beta3 caused a 5-mV hyperpolarizing shift in the threshold of activation of PN3, and a threefold increase in the peak current amplitude when compared with PN3 expressed alone. On the basis of these results, we examined the expression of beta-subunits in the chronic constriction injury model of neuropathic pain. Results revealed a significant increase in beta3 mRNA expression in small-diameter sensory neurons of the ipsilateral DRG. These results show that beta3 is the dominant auxiliary sodium channel subunit in small-diameter neurons of the rat DRG and that it is significantly upregulated in a model of neuropathic pain.

Ultrastructural observations of synaptic connections of vibrissa afferent terminals in cat principal sensory nucleus and morphometry of related synaptic elements

Previous work suggests that slowly adapting (SA) periodontal afferents have different synaptic arrangements in the principal (Vp) and oral trigeminal nuclei and that the synaptic structure associated with transmitter release may be related directly to bouton size. The present study examined the ultrastructures of SA and fast adapting (FA) vibrissa afferents and their associated unlabeled axonal endings in the cat Vp by using intra-axonal labeling with horseradish peroxidase and a morphometric analysis. All SA and FA afferent boutons contained clear, round, synaptic vesicles. All the FA and most SA boutons were presynaptic to dendrites, but a few SA boutons were axosomatic. Both types of bouton were frequently postsynaptic to unlabeled axonal ending(s) containing pleomorphic, synaptic vesicles (P-ending). The size of labeled boutons was larger in FA than SA afferents, but the size of dendrites postsynaptic to labeled boutons was larger for SA than FA afferents. Large-sized FA and SA boutons made synaptic contacts with small-diameter dendrites. The size of FA and SA boutons was larger than that of their associated P-endings. A morphometric analysis made on the pooled data of SA and FA boutons indicated that apposed surface area, active zone number, total active zone area, vesicle number, and mitochondrial volume were highly correlated in a positive linear manner with labeled bouton volume. These relationships were also applicable to unlabeled P-endings, but the range of each parameter was smaller than that of the labeled boutons. These observations provide evidence that the two functionally distinct types of vibrissa afferent manifest unique differences but share certain structural features in the synaptic organization and that the ultrastructural "size principle" proposed by Pierce and Mendell ([1993] J. Neurosci. 13:4748-4763) for Ia-motoneuron synapses is applicable to the somatosensory system.

Electron microscopy of immunoreactivity patterns for glutamate and gamma-aminobutyric acid in synaptic glomeruli of the feline spinal trigeminal nucleus (Subnucleus Caudalis)

We studied the ultrastructure of the synaptic organization in the feline spinal trigeminal nucleus, emphasizing specific neurotransmitter patterns within lamina II of the pars caudalis/medullary dorsal horn. Normal adults were perfused, and Vibratome sections from pars caudalis were processed for electron microscopy. Ultrathin sections were reacted with antibodies for the excitatory neurotransmitter glutamate (Glu) and for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by using postembedding immunogold techniques. Both single- and double-labeled preparations were examined. Results with single labeling show that Glu-immunoreactive terminals have round synaptic vesicles and form asymmetric synaptic contacts onto dendrites. GABA-immunoreactive axon terminals and vesicle-containing dendrites have pleomorphic vesicles, and the axon terminals form symmetric contacts onto dendrites and other axons. Double labeling on a single section shows glomeruli with central Glu-immunoreactive terminals that are presynaptic to dendrites, including GABA+ vesicle-containing dendrites. These Glu+ terminals are also postsynaptic to GABA+ axon terminals, and these GABA-immunoreactive terminals may also be presynaptic to the GABA+ vesicle-containing dendrites. Quantitative analyses confirm the specificity of the Glu and GABA immunoreactivities seen in the various glomerular profiles. The results suggest that a subpopulation of Glu-immunoreactive primary afferents (excitatory) may be under the direct synaptic influence of a GABA-immunoreactive intrinsic pathway (inhibitory) by both presynaptic and postsynaptic mechanisms.

Projections of ankle joint afferents to the spinal cord and brainstem of the chicken (Gallus g. domesticus)

The projections of the ankle joint capsule afferents were studied by transganglionic transport of horseradish peroxidase injected directly into the ankle joint. The number and size of the labelled dorsal root ganglion cells were measured from synsacral nerves 2-9. In the dorsal root ganglia, all sizes of sensory neurones were labelled, and the largest number of labelled cells was in ganglia 5-7. The extensive sympathetic innervation of the ankle joint was identified by the large number of cell bodies labelled in the sympathetic ganglia of the paravertebral chain. Labelled afferent fibres projected to the spinal cord from the 2nd to the 8th synsacral nerves, with the rostral projection mainly via Lissauer's tract and the dorsal funiculus. Terminal labelling in the dorsal horn was identified in laminae I-III and VI, with a slight projection to V. Two areas of dense labelling, which did not correspond with the largest number of labelled dorsal root ganglion cells, were identified. A rostral area with the highest density of label was observed at the level of synsacral nerves 3-4 and a second slightly less dense area between synsacral nerves 7-8. In the caudal medulla, diffuse terminal labelling was observed in the nucleus gracilis et cuneatus, nucleus of the tractus solitarius, and the nucleus cuneatus externus. These results are discussed in a comparative context to identify similarities and differences between different primary afferent projections in birds and mammals and to highlight the possible functional significance of the avian articular afferent projection.

Multiple protracted cauda equina constrictions cause deep derangement in the lumbosacral spinal cord circuitry in the dog

Neuropathological changes of the neuronal pools and spinal cord circuitry in the lumbosacral segments were studied in a canine model of multiple protracted cauda equina constrictions. Anterograde degeneration of all sacrococcygeal and L7 dorsal root fibers was detected in S1-S3 and lower lumbar segments. A narrow degenerated gracile fascicle was found in all thoracic and cervical segments terminating in the gracile nucleus. Transneuronal degeneration of middle-sized and large neurons, located in S1-S3 and sporadically in L7 segments, was noted. Identical transneuronal degeneration was seen in a group of small neurons located in the ventralmost part of lamina VII in S1-S3 segments. Simultaneously, a terminal degeneration was detected in the lateral cervical nucleus and in the ventral posterior lateral nucleus of the ventrobasal thalamic complex. Concomitantly, a fully developed retrograde degeneration affecting motoneurons in the ventrolateral portion of the anterior horn in S1-S3 segments appeared.

Morphology and synaptic connections of slowly adapting periodontal afferent terminals in the trigeminal subnuclei principalis and oralis of the cat

Previous studies suggest that sensory information from primary afferent fibers is processed in a distinct manner in the individual subnuclei of trigeminal sensory nuclear complex. The present study has addressed this issue by using intra-axonal labeling with horseradish peroxidase to examine the ultrastructure and synaptic organization of axon terminals from slowly adapting (SA) periodontal afferents in the ventral subdivision (Vpv) of principalis and the rostro-dorsomedial part (Vo.r) of oralis. Our observations are based on complete or near-complete reconstructions of 139 synaptic boutons in Vpv and 105 in Vo.r. All the labeled boutons contained clear, spherical, synaptic vesicles and were presynaptic to unlabeled dendrites, and they were frequently postsynaptic to unlabeled axon terminals containing pleomorphic synaptic vesicles (P-endings). The P-endings frequently formed axodendritic synapses on dendrites which received axodendritic synapses from labeled boutons (synaptic triads). On the basis of the number of contacts, synaptic arrangements associated with the labeled boutons could be subgrouped into simple (one or two contacts), intermediate (three or four contacts), and complex (five or more contacts) types. The labeled boutons varied from round to elongated forms with smooth to more irregular or scalloped contours. The boutons with scalloped contour were much more frequent in the complex type. The boutons of the intermediate type were significantly smaller than the complex type and larger than the simple type. The SA periodontal afferent terminals participated in each type of synaptic arrangements in Vpv, but were mostly of the simple type in Vo.r. The size of labeled boutons was significantly larger in Vpv than in Vo.r. The total number of axodendritic and axoaxonic contacts per labeled bouton was significantly higher in Vpv than in Vo.r. Another difference was the more frequent occurrence of synaptic triads in Vpv than in Vo.r. These observations provide evidence that sensory information from primary afferent fibers is processed in a different manner in the two subnuclei.

Percutaneous cervical cordotomy: a review of 181 operations on 146 patients with a study on the location of "pain fibers" in the C-2 spinal cord segment of 29 cases

The authors present a review of 146 patients who underwent 181 percutaneous cervical cordotomies for intractable pain. In addition, an anatomical-clinical correlation was carried out for 29 of these patients. It was found that the fibers subserving pain sensation in the C-2 segment lie in the anterolateral funiculus between the level of the denticulate ligament and a line drawn perpendicularly from the medial angle of the ventral gray-matter horn to the surface of the cord. The best analgesic results have been obtained by creating lesions that extend 5.0 mm deep to the surface of the cord and destroy about 20% of the hemicord. There is a somatotopic organization with sacral fibers running ventromedially and cervical fibers running dorsolaterally. The authors believe that the ascending fibers subserving the distinct sensations of pain induced by tissue damage and pinprick, although mixed (overlapping) in the anterolateral funiculus of the spinal cord, are physiologically distinct from one another. Whereas some cordotomies, both in the current series and as reported in the literature, may affect these functions differentially, optimum pain relief seems to be obtained only when pinprick sensation is also abolished in the affected segments. Evoked pain sensation is not abolished by cordotomy, but its threshold is greatly raised. When pathological pain is completely abolished, so is pinprick sensation. However, in a number of cases where pathological pain was only partially alleviated, pinprick sensation remained intact. The significance of these and other cases reported in the literature is discussed. The importance of clinically distinguishing between pain caused by tissue damage and pinprick sensation is emphasized, as well as that between return of pre-existing or new tissue-damage pain and painful dysesthesia.

Neural substrates of pain and analgesia

The anatomic, physiologic, and chemical properties of systems involved in encoding and transmitting nociceptive input provide a basis for understanding the experience of pain. Moreover, the fact that these nociceptive systems can be modulated by other neural and humoral systems provides explanations for pain inhibition, pain enhancement, and the variability observed with various types of pain. Neural plasticity and permanent restructuring of these systems following injury also are likely to contribute to short- and long-term changes in the experience of pain. In summary, our understanding of acute and chronic pain has been significantly advanced through investigations of the neural substrates of pain and analgesia.

Ultrastructural morphology, synaptic relationships, and CGRP immunoreactivity of physiologically identified C-fiber terminals in the monkey spinal cord

The spinal cord terminations of two electrophysiologically identified single C-fibers (one identified as a C-nociceptor) were intra-axonally labeled with horseradish peroxidase and analyzed with both light and electron microscopy. Serial section ultrastructural analysis and postembedding immunocytochemical techniques for calcitonin gene-related peptide (CGRP), substance P (SP), and GABA were used to study the synaptology, and neuropeptide content. All C-terminal synapses were in laminae I and II. The terminals sampled (n = 73) from these two C-fibers rarely established glomerular synaptic complexes, but rather, simple terminals, usually measuring 1-4 microns in length and 1-3 microns in diameter. They most often established 1 or 2 (range 1 to 5) quite large asymmetric axodendritic synaptic contacts. Postsynaptic structures included dendritic spines and shafts with and without vesicles. C-terminals were filled with small round synaptic vesicles (45-60 nm) and also contained variable numbers of large dense-core vesicles (LDCVs, 80-110 nm). LDCVs inside identified C-terminals frequently displayed CGRP immunoreactivity. We were unable to detect SP immunoreactivity inside our sample of C-fiber LDCVs. C-terminals were never found postsynaptic to other profiles. Thus, the C-fiber terminals sampled in this study have simple synaptology, do not receive presynaptic control and contain CGRP immunoreactivity. They differ greatly from the terminals of A delta nociceptors studied previously by our group that had glomerular endings, often received presynaptic input and did not contain CGRP immunoreactivity. This suggests the existence of different processing mechanisms, at the level of the first synapse, for nociceptive inputs arriving to lamina I and II through different types of primary afferents.

Stimulation by corticotropin-releasing factor of the release of immunoreactive dynorphin A from mouse spinal cords in vitro

Corticotropin-releasing factor (CRF) has been shown to release endogenous opioid peptides from several rat brain regions. Since we have demonstrated previously that the actions produced by intrathecally administered CRF in mice involve spinal kappa opioid receptors, experiments were conducted in this study to test the possibility that CRF may release dynorphin A, a putative endogenous kappa opioid agonist, from the mouse spinal cord. Using a superfusion system in vitro, mouse spinal cords were superfused with aerated (95% O2, 5% CO2) Krebs-Ringer buffer. Fractions of superfusion were collected and dynorphin A levels in each fraction were monitored by radioimmunoassay. The presence of CRF in the perfusion buffer stimulated significantly the release of immunoreactive dynorphin A. The releasing rate of immunoreactive dynorphin A returned to the basal level after withdrawing CRF from the superfusion buffer. The stimulatory effect of CRF on the release of immunoreactive dynorphin A was abolished by alpha-helical CRF-(9-41), a CRF receptor antagonist, indicating that the dynorphin-releasing effect of CRF was mediated by CRF receptors in the spinal cord. Also the dynorphin-releasing effect of CRF was a concentration-related phenomenon, with an estimated EC50 value of 5.3 nM. The results from this study support the hypothesis that intrathecally administered CRF may produce its effects by releasing endogenous dynorphin from the terminals of dynorphin-containing neurons in the spinal cord. This study also provides evidence to support the notion that there is a close communication between CRF- and opioid peptide-containing neuronal pathways in the central nervous system.

Somatosensory function following dorsal root entry zone lesions in patients with neurogenic pain or spasticity

The goal of this study was to assess the effects of the dorsal root entry zone (DREZ) lesioning procedure, microsurgical DREZ-otomy (MDT), on spinal cord somatosensory function based on peri- and intraoperative clinical and electrophysiological data. The study was performed prospectively on a series of 20 patients suffering from either chronic neurogenic pain or spasticity. Physiological observations were made of the intraoperative evoked electrospinographic recordings as collected from the surface of the spinal cord. The MDT procedure produced analgesia or severe hypalgesia, moderate hypesthesia, and only slight deficits in proprioception and cutaneous spatial discrimination on the body segments operated on. These clinical data correlated well with evoked electrospinographic recordings, which showed a moderate effect of MDT on presynaptic compound action potentials recorded from the spinal cord (N11 and N21), a partial or even reversible effect on the cortical postcentral N20 wave, a more marked effect on the postsynaptic dorsal horn waves N13 and N24 related to large primary afferent fibers, and a disappearance of dorsal horn waves related to finer afferents (N2 and possibly N3). These data provide evidence for an acceptably selective action of MDT on spinal cord nociceptive mechanisms, and for a partial, often slight, involvement of the other somatosensory domains. The presence of abnormal evoked electrospinographic waves is discussed in relation to the mechanisms of neurogenic pain and spasticity. The hypothesis of a "retuning" of the dorsal horn as the mode of action of MDT is presented.

Light microscopic and ultrastructural analysis of GABA-immunoreactive profiles in the monkey spinal cord

It is hypothesized that terminals containing gamma-aminobutyric acid (GABA) participate in presynaptic inhibition of primary afferents. To date, few convincing GABA-immunoreactive (GABA-IR) axo-axonic synapses have been demonstrated in support of this theory. The goal of this study is to document the relationship between GABA-IR profiles and central terminals in glomerular complexes in lumbar cord of the monkey (Macaca fascicularis). In addition, the relationship between GABA-IR profiles and other neural elements are analyzed in order to better understand the processing of sensory input in the spinal cord. GABA-IR cell bodies were present in Lissauer's tract (LT) and in all laminae in the spinal gray matter except lamina IX. GABA-IR fibers and terminals were heavily concentrated in LT; laminae I, II, and III; and present in moderate concentration in the deeper laminae of the dorsal horn, ventral horn (especially in association with presumed motor neurons), and lamina X. Electron microscopic analysis confined to LT and laminae I, II, and III demonstrated GABA-IR cell bodies, dendrites, and myelinated and unmyelinated fibers. GABA-IR cell bodies received sparse synaptic input, some of which was immunoreactive for GABA. The majority of the synaptic input to GABA-IR neurons occurred at the dendritic level. Furthermore, the presence of numerous vesicle-containing GABA-IR dendrites making synaptic interactions indicated that GABA-IR dendrites also provided a major site of output. Two consistent arrangements were observed in laminae I-III concerning vesicle-containing GABA-IR dendrites: 1) they were often postsynaptic to central terminals and 2) they participated in reciprocal synapses. The majority of GABA-IR axon terminals observed contained round clear vesicles and varying numbers of dense core vesicles. Only on rare occasions were GABA-IR terminals with flattened vesicles observed. GABA-IR terminals were not observed as presynaptic elements in axo-axonic synapses; however, on some occasions, GABA-IR profiles presumed to be axon terminals were observed postsynaptic to large glomerular type terminals. Our findings suggest that a frequent synaptic arrangement exists in which primary afferent terminals relay sensory information into a GABAergic system for further processing. Furthermore, GABA-IR dendrites appear to be the major source of input and output for this inhibitory system. The implications of this GABAergic neurocircuitry are discussed in relation to the processing of sensory input in the superficial dorsal horn and in terms of mechanisms of primary afferent depolarization (PAD).

Peripheral but not intracerebroventricular corticotropin-releasing hormone (CRH) produces antinociception which is not opioid mediated

Corticotropin-releasing hormone and endogenous opioid peptide systems are both activated during stress. An elevation of the pain threshold also occurs under conditions of stress. In the present study the effects of CRH antinociception were examined. Rats were treated with CRH either centrally (i.c.v.) or peripherally (intracardially; i.c.) and their tail-flick latencies were measured. Central application of CRH (0-30 micrograms) was without effect on the analgesic test, while after peripheral application (0-32 micrograms) CRH produced a dose-dependent increase in tail-flick latencies. In a subsequent experiment we examined the possible involvement of endogenous opioids in the peripheral CRH-induced antinociceptive effects. To this end, two approaches were used: animals were either acutely treated with the opioid antagonist naloxone (3 or 6 mg/kg), or they were rendered tolerant to morphine, and then tested with CRH. In both cases, CRH effects on the tail-flick latencies were not modified. Our findings suggest that: (a) CRH may modulate pain sensitivity during stress; (b) opioids do not mediate this effect; and (c) brain CRH receptors are probably not involved in these processes.

Primate spinothalamic pathways: I. A quantitative study of the cells of origin of the spinothalamic pathway

In six monkeys spinothalamic (STT) cells were retrogradely labeled by injecting 2% wheat germ agglutinin-conjugated horseradish peroxidase into the somatosensory thalamus. Following a 5-day survival period, the animals were perfused and the tissue was removed and processed with the tetramethyl benzidine technique. In all animals there were HRP-labeled STT cells in all segments of the spinal cord. In one old world monkey, the injection included most of the thalamus and resulted in 18.235 estimated total number of STT cells. Of this total, 35% were located in the upper cervical segments (C1-C3), 18% were located in C4-C8, 19% were in the thoracic spinal cord with most found in T1-T3; 6% were in L1-L3, 13% were in L4-L7, and 7% were in the coccygeal segments. Of the total labeled STT cells, 17% were found in the spinal cord ipsilateral to the thalamic injections; 53% of these cells were located in C1-C3 primarily in lamina VIII. The percentage of label found in the contralateral lower cervical region laminae I-III (43-50%), IV-VI (33-48%), and VII-X (8-17%) was similar among three animals with similar thalamic injections. The distributions of the shapes of the labeled STT cells were similar for each lamina between the lower cervical and lower lumbar regions. The mean diameter of the labeled STT cells varied with spinal cord segment and lamina. The lamina I STT cells were the smallest. In the cervical spinal cord, lamina VIII STT cells had the largest diameters, while in the lumbar region laminae IV-VI had the largest STT cells.

Primate spinothalamic pathways: II. The cells of origin of the dorsolateral and ventral spinothalamic pathways

The cells of origin of the dorsolateral (DSTT) and the ventral (VSTT) spinothalamic tracts were studied in 11 monkeys. The spinothalamic tract cells were retrogradely labeled by horseradish peroxidase (HRP) injected in the thalamus. All animals also received a midthoracic spinal cord lesion on the side ipsilateral to the thalamic injections. The distribution of labeled cells found in these animals throughout the cervical segments was similar to animals with no spinal cord lesions. Five animals had ventral quadrant lesions to demonstrate the cells of origin of the DSTT. In macaques with complete ventral quadrant lesions, more than 80% of the HRP label in the contralateral L4-L7 segments was located in lamina I, while in squirrel monkeys, the label in the contralateral lower lumbar region was distributed between laminae I-III and IV-VI. Few labeled cells were found in laminae VII-X. Six animals received dorsolateral funiculus lesions to demonstrate the cells of origin of the VSTT. In animals with adequate lesions, 84-99% of the contralateral HRP label in L4-L7 was located in laminae IV-X. Macaques had a larger percentage of labeled cells located in lamina I than squirrel monkeys. The results indicate the existence of two spinothalamic pathways in the primate. The DSTT was calculated to compose about one fourth of the total spinothalamic population.

Electrodiagnosis of human dorsal sacral nerve roots by recording afferent and efferent extracellular action potentials

Single extracellular nerve action potentials from afferent fibres with various functions were recorded from human sacral nerve roots. It was shown that the potentials from these fibres can have different wave forms (amplitude, duration) and conduction velocities. The smaller potentials with longer durations have lower cut-off frequencies for certain identification than the larger potentials of shorter duration. The conduction velocity diagnosis covers a range of velocities with a factor of about 10. The slowest measured conduction velocities were between 4 and 10 m/sec. The identification of the functions of afferents in nerve roots is possible by calculating conduction velocities and stimulated activity increase measurements. Besides touch and pain fibres from the skin, afferents from mechano-receptors of the urinary bladder and the anal canal could be detected in dorsal sacral roots. There is evidence of motoneurons in the dorsal sacral roots supplying fatigue resistant muscle fibres. Sacral nerve root electrodiagnosis can be used in operations to identify physiologically-stimulated afferents and reflex activated motoneurons and, therefore, possibly will be useful in nerve anastomoses and nerve root stimulations in paraplegia.

A dorsolateral spinothalamic tract in macaque monkey

Prior work has indicated the existence of a major spinal cord pathway made up of lamina I cell axons ascending in the dorsolateral funiculus in both rat and cat. In cat, a portion of this lamina I dorsolateral funiculus pathway terminates in the thalamus. The purpose of this report is to demonstrate that a similar dorsolateral spinothalamic tract exists in macaque monkey. Retrograde transport of horseradish peroxidase, injected into the somatosensory thalamus of monkeys, was used to identify the cells of origin of the spinothalamic tract in the cervical and lumbar enlargements. In order to determine the funicular courses of the axons contributing to the spinothalamic pathway, thalamic injections of horseradish peroxidase were combined with ipsilateral ventral or dorsolateral thoracic spinal cord lesions. The results indicate that in macaque monkey many lamina I cell axons ascend to the thalamus in the dorsolateral funiculus, contralateral to their parent cells. Some lamina I cell axons as well as the majority of axons of spinothalamic cells located in deeper laminae ascend in the contralateral ventral quadrant to terminate in the thalamus. The existence in macaque of a dorsolateral spinothalamic pathway comprised of lamina I cell axons strongly implies the presence of a similar pathway in humans and has important implications regarding the mechanisms underlying both clinical and experimental nociception.

Craniofacial postherpetic neuralgia managed by stereotactic spinal trigeminal nucleotomy

Postherpetic craniofacial neuralgias are notoriously difficult to deal with. Nevertheless, stereotactic spinal trigeminal nucleotomy seems to be a rational approach, as both experimental and clinical data strongly suggest the relevance of nucleus caudalis for certain facial neurogenic pain phenomena. From a series of 136 consecutive nucleotomies, 80 were performed for deafferentation pain. The long-term results of 25 such cases, who underwent this procedure for postherpetic neuralgia, are reported. Their pain was referred to the Vth, to the VII, IX and Xth, and to the C2-3 dermatomes. Abolition of the allodynia, and disappearance of, or marked reduction in, the deep background pain was achieved in 76% of the cases overall. The follow-up period ranged from 1 to 13 years. There was no untoward side-effects. Technical and electrophysiological data germane to accurate target placement are discussed. Spinal trigeminal nucleotomy is then a specially suitable procedure for postherpetic craniofacial dysaesthesiae.

Reorganization of primary afferent nerve terminals in the spinal dorsal horn of the primate caudal to anterolateral chordotomy

A primate model has been used to explore the possibility that anterolateral chordotomy may produce intraspinal sprouting or rearrangement of primary afferent nerve terminations that could account for delayed postoperative recovery of sensory function. Monkeys were trained to limit the duration of an electrical stimulus, and the vigor and frequency of their escape responses were used to differentiate painful from nonpainful levels of stimulation. Behavioral testing after chordotomy revealed: 1) contralateral hypalgesia in all animals, with sensory recovery in half of the group, and 2) bilateral decreases in reflexive force in all animals, with reflex recovery in the majority of monkeys. At the terminal experiment, dorsal rootlets caudal to the spinal lesion were labeled bilaterally with HRP, and the distribution of labeled synaptic complexes was determined within the dorsal horn. When compared to controls, animals undergoing chordotomy showed a loss of terminals in the superficial dorsal horn and an increase of synaptic enlargements in deeper layers. These effects were bilateral, but were most pronounced on the side contralateral to chordotomy. Animals with diffuse spinal lesions showed a completely different change in the distribution of primary afferent terminals. Animals with sensory recovery demonstrated a more normal terminal distribution pattern than persistently hypalgesic monkeys, but there was considerable variability in the data, and analysis by different statistical tests yielded varying results.

Nociceptive responses to altered GABAergic activity at the spinal cord

GABA agonists and antagonists were injected intrathecally at the spinal cord, to determine their effect on nociceptive thresholds. Tactile stimulation, applied against the flank by a medium diameter von Frey fiber (5.5 g force), elicited distress vocalizations after, but not before injection of the GABA antagonists, bicuculline MI or picrotoxin (0.25 and 1 microgram dosages). Vocalization threshold to tail shock was significantly reduced by bicuculline MI or picrotoxin. Tail flick withdrawal latency from radiant heat was not altered by GABA antagonists. The GABA agonist, muscimol, significantly elevated vocalization threshold to tail shock at a 5 micrograms dose. At a lower dose level (1 microgram), muscimol significantly reduced vocalization threshold to tail shock. Tail flick latency was significantly prolonged by the 5 micrograms dose of muscimol; however, flaccid paralysis of the hind limbs was also evident. Nociceptive thresholds were not altered by GABA or saline injection. These findings indicate that GABAergic activity contributes to the tonic modulation of nociception at the spinal cord.

Ultrastructure of marginal zone during prenatal development of human spinal cord

Electron microscopic studies were conducted in the marginal zone (lamina I) in human fetuses ranging from 8-25 weeks of gestational age. At 8 weeks the neurons have indented nuclei and sparse organelles in the cytoplasm. The neuropil shows contacts between the axons and dendritic profiles. Some of them are well defined synapses with post synaptic thickening and agranular spherical vesicles in the presynaptic terminal. At 18 weeks compactly packed organelles with long cisternae of rough endoplasmic reticulum could be visualized in the neuronal cytoplasm. At 25 weeks the neurons have heterochromatin patches in the nuclei. Axosomatic, dendrodendritic, axoaxonic, symmetrical, asymmetrical and multisynaptic contacts with agranular and dense core vesicles are seen at different sequential age periods.

Evidence for glycoconjugate in nociceptive primary sensory neurons and its origin from the Golgi complex

Glycoconjugates with terminal galactose residues were localized in rat spinal cord and spinal ganglia using lectin-HRP conjugates of Griffonia simplicifolia and Glycine max agglutinins. Alternate staining of serial sections with HRP-labelled lectins and an antibody for substance P (SP) showed staining in identical primary sensory neurons with both methods. Similarly, lectin-reactive as well as SP-positive fibers were found in Rexed laminae I and II, Lissauer's tract, the spinal nucleus and tract of the trigeminal nerve, the nucleus commissuralis and a small bundle of fibers just ventral to the central canal. Administration of capsaicin to neonatal rats produced a significant decrease in lectin-reactive fibers of the substantia gelatinosa, and in the number of lectin-reactive sensory neurons. The coexistence of SP with galactose-containing glycoconjugates in spinal ganglion neurons, as well as sensitivity of these cells to capsaicin, provided a basis for classifying the reactive neurons as nociceptive in type. Ligation of dorsal roots resulted in disappearance of lectin reactivity in the spinal cord and caused accumulation of lectin-positive material proximal to the ligature, indicating somatofugal transport of galactose-containing glycoconjugates. Colchicine injection caused an increase in SP reactivity in dorsal ganglion neurons but no change in lectin staining of galactoconjugate. At the ultrastructural level affinity for the lectin conjugates was confined to the Golgi cisternae and the plasmalemma of B-type sensory neurons in the dorsal ganglion. The axolemma of unmyelinated processes stained selectively in dorsal roots and the substantia gelatinosa of the spinal cord. These findings provide evidence for the presence in certain sensory cells of a characteristic galactosylconjugate which may prove to be of significance in nerve function.

The spinothalamic system of the rat. I. Locations of cells of origin

Horseradish peroxidase retrograde transport has been used to locate neurons of the rat spinal cord and lower medulla that project to the thalamus. Eight groups of spinothalamic cells are identified, some of which are anatomically continuous with thalamically projecting groups in the lower medulla. Most of the groups are seen only at the highest cervical levels, and several of them have not been previously recognised as spinothalamic relays. They are marginal layer (M), ventral border of the substantia gelatinosa (SGv), neck of the dorsal horn (N), lateral cervical nucleus (LCN), ventromedial portion of the dorsal horn (DHvm), intermediate gray zone (IGZ), dorsal portion of the ventral horn (VHd), and ventral portion of the ventral horn (VHv). Most of the cell bodies are contralateral to their thalamic terminations; only the VHd group is ipsilateral. The major finding conflicts with traditional concepts of the spinothalamic system, and concerns the rostrocaudal distribution of the cells of origin. With the sole exception of the DHvm group, the great majority of the thalamically projecting neurons of the rat are confined to the most rostral spinal levels (medulla/cord junction through C4). Below C4, most of the spinothalamic cells are concentrated in a single DHvm group between levels T9 and L4, probably concerned with hindlimb proprioception. The spinothalamic groups at high cervical levels may be relays for information ascending from lower regions. This might help to explain why, in man, surgical destruction of fibres crossing the midline in a single high cervical segment can cause a loss of pain sensation over most of the body.

A double-blind trial of the analgesic properties of physostigmine in postoperative patients

A double-blind clinical trial of the analgesic and antisedative effects of physostigmine was carried out on surgical patients (n = 60) during the first hours postoperatively. Pethidine and placebo were included for comparison in the double-blind study. The degree of pain and sedation was estimated when the patient demanded analgesics and immediately before the administration of the test drug. The dosage administered i.v. was: physostigmine salicylate 2 mg, placebo = saline, or pethidine chloride 50 mg. After this, the same parameters were recorded at regular intervals. In addition, ventilatory rate, pulse rate, systolic blood pressure and side effects, if any, were noted. The results showed that physostigmine caused analgesia that was of the same magnitude as pethidine during the first 15 min, after which it decreased to the level of the placebo at 30 min. An antisedative or arousal effect was recorded over a somewhat longer time period; after this, there was no difference between placebo and physostigmine. In contrast to pethidine, physostigmine caused no decrease in the ventilatory rate. The pulse rate and systolic blood pressure did not change in any of the groups. Although the durations of the analgesic and antisedative effects of physostigmine were short, the use of this drug may well be preferable to the use of e.g. naloxone when immediate alertness of the patient is wanted without causing an increase in postoperative pain.

Galanin-like immunoreactivity in capsaicin sensitive sensory neurons and ganglia

In rats treated with capsaicin (CAP) as neonates, galanin-like (GA) immunoreactivity is markedly decreased in the trigeminal ganglion and the dorsal root ganglia as well as in the superficial layers of the dorsal spinal cord (laminae I and II), the substantia gelatinosa, the nucleus and tractus of the spinal trigeminal nerve and the nucleus commissuralis. Since CAP causes selective degeneration of primary sensory neurons of the C-fiber type and type B-cells of sensory ganglia, it is concluded that GA in CAP-sensitive primary sensory neurons represents a novel peptidergic system possibly involved in the transformation or modulation of peripheral nociceptive impulses. This system differs from the CAP-resistant GA-like neurons in other brain areas.

Corticotropin releasing factor-like immunoreactivity in sensory ganglia and capsaicin sensitive neurons of the rat central nervous system: colocalization with other neuropeptides

Immunohistochemistry and radioimmunoassay (RIA) revealed that corticotropin releasing factor (CRF)-like immunoreactivity was found to be colocalized with substance P (SP)-, somatostatin (SST)- and leu-enkephalin (LENK)-like immunoreactivity in the dorsal root- and trigeminal ganglia, the dorsal horn of the spinal cord (laminae I and II), the substantia gelatinosa, and at the lateral border of the spinal nucleus and in the tractus spinalis of the trigeminal nerve. These peptides were also located in fast blue labeled cells of the trigeminal ganglion following injection of the dye into the spinal trigeminal area. This indicates that there are possible sensory projections of these peptides into the spinal trigeminal area. Capsaicin treatment of neonatal rats resulted in a marked decrease in the density of CRF-, SP-, VIP- and CCK-containing neurons in the above mentioned hindbrain areas, whereas SST- and LENK-immunoreactivity were not changed. RIA revealed that, compared to controls, CRF, SP and VIP concentrations in these areas were decreased in rats pretreated with capsaicin, while SST levels were increased; CCK and LENK levels were unchanged. It is concluded that the primary afferent neurons of the nucleus and tractus spinalis of the trigeminal nerve are richly endowed with a number of peptides some of which are sensitive to capsaicin action. The close anatomical proximity of these peptide containing neurons suggests the possibility of a coexistance of one or more of these substances.

Projections from C2 and C3 nerves supplying muscles and skin of the cat neck: a study using transganglionic transport of horseradish peroxidase

Transganglionic transport of HRP has been used to trace the pathways and termination sites of cutaneous and muscle afferent axons entering from the C2 and C3 dorsal rami. The muscle afferent projection in the spinal cord is restricted and (apart from the ventral horn) largely confined to the intermediate gray matter. There is a muscle afferent projection to the ventrolateral main cuneate nucleus and a complex pattern of projection through the extent of the external cuneate nucleus. In contrast, the cutaneous spinal projection is abundant with extensive filling of axons in the tract of Lissauer and many termination sites in the lateral substantia gelatinosa. Axons enter the lateral gray matter of the cervical spinal cord from the dorsal columns and the dorsolateral funiculus and terminate in the lateral one-third of the dorsal horn as far rostral as the spinomedullary junction. Axons of the tract of Lissauer form a complex web around the dorsal horn and many penetrate rostrally to the region of the spinomedullary junction, where they terminate among clusters of interstitial cells on and close to the dorsal medullary surface. Cutaneous afferent axons from the dorsal columns turn into the main cuneate nucleus and enter a dense mass of HRP-reaction product which occupies the most ventrolateral part of the nucleus for its entire length.

A comparison of the anatomical distribution of substance P and substance P receptors in the rat central nervous system

A comparison of anatomical distributions of substance P (SP) and substance P receptors in the rat central nervous system was performed. SP was localized by microdissection and radioimmunoassay and SP fibers and cell bodies by immunohistochemistry. Receptors for 125I-Bolton Hunter labelled SP (125I-BH-SP) were characterized pharmacologically by a slice binding technique in sections that contained primarily striatum. The receptor was saturable and had an equilibrium dissociation constant (KD) of 0.30 nM and maximum number of binding sites (Bmax) of 37.8 fmol/mg protein. Pharmacological characterization using C terminal fragments and naturally occurring analogues of SP reflected characteristics of the receptor which had been shown previously in bioassays and biochemical assays. Comparison of distribution of SP fibers and cell bodies and SP receptors indicated that there is no consistent relationship between the amount of SP receptor and density of SP fibers or cell bodies in a given region of the brain.