Do convergent neurones in the spinal dorsal horn discriminate nociceptive from non-nociceptive information?

Neural mechanisms underlying the conditioned pain modulation response: a narrative review of neuroimaging studies

ABSTRACT

Processing spatially distributed nociceptive information is critical for survival. The conditioned pain modulation (CPM) response has become a common psychophysical test to examine pain modulation capabilities related to spatial filtering of nociceptive information. Neuroimaging studies have been conducted to elucidate the neural mechanisms underlying the CPM response in health and chronic pain states, yet their findings have not been critically reviewed and synthesized before. This narrative review presents a simplified overview of MRI methodology in relation to CPM assessments and summarizes the findings of neuroimaging studies on the CPM response. The summary includes functional MRI studies assessing CPM responses during scanning as well as functional and structural MRI studies correlating indices with CPM responses assessed outside of the scanner. The findings are discussed in relation to the suggested mechanisms for the CPM response. A better understanding of neural mechanisms underlying spatial processing of nociceptive information could advance both pain research and clinical use of the CPM response as a marker or a treatment target.

Role of primary somatosensory cortex in the coding of pain

The intensity and submodality of pain are widely attributed to stimulus encoding by peripheral and subcortical spinal/trigeminal portions of the somatosensory nervous system. Consistent with this interpretation are studies of surgically anesthetized animals, demonstrating that relationships between nociceptive stimulation and activation of neurons are similar at subcortical levels of somatosensory projection and within the primary somatosensory cortex (in cytoarchitectural areas 3b and 1 of somatosensory cortex, SI). Such findings have led to characterizations of SI as a network that preserves, rather than transforms, the excitatory drive it receives from subcortical levels. Inconsistent with this perspective are images and neurophysiological recordings of SI neurons in lightly anesthetized primates. These studies demonstrate that an extreme anterior position within SI (area 3a) receives input originating predominantly from unmyelinated nociceptors, distinguishing it from posterior SI (areas 3b and 1), long recognized as receiving input predominantly from myelinated afferents, including nociceptors. Of particular importance, interactions between these subregions during maintained nociceptive stimulation are accompanied by an altered SI response to myelinated and unmyelinated nociceptors. A revised view of pain coding within SI cortex is discussed, and potentially significant clinical implications are emphasized.

Activation of lumbar spinal wide-dynamic range neurons by a sanshool derivative

The enigmatic sensation of tingle involves the activation of primary sensory neurons by hydroxy-alpha-sanshool, a tingly agent in Szechuan peppers, by inhibiting two-pore potassium channels. Central mechanisms mediating tingle sensation are unknown. We investigated whether a stable derivative of sanshool-isobutylalkenyl amide (IBA)-excites wide-dynamic range (WDR) spinal neurons that participate in transmission of chemesthetic information from the skin. In anesthetized rats, the majority of WDR and low-threshold units responded to intradermal injection of IBA in a dose-related manner over a >5-min time course and exhibited tachyphylaxis at higher concentrations (1 and 10%). Almost all WDR and low-threshold units additionally responded to the pungent agents mustard oil (allyl isothiocyanate) and/or capsaicin, prompting reclassification of the low-threshold cells as WDR. The results are discussed in terms of the functional role of WDR neurons in mediating tingle sensation.

Modulation of an inhibitory jaw reflex by remote noxious stimulation: effects of spatial conditioning factors

In humans, inhibitory jaw reflexes can be depressed by painful stimulation of remote parts of the body. The underlying mechanisms may involve diffuse noxious inhibitory controls (DNIC). Animal experiments have shown that the neurons which may mediate DNIC show spatial encoding (i.e. their responses vary in relation to the size of the body area being stimulated). The aim of this study was to investigate whether the modulation of an inhibitory jaw reflex shows similar spatial dependency. Electromyographic recordings were made in 9 subjects, from a masseter muscle that was activated to a level equivalent to 10% of that obtained during a maximum voluntary contraction. Reflex inhibitions were evoked by electrical stimuli to the upper lip, either alone (controls) or during the application of conditioning stimuli (47 degrees C water) to the fingers, the hand, the half forearm or the whole forearm. Conditioning stimuli applied to the larger but not to the smaller areas resulted in significant modulations of the reflex. There was a significant correlation between stimulus area and reflex magnitude. These results demonstrate a spatial dependency for the modulation of an inhibitory jaw reflex by painful stimuli -- a further parallel with DNIC as studied on single neurons in animals.

The whole body receptive field of dorsal horn multireceptive neurones

Multireceptive neurones are found in the spinal dorsal horn and may be projection neurones and/or interneurones for polysynaptic reflexes. The cutaneous receptive field of a multireceptive neurone exhibits a gradient of sensitivity with the centre responding to any mechanical stimulus, including hair movements and light touch, while the periphery responds only to noxious stimuli. These neurones also receive signals from viscera, muscles and joints. This convergence of inputs means that multireceptive neurones are continuously capturing all the information from both the interface with the external environment (the skin) and the internal milieu (the viscera, muscles, etc.). This information constitutes a 'basic somaesthetic activity' that could help the somatosensory system build a 'global representation of the body'. In addition to be seen as a global entity, the output of multireceptive neurones should be understood in dynamic terms since the size of the peripheral fields of the individual neurones may change, as a result of the plasticity of both excitatory and inhibitory segmental processes. Furthermore, the activity of these neurones can be inhibited from most of the remaining parts of the body via supraspinal mechanisms. These diffuse noxious inhibitory controls (DNIC) are triggered by peripheral A delta- and C-fibres, involve brain structures confined to the caudal-most part of the medulla including the subnucleus reticularis dorsalis (SRD) and are mediated by descending pathways in the dorsolateral funiculi. A painful focus that both activates a segmental subset of neurones and inhibits the remaining population can seriously disrupt this basic activity, resulting in the distortion of the body representation in favour of the painful focus, which becomes pre-eminent and (relatively) oversized.

Physiological properties of the lamina I spinoparabrachial neurons in the rat

Single-unit extracellular recordings of spino-parabrachial (spino-PB) neurons (n = 53) antidromically driven from the contralateral parabrachial (PB) area were performed in the lumbar cord in anesthetized rats. All the spino-PB neurons were located in the lamina I of the dorsal horn. Their axons exhibited conduction velocities between 2.8 and 27.8 m/s, in the thin myelinated fibers range. They had an extremely low spontaneous activity (median = 0. 064 Hz) and a small excitatory receptive field (</=2 toes or pads). They were all activated by both peripheral A (mainly Adelta) and C fibers after intense transcutaneous electrical stimulation. Their discharge always increased in response to noxious natural stimuli of increasing intensities. The great majority (75%) of spino-PB neurons were nociceptive specific, i.e., they were excited only by noxious stimuli. The remaining (25%) still were excited primarily by noxious stimuli but also responded moderately to innocuous stimuli. Almost all spino-PB neurons (92%, 49/53) were activated by both mechanical and heat noxious stimuli. Among them, 35% were in addition moderately activated by noxious cold (thresholds between +20 and -10 degrees C). Only (8%, 4/53) responded exclusively to noxious heat. Spino-PB neurons clearly encoded the intensity of mechanical (n = 39) and thermal (n = 38) stimuli in the noxious range, and most of the individual stimulus-response functions were monotonic and positive up to 40/60 N. cm(-2) and 50 degrees C, respectively. For the mechanical modality, the mean threshold was 11.5 +/- 1.25 N. cm(-2) (mean +/- SE), the response increased almost linearly with the logarithm of the pressure between 10 and 60 N. cm(-2), the mean p(50) (pressure evoking 50% of the maximum response) and the maximum responsiveness were: 30 +/- 2.4 N. cm(-2) and 40.5 +/- 5 Hz, respectively. For the thermal modality, the mean threshold was 43.6 +/- 0.5 degrees C, the mean curve had a general sigmoid aspect, the steepest portion being in the 46-48 degrees C interval, the mean t(50) and the maximum responsiveness were: 47.4 +/- 0.3 degrees C and 40 +/- 4.4 Hz, respectively. Most of the spino-PB neurons tested (13/16) had their noxiously evoked responses clearly inhibited by heterotopic noxious stimuli. The mean response to noxious stimuli during heterotopic stimuli was 31.7 +/- 6.1% of the control response. We conclude that the nociceptive properties of the lamina I spino-PB neurons are reflected largely by those of PB neurons that were suggested to be involved in autonomic and emotional/aversive aspects of pain.

Responses of neurons in the region of human thalamic principal somatic sensory nucleus to mechanical and thermal stimuli graded into the painful range

The role of the region of the principal somatic sensory nucleus of the human thalamus (ventral caudal - Vc) in signaling painful sensations is unclear. We have now studied the response of cells (n = 57) in this region to both thermal and mechanical stimuli graded into the painful range during surgeries (n = 24) for treatment of movement disorders. Fifteen cells had a graded response to mechanical stimuli extending into the painful range and, thus, were classified in the wide dynamic range (WDR) category. The mean stimulus-response function of cells in the WDR class, normalized to baseline, showed a fourfold mean increase in firing rate above baseline across the mechanical series of stimuli. Seven of these cells responded to heat stimuli (WDR-H) and two responded to cold stimuli (WDR-C). Twenty-five cells were in a class (multiple receptive - MR) that showed a response to both brush and compressive stimuli, although the responses were not graded into the painful range. Three of these cells (MR-H) had a response to heat stimuli and five cells responded to cold stimuli (MR-C). Nine cells responded to brushing without a response to the compressive stimuli (low threshold - LT). Cells responsive to painful mechanical and thermal stimuli were located throughout the thalamic region where cells responded to nonpainful cutaneous stimulation. These results show that cells in the region of the human thalamic principal somatic sensory nucleus respond to mechanical and thermal stimuli extending into the painful range.

A role for the dorsal column in nociceptive visceral input into the thalamus of primates

A possible role of the dorsal column (DC) in the processing of visceral pain has gained attention after studies in the rat have revealed that the DC transmits a major part of the pelvic visceral nociceptive input from the colon into the thalamus. Furthermore, clinical interventions aimed at interrupting ascending DC axons near the midline were successful in relieving the pain suffered by patients with cancer of the pelvic organs. The purpose of this study was to check whether a DC lesion in monkeys would reduce the responses of thalamic neurons to graded colorectal distension (CRD) as in rats. Experiments were done on anesthetized male monkeys (Macaca fascicularis). Extracellular single cell recordings were made in the ventrolateral complex of the thalamus, mainly the ventral posterolateral (VPL) nucleus, in response to visceral and cutaneous stimulation. Of 80 VPL cells isolated, CRD activated 25, inhibited 25, and had no effect on 30 neurons. The responses of six viscerosensitive VPL neurons were recorded before and after a lesion of the DC at or above the T10 spinal segment. Lesions of other spinal tracts were made after the DC lesion. The results show that the DC lesion significantly reduced the responses of the thalamic neurons tested with CRD by >50%. Lesions of other tracts did not have a consistent effect. These results corroborate findings in the rat and support the proposal that the DC plays an important role in transmitting nociceptive visceral input into the thalamus and subsequently in visceral pain.

Facilitation of a nociceptive flexion reflex in man by nonnoxious radiant heat produced by a laser

Electromyographic recordings were made in healthy volunteers from the knee-flexor biceps femoris muscle of the nociceptive RIII reflex elicited by electrical stimulation of the cutaneous sural nerve. The stimulus intensity was adjusted to produce a moderate pricking-pain sensation. The test responses were conditioned by a nonnoxious thermal (</=40 degrees C) stimulus applied to the receptive field of the sural nerve. This stimulus was delivered by a CO2 laser stimulator and consisted of a 100-ms pulse of heat with a beam diameter of 20 mm. Its power was 22.7 +/- 4.2 W (7.2 mJ/mm2), and it produced a sensation of warmth. The maximum surface temperature reached at the end of the period of stimulation was calculated to be 7 degrees C above the actual reference temperature of the skin (32 degrees C). The interval between the laser (conditioning) and electrical (test) stimuli was varied from 50 to 3, 000 ms in steps of 50 ms. It was found that the nociceptive flexion reflex was facilitated by the thermal stimulus; this modulation occurred with particular conditioning-test intervals, which peaked at 500 and 1,100 ms with an additional late, long-lasting phase between 1,600 and 2,300 ms. It was calculated that the conduction velocities of the cutaneous afferent fibers responsible for facilitating the RIII reflex, fell into three ranges: one corresponding to A delta fibers (3.2 m/s) and two in the C fiber range (1.3 and 0.7 m/s). It is concluded that information emanating from warm receptors and nociceptors converges. In this respect, the present data show, for the first time, that in man, conditioning nonnociceptive warm thermoreceptive A delta and C fibers results in an interaction at the spinal level with a nociceptive reflex. This interaction may constitute a useful means whereby signals add together to trigger flexion reflexes in defensive reactions and other basic motor behaviors. It also may contribute to hyperalgesia in inflammatory processes. The methodology used in this study appears to be a useful noninvasive tool for exploring the thermoalgesic mechanisms in both experimental and clinical situations.

Temporal summation of C-fiber afferent inputs: competition between facilitatory and inhibitory effects on C-fiber reflex in the rat

Long-lasting facilitations of spinal nociceptive reflexes resulting from temporal summation of nociceptive inputs have been described on many occasions in spinal, nonanesthetized rats. Because noxious inputs also trigger powerful descending inhibitory controls, we investigated this phenomenon in intact, halothane-anesthetized rats and compared our results with those obtained in other preparations. The effects of temporal summation of nociceptive inputs were found to be very much dependent on the type of preparation. Electromyographic responses elicited by single square-wave electrical shocks (2 ms, 0.16 Hz) applied within the territory of the sural nerve were recorded in the rat from the ipsilateral biceps femoris. The excitability of the C-fiber reflex recorded at 1.5 times the threshold (T) was tested after 20 s of electrical conditioning stimuli (2 ms, 1 Hz) within the sural nerve territory. During the conditioning procedure, the C-fiber reflex was facilitated (wind-up) in a stimulus-dependent fashion in intact, anesthetized animals during the application of the first seven conditioning stimuli; thereafter, the magnitude of the responses reached a plateau and then decreased. Such a wind-up phenomenon was seen only when the frequency of stimulation was 0.5 Hz or higher. In spinal, unanesthetized rats, the wind-up phenomenon occurred as a monotonic accelerating function that was obvious during the whole conditioning period. An intermediate picture was observed in the nonanesthetized rat whose brain was transected at the level of the obex, but the effects of conditioning were profoundly attenuated when such a preparation was anesthetized. In intact, anesthetized animals the reflex was inhibited in a stimulus-dependent manner during the postconditioning period. These effects were not dependent on the frequency of the conditioning stimulus. Such inhibitions were blocked completely by transection at the level of the obex, and in nonanesthetized rats were then replaced by a facilitation. A similar long-lasting facilitation was seen in nonanesthetized, spinal rats. It is concluded that, in intact rats, an inhibitory mechanism counteracts the long-lasting increase of excitability of the flexor reflex seen in spinal animals after high-intensity, repetitive stimulation of C-fibers. It is suggested that supraspinally mediated inhibitions also participate in long term changes in spinal cord excitability after noxious stimulation.

Responses of rat sacral spinal neurons to mechanical and noxious thermal stimulation of the tail

In this study we investigated the receptive field properties, responses to mechanical and thermal stimuli, and sensitivity to systemic administration of pentobarbital sodium and morphine of single neurons recorded in the sacral spinal cords of pentobarbital-anesthetized rats. Fifty-three neurons responded to innocuous mechanical stimulation of the tail. Of 45 neurons that were additionally tested with noxious thermal stimulation, 62% responded and were classified as wide-dynamic-range or multireceptive neurons. Recording sites were located mainly in the middle layers of the S2-S4 dorsal horn. Mechanosensitive receptive fields on the tail varied widely in size (range 0.14-35 cm2, mean 10.33 cm2) and form, and were in nearly all cases bilateral. Most neurons responded with a high-frequency discharge followed by a more slowly adapting response to pressure stimuli delivered with von Frey hairs. Responses (maximal frequency and total number of impulses) increased in a graded manner to pressure stimuli ranging from 1.2 to 447 g. For neurons responsive to noxious heating of the tail, responses increased in a linear manner over the range of 38-54 degrees C and often leveled off at higher temperatures. Of nine neurons tested with both graded von Frey and noxious heat stimuli, mean responses (maximal frequency and total number of impulses) evoked by the strongest pressure stimuli were larger than those evoked by the most intense heat stimuli, but the difference was not statistically significant. Responses to repeated 48 degrees C stimuli were significantly attenuated within 8 min after systemic administration of morphine (1 or 2 mg/kg ip), reaching maximal suppression (to 37.3%; N = 13) after 18 min, with recovery following systemic naloxone. After morphine (1 and 2 mg/kg ip), the slope of the population stimulus-response function for noxious heat was reduced (51.8%), and the threshold was increased (by 4 degrees C). Responses to noxious heat were significantly depressed (to a mean of 54%; N = 10) by supplemental administration of pentobarbital (mean 17 mg/kg over 5 min). On the basis of similarities between the present data and previous behavioral measures of tail flick stimulus-response functions and their modulation, it is suggested that some of the present neurons might function as interneurons in the tail flick reflex arc.

The medullary subnucleus reticularis dorsalis (SRD) as a key link in both the transmission and modulation of pain signals

The involvement of the dorsal part of the caudal medulla in both the transmission and modulation of pain is supported by recent electrophysiological and anatomical data. In this review, we analyse the features of a well-delimited area within the caudal-most aspect of the medulla, the subnucleus reticularis dorsalis (SRD) which plays a specific role in processing cutaneous and visceral nociceptive inputs. From a general viewpoint, the reciprocal connections between the caudal medulla and spinal cord suggest that this area is an important link in feedback loops which regulate spinal outflow. Moreover, the existence of SRD-thalamic connections put a new light on the role of spino-reticulo-thalamic circuits in pain transmission.

[Physiology of nociception]

Nociception is related to the mechanisms elicited by stimuli threatening the integrity of the organism. At the peripheral level, unmyelinated C fibres (C polymodal nociceptores) or fine myelinated A delta fibres are excited by noxious stimulation, directly or indirectly by inflammatory processes. Nociceptive afferent fibres terminate in the superficial laminae of the dorsal horn of the spinal cord where informations are integrated and controlled. These first synapses are modulated by excitatory amino acids (glutamate and aspartate) and many peptides (substance P, CGRP, CCK, endogenous opiods). The majority of ascending pathways involved in nociception are located in the ventrolateral controlateral quadrant of the cord (spinorelicular and spinothalamic tracts). Many supraspinal sites are activated following nociceptive stimuli, with relays in the reticular formation of the brain stem (including the subnucleus reticularis dorsalis), the ponto-mesencephalic regions (periaqueducal gray matter and parabrachial area) and thalamic sites. Amygdala and hypothamic targets could be involved in motivational reactions and neuroendocrine adaptations to a noxious event. The cingular, insular and somatosensory cortices also receive nociceptive informations. Nociceptive signals are modulated at all levels of their transmission; the more extensively studied controls are located at the spinal level. Segmental controls are inhibitory effects produced by non-noxious mechanical stimuli. Spinal signals can also be inhibited following activation of bulbopinal descending inhibitor pathways and release of serotonin, norepinephrine and, indirectly, endogenous opiods. Inhibitory controls triggered by noxious stimuli could facilitate the extraction of the nociceptive tone of informations having priority over other stimuli.

The dominant class of somatosensory neurone recorded in the spinal dorsal horn of awake sheep has wide dynamic range properties

In order to investigate the properties of dorsal horn neurones in the absence of the distorting influences of anaesthesia, preparative surgery, prior training or excessive restraint, recordings have been made in sheep chronically prepared for single-cell recording. Within the limitations of sampling error of dorsal horn neurones with cutaneous receptive fields, the cell type most frequently encountered had wide dynamic range (WDR; convergent; multireceptive) properties; these accounted for 59% of the 46 neurones that were examined in detail. High-threshold mechanoreceptive (nocispecific) and low-threshold mechanoreceptive neurones formed 11% and 30% of the sample, respectively. These and other data indicate that under normal physiological conditions in the awake state, many spinal neurones do indeed have WDR properties, implying that these cells have an important function in nociceptive processing.

The roles of spatial recruitment and discharge frequency in spinal cord coding of pain: a combined electrophysiological and imaging investigation

An investigation was conducted to examine both temporal and spatial factors likely to be involved in spinal cord nociceptive coding by wide cord nociceptive neurons. Three separate methodologies were employed. First, the impulse frequency responses of L4 spinal cord wide-dynamic-range (WDR) neurons to gentle mechanical stimulation, vigorous but innocuous brushing, warmth (43 degrees C), and nociceptive thermal stimuli (45-49 degrees C) were electrophysiologically characterized in unanesthetized, spinal cord-transected rats. Second, the spatial distribution of evoked activity in response to the same types of mechanical and thermal stimuli was examined utilizing the 14C-2-deoxyglucose (2-DG) metabolic mapping method in the same type of animal preparation. Finally, the contributions of impulse frequency and numbers of neurons activated to encoding the distinction between painful and non-painful sensations were directly evaluated by electrically stimulating axons within the spinal cord anterolateral quadrant (ALQ) of conscious human subjects. Electrophysiological findings revealed that vigorous but innocuous brushing produced intermediate rates of impulse discharge significantly greater than those produced by 35 and 43 degrees C stimuli, yet indistinguishable from those produced by relatively low nociceptive temperatures (45-47 degrees C). Thus, the discharge frequencies of individual dorsal horn WDR neurons alone do not provide sufficient information to encode the distinction between innocuous and low intensity nociceptive stimuli. Mapping of spinal cord activity by the 2-DG method revealed that nociceptive stimuli activated extensive rostro-caudal regions extending from L1-L5. In contrast, vigorous but innocuous brushing evoked metabolic activity that was confined to a narrow zone within L3. Thus, as predicted from previous studies, the distinction between nociceptive and non-nociceptive sensory events may be encoded, in part, by differences in the spatial distribution, and hence, the relative numbers of spinal cord neurons activated by nociceptive and innocuous stimuli. The responses of conscious human subjects to varying frequencies and intensities of electrical ALQ stimulation clarify the significance of the large numbers of spinal cord neurons activated by nociceptive stimuli. With stimulus frequency held constant at 50 Hz, low stimulus currents, sufficient to activate only small numbers of ALQ axons, produced innocuous sensations. Higher stimulus currents, sufficient to activate larger numbers of neurons, consistently produced painful sensations. Increasing ALQ stimulus frequency at currents subthreshold for pain or increasing stimulus currents at frequencies subthreshold for pain resulted in painful sensations, thus indicating that both discharge frequency and numbers of neurons activated are both important factors in the encoding of pain.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of visceral distension on the activities of neurones receiving cutaneous inputs in the rat lumbar dorsal horn; comparison with effects of remote noxious somatic stimuli

(1) Unitary extracellular recordings were made from 92 lumbar dorsal horn neurones in urethane-anaesthetised rats. These neurones were classed as 'noxious-only' (4), 'non-noxious-only' (33) or 'convergent' (55) by their responses to stimulation of their cutaneous receptive fields on the ipsilateral hindpaw. (2) Distension of abdominal viscera (colon, urinary bladder) depressed the activities of the vast majority (93%) of the convergent neurones but of only one other cell (a non-noxious-only neurone). Similarly, noxious stimulation of widespread somatic structures depressed activity in all but one of the convergent neurones but in only 3 other cells (one non-noxious- and two noxious-only neurones). One or other of these procedures also excited 3 cells--one convergent neurone responding to distension of the colon, another to stimulation of widespread somatic structures and one non-noxious-only neurone being excited by stimulation on the contralateral hindpaw. (3) The inhibitory effects of the noxious somatic stimuli were very like those described previously and termed 'diffuse noxious inhibitory controls' (DNIC) and it seems likely that the effects of the visceral stimuli were also manifestations of DNIC, particularly in view of their similar, nearly total, specificity to convergent neurones. There were however, some small differences in the extent and temporal evolution of the inhibitory effects of the visceral and of the somatic stimuli--the visceral stimuli generally producing weaker inhibitions with slower rates of onset and recovery. It is proposed that these differences may have reflected different amounts and patterns of activity in the relevant primary afferent fibres rather than being due to different central neural mechanisms. (4) These results and the likely explanation that the effects of the visceral stimuli were mediated by a diffuse mechanism should be taken into account when interpreting the results of other studies in which inhibitory effects are produced by visceral stimulation.

Signalling of a step-like intensity change of noxious mechanical stimuli by dorsal horn neurones in the rat spinal cord

1. Single-unit extracellular recordings were made from thirty-one dorsal horn neurones in the sacral spinal cord of barbiturate-anaesthetized rats. Each neurone was tested with four noxious mechanical pinches applied to its receptive field on the tail. Each pinch lasted 120 s, with a step-like change in intensity after 60 s. In two pinches the step increased the intensity, from 4 to 6 N or from 6 to 8 N, and in two the step decreased the intensity, from 8 to 6 N or from 6 to 4 N. 2. The ability of the neurones to signal these step changes in intensity was examined. Five neurones with an exclusively low-threshold afferent input (class 1) were tested, and found to fire only briefly at the start of the 120 s stimulus. Neurones with a high-threshold input (nociceptive neurones), either exclusively (class 3; n = 10) or in addition to a low-threshold input (class 2: n = 16), responded throughout the 120 s stimuli. 3. Nociceptive dorsal horn neurones have been divided into two groups of 'good' and 'poor' encoders on the basis of their response to the step changes in intensity. 4. 'Good' encoders (n = 13) were neurones signalling both a step increase and a step decrease in intensity, of which seven were class 2 and six class 3, five recorded in the superficial dorsal horn and eight in the deep dorsal horn. 5. 'Poor' encoders (n = 13) were neurones which failed to signal one or both of the step changes in intensity, of which nine were class 2 and four class 3, three recorded in the superficial dorsal horn and ten in the deep dorsal horn. 6. These results demonstrate that neurones with similar input properties and location are not necessarily a homogeneous group in terms of their processing of nociceptive stimuli. Moreover, they suggest that subgroups of both class 2 and class 3 and of superficial and deep dorsal horn neurones contribute to the different components of a nociceptive response. 7. We propose that the output and projection target of a particular dorsal horn neurone are more important than its afferent input in determining its role in nociceptive processing.

Single unit activity at ventromedial medulla level in the awake, freely moving rat: effects of noxious heat and light tactile stimuli onto convergent neurons

In this study, we recorded single unit activity at the ventromedial medulla (VMM) level in the awake, freely moving rat. In agreement with previous work under the same conditions, we found a vast majority of neurons which possess heterosensory and heterosegmental inputs ('convergent'). These units are activated either by auditory or mechanical innocuous and noxious stimuli applied all over the body surface. The activation threshold of these neurons is very low since light stimulation such as air puff produce intense bursts. In addition to this highly represented neuronal class, we also find another consistent VMM group of neurons which fire in relation to precise or generalized body movements. The main result of the present work is that, in addition to auditory and mechanical inputs, a relatively high proportion of VMM convergent neurons are activated by noxious heat pulses between 43 and 51 degrees C. In this range, it was possible to obtain stimulus-response functions with 2 degrees C steps only when a skin twitch reflex produced by the heat was present, also encoding the temperature intensity. In comparison to the VMM activations produced by an intense noxious heat pulse such as 51 degrees C, either auditory or controlled light touch stimuli induced a more robust response in terms of maximum frequency of discharge. Differential properties of VMM neurons in relation to innocuous and noxious information were also found using repetitive stimulation: although a strong and fast habituation of the 51 degrees C responses was observed, this phenomenon was not present for light touch induced activations. We propose that these differential properties might reflect separate pathways reaching the VMM, the one carrying innocuous information possibly relayed through the dorsal column nuclei. Although obtaining stimulus-response functions might implicate the VMM convergent neurons in the sensory-discriminative aspect of pain, their massive heterosensory and heterosegmental inputs favor a role in more general processes such as alertness or stress. Also, due to massive convergent properties, the involvement of this neuronal class in specific bulbospinal descending control systems of nociceptive information is questionable, Finally, our results obtained in the awake, freely moving rat strongly differ from the anesthetized preparation in that we found neither nociceptive specific units nor neurons inhibited by noxious peripheral stimulations largely described in this approach.

Intracerebroventricular morphine restores the basic somesthetic activity of dorsal horn convergent neurones in the rat

We have proposed that a painful focus will disturb the global activity of spinal and trigeminal convergent neurones in two complementary ways: by activation of the corresponding segmental pool of neurones and by an inhibition mediated by diffuse noxious inhibitory controls of the remaining neuronal population. Morphine (10 micrograms) administered within the third ventricle blocks diffuse noxious inhibitory controls acting on a basic somesthetic activity simulated by responses of convergent neurones to innocuous stimuli. It is proposed that analgesia induced by intracerebroventricular morphine could result, at least in part, from restoration of the basic somesthetic activity.

Pentobarbital, in subanesthetic doses, depresses spinal transmission of nociceptive information but does not affect stimulation-produced descending inhibition in the cat

The present study evaluates the effect of systemic pentobarbital on the spinal transmission of nociceptive information and on stimulation-produced descending inhibition in the deeply anesthetized, paralyzed cat. Single neuronal responses to noxious skin heating were recorded extracellulary in the lumbar dorsal horn and found to be depressed by pentobarbital at subanesthetic doses (4.0, 8.0, 17.0 and 24.5 mg/kg) in a dose-dependent manner. At 0.5 and 1.5 mg/kg, depression by pentobarbital was positively correlated with the depth of the recording site in the spinal cord (laminae IV-VI), i.e., neurons in deeper laminae (V-VI) were attenuated, while neurons in lamina IV were unaffected. At all doses tested, pentobarbital failed to affect stimulation-produced descending inhibition from either the midbrain periaqueductal gray or the medullary nucleus raphe magnus. The present data furnish evidence for the antinociceptive potency of pentobarbital, they do not support the view that a 'partial pharmacological spinal cord transection' would attenuate stimulation-produced descending inhibition of nociceptive dorsal horn neurons.

Anatomy, physiology, and neuropharmacology of cancer pain

The anatomy, physiology, and pharmacology of nociception and its modification by analgesic drugs have been studied extensively in the past decade. Although the neural mechanisms of nociceptors and the stimuli that activate them are much better understood, it must be emphasized that the perception of pain, as well as the meaning of pain to the individual, is a complex behavioral phenomenon and involves psychologic and emotional processes in addition to activation of nociceptive pathways. Pain related to malignant disease can be classified as somatic, visceral, and deafferentation in type. Somatic pain and visceral pain involve direct activation of nociceptors and are often a complication of tumor infiltration of tissues or injury of tissues as a consequence of cancer therapy. The management of this type of pain is typically accomplished by treating the tumor (with surgery, chemotherapy, and/or radiation therapy) and by using the appropriate non-narcotic, narcotic, and adjuvant analgesic agents. Neuroablative therapies may be helpful in specific circumstances. For example, cordotomy may be helpful for unilateral pain below the waist in patients with somatic and visceral pain. This procedure may also be helpful for early deafferentiation pain (i.e., lumbosacral plexopathy) in which peripheral nerves are compressed but not infiltrated or destroyed by metastatic tumor growth. Deafferentiation pain may be a complication of tumor infiltration of peripheral nerve or of cancer therapy that injures neural tissue. This type of pain is often poorly tolerated and difficult to control, particularly if not treated early and aggressively. Although incompletely understood, the pathophysiology of deafferentation pain appears to be different from that of somatic or visceral pain, and the treatment approaches may be different. Management approaches to deafferentation pain usually emphasize treatment of the pain, because injury to the nervous system may be difficult to reverse, even if one can successfully treat the underlying malignancy, and many deafferentation pain syndromes occur as a complication of cancer therapy. The role of narcotic analgesics in the management of deafferentation pain is not clear, although the published experience suggests that they are less useful than in somatic or visceral pain.

Supraspinal morphine and descending inhibitions acting on the dorsal horn of the rat

1. Recordings were made from thirty-nine convergent neurones in the lumbar enlargement of the rat spinal cord. These neurones were activated by both innocuous and noxious stimuli applied to their excitatory receptive fields located on the extremity of the ipsilateral hind paw. Transcutaneous application of suprathreshold 2 ms square-wave pulses to the centre of the receptive field resulted in responses to A- and C-fibre activation being observed; a mean of 18.8 +/- 1.8 C-fibre latency spikes was evoked per stimulus. This type of response was inhibited by applying noxious conditioning stimuli to heterotopic body areas; immersing the tail in a 52 degrees C water-bath caused a mean 54.5 +/- 2.3% inhibition of the C-fibre-evoked response; such inhibitory processes have been termed diffuse noxious inhibitory controls (d.n.i.c.). 2. The effects of microinjections of morphine (5 micrograms; 0.2 microliter) on both the unconditioned C-fibre-evoked response and inhibitory processes triggered from the tail were investigated in an attempt to answer two questions: (a) does morphine increase tonic descending inhibitory processes and (b) what are the effects of morphine on descending inhibitory processes triggered by noxious stimuli? 3. The predominant effect of periaqueductal grey matter (p.a.g.) morphine on the C-fibre-evoked responses was a facilitation: 51% of cells had their C-fibre-evoked responses increased by morphine (by roughly 50%); 31% of cells were not influenced while the remaining 18% of units were depressed; however the cells classified as depressed were only marginally so. No clear relationships were found either between the microinjection sites in the p.a.g. and their corresponding effects or between the number of C-fibre-spikes evoked in the control sequences and the subsequent effect of morphine. 4. While d.n.i.c. was not altered by morphine in 56% of cases, it was clearly reduced in the remaining cells. The effects were immediate but peaked at 40 min following the microinjection (a mean 77% reduction) and then returned towards control values. All but three of the corresponding microinjection sites were such as to include the medio-ventral p.a.g. including the nucleus raphé dorsalis. In contrast none of the cases where d.n.i.c. was unaltered included microinjection sites in this region. 5. No relationship was found between the changes in d.n.i.c. and the number of spikes evoked in the control sequences, or the changes in the C-fibre responses. 6. Autoradiographic controls using [3H]morphine showed a large diffusion of the drug within an area of about 0.75 mm around the tip of the cannula.(ABSTRACT TRUNCATED AT 400 WORDS)

A hypothesis on the physiological basis for causalgia and related pains

A hypothesis is presented concerning the neuronal mechanisms which subserve the sympathetically maintained pains such as causalgia and reflex sympathetic dystrophy. The hypothesis rests on two assumptions: that a high rate of firing in spinal wide-dynamic-range (WDR) or multireceptive neurons results in painful sensations; and that nociceptor responses associated with trauma can produce long-term sensitization of WDR neurons. The hypothesis states that chronic sympathetically maintained pains are mediated by activity in low-threshold, myelinated mechanoreceptors, that this afferent activity results from sympathetic efferent actions upon the receptors or upon afferent fibers ending in a neuroma and that these afferent fibers evoke sufficient activity in sensitized spinal WDR neurons to produce a painful sensation. This hypothesis is based on known characteristics of these neuronal populations studied in experimental animals and on the observed sensory disturbances reported in patients successfully treated with sympathetic blocks. This hypothesis does not require nerve injury or dystrophic tissue. It explains both the continuous pain and the allodynia that are common to these syndromes and their abolition by sympathetic block. Specific changes are proposed in the diagnosis and treatment of post-traumatic pains.

Morphological features of lamina V neurons receiving nociceptive input in cat sacrocaudal spinal cord

Thirty-six neurons from laminae III-VII in cat sacrocaudal spinal cord were labeled by intracellular injection of horseradish peroxidase, following physiological characterization. Of these 36 neurons, 24 had cell bodies within lamina V. Twelve lamina V neurons were multireceptive; i.e., they responded differentially to innocuous and noxious mechanical stimuli. Most multireceptive neurons had the following morphological features: (1) large cell bodies; (2) extensive dendritic spreads in all directions; and (3) axons which ascended in the contralateral ventral white matter. Three labeled lamina V neurons were activated only by noxious stimuli. Compared to the multireceptive neurons, these nociceptive-specific (NS) units had smaller cell bodies but a similar dendritic spread. Seven lamina V neurons were excited by innocuous mechanical stimuli with no evidence of nociceptive input. These seven neurons had less extensive dendritic trees than the multireceptive and the NS neurons. Six neurons labeled in lamina VII (three multireceptive and three NS) contrasted to most lamina V cells by having smaller cell bodies and short, sparsely branched dendrites. Among the lamina VII neurons, there was no obvious morphological feature that distinguished the multireceptive group from the NS group. Fifteen fully stained neurons from laminae III-VII had late discharges which were correlated with C fiber input. The dendrites of three of these neurons extended into laminae II and I; the dendrites of two neurons reached into the inner portion of lamina II; and the dorsal dendrites of the remaining ten neurons extended no further than the nucleus proprius (laminae III and IV). Thus, deeper dorsal horn neurons evincing reliable, excitatory influences from C fibers do not necessarily have superficially situated dendrites. Tests for correlations between size of cutaneous, excitatory receptive field (RF) and dendritic spread revealed a significant positive correlation between the mediolateral extent of dendritic spread and the size of the low-threshold component of the RF for lamina V neurons.

Bicuculline and spinal inhibition produced by dorsal column stimulation in the cat

In barbiturate anaesthetized cats, dorsal column stimulation inhibited ascending volleys recorded in the antero-lateral spinal fasciculus from electrical stimulation of the contralateral tibial nerve and the excitation of neurones of the dorsal horn by noxious heating of the skin. The inhibition was non-selective. Intravenous bicuculline (0.2-0.6 mg/kg) reduced dorsal column induced inhibition of ascending volleys. Bicuculline but not strychnine, administered electrophoretically from micropipettes, reduced dorsal column induced inhibition of the excitation of dorsal horn neurones by noxious heat. These findings suggest that the inhibition studied was produced by release of gamma-aminobutyric acid. This amino acid may play a role in the clinical suppression of pain produced by dorsal column stimulation.

Effects of topical baclofen on C fibre-evoked neuronal activity in the rat dorsal horn

Baclofen appears to be an agonist for the bicuculline-insensitive gamma-aminobutyrateB receptors associated with C fibre terminals in the dorsal horn of the spinal cord. We have tested the effect of baclofen (applied intrathecally onto the spinal cord) on the A and C fibre-evoked responses of convergent/multireceptive neurones in the halothane-anaesthetized rat. L-Baclofen produced a dose-dependent inhibition of the C fibre- and pinch-evoked activity of these neurones which persisted for 2 h whilst the A fibre and tactile activities were little changed. The C fibre-evoked (X 3 threshold) responses were markedly or completely inhibited 10 min after doses of between 0.25 and 30 micrograms of L-baclofen (n = 21) with 0.05 micrograms causing a 48% (n = 3) and 0.01 micrograms a 28% inhibition (n = 3). D-Baclofen (30 micrograms), the inactive isomer, produced no significant changes in activity (n = 10). Bicuculline (60 micrograms) applied intrathecally before (n = 7) or after (n = 8) L-baclofen did not reverse the inhibitions. Intravenous baclofen (1-3 mg/kg) also produced neuronal inhibitions similar to the effects of intrathecal injection. The results suggest that gamma-aminobutyrateB receptors may exert a presynaptic control of C fibre afferents in the dorsal horn following intrathecal administration in the rat.

A positive feedback loop between spinal cord nociceptive pathways and antinociceptive areas of the cat's brain stem

Electrophysiological evidence has been obtained suggesting the presence of reciprocal excitation between descending pathways from the nucleus raphe magnus (NRM) and adjacent reticular formation (Ret.F) and spinal cord neurones projecting to these brain stem areas. In decerebrate and decerebellate cats, 40 spinal cord neurones were recorded whose recording sites were in or close to lamina VIII of the lumbar spinal cord. All 40 neurones recorded in the lumbar cord were postsynaptically excited by electrical stimulation of the NRM, the Ret.F. or most commonly, of both. The excitation was mediated by fast-conducting fibres and lasted for over 100 msec after a single shock. The shortest latency responses were obtained following stimulation of the contralateral Ret.F. These neurones had complex peripheral inputs subjected to descending controls. All the neurones could be excited by deep pressure of the ipsilateral and/or contralateral hind limbs. Peripheral inhibitory inputs were also observed. Eighteen out of the 40 neurones had axons that projected to NRM and the adjacent Ret.F. Conduction velocities ranged between 31.6 and 91 m/sec. In addition, 11 other axons were recorded in the white matter of the cervical cord from neurones projecting to NRM and Ret.F. Conduction velocities of this group of axons ranged between 13 and 70 m/sec. The majority of the axons projecting to NRM and Ret.F. were found to join pathways in the ventro-lateral quadrant of the spinal cord either ipsi- or contralaterally to their Ret.F. destination. Recordings were also made from 12 neurones whose recording sites were located in the NRM and Ret.F. Their responses to electrical stimulation of sites within lamina VIII of the lumbar spinal cord were studied. Only excitatory responses could be evoked by such stimulation. These results are discussed in relation to the mechanisms of activation of central antinociceptive systems.

Depression of activities of dorsal horn convergent neurones by propriospinal mechanisms triggered by noxious inputs; comparison with diffuse noxious inhibitory controls (DNIC)

The ability of heterotopic noxious stimuli to inhibit the activity of dorsal horn convergent neurones was investigated in both intact anesthetized, and spinal unanesthetized rats. Forty-four convergent neurones in lumbar dorsal horn were recognized by their ability to respond to both noxious and non-noxious natural stimuli and by their characteristic responses corresponding to A- and C-fibre activity following electrical stimulation of their cutaneous excitatory receptive fields on the ipsilateral hindpaw. The application of a sustained pinch to the excitatory receptive field resulted in an initial phasic activation of the neurone, which adapted to a stable tonic level of activity (mean 31.8 +/- 2.2 spikes/s). The levels of activity produced in this fashion were not appreciably different between the two types of preparation. In the intact anesthetized rat, the tonic activity produced by the sustained pinch could be strongly depressed by noxious conditioning stimuli applied to various parts of the body for all 10 neurones studied: heating the tail or pinching the contralateral hindpaw, the tail or a forepaw during 30 s each resulted in comparable inhibitions which had mean values in the order of 80% and which were always marked by post-effects lasting for upwards of 30 s. These inhibitory effects have been called Diffuse Noxious Inhibitory Controls (DNIC). In the spinal unanesthetized rat, the tonic activity was depressed to some extent by the same conditioning stimuli, for only 16/34 neurones studied. By comparison with the intact animals these inhibitions were weak, adapted to base-line levels within 30 s and were more marked for conditioning stimuli applied to structures proximal (tail, contralateral hindpaw) to the excitatory receptive field than for stimuli applied more distally (forepaws). The differences between the inhibitions found in the intact and spinal preparations were subsequently confirmed in a series of experiments in which single convergent neurones were studied before and after the pharmacological blocking of the cervical spinal cord in anaesthetized rats. The results in the spinal preparations provide evidence for the existence of some propriospinal modulatory processes, triggered by the onset of noxious stimulation and acting on convergent neurones. These processes appear to be different from those mediating DNIC, which have been shown to involve supraspinal structures, to concern all convergent neurones, to be very potent and associated with long-lasting post-effects whether the conditioning noxious stimuli are applied to parts of the body proximal or distal to the excitatory receptive field.