Assembly of the dorsal horn somatotopic map

Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study

Objectives

To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP) persisting after childbirth with the purpose to improve diagnostics and give implications for treatment.

Materials and Methods

In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas.

Results

Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm^² (19.2 to 53.7) in women with CPP as compared to 3.2 mm^² (1.0 to 5.1) in women without CPP, p< 0.0001.

Conclusions

Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.

Action-based body maps in the spinal cord emerge from a transitory floating organization

During development primary afferents grow into and establish neuronal connections in the spinal cord, thereby forming the basis for how we perceive sensory information and control our movements. In the somatosensory system, myriads of primary afferents, conveying information from different body locations and sensory modalities, get organized in the dorsal horn of the spinal cord so that spinal multisensory circuits receive topographically ordered information. How this intricate pathfinding is brought about during development is, however, largely unknown. Here we show that a body representation closely related to motor patterns emerges from a transitory floating and plastic organization through profound activity-dependent rewiring, involving both sprouting and elimination of afferent connections, and provide evidence for cross-modality interactions in the alignment of the multisensory input. Thus, far from being inborn and stereotypic, the dorsal horn of the spinal cord now appears to be a highly adaptive brain-body interface.

Action-based sensory encoding in spinal sensorimotor circuits

The concept of a modular organisation of the spinal withdrawal reflex circuits has proven to be fundamental for the understanding of how the spinal cord is organised and how the sensorimotor circuits translate sensory information into adequate movement corrections. Recent studies indicate that a task-related body representation is engraved at the network level through learning-dependent mechanisms involving an active probing procedure termed 'somatosensory imprinting' during development. It was found that somatosensory imprinting depends on the tactile input that is associated with spontaneous movements that occur during sleep and results in elimination of erroneous connections and establishment of correct connections. In parallel studies it was found that the strength of the first order tactile synapses in rostrocaudally elongated zones in the adult dorsal horn in the lower lumbar cord is related to the modular organisation of the withdrawal reflexes. Hence, the topographical organisation of the tactile input to this spinal area seems to be action-based rather than a simple body map as previously thought. Far from being innate and adult like at birth, the adult organisation seems to emerge from an initial 'floating' and diffuse body representation with many inappropriate connections through profound activity-dependent rearrangements of afferent synaptic connections. It is suggested that somatosensory imprinting plays a key role in the self-organisation of the spinal cord during development.

From innervation density to tactile acuity 2: embryonic and adult pre- and postsynaptic somatotopy in the dorsal horn

We tested the hypothesis that dorsal horn laminae III-IV cell receptive fields (RFs) are initially established in three steps: cutaneous axons penetrate the dorsal horn near their rostrocaudal (RC) levels of entry into the spinal cord. Their terminal branches distribute mediolaterally (ML) according to their relative distoproximal RF locations on the leg, and form nonselective synapses with nearby dorsal horn cell dendrites, establishing the initial dorsal horn cell RFs. Rootlet axon RFs in adult cats were used to approximate the RC entry levels of hindlimb skin input. Cord dorsum recordings of monosynaptic field potentials evoked by electrical skin stimulation provided the RC distributions of synaptic input. These were in close agreement. Simulated projections of all 22,000 hindlimb axons were similar to projections predicted from EPSP distributions, and with the observed projections of dorsal roots, cutaneous nerves, and individual axons. The simulated terminals were connected nonselectively to nearby dendrites of 135,000 simulated lamina III-IV cells whose dendritic surface area distributions were based on intracellularly stained cells. There was an overall similarity among pre- and postsynaptic embryonic and adult somatotopies, with a progressive transformation of RF angular location as a function of RC, ML dorsal horn location from an initial embryonic presynaptic concentric pattern to an adult postsynaptic radial one. The initial embryonic dorsal horn cell RF assembly hypothesis was supported by the simulations, as was the additional hypothesis that further refinement of connections would be necessary to establish sufficient selectivity to account for observed adult RFs and somatotopy.

From innervation density to tactile acuity

We tested the hypothesis that the population receptive field representation (a superposition of the excitatory receptive field areas of cells responding to a tactile stimulus) provides spatial information sufficient to mediate one measure of static tactile acuity. In psychophysical tests, two-point discrimination thresholds on the hindlimbs of adult cats varied as a function of stimulus location and orientation, as they do in humans. A statistical model of the excitatory low threshold mechanoreceptive fields of spinocervical, postsynaptic dorsal column and spinothalamic tract neurons was used to simulate the population receptive field representations in this neural population of the one- and two-point stimuli used in the psychophysical experiments. The simulated and observed thresholds were highly correlated. Simulated and observed thresholds' relations to physiological and anatomical variables such as stimulus location and orientation, receptive field size and shape, map scale, and innervation density were strikingly similar. Simulated and observed threshold variations with receptive field size and map scale obeyed simple relationships predicted by the signal detection model, and were statistically indistinguishable from each other. The population receptive field representation therefore contains information sufficient for this discrimination.

Spinal sensorimotor transformation: relation between cutaneous somatotopy and a reflex network

The projection of primary afferents onto spinal interneurons constitutes the first step in sensorimotor transformations performed by spinal reflex systems. Despite extensive studies on spinal somatotopy, uncertainties remain concerning the extent and significance of representational overlap and relation to spinal reflex circuits. To address these issues, the cutaneous projection from the hindpaw and its relation to the topography of lamina V neurons encoding withdrawal reflex strength ("reflex encoders") was studied in rats. Thin and coarse primary afferent terminations in laminas II and III-IV, respectively, were mapped by wheat germ agglutinin-horseradish peroxidase and choleragenoid tracing. The functional weights of these projections were characterized by mapping nociceptive and tactile field potentials and compared with the topography of reflex encoders. Both anatomical and physiological data indicate that thin and coarse skin afferent input is spatially congruent in the horizontal plane. The representation of the hindpaw in the spinal cord was found to be intricate, with a high degree of convergence between the projections from different skin sites. "Somatotopic disruptions" such as the representation of central pads medial to that of the digits were common. The weight distribution of the cutaneous convergence patterns in laminas III-IV was similar to that of lamina V reflex encoders. This suggests that the cutaneous convergence and features such as somatotopic disruptions have specific relations to the sensorimotor transformations performed by reflex interneurons in the deep dorsal horn. Hence, the spinal somatotopic map may be better understood in light of the topography of such reflex systems.

Proprioception from a spinocerebellar perspective

This review explores how proprioceptive sensory information is organized at spinal cord levels as it relates to a sense of body position and movement. The topic is considered in an historical context and develops a different framework that may be more in tune with current views of sensorimotor processing in other central nervous system structures. The dorsal spinocerebellar tract (DSCT) system is considered in detail as a model system that may be considered as an end point for the processing of proprioceptive sensory information in the spinal cord. An analysis of this system examines sensory processing at the lowest levels of synaptic connectivity with central neurons in the nervous system. The analysis leads to a framework for proprioception that involves a highly flexible network organization based in some way on whole limb kinematics. The functional organization underlying this framework originates with the biomechanical linkages in the limb that establish functional relationships among the limb segments. Afferent information from limb receptors is processed further through a distributed neural network in the spinal cord. The result is a global representation of hindlimb parameters rather than a muscle-by-muscle or joint-by-joint representation.

Dorsal horn spatial representation of simple cutaneous stimuli

A model of lamina III-IV dorsal horn cell receptive fields (RFs) has been developed to visualize the spatial patterns of cells activated by light touch stimuli. Low-threshold mechanoreceptive fields (RFs) of 551 dorsal horn neurons recorded in anesthetized cats were characterized by location of RF center in cylindrical coordinates, area, length/width ratio, and orientation of long axis. Best-fitting ellipses overlapped actual RFs by 90%. Exponentially smoothed mean and variance surfaces were estimated for these five variables, on a grid of 40 points mediolaterally by 20/segment rostrocaudally in dorsal horn segments L4-S1. The variations of model RF location, area, and length/width ratio with map location were all similar to previous observations. When elliptical RFs were simulated at the locations of the original cells, the RFs of real and simulated cells overlapped by 64%. The densities of cell representations of skin points on the hindlimb were represented as pseudocolor contour plots on dorsal view maps, and segmental representations were plotted on the standard views of the leg. Overlap of modeled and real segmental representations was at the 84% level. Simulated and observed RFs had similar relations between area and length/width ratio and location on the hindlimb: r(A) = 0.52; r(L/W) = 0.56. Although the representation of simple stimuli was orderly, and there was clearly only one somatotopic map of the skin, the representation of a single point often was not a single cluster of active neurons. When two-point stimuli were simulated, there usually was no fractionation of response zones or addition of new zones. Variation of stimulus size (area of skin contacted) produced less variation of representation size (number of cells responding) than movement of stimuli from one location to another. We conclude that stimulus features are preserved poorly in their dorsal horn spatial representation and that discrimination mechanisms that depend on detection of such features in the spatial representation would be unreliable.