Somesthesis and the chemical senses

Theories of pain: from specificity to gate control

Several theoretical frameworks have been proposed to explain the physiological basis of pain, although none yet completely accounts for all aspects of pain perception. Here, we provide a historical overview of the major contributions, ideas, and competing theories of pain from ancient civilizations to Melzack and Wall's Gate Control Theory of Pain.

Pain mechanisms: a commentary on concepts and issues

This commentary on ideas about neural mechanisms underlying pain is aimed at providing perspective for a reader who does not work in the field of mammalian somatic sensation. It is not a comprehensive review of the literature. The organization is historical to chronicle the evolution of ideas. The aim is to call attention to source of concepts and how various ideas have fared over time. One difficulty in relating concepts about pain is that the term is used to refer to human and animal reactions ranging from protective spinal reflexes to complex affective behaviors. As a result, the spectrum of "pain"-related neural organization extends to operation of multiple neuronal arrangements. Thinking about pain has shadowed progress in understanding biological mechanisms, in particular the manner of function of nervous systems. This essay concentrates on the evolution of information and concepts from the early 19th century to the present. Topics include the assumptions underlying currently active theories about pain mechanisms. At the end, brief consideration is given to present-day issues, e.g., chronic pain, central pain, and the view of pain as an emotion rather than a sensation. The conceptual progression shows that current controversies have old roots and that failed percepts often resurface after seemingly having been put to rest by argument and evidence.

Pathogenesis and treatment of pruritus in cholestasis

Pruritus is an enigmatic, seriously disabling symptom accompanying cholestatic liver diseases and a broad range of other disorders. Most recently, novel itch-specific neuronal pathways, itch mediators and their relevant receptors have been identified. In addition, new antipruritic therapeutic strategies have been developed and/or are under evaluation. This review highlights recent experimental and clinical findings focusing on the pathogenesis and actual treatment of pruritus in cholestatic liver disease. Evidence-based therapeutic recommendations, including the use of anion exchange resins cholestyramine, colestipol and colesevelam, the microsomal enzyme inducer rifampicin, the opioid receptor antagonists naltrexone and naloxone, and the serotonin reuptake inhibitor sertraline, are provided.

Ideas about pain, a historical view

The expression 'painful' can be used to describe both an embarrassing moment and a cut on the finger. An explanation for this dichotomy can be found in the convoluted history of ideas about pain. Whether pain is an independent sensation and the product of dedicated neural mechanisms continues to be a topic of debate. This overview concentrates on the issue of specificity together with other notable information regarding pain that has emerged since 1800.

Sensory experiences in humans and single-unit activity in cats evoked by polymodal stimulation of the cornea

1. The cornea of human subjects and of anaesthetised cats was stimulated with a jet of air of controlled flow, temperature and CO(2) concentration delivered by a gas aesthesiometer. 2. In humans, the intensity and magnitude of various components of the sensory experience (intensity of the sensation, degree of irritation, magnitude of burning and stinging pain, magnitude of the cold and warm components of the sensation) were measured using separate visual analog scales. In anaesthetised cats, the impulse response to the same stimuli was recorded from single mechanosensory, polymodal and cold-sensitive corneal fibres in the ciliary nerves. 3. Intensity-response curves for mechanical stimulation showed that all parameters of the sensation experienced by humans increased with the intensity of the stimulus. Mechanical stimuli recruited mainly phasic mechanosensory and polymodal afferents in the cat. 4. Acidic stimulation with gas mixtures of increasing CO(2) concentration evoked irritation, burning and to a lesser extent stinging pain of a magnitude roughly proportional to the intensity of the stimulus in humans. CO(2) primarily recruited polymodal afferents and weakly excited cold-sensitive fibres in the cat's cornea. 5. Heat stimuli evoked in humans a sensation profile similar to CO(2) but accompanied by a warmth component. In the cat's cornea, heat excited only polymodal fibres and silenced cold-sensitive corneal units. 6. Cold stimuli applied to the human cornea elicited a sensation of cooling that became irritant at the lowest temperatures. Corneal cold-sensitive fibres of the cat were activated in a manner proportional to the temperature drop, while polymodal nociceptor fibres were recruited only by the lowest temperatures. Topical menthol (0.2 mM) applied to humans evoked and later eliminated cold sensations produced by cold stimuli while the irritation sensation caused by low temperature stimuli still persisted. 7. Human subjects were able to identify masked mechanical, thermal and chemical stimuli applied to the cornea. 8. Irritation and cold sensations can therefore be evoked separately from the cornea by selective activation of mechanosensory, polymodal and cold corneal sensory afferents. Stimulation with different forms of energy usually leads to combined activation and/or inhibition of the different populations of sensory afferent fibres, evoking blended sensations that include irritation and thermal components in a variable degree.

Patterns in the brain. Neuronal population coding in the somatosensory system

The aim of this article is to review some basic principles of neural coding, with an emphasis on mechanisms of stimulus representation in ensembles of neurons. The theory of "across-neuron response patterns" (ANRPs), first suggested by Thomas Young (1802) and fully developed by Robert Erickson (1963-2000), is summarized and applied to the problem of coding in primary afferent fibers and cortical neurons of the somatosensory system. The basic premise of the theory is that precise information about stimulus features cannot be encoded by single neurons, but is encoded by patterns of activity across populations of neurons. Different stimuli produce uniquely different patterns of ensemble activity (ANRPs)-discrimination between two stimuli is based on the absolute difference in total amount of activity (neural mass difference) of the ANRPs for those stimuli. Review of the literature shows that ANRPs and related population codes can accurately represent and differentiate among various stimulus parameters that cannot be distinguished by single neurons alone. Finally, the behavior of neuronal ensembles can be used to account for the sensory-perceptual changes associated with plasticity of thalamocortical circuits following selective sensorimotor deprivation or experience.

Mapping brain activation to odorants in patients with smell loss by functional MRI

PURPOSE

Our goal was to use functional MRI (fMRI) to develop an objective, noninvasive technique by which patients with smell loss can be identified, their abnormalities quantitated, their results compared with findings in normal subjects, and visual representation of their CNS pathology obtained.

METHOD

Functional MR brain scans were obtained in eight patients with hyposmia in response to three olfactory stimuli (pyridine, menthone, amyl acetate) in three coronal brain sections selected from anterior to posterior temporal brain regions using multislice FLASH MRI. Results were compared with similar studies performed in 17 normal subjects. Activation images were derived using correlation analysis, and ratios of area of brain activated to total brain area were obtained.

RESULTS

Brain activation to each stimulus was lower in each section in patients compared with normal subjects and reached statistical significance for mean activation for each odor and in six of the nine individual sections studied. Activation in patients was found in regions previously associated with CNS processing of olfactory stimuli in normal subjects, but activation in patients was much less, particularly in inferior frontal and cingulate gyral regions of frontal cortex and in regions of medial and posterior temporal cortex.

CONCLUSION

These results demonstrate quantitative CNS changes in smell function in response to olfactory stimuli in patients with hyposmia, demonstrate a novel, objective method by which these patients can be identified, and provide maps of the CNS changes associated with their smell loss.

Representation of visual stimuli in inferior temporal cortex

In primates, inferior temporal (IT) cortex is crucial for the processing and storage of visual information about form and colour. This article reviews the properties of IT neurons and considers how these properties may underlie the perceptual and mnemonic functions of IT cortex. The available evidence suggests that the processing of the facial image by IT cortex is similar to its processing of other visual patterns. Faces and other complex visual stimuli appear to be represented by the pattern of responses over a population of IT neurons rather than by the responses of specific ‘feature detectors’ or ‘grandmother’ cells. IT neurons with adult-like stimulus properties are present in monkeys as young as six weeks old.

[The characteristics of the formation of temperature information in afferent units]

Impulse activity of single afferent fibres of the spinal cord dorsal roots of cats was investigated under local mechanical, heat and cold influence on receptive fields of their skin. These influences did not change the frequency of impulsation, but changed redistribution of interimpulse intervals. It is supposed that formation of polyfunctional properties of single afferent fibres is realized due to their polychannel information.

A mathematical model of the gate control theory of pain

The first test which any theory of pain must pass is that it must be able to explain the phenomena observed in acute pain in humans. This criterion is used to test the major theory of pain at present, the gate control theory of Melzack & Wall (1965, 1982). The theory is explicit enough to be cast in mathematical terms, and the mathematical model is shown to explain the observations considered. It also points up a common misconception on the consequences of the theory, and thus demolishes an argument which has been used against it. A hypothesis of the origin of rhythmic pain is then made, and consequent testable predictions given. This is the first time that the gate control theory has been used to explain any quality of pain. It has important consequences for the treatment of such pain. Finally, the applicability of the gate control theory as an explanation for chronic pain is discussed.

A review of pruritus

This article reviews the neurophysiology of pruritus and presents evidence that itch is a separate modality from pain, rather than a submodality of pain. The numerous suggested pruritogens are reviewed, and evidence supporting each one is critically examined. The systemic causes of generalized pruritus are reviewed, with detailed review of the literature on uremic pruritus, cholestatic pruritus, and the pruritus associated with polycythemia vera. The specific treatments used for each of these conditions are reviewed, as well as the use of antihistamines in generalized pruritus. An approach to the workup of a patient with pruritus is suggested.

Influence of transcutaneous nerve stimulation (TNS) on acute pain

Using transcutaneous nerve stimulation (TNS) simple surgical procedures such as tooth extractions and nerve biopsies can be performed without the usual anesthetics. Estimation of threshold and suprathreshold intensities of painful electrical stimuli show no significant change during TNS. Only the threshold for non-painful electrical stimuli is slightly increased. Cortical potentials evoked by electrical peripheral nerve stimulation are not significantly modulated by TNS. Latencies of the early components 0, I--III are unchanged, the amplitudes only slightly reduced. These observations are in contradiction to the 'gate-control' theory of pain.

Itch and Vibration

Itch produced by application of cowage to the wrist was reduced in intensity by vibration of the stimulated area. Application of vibration to the opposite wrist also reduced intensity. The results may be attributed to physiological activities occurring at the early stages of information transmission.