The innervation of blood vessels in striated muscle and skin

Hyperthermia associated with spinal radiculopathy as determined by digital infrared thermographic imaging

In general, in digital infrared thermographic imaging (DITI) of patients with unilateral spinal radicular pain, the thermal pattern of the extremities of the side of lesion shows hypothermia compared to the opposite, intact side. However, sometimes, DITI shows hyperthermia on the side of the lesion, and this variation can cause confusion. We compared the data of both hypothermia and hyperthermia patients to clarify the factors determining different thermal characteristics in spinal radiculopathy.We retrospectively collected data from patients who underwent DITI at a single center. The final cohort (n = 224) was allocated into 2 groups, a hypothermia group (n = 180) or a hyperthermia group (n = 44). We compared the various factors, including demographic factors and symptom-related factors, that might affect the results of DITI.Except the presence of trauma history (13.9% vs 31.8%, odds ratio 2.893, P = .008), no significant intergroup difference was found in baseline demographic factors, including age, gender, diabetes mellitus, spinal level of pathology, and intervention history. Among symptom-related factors, in the hyperthermia group, the symptom duration was shorter (10.64 weeks [95% confidence interval (CI) 8.36-13.04] vs 2.10 weeks [95% CI 1.05-3.53], P < .001) and Visual Analogue Scale (VAS) of radicular pain was higher (4.23 ± 1.29 vs 5.18 ± 1.40, P < .001) than in the hypothermia group. Also, in the regression analysis, significant factors for hyperthermia include the presence of trauma history, shorter symptom duration (cut-off value 2.50 weeks or less) and higher VAS of radicular pain (cut-off value 4.50 or more).In patients with trauma history, acute phase, and severe radicular pain, hyperthermia in DITI is not unusual and careful interpretation of the DITI results is necessary for proper diagnosis and treatment decisions in spinal radiculopathy.

Cortical representation of venous nociception in humans

Painful sensations can be evoked by application of thermal, mechanical, and chemical stimuli to the blood vessels. The cortical substrates of these sensations are unknown. We therefore used whole-head magnetoencephalography to record cortical responses to painful laser stimuli applied cutaneously and intravenously to the dorsum of the hand in healthy human subjects. Similar to the cutaneous stimuli, venous stimulation nearly simultaneously activated the contralateral primary and the bilateral secondary somatosensory cortices. In the venous stimulation condition, all activation peaks were about 50 ms earlier than in the cutaneous stimulation condition. Locations of responses to both stimuli did not differ. These results show that the afferent volley from the veins reaches the cerebral cortex significantly earlier than that from the skin. This might be due to differences in peripheral conduction velocity. Apart from this, these findings demonstrate that venous nociception shares the cortical representation of cutaneous nociception in human somatosensory cortices. Thus the cortical representation of nociceptive processing from tissues of mesodermal and ectodermal origin appears to be similar.

Localization of sympathetic postganglionic neurons innervating the femoral-saphenous vein in cats

Physiological and histochemical studies have suggested that the limb veins are innervated by sympathetic adrenergic fibers. In the present experiment, horseradish peroxidase (HRP) was used as a retrograde tracer to identify and localize the sympathetic postganglionic neurons that innervate the femoral-saphenous vein in cats. In anesthetized cats, HRP was applied perivascularly on a femoral and a saphenous vein segment (4-8 mm in length for each segment) to allow uptake into the nerve endings. The sympathetic chains on both sides were dissected after the animal was sacrificed and fixed 60 h following the HRP application. Histological examination on serial section was done to count the HRP-labeled neurons in each sympathetic ganglion from L1 to S1. In 10 cats, the total number of HRP neurons amounted to 8569. Most neurons arose from L3 (47%) and then L4 (31%). The number of neurons became progressively decreasing towards both ends of the sympathetic chain. Few neurons (less than 2% of the total) were discovered in the contralateral sympathetic ganglia. In each ganglion, the distribution of HRP neurons appeared to be scattering. Our findings provide anatomical evidence to support that the femoral-saphenous vein of the cat was innervated by the sympathetic efferent fibers. The main origins of these neurons are the third and fourth lumbar sympathetic ganglia.

Quantification of thermal asymmetry. Part 2: Application in low-back pain and sciatica

Temperature differences between the lower extremities were measured using a computerized thermometric scanning system in order to compare the degree of thermal asymmetry in 144 patients with low-back pain. The patients displayed highly significant thermal asymmetries, with the involved limb being cooler (p less than 0.001). When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in 90 normal control subjects, the positive predictive value of thermometry in detecting root impingement was 94.7% and the specificity was 87.5%. These values indicate that calculation of temperature asymmetry is particularly effective in evaluating reported pain in psychosocially affected patient populations in whom the chance of positive myelography or impaired root function is low. In this group of patients, thermometric study provides physicians with important information for proper decision making. The test can be performed to avoid more invasive and probably less revealing diagnostic or exploratory surgical procedures.

Responses of spinal cord neurons following stimulation of A beta femoral-saphenous venous afferent fibers

A population of large (A beta) afferents is known to have endings in the wall of the femoral-saphenous vein. These afferents project to the lower lumbar spinal cord. The purpose of the present study was to identify, localize, and characterize spinal neurons that receive inputs from such afferents. Responses of 50 neurons in the L6 spinal cord segment of decerebrate-spinal cats or intact cats anesthetized using alpha-chloralose were recorded following electrical stimulation of these afferents. Observations were also made on the convergence of muscle and cutaneous afferent inputs onto neurons driven by stimulation of afferents terminating in the femoral-saphenous vein. All recording sites were marked either by intracellularly staining the element characterized with HRP or by extracellularly iontophoresing a small quantity of this tracer. The cells were driven for long durations (mean of 51.5 ms, S.E.M. of 10.0) by single-shock stimulation of femoral-saphenous venous afferents. The recording sites were located in Rexed's laminae IV-VIII and X. Eight of the 50 neurons were activated by venous afferent stimulation at latencies equal to or shorter than that of the first negative wave of the cord dorsum potential; these units were driven at a mean latency of 1.4 ms (S.E.M. of 0.25) following the arrival of the afferent volley at the cord and were assumed to receive monosynaptic, or at least relatively direct, inputs from the primary afferents. Most of these cells (6 of 8) were located in lamina V. The majority of the neurons studied (37 of 50) were activated at latencies longer than 3 ms following the arrival of the afferent volley at the cord; about half (19 of 37) of those activated at longer latencies were located in lamina VII, and the rest were scattered among the other laminae. Twenty-eight of 40 venous afferent-driven cells tested could also be activated by electrical stimulation of either the posterior tibial or sural nerve. In general, the stimulation intensities necessary to activate the neurons were only sufficient to excite large (A alpha or A beta) muscle and cutaneous afferents. Neurons receiving the shortest latency inputs from the femoral-saphenous vein were less likely to receive convergent inputs from muscle or skin than were neurons activated by venous afferents at longer latency.

Tracing of afferent pathways from the femoral-saphenous vein to the dorsal root ganglia using transport of horseradish peroxidase

The retrograde transport of horseradish peroxidase (HRP) was used to trace afferents from the femoral-saphenous vein to the dorsal root ganglia in the cat. Afferents arising along the entire length of the vein projected to very localized spinal levels; 63% of the labeled cells counted were located in the L6 dorsal root ganglion, 37% were located in the L5 ganglion and less than 1% were located at other levels. Most of the cell bodies labeled by the application of HRP to the femoral-saphenous vein were small in size (diameter less than 35 microns). However, some large cell bodies (diameter greater than 50 microns) were also noted. It was estimated that over two-thirds of the femoral-saphenous venous afferents were C fibers; at least 15% were estimated to be A fibers. The largest venous afferents were predicted to conduct action potentials at approximately 60 m/s.

Properties of femoral venous afferent inputs and lumbosacral distribution of spinal evoked activity

The present studies were done to determine details of the anatomical and physiological characteristics of femoral-saphenous venous afferent input to the lumbar spinal cord. Gross anatomical examination revealed that afferent bundles could be seen coursing from the saphenous nerve to the femoral-saphenous vein. Compound action potentials elicited by femoral-saphenous venous afferent stimulation were recorded from the femoral nerve and in dorsal rootlets of the 6th lumbar cord segment. The compound action potentials included activity correlated with that of fibers conducting impulses at the rate of 31 to 61 m/s. Lumbar cord dorsum potentials elicited by femoral-saphenous venous afferent stimulation were abolished by rhizotomy of the most caudal rootlets of the 6th lumbar cord segment. L6 was also the cord segment from which the largest amplitude cord dorsum negative potentials were recorded, while action potentials with large late positive waves were recorded from more caudal cord segments. These observations suggested that the L6 segment contained the largest number of spinal neurons responding to primary femoral-saphenous venous afferent input, and that input reached the more caudal segments via intersegmental connections. A proposed physiological role of these afferents is briefly described.

Lumbar spinal cord responses to limb vein distention

The purpose of this study was to determine if central neural responses were elicited by distention of limb veins, and to compare the pattern of these response to those produced in previous studies using electrical stimulation to excite limb venous afferent fibers. Spinal evoked potentials were measured in response to stretch of the wall of a segment of the femoral-saphenous vein by perfusion-distention or by mechanical stretch. These studies revealed that spinal cord evoked potentials were elicited by these procedures, and that the activated venous afferent fibers coursed through the saphenous nerve and entered the sixth lumber spinal cord segment. The minimum stretches which were required to elicit spinal evoked potentials were produced by perfusion pressures starting at 2-3 mm Hg, or by mechanical stretch of the wall of 5 micron/mm. A vein wall proprioceptor hypothesis is proposed and discussed in the light of these findings. In addition to the cord dorsum evoked potentials, distention or stretch of the vein wall elicited ventral root potentials (excitatory postsynaptic population potentials) which are known to be produced by excitatory inputs to motoneurons. A venous afferent mediated muscle-tonus venopressor mechanism hypothesis is proposed and discussed in the light of these and previous findings.

Interactions between femoral venous afferents and lumbar spinal reflex pathways

This study reports findings of spinal reflex connections of afferent fibers electrically excited in the wall of the femoral vein. Condition-test experiments, and EMG recordings revealed that the femoral venous afferents have facilitatory connections to flexor and extensor motoneurons of both the proximal and the distal hindlimb muscles. Femoral venous afferent stimulation which produced facilitation, also produced inhibition of the test reflexes following the facilitation. Because the inhibition was enhanced by diazepam injection and because the inhibitory time-course correlated closely to the time-courses of both dorsal root potentials and individual tests of primary afferent depolarization, the inhibition was suggested to be produced by presynaptic inhibition. The potentially significant role of the venous afferent connections in a reflex-elicited skeletal muscle pump or in an increase in intramuscular venous counterpressure is discussed.