1
|
Jan Pawlik R, Aulenkamp J, Elsenbruch S. Wenn aus einem Bauchgefühl viszerale Schmerzen werden:
Placebo- und Nocebo-Mechanismen entlang der Darm-Hirn-Achse. AKTUELLE ERNÄHRUNGSMEDIZIN 2023. [DOI: 10.1055/a-1976-9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
ZusammenfassungDas Erleben von Schmerz ist nach heutigem Verständnis durch eine Vielzahl
biologischer, psychologischer und sozialer Faktoren geprägt und somit
eine komplexe, von der Nozizeption abzugrenzende, psychologische Erfahrung.
Entsprechend ist das Schmerzerleben durch psychologische Faktoren modulierbar
und chronische Schmerzen werden als biopsychosoziale Erkrankungen verstanden.
Dies gilt auch für den Viszeralschmerz, dem spezifische
psychophysiologische Prinzipien und neurobiologische Mechanismen zugrunde
liegen, was eine interdisziplinäre Betrachtung unter Einbeziehung der
Psychologie und der Neurowissenschaften erforderlich macht. Ausgehend von den
bidirektionalen Verbindungen zwischen Darm und Hirn und aufbauend auf einem
biopsychosozialen Krankheitsmodell beschreibt dieser Übersichtsbeitrag
psychologische Mechanismen, die bei der Entstehung, Aufrechterhaltung und
Therapie viszeraler Schmerzen wichtig sind. Dabei liegt der Fokus auf positiven
und negativen Erwartungseffekten im psychosozialen Behandlungskontext.
Therapieerwartungen können Krankheitssymptome sowohl positiv als auch
negativ beeinflussen. Diese gemeinhin als Placebo- und Noceboeffekte bekannten
Phänomene, die durch die Arzt-Patient Kommunikation, Lernprozesse,
Stress und Furcht vermittelt werden, sind auch für den Viszeralschmerz
bei gastrointestinalen Erkrankungen zunehmend anerkannt und Gegenstand aktueller
grundlagenwissenschaftlicher und klinischer Forschungsaktivitäten. Neue
interdisziplinäre und translationale Forschungsansätze aus der
Forschung zu Placebo- und Noceboeffekten liefern spannende Einblicke in die
zahlreichen Verbindungen und Wechselbeziehungen zwischen Darm und Gehirn bei
normalen wie auch pathologischen Darm-Hirn Interaktionen und können dazu
beitragen, die Pathophysiologie von Erkrankungen, die mit viszeralen Schmerzen
einhergehen, besser zu verstehen und wichtige Erkenntnisse für neue
Therapieansätze zu gewinnen.
Collapse
Affiliation(s)
- Robert Jan Pawlik
- Abteilung für Medizinische Psychologie und Medizinische
Soziologie, Ruhr-Universität Bochum Medizinische Fakultät,
Bochum, Germany
| | - JanaLuisa Aulenkamp
- Klinik für Anästhesiologie und Intensivmedizin,
Universitätsklinikum Essen, Essen, Germany
- Klinik für Neurologie, Zentrum für Translationale
Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Essen,
Germany
| | - Sigrid Elsenbruch
- Abteilung für Medizinische Psychologie und Medizinische
Soziologie, Ruhr-Universität Bochum Medizinische Fakultät,
Bochum, Germany
- Klinik für Neurologie, Zentrum für Translationale
Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Essen,
Germany
| |
Collapse
|
2
|
Xu QY, Zhang HL, Du H, Li YC, Ji FH, Li R, Xu GY. Identification of a Glutamatergic Claustrum-Anterior Cingulate Cortex Circuit for Visceral Pain Processing. J Neurosci 2022; 42:8154-8168. [PMID: 36100399 PMCID: PMC9637003 DOI: 10.1523/jneurosci.0779-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/21/2022] Open
Abstract
Chronic visceral pain is a major challenge for both patients and health providers. Although the central sensitization of the brain is thought to play an important role in the development of visceral pain, the detailed neural circuits remain largely unknown. Using a well-established chronic visceral hypersensitivity model induced by neonatal maternal deprivation (NMD) in male mice, we identified a distinct pathway whereby the claustrum (CL) glutamatergic neuron projecting to the anterior cingulate cortex (ACC) is critical for visceral pain but not for CFA-evoked inflammatory pain. By a combination of in vivo circuit-dissecting extracellular electrophysiological approaches and visceral pain related electromyographic (EMG) recordings, we demonstrated that optogenetic inhibition of CL glutamatergic activity suppressed the ACC neural activity and visceral hypersensitivity of NMD mice whereas selective activation of CL glutamatergic activity enhanced the ACC neural activity and evoked visceral pain of control mice. Further, optogenetic studies demonstrate a causal link between such neuronal activity and visceral pain behaviors. Chemogenetic activation or inhibition of ACC neural activities reversed the effects of optogenetic manipulation of CL neural activities on visceral pain responses. Importantly, molecular detection showed that NMD significantly enhances the expression of NMDA receptors and activated CaMKIIα in the ACC postsynaptic density (PSD) region. Together, our data establish a functional role for CL→ACC glutamatergic neurons in gating visceral pain, thus providing a potential treatment strategy for visceral pain.SIGNIFICANCE STATEMENT Studies have shown that sensitization of anterior cingulate cortex (ACC) plays an important role in chronic pain. However, it is as yet unknown whether there is a specific brain region and a distinct neural circuit that helps the ACC to distinguish visceral and somatic pain. The present study demonstrates that claustrum (CL) glutamatergic neurons maybe responding to colorectal distention (CRD) rather than somatic stimulation and that a CL glutamatergic projection to ACC glutamatergic neuron regulates visceral pain in mice. Furthermore, excessive NMDA receptors and overactive CaMKIIα in the ACC postsynaptic density (PSD) region were observed in mice with chronic visceral pain. Together, these findings reveal a novel neural circuity underlying the central sensitization of chronic visceral pain.
Collapse
Affiliation(s)
- Qi-Ya Xu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, People's Republic of China
| | - Hai-Long Zhang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, People's Republic of China
| | - Han Du
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, People's Republic of China
| | - Yong-Chang Li
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, People's Republic of China
| | - Fu-Hai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Guang-Yin Xu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, People's Republic of China
| |
Collapse
|
3
|
New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10110860. [PMID: 33105749 PMCID: PMC7690567 DOI: 10.3390/diagnostics10110860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. METHODS AND PARTICIPANTS A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. RESULTS TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. CONCLUSION This paper showed that the introduction of new technology-CP OCT-in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.
Collapse
|
4
|
Fang Y, Han S, Li X, Xie Y, Zhu B, Gao X, Ma C. Cutaneous Hypersensitivity as an Indicator of Visceral Inflammation via C-Nociceptor Axon Bifurcation. Neurosci Bull 2020; 37:45-54. [PMID: 32902804 PMCID: PMC7811974 DOI: 10.1007/s12264-020-00577-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022] Open
Abstract
Pain on the body surface can accompany disorders in the deep tissue or internal organs. However, the anatomical and physiological mechanisms are obscure. Here, we provided direct evidence of axon bifurcation in primary C-nociceptive neurons that innervate both the skin and a visceral organ. Double-labeled dorsal root ganglion (DRG) neurons and Evans blue extravasation were observed in 3 types of chemically-induced visceral inflammation (colitis, urocystitis, and acute gastritis) rat models. In the colitis model, mechanical hypersensitivity and spontaneous activity were recorded in vivo from double-labeled C-nociceptive neurons in S1 or L6 DRGs. These neurons showed significantly enhanced responses to both somatic stimulation and colorectal distension. Our findings suggest that the branching of C-nociceptor axons contribute to cutaneous hypersensitivity in visceral inflammation. Cutaneous hypersensitivity on certain locations of the body surface might serve as an indicator of pathological conditions in the corresponding visceral organ.
Collapse
Affiliation(s)
- Yehong Fang
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
| | - Shu Han
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xiaoxue Li
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yikuan Xie
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
| | - Bing Zhu
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xinyan Gao
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Chao Ma
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China. .,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
5
|
Urits I, Li N, Bahrun E, Hakobyan H, Anantuni L, An D, Berger AA, Kaye AD, Paladini A, Varrassi G, Vorenkamp KE, Viswanath O. An evidence-based review of CGRP mechanisms in the propagation of chronic visceral pain. Best Pract Res Clin Anaesthesiol 2020; 34:507-516. [PMID: 33004162 DOI: 10.1016/j.bpa.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
Chronic pain is typically defined as pain that persists after acute tissue damage and inflammation or as pain that follows a chronic disease process and lasts more than three months. Because of its debilitating impact on the quality of life of patients, recent research aims to investigate the mechanisms behind nociception to discover novel therapeutic agents to alleviate pain. One such target is the neuropeptide calcitonin gene-related peptide (CGRP), which has shown to play an integral role in migraine pathophysiology. Effective treatments of migraines with CGRP antagonists have stimulated our efforts toward checking a possible involvement of CGRP in nonheadache pain conditions such as hypertension, congestive heart failure, Alzheimer's disease, and vascular ischemia. Here, we provide a brief overview of chronic pain, with a particular emphasis on the role of CGRP as a fundamental mediator of nociceptive pain as well as a target for novel therapeutic agents.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Nathan Li
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Ehab Bahrun
- Georgetown University School of Medicine, Washington, DC, USA
| | - Hayk Hakobyan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Lekha Anantuni
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Daniel An
- Georgetown University School of Medicine, Washington, DC, USA
| | - Amon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | | | | | | | - Omar Viswanath
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants, Envision Physician Services, Phoenix, AZ, USA; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| |
Collapse
|
6
|
|
7
|
Abstract
Zusammenfassung. Das Urethralsyndrom bei Frauen mit Schmerzen in der Harnröhre und Blasenentleerungsstörungen ist eine Ausschlussdiagnose. Zu den möglichen Ursachen zählen unter anderem Infektionen, Entzündungen der paraurethralen Drüsen, Verspannungen der Sphinkteren und/oder der Beckenbodenmuskulatur, Östrogenmangelerscheinungen, Traumata, Neuropathien, Allergien und psychosomatische Störungen. Patientinnen mit Urethralsyndrom müssen ganzheitlich betrachtet, abgeklärt und behandelt werden. Während der Abklärung und Behandlung benötigen diese Patientinnen viel Zeit und Aufmerksamkeit. Heute gilt als sicher, dass bei vielen somatischen Leiden psychosoziale Faktoren mitspielen, die den Verlauf der Erkrankung entscheidend beeinflussen können und im Behandlungsprozess berücksichtigt werden müssen.
Collapse
|
8
|
Elsenbruch S, Enck P. Psychobiologische Mechanismen bei der Pathophysiologie chronischer viszeraler Schmerzen. Schmerz 2016; 30:407-411. [DOI: 10.1007/s00482-016-0130-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|