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Mehnert J, Tinnermann A, Basedau H, May A. Functional representation of trigeminal nociceptive input in the human periaqueductal gray. SCIENCE ADVANCES 2024; 10:eadj8213. [PMID: 38507498 PMCID: PMC10954197 DOI: 10.1126/sciadv.adj8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
The periaqueductal gray (PAG) is located in the mesencephalon in the upper brainstem and, as part of the descending pain modulation, is considered a crucial structure for pain control. Its modulatory effect on painful sensation is often seen as a systemic function affecting the whole body similarly. However, recent animal data suggest some kind of somatotopy in the PAG. This would make the PAG capable of dermatome-specific analgesic function. We electrically stimulated the three peripheral dermatomes of the trigemino-cervical complex and the greater occipital nerve in 61 humans during optimized brainstem functional magnetic resonance imaging. We provide evidence for a fine-grained and highly specific somatotopic representation of nociceptive input in the PAG in humans and a functional connectivity between the individual representations of the peripheral nerves in the PAG and the brainstem nuclei of these nerves. Our data suggest that the downstream antinociceptive properties of the PAG may be rather specific down to the level of individual dermatomes.
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Affiliation(s)
| | | | - Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Eppendorf, 20146 Hamburg, Germany
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Yang Y, Rao C, Yin T, Wang S, Shi H, Yan X, Zhang L, Meng X, Gu W, Du Y, Hong F. Application and underlying mechanism of acupuncture for the nerve repair after peripheral nerve injury: remodeling of nerve system. Front Cell Neurosci 2023; 17:1253438. [PMID: 37941605 PMCID: PMC10627933 DOI: 10.3389/fncel.2023.1253438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Peripheral nerve injury (PNI) is a structural event with harmful consequences worldwide. Due to the limited intrinsic regenerative capacity of the peripheral nerve in adults, neural restoration after PNI is difficult. Neurological remodeling has a crucial effect on the repair of the form and function during the regeneration of the peripheral nerve after the peripheral nerve is injured. Several studies have demonstrated that acupuncture is effective for PNI-induced neurologic deficits, and the potential mechanisms responsible for its effects involve the nervous system remodeling in the process of nerve repair. Moreover, acupuncture promotes neural regeneration and axon sprouting by activating related neurotrophins retrograde transport, such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF), N-cadherin, and MicroRNAs. Peripheral nerve injury enhances the perceptual response of the central nervous system to pain, causing central sensitization and accelerating neuronal cell apoptosis. Together with this, the remodeling of synaptic transmission function would worsen pain discomfort. Neuroimaging studies have shown remodeling changes in both gray and white matter after peripheral nerve injury. Acupuncture not only reverses the poor remodeling of the nervous system but also stimulates the release of neurotrophic substances such as nerve growth factors in the nervous system to ameliorate pain and promote the regeneration and repair of nerve fibers. In conclusion, the neurological remodeling at the peripheral and central levels in the process of acupuncture treatment accelerates nerve regeneration and repair. These findings provide novel insights enabling the clinical application of acupuncture in the treatment of PNI.
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Affiliation(s)
- Yongke Yang
- Beilun District People’s Hospital, Ningbo, China
| | - Chang Rao
- Tianjin Union Medical Center, Tianjin, China
| | - Tianlong Yin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shaokang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huiyan Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xin Yan
- National Anti-Drug Laboratory Beijing Regional Center, Beijing, China
| | - Lili Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xianggang Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenlong Gu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Feng Hong
- Beilun District People’s Hospital, Ningbo, China
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Nguyen E, Grajales-Reyes JG, Gereau RW, Ross SE. Cell type-specific dissection of sensory pathways involved in descending modulation. Trends Neurosci 2023; 46:539-550. [PMID: 37164868 PMCID: PMC10836406 DOI: 10.1016/j.tins.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Abstract
Decades of research have suggested that stimulation of supraspinal structures, such as the periaqueductal gray (PAG) and rostral ventromedial medulla (RVM), inhibits nocifensive responses to noxious stimulation through a process known as descending modulation. Electrical stimulation and pharmacologic manipulations of the PAG and RVM identified transmitters and neuronal firing patterns that represented distinct cell types. Advances in mouse genetics, in vivo imaging, and circuit tracing methods, in addition to chemogenetic and optogenetic approaches, allowed the characterization of the cells and circuits involved in descending modulation in further detail. Recent work has revealed the importance of PAG and RVM neuronal cell types in the descending modulation of pruriceptive as well as nociceptive behaviors, underscoring their roles in coordinating complex behavioral responses to sensory input. This review summarizes how new technical advances that enable cell type-specific manipulation and recording of neuronal activity have supported, as well as expanded, long-standing views on descending modulation.
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Affiliation(s)
- Eileen Nguyen
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Jose G Grajales-Reyes
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Robert W Gereau
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Sarah E Ross
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Pagano RL, Dale CS, Campos ACP, Hamani C. Translational aspects of deep brain stimulation for chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1084701. [PMID: 36713643 PMCID: PMC9874335 DOI: 10.3389/fpain.2022.1084701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
The use of deep brain stimulation (DBS) for the treatment of chronic pain was one of the first applications of this technique in functional neurosurgery. Established brain targets in the clinic include the periaqueductal (PAG)/periventricular gray matter (PVG) and sensory thalamic nuclei. More recently, the anterior cingulum (ACC) and the ventral striatum/anterior limb of the internal capsule (VS/ALIC) have been investigated for the treatment of emotional components of pain. In the clinic, most studies showed a response in 20%-70% of patients. In various applications of DBS, animal models either provided the rationale for the development of clinical trials or were utilized as a tool to study potential mechanisms of stimulation responses. Despite the complex nature of pain and the fact that animal models cannot reliably reflect the subjective nature of this condition, multiple preparations have emerged over the years. Overall, DBS was shown to produce an antinociceptive effect in rodents when delivered to targets known to induce analgesic effects in humans, suggesting a good predictive validity. Compared to the relatively high number of clinical trials in the field, however, the number of animal studies has been somewhat limited. Additional investigation using modern neuroscience techniques could unravel the mechanisms and neurocircuitry involved in the analgesic effects of DBS and help to optimize this therapy.
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Affiliation(s)
- Rosana L. Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Camila S. Dale
- Laboratory of Neuromodulation and Experimental Pain, Department of Anatomy, University of São Paulo, São Paulo, Brazil
| | | | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Toronto, ON, Canada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada,Correspondence: Clement Hamani
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Zhang T, Liang H, Wang Z, Qiu C, Peng YB, Zhu X, Li J, Ge X, Xu J, Huang X, Tong J, Ou-Yang J, Yang X, Li F, Zhu B. Piezoelectric ultrasound energy-harvesting device for deep brain stimulation and analgesia applications. SCIENCE ADVANCES 2022; 8:eabk0159. [PMID: 35427156 PMCID: PMC9012468 DOI: 10.1126/sciadv.abk0159] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Supplying wireless power is a challenging technical problem of great importance for implantable biomedical devices. Here, we introduce a novel implantable piezoelectric ultrasound energy-harvesting device based on Sm-doped Pb(Mg1/3Nb2/3)O3-PbTiO3 (Sm-PMN-PT) single crystal. The output power density of this device can reach up to 1.1 W/cm2 in vitro, which is 18 times higher than the previous record (60 mW/cm2). After being implanted in the rat brain, under 1-MHz ultrasound with a safe intensity of 212 mW/cm2, the as-developed device can produce an instantaneous effective output power of 280 μW, which can immediately activate the periaqueductal gray brain area. The rat electrophysiological experiments under anesthesia and behavioral experiments demonstrate that our wireless-powered device is well qualified for deep brain stimulation and analgesia applications. These encouraging results provide new insights into the development of implantable devices in the future.
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Affiliation(s)
- Tao Zhang
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Huageng Liang
- Department of Urology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhen Wang
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Chaorui Qiu
- Electronic Materials Research Lab, Key Lab of Education Ministry/International Center for Dielectric Research, School of Electronic and Information Engineering, State Key Laboratory for Mechanical Behavior of Materials, Xi’an Jiaotong University, Xi’an 710049, China
| | - Yuan Bo Peng
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Xinyu Zhu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Jiapu Li
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xu Ge
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Jianbo Xu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xian Huang
- Department of Urology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Junwei Tong
- Department of Urology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Ou-Yang
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xiaofei Yang
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Fei Li
- Electronic Materials Research Lab, Key Lab of Education Ministry/International Center for Dielectric Research, School of Electronic and Information Engineering, State Key Laboratory for Mechanical Behavior of Materials, Xi’an Jiaotong University, Xi’an 710049, China
| | - Benpeng Zhu
- School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China
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Zhang T, Wang Z, Liang H, Wu Z, Li J, Ou-Yang J, Yang X, Peng YB, Zhu B. Transcranial Focused Ultrasound Stimulation of Periaqueductal Gray for Analgesia. IEEE Trans Biomed Eng 2022; 69:3155-3162. [PMID: 35324431 DOI: 10.1109/tbme.2022.3162073] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Transcranial focused ultrasound (tFUS) is regarded as a promising non-invasive stimulation tool for modulating brain circuits. The aim of this study is to explore the feasibility of tFUS stimulation for analgesia application. METHODS 50 l of 3% formalin solution was injected into the rats left hindpaw to build a pain model, and then the local field potential (LFP) activities of the dorsal horn were tracked after a recording electrode was placed in the spinal cord. Rats were randomly divided into two groups: control group and tFUS group. At the 30th minute after formalin injection, tFUS (US-650 kHz, PD = 1 ms, PRF = 100 Hz, 691 mW/cm2) was conducted to stimulate the periaqueductal gray (PAG) for 5 minutes (on 5 s and off 5 s) in tFUS group, but there was no treatment in control group. In addition, the analgesia mechanism (LFP recording from the PAG) and safety assessment (histology analysis) were carried out. RESULTS The tFUS stimulation of the PAG can suppress effectively the nociceptive activity generated by formalin. The findings of the underlying mechanism exploration indicated that the tFUS stimulation was able to activate the PAG directly without causing significant temperature change and tissue injury. CONCLUSION The results illustrated that the tFUS stimulation of the PAG can achieve the effect of analgesia. SIGNIFICANCE This work provides new insights for the development of non-invasive analgesic technology in the future.
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Ram A, Edwards T, McCarty A, Afrose L, McDermott MV, Bobeck EN. GPR171 Agonist Reduces Chronic Neuropathic and Inflammatory Pain in Male, But Not Female Mice. FRONTIERS IN PAIN RESEARCH 2021; 2:695396. [PMID: 35295419 PMCID: PMC8915562 DOI: 10.3389/fpain.2021.695396] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/17/2021] [Indexed: 12/22/2022] Open
Abstract
Chronic pain is a growing public health crisis that requires exigent and efficacious therapeutics. GPR171 is a promising therapeutic target that is widely expressed through the brain, including within the descending pain modulatory regions. Here, we explore the therapeutic potential of the GPR171 agonist, MS15203, in its ability to alleviate chronic pain in male and female mice using a once-daily systemic dose (10 mg/kg, i.p.) of MS15203 over the course of 5 days. We found that in our models of Complete Freund's Adjuvant (CFA)-induced inflammatory pain and chemotherapy-induced peripheral neuropathy (CIPN), MS15203 did not alleviate thermal hypersensitivity and allodynia, respectively, in female mice. On the other hand, MS15203 treatment decreased the duration of thermal hypersensitivity in CFA-treated male mice following 3 days of once-daily administration. MS15203 treatment also produced an improvement in allodynia in male mice, but not female mice, in neuropathic pain after 5 days of treatment. Gene expression of GPR171 and that of its endogenous ligand BigLEN, encoded by the gene PCSK1N, were unaltered within the periaqueductal gray (PAG) in both male and female mice following inflammatory and neuropathic pain. However, following neuropathic pain in male mice, the protein levels of GPR171 were decreased in the PAG. Treatment with MS15203 then rescued the protein levels of GPR171 in the PAG of these mice. Taken together, our results identify GPR171 as a GPCR that displays sexual dimorphism in alleviation of chronic pain. Further, our results suggest that GPR171 and MS15203 have demonstrable therapeutic potential in the treatment of chronic pain.
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Affiliation(s)
- Akila Ram
- Department of Biology, Utah State University, Logan, UT, United States
| | - Taylor Edwards
- Department of Biology, Utah State University, Logan, UT, United States
| | - Ashley McCarty
- Department of Biology, Utah State University, Logan, UT, United States
| | - Leela Afrose
- Department of Biology, Utah State University, Logan, UT, United States
| | - Max V. McDermott
- Department of Biology, Utah State University, Logan, UT, United States
- Interdisciplinary Neuroscience Program, Utah State University, Logan, UT, United States
| | - Erin N. Bobeck
- Department of Biology, Utah State University, Logan, UT, United States
- Interdisciplinary Neuroscience Program, Utah State University, Logan, UT, United States
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8
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Vo L, Drummond PD. Analgesia to pressure–pain develops in the ipsilateral forehead after high- and low-frequency electrical stimulation of the forearm. Exp Brain Res 2013; 232:685-93. [DOI: 10.1007/s00221-013-3776-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/10/2013] [Indexed: 12/13/2022]
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9
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Reduction of Pain Behavior by Stimulation of the Basolateral Amygdalar Nuclei in Freely Moving Rats. NEUROPHYSIOLOGY+ 2012. [DOI: 10.1007/s11062-012-9310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Periaqueductal gray stimulation suppresses spontaneous pain behavior in rats. Neurosci Lett 2012; 514:42-5. [DOI: 10.1016/j.neulet.2012.02.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 11/17/2022]
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11
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Kim HY, Wang J, Lee I, Kim HK, Chung K, Chung JM. Electroacupuncture suppresses capsaicin-induced secondary hyperalgesia through an endogenous spinal opioid mechanism. Pain 2009; 145:332-340. [PMID: 19646817 PMCID: PMC2762198 DOI: 10.1016/j.pain.2009.06.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 12/14/2022]
Abstract
Central sensitization, caused either by tissue inflammation or peripheral nerve injury, plays an important role in persistent pain. An animal model of capsaicin-induced pain has well-defined peripheral and central sensitization components, thus is useful for studying the analgesic effect on two separate components. The focus of this study is to examine the analgesic effects of electroacupuncture (EA) on capsaicin-induced secondary hyperalgesia, which represents central sensitization. Capsaicin (0.1%, 20 microl) was injected into the plantar side of the left hind paw, and foot withdrawal thresholds in response to von Frey stimuli (mechanical sensitivity) were determined for both primary and secondary hyperalgesia in rats. EA (2 Hz, 3 mA) was applied to various pairs of acupoints, GB30-GB34, BL40-BL60, GV2-GV6, LI3-LI6 and SI3-TE8, for 30 min under isoflurane anesthesia and then the effect of EA on mechanical sensitivity of paw was determined. EA applied to the ipsilateral SI3-TE8, but to none of the other acupoints, significantly reduced capsaicin-induced secondary hyperalgesia but not primary hyperalgesia. EA analgesic effect was inhibited by a systemic non-specific opioid receptor (OR) antagonist or an intrathecal mu- or delta-OR antagonist. EA analgesic effect was not affected by an intrathecal kappa-OR antagonist or systemic adrenergic receptor antagonist. This study demonstrates that EA produces a stimulation point-specific analgesic effect on capsaicin-induced secondary hyperalgesia (central sensitization), mediated by activating endogenous spinal mu- and delta-opioid receptors.
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Affiliation(s)
- Hee Young Kim
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
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12
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Pertovaara A, Almeida A. Chapter 13 Descending inhibitory systems. HANDBOOK OF CLINICAL NEUROLOGY 2006; 81:179-192. [PMID: 18808835 DOI: 10.1016/s0072-9752(06)80017-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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13
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Finn DP, Jhaveri MD, Beckett SRG, Roe CH, Kendall DA, Marsden CA, Chapman V. Effects of direct periaqueductal grey administration of a cannabinoid receptor agonist on nociceptive and aversive responses in rats. Neuropharmacology 2003; 45:594-604. [PMID: 12941373 DOI: 10.1016/s0028-3908(03)00235-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The analgesic potential of cannabinoids may be hampered by their ability to produce aversive emotion when administered systemically. We investigated the hypothesis that the midbrain periaqueductal grey (PAG) is a common substrate mediating the anti-nociceptive and potential aversive effects of cannabinoids. The rat formalin test was used to model nociceptive behaviour. Intra-PAG microinjection of the excitatory amino acid D,L-homocysteic acid (DLH) was used to induce an aversive, panic-like reaction characteristic of the defensive "fight or flight" response. Administration of the cannabinoid receptor agonist HU210 (5 microg/rat) into the dorsal PAG significantly reduced the second phase of formalin-evoked nociceptive behaviour, an effect which was blocked by co-administration of the CB(1) receptor antagonist SR141716A (50 microg/rat). This anti-nociceptive effect was accompanied by an HU210-induced attenuation of the formalin-evoked increase in Fos protein expression in the caudal lateral PAG. Intra-dorsal PAG administration of HU210 (0.1, 1 or 5 microg/rat) significantly reduced the aversive DLH-induced explosive locomotor response. The anti-nociceptive effect of HU210 is likely to result from activation of the descending inhibitory pain pathway. Mechanisms mediating the anti-aversive effects of cannabinoids in the PAG remain to be elucidated. These data implicate a role for the PAG in both cannabinoid-mediated anti-nociceptive and anti-aversive responses.
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Affiliation(s)
- D P Finn
- Institute of Neuroscience, School of Biomedical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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14
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Goadsby PJ. Neurovascular headache and a midbrain vascular malformation: evidence for a role of the brainstem in chronic migraine. Cephalalgia 2002; 22:107-11. [PMID: 11972577 DOI: 10.1046/j.1468-2982.2002.00323.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Migraine is a common, disabling form of primary headache that has been linked by functional imaging studies to activation in the rostral brainstem. In specialty clinics migraine is most commonly seen in association with frequent less feature full headache that has been called transformed migraine or more recently termed chronic migraine. A patient is described with frequent migraine, 3 days per week, and less feature full headaches on other days. The patient has a cavernoma in the midbrain that has bled. She was previously headache free and now has contralateral daily headache. The patient supports the functional imaging observations from positron emission tomography (PET) that the rostral brainstem is pivotal in migraine pathophysiology, particularly the contralateral midbrain periaqueductal grey matter. Moreover, the patient's lesion provides biologically plausible support that a single entity causes her clinical presentation: chronic migraine, not two-disorders, migraine and tension-type headache.
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Affiliation(s)
- P J Goadsby
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
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15
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Knight YE, Goadsby PJ. The periaqueductal grey matter modulates trigeminovascular input: a role in migraine? Neuroscience 2002; 106:793-800. [PMID: 11682164 DOI: 10.1016/s0306-4522(01)00303-7] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The periaqueductal grey (PAG) region of the brainstem is a known modulator of somatic pain transmission. Migraine is likely to be due to episodic brain dysfunction in pathways involved in the control of pain and other sensory modalities, such as light and sound. To investigate the influence of the PAG on pain transmission from intracranial structures, we examined spinal trigeminal neuronal activity in response to PAG stimulation in a model of trigeminovascular nociception in the cat. Evoked trigeminal neuronal activity in the spinal cord was reversibly inhibited by stimulation of the PAG. The effect was robust with a mean reduction in evoked activity of -61+/-21%. This effect could be seen both ipsilateral and contralateral to the side of PAG stimulation and was well localised to the ventrolateral PAG. These data demonstrate that a role of the PAG is to inhibit afferent trigeminal nociceptive traffic. Considered with neurosurgical and human functional imaging studies, these data support the notion that brainstem dysfunction might lead to disinhibition of trigeminal afferents and be important in the pain process of migraines.
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Affiliation(s)
- Y E Knight
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK
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16
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Danziger N, Weil-Fugazza J, Le Bars D, Bouhassira D. Stage-dependent changes in the modulation of spinal nociceptive neuronal activity during the course of inflammation. Eur J Neurosci 2001; 13:230-40. [PMID: 11168527 DOI: 10.1046/j.0953-816x.2000.01375.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Spinal and supraspinal controls can tonically or phasically modulate the output of spinal nociceptive neurons. Alterations of these modulatory systems have been described during the acute stage of inflammation. In the present study in the rat, tonic descending controls were assessed during acute (24--48 h) and chronic (3--4 weeks) stages of monoarthritis of the ankle. The electrophysiological properties of spinal convergent neurons with ankle input were compared before and after spinalization. In a parallel series of experiments, spinal convergent neurons were recorded from the normal side in order to assess the propriospinal and supraspinal inhibitory controls triggered by nociceptive stimulation of the inflamed ankle. Tonic descending inhibition of convergent neurons with input from the inflamed ankle was enhanced during the acute stage and then decreased during the chronic stage of monoarthritis. Contralateral-induced inhibitions exhibited a similar temporal evolution. Time-dependent changes in the spinal transmission of nociceptive signals were shown by removing descending modulation in animals with monoarthritis; sensitization of spinal neurons with input from the inflamed ankle was demonstrated during the acute stage of monoarthritis, whereas a crossed transmission between inflamed and normal sides was observed during the chronic stage of the disease. These results show that dynamic and stage-dependent modifications of descending controls tend to dampen the central changes associated with inflammation.
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Affiliation(s)
- N Danziger
- INSERM U-161, 2 rue d'Alésia, 75014 Paris, France
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17
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HOSKIN KARENL, BULMER DAVIDCE, LASALANDRA MICHELE, JONKMAN ANJA, GOADSBY PETERJ. Fos expression in the midbrain periaqueductal grey after trigeminovascular stimulation. J Anat 2001; 198:29-35. [PMID: 11215764 PMCID: PMC1468188 DOI: 10.1046/j.1469-7580.2001.19810029.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is an accumulating body of evidence suggesting that the periaqueductal grey (PAG) is involved in the pathophysiology of migraine. Positron emission tomography (PET) studies in humans have shown that the caudal ventrolateral midbrain, encompassing the ventrolateral PAG, has activations during migraine attacks. The PAG may well be involved not only through the descending modulation of nociceptive afferent information, but also by its ascending projections to the pain processing centres of the thalamus. In this study the intranuclear oncogene protein Fos was used to mark cell activation in the PAG following stimulation of the trigeminally-innervated superior sagittal sinus (SSS) in both cats and in nonhuman primates (Macaca nemestrina). Fos expression in the PAG increased following stimulation to a median of 242 cells (interquartile range 236-272) in the cat and 155 cells (range 104-203) in the monkey, compared with control levels of 35 cells (21-50) and 26 cells (18-33), respectively. Activation was predominantly in the ventrolateral area of the caudal PAG suggesting that the PAG is involved following trigeminally-evoked craniovascular pain.
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Affiliation(s)
- KAREN L.
HOSKIN
- Department of Clinical Neurology, Institute of Neurology, London
| | | | | | - ANJA JONKMAN
- Faculty of Medical Sciences, University Hospital, Groningen, The Netherlands
| | - PETER J.
GOADSBY
- Department of Clinical Neurology, Institute of Neurology, London
- Correspondence to Professor Peter J. Goadsby, Institute of Neurology, Queen Square, London WCIN 3BG, UK. Fax: +44 20 7813 0349; e-mail:
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18
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Lee BH, Park SH, Won R, Park YG, Sohn JH. Antiallodynic effects produced by stimulation of the periaqueductal gray matter in a rat model of neuropathic pain. Neurosci Lett 2000; 291:29-32. [PMID: 10962146 DOI: 10.1016/s0304-3940(00)01375-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It has been well documented that there is opioid resistance in neuropathic pain. This indicates that the endogenous opioid system may not be involved effectively in modulating neuropathic pain. The present study sought to determine if activation of the descending pain inhibition system might produce analgesia in the animal neuropathic model we developed. Under ketamine anesthesia, male Sprague-Dawley rats were chronically implanted with stimulating electrodes in the ventral periaqueductal gray matter (PAG) and both the tibial and sural nerves of the sciatic nerve branches were severed. Pain sensitivity was measured with a von Frey filament and acetone applied to the sensitive area for 1 week postoperatively. Rats with neuropathic pain syndrome after transection of the tibial and sural nerves were tested as to the analgesic effects of ventral PAG stimulation for an additional two weeks. Electrical stimulation of the ventral PAG turned out to be highly effective in alleviating neuropathic pain. Mechanical allodynia and cold allodynia were reduced by PAG stimulation. Naloxone reversed the antiallodynic effects of ventral PAG stimulation. These results suggest that activation of the descending pain inhibition system including the ventral PAG reduces neuropathic pain syndrome and that opiates are involved in this system.
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Affiliation(s)
- B H Lee
- Medical Research Center, Yonsei University College of Medicine, CPO Box 8044, 120-752, Seoul, South Korea
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19
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Morgan MM. Paradoxical inhibition of nociceptive neurons in the dorsal horn of the rat spinal cord during a nociceptive hindlimb reflex. Neuroscience 1999; 88:489-98. [PMID: 10197769 DOI: 10.1016/s0306-4522(98)00238-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nociceptive-specific and multireceptive neurons in the lumbar dorsal horn are excited by noxious stimuli applied to the hindpaw and inhibited by noxious stimuli applied to distant body regions. Given that at least a subset of these neurons are part of the circuit for nociceptive reflexes, inhibition of nociceptive-specific and multireceptive neurons should inhibit nociceptive reflexes. Unfortunately, previous attempts to test this hypothesis have been inconclusive because of methodological differences between electrophysiological and behavioral experiments. The present study overcame this problem by recording neural and reflex activity simultaneously. Rats were anesthetized with halothane and surgically prepared for single-unit recording from the lumbar dorsal horn. Hindpaw heat caused a burst of activity that reliably preceded hindpaw withdrawal in 10 nociceptive-specific and 17 multireceptive neurons. A distant noxious stimulus (tail in 50 degrees C water or ear pinch) inhibited the evoked activity of both nociceptive-specific and multireceptive neurons and simultaneously changed the topography of the hindpaw reflex from flexion to extension without altering reflex latency. The present data are consistent with previous reports of inhibition of nociceptive-specific and multireceptive neurons during application of a distant noxious stimulus. However, inhibition of nociceptive-specific and multireceptive neurons concomitant with a shift in the hindlimb reflex from flexion to extension suggests that these neurons are part of the circuit for flexor reflexes specifically. Presumably, lateral inhibition from the flexor to extensor circuit allows for the release of hindlimb extension when neurons in the flexion circuit are inhibited by a distant noxious stimulus. Such a system reduces the chance of injury by allowing for withdrawal reflexes to a single noxious stimulus and escape reactions, such as running and jumping, to multiple noxious stimuli.
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Affiliation(s)
- M M Morgan
- Department of Psychology, Washington State University, Vancouver 98686, USA
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20
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Pertovaara A, Kontinen VK, Kalso EA. Chronic spinal nerve ligation induces changes in response characteristics of nociceptive spinal dorsal horn neurons and in their descending regulation originating in the periaqueductal gray in the rat. Exp Neurol 1997; 147:428-36. [PMID: 9344567 DOI: 10.1006/exnr.1997.6555] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied whether a chronic neuropathy induced by unilateral spinal nerve ligation changes the response characteristics of spinal dorsal horn wide-dynamic range (WDR) neurons or their periaqueductal gray (PAG)-induced descending modulation. Experiments were performed in rats with behaviorally demonstrated allodynia induced by spinal nerve ligation and in a group of nonneuropathic control rats. The stimulus-response functions of WDR neurons for mechanical and thermal stimuli and the modulation of their peripherally evoked responses by electrical stimulation of the PAG were determined under pentobarbital anesthesia. The results showed that neuropathy caused a significant leftward shift in stimulus-response functions for mechanical stimuli. In contrast, stimulus-response functions for noxious heat stimuli in the neuropathic limb were, if anything, shifted rightward, although this shift was short of statistical significance. In neuropathic rats, PAG stimulation produced a significantly stronger attenuation of spinal neuronal responses induced by noxious heat in the unoperated than in the operated side. At the intensity that produced attenuation of noxious heat stimuli, PAG stimulation did not produce any significant change in spinal neuronal responses evoked by mechanical stimuli either from the operated or the nonoperated hindlimb of the neuropathic rats. Spontaneous activity of WDR neurons was higher in the operated side of neuropathic rats than in control rats. Afterdischarges evoked by peripheral stimuli were observed in 1/16 of the WDR neurons ipsilateral to spinal nerve ligation and not at all in other experimental groups. The WDR neurons studied were not activated by innocuous or noxious cold stimuli. The results indicate that spinal nerve ligation induces increased spontaneous activity and enhanced responses to mechanical stimuli in the spinal dorsal horn WDR neurons, whereas noxious heat-evoked responses are not significantly changed or if anything, attenuated. Moreover, the inhibition of noxious heat stimuli by PAG stimulation is attenuated in the neuropathic side. It is proposed that the observed changes in the response characteristics of the spinal dorsal horn WDR neurons and in their descending modulation may contribute to the neuropathic symptoms in these animals.
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Affiliation(s)
- A Pertovaara
- Department of Physiology, University of Helsinki, Finland
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21
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Keay KA, Crowfoot LJ, Floyd NS, Henderson LA, Christie MJ, Bandler R. Cardiovascular effects of microinjections of opioid agonists into the 'Depressor Region' of the ventrolateral periaqueductal gray region. Brain Res 1997; 762:61-71. [PMID: 9262159 DOI: 10.1016/s0006-8993(97)00285-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Microinjections of excitatory amino acids made into the ventrolateral midbrain periaqueductal gray of the rat have revealed that neurons in this region integrate a reaction characterised by quiescence, hyporeactivity, hypotension and bradycardia. Microinjections of both excitatory amino acids and opioids into the ventrolateral periaqueductal gray have shown also that it is a key central site mediating analgesia. The effects of injections of opioids into the ventrolateral periaqueductal gray on arterial pressure and heart rate or behaviour are unknown. In this study we first mapped in the rat the extent of the ventrolateral periaqueductal gray hypotensive region as revealed by microinjections of excitatory amino acids. We found that ventrolateral periaqueductal gray depressor region extended more rostrally than previously thought into the tegmentum ventrolateral to the periaqueductal gray. Subsequently we studied for the first time, the effects of microinjections of mu-, delta-, and kappa-opioid agonists made into the ventrolateral periaqueductal grey depressor region. In contrast to the effects of excitatory amino acid injections, microinjections of the mu-opioid agonist ([D-Ala2,N-Me-Phe4,Gly-ol5]enkephalin) evoked hypertension and tachycardia at approximately 50% of sites. Similar to excitatory amino acid injections, microinjections of both the delta-opioid agonist ([D-Pen2,D-Pen5]enkephalin), and the kappa-opioid agonist ((5,7,8)-(+)-N-Methyl-N-[7-(1-pyrrolidinyl)-1-oxaspiro[4.5]dec-8-y l]-benzeneacetamide) evoked either a hypotension and bradycardia, or had no effect. These results indicate that different opiate receptor subtypes are present on a distinct population of ventrolateral periaqueductal gray neurons, or at different ventrolateral periaqueductal gray synaptic locations (pre- or post-synaptic).
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MESH Headings
- Analgesics/pharmacology
- Animals
- Benzeneacetamides
- Blood Pressure/drug effects
- Bradycardia/physiopathology
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-
- Enkephalin, D-Penicillamine (2,5)-
- Enkephalins/pharmacology
- Excitatory Amino Acids/pharmacology
- Heart Rate/drug effects
- Homocysteine/analogs & derivatives
- Homocysteine/pharmacology
- Hypertension/physiopathology
- Hypotension/physiopathology
- Male
- Microinjections
- Neural Inhibition/drug effects
- Neural Inhibition/physiology
- Pain/drug therapy
- Pain/physiopathology
- Periaqueductal Gray/chemistry
- Periaqueductal Gray/physiology
- Pyrrolidines/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Opioid/agonists
- Receptors, Opioid, delta/agonists
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, mu/agonists
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Affiliation(s)
- K A Keay
- Department of Anatomy and Histology and Institute for Biomedical Research, The University of Sydney, NSW, Australia.
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22
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Abstract
Hyperexcitable reflex blinks are a cardinal sign of Parkinson's disease. The first step in the circuit linking the basal ganglia and brainstem reflex blink circuits is the inhibitory nigrostriatal pathway (Basso et al., 1996). The current study reports the circuits linking the superior colliculus (SC) to trigeminal reflex blink circuits. Microstimulation of the deep layers of the SC suppresses subsequent reflex blinks at a latency of 5.4 msec. This microstimulation does not activate periaqueductal gray antinociceptive circuits. The brainstem structure linking SC to reflex blink circuits must suppress reflex blinks at a shorter latency than the SC and produce the same effect on reflex blink circuits as SC stimulation, and removal of the structure must block SC modulation of reflex blinks. Only the nucleus raphe magnus (NRM) meets these requirements. NRM microstimulation suppresses reflex blinks with a latency of 4.4 msec. Like SC stimulation, NRM microstimulation reduces the responsiveness of the spinal trigeminal nucleus. Finally, blocking the receptors for the NRM transmitter serotonin eliminates SC modulation of reflex blinks, and muscimol inactivation of the NRM transiently prevents SC modulation of reflex blinks. Thus, the circuit through which the basal ganglia modulates reflex blinking is (1) the substantia nigra pars reticulata inhibits SC neurons, (2) the SC excites tonically active NRM neurons, and (3) NRM neurons inhibit spinal trigeminal neurons involved in reflex blink circuits.
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Mouton LJ, Holstege G. The periaqueductal gray in the cat projects to lamina VIII and the medial part of lamina VII throughout the length of the spinal cord. Exp Brain Res 1994; 101:253-64. [PMID: 7531157 DOI: 10.1007/bf00228745] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The periaqueductal gray (PAG) plays an important role in analgesia as well as in motor activities, such as vocalization, cardiovascular changes, and movements of the neck, back, and hind limbs. Although the anatomical pathways for vocalization and cardiovascular control are rather well understood, this is not the case for the pathways controlling the neck, back, and hind limb movements. This led us to study the direct projections from the PAG to the spinal cord in the cat. In a retrograde tracing study horseradish peroxidase (HRP) was injected into different spinal levels, which resulted in large HRP-labeled neurons in the lateral and ventrolateral PAG and the adjacent mesencephalic tegmentum. Even after an injection in the S2 spinal segment a few of these large neurons were found in the PAG. Wheat germ agglutinin-conjugated HRP injections in the ventrolateral and lateral PAG resulted in anterogradely labeled fibers descending through the ventromedial, ventral, and lateral funiculi. These fibers terminated in lamina VIII and the medial part of lamina VII of the caudal cervical, thoracic, lumbar, and sacral spinal cord. Interneurons in these laminae have been demonstrated to project to axial and proximal muscle motoneurons. The strongest PAG-spinal projections were to the upper cervical cord, where the fibers terminated in the lateral parts of the intermediate zone (laminae V, VII, and the dorsal part of lamina VIII). These laminae contain the premotor interneurons of the neck muscles. This distribution pattern suggests that the PAG-spinal pathway is involved in the control of neck and back movements. Comparing the location of the PAG-spinal neurons with the results of stimulation experiments leads to the supposition that the PAG-spinal neurons play a role in the control of the axial musculature during threat display.
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Affiliation(s)
- L J Mouton
- Department of Anatomy and Embryology, Faculty of Medicine, Rijksuniversiteit Groningen, The Netherlands
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Barbaresi P, Minelli A, Gazzanelli G, Malatesta M. Commissural connections of the cat periaqueductal gray matter studied with anterograde and retrograde tract-tracing techniques. Neuroscience 1994; 60:781-99. [PMID: 7523986 DOI: 10.1016/0306-4522(94)90504-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The commissural connections of the periaqueductal gray matter were investigated by light and electron microscopy by using the anterograde tracer Phaseolus vulgaris leucoagglutinin and the retrograde tracer horseradish peroxidase. In the first group of seven animals (1-7), single injections of Phaseolus vulgaris leucoagglutinin were performed iontophoretically (4.5 microA for 30 min) into various subdivisions of the periaqueductal gray matter. On light microscopic examination, injection sites were characterized by several immunolabeled neurons of different sizes and morphology, with the cytoplasm, nucleus and neuronal processes intensely stained. Many labeled fibers turned from injection sites toward all contralateral periaqueductal gray matter subdivisions, but anterograde labeling was densest in the regions homotopic to those injected. Commissural fibers bore along their course many en passant boutons of different sizes and morphology, and gave off spine-like processes, at the end of which one terminal bouton was observed. Labeled fibers branched into numerous collaterals which ended in a terminal array of 10-20 en passant and en grappe boutons. At the electron microscopic level, commissural axons were observed in close proximity to the cytoplasmic membranes of cells. Axon terminals formed symmetric or asymmetric synapses mainly on dendritic shafts of neurons and rarely on vesicle-containing profiles. Horseradish peroxidase experiments were carried out in four cats (1-4). The tracer was injected iontophoretically into different regions of the periaqueductal gray matter of three cats (1-3). Retrogradely labeled neurons giving rise to commissural connections had a morphology similar to that of polygonal, triangular and fusiform cells described in previous Golgi studies. The perikaryal cross-sectional area of commissural neurons was smaller than that of neurons projecting outside the periaqueductal gray matter (mean value of commissural neurons 149.77 microns 2 vs 261.19 microns 2 for projecting neurons), which were retrogradely labeled by pressure-injecting horseradish peroxidase into several targets of periaqueductal gray matter (4). Moreover, since the distribution of sizes of the two populations of the periaqueductal gray matter overlapped in the range of 90-300 microns 2, a considerable number of projecting neurons were as small as commissural neurons. The present results suggest that commissural fibers could reciprocally connect zones of the periaqueductal gray matter with similar functions, and originate from small and medium-sized neurons, some of which are also projecting neurons.
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Affiliation(s)
- P Barbaresi
- Institute of Human Physiology, University of Ancona, Italy
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25
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Dennis BJ, Meller ST. Investigations on the periaqueductal gray (PAG) of the rabbit: with consideration of experimental procedures and functional roles of the PAG. Prog Neurobiol 1993; 41:403-34. [PMID: 7692466 DOI: 10.1016/0301-0082(93)90025-n] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B J Dennis
- Department of Physiology, University of Adelaide, Australia
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