Postsynaptic alpha 1- and alpha 2-adrenoceptors mediating the action of the sympathetic system on muscle spindles, in the rabbit

The Role of the Autonomic Nervous System in Headache: Biomarkers and Treatment

Purpose of Review

In this review, the role of the autonomic nervous system in tension-type headache and migraine is reviewed.

Recent Findings

A pathophysiological model for tension-type headache is proposed that is compatible with most physiological and behavioral literature.

Summary

A treatment protocol is described that follows from this model. For migraine, incorporating autonomic factors into the pathophysiology offers rationales for behavioral interventions that have been shown to be useful in migraine treatment and a biofeedback protocol is proposed.

α1 adrenergic receptor activation has a dynamic effect on masticatory muscle afferent fibers

Temporomandibular Disorder (TMD) patients report amplification of pain in the masticatory muscles after psychological trauma or stressful conditions. The mechanisms underlying this phenomenon are yet to be elucidated. This study combined immunohistochemistry with single cell in vivo electrophysiology recordings of masticatory muscle afferent fibers to investigate the role of α₁-adrenergic receptors in muscle nociception. It was found that a subset of trigeminal afferent fibers which innervate the masseter and temporal muscles expressed α_1a, α_1b and α_1d receptors, including a smaller number of putative nociceptors which co-expressed TrpV₁ receptors. Local injection of the selective α₁ adrenergic receptor agonist phenylephrine into masticatory muscle decreased and increased the mechanical activation threshold of slow and fast conducting afferent fibers, respectively. This effect was reversed by co-administration of the α₁ selective antagonist terazosin. To rule out the possibility that local ischemia was responsible for the observed effect of phenylephrine on masticatory muscle afferent fibers, additional experiments were conducted where blood flow to the masticatory muscle was reduced by common carotid artery occlusion. This investigation found that muscle blood flow occlusion increased the mechanical activation threshold of the majority of masticatory muscle afferent fibers unrelated to conduction velocity. These findings suggest that under conditions of increased sympathetic tone, such as those related to stress, noradrenaline may sensitize masticatory muscle nociceptors to increase pain and desensitize muscle proprioceptors to alter muscle tone, through activation of α₁ receptors.

Large-dose epinephrine reduces skeletal muscle blood flow under general anesthesia in rabbits

The goal of this study was to investigate the effect of an epinephrine continuous infusion on muscle blood flow in rabbits. Sixteen male Japan White rabbits were randomly allocated to 1 of 2 groups: epinephrine continuous infusion at 0.01 μg/kg/min (Ep-0.01 group, n = 8) and at 0.1 μg/kg/ min (Ep-0.1 group, n = 8). The observed variables were heart rate, femoral artery blood pressure, common carotid artery blood flow (CCBF), masseter muscle blood flow (MBF), and quadriceps muscle blood flow (QBF). In the Ep-0.01 group, CCBF, MBF, and QBF were increased by 14, 22, and 21% from respective control values. In contrast, in the Ep-0.1 group, CCBF, MBF and QBF were decreased by 10, 30, and 27% from respective control values. There were no differences in the percentage change between MBF and QBF during epinephrine continuous infusion. Positive correlations were observed between CCBF and MBF and between CCBF and QBF. In conclusion, skeletal muscle blood flow was increased during the small-dose epinephrine infusion, whereas it was decreased during large-dose infusion.

Immunohistochemical localization of alpha(1a)-adrenoreceptors in muscle spindles of rabbit masseter muscle

The expression of alpha(1a)-adrenoreceptors (alpha(1a)-ARs) within the muscle spindles of rabbit masseter muscle was investigated. The alpha(1a)-ARs were detected by immunohistochemical fluorescent method and examined along the entire length of 109 cross serially sectioned spindles. The sympathetic fibers were visualized by the immunofluorescent labeling of the noradrenaline synthesizing enzymes tyrosine hydroxylase (TH) and dopamine beta-hydroxylase (DBH). In order to recognize the intrafusal muscle fiber types, antibodies for different myosin heavy chain isoforms (MyHCI) were used. TH and DBH immunolabeled nerve fibers have been observed within the capsule lamellar layers, in the periaxial fluid space and close to intrafusal muscle fibers. The alpha(1a)-ARs were detected on the smooth muscle cells of the blood vessels coursing in the muscle and in the capsule lamellar layers or within the periaxial fluid space of the spindles. Moreover, at the polar regions of a high percentage (88.1%) of muscle spindles a strong alpha(1a)-ARs immunoreactivity was present on the intrafusal muscle fibers. In double immunostained sections for alpha(1a)-ARs and MyHCI it was evidenced that both bag, and nuclear chain fibers express alpha(1a)-ARs. The receptors that we have detected by immunofluorescence may support a direct control by adrenergic fibers on muscle spindle.

Lumbar position sense acuity during an electrical shock stressor

BACKGROUND

Optimal motor control of the spine depends on proprioceptive input as a prerequisite for co-ordination and the stability of the spine. Muscle spindles are known to play an important role in proprioception. Animal experiments suggest that an increase in sympathetic outflow can depress muscle spindle sensitivity. As the muscle spindle may be influenced by sympathetic modulation, we hypothesized that a state of high sympathetic activity as during mental stress would affect the proprioceptive output from the muscle spindles in the back muscles leading to alterations in proprioception and position sense acuity. The aim was to investigate the effect of mental stress, in this study the response to an electrical shock stressor, on position sense acuity in the rotational axis of the lumbar spine.

METHODS

Passive and active position sense acuity in the rotational plane of the lumbar spine was investigated in the presence and absence of an electrical shock stressor in 14 healthy participants. An electrical shock-threat stressor lasting for approximately 12 minutes was used as imposed stressor to build up a strong anticipatory arousal: The participants were told that they were going to receive 8 painful electrical shocks however the participants never received the shocks. To quantify the level of physiological arousal and the level of sympathetic outflow continuous beat-to-beat changes in heart rate (beats x min(-1)) and systolic, diastolic and mean arterial blood pressure (mmHg) were measured. To quantify position sense acuity absolute error (AE) expressed in degrees was measured. Two-way analysis of variance with repeated measurements (subjects as random factor and treatments as fixed factors) was used to compare the different treatments.

RESULTS

Significant increases were observed in systolic blood pressure, diastolic blood pressure, and heart rate during the stress sessions indicating elevated sympathetic activity (15, 14 and 10%, respectively). Despite pronounced changes in the sympathetic activity and subjective experiences of stress no changes were found in position sense acuity in the rotational plane of the lumbar spine in the presence of the electrical shock stressor compared to the control period.

CONCLUSION

The present findings indicate that position sense acuity in the rotational plane of the spine was unaffected by the electrical shock stressor.

Sympathetic outflow enhances the stretch reflex response in the relaxed soleus muscle in humans

Animal experiments suggest that an increase in sympathetic outflow can depress muscle spindle sensitivity and thus modulate the stretch reflex response. The results are, however, controversial, and human studies have failed to demonstrate a direct influence of the sympathetic nervous system on the sensitivity of muscle spindles. We studied the effect of increased sympathetic outflow on the short-latency stretch reflex in the soleus muscle evoked by tapping the Achilles tendon. Nine subjects performed three maneuvers causing a sustained activation of sympathetic outflow to the leg: 3 min of static handgrip exercise at 30% of maximal voluntary contraction, followed by 3 min of posthandgrip ischemia, and finally during a 3-min mental arithmetic task. Electromyography was measured from the soleus muscle with bipolar surface electrodes during the Achilles tendon tapping, and beat-to-beat changes in heart rate and mean arterial blood pressure were monitored continuously. Mean arterial pressure was significantly elevated during all three maneuvers, whereas heart rate was significantly elevated during static handgrip exercise and mental arithmetic but not during posthandgrip ischemia. The peak-to-peak amplitude of the short-latency stretch reflex was significantly increased during mental arithmetic ( P < 0.05), static handgrip exercise ( P < 0.001), and posthandgrip ischemia ( P < 0.005). When expressed in percent change from rest, the mean peak-to-peak amplitude increased by 111 (SD 100)% during mental arithmetic, by 160 (SD 103)% during static handgrip exercise, and by 90 (SD 67)% during posthandgrip ischemia. The study clearly indicates a facilitation of the short-latency stretch reflex during increased sympathetic outflow. We note that the enhanced stretch reflex responses observed in relaxed muscles in the absence of skeletomotor activity support the idea that the sympathetic nervous system can exert a direct influence on the human muscle spindles.

Efferent and afferent innervations of Mueller's muscle related to involuntary contraction of the levator muscle: important for avoiding injury during eyelid surgery

Because stretching of Mueller's muscle induces involuntary contraction of the levator muscle, we hypothesised that Mueller's muscle functions as a serial kind of muscle spindle of the levator muscle. To confirm the presence and location of efferent and afferent innervations of Mueller's muscle, cadavers' eyelids were microscopically and macroscopically examined, and the resultant findings were physiologically confirmed in patients' eyelids during surgery. Fine neural myelinated structures acting as a mechanoreceptor were found in the proximal Mueller's muscle. Mueller's muscle is doubly innervated by the unmyelinated sympathetic efferent nerve and the myelinated trigeminal proprioceptive afferent nerve, both of which run transversely on the proximal Mueller's muscle to join the lacrimal nerve. Electrical stimulation of the transverse nerve fibres induced involuntary contraction of both the levator muscle as the Hoffmann reflex and Mueller's muscle. Surgical injury to these nerve fibres should be avoided to preserve involuntary contraction of the levator muscle.

Migraine and tension-type headache reduction through pericranial muscular suppression: a preliminary report

Migraine and tension-type headaches have always plagued mankind. In spite of all the research dollars spent trying to determine the etiologies of these headaches, the neurology community still has not established a known cause of migraine and tension type headaches. This paper describes a study that was conducted for the U.S. Food and Drug Administration in which the efficacy of the Nociceptive Trigeminal Inhibition Tension Suppression System was evaluated and proved safe and efficacious in the reduction of medically diagnosed migraine and tension-type headache.

Muscle damping measured with a modified pendulum test in patients with fibromyalgia, lumbago, and cervical syndrome

STUDY DESIGN

Muscle tension with tenderness may be localized or generalized as in fibromyalgia. Wartenberg's pendulum test might be appropriate for quantitating muscle damping, at least in generalized cases.

OBJECTIVE

Damping values provide a quantitative measure of muscle tension and of the response to various treatments.

SUMMARY OF THE BACKGROUND DATA

According to recent anatomic and experimental works, intrafusal muscle fibers are double-innervated by gamma motoneurons and sympathetic fibers. With electromyograph recording, the activity of extrafusal fibers and gamma motoneurons (reflexes) can be assessed and separated from the action of the sympathetic system.

METHODS

An electrogoniometer registers the movements of the freely swinging leg. On the oscilloscope, the patient's nodular curve is compared with an ideal calculated dampened curve to find the damping value. Electromyograph surface electrodes from the knee extensors and flexors detect the activity of extrafusal fibers and the occurrence of reflexes.

RESULTS

In longstanding severe fibromyalgia, damping values are almost always elevated, at least in one leg. Half or more of patients with chronic lumbago and cervical syndrome present with increased damping. The surface electromyograph remains silent (in contrast to spastic patients).

CONCLUSION

The findings support the hypothesis that muscle tension in rheumatic patients results from overactivity of the sympathetic system (or part of it). Even in clinically localized pain syndromes, muscle damping is often increased in the legs. The test is valuable for quantitating muscle tension and the effectiveness of therapeutic methods.

Vascular and endocrine control of muscle metabolism

Important differences exist between perfused and incubated (or perifused) skeletal muscle preparations with regard to their metabolism and control. A growing body of evidence suggests that the differences may be due to the role played by the vascular system. In the constant-flow perfused rat hindlimb preparation, a group of vasoconstrictors has been identified that enhance muscle metabolism and aerobic contractility. Another group of vasoconstrictors decrease muscle metabolism and aerobic contractility even though perfusate flow remains constant. All effects of both groups of vasoconstrictors are opposed by vasodilators. Because none of the vasoconstrictor effects is evident when isolated muscles are incubated or perifused, involvement of an active vascular system is indicated. Although some hormones may act directly on muscle by purely endocrine effects, a vascular component of their actions is now emerging. Mechanisms to account for vascular control of perfused skeletal muscle metabolism may involve 1) functional vascular shunts where the proportion of flow processed by these is regulated by site-specific vasomodulators, 2) a direct response to a change in the rate of supply of nutrients and removal of products, and 3) a signal substance released by vascular tissue in association with vasoconstriction that interacts with surrounding skeletal muscle cells. Impaired control at the level of the vascular system may have implications for long-term access of nutrients and hormones and therefore the control of skeletal muscle metabolism and contractile performance.

Action of the sympathetic system on skeletal muscle

The action exerted by the sympathetic system on skeletal muscle is briefly reviewed with regard to the effects induced by the adrenergic mediator on extra-fusal muscle fibre contractility and on muscle spindle receptor organs. In particular, the different responses of slow - and fast - contracting muscles to catecholamine administration and to sympathetic stimulation are reported. Also, the sympathetically--induced effects on muscle spindle afferent activity are discussed on the basis of recent anatomical and functional data suggesting the existence of a direct action exerted by noradrenergic axons on intrafusal muscle fibres. Some of the possible implications of these data are then briefly mentioned.

Tension development in lumbrical muscles and concomitant increase of activity in A alpha and A beta afferents during sympathetic stimulation in the cat

In anaesthetized and curarized cats electrical stimulation of the lumbar sympathetic trunk, at frequencies within the physiological range, induces the development of a small tension in superficial lumbrical muscles (50-100 mg in different preparations). This effect can be reproduced in anaesthetized and curarized cats by stimulating the peripheral stump of the tibial nerve with parameters adequate to activate the entire C-fibre group, and therefore postganglionic sympathetic fibers. The collision technique was used to evaluate in the tibial nerve possible changes in afferent activity from the skinned foot. It was found that an increase of non-cutaneous activity consistently occurs in A beta and, occasionally, in A alpha fibre groups. Secondary and primary spindle afferents, respectively, belong to these fibre groups. It was also found that: (1) the tension development in lumbrical muscles and the increase of the afferent activity of non-cutaneous origin exhibit similar time courses; (2) the two events are affected in parallel by the same stimulus parameters; (3) both events are abolished by alpha-adrenoceptor antagonists. Therefore the possibility of a sympathetic fusimotor action affecting mainly secondary afferents is suggested and discussed.