Projections from the renal nerve to the cat's lateral somatosensory thalamus

Visceral pain originating from the upper urinary tract

Pain originating from the upper urinary tract is a common problem and stone colic is one of the most intense pain conditions that can be experienced in the clinic. The pain is difficult to alleviate and often leads to medical attention. In humans, pain mechanisms of the upper urinary tract pain are still poorly understood, which often leads to a trial and error approach in clinical pain management. Pain from the upper urinary tract seems to have all the characteristics of pure visceral pain, including referred pain with or without hyperalgesia/trophic changes in somatic tissues and viscero-visceral hyperalgesia. However, further studies are needed to better understand these visceral pain mechanisms with regard to optimising pain management. This review gives an introduction to visceral pain in general and upper urinary tract pain in particular, with special reference to pain pathways and pharmacological and non-pharmacological pain modulation.

"Pusher syndrome" following cortical lesions that spare the thalamus

Stroke patients with "pusher syndrome" show severe misperception of their own upright body orientation although visual-vestibular processing is almost intact. This dissociation argues for a second graviceptive system in humans for the perception of body orientation. Recent studies revealed that the posterior thalamus is an important part of this system. The present investigation aimed to study the cortical representation of this system beyond the thalamus. We evaluated 45 acute patients with and without contraversive pushing following left-or right-sided cortical lesions sparing the thalamus. In both hemispheres, the simple lesion overlap associated with contraversive pushing typically centered on the insular cortex and parts of the postcentral gyrus. The comparison between pusher patients and controls who were matched with respect to age, lesion size, and the frequency of spatial neglect, aphasia and visual field defects revealed only very small regions that were specific for the pusher patients with cortical damage sparing the thalamus. Obviously, the cortical structures representing our control of upright body orientation are in close anatomical proximity to those areas that induce aphasia in the left hemisphere and spatial neglect in the right hemisphere when lesioned. We conclude that in addition to the subcortical area previously identified in the posterior thalamus, parts of the insula and postcentral gyrus appear to contribute at cortical level to the processing of the afferent signals mediating the graviceptive information about upright body orientation.

Baroreceptive and somatosensory convergent thalamic neurons project to the posterior insular cortex in the rat

Connectivity between the rat posterior insula and the ventrobasal thalamus has been demonstrated anatomically. Neurons convergent for baroreceptor and nociceptive input have also been identified in the homologous anterior insula of the primate. Whether similar convergent cells exist in the ventrobasal thalamus was investigated in 30 urethane anesthetized male Sprague--Dawley rats. Six classes of cells were identified in the right ventrobasal thalamus: (a) 83/159 (52%) baroreceptive and nociceptive convergent units; (b) 2/159 (1%) convergent cells responding to baroreceptor activation and light touch; (c) 44/159 (28%) purely nociceptive units; (d)10/159 (6%) purely baroreceptive units; (e) 1/159 (0.6%) cells responding to brush alone and (f) 19/159 (12%) unresponsive units. Of the viscerosomatic convergent cells, 66/85 (78%) were situated in the ventroposterolateral nucleus (VPL), 6/85 (7%) in the ventroposterolateral parvicellular nucleus (VPLpc), and 13/85 (15%) in the ventroposteromedial nucleus (VPM). Fifteen right ventrobasal thalamic units were antidromically activated and 34 units orthodromically activated by right posterior insular microstimulation. Cobalt injection into the right ventrobasal thalamus blocked the right insular response to baroreceptor activation by >70%. These data indicate: (a) baroreceptive and somatosensory nociceptive convergent units exist in the ventrobasal thalamus; (b) thalamic convergent neurons project directly to the ipsilateral posterior insula and receive reciprocal insulothalamic projections; and (c) a significant proportion of baroreceptor input relays to the posterior insula through the ipsilateral ventrobasal thalamus.

Responses of neurons in the lateral thalamus of the cat to stimulation of urinary bladder, colon, esophagus, and skin

In seven female alpha-chloralose-anesthetized cats, 52 lateral thalamic neurons were tested with noxious distension of the urinary bladder, the distal colon and the lower esophagus. In addition, the neurons were characterized with innocuous and noxious mechanical stimulation of the skin and deep structures. Of the 52 neurons tested, 32 (62%) were visceroceptive. Of these visceroceptive neurons, 20 (63%) were located in the periphery of the ventral posterolateral nucleus (VPLp), 10 (31%) in the adjacent posterior complex (PO), and two (6%) in the ventrolateral nucleus (VL). No differences were found with respect to location between neurons responsive or unresponsive to visceral stimulation. Ten neurons (31%) received input from more than one viscus and, therefore, showed viscerovisceral convergence. Excitatory or "inhibitory" responses were elicited by stimulation of the esophagus in 21 neurons, of the colon in 13, and of the urinary bladder in 11 neurons. No indications were found for a segregation of neurons responsive to a certain viscus and their location in VPLp or PO. Of 51 neurons, for which a somatic receptive field was determined, 44 (86%) exhibited low threshold type (LT), and seven (14%) wide dynamic range type (WDR) responses. The data indicate that there might exist a somatovisceral coregistration, because many neurons (69%) had homosegmental receptive fields, and bladder stimulation was the most successful stimulus. It is concluded that VPLp and the adjacent PO in the cat play a role in the perception and localization of painful events originating from thoracic and pelvic organs.