The articular polymodal nociceptor in health and disease

Effect of mobilization with movement on lateral knee pain due to proximal tibiofibular joint hypomobility

This case report describes a 45-year-old female who presented with lateral knee pain over the right proximal tibiofibular joint (PTFJ) managed unsuccessfully with rest, medications, bracing, injection, and physiotherapy. Clinical diagnosis of PTFJ hypomobility was based on concordant symptom reproduction with palpatory tenderness, accessory motion testing, and restricted anterior glide of the fibula. Intervention consisted of Mulligan's mobilization with movement and taping over the right PTFJ with immediate improvements noticed in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 6 months revealed that the patient was pain free and fully functional.

Effect of a novel mobilization with movement procedure on anterolateral ankle impingement - A case report

This case report describes a 50-year-old male who presented with right anterolateral ankle pain managed unsuccessfully with rest, medications, bracing, injection, physical therapy, and massage therapy. Clinical diagnosis of anterolateral ankle impingement was based on concordant symptom reproduction with palpatory tenderness and a positive lateral synovial impingement test. This case report is a potential first time description of the successful management of anterolateral ankle impingement utilizing a novel Mulligan's mobilization with movement procedure (consisting of internal rotation of the distal tibia) and taping with immediate improvements noted in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 4 months revealed that the patient was pain free and fully functional.

Guarding pain and spontaneous activity of nociceptors after skin versus skin plus deep tissue incision

BACKGROUND

Guarding pain after rat plantar incision is similar to pain at rest in postoperative patients. Spontaneous activity (SA) in nociceptive pathways quite likely transmits such ongoing pain. This study examined the extent of tissue injury by incision on pain behaviors and nociceptor SA.

METHODS

Rat pain behaviors were measured after a sham procedure, skin incision, or skin plus deep tissue incision. Separate groups of rats underwent in vivo single-fiber recording 1 day after a sham procedure, skin, or skin plus deep tissue incision or 7 days after skin plus deep tissue incision.

RESULTS

Compared with the control procedure, skin incision induced moderate guarding on the day of incision only, whereas skin plus deep tissue incision caused guarding for 5 days. Mechanical and heat hyperalgesia were similar in both incised groups, except that mechanical hyperalgesia lasted longer after skin plus deep tissue incision. On Postoperative Day 1, skin incision (18.2%) produced a similar prevalence of SA in nociceptors as in controls (13.0%), whereas skin plus deep tissue incision generated a greater prevalence of SA (61.0%); SA rate also tended to be greater (6.1 vs. 10.0 imp/s) after skin plus deep tissue incision. Seven days after skin plus deep tissue incision, the SA prevalence was similar (13.6%) as in controls.

CONCLUSIONS

These data demonstrated that incised deep tissue rather than skin had a central role in the genesis of guarding behavior and nociceptor SA. Understanding the responses of deep tissue to incision and the mechanisms for deep tissue pain will improve postoperative pain management.

Recent developments in transient receptor potential vanilloid receptor 1 agonist-based therapies

Capsaicin and other naturally occurring pungent molecules have been used for centuries as topical analgesics and rubefactants to treat a variety of chronically painful conditions. Recently, instillations of high-concentration capsaicin and resiniferatoxin solutions have been found to be useful for the management of persistent bladder pain or overactive bladder. However, only within the last 7 years has it been appreciated that the selective action of these compounds on a subset of sensory nerve fibres is mediated by agonist activity at a ligand-gated ion channel called the transient receptor potential vanilloid receptor 1 (TRPV1). Accordingly, this discovery has fueled intensive research and drug development efforts, mainly in a search for novel analgesic or anti-inflammatory therapies. Two different, but non-mutually exclusive, strategies are being pursued: optimisation of TRPV1 agonist-based therapies, which can functionally inactivate nociceptive nerve fibres, and identification of receptor antagonists, which would prevent nociceptive fibres from being activated by ongoing inflammatory stimuli. Available information on TRPV1 agonists in development and their biological rationale will be summarised in this review.

A Comparison of Pressure Pain Detection Thresholds in People With Chronic Low Back Pain and Volunteers Without Pain

Background and Purpose. Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. Subjects and Methods. Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. Results. A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm2 versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm2 versus 6.1 lb/cm2) and for PPDT related to the lumbar spine (5.9 lb/cm2 versus 8.0 lb/cm2). Discussion and Conclusion. Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.

Causes of pain in degenerative bone and joint disease: a lesson from vertebroplasty

Pain in degenerative bone and joint disease is usually attributed to sensitized nociceptors in inflamed periarticular soft tissues. Here we draw attention to the potential contribution of intrinsic bone innervation. The structure and innervation of articular bone ends is analogous to that of teeth. Although some dental pain derives from inflamed periodontal soft tissue, a more important source is the dentine and root canal. By analogy, pain on weight bearing in osteoarthritis and related conditions may be due to compressive forces applied to the innervation of subchondral bone exposed by erosion of the overlying cartilage. Pain relief obtained by injecting acrylic cement into the bone interior during percutaneous vertebroplasty is consistent with this concept. The development of a new family of pain relief options based on "marrow canal treatment" may be a realistic possibility.

The presence and role of the tetrodotoxin-resistant sodium channel Na(v)1.9 (NaN) in nociceptive primary afferent neurons

This is the first examination of sensory receptive properties and associated electrophysiological properties in vivo of dorsal root ganglion (DRG) neurons that express the TTX-resistant sodium channel Na(v)1.9 (NaN). Intracellular recordings in lumbar DRGs in Wistar rats enabled units with dorsal root C-, Adelta-, or Aalpha/beta-fibers to be classified as nociceptive, low-threshold mechanoreceptive (LTM), or unresponsive. Intracellular dye injection enabled subsequent immunocytochemistry for Na(v)1.9-like immunoreactivity (Na(v)1.9-LI). Na(v)1.9-LI was expressed selectively in nociceptive-type (C- and A-fiber nociceptive and C-unresponsive) units. Of the nociceptive units, 64, 54, and 31% of C-, Adelta-, and Aalpha/beta-fiber units, respectively, were positive for Na(v)1.9-LI. C-unresponsive units were included in the nociceptive-type group on the basis of their nociceptor-like membrane properties; 91% were positive. Na(v)1.9-LI was undetectable in Adelta- or Aalpha/beta-fiber LTM units and in one C-LTM unit. Na(v)1.9-LI intensity was correlated negatively with soma size and conduction velocity in nociceptive units and with conduction velocity in C-fiber units. There was a positive correlation with action potential rise time in nociceptive-type units with membrane potentials equal to or more negative than -50 mV. The data provide direct evidence that Na(v)1.9 is expressed selectively in (but not in all) C- and A-fiber nociceptive-type units and suggest that Na(v)1.9 contributes to membrane properties that are typical of nociceptive neurons.

[Critical analysis of animal models of acute pain. II]

OBJECTIVE

To analyse models of acute pain in experimental animals.

DATA SOURCES

References were obtained from computerised bibliographic data banks (Medline and others) and the authors' personal documents.

DATA SYNTHESIS

The majority of tests permit only a measurement of threshold, whereas clinical pain is almost always prolonged. The relationships between tests of acute pain and motor activity are reviewed from a number of standpoints; in particular we consider the influence, which postural adjustments of the animal may exert on motor responses in the limbs and the significance of flexor and extensor reflexes. In analysing the problem of the sensitivity of tests, we raise the following questions: 1) what type(s) of fibres underlie the observed responses and might these be different depending on whether one is stimulating a healthy or an inflamed tissue; 2) what significance do measurements of "latency" have when a stimulus is increasing; 3) how valid are the methods of analysing the results? The influence of species and the genetic line used in tests and the specificity and predictivity of tests are considered. Finally, we review those factors, which may distort behavioural measurements in animals, notably--pharmacokinetics, interactions between heterotopic stimuli, environmental factors and related psychophysiological/psychological considerations (subjective "undesirable" phenomena, learning phenomena). We pay particular attention to related physiological functions (thermoregulation, vasomotricity, blood pressure). These considerations lead us to re-position nociception within a much larger homeostatic framework which in addition to pain, includes phenomena such as anxiety and vegetative functions. They also suggest that we should define an "effective stimulus" as one, which activates nociceptive nerve terminals after a physical stimulus, has passed through a "peripheral lens" which regulates its intensity for reasons, which are physical, albeit of biological origin. Finally they remind us that the "system of pain" forms part of a whole set of subsystems--sensory, motor, vegetative, emotional, motivational--which scientific method, being reductionist by nature, cannot study in its entirety. However one must consider results of nociceptive tests within this general context.

CONCLUSION

It is only by taking the approach described in this review, that fundamental and clinical research can interact usefully.

Overview of pain in the lame patient

Pain is often the limiting factor associated with joint disease. Pain results from the stimulation of nociceptors by excessive mechanical stimulation, chemical stimulation associated with the inflammatory process, or a combination of both. Even though OA is considered to be a noninflammatory disease, the mild degree of inflammation frequently associated with this condition can result in peripheral sensitization. This results in increased spontaneous activity and decreased activation threshold of nociceptive fibers. Activity of the primary joint afferents also leads to changes within the dorsal spinal horn, resulting in central sensitization and changes in the neural structures of the dorsal horn that facilitate and amplify the nociceptive response. Changes in the periarticular tissues correspond to the neurobiologic changes, resulting in increased stimulation of nociceptors caused by mechanical and chemical alterations resulting from tissue damage. Similar pathophysiologic events occur regardless of whether the initiating event is an acute joint injury or a chronic condition such as OA. The combination of these events results in the complex dynamic of joint pain. Because of this complex interaction of the musculoskeletal and nervous systems, it is difficult to imagine a single treatment that is effective for the alleviation of pain, because that agent would require inhibition of a number of stimulatory pathways. Instead, restoration of mechanical integrity, relief of peripheral inflammation, and blockage of central neurotransmission are all likely to have a role in the relief of joint pain and resolution of lameness.

Effects of intracolonic opioid receptor agonists on polymodal pelvic nerve afferent fibers in the rat

We studied the effects of intracolonic administration of opioid receptor agonists (ORAs) on responses of pelvic nerve afferent fibers to colorectal distension (CRD) and heat. Single-fiber recordings were made from the decentralized S1 dorsal rootlet in the rat. An approximately 7-cm length of descending colon was isolated in situ to permit intracolonic perfusion with Krebs solution, which, when the outflow was clamped, was used to distend the colon. Responses to noxious CRD (40 mmHg, 30 s) were tested after intracolonic instillation of mu-, delta- or kappa-ORAs. Intracolonic administration of the kappa-ORAs EMD 61,753 (n = 5/12) and U62,066 (n = 8/11), but not either the mu-ORA fentanyl or the delta-ORA SNC-80, concentration-dependently inhibited responses of afferent fibers. For fibers unaffected by intracolonic administration of EMD 61,753 or U62,066, intra-arterial administration of kappa-ORAs was effective. Forty-one of 54 mechanosensitive fibers also responded to intracolonic instillation of heated Krebs solution (50 degrees C). Intra-arterial injection of fentanyl or SNC-80 did not attenuate responses to heat. Either intracolonic or intra-arterial administration of EMD 61,753 or U62, 066, however, inhibited afferent fiber responses to heat. These results document that mechanical and thermal sensitivity of polymodal pelvic nerve afferent fibers innervating the rat colon can be inhibited peripherally by intracolonic instillation of kappa-ORAs.

Primitivism and plasticity of pain--implication of polymodal receptors

Bio-warning and defense mechanisms play the most fundamental roles in living organisms. From an evolutionary point of view, nociceptive systems are very primitive and are richly provided with humoral signaling mechanisms of aboriginal humoral defense systems, as reflected in the primitive nature of the polymodal receptor, a poorly differentiated sensory receptor signaling nociceptive information. Recent advances in studies on pain have made it possible to explain neural mechanisms of pain systems under physiological conditions and reveal that there is a large gap between physiological and pathological pains. Protracted nociceptive inputs under pathological conditions induce plastic, either functional or structural, alterations in the nociceptive pathways. These plastic changes lead to crosstalk among the neural networks, including circuits related to motor, autonomic, or psychological functions. These plastic changes, once established, persist even after the original pain sources disappear in a memory-like fashion. Thus, it is revealed that chronic pain cannot be treated by blocking pain pathways, which is effective against acute pain, but require treatment from a multidisciplinary perspective.