DIFFERENTIAL SUPRASPINAL CONTROL OF INHIBITORY AND EXCITATORY ACTIONS FROM THE FRA TO ASCENDING SPINAL PATHWAYS

[Pathophysiology of spasticity]

The term "spasticity" describes the velocity-dependent increase in tonic stretch reflexes. The symptom is commonly seen in patients with injury to the central nervous system. It is rarely isolated but, instead, part of a set of symptoms that is sometimes confusing. However, the pathophysiology of the symptom has evolved over the past three decades, and it is now considered part of a global process that includes not only spinal reflex loop modifications, but also changes in the biomechanical properties of muscle fibers. Finally, recent studies of changes in the membrane properties of motor neurons and the occurrence of plateau potential have opened new perspectives. This review aims to describe these new pathophysiological models.

The physiology and processing of pain: a review

Despite the many advances in our understanding of the mechanisms underlying pain processing, pain continues to be a major healthcare problem in the United States. Each day, millions of Americans are affected by both acute and chronic pain conditions, costing in excess of $100 billion for treatment-related costs and lost work productivity. Thus, it is imperative that better treatment strategies be developed. One step toward improving pain management is through increased knowledge of pain physiology. Within the nervous system, there are several pathways that transmit information about pain from the periphery to the brain. There is also a network of pathways that carry modulatory signals from the brain and brainstem that alter the incoming flow of pain information. This article provides a review to the physiology and processing of pain.

Effect of Chronic Inflammation on Dorsal Horn Nociceptive Neurons in Aged Rats

To elucidate the effect of chronic inflammation on spinal nociceptive neurons in the elderly, we compared nocifensive behavior, peripheral inflammatory responses, and spinal dorsal horn neuronal activities between the aged (29–34 mo) and adult (7–12 mo) male rats after injection of complete Freund's adjuvant (CFA) into the hind paw. Aged rats exhibited a significantly lower mechanical paw withdrawal threshold before inflammation. However, after CFA injection mechanical allodynia developed in both adult and aged rats after CFA injection. The changes of foot temperature and thickness after CFA injection were greater and lasted longer in aged than in adult rats. Sets of 124 wide dynamic range (WDR) neurons (aged: 59, adult: 65) and 26 nociceptive specific (NS) neurons (aged: 13, adult: 13) were recorded from the lumber spinal dorsal horn. NS neurons from the inflamed adult rats showed significantly higher responses to noxious mechanical stimulation than those in aged rats, whereas WDR neurons from inflamed adult and aged rats were similar. Background activity of WDR neurons from the adult rats increased after CFA, whereas WDR neurons of aged rats and NS neurons from either group were not. The afterdischarge followed by noxious mechanical stimulation was significantly greater for WDR neurons in both adult and aged rats, whereas no significant differences were observed in NS neurons. Two days after CFA injection, Fos expression increased similarly in aged and adult rats. Thus the aged rats showed enhanced peripheral inflammatory responses to CFA injection with only a slight change in dorsal horn neuronal activity. Together with our previous finding that nociceptive neurons in aged rats exhibit hyperexcitability, these results suggest that the dorsal horn nociceptive system becomes sensitized with advancing age and its excitability cannot be further increased by inflammation.

Sucrose ingestion causes opioid analgesia

The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l) for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex) were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean +/- SEM, N = 12) for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 +/- 0.04, 0.10 +/- 0.05, 0.15 +/- 0.08 and 0.49 +/- 0.07, respectively. One-way ANOVA indicated a significant difference (F(3, 47) = 9.521, P < 0.001) and the Tukey multiple comparison test (P < 0.05) showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7) receiving sucrose exhibited an analgesia index of 0.20 +/- 0.10 while rats receiving only sucrose (N = 7) had an index of 0.68 +/- 0.11 (t = 0.254, 10 degrees of freedom, P < 0.03). This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.

Mechanisms of chronic pain

Chronic pain differs from acute pain in that it serves no useful function, causes suffering, limits activities of daily living, and increases costs of healthcare payments, disability, and litigation fees. Pain perception begins with activation of peripheral nociceptors and conduction through myelinated A delta and unmyelinated C fibers to the dorsal root ganglion. From here, signals travel via the spinothalamic tract to the thalamus and the somatosensory cortex. Modulation of sensory input (i.e., pain) occurs at many levels. Nociceptors are also neuroeffectors, and transmission can be modulated by their cell bodies, which secrete inflammatory mediators, neuropeptides, or other pain-producing substances. Descending pathways from the hypothalamus, which has opioid-sensitive receptors and is stimulated by arousal and emotional stress, can transmit signals to the dorsal horn that modulate ascending nociceptive transmissions. Modulation to alter the perception of pain also can occur at higher centers (e.g., frontal cortex, midbrain, medulla) by opioids, anti-inflammatory agents, as well as antagonists and agonists of neurotransmitters. This article will review our current knowledge of the mechanisms involved in (1) the transduction of tissue injury or disease signals (nociception and nociceptive receptors); (2) the transmission of signals rostrally to the thalamus and higher nervous system centers (involving perception of the quality, location, and intensity of noxious signals); and (3) the modulation of ascending sensory messages at all levels (periphery, spinal cord, and higher centers).

The functional development of descending inhibitory pathways in the dorsolateral funiculus of the newborn rat spinal cord

The postnatal development of descending inhibition in the spinal cord has been studied in the rat. Electrophysiological recordings were made in neonatal rat pups of the activity in single lumbar dorsal horn cells evoked by stimulation of the skin of the hindlimb. Descending inhibition was tested by observing the effect of stimulation of the dorsolateral funiculus (DLF) at thoracic level on the dorsal horn cell responses. In adults the DLF is known to contain descending axons from the brainstem which inhibit dorsal horn cell activity. Such inhibition was always observed in days 22-24 rat pups. At 18 days of age it was present but required higher-intensity stimulation to produce an effect. On day 12 only half the dorsal horn cells tested were inhibited by DLF stimulation and then only weakly. On day 9 no cells were inhibited. Application of horseradish peroxidase to DLF axons in the lumbar cord resulted in retrograde labelling of cells in the medulla, pons and midbrain. The labelling on day 6 was comparable to the adult. The results show that despite the early anatomical existence of a descending DLF pathway, there is no functional descending inhibition until days 10-12 of life. It is suggested that this is due to delayed maturation of crucial interneurones in the dorsal horn or to insufficient levels of 5-hydroxytryptamine or other neurochemicals in the descending DLF axon terminals.

Electrophysiological characteristics of lumbosacral evoked potentials in patients with established spinal cord injury

Surface electrodes positioned over the S1 and T12 vertebrae and referenced to T6 were used to record spinal potentials evoked by unilateral stimulation of the posterior tibial nerve at the knee. Data were collected on 24 patients who received spinal cord injuries 2 months to 31 years previously. The recording sites were below the level of spinal injury. The lumbosacral evoked potentials (LSEPs) were compared with the results of measurements obtained from 19 neurologically healthy subjects. Additional data were collected on each patient to characterize segmental reflex responses and preservation of sensory and motor functions associated with the L5 through S2 segments of the spinal cord. Assuming that the LSEP reflects the activity of spinal cord interneurons, the results demonstrate a degree of spinal cord dysfunction caudal to the area of injury in a substantial number of the patients with spinal cord injury which we studied.

Descending influences on receptive fields and activity of single units recorded in laminae 1,2 and 3 of cat spinal cord

Units (108) were isolated in laminae 1,2 and 3 in segments L7-Sl of decerebrate cat spinal cord. For each unit, the size and nature of its receptive field (RF) was delineated. Then the dorsolateral funiculus (DLF) was stimulated for 1 sec with 10 or 50 Hz, 0.1 msec square waves and the response characteristics of the unit were again examined. Of the 108 units, 55 were excited or facilitated, 6 were inhibited (all in lamina 3) and 47 were unaffected. While some of the excited units responded only during the stimulus train, the majority showed prolonged excitation or facilitation lasting over one minute. The excited units were predominantly those responding to pressure or to brush, touch and pressure. Of the pressure units, 73% were excited or facilitated in contrast to only 29% of the brush/touch units. Most of the excited units showed expansion of their RFs. While many units of this type show ongoing variations of excitability and RF size, the evoked responses reported were sufficiently time-locked to the stimulus for it to be apparent that they were caused by the DLF stimulation. The unit's responses still occurred when the DLF was stimulated caudal to a complete cord transection so that the effects did not pass through the brain stem. The major effect of descending systems or of DLF stimulation previously reported on the large cells of laminae 1,4 and 5 has been inhibition. Here we report that a major descending influence on many units of laminae 1,2 and 3 is excitatory. Therefore it is suggested that a population of small interneurons in the superficial laminae could contribute to the descending inhibition of large dorsal horn neurons.

Messages conveyed by spinocerebellar pathways during scratching in the cat. II. Activity of neurons of the ventral spinocerebellar tract

(1) The activity of neurons of the ventral spinocerebellar tract (VSCT) during scratching was studied in thalamic and decapitate cats. The neurons were identified antidromically either by stimulation of the hindlimb area in the anterior lobe of the cerebellum (in thalamic cats) or by stimulation of the contralateral ventrolateral funiculus of the spinal cord (in decapitate cats). The scratch reflex was elicited by stimulation of either the pinna (in thalamic cats) or the cervical spinal cord (in decapitate cats). In most experiments, animals were immobilized and the activity of VSCT neurons was recorded during fictitious scratching. (2) During both actual and fictitious scratching, the discharge of VSCT neurons was rhythmically modulated in relation with the scratch cycle: neurons fired in bursts separated with periods of silence. Phases of activity of different neurons were unevenly distributed over the scratch cycle: most neurons fired within the limits of the flexor phase of the cycle. (3) The firing pattern of VSCT neurons during fictitious scratching was similar to that during actual scratching. Therefore, rhythmical burst firing of VSCT neurons is determined mainly by central mechanisms and not by a rhythmical sensory input. (4) The firing pattern of VSCT neurons in decapitate cats was similar to that in thalamic cats. Therefore, rhythmical burst firing of VSCT neurons is determined mainly by the central spinal mechanism and not by supraspinal motor centers. (5) The VSCT neurons which fired in long bursts during the greater part of the flexor phase were usually activated during the latent period of scratching, while those firing later in the cycle were usually either inhibited or not affected during this period. (6) The antidromic response in most VSCT neurons could be evoked from a large number of points in the hindlimb area of the cerebellar anterior lobe, both in the vermis and in the pars intermedia. Due to such extensive branching of axons, each point of the cortex receives signals from neurons firing in different phases of the cycle. But axons of VSCT neurons firing in long bursts during the greater part of the flexor phase terminate more extensively in the pars intermedia, while axons of neurons firing later in the cycle terminate more extensively in the vermis. (7) The functioning of the VSCT is essentially similar to that of the spino-reticulocerebellar pathway (SRCP). Both pathways convey messages about activity of the central spinal mechanism generating the motor output pattern of scratching, but the VSCT is active mainly in the flexor phase of the scratch cycle and the SRCP in the extensor one. A hypothesis is advanced that these pathways monitor activity of different groups of spinal interneurons.

The laminar organization of dorsal horn and effects of descending impulses

1. An examination of the physiological properties of cells in cat lumbar dorsal horn shows that there are three horizontal laminae which correspond approximately to Rexed (1952) laminae 4, 5, and 6.2. A summary diagram (Fig. 9) suggests the relation of the laminae to each other and to afferent and descending fibres. All three laminae respond to cutaneous stimulation but only lamina 6 responds to movement. By comparing responses of cells in decerebrate and spinal preparations, it is shown that the brain stem inhibits cutaneous responses and enhances movement responses. Pyramidal tract stimulation affects cells in laminae 4, 5, and 6.3. Cells in lamina 4 have small cutaneous receptive fields and respond as though many different types of specific cutaneous afferents converge on them. Cells in lamina 5 respond as though many cells of lamina 4 converge on them. In the decerebrate animal the responses of lamina 5 cells habituate to repeated light pressure stimuli but the cells remain responsive to new stimuli in other parts of their receptive field. Impulses descending from the brain stem can switch the modality of lamina 6 cells from cutaneous to proprioceptive.

Short-latency projections to the cat's cerebral cortex from skin and muscle afferents in the contralateral forelimb

1. The potentials evoked in the first sensorimotor area on stimulation of muscle and skin nerves in the contralateral forelimb were recorded in preparations with either the dorsal funiculus (DF) or the spinocervical tract (SCT) interrupted.2. The short-latency, surface-positive potentials in these preparations are mediated by the remaining path, either the DF or SCT.3. Cutaneous afferents project through both paths to two discrete areas which correspond to the classical sensory and motor cortices (Fig. 10 A and B). The projection areas are not identical: the DF path seems to activate most effectively the sensory cortex; and the SCT path, most effectively the motor cortex.4. The potentials evoked from cutaneous nerves have a similar latency in the two areas. On stimulation of the superficial radial nerve the latency was about 4.5 msec in preparations with intact DF, and about 5.3 msec in preparations with intact SCT.5. High threshold muscle afferents project to the same areas as the cutaneous afferents.6. Group I muscle afferents project, exclusively through the DF path, to an area distinct from the two cutaneous projection areas (Fig. 10C). It occupies a caudal part of the motor cortex and an intermediate zone between the sensory and motor cortices.7. The projection areas are compared with the recent cytoarchitectonic map of Hassler & Muhs-Clement (1964) (Fig. 10D).8. It is suggested that the afferent projections to the motor cortex and the intermediate zone are used in the integration of movements elicited from the cortex. The general similarity in the organization of afferent paths to the motor cortex and the cerebellum is pointed out.