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Fitzgerald M. The Bayliss-Starling Prize Lecture: The developmental physiology of spinal cord and cortical nociceptive circuits. J Physiol 2024; 602:1003-1016. [PMID: 38426221 DOI: 10.1113/jp283994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
When do we first experience pain? To address this question, we need to know how the developing nervous system processes potential or real tissue-damaging stimuli in early life. In the newborn, nociception preserves life through reflex avoidance of tissue damage and engagement of parental help. Importantly, nociception also forms the starting point for experiencing and learning about pain and for setting the level of adult pain sensitivity. This review, which arose from the Bayliss-Starling Prize Lecture, focuses on the basic developmental neurophysiology of early nociceptive circuits in the spinal cord, brainstem and cortex that form the building blocks of our first pain experience.
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Affiliation(s)
- Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
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Xu Y, Koch SC, Chamessian A, He Q, Sundukova M, Heppenstall P, Ji R, Fitzgerald M, Beggs S. Microglial Refinement of A-Fiber Projections in the Postnatal Spinal Cord Dorsal Horn Is Required for Normal Maturation of Dynamic Touch. J Neurosci 2024; 44:e1354232023. [PMID: 37989592 PMCID: PMC10860632 DOI: 10.1523/jneurosci.1354-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
Sensory systems are shaped in postnatal life by the refinement of synaptic connectivity. In the dorsal horn of the spinal cord, somatosensory circuits undergo postnatal activity-dependent reorganization, including the refinement of primary afferent A-fiber terminals from superficial to deeper spinal dorsal horn laminae which is accompanied by decreases in cutaneous sensitivity. Here, we show in the mouse that microglia, the resident immune cells in the CNS, phagocytose A-fiber terminals in superficial laminae in the first weeks of life. Genetic perturbation of microglial engulfment during the initial postnatal period in either sex prevents the normal process of A-fiber refinement and elimination, resulting in an altered sensitivity of dorsal horn cells to dynamic tactile cutaneous stimulation, and behavioral hypersensitivity to dynamic touch. Thus, functional microglia are necessary for the normal postnatal development of dorsal horn sensory circuits. In the absence of microglial engulfment, superfluous A-fiber projections remain in the dorsal horn, and the balance of sensory connectivity is disrupted, leading to lifelong hypersensitivity to dynamic touch.
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Affiliation(s)
- Yajing Xu
- Neuroscience, Physiology and Pharmacology, UCL, London, WC1E 6BT United Kingdom
| | - Stephanie C Koch
- Neuroscience, Physiology and Pharmacology, UCL, London, WC1E 6BT United Kingdom
| | - Alexander Chamessian
- Duke University School of Medicine, Duke University, Durham, North Carolina 27710
| | - Qianru He
- Duke University School of Medicine, Duke University, Durham, North Carolina 27710
| | - Mayya Sundukova
- SISSA (International School for Advanced Studies), 34136 Trieste, Italy
| | - Paul Heppenstall
- SISSA (International School for Advanced Studies), 34136 Trieste, Italy
| | - RuRong Ji
- Duke University School of Medicine, Duke University, Durham, North Carolina 27710
| | - Maria Fitzgerald
- Neuroscience, Physiology and Pharmacology, UCL, London, WC1E 6BT United Kingdom
| | - Simon Beggs
- Neuroscience, Physiology and Pharmacology, UCL, London, WC1E 6BT United Kingdom
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH United Kingdom
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Zandvoort CS, van der Vaart M, Robinson S, Usman F, Schmidt Mellado G, Evans Fry R, Worley A, Adams E, Slater R, Baxter L, de Vos M, Hartley C. Sensory event-related potential morphology predicts age in premature infants. Clin Neurophysiol 2024; 157:61-72. [PMID: 38064929 DOI: 10.1016/j.clinph.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/18/2023] [Accepted: 11/04/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE We investigated whether sensory-evoked cortical potentials could be used to estimate the age of an infant. Such a model could be used to identify infants who deviate from normal neurodevelopment. METHODS Infants aged between 28- and 40-weeks post-menstrual age (PMA) (166 recording sessions in 96 infants) received trains of visual and tactile stimuli. Neurodynamic response functions for each stimulus were derived using principal component analysis and a machine learning model trained and validated to predict infant age. RESULTS PMA could be predicted accurately from the magnitude of the evoked responses (training set mean absolute error and 95% confidence intervals: 1.41 [1.14; 1.74] weeks,p = 0.0001; test set mean absolute error: 1.55 [1.21; 1.95] weeks,p = 0.0002). Moreover, we show that their predicted age (their brain age) is correlated with a measure known to relate to maturity of the nervous system and is linked to long-term neurodevelopment. CONCLUSIONS Sensory-evoked potentials are predictive of age in premature infants and brain age deviations are related to biologically and clinically meaningful individual differences in nervous system maturation. SIGNIFICANCE This model could be used to detect abnormal development of infants' response to sensory stimuli in their environment and may be predictive of neurodevelopmental outcome.
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Affiliation(s)
- Coen S Zandvoort
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Shellie Robinson
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Fatima Usman
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Ria Evans Fry
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Alan Worley
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Eleri Adams
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Maarten de Vos
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven, Leuven, Belgium
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
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Vogel A, Ueberbach T, Wilken-Schmitz A, Hahnefeld L, Franck L, Weyer MP, Jungenitz T, Schmid T, Buchmann G, Freudenberg F, Brandes RP, Gurke R, Schwarzacher SW, Geisslinger G, Mittmann T, Tegeder I. Repetitive and compulsive behavior after Early-Life-Pain associated with reduced long-chain sphingolipid species. Cell Biosci 2023; 13:155. [PMID: 37635256 PMCID: PMC10463951 DOI: 10.1186/s13578-023-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Pain in early life may impact on development and risk of chronic pain. We developed an optogenetic Cre/loxP mouse model of "early-life-pain" (ELP) using mice with transgenic expression of channelrhodopsin-2 (ChR2) under control of the Advillin (Avil) promoter, which drives expression of transgenes predominantly in isolectin B4 positive non-peptidergic nociceptors in postnatal mice. Avil-ChR2 (Cre +) and ChR2-flfl control mice were exposed to blue light in a chamber once daily from P1-P5 together with their Cre-negative mother. RESULTS ELP caused cortical hyperexcitability at P8-9 as assessed via multi-electrode array recordings that coincided with reduced expression of synaptic genes (RNAseq) including Grin2b, neurexins, piccolo and voltage gated calcium and sodium channels. Young adult (8-16 wks) Avil-ChR2 mice presented with nociceptive hypersensitivity upon heat or mechanical stimulation, which did not resolve up until one year of age. The persistent hypersensitivy to nociceptive stimuli was reflected by increased calcium fluxes in primary sensory neurons of aged mice (1 year) upon capsaicin stimulation. Avil-ChR2 mice behaved like controls in maze tests of anxiety, social interaction, and spatial memory but IntelliCage behavioral studies revealed repetitive nosepokes and corner visits and compulsive lickings. Compulsiveness at the behavioral level was associated with a reduction of sphingomyelin species in brain and plasma lipidomic studies. Behavioral studies were done with female mice. CONCLUSION The results suggest that ELP may predispose to chronic "pain" and compulsive psychopathology in part mediated by alterations of sphingolipid metabolism, which have been previously described in the context of addiction and psychiatric diseases.
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Affiliation(s)
- Alexandra Vogel
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Timo Ueberbach
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Annett Wilken-Schmitz
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Lisa Hahnefeld
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Luisa Franck
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Marc-Philipp Weyer
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Tassilo Jungenitz
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Tobias Schmid
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Partner Site Frankfurt, German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Giulia Buchmann
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Florian Freudenberg
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University Hospital, Frankfurt, Germany
| | - Ralf P Brandes
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Robert Gurke
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Stephan W Schwarzacher
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Thomas Mittmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Irmgard Tegeder
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany.
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Kuderava Z, Kozar M, Visnovcova Z, Ferencova N, Tonhajzerova I, Prsova L, Zibolen M. Sympathetic nervous system activity and pain-related response indexed by electrodermal activity during the earliest postnatal life in healthy term neonates. Physiol Res 2023; 72:393-401. [PMID: 37449751 PMCID: PMC10668994 DOI: 10.33549/physiolres.935061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/16/2023] [Indexed: 08/26/2023] Open
Abstract
Sympathetic nervous system (SNS) undergoes a prolonged period of fetal and neonatal development and maturation during which is vulnerable to a variety of influences (e.g. painful experiences). Thus, we aimed to evaluate SNS activity at rest and in response to stressful stimulus (pain) within the earliest postnatal life in healthy term neonates using electrodermal activity (EDA) measures. In twenty eutrophic healthy term neonates EDA was recorded within the first two hours after birth (measurement 1 - M1) and 72 h after birth (measurement 2 - M2) at rest and in response to pain (M1 - intramuscular K vitamin administration; M2 - heel stick). Evaluated parameters were skin conductance level (SCL), non-specific skin conductance responses (NS.SCRs), skin SCL 10 s before pain stimulus (SCL_10 before pain), skin conductance response (SCR) peak after pain stimulus, SCL 10 s after pain stimulus (SCL_10 after pain), SCR magnitude, latency, SCR rise/decline time, SCR half recovery time. SCL was significantly decreased at rest during M2 compared to M1 (p=0.010). SCL_10 before pain, SCR peak after pain, and SCL_10 after pain stimulus were significantly decreased in M2 compared to M1 (p=0.014, p=0.020, p=0.011, respectively). SCL was significantly decreased and NS.SCRs were significantly higher in the recovery period after the pain stimulus during M2 compared to M1 (p=0.015, p=0.032, respectively). Our results indicate EDA parameters sensitive to detect sympathetic changes during the earliest postnatal life reflecting its potential in early diagnosis of the autonomic maturation - linked pathological states in neonates.
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Affiliation(s)
- Z Kuderava
- Department of Neonatology, University Hospital in Martin and Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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Xu Y, Moulding D, Jin W, Beggs S. Microglial phagocytosis mediates long-term restructuring of spinal GABAergic circuits following early life injury. Brain Behav Immun 2023; 111:127-137. [PMID: 37037363 DOI: 10.1016/j.bbi.2023.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
Peripheral injury during the early postnatal period alters the somatosensory system, leading to behavioural hyperalgesia upon re-injury in adulthood. Spinal microglia have been implicated as the cellular mediators of this phenomenon, but the mechanism is unclear. We hypothesised that neonatal injury (1) alters microglial phagocytosis of synapses in the dorsal horn leading to long-term structural changes in neurons, and/or (2) trains microglia, leading to a stronger microglial response after re-injury in adulthood. Using hindpaw surgical incision as a model we showed that microglial density and phagocytosis increased in the dorsal horn region innervated by the hindpaw. Dorsal horn microglia increased engulfment of synapses following injury, with a preference for those expressing the vesicular GABA transporter VGAT and primary afferent A-fibre terminals in neonates. This led to a long-term reduction of VGAT density in the dorsal horn and reduced microglial phagocytosis of VGLUT2 terminals. We also saw an increase in apoptosis following neonatal injury, which was not limited to the dorsal horn suggesting that larger circuit wide changes are happening. In adults, hindpaw incision increased microglial engulfment of predominantly VGAT synapses but did not alter the engulfment of A-fibres. This engulfment was not affected by prior neonatal injury, suggesting that microglial phagocytosis was not trained. These results highlight microglial phagocytosis in the dorsal horn as an important physiological response towards peripheral injury with potential long-term consequences and reveals differences in microglial responses between neonates and adults.
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Affiliation(s)
- Yajing Xu
- University College London, United Kingdom
| | - Dale Moulding
- University College London, United Kingdom; UCL GOS Institute of Child Health, United Kingdom
| | | | - Simon Beggs
- University College London, United Kingdom; UCL GOS Institute of Child Health, United Kingdom.
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Symons FJ, Burkitt CC, Wilcox G, McAdams B, Crabb GW, Kennedy WR. Modifying quantitative sensory testing to investigate behavioral reactivity in a pediatric global developmental delay sample: Relation to peripheral innervation and chronic pain outcomes. Dev Psychobiol 2022; 64:e22329. [PMID: 36426784 PMCID: PMC9708098 DOI: 10.1002/dev.22329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Early tactile and nociceptive (pain) mechanisms in children with global developmental delay at risk for intellectual and developmental disability are not well understood. Sixteen children with global developmental delay (mean age = 5.1 years, SD = 1.4; 50% male) completed a modified quantitative sensory testing (mQST) protocol, an epidermal (skin) punch biopsy procedure, and parent-endorsed measures of pain. Children with reported chronic pain had significantly greater epidermal nerve fiber density (ENFd) compared to children without chronic pain. Based on the mQST trials, ENFd values were associated with increased vocal reactivity overall and specifically during the light touch and cool thermal stimulus trials. The findings support the feasibility of an integrative biobehavioral approach to test nociceptive and tactile peripheral innervation and behavioral reactivity during a standardized sensory test in a high-risk sample for which there is often sensory dysfunction and adaptive behavior impairments.
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Affiliation(s)
- Frank J. Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
| | - Chantel C. Burkitt
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
- Gillette Children’s Specialty Healthcare, Saint Paul, MN
| | - George Wilcox
- Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Brian McAdams
- Department of Dermatology, University of Minnesota, Minneapolis, MN
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de Kort AR, Joosten EA, Patijn J, Tibboel D, van den Hoogen NJ. Selective Targeting of Serotonin 5-HT1a and 5-HT3 Receptors Attenuates Acute and Long-Term Hypersensitivity Associated With Neonatal Procedural Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:872587. [PMID: 35571143 PMCID: PMC9091564 DOI: 10.3389/fpain.2022.872587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Neonatal painful procedures causes acute pain and trigger long-term changes in nociceptive processing and anxiety behavior, highlighting the need for adequate analgesia during this critical time. Spinal serotonergic receptors 5-HT1a and 5-HT3 play an important role in modulating incoming nociceptive signals in neonates. The current study aims to attenuate acute and long-term hypersensitivity associated with neonatal procedural pain using ondansetron (a 5-HT3 antagonist) and buspirone (a 5-HT1a agonist) in a well-established rat model of repetitive needle pricking. Sprague-Dawley rat pups of both sexes received ondansetron (3 mg/kg), buspirone (3 mg/kg) or saline prior to repetitive needle pricks into the left hind-paw from postnatal day 0-7. Control animals received tactile stimulation or were left undisturbed. Acute, long-term, and post-operative mechanical sensitivity as well as adult anxiety were assessed. Neonatal 5-HT1a receptor agonism completely reverses acute hypersensitivity from P0-7. The increased duration of postoperative hypersensitivity after re-injury in adulthood is abolished by 5-HT3 receptor antagonism during neonatal repetitive needle pricking, without affecting baseline sensitivity. Moreover, 5-HT1a and 5-HT3 receptor modulation decreases adult state anxiety. Altogether, our data suggests that targeted pharmacological treatment based on the modulation of spinal serotonergic network via the 5-HT1a and 5-HT3 receptors in neonates may be of use in treatment of neonatal procedural pain and its long-term consequences. This may result in a new mechanism-based therapeutic venue in treatment of procedural pain in human neonates.
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Affiliation(s)
- Anne R. de Kort
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Jacob Patijn
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Nynke J. van den Hoogen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Comparative Biology and Experimental Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Jones L, Verriotis M, Cooper RJ, Laudiano-Dray MP, Rupawala M, Meek J, Fabrizi L, Fitzgerald M. Widespread nociceptive maps in the human neonatal somatosensory cortex. eLife 2022; 11:71655. [PMID: 35451960 PMCID: PMC9090328 DOI: 10.7554/elife.71655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Topographic cortical maps are essential for spatial localisation of sensory stimulation and generation of appropriate task-related motor responses. Somatosensation and nociception are finely mapped and aligned in the adult somatosensory (S1) cortex, but in infancy, when pain behaviour is disorganised and poorly directed, nociceptive maps may be less refined. We compared the topographic pattern of S1 activation following noxious (clinically required heel lance) and innocuous (touch) mechanical stimulation of the same skin region in newborn infants (n = 32) using multioptode functional near-infrared spectroscopy (fNIRS). Within S1 cortex, touch and lance of the heel elicit localised, partially overlapping increases in oxygenated haemoglobin concentration (Δ[HbO]), but while touch activation was restricted to the heel area, lance activation extended into cortical hand regions. The data reveals a widespread cortical nociceptive map in infant S1, consistent with their poorly directed pain behaviour.
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Affiliation(s)
- Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Madeleine Verriotis
- Department of Developmental Neuroscience, University College London, London, United Kingdom
| | - Robert J Cooper
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Mohammed Rupawala
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
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San Martín VP, Sazo A, Utreras E, Moraga-Cid G, Yévenes GE. Glycine Receptor Subtypes and Their Roles in Nociception and Chronic Pain. Front Mol Neurosci 2022; 15:848642. [PMID: 35401105 PMCID: PMC8984470 DOI: 10.3389/fnmol.2022.848642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 01/23/2023] Open
Abstract
Disruption of the inhibitory control provided by the glycinergic system is one of the major mechanisms underlying chronic pain. In line with this concept, recent studies have provided robust proof that pharmacological intervention of glycine receptors (GlyRs) restores the inhibitory function and exerts anti-nociceptive effects on preclinical models of chronic pain. A targeted regulation of the glycinergic system requires the identification of the GlyR subtypes involved in chronic pain states. Nevertheless, the roles of individual GlyR subunits in nociception and in chronic pain are yet not well defined. This review aims to provide a systematic outline on the contribution of GlyR subtypes in chronic pain mechanisms, with a particular focus on molecular pathways of spinal glycinergic dis-inhibition mediated by post-translational modifications at the receptor level. The current experimental evidence has shown that phosphorylation of synaptic α1β and α3β GlyRs are involved in processes of spinal glycinergic dis-inhibition triggered by chronic inflammatory pain. On the other hand, the participation of α2-containing GlyRs and of β subunits in pain signaling have been less studied and remain undefined. Although many questions in the field are still unresolved, future progress in GlyR research may soon open new exciting avenues into understanding and controlling chronic pain.
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Affiliation(s)
- Victoria P. San Martín
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
- Millennium Nucleus for the Study of Pain (MiNuSPain), Santiago, Chile
| | - Anggelo Sazo
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
- Millennium Nucleus for the Study of Pain (MiNuSPain), Santiago, Chile
| | - Elías Utreras
- Millennium Nucleus for the Study of Pain (MiNuSPain), Santiago, Chile
- Department of Biology, Faculty of Science, Universidad de Chile, Santiago, Chile
| | - Gustavo Moraga-Cid
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
- Millennium Nucleus for the Study of Pain (MiNuSPain), Santiago, Chile
| | - Gonzalo E. Yévenes
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
- Millennium Nucleus for the Study of Pain (MiNuSPain), Santiago, Chile
- *Correspondence: Gonzalo E. Yévenes,
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Marchal A, Melchior M, Dufour A, Poisbeau P, Zores C, Kuhn P. Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121081. [PMID: 34943277 PMCID: PMC8700556 DOI: 10.3390/children8121081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 04/12/2023]
Abstract
Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the "Douleur Aigue du Nouveau-né" (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.
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Affiliation(s)
- Audrey Marchal
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
| | - Meggane Melchior
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA, CNRS UMR-7364), Centre National de la Recherche Scientifique, Université de Strasbourg, 67000 Strasbourg, France;
| | - Pierrick Poisbeau
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
| | - Claire Zores
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA, CNRS UMR-7364), Centre National de la Recherche Scientifique, Université de Strasbourg, 67000 Strasbourg, France;
| | - Pierre Kuhn
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
- Correspondence: ; Tel.: +33-388127779
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12
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Walker SM, Malkmus S, Eddinger K, Steinauer J, Roberts AJ, Shubayev VI, Grafe MR, Powell SB, Yaksh TL. Evaluation of neurotoxicity and long-term function and behavior following intrathecal 1 % 2-chloroprocaine in juvenile rats. Neurotoxicology 2021; 88:155-167. [PMID: 34801587 DOI: 10.1016/j.neuro.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 01/20/2023]
Abstract
Spinally-administered local anesthetics provide effective perioperative anesthesia and/or analgesia for children of all ages. New preparations and drugs require preclinical safety testing in developmental models. We evaluated age-dependent efficacy and safety following 1 % preservative-free 2-chloroprocaine (2-CP) in juvenile Sprague-Dawley rats. Percutaneous lumbar intrathecal 2-CP was administered at postnatal day (P)7, 14 or 21. Mechanical withdrawal threshold pre- and post-injection evaluated the degree and duration of sensory block, compared to intrathecal saline and naive controls. Tissue analyses one- or seven-days following injection included histopathology of spinal cord, cauda equina and brain sections, and quantification of neuronal apoptosis and glial reactivity in lumbar spinal cord. Following intrathecal 2-CP or saline at P7, outcomes assessed between P30 and P72 included: spinal reflex sensitivity (hindlimb thermal latency, mechanical threshold); social approach (novel rat versus object); locomotor activity and anxiety (open field with brightly-lit center); exploratory behavior (rearings, holepoking); sensorimotor gating (acoustic startle, prepulse inhibition); and learning (Morris Water Maze). Maximum tolerated doses of intrathecal 2-CP varied with age (1.0 μL/g at P7, 0.75 μL/g at P14, 0.5 μL/g at P21) and produced motor and sensory block for 10-15 min. Tissue analyses found no significant differences across intrathecal 2-CP, saline or naïve groups. Adult behavioral measures showed expected sex-dependent differences, that did not differ between 2-CP and saline groups. Single maximum tolerated in vivo doses of intrathecal 2-CP produced reversible spinal anesthesia in juvenile rodents without detectable evidence of developmental neurotoxicity. Current results cannot be extrapolated to repeated dosing or prolonged infusion.
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Affiliation(s)
- Suellen M Walker
- Department of Anesthesiology, University of California San Diego, CA, USA; Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health and Department of Anaesthesia and Pain Medicine, Great Ormond St Hospital Foundation Trust, London, United Kingdom.
| | - Shelle Malkmus
- Department of Anesthesiology, University of California San Diego, CA, USA
| | - Kelly Eddinger
- Department of Anesthesiology, University of California San Diego, CA, USA
| | - Joanne Steinauer
- Department of Anesthesiology, University of California San Diego, CA, USA
| | - Amanda J Roberts
- Animal Models Core, Scripps Research Institute, La Jolla, CA, USA
| | - Veronica I Shubayev
- Department of Anesthesiology, University of California San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Marjorie R Grafe
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Susan B Powell
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Tony L Yaksh
- Department of Anesthesiology, University of California San Diego, CA, USA
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13
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Gomes CI, Barr GA. Local injury and systemic infection in infants alter later nociception and pain affect during early life and adulthood. Brain Behav Immun Health 2021; 9:100175. [PMID: 34589906 PMCID: PMC8474633 DOI: 10.1016/j.bbih.2020.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/25/2022] Open
Abstract
Newborns in intensive care are regularly exposed to minor painful procedures at developmental time points when noxious stimulation would be normally absent. Pain from these interventions is inconsistently treated and often exists concurrently with systemic infection, a common comorbidity of prematurity. Our understanding of the independent and combined effects of early painful experiences and infection on pain response is incomplete. The main goals of this research therefore were to understand how pain and infection experienced early in life influence future nociceptive and affective responses to painful stimuli. Rat pups were infected with E-coli on postnatal day 2 (PN2) and had left hind paw injury with carrageenan on PN3. Standard thermal tests for acute pain, formalin tests for inflammatory pain, and conditioned place aversion testing were performed at different ages to assess the nociceptive and affective components of the pain response. Early E-coli infection and early inflammatory injury with carrageenan both independently increased pain scores following hind paw reinjury with formalin on PN8, with effects persisting into adulthood in the carrageenan exposed group. When experienced concurrently, early E-coli infection and carrageenan exposure also increased conditioned aversion to pain in adults. Effect of sex was significant only in formalin testing, with males showing higher pain scores in infancy and females showing higher pain scores as adults. These findings demonstrate that infection experienced early in life can alter both the nociceptive and affective components of the pain response and that there is a cumulative effect of local and systemic pro-inflammatory processes on the aversive component of pain.
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Affiliation(s)
- Carly I Gomes
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Department of Psychology, University of Pennsylvania, 425 S. University Avenue, Stephen A. Levin Building, Philadelphia, PA, USA
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14
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Berthézène CD, Rabiller L, Jourdan G, Cousin B, Pénicaud L, Casteilla L, Lorsignol A. Tissue Regeneration: The Dark Side of Opioids. Int J Mol Sci 2021; 22:7336. [PMID: 34298954 PMCID: PMC8307464 DOI: 10.3390/ijms22147336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Abstract
Opioids are regarded as among the most effective analgesic drugs and their use for the management of pain is considered standard of care. Despite their systematic administration in the peri-operative period, their impact on tissue repair has been studied mainly in the context of scar healing and is only beginning to be documented in the context of true tissue regeneration. Indeed, in mammals, growing evidence shows that opioids direct tissue repair towards scar healing, with a loss of tissue function, instead of the regenerative process that allows for recovery of both the morphology and function of tissue. Here, we review recent studies that highlight how opioids may prevent a regenerative process by silencing nociceptive nerve activity and a powerful anti-inflammatory effect. These data open up new perspectives for inducing tissue regeneration and argue for opioid-restricted strategies for managing pain associated with tissue injury.
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Affiliation(s)
- Cécile Dromard Berthézène
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
| | - Lise Rabiller
- Alan Edwards Center for Research on Pain, Department of Physiology and Cell Information Systems, McGill University, Montreal, QC H3A 0G1, Canada;
| | - Géraldine Jourdan
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
| | - Béatrice Cousin
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
| | - Luc Pénicaud
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
| | - Louis Casteilla
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
| | - Anne Lorsignol
- RESTORE Research Center, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, 31000 Toulouse, France; (C.D.B.); (G.J.); (B.C.); (L.P.); (L.C.)
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15
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Tang J, Su Q, Zhang X, Qin W, Liu H, Liang M, Yu C. Brain Gene Expression Pattern Correlated with the Differential Brain Activation by Pain and Touch in Humans. Cereb Cortex 2021; 31:3506-3521. [PMID: 33693675 DOI: 10.1093/cercor/bhab028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
Genes involved in pain and touch sensations have been studied extensively, but very few studies have tried to link them with neural activities in the brain. Here, we aimed to identify genes preferentially correlated to painful activation patterns by linking the spatial patterns of gene expression of Allen Human Brain Atlas with the pain-elicited neural responses in the human brain, with a parallel, control analysis for identification of genes preferentially correlated to tactile activation patterns. We identified 1828 genes whose expression patterns preferentially correlated to painful activation patterns and 411 genes whose expression patterns preferentially correlated to tactile activation pattern at the cortical level. In contrast to the enrichment for astrocyte and inhibitory synaptic transmission of genes preferentially correlated to tactile activation, the genes preferentially correlated to painful activation were mainly enriched for neuron and opioid- and addiction-related pathways and showed significant overlap with pain-related genes identified in previous studies. These findings not only provide important evidence for the differential genetic architectures of specific brain activation patterns elicited by painful and tactile stimuli but also validate a new approach to studying pain- and touch-related genes more directly from the perspective of neural responses in the human brain.
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Affiliation(s)
- Jie Tang
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Qian Su
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for China, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Xue Zhang
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Wen Qin
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Huaigui Liu
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Meng Liang
- Tianjin Key Laboratory of Functional Imaging, School of Medical Imaging, Tianjin Medical University, Tianjin 300052, P.R. China
| | - Chunshui Yu
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, P.R. China
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16
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Salaün JP, Poirel N, Dahmani S, Chagnot A, Gakuba C, Ali C, Gérard JL, Hanouz JL, Orliaguet G, Vivien D. Preventing the Long-term Effects of General Anesthesia on the Developing Brain: How Translational Research can Contribute. Neuroscience 2021; 461:172-179. [PMID: 33675916 DOI: 10.1016/j.neuroscience.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
In 2017, the Food and Drug Administration published a safety recommendation to limit the exposure to general anesthesia as much as possible below the age of three. Indeed, several preclinical and clinical studies have questioned the possible toxicity of general anesthesia on the developing brain. Since then, recent clinical studies tried to mitigate this alarming issue. What is true, what is false? Contrary to some perceptions, the debate is not over yet. Only stronger translational research will allow scientists to provide concrete answers to this public health issue. In this review, we will provide and discuss the more recent data in this field, including the point of view of preclinical researchers, neuropsychologists and pediatric anesthesiologists. Through translational research, preclinical researchers have more than ever a role to play to better understand and identify long-term effects of general anesthesia for pediatric surgery on brain development in order to minimize it.
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Affiliation(s)
- Jean-Philippe Salaün
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14033, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen 14000, France.
| | - Nicolas Poirel
- Université de Paris, LaPsyDÉ, CNRS, F-75005 Paris, France; Institut Universitaire de France (IUF), Paris, France
| | - Souhayl Dahmani
- Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France; Paris Diderot University, 10 Avenue de Verdun, 75010 Paris, France; DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France
| | - Audrey Chagnot
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen 14000, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14033, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen 14000, France
| | - Carine Ali
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen 14000, France
| | - Jean-Louis Gérard
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14033, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14033, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP. Centre - Université de Paris, France; EA 7323 Université de Paris "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Paris, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen 14000, France; Department of Clinical Research, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14033, France
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17
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Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:47-87. [PMID: 33064998 DOI: 10.1016/s2352-4642(20)30277-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK; Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium.
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK; Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, AB, Canada
| | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Christine T Chambers
- Department of Psychology and Neuroscience, and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Geert Crombez
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Neil Schechter
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suellen M Walker
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Chantal Wood
- Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
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18
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Distinct Age-Dependent C Fiber-Driven Oscillatory Activity in the Rat Somatosensory Cortex. eNeuro 2020; 7:ENEURO.0036-20.2020. [PMID: 32759177 PMCID: PMC7545434 DOI: 10.1523/eneuro.0036-20.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
When skin afferents are activated, the sensory signals are transmitted to the spinal cord and eventually reach the primary somatosensory cortex (S1), initiating the encoding of the sensory percept in the brain. While subsets of primary afferents mediate specific somatosensory information from an early age, the subcortical pathways that transmit this information undergo striking changes over the first weeks of life, reflected in the gradual emergence of specific sensory behaviors. We therefore hypothesized that this period is associated with differential changes in the encoding of incoming afferent volleys in S1. To test this, we compared S1 responses to A fiber skin afferent stimulation and A + C skin afferent fiber stimulation in lightly anaesthetized male rats at postnatal day (P)7, P14, P21, and P30. Differences in S1 activity following A and A + C fiber stimulation changed dramatically over this period. At P30, A + C fiber stimulation evoked significantly larger γ, β, and α energy increases compared with A fiber stimulation alone. At younger ages, the changes in S1 oscillatory activity evoked by the two afferent volleys were not significantly different. Silencing TRPV1+ C fibers with QX-314 significantly reduced the γ and β S1 oscillatory energy increases evoked by A + C fibers, at P30 and P21, but not at younger ages. Thus, C fibers differentially modulate S1 oscillatory activity only from the third postnatal week, well after the functional maturation of the somatosensory cortex. This age-related change in afferent evoked S1 oscillatory activity may underpin the maturation of sensory discrimination in the developing brain.
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19
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Segelcke D, Reichl S, Neuffer S, Zapp S, Rüther T, Evers D, Zahn PK, Pogatzki-Zahn EM. The role of the spinal cyclooxygenase (COX) for incisional pain in rats at different developmental stages. Eur J Pain 2019; 24:312-324. [PMID: 31566273 DOI: 10.1002/ejp.1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cyclooxygenase enzymes (COX)-1 and COX-2 are important targets for pain relief after surgery, but the spinal contribution of both isoforms is still unclear, e.g., from a developmental point of view. Here, we studied changes of spinal COX-1 and COX-2 expression and their functional relevance in rats of different ages for pain-related behaviour after incision. METHODS Mechanical paw withdrawal thresholds (PWT) were assessed before and after incision and after intrathecal administration (IT) of SC-560 (COX-1 inhibitor) or NS-398 (COX-2 inhibitor) in rats aged 5, 14 and 28 days (P5, P14, P28). Furthermore, spinal expressions of COX m-RNA and proteins were investigated. RESULTS In P5 rats, only IT-administered NS-398 but not SC-560 significantly reversed the decreased PWT after incision. In P14 rats, none of the substance modified PWT, and in P28 rats, only SC-560 increased PWT. Spinal COX-2 mRNA and protein were increased in P5 but not in P14 and P28 rats after incision. Whereas COX-2 is located in spinal neurons, COX-1 is mainly found in spinal microglia cells. CONCLUSION Our results demonstrate a possible developmental transition from COX-2 to COX-1 activation. Whereas in adult rats spinal COX-1 but not COX-2 is involved in pain-related behaviour after incision, it seems opposite in P5 rats. Interestingly, in P14, neither COX-1 nor COX-2 seems to play a role. This switch may relate to altered neuronal/microglia activation. Our findings indicate specific mechanisms to pain after incision that are age-dependent and may guide further research improving paediatric pain management. SIGNIFICANCE Postoperative pain in pediatric patients after surgery is still poorly controlled; this might contribute to long-lasting alteration in the nociceptive system and prolonged chronic pain. Here we show a possible developmental switch in the COX-dependent pathway for nociceptive spinal transmission that may explain why pain management in young children needs to be related to age-dependent mechanisms.
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Affiliation(s)
- Daniel Segelcke
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Sylvia Reichl
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Simon Neuffer
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Sebastian Zapp
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Theresa Rüther
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Dagmar Evers
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University, BG-Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Department for Anesthesiology, Operative Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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20
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van den Hoogen NJ, de Kort AR, Allegaert KM, Joosten EA, Simons SHP, Tibboel D, van den Bosch GE. Developmental neurobiology as a guide for pharmacological management of pain in neonates. Semin Fetal Neonatal Med 2019; 24:101012. [PMID: 31221544 DOI: 10.1016/j.siny.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pain in newborn children should be prevented due to negative short- and long-term consequences. A good understanding of the development of the nociceptive system in newborns is necessary to enable optimal pain assessment, and most importantly to treat and prevent pain adequately in neonates. So far, preclinical juvenile animal studies have led to a tremendous amount of information regarding the development of the nociceptive system. In addition, they have made clear that the developmental stage of the nociceptive system may influence the mechanism of action of different classes of analgesics. Age specific analgesic therapy, based on post-menstrual age, should therefore be considered by incorporating information on the developmental stages of the nociceptive system in combination with knowledge from pharmacokinetic and -dynamic studies in neonates.
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Affiliation(s)
- Nynke J van den Hoogen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Anne R de Kort
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Karel M Allegaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Development and Regeneration, KU, Leuven, Leuven, Belgium
| | - Elbert A Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gerbrich E van den Bosch
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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21
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Repeated touch and needle-prick stimulation in the neonatal period increases the baseline mechanical sensitivity and postinjury hypersensitivity of adult spinal sensory neurons. Pain 2019. [PMID: 29528964 PMCID: PMC5959002 DOI: 10.1097/j.pain.0000000000001201] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neonatal abnormal noxious and tactile stimulations facilitate the activity of spinal neurons, which leads to an altered somatosensory and pain phenotype in adulthood. Noxious stimulation at critical stages of development has long-term consequences on somatosensory processing in later life, but it is not known whether this developmental plasticity is restricted to nociceptive pathways. Here, we investigate the effect of repeated neonatal noxious or innocuous hind paw stimulation on adult spinal dorsal horn cutaneous mechanical sensitivity. Neonatal Sprague-Dawley rats of both sexes received 4 unilateral left hind paw needle pricks (NPs, n = 13) or 4 tactile (cotton swab touch) stimuli, per day (TC, n = 11) for the first 7 days of life. Control pups were left undisturbed (n = 17). When adult (6-8 weeks), lumbar wide-dynamic-range neuron activity in laminae III-V was recorded using in vivo extracellular single-unit electrophysiology. Spike activity evoked by cutaneous dynamic tactile (brush), pinch and punctate (von Frey hair) stimulation, and plantar receptive field areas were recorded, at baseline and 2 and 5 days after left plantar hind paw incision. Baseline brush receptive fields, von Frey hair, and pinch sensitivity were significantly enhanced in adult NP and TC animals compared with undisturbed controls, although effects were greatest in NP rats. After incision, injury sensitivity of adult wide-dynamic-range neurons to both noxious and dynamic tactile hypersensitivity was significantly greater in NP animals compared with TC and undisturbed controls. We conclude that both repeated touch and needle-prick stimulation in the neonatal period can alter adult spinal sensory neuron sensitivity to both innocuous and noxious mechanical stimulation. Thus, spinal sensory circuits underlying touch and pain processing are shaped by a range of early-life somatosensory experiences.
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22
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Paediatric Pain Medicine: Pain Differences, Recognition and Coping Acute Procedural Pain in Paediatric Emergency Room. ACTA ACUST UNITED AC 2018; 54:medicina54060094. [PMID: 30486427 PMCID: PMC6306713 DOI: 10.3390/medicina54060094] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/01/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022]
Abstract
Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood. There are a variety of pain assessment tools for children and they should be chosen according to the patient’s age, developmental stage, communication skills, and medical condition. Psychological factors such as PER environment, preprocedural preparation, and parental involvement should also be considered. There are proven methods to reduce a patient’s pain and anxiety during different procedures in PER. Distraction techniques such as music, videogames, virtual reality, or simple talk about movies, friends, or hobbies as well as cutaneous stimulation, vibration, cooling sprays, or devices are effective to alleviate procedural pain and anxiety. A choice of distraction technique should be individualized, selecting children who could benefit from nonpharmacological pain treatment methods or tools. Nonpharmacological pain management may reduce dosage of pain medication or exclude pharmacological pain management. Most nonpharmacological treatment methods are cheap, easily accessible, and safe to use on every child, so it should always be a first choice when planning a patient’s care. The aim of this review is to provide a summary of paediatric pain features, along with their physiology, assessment, management, and to highlight the importance and efficacy of nonpharmacological pain management in an urgent paediatric care setting.
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23
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Kerui G, Jasmin L. Dual effects of brain sparing opioid in newborn rats: Analgesia and hyperalgesia. NEUROBIOLOGY OF PAIN 2018; 3:1-7. [PMID: 31194154 PMCID: PMC6550121 DOI: 10.1016/j.ynpai.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 01/16/2023]
Abstract
The peripherally acting opioid loperamide produces sustained antinociception in the newborn rat. Loperamide minimally crosses the blood brain barrier in the newborn rat. Daily systemic administration of loperamide produces opioid induced hyperalgesia in the newborn rat.
Effective pain management in neonates without the unwanted central nervous system (CNS) side effects remains an unmet need. To circumvent these central effects we tested the peripherally acting (brain sparing) opioid agonist loperamide in neonate rats. Our results show that: 1) loperamide (1 mg/kg, s.c.) does not affect the thermal withdrawal latency in the normal hind paw while producing antinociception in all pups with an inflamed hind paw. 2) A dose of loperamide 5 times higher resulted in only 6.9 ng/mL of loperamide in the cerebrospinal fluid (CSF), confirming that loperamide minimally crosses the blood–brain barrier (BBB). 3) Unexpectedly, sustained administration of loperamide for 5 days resulted in a hyperalgesic behavior, as well as increased excitability (sensitization) of dorsal root ganglia (DRGs) and spinal nociceptive neurons. This indicates that opioid induced hyperalgesia (OIH) can be induced through the peripheral nervous system. Unless prevented, OIH could in itself be a limiting factor in the use of brain sparing opioids in the neonate.
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Affiliation(s)
- Gong Kerui
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Luc Jasmin
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, United States
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24
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Tuulari JJ, Scheinin NM, Lehtola S, Merisaari H, Saunavaara J, Parkkola R, Sehlstedt I, Karlsson L, Karlsson H, Björnsdotter M. Neural correlates of gentle skin stroking in early infancy. Dev Cogn Neurosci 2017; 35:36-41. [PMID: 29241822 PMCID: PMC6968958 DOI: 10.1016/j.dcn.2017.10.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022] Open
Abstract
The infant brain is sensitive to gentle skin stroking within the first weeks of age. The postcentral gyrus and posterior insular cortex are responsive to stroking. Social touch activates both somatosensory and socio-affective brain areas in infancy.
Physical expressions of affection play a foundational role in early brain development, but the neural correlates of affective touch processing in infancy remain unclear. We examined brain responses to gentle skin stroking, a type of tactile stimulus associated with affectionate touch, in young infants. Thirteen term-born infants aged 11–36 days, recruited through the FinnBrain Birth Cohort Study, were included in the study. Soft brush strokes, which activate brain regions linked to somatosensory as well as socio-affective processing in children and adults, were applied to the skin of the right leg during functional magnetic resonance imaging. We examined infant brain responses in two regions-of-interest (ROIs) known to process gentle skin stroking – the postcentral gyrus and posterior insular cortex – and found significant responses in both ROIs. These results suggest that the neonate brain is responsive to gentle skin stroking within the first weeks of age, and that regions linked to primary somatosensory as well as socio-affective processing are activated. Our findings support the notion that social touch may play an important role in early life sensory processing. Future research will elucidate the significance of these findings for human brain development.
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Affiliation(s)
- Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Satu Lehtola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Turku PET Centre, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Isac Sehlstedt
- Center for Social and Affective Neuroscience, Linköping University, Sweden; Department of Psychology, University of Gothenburg, Sweden
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Malin Björnsdotter
- Center for Social and Affective Neuroscience, Linköping University, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
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Barney CC, Tervo R, Wilcox GL, Symons FJ. A Case-Controlled Investigation of Tactile Reactivity in Young Children With and Without Global Developmental Delay. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:409-421. [PMID: 28846038 DOI: 10.1352/1944-7558-122.5.409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessing tactile function among children with intellectual, motor, and communication impairments remains a clinical challenge. A case control design was used to test whether children with global developmental delays (GDD; n = 20) would be more/less reactive to a modified quantitative sensory test (mQST) compared to controls (n = 20). Reactivity was indexed by blinded behavioral coding across vocal, facial, and gross motor responses during the mQST. On average the children with GDD were significantly more reactive than controls to most tactile sensory modalities including light touch (p = .034), pin prick (p = .008), cool (p = .039), pressure (p = .037), and repeated von Frey (p = .003). The results suggest the mQST approach was feasible and highlights the GDD sample was more reactive than controls to a range of stimuli.
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Affiliation(s)
- Chantel C Barney
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - Raymond Tervo
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - George L Wilcox
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - Frank J Symons
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
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26
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The developmental emergence of differential brainstem serotonergic control of the sensory spinal cord. Sci Rep 2017; 7:2215. [PMID: 28533557 PMCID: PMC5440407 DOI: 10.1038/s41598-017-02509-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/12/2017] [Indexed: 12/29/2022] Open
Abstract
Descending connections from brainstem nuclei are known to exert powerful control of spinal nociception and pain behaviours in adult mammals. Here we present evidence that descending serotonergic fibres not only inhibit nociceptive activity, but also facilitate non-noxious tactile activity in the healthy adult rat spinal dorsal horn via activation of spinal 5-HT3 receptors (5-HT3Rs). We further show that this differential serotonergic control in the adult emerges from a non-modality selective system in young rats. Serotonergic fibres exert background 5-HT3R mediated facilitation of both tactile and nociceptive spinal activity in the first three postnatal weeks. Thus, differential descending serotonergic control of spinal touch and pain processing emerges in late postnatal life to allow flexible and context-dependent brain control of somatosensation.
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27
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Postnatal maturation of the spinal-bulbo-spinal loop: brainstem control of spinal nociception is independent of sensory input in neonatal rats. Pain 2016; 157:677-686. [PMID: 26574823 PMCID: PMC4751743 DOI: 10.1097/j.pain.0000000000000420] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The rostroventral medial medulla (RVM) is part of a rapidly acting spino-bulbo-spinal loop that is activated by ascending nociceptive inputs and drives descending feedback modulation of spinal nociception. In the adult rat, the RVM can facilitate or inhibit dorsal horn neuron inputs but in young animals descending facilitation dominates. It is not known whether this early life facilitation is part of a feedback loop. We hypothesized that the newborn RVM functions independently of sensory input, before the maturation of feedback control. We show here that noxious hind paw pinch evokes no fos activation in the RVM or the periaqueductal gray at postnatal day (P) 4 or P8, indicating a lack of nociceptive input at these ages. Significant fos activation was evident at P12, P21, and in adults. Furthermore, direct excitation of RVM neurons with microinjection of DL-homocysteic acid did not alter the net activity of dorsal horn neurons at P10, suggesting an absence of glutamatergic drive, whereas the same injections caused significant facilitation at P21. In contrast, silencing RVM neurons at P8 with microinjection of lidocaine inhibited dorsal horn neuron activity, indicating a tonic descending spinal facilitation from the RVM at this age. The results support the hypothesis that early life descending facilitation of spinal nociception is independent of sensory input. Since it is not altered by RVM glutamatergic receptor activation, it is likely generated by spontaneous brainstem activity. Only later in postnatal life can this descending activity be modulated by ascending nociceptive inputs in a functional spinal-bulbo-spinal loop.
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28
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Verriotis M, Chang P, Fitzgerald M, Fabrizi L. The development of the nociceptive brain. Neuroscience 2016; 338:207-219. [DOI: 10.1016/j.neuroscience.2016.07.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 12/20/2022]
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29
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Chang P, Fabrizi L, Olhede S, Fitzgerald M. The Development of Nociceptive Network Activity in the Somatosensory Cortex of Freely Moving Rat Pups. Cereb Cortex 2016; 26:4513-4523. [PMID: 27797835 PMCID: PMC5193146 DOI: 10.1093/cercor/bhw330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/02/2016] [Indexed: 12/13/2022] Open
Abstract
Cortical perception of noxious stimulation is an essential component of pain experience but it is not known how cortical nociceptive activity emerges during brain development. Here we use continuous telemetric electrocorticogram (ECoG) recording from the primary somatosensory cortex (S1) of awake active rat pups to map functional nociceptive processing in the developing brain over the first 4 weeks of life. Cross-sectional and longitudinal recordings show that baseline S1 ECoG energy increases steadily with age, with a distinctive beta component replaced by a distinctive theta component in week 3. Event-related potentials were evoked by brief noxious hindpaw skin stimulation at all ages tested, confirming the presence of functional nociceptive spinothalamic inputs in S1. However, hindpaw incision, which increases pain sensitivity at all ages, did not increase S1 ECoG energy until week 3. A significant increase in gamma (20–50 Hz) energy occurred in the presence of skin incision at week 3 accompanied by a longer-lasting increase in theta (4–8 Hz) energy at week 4. Continuous ECoG recording demonstrates specific postnatal functional stages in the maturation of S1 cortical nociception. Somatosensory cortical coding of an ongoing pain “state” in awake rat pups becomes apparent between 2 and 4 weeks of age.
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Affiliation(s)
- P Chang
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK.,Current address: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK
| | - L Fabrizi
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK
| | - S Olhede
- Department of Statistical Science, University College London, London WC1E6BT, UK
| | - M Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E6BT, UK
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30
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Fitzgerald M. What do we really know about newborn infant pain? Exp Physiol 2016; 100:1451-7. [PMID: 26446174 DOI: 10.1113/ep085134] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/05/2015] [Indexed: 02/03/2023]
Abstract
NEW FINDINGS What is the topic of this review? Pain in infancy. What advances does it highlight? New neurophysiological research on pain processing in the human infant brain. Increased awareness of pain in the newborn has led to the development of numerous assessment tools for use in neonatal intensive care units. Here, I argue that we still know too little about the neurophysiological basis for infant pain to interpret data from clinical observational measures. With increased understanding of how the neural activity and CNS connections that underlie pain behaviour and perception develop in the newborn will come better measurement and treatment of their pain. This review focuses upon two interconnected nociceptive circuits, the spinal cord dorsal horn and the somatosensory cortex in the brain, to highlight what we know and what we do not know about infant pain. The effectiveness of oral sucrose, widely used in clinical practice to relieve infant pain, is discussed as a specific example of what we do not know. This 'hot topic review' highlights the importance of new laboratory-based neurophysiological research for the treatment of newborn infant pain.
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Affiliation(s)
- Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, WC1E 6BT, UK
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31
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Hartley C, Moultrie F, Gursul D, Hoskin A, Adams E, Rogers R, Slater R. Changing Balance of Spinal Cord Excitability and Nociceptive Brain Activity in Early Human Development. Curr Biol 2016; 26:1998-2002. [PMID: 27374336 PMCID: PMC4985558 DOI: 10.1016/j.cub.2016.05.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/25/2016] [Accepted: 05/24/2016] [Indexed: 01/28/2023]
Abstract
In adults, nociceptive reflexes and behavioral responses are modulated by a network of brain regions via descending projections to the spinal dorsal horn [1]. Coordinated responses to noxious inputs manifest from a balance of descending facilitation and inhibition. In contrast, young infants display exaggerated and uncoordinated limb reflexes [2]. Our understanding of nociceptive processing in the infant brain has been advanced by the use of electrophysiological and hemodynamic imaging [3, 4, 5, 6]. From approximately 35 weeks’ gestation, nociceptive-specific patterns of brain activity emerge [7], whereas prior to this, non-specific bursts of activity occur in response to noxious, tactile, visual, and auditory stimulation [7, 8, 9, 10]. During the preterm period, refinement of spinal cord excitability is also observed: reflex duration shortens, response threshold increases, and improved discrimination between tactile and noxious events occurs [2, 11, 12]. However, the development of descending modulation in human infants remains relatively unexplored. In 40 infants aged 28–42 weeks’ gestation, we examined the relationship between nociceptive brain activity and spinal reflex withdrawal activity in response to a clinically essential noxious procedure. Nociceptive-specific brain activity increases in magnitude with gestational age, whereas reflex withdrawal activity decreases in magnitude, duration, and latency across the same developmental period. By recording brain and spinal cord activity in the same infants, we demonstrate that the maturation of nociceptive brain activity is concomitant with the refinement of noxious-evoked limb reflexes. We postulate that, consistent with studies in animals, infant reflexes are influenced by the development of top-down inhibitory modulation from maturing subcortical and cortical brain networks. Noxious-evoked brain activity increases in magnitude across the preterm period Maturation of nociceptive brain activity coincides with reflex activity refinement This may relate to the emergence of top-down inhibition in human infants
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Affiliation(s)
- Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Deniz Gursul
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Amy Hoskin
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Richard Rogers
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK.
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32
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Mermet-Joret N, Chatila N, Pereira B, Monconduit L, Dallel R, Antri M. Lamina specific postnatal development of PKCγ interneurons within the rat medullary dorsal horn. Dev Neurobiol 2016; 77:102-119. [PMID: 27346325 DOI: 10.1002/dneu.22414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 01/17/2023]
Abstract
Protein kinase C gamma (PKCγ) interneurons, located in the superficial spinal (SDH) and medullary dorsal horns (MDH), have been shown to play a critical role in cutaneous mechanical hypersensitivity. However, a thorough characterization of their development in the MDH is lacking. Here, it is shown that the number of PKCγ-ir interneurons changes from postnatal day 3 (P3) to P60 (adult) and such developmental changes differ according to laminae. PKCγ-ir interneurons are already present at P3-5 in laminae I, IIo, and III. In lamina III, they then decrease from P11-P15 to P60. Interestingly, PKCγ-ir interneurons appear only at P6 in lamina IIi, and they conversely increase to reach adult levels at P11-15. Analysis of neurogenesis using bromodeoxyuridine (BrdU) does not detect any PKCγ-BrdU double-labeling in lamina IIi. Quantification of the neuronal marker, NeuN, reveals a sharp neuronal decline (∼50%) within all superficial MDH laminae during early development (P3-15), suggesting that developmental changes in PKCγ-ir interneurons are independent from those of other neurons. Finally, neonatal capsaicin treatment, which produces a permanent loss of most unmyelinated afferent fibers, has no effect on the development of PKCγ-ir interneurons. Together, the results show that: (i) the expression of PKCγ-ir interneurons in MDH is developmentally regulated with a critical period at P11-P15, (ii) PKCγ-ir interneurons are developmentally heterogeneous, (iii) lamina IIi PKCγ-ir interneurons appear less vulnerable to cell death, and (iv) postnatal maturation of PKCγ-ir interneurons is due to neither neurogenesis, nor neuronal migration, and is independent of C-fiber development. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 102-119, 2017.
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Affiliation(s)
- Noemie Mermet-Joret
- Neuro-Dol, Clermont Université, Université D'Auvergne, BP 10448, F-63000, Clermont-Ferrand & Inserm U1107, Clermont-Ferrand, F-63100, France
| | - Nadwa Chatila
- Neuro-Dol, Clermont Université, Université D'Auvergne, BP 10448, F-63000, Clermont-Ferrand & Inserm U1107, Clermont-Ferrand, F-63100, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, F-63100, France
| | - Lénaic Monconduit
- Neuro-Dol, Clermont Université, Université D'Auvergne, BP 10448, F-63000, Clermont-Ferrand & Inserm U1107, Clermont-Ferrand, F-63100, France
| | - Radhouane Dallel
- Neuro-Dol, Clermont Université, Université D'Auvergne, BP 10448, F-63000, Clermont-Ferrand & Inserm U1107, Clermont-Ferrand, F-63100, France.,Service D'Odontologie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63000, France
| | - Myriam Antri
- Neuro-Dol, Clermont Université, Université D'Auvergne, BP 10448, F-63000, Clermont-Ferrand & Inserm U1107, Clermont-Ferrand, F-63100, France
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33
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Juif PE, Salio C, Zell V, Melchior M, Lacaud A, Petit-Demouliere N, Ferrini F, Darbon P, Hanesch U, Anton F, Merighi A, Lelièvre V, Poisbeau P. Peripheral and central alterations affecting spinal nociceptive processing and pain at adulthood in rats exposed to neonatal maternal deprivation. Eur J Neurosci 2016; 44:1952-62. [DOI: 10.1111/ejn.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Pierre-Eric Juif
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Chiara Salio
- Department of Veterinary Sciences; Università degli Studi di Torino; Torino Italy
| | - Vivien Zell
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Meggane Melchior
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Adrien Lacaud
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Nathalie Petit-Demouliere
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Francesco Ferrini
- Department of Veterinary Sciences; Università degli Studi di Torino; Torino Italy
| | - Pascal Darbon
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Ulrike Hanesch
- Laboratory of Neurophysiology and Psychobiology; University of Luxembourg; Luxembourg Luxembourg
| | - Fernand Anton
- Laboratory of Neurophysiology and Psychobiology; University of Luxembourg; Luxembourg Luxembourg
| | - Adalberto Merighi
- Department of Veterinary Sciences; Università degli Studi di Torino; Torino Italy
| | - Vincent Lelièvre
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
| | - Pierrick Poisbeau
- Institute of Cellular and Integrative Neurosciences (INCI); Centre National de la Recherche Scientifique; University of Strasbourg; 5 Rue Blaise Pascal F-67084 Strasbourg France
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Dusing SC. Postural variability and sensorimotor development in infancy. Dev Med Child Neurol 2016; 58 Suppl 4:17-21. [PMID: 27027603 DOI: 10.1111/dmcn.13045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2015] [Indexed: 11/27/2022]
Abstract
Infants develop skills through a coupling between their sensory and motor systems. Newborn infants must interpret sensory information and use it to modify movements and organize the postural control system based on the task demands. This paper starts with a brief review of evidence on the use of sensory information in the first months of life, and describes the importance of movement variability and postural control in infancy. This introduction is followed by a review of the evidence for the interactions between the sensory, motor, and postural control systems in typically development infants. The paper highlights the ability of young infants to use sensory information to modify motor behaviors and learn from their experiences. Last, the paper highlights evidence of atypical use of sensory, motor, and postural control in the first months of life in infants who were born preterm, with neonatal brain injury or later diagnosed with cerebral palsy (CP).
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Affiliation(s)
- Stacey C Dusing
- Motor Development Lab, Department of Physical Therapy, Department of Pediatrics, Children's Hospital of Richmond, Virginia Leadership Education in Neurodevelopmental Disabilities Program, Virginia Commonwealth University, Richmond, VA, USA
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35
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Hartley C, Goksan S, Poorun R, Brotherhood K, Mellado GS, Moultrie F, Rogers R, Adams E, Slater R. The relationship between nociceptive brain activity, spinal reflex withdrawal and behaviour in newborn infants. Sci Rep 2015; 5:12519. [PMID: 26228435 PMCID: PMC4521152 DOI: 10.1038/srep12519] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022] Open
Abstract
Measuring infant pain is complicated by their inability to describe the experience. While nociceptive brain activity, reflex withdrawal and facial grimacing have been characterised, the relationship between these activity patterns has not been examined. As cortical and spinally mediated activity is developmentally regulated, it cannot be assumed that they are predictive of one another in the immature nervous system. Here, using a new experimental paradigm, we characterise the nociceptive-specific brain activity, spinal reflex withdrawal and behavioural activity following graded intensity noxious stimulation and clinical heel lancing in 30 term infants. We show that nociceptive-specific brain activity and nociceptive reflex withdrawal are graded with stimulus intensity (p < 0.001), significantly correlated (r = 0.53, p = 0.001) and elicited at an intensity that does not evoke changes in clinical pain scores (p = 0.55). The strong correlation between reflex withdrawal and nociceptive brain activity suggests that movement of the limb away from a noxious stimulus is a sensitive indication of nociceptive brain activity in term infants. This could underpin the development of new clinical pain assessment measures.
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Affiliation(s)
| | - Sezgi Goksan
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | - Ravi Poorun
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | | | | | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, OX3 9DU, UK
| | - Richard Rogers
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, OX3 9DU, UK
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, OX3 9DU, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, OX3 9DU, UK
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Beggs S. Long-Term Consequences of Neonatal Injury. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:176-80. [PMID: 26174217 PMCID: PMC4459244 DOI: 10.1177/070674371506000404] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/01/2014] [Indexed: 12/30/2022]
Abstract
The maturation of the central nervous system's (CNS's) sensory connectivity is driven by modality-specific sensory input in early life. For the somatosensory system, this input is the physical, tactile interaction with the environment. Nociceptive circuitry is functioning at the time of birth; however, there is still considerable organization and refinement of this circuitry that occurs postnatally, before full discrimination of tactile and noxious input is possible. This fine-tuning involves separation of tactile and nociceptive afferent input to the spinal cord's dorsal horn and the maturation of local and descending inhibitory circuitry. Disruption of that input in early postnatal life (for example, by tissue injury or other noxious stimulus), can have a profound influence on subsequent development, and consequently the mature functioning of pain systems. In this review, the impact of neonatal surgical incision on nociceptive circuitry is discussed in terms of the underlying developmental neurobiology. The changes are complex, occurring at multiple anatomical sites within the CNS, and including both neuronal and glial cell populations. The altered sensory input from neonatal injury selectively modulates neuronal excitability within the spinal cord, disrupts inhibitory control, and primes the immune system, all of which contribute to the adverse long-term consequences of early pain exposure.
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Affiliation(s)
- Simon Beggs
- Research Associate, Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario; Assistant Professor, Faculty of Dentistry, University of Toronto, Toronto, Ontario
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37
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Schwaller F, Fitzgerald M. The consequences of pain in early life: injury-induced plasticity in developing pain pathways. Eur J Neurosci 2014; 39:344-52. [PMID: 24494675 PMCID: PMC4264936 DOI: 10.1111/ejn.12414] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 12/14/2022]
Abstract
Pain in infancy influences pain reactivity in later life, but how and why this occurs is poorly understood. Here we review the evidence for developmental plasticity of nociceptive pathways in animal models and discuss the peripheral and central mechanisms that underlie this plasticity. Adults who have experienced neonatal injury display increased pain and injury-induced hyperalgesia in the affected region but mild injury can also induce widespread baseline hyposensitivity across the rest of the body surface, suggesting the involvement of several underlying mechanisms, depending upon the type of early life experience. Peripheral nerve sprouting and dorsal horn central sensitization, disinhibition and neuroimmune priming are discussed in relation to the increased pain and hyperalgesia, while altered descending pain control systems driven, in part, by changes in the stress/HPA axis are discussed in relation to the widespread hypoalgesia. Finally, it is proposed that the endocannabinoid system deserves further attention in the search for mechanisms underlying injury-induced changes in pain processing in infants and children.
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Affiliation(s)
- Fred Schwaller
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
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Abstract
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
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Jankowski MP, Ross JL, Weber JD, Lee FB, Shank AT, Hudgins RC. Age-dependent sensitization of cutaneous nociceptors during developmental inflammation. Mol Pain 2014; 10:34. [PMID: 24906209 PMCID: PMC4059454 DOI: 10.1186/1744-8069-10-34] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/22/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND It is well-documented that neonates can experience pain after injury. However, the contribution of individual populations of sensory neurons to neonatal pain is not clearly understood. Here we characterized the functional response properties and neurochemical phenotypes of single primary afferents after injection of carrageenan into the hairy hindpaw skin using a neonatal ex vivo recording preparation. RESULTS During normal development, we found that individual afferent response properties are generally unaltered. However, at the time period in which some sensory neurons switch their neurotrophic factor responsiveness, we observe a functional switch in slowly conducting, broad spiking fibers ("C"-fiber nociceptors) from mechanically sensitive and thermally insensitive (CM) to polymodal (CPM). Cutaneous inflammation induced prior to this switch (postnatal day 7) specifically altered mechanical and heat responsiveness, and heat thresholds in fast conducting, broad spiking ("A"-fiber) afferents. Furthermore, hairy skin inflammation at P7 transiently delayed the functional shift from CM to CPM. Conversely, induction of cutaneous inflammation after the functional switch (at P14) caused an increase in mechanical and thermal responsiveness exclusively in the CM and CPM neurons. Immunocytochemical analysis showed that inflammation at either time point induced TRPV1 expression in normally non-TRPV1 expressing CPMs. Realtime PCR and western blotting analyses revealed that specific receptors/channels involved in sensory transduction were differentially altered in the DRGs depending on whether inflammation was induced prior to or after the functional changes in afferent prevalence. CONCLUSION These data suggest that the mechanisms of neonatal pain development may be generated by different afferent subtypes and receptors/channels in an age-related manner.
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Affiliation(s)
- Michael P Jankowski
- Department of Anesthesia, Division of Pain Management, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 6016, Cincinnati, OH 45229, USA.
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40
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Abstract
Spontaneous activity is known to be essential for the proper formation of sensory networks in the developing CNS. This activity can be produced by a variety of mechanisms including the presence of "pacemaker" neurons, which can be defined by their intrinsic ability to generate rhythmic bursts of action potential discharge. Recent work has identified pacemaker activity within lamina I of the neonatal rodent spinal cord that emerges from a complex interaction between voltage-dependent and voltage-independent ("leak") ionic conductances, including an important modulatory role for the inward-rectifying K(+) (Kir) channels. The available evidence suggests that lamina I pacemakers are glutamatergic and project extensively throughout the dorsal-ventral axis of the spinal cord, although the identity of their postsynaptic targets has yet to be elucidated. A better understanding of this connectivity could yield valuable insight into the role of the lamina I pacemaker population in the maturation of spinal circuitry underlying nociceptive processing and/or sensorimotor integration.
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Affiliation(s)
- Mark L Baccei
- Pain Research Center, Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
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41
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de Lalouvière LLH, Ioannou Y, Fitzgerald M. Neural mechanisms underlying the pain of juvenile idiopathic arthritis. Nat Rev Rheumatol 2014; 10:205-11. [DOI: 10.1038/nrrheum.2014.4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cornelissen L, Fabrizi L, Patten D, Worley A, Meek J, Boyd S, Slater R, Fitzgerald M. Postnatal temporal, spatial and modality tuning of nociceptive cutaneous flexion reflexes in human infants. PLoS One 2013; 8:e76470. [PMID: 24124564 PMCID: PMC3790695 DOI: 10.1371/journal.pone.0076470] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/28/2013] [Indexed: 12/22/2022] Open
Abstract
Cutaneous flexion reflexes are amongst the first behavioural responses to develop and are essential for the protection and survival of the newborn organism. Despite this, there has been no detailed, quantitative study of their maturation in human neonates. Here we use surface electromyographic (EMG) recording of biceps femoris activity in preterm (<37 weeks gestation, GA) and term (≥ 37 weeks GA) human infants, less than 14 days old, in response to tactile, punctate and clinically required skin-breaking lance stimulation of the heel. We show that all infants display a robust and long duration flexion reflex (>4 seconds) to a single noxious skin lance which decreases significantly with gestational age. This reflex is not restricted to the stimulated limb: heel lance evokes equal ipsilateral and contralateral reflexes in preterm and term infants. We further show that infant flexion withdrawal reflexes are not always nociceptive specific: in 29% of preterm infants, tactile stimulation evokes EMG activity that is indistinguishable from noxious stimulation. In 40% of term infants, tactile responses are also present but significantly smaller than nociceptive reflexes. Infant flexion reflexes are also evoked by application of calibrated punctate von Frey hairs (vFh), 0.8-17.2 g, to the heel. Von Frey hair thresholds increase significantly with gestational age and the magnitude of vFh evoked reflexes are significantly greater in preterm than term infants. Furthermore flexion reflexes in both groups are sensitized by repeated vFh stimulation. Thus human infant flexion reflexes differ in temporal, modality and spatial characteristics from those in adults. Reflex magnitude and tactile sensitivity decreases and nociceptive specificity and spatial organisation increases with gestational age. Strong, relatively non-specific, reflex sensitivity in early life may be important for driving postnatal activity dependent maturation of targeted spinal cord sensory circuits.
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Affiliation(s)
- Laura Cornelissen
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - Deborah Patten
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - Alan Worley
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College Hospital, London, United Kingdom
| | - Stewart Boyd
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Rebeccah Slater
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
- * E-mail:
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43
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Stein PSG. Molecular, genetic, cellular, and network functions in the spinal cord and brainstem. Ann N Y Acad Sci 2013; 1279:1-12. [PMID: 23530997 DOI: 10.1111/nyas.12083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies of the model systems of spinal cord and brainstem reveal molecular, genetic, and cellular mechanisms that are critical for network and behavioral functions in the nervous system. Recent experiments establish the importance of neurogenetics in revealing cellular and network properties. Breakthroughs that utilize direct visualization of neuronal activity and network structure provide new insights. Major discoveries of plasticity in the spinal cord and brainstem contribute to basic neuroscience and, in addition, have promising therapeutic implications.
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Affiliation(s)
- Paul S G Stein
- Biology Department, Washington University, St. Louis, MO 63130, USA.
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