PRESYNAPTIC HYPERPOLARIZATION: A ROLE FOR FINE AFFERENT FIBRES

Facilitation of sensory transmission to motoneurons during cortical or sensory-evoked primary afferent depolarization (PAD) in humans

Sensory and corticospinal tract (CST) pathways activate spinal GABAergic interneurons that have axoaxonic connections onto proprioceptive (Ia) afferents that cause long-lasting depolarizations (termed primary afferent depolarization, PAD). In rodents, sensory-evoked PAD is produced by GABAA receptors at nodes of Ranvier in Ia afferents, rather than at presynaptic terminals, and facilitates spike propagation to motoneurons by preventing branch-point failures, rather than causing presynaptic inhibition. We examined in 40 human participants whether putative activation of Ia-PAD by sensory or CST pathways can also facilitate Ia afferent activation of motoneurons via the H-reflex. H-reflexes in several leg muscles were facilitated by prior conditioning from low-threshold proprioceptive, cutaneous or CST pathways, with a similar long-lasting time course (∼200 ms) to phasic PAD measured in rodent Ia afferents. Long trains of cutaneous or proprioceptive afferent conditioning produced longer-lasting facilitation of the H-reflex for up to 2 min, consistent with tonic PAD in rodent Ia afferents mediated by nodal α5-GABAA receptors for similar stimulation trains. Facilitation of H-reflexes by this conditioning was likely not mediated by direct facilitation of the motoneurons because isolated stimulation of sensory or CST pathways did not alone facilitate the tonic firing rate of motor units. Furthermore, cutaneous conditioning increased the firing probability of single motor units (motoneurons) during the H-reflex without increasing their firing rate at this time, indicating that the underlying excitatory postsynaptic potential was more probable, but not larger. These results are consistent with sensory and CST pathways activating nodal GABAA receptors that reduce intermittent failure of action potentials propagating into Ia afferent branches. KEY POINTS: Controlled execution of posture and movement requires continually adjusted feedback from peripheral sensory pathways, especially those that carry proprioceptive information about body position, movement and effort. It was previously thought that the flow of proprioceptive feedback from Ia afferents was only reduced by GABAergic neurons in the spinal cord that sent axoaxonic projections to the terminal endings of sensory axons (termed GABAaxo neurons). Based on new findings in rodents, we provide complementary evidence in humans to suggest that sensory and corticospinal pathways known to activate GABAaxo neurons that project to dorsal parts of the Ia afferent also increase the flow of proprioceptive feedback to motoneurons in the spinal cord. These findings support a new role for spinal GABAaxo neurons in facilitating afferent feedback to the spinal cord during voluntary or reflexive movements.

Elucidating afferent-driven presynaptic inhibition of primary afferent input to spinal laminae I and X

Although spinal processing of sensory information greatly relies on afferent-driven (AD) presynaptic inhibition (PI), our knowledge about how it shapes peripheral input to different types of nociceptive neurons remains insufficient. Here we examined the AD-PI of primary afferent input to spinal neurons in the marginal layer, lamina I, and the layer surrounding the central canal, lamina X; two nociceptive-processing regions with similar patterns of direct supply by Aδ- and C-afferents. Unmyelinated C-fibers were selectively activated by electrical stimuli of negative polarity that induced an anodal block of myelinated Aβ/δ-fibers. Combining this approach with the patch-clamp recording in an ex vivo spinal cord preparation, we found that attenuation of the AD-PI by the anodal block of Aβ/δ-fibers resulted in the appearance of new mono- and polysynaptic C-fiber-mediated excitatory postsynaptic current (EPSC) components. Such homosegmental Aβ/δ-AD-PI affected neurons in the segment of the dorsal root entrance as well as in the adjacent rostral segment. In their turn, C-fibers from the L5 dorsal root induced heterosegmental AD-PI of the inputs from the L4 Aδ- and C-afferents to the neurons in the L4 segment. The heterosegmental C-AD-PI was reciprocal since the L4 C-afferents inhibited the L5 Aδ- and C-fiber inputs, as well as some direct L5 Aβ-fiber inputs. Moreover, the C-AD-PI was found to control the spike discharge in spinal neurons. Given that the homosegmental Aβ/δ-AD-PI and heterosegmental C-AD-PI affected a substantial percentage of lamina I and X neurons, we suggest that these basic mechanisms are important for shaping primary afferent input to the neurons in the spinal nociceptive-processing network.

The introduction and current status of the multidimensional model of pain neurobiology

Conceptual models are useful because they guide our practical actions related to whatever is represented by the model; this includes research that reveals the limitations of these actions and the potential for their improvement. These statements apply to many aspects of daily life and especially to pain as a challenge for both clinical practice specifically and neurobiology generally. In the first half of the 20th century, our conceptual model of pain, to the extent that it existed at all, was based on evidence supporting the proposition that pain emerged from activity within a very spatially limited set of central nervous system (CNS) structures located within the cerebral cortex and it's oligosynaptic connections with the thalamus. This CNS activity was strongly associated with the activation of physiologically distinct and specialized somatovisceral afferent fibers. All, or nearly all, aspects of the pain experience were thought to arise from, and be modified by, changes in that localized CNS activity. There was no compelling and widely accepted reason to consider an alternative model. However, neurophysiological, neuroanatomical, behavioral, and clinical evidence emerging in the late mid-20th century prompted a reconsideration of the prevailing model of pain neurobiology. Based on this new evidence and the perceived limitations of the prevailing model, pain could then be reasonably conceived as a multidimensional experience arising from the conjoint activation of physiologically and anatomically distinct but interacting CNS structures each separately mediating sensory discriminative, affective, and cognitive aspects of pain. This brief historical review describes the intellectual climate at the time this multidimensional model was proposed, the dispositions for resisting or accepting it, and concludes with a comment on the current status of the model as a fusion of distributed activations that create a unified perception of pain.

Neuromodulation using ultra low frequency current waveform reversibly blocks axonal conduction and chronic pain

Chronic pain remains a leading cause of disability worldwide, and there is still a clinical reliance on opioids despite the medical side effects associated with their use and societal impacts associated with their abuse. An alternative approach is the use of electrical neuromodulation to produce analgesia. Direct current can block action potential propagation but leads to tissue damage if maintained. We have developed a form of ultra low frequency (ULF) biphasic current and studied its effects. In anesthetized rats, this waveform produced a rapidly developing and completely reversible conduction block in >85% of spinal sensory nerve fibers excited by peripheral stimulation. Sustained ULF currents at lower amplitudes led to a slower onset but reversible conduction block. Similar changes were seen in an animal model of neuropathic pain, where ULF waveforms blocked sensory neuron ectopic activity, known to be an important driver of clinical neuropathic pain. Using a computational model, we showed that prolonged ULF currents could induce accumulation of extracellular potassium, accounting for the slowly developing block observed in rats. Last, we tested the analgesic effects of epidural ULF currents in 20 subjects with chronic leg and back pain. Pain ratings improved by 90% after 2 weeks. One week after explanting the electrodes, pain ratings reverted to 72% of pretreatment screening value. We conclude that epidural spinal ULF neuromodulation represents a promising therapy for treating chronic pain.

Nociception induces a differential presynaptic modulation of the synaptic efficacy of nociceptive and proprioceptive joint afferents

A previous study has indicated that during the state of central sensitization induced by the intradermic injection of capsaicin, there is a gradual facilitation of the dorsal horn neuronal responses produced by stimulation of the high-threshold articular afferents that is counteracted by a concurrent increase of descending inhibitory actions. Since these changes occurred without significantly affecting the responses produced by stimulation of the low-threshold articular afferents, it was suggested that the capsaicin-induced descending inhibition included a preferential presynaptic modulation of the synaptic efficacy of the slow conducting nociceptive joint afferents (Ramírez-Morales et al., Exp Brain Res 237:1629-1641, 2019). The present study was aimed to investigate more directly the contribution of presynaptic mechanisms in this descending control. We found that in the barbiturate anesthetized cat, stimulation of the high-threshold myelinated afferents in the posterior articular nerve (PAN) produces primary afferent hyperpolarization (PAH) in the slow conducting (25-35 m/s) and primary afferent depolarization (PAD) in the fast conducting (40-50 m/s) articular fibers. During the state of central sensitization induced by capsaicin, there is a supraspinally mediated shift of the autogenic PAH to PAD that takes place in the slow conducting fibers, basically without affecting the autogenic PAD generated in the fast conducting afferents. It is suggested that the change of presynaptic facilitation to presynaptic inhibition induced by capsaicin on the slow articular afferents is part of an homeostatic process aimed to keep the nociceptive-induced neuronal activity within manageable limits while preserving the proprioceptive information required for proper control of movement.

Post-mortem 11.7 Tesla Magnetic Resonance Imaging vs. Polarized Light Imaging Microscopy to Measure the Angle and Orientation of Dorsal Root Afferents in the Human Cervical Dorsal Root Entry Zone

Background: Destruction of the afferents by dorsal root entry zone (DREZ) surgery may be an effective treatment of intractable neuropathic pain, though it remains a high-risk surgical intervention. Potential complications due to the lesioning of structures within the cervical spinal cord other than the DREZ can be minimized by accurate knowledge of the optimal insertion angle [i.e., the angle between the DREZ and the posterior median sulcus (PMS)]. The employed insertion angle was based on measurements between the DREZ and the PMS on post-mortem transverse slices. However, new, more sophisticated imaging techniques are currently available and are thought to yield higher spatial resolution and more accurate images.

Obejctive: This article measures the angle between the DREZ and the PMS on 11.7T post-mortem magnetic resonance images and compares these findings with polarized light imaging (PLI) microscopy images of the same specimens in order to quantify fiber orientation within the DREZ.

Methods: To visualize the anatomy of the cervical DREZ, magnetic resonance imaging (MRI), diffusion-weighted MRI (dMRI), probabilistic tractography, and PLI were performed on three post-mortem human cervical spinal cords at level C5–C6. The MR data was used to measure the angle between the DREZ and the PMS. MR images were complemented by probabilistic tractography results. Then, the orientation of fibers within the DREZ was quantified by use of PLI microscopy.

Results: Median angle between the DREZ and the PMS, as measured on MR-images, was found to be 40.1° (ranging from 34.2° to 49.1°) and 39.8° (ranging from 31.1° to 47.8°) in the left and right hemicord, respectively. Median fiber orientation within the DREZ, as quantified by PLI, was 28.5° (ranging from 12.0° to 44.3°) and 27.7° (ranging from 8.5° to 38.1°) in the left and right hemicord, respectively.

Conclusion: Our study, which provides an improved understanding of the anatomy of the DREZ, the angle between the DREZ and the PMS and the median fiber orientation within the DREZ, could contribute to safer DREZ-lesioning surgery to treat chronic neuropathic pain in the future.

Constructing and deconstructing the gate theory of pain

The gate theory of pain, published by Ronald Melzack and Patrick Wall in Science in 1965, was formulated to provide a mechanism for coding the nociceptive component of cutaneous sensory input. The theory dealt explicitly with the apparent conflict in the 1960s between the paucity of sensory neurons that responded selectively to intense stimuli and the well-established finding that stimulation of the small fibers in peripheral nerves is required for the stimulus to be described as painful. It incorporated recently discovered mechanisms of presynaptic control of synaptic transmission from large and small sensory afferents, which was suggested to "gate" incoming information depending on the balance between these inputs. Other important features included the convergence of small and large sensory inputs on spinal neurons that transmitted the sensory information to the forebrain as well as the ability of descending control pathways to affect the biasing established by the gate. The clarity of the model and its description gave this article immediate visibility, with numerous attempts made to test its various predictions. Although subsequent experiments and clinical findings have made clear that the model is not correct in detail, the general ideas put forth in the article and the experiments they prompted in both animals and patients have transformed our understanding of pain mechanisms.

Nerve lesioning with direct current

Spastic hypertonus (muscle over-activity due to exaggerated stretch reflexes) often develops in people with stroke, cerebral palsy, multiple sclerosis and spinal cord injury. Lesioning of nerves, e.g. with phenol or botulinum toxin is widely performed to reduce spastic hypertonus. We have explored the use of direct electrical current (DC) to lesion peripheral nerves. In a series of animal experiments, DC reduced muscle force by controlled amounts and the reduction could last several months. We conclude that in some cases controlled DC lesioning may provide an effective alternative to the less controllable molecular treatments available today.

Pain modulation by nitric oxide in the spinal cord

Nitric oxide (NO) is a versatile messenger molecule first associated with endothelial relaxing effects. In the central nervous system (CNS), NO synthesis is primarily triggered by activation of N-methyl-D-aspartate (NMDA) receptors and has a Janus face, with both beneficial and harmful properties. There are three isoforms of the NO synthesizing enzyme nitric oxide synthase (NOS): neuronal (nNOS), endothelial (eNOS), and inducible nitric oxide synthase (iNOS), each one involved with specific events in the brain. In the CNS, nNOS is involved with modulation of synaptic transmission through long-term potentiation in several regions, including nociceptive circuits in the spinal cord. Here, we review the role played by NO on central pain sensitization.

In search of lost presynaptic inhibition

This chapter presents an historical review on the development of some of the main findings on presynaptic inhibition. Particular attention is given to recent studies pertaining the differential GABAa control of the synaptic effectiveness of muscle, cutaneous and articular afferents, to some of the problems arising with the identification of the interneurons mediating the GABAergic depolarization of primary afferents (PAD) of muscle afferents, on the influence of the spontaneous activity of discrete sets of dorsal horn neurons on the pathways mediating PAD of muscle and cutaneous afferents, and to the unmasking of the cutaneous-evoked responses in the lumbosacral spinal cord and associated changes in tonic PAD that follow acute and chronic section of cutaneous nerves. The concluding remarks are addressed to several issues that need to be considered to have a better understanding of the functional role of presynaptic inhibition and PAD on motor performance and sensory processing and on their possible contribution to the shaping of a higher coherence between the cortically programmed and the executed movements.

Analysis of nerve conduction block induced by direct current

The mechanisms of nerve conduction block induced by direct current (DC) were investigated using a lumped circuit model of the myelinated axon based on Frankenhaeuser-Huxley (FH) model. Four types of nerve conduction block were observed including anodal DC block, cathodal DC block, virtual anodal DC block, and virtual cathodal DC block. The concept of activating function was used to explain the blocking locations and relation between these different types of nerve block. Anodal/cathodal DC blocks occurred at the axonal nodes under the block electrode, while virtual anodal/cathodal DC blocks occurred at the nodes several millimeters away from the block electrode. Anodal or virtual anodal DC block was caused by hyperpolarization of the axon membrane resulting in the failure of activating sodium channels by the arriving action potential. Cathodal or virtual cathodal DC block was caused by depolarization of the axon membrane resulting in inactivation of the sodium channel. The threshold of cathodal DC block was lower than anodal DC block in most conditions. The threshold of virtual anodal/cathodal blocks was about three to five times higher than the threshold of anodal/cathodal blocks. The blocking threshold was decreased with an increase of axonal diameter, a decrease of electrode distance to axon, or an increase of temperature. This simulation study, which revealed four possible mechanisms of nerve conduction block in myelinated axons induced by DC current, can guide future animal experiments as well as optimize the design of electrodes to block nerve conduction in neuroprosthetic applications.

Analysis of Slow Depolarizing Potential in Frog Taste Cell Induced by Parasympathetic Efferent Stimulation under Hypoxia

Strong electrical stimulation (ES) of the frog glossopharyngeal (GP) efferent nerve induced slow depolarizing potentials (DPs) in taste cells under hypoxia. This study aimed to elucidate whether the slow DPs were postsynaptically induced in taste cells. After a block of parasympathetic nerve (PSN) ganglia by tubocurarine, ES of GP nerve never induced slow DPs in the taste cells, so slow DPs were induced by PSN. When Ca(2+) in the blood plasma under hypoxia was decreased to approximately 0.5 mM, the slow DPs reduced in amplitude and lengthened in latency. Increasing the normal Ca(2+) to approximately 20 mM increased the amplitude of slow DPs and shortened the latency. Addition of Cd(2+) to the plasma greatly reduced the amplitude of slow DPs and lengthened the latency. These data suggest that the slow DPs depend on Ca(2+) and Cd(2+) concentration at the presynaptic PSN terminals of taste disk. Antagonists, [D-Arg(1), D-Trp(7,9), Leu(11)]-substance P and L-703 606, of neurotransmitter substance P neurokinin(1) receptor completely blocked the slow DPs. Intravenous application of substance P induced a DP of approximately 7 mV and a reduction of membrane resistance of approximately 48% in taste cells. A nonselective cation channel antagonist, flufenamic acid, completely blocked the slow DPs. These findings suggest that the slow DPs are postsynaptically initiated in frog taste cells under hypoxia by opening nonselective cation channels on the postsynaptic membrane after substance P is probably released from the presynaptic PSN axon terminals.

Depression of Gustatory Receptor Potential in Frog Taste Cell by Parasympathetic Nerve-Induced Slow Hyperpolarizing Potential

Parasympathetic nerve (PSN) innervates taste cells of the frog taste disk, and electrical stimulation of PSN elicited a slow hyperpolarizing potential (HP) in taste cells. Here we report that gustatory receptor potentials in frog taste cells are depressed by PSN-induced slow HPs. When PSN was stimulated at 30 Hz during generation of taste cell responses, the large amplitude of depolarizing receptor potential for 1 M NaCl and 1 mM acetic acid was depressed by approximately 40% by slow HPs, but the small amplitude of the depolarizing receptor potential for 10 mM quinine-HCl (Q-HCl) and 1 M sucrose was completely depressed by slow HPs and furthermore changed to the hyperpolarizing direction. The duration of the depolarizing receptor potentials depressed by slow HPs prolonged with increasing period of PSN stimulation. As tastant-induced depolarizing receptor potentials were increased, the amplitude of PSN-induced slow HPs inhibiting the receptor potentials gradually decreased. The mean reversal potentials of the slow HPs were approximately -1 mV under NaCl and acetic acid stimulations, but approximately -14 mV under Q-HCl and sucrose stimulations. This implies that when a slow HP was evoked on the same amplitude of depolarizing receptor potentials, the depression of the NaCl and acetic acid responses in taste cells was larger than that of Q-HCl and sucrose responses. It is concluded that slow HP-induced depression of gustatory depolarizing receptor potentials derives from the interaction between gustatory receptor current and slow hyperpolarizing current in frog taste cells and that the interaction is stronger for NaCl and acetic acid stimulations than for Q-HCl and sucrose stimulations.

Tonic Activity of Parasympathetic Efferent Nerve Fibers Hyperpolarizes the Resting Membrane Potential of Frog Taste Cells

We investigated the relationship between the membrane potential of frog taste cells in the fungiform papillae and the tonic discharge of parasympathetic efferent fibers in the glossopharyngeal (GP) nerve. When the parasympathetic preganglionic fibers in the GP nerve were kept intact, the mean membrane potential of Ringer-adapted taste cells was -40 mV but decreased to -31 mV after transecting the preganglionic fibers in the GP nerve and crushing the postganglionic fibers in the papillary nerve. The same result occurred after blocking the nicotinic acetylcholine receptors on parasympathetic ganglion cells in the tongue and blocking the substance P neurokinin-1 (NK-1) receptors in the gustatory efferent synapses. This indicates that the parasympathetic nerve (PSN) hyperpolarizes the membrane potential of frog taste cells by -9 mV. Repetitive stimulation of a transected GP nerve revealed that a -9-mV hyperpolarization of taste cells maintained under the intact GP nerve derives from an approximately 10-Hz discharge of the PSN efferent fibers. The mean frequency of tonic discharges extracellularly recorded from PSN efferent fibers of the taste disks was 9.1 impulses/s. We conclude that the resting membrane potential of frog taste cells is continuously hyperpolarized by on average -9 mV by an approximately 10-Hz tonic discharge from the parasympathetic preganglionic neurons in the medulla oblongata.

Direct current electrical conduction block of peripheral nerve

Electrical currents can be used to produce a block of action potential conduction in whole nerves. This block has a rapid onset and reversal. The mechanism of electrical nerve conduction block has not been conclusively determined, and inconsistencies appear in the literature regarding whether the block is produced by membrane hyperpolarization, depolarization, or through some other means. We have used simulations in a nerve membrane model, coupled with in vivo experiments, to identify the mechanism and principles of electrical conduction block. A nerve simulation package (Neuron) was used to model direct current (dc) block in squid, frog, and mammalian neuron models. A frog sciatic nerve/gastrocnemius preparation was used to examine nerve conduction block in vivo. Both simulations and experiments confirm that depolarization block requires less current than hyperpolarization block. Dynamic simulations suggest that block can occur under both the real physical electrode as well as adjacent virtual electrode sites. A hypothesis is presented which formulates the likely types of dc block and the possible block current requirements. The results indicate that electrical currents generally produce a conduction block due to depolarization of the nerve membrane, resulting in an inactivation of the sodium channels.

Interactions between cutaneous afferent inputs to a withdrawal reflex in the decerebrated rabbit and their control by descending and segmental systems

Previous studies have suggested that activation of nociceptive afferents from the heel recruits a supraspinal mechanism, which is modulated by adrenergic descending inhibition, that augments withdrawal reflexes in medial gastrocnemius (MG) motoneurones. To test this idea, we have studied the temporal evolution of reflexes evoked in MG by electrical stimulation of sural nerve A(beta)-, A(delta)- and C-fibre axons at 1 Hz, in decerebrated rabbits. Reflexes were analysed in three time bands, estimated to accord to afferent drive from A(beta)- (phase 1), A(delta)- (phase 2) and C-fibre (phase 3) inputs. Stimulation of A(delta)- and C-fibres gave significant temporal summation of all reflexes. The alpha(2)-adrenoceptor antagonist RX 821002 ((2-(2,3-dihydro-2-methoxy-1,4-benzodioxin-2-yl)-4,5-dihydro-1-H-imidazole)-HCl) (100 microg intrathecal (i.t.)) potentiated, and the alpha(2)-agonist dexmedetomidine (1-30 microg i.t.) depressed all reflexes per se, but the effects of these drugs on temporal summation were secondary to changes in baseline excitability. When C-fibres were stimulated, the N-methyl-D-aspartate (NMDA) receptor antagonist dizocilpine (1 mg i.t.) reduced temporal summation of phase 2 and 3 but not phase 1 reflexes. Spinalisation at L1 in the absence of drugs increased phase 2 and 3 reflexes but had no effect on phase 1, whereas spinalisation after RX 821002 resulted in decreased phase 1 responses with no significant change in later phases. Spinalisation in the presence of dizocilpine resulted in small reductions in phase 3 reflexes only. In all cases spinalisation virtually abolished temporal summation. In spinalised animals, dizocilpine selectively reduced late reflexes, and the opioid antagonist naloxone (100 microg i.t.) augmented all reflexes but gave rise to temporal subtraction of reflexes when C-fibres were stimulated.The present experiments have revealed a number of novel and important features of the sural-MG reflex pathway: (i) activity in fine afferent axons augments the reflexogenic potential of all subsequent afferent input, thereby allowing all afferent drive from the sural field to contribute to withdrawal of the heel; (ii) endogenous adrenergic control of this reflex pathway is completely non-selective; (iii) there is a non-adrenergic element of descending inhibition that is selective for the late components of MG reflex responses, and this element is directed particularly against transmission through NMDA receptors; (iv) temporal summation in this reflex is dependent on NMDA receptor-dependent and -independent mechanisms; and (v) this temporal summation is in some way dependent on the integrity of descending pathways.

Contribution of TTX-resistant C-fibres and Adelta-fibres to nociceptive flexor-reflex and non-flexor-reflex pathways in cats

The contribution of Adelta-fibres and C-fibres activated by noxious heat stimulation of the central pad of the foot to nociceptive spinal flexor reflex pathways (FRA-type) and to nociceptive excitatory reflex pathways to foot extensors (non-FRA type) was investigated in high spinal cats. A-fibres were completely blocked by tetrodotoxin (TTX), leaving C-fibre conduction intact. Thus, effects persisting after TTX were attributed to nociceptive C-fibres while the contribution of nociceptive Adelta-fibres was defined by the difference between those effects and the control effects before TTX. The initial action of noxious stimulation on both types of reflex action was mediated predominantly by Adelta-fibres, while the later action was mainly mediated by C-fibres. In two (out of seven) experiments Adelta-fibres exerted a significant inhibitory influence on the C-fibre action in FRA pathways, but such an inhibitory interaction between the two fibre groups was absent in the non-FRA reflex pathways. The technique of TTX application at the peripheral nerve proved to be a reliable method for a long-lasting selective investigation of C-fibre effects. The results revealed that both Adelta- and C-fibres contributed to nociceptive FRA and non-FRA reflex pathways.

Second messengers, the substantia gelatinosa and injury-induced persistent pain

Although there is now unequivocal evidence that the circuitry within the substantia gelatinosa is a major contributor to the transmission and control of nociceptive messages, this was not known 35 years ago, when Pat Wall first focussed attention on this region. In addition to being the target of neurochemically distinct nociceptors, this region contains a heterogeneous population of excitatory and inhibitory interneurons. This review focuses on the contribution of second messenger systems that are found in the substantia gelatinosa. In particular the review highlights their critical contribution to the development of persistent pain conditions in the setting of tissue and nerve injury. Several of the studies used animals with deletions of genes that encode major second messenger molecules, including protein kinase A, C and nitric oxide synthase. Our laboratory has shown that mice with a deletion of the gene that encodes the gamma isoform of protein kinase C (which is almost exclusively expressed in a population of interneurons of the inner part of the substantia gelatinosa) have completely normal acute pain responses. However, the allodynia that characteristically develops after injury does not occur in these mice, particularly when it is generated by partial sciatic nerve injury. By contrast, deletion of genes that encode protein kinase A subunits only show deficits in the development of tissue inflammation-induced pain. These differences highlight the selectivity that characterizes the contribution of different second messenger molecules. Because of the restricted distribution of these molecules, it is likely that they are activated by different populations of primary afferent nociceptor and under very different conditions of injury. Understanding the circuitry within the substantia gelatinosa is thus critical to elucidating the mechanisms through which these second messenger molecules contribute to the development of persistent pain in the setting of injury.

An investigation of the gate control theory of pain using the experimental pain stimulus of potassium iontophoresis

This study investigated a prediction derived from gate control theory-that there would be a pulse of pain as a pain stimulus was being ramped off due to the rapidly transmitting, inhibitory large fiber activity falling away sooner at the spinal level than the excitatory activity of the slow-transmitting, small nociceptive afferents. A further prediction was that the more distant the peripheral stimulus was from the spine, the greater the pain pulse would be. Fourteen subjects had the pain stimulus of iontophoretically applied potassium ions (K+) applied to an upper and a lower site on the dominant arm. In a threshold detection task using the double random staircase method, subjects were asked to indicate whether they could detect a pulse of additional pain during this ramp-off phase. The average rate of stimulus ramp-off in order to detect a pain pulse was statistically greater for the upper-arm site (14.3 micrograms K+/sec) than for the lower-arm site (9.4 micrograms K+/sec). These results were consistent with gate control theory. Alternative explanations, including intrinsic differences in nociceptive responding for different dermatomes and anode break, were considered. It was concluded that the detection of a pain pulse during the ramping off of a peripheral pain stimulus potentially provides a quantitative measure of the spinal modulation of pain.

Pain pathways and transmission

Pain has been a major concern of humankind since the ancient times, and it remains one of the most important subjects of all health care professionals. Despite the obvious overwhelming clinical importance, the major advances in its diagnosis and therapy have been made only recently. "How do the sensory apparatus of the body and system of signal transmission relate to pain of peripheral origin?" is the topic of discussion. To do this, it is important to understand what constitutes the total pain experience. It consists of: 1) signal transduction at the peripheral receptor site, 2) signal conduction along the peripheral nerve, 3) pain modulation at the level of the spinal cord, 4) pain perception at the supraspinal site, and 5) the associated sensations, emotional reactions, and effective state. The signal transmission related to pain may be modified by various analgesic agents. Specific analgesic agent has a specific site of action which may be at peripheral receptors, at peripheral nerves, at the level of the spinal cord, at supraspinal levels by activating descending inhibitory systems, or at more cephalad levels by reducing the affective component of pain.

Interaction between afferent neurones in a crab muscle receptor organ

Two of the three mechanoreceptor neurones which innervate the crab thoracic-coxal muscle receptor organ are non-spiking. The third, the small diameter P neurone, employs graded amplitude receptor potentials with either spikes or graded amplitude active membrane responses superimposed. An excitatory synaptic connection between one of the larger non-spiking afferents and the P neurone has now been detected within the thoracic ganglion. This novel connection between two afferents innervating the same receptor strand effectively extends the dynamic sensitivity range of the P neurone.

Locus coeruleus control of spinal motor output

Using electrophysiological techniques, we investigated the functional properties of the coeruleospinal system for regulating the somatomotor outflow at lumbar cord levels. Many of the fast-conducting, antidromically activated coeruleospinal units were shown to exhibit the alpha 2-receptor response common to noradrenergic locus coeruleus (LC) neurons. Electrically activating the coeruleospinal system potentiated the lumbar monosynaptic reflex and depolarized hindlimb flexor and extensor motoneurons via an alpha 1-receptor mechanism. The latter synaptically induced membrane depolarization was mimicked by norepinephrine applied iontophoretically to motoneurons. That LC inhibited Renshaw cell activity and induced a positive dorsal root potential at the lumbar cord also reinforced LC's action on motor excitation. We conclude that LC augments the somatomotor output, at least in part, via an alpha 1-adrenoceptor-mediated excitation of ventral horn motoneurons. Such process is being strengthened by LC's suppression of the recurrent inhibition pathway as well as by its presynaptic facilitation of afferent impulse transmission at the spinal cord level.

Cerebellar evoked potential elicited by stimulation of C-fiber in saphenous nerve of cat

Stimulation of the saphenous nerve above C-fiber threshold strength evoked a field potential which consisted of an early component with latency of 11.8 +/- 3.5 ms and a late component with latency of 312.1 +/- 17.5 ms on the cerebellar cortex. After the A-fibers in saphenous nerve were blocked by the polarizing current selectivity, the stimulation at C-fiber suprathreshold elicited a C-fiber cerebellar evoked potential (C-CEP) with latency of 134.2 +/- 18.4 ms. C-CEP had the maximal amplitude on the vermian lobule VI of the contra- and ipsilateral cerebellar cortex and its phases reversed in the deep layer of this area. It was suggested that the selective C-fiber input could reach the cerebellar cortex and elicit a characteristic evoked potential. However, when A- and C-fiber inputs were elicited simultaneously, C-CEP might be inhibited by the A-fiber input.

Hypnotic versus active cognitive strategies for alleviation of procedural distress in pediatric oncology patients

This study provided a differential comparison of the efficacy of standardized instruction in hypnosis or active cognitive strategy for provision of relief from procedurally induced pain and anxiety. Subjects were instructed to self-direct in the use of strategies during medical procedures. Twenty pediatric oncology patients participated in the study. They were not informed that hypnosis was one of the strategies. Subjects were screened for hypnotizability and randomly assigned to treatments. Demographic data were collected. Pre-strategy training observations were made during a Bone Marrow Aspiration or Lumbar Puncture (BMA/LP) using visual analog scales, the McGill Pain Questionnaire, State-Trait Anxiety Inventory, pulse and temperature readings, and interview. Following strategy training, data were collected during a second BMA/LP using the same measures as employed pre-intervention. Results indicated that both strategies were effective in providing pain reduction. Neither technique provided for anxiety reduction. Hypnotizability scale scores failed to correlate with degree of pain reduction.

Phase-linked modulation of excitability of presynaptic terminals of low-threshold afferent fibers in the inferior alveolar nerve during cortically induced fictive mastication in the guinea pig

Excitability of presynaptic terminals of low-threshold primary afferent fibers in the inferior alveolar nerve was tested in the trigeminal spinal nucleus of the ketamine-anesthetized, paralyzed guinea pig, by Wall's method. Fictive mastication was induced by repetitive stimulation of the cortical masticatory area, and was monitored by rhythmical burst activity in the jaw-opening anterior digastric motoneuron pool. The excitability was rhythmically modulated in a phase-linked manner during the masticatory cycle: it was decreased coincidentally with the digastric burst activity (jaw-opening phase) and increased during the middle and late periods of the interburst phase (jaw-closing phase) of the masticatory cycle. The results imply that presynaptic modulation of synaptic transmission of peripheral inputs from primary afferents to interneurons in the jaw-opening reflex pathway may contribute to the rhythmical modulation of the jaw-opening reflex evoked by innocuous stimulation of the intraoral structures during mastication; presynaptic inhibition contributing to the depression of the jaw-opening reflex during the jaw-closing phase and presynaptic facilitation to its enhancement during the jaw-opening phase.

Prolonged C-fibre mediated facilitation of the flexion reflex in the rat is not due to changes in afferent terminal or motoneurone excitability

A standard suprathreshold mechanical stimulus applied to the hindpaw of decerebrate-spinal rats produces a discharge in hamstring flexor alpha-motoneurones which is stable for hours, provided no tissue injury is produced. Tissue injury results, however, in a decrease of threshold and an increase in the responsiveness of the reflex. This reflex hypersensitivity can be mimicked by brief (20 s) low frequency (1 Hz) conditioning stimuli to muscle or cutaneous nerves, if C-fibres are recruited. The prolonged post-conditioning facilitation of the flexion reflex by C-afferent volleys is now shown to be independent of changes in the excitability of the test afferent terminals in the dorsal horn and of the motoneurones. The hypersensitivity is therefore due to changes in the interneurones that link cutaneous nociceptive afferents with flexor motoneurones.

Dorsal column stimulation does not inhibit segmental nociceptive reflexes of hind limbs

Stimulation of the dorsal columns has been shown to inhibit many indices of nociception. We report here that dorsal column stimulation does not inhibit two such nociceptive reflexes in the decerebrate cat: the flexion and the crossed extension reflex. In fact, such stimulation typically facilitates these reflexes. These findings suggest that the use of segmental nociceptive reflexes as models of pain perception may not be wholly appropriate.

Demonstration of the synaptic origin of primary afferent depolarisation (PAD) in the isolated spinal cord of the hamster

Intracellular recordings have been made from 31 primary afferent fibres within the dorsal horn of an isolated mammalian spinal cord. In 17 fibres stimulation of an adjacent dorsal root evoked primary afferent depolarization (PAD); these fibres also showed spontaneous depolarizations. Replacement of the calcium in the perfusing medium by manganese blocked both evoked and spontaneous activity showing them to be of synaptic origin. Observations on the effects of current injection and of bicuculline support an involvement of GABA in the generation of PAD.

An investigation of the dorsal root reflex using an in vitro preparation of the hamster spinal cord

A detailed description is given of an hemisected spinal cord preparation from adult golden hamsters and this preparation has been used to investigate the physiology of the dorsal root reflex. In addition to antidromic reflex discharges which could be recorded from lumbar dorsal roots following stimulation of adjacent dorsal roots or the dorsal columns, spontaneous firing was also recorded from the dorsal roots. This activity reached a peak at 27 degrees C and was abolished at temperatures above 35 degrees C. Both the evoked and the spontaneous dorsal root activity were demonstrated to be travelling antidromically along the dorsal roots out of the cord, and replacement of the calcium in the bathing medium by manganese showed them to be of synaptic origin. Stimulation of a lumbar dorsal root was found to evoke a reflex in up to 4 adjacent spinal segments in both rostral and caudal directions, and a period of depressed activity was demonstrated following both evoked and spontaneous discharges. A time-locked relationship was found between the dorsal root reflex and the slow dorsal horn potential recorded from within the spinal cord.