Delayed activation of nociceptors: correlation with delayed pain sensations induced by sustained stimuli

Comparative analysis of head-tilt and forward head position during laptop use between females with postural induced headache and healthy controls

OBJECTIVES

To compare 1) maximum manually induced head-protraction, head-tilt and forward head position and 2) the evolution of head-tilt and forward head position during a laptop-task between a headache- and control-group.

METHODS

Angles for maximum head-protraction, head-tilt and forward head position of 12 female students with postural induced headache and 12 female healthy controls were calculated at baseline and while performing a laptop-task.

RESULTS

The headache-group demonstrated an increased passive head-protraction of 22.30% compared to the control-group. The ratio of forward head position during habitual sitting to the maximum head-protraction differed significantly (p = 0.046) between headache-group (1.4 ± 0.4) and the control-group (1.1 ± 0.2). The headache-group showed a biphasic forward head position and head-tilt profile. These profiles differed significantly (p < 0.05) between groups and were negatively correlated (rE = -0.927).

CONCLUSION

The headache-group showed a larger passive head-protraction with a habitual forward head-position further located from the end-range. During the laptop-task forward head position and head-tilt behaved biphasically with a more static forward head position and a more dynamic head-tilt.

Sensory and signaling mechanisms of bradykinin, eicosanoids, platelet-activating factor, and nitric oxide in peripheral nociceptors

Peripheral mediators can contribute to the development and maintenance of inflammatory and neuropathic pain and its concomitants (hyperalgesia and allodynia) via two mechanisms. Activation or excitation by these substances of nociceptive nerve endings or fibers implicates generation of action potentials which then travel to the central nervous system and may induce pain sensation. Sensitization of nociceptors refers to their increased responsiveness to either thermal, mechanical, or chemical stimuli that may be translated to corresponding hyperalgesias. This review aims to give an account of the excitatory and sensitizing actions of inflammatory mediators including bradykinin, prostaglandins, thromboxanes, leukotrienes, platelet-activating factor, and nitric oxide on nociceptive primary afferent neurons. Manifestations, receptor molecules, and intracellular signaling mechanisms of the effects of these mediators are discussed in detail. With regard to signaling, most data reported have been obtained from transfected nonneuronal cells and somata of cultured sensory neurons as these structures are more accessible to direct study of sensory and signal transduction. The peripheral processes of sensory neurons, where painful stimuli actually affect the nociceptors in vivo, show marked differences with respect to biophysics, ultrastructure, and equipment with receptors and ion channels compared with cellular models. Therefore, an effort was made to highlight signaling mechanisms for which supporting data from molecular, cellular, and behavioral models are consistent with findings that reflect properties of peripheral nociceptive nerve endings. Identified molecular elements of these signaling pathways may serve as validated targets for development of novel types of analgesic drugs.

Postural neck pain: An investigation of habitual sitting posture, perception of ‘good’ posture and cervicothoracic kinaesthesia

Impairments of cervico-cephalic kinaesthesia and habitual forward head posture have been considered important in the aetiology of postural neck pain, yet these factors have not been specifically examined in a homogeneous clinical population. The objective of this study was to compare the habitual sitting posture (HSP), perception of good posture and postural repositioning error (PRE) of the cervico-thoracic (CT) spine in individuals with postural neck pain, with a matched group of asymptomatic subjects. Twenty-one subjects with postural neck pain and 22 asymptomatic control subjects were recruited into the study. An optical motion analysis system was used to measure the HSP and perceived 'good' sitting posture. PRE was measured over six trials where the subject attempted to replicate their self-selected 'good' posture. There was no difference between the groups in the HSP but significant differences were identified in the perception of 'good' posture. Posture repositioning error was higher for the head posture variables than for CT and shoulder girdle variables in both groups. However, there was no significant difference in posture repositioning error between groups for any of the posture measures. The findings suggest that individuals with postural neck pain may have a different perception of 'good' posture, but no significant difference in HSP or kinaesthetic sensibility compared with matched asymptomatic subjects.

Referred pain and hyperalgesia in human tendon and muscle belly tissue

The sensitivity of tendon and tendon-bone junction is not fully described although these tissues have high clinical impacts. This study assessed (1) pain intensity and referred pain caused by hypertonic saline injection to the proximal tendon-bone junction (PTBJ), tendon and muscle belly sites of tibialis anterior muscle and (2) pressure pain sensitivity, pre, during and post hypertonic saline injections. Eighteen subjects (14 males and 4 females) participated. Subjects also had constant mechanical stimulation for 120s at 130% of baseline pressure pain threshold (PPT) during which VAS parameters were recorded. VAS parameters after hypertonic saline for PTBJ (VAS area, VAS peak), and tendon sites (VAS area, duration and time to maximum VAS) were significantly (P < 0.05) higher than muscle belly. During hypertonic saline pain all three sites displayed local and frequently enlarged and referred pain areas. Hypertonic saline pain at the PTBJ and tendon transiently increased pressure sensitivity at these sites (P < 0.05). When referred pain was caused by mechanical stimulation it occurred predominantly at the PTBJ and tendon sites (86% cases). Constant mechanical stimulation caused steadily increasing pain (summation of pain) at all sites. Hypertonic saline pain at the tendon and PTBJ caused significantly higher (P < 0.001) final VAS scores compared to the muscle belly site. The results indicate the PTBJ and tendon sites are more sensitive and susceptible to sensitisation by hypertonic saline than muscle belly. Furthermore, there may be site specific central changes reflected by the differences in the results regarding sensitivity and summation over time.

Mechano-insensitive nociceptors encode pain evoked by tonic pressure to human skin

Single unmyelinated axons in the superficial branch of the peroneal nerve of human subjects were recorded (microneurography) and the response patterns during tonic pressure stimulation (14N at 30 mm(2); 120 s) were assessed using the previously described "marking technique". It was found that tonic pressure stimuli induced augmenting pain responses which were matched by the discharges of initially mechano-insensitive ("silent") C-units, whereas mechano- and heat-responsive "polymodal" C-nociceptors showed a response pattern incompatible with the stimulus-induced perceptions, namely strong initial excitation, followed by adaptation. Eighteen mechano- and heat-responsive "polymodal" C-fibers and 11 mechano-insensitive units were studied. The former had von Frey thresholds <160 mN, the latter were not excited by a von Frey filament of 750 mN (six of them responded to radiant heat stimulation). However, in the course of pressure stimulation, nine of the 11 mechano-insensitive units were activated after more than 20s. A second, identical pressure stimulus induced a stronger response in mechano-insensitive and a weaker response in mechano-responsive units. The stronger response, indicating sensitization, matched the more intense pain perception during the second pressure stimulus. It is concluded that mechano-insensitive C-nociceptors encode pressure-induced pain in human hairy skin and that they play an important role in static mechanical hyperalgesia.

Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions

Recent research has shown that peripheral mechanisms of pain are much more complex than previously thought, and they differ for acutely injured normal tissues compared with chronic inflammation or neuropathic (nerve injury) pain. The purpose of the present review is to describe uses of dental injury models as experimental tools for understanding the normal functions of polymodal nociceptive nerves in healthy tissues, their neuroinflammatory interactions, and their roles in healing. A brief review of normal dental innervation and its interactions with healthy pulp tissue will be presented first, as a framework for understanding the changes that occur after injury. Then, the different types of dental injury that allow gradation of the extent of tissue damage will be described, along with the degree and duration of inflammation, the types of reactions in the trigeminal ganglion and brainstem, and the type of healing. The dental injury models have some unique features compared with neuroinflammation paradigms that affect other peripheral tissues such as skin, viscera, and joints. Peripheral inflammation models can all be contrasted to nerve injury studies that produce a different kind of neuroplasticity and neuropathic pain. Each of these models provides different insights about the normal and pathologic functions of peripheral nerve fibers and their effects on tissue homeostasis, inflammation, and wound healing. The physical confinement of dental pulp and its innervation within the tooth, the high incidence of polymodal A-delta and C-fibers in pulp and dentin, and the somatotopic organization of the trigeminal ganglion provide some special advantages for experimental design when dental injury models are used for the study of neuroinflammatory interactions.

Peripheral coding of tonic mechanical cutaneous pain: comparison of nociceptor activity in rat and human psychophysics

These experiments investigated temporal summation mechanisms of tonic cutaneous mechanical pain. Human volunteers provided psychophysical estimates of pain intensity, which were compared with discharge patterns of rat cutaneous nociceptors tested with identical stimulus protocols. Human subjects made either intermittent or continuous ratings of pain intensity during stimulation of the skin between the thumb and first finger. Stimulus intensities of 25, 50, and 100 g were applied with a probe of contact area of 0.1 mm(2) for 2 min. Pain perception significantly increased during stimulation (temporal summation) for the 50- and 100-g stimulus intensities. Sequential conduction block of the myelinated fibers supplying the stimulated skin was used to investigate the role of A-fiber mechanoreceptors and nociceptors in this temporal summation. Conduction block of the Abeta fibers resulted in an increase in mechanically evoked pain estimates and an increase in temporal summation, consistent with loss of Abeta-mediated inhibition. When only conduction in the unmyelinated fibers remained, pain estimates were reduced to the preblock levels, but temporal summation was still present. Electrophysiological recordings were made from filaments of the sciatic nerve supplying receptors in the plantar skin of barbiturate-anesthetized rats. Forty units fulfilled the identification criteria for nociceptors: 20 A-fiber and 20 C-fiber nociceptors. Each unit was characterized by recording its responses to graded mechanical and heat stimuli. Nociceptors were also tested with stimuli identical to those applied to the human subjects. The responses of all units to sustained mechanical stimuli were adaptive-that is, they exhibited a gradual decline in response with time. However, the time course of adaptation varied among units. All the C-fiber nociceptors and one-half of the A-fiber nociceptors had rapidly adapting responses. The remainder of the A-fibers displayed slowly adapting responses. One-third of all units also showed short-duration increases in firing rate during stimulation. The latency after stimulus onset of this rate acceleration was inversely related to stimulus intensity. Despite the apparent disparity between perceptual temporal summation and nociceptor adaptation, central and peripheral mechanisms are proposed that can reconcile the relationship between nociceptor activity and pain perception.

Effect of subcutaneous administration of calcium channel blockers on nerve injury-induced hyperalgesia

Recent studies suggest that calcium contributes to peripheral neural mechanisms of hyperalgesia associated with nerve damage. In this animal behavioural study, we examined further the contribution of calcium in neuropathic pain by testing whether subcutaneous administration of either a calcium chelating agent or voltage-dependent calcium channel blockers attenuate nerve injury-induced hyperalgesia to mechanical stimulation. Studies were carried out in animals with partially ligated sciatic nerves, an established animal model of neuropathic pain. The nociceptive flexion reflex was quantified using an Ugo Basile Analgesymeter. Partial nerve injury induced a significant decrease in mechanical threshold compared to the sham operated controls. Daily subcutaneous injections of the calcium chelating agent, Quin 2 (20 microgram/2.5 microliter), significantly attenuated the nerve injury-induced hyperalgesia. Similarly, SNX-111, a N-type channel blocker, also significantly attenuated the nerve injury-induced hyperalgesia. SNX-230, a P and/or Q-type channel blocker, and nifedipine, a L-type channel blocker, had no effect on the hyperalgesia to mechanical stimulation. In control experiments, SNX-111 had no effect on mechanical thresholds when administered subcutaneously in either the hindpaw of normal animals or the back of the neck in nerve injury animals. This study shows that neuropathic pain involves a local calcium-dependent mechanism in the receptive field of intact neurons of an injured nerve, since it can be alleviated by subcutaneous injections of either a calcium chelating agent or SNX-111, a N-type calcium channel blocker. These agents may be effective, peripherally acting therapeutic agents for neuropathic pain.

Tensile and compressive responses of nociceptors in rat hairy skin

Mechanically sensitive nociceptor afferents were studied in a preparation of isolated skin from rat leg. Each neuron was studied while the skin was subjected to tensile and compressive loading. The experiment was designed to create highly uniform states of stress in both tension and compression. Tensile loads were applied by pulling on the edges of the sample. Applied loads were used to determine the tensile stresses. Surface displacements were used to determine tensile strains. Compressive loads were applied by indenting the surface of the skin with flat indenter tips applied under force control. The skin was supported by a flat, hard substrate. Compressive stresses were determined from the applied loads and tip geometry. Compressive strains were determined from skin thickness and tip excursions. All nociceptors were activated by both tensile and compressive loading. There was no interaction between the responses to compressive and tensile stimuli (i.e., the responses were simply additive). Responses of nociceptors were better related to tensile and compressive stresses than to strains. Nociceptors responded better to tensile loading than to compressive loading. Response thresholds were lower and sensitivities were higher for tensile stress than for compressive stress. The response to compression was better related to compressive stress than to other stimulus parameters (i.e., load/circumference or simply load). Indentations of intact skin over a soft substrate such as muscle would be expected to cause widespread activation of nociceptors because of tensile stresses.

C-fiber mechanical stimulus-response functions are different in inflammatory versus neuropathic hyperalgesia in the rat

To compare changes in primary afferent nociceptors associated with inflammatory versus neuropathic hyperalgesia, we evaluated in rats the mechanical stimulus-response function of isolated C-fiber primary afferent nociceptors to 10-s stimuli of differing mechanical strengths; 36 fibers after prostaglandin E2, 28 fibers from streptozotocin-diabetic rats and 46 fibers from control, non-treated rats were examined. Intradermal injection of prostaglandin E2 decreased mechanical threshold of 19 of 35 (54%) C-fibers. C-fibers that demonstrated a decrease in the mechanical threshold after prostaglandin E2 also showed an increased response to suprathreshold stimuli. The increase in the number of action potentials in prostaglandin E2-treated C-fibers was greatest at lower magnitude stimulus intensities, i.e. near threshold; the response to higher magnitude stimulus intensities was unchanged from that in control animals. In contrast, an increase in the number of action potentials seen in C-fibers from streptozotocin-diabetic rats was not seen at low-magnitude stimulus intensities; rather, a pronounced increase in response was seen at high-magnitude stimulus intensities. The von Frey hair thresholds for C-fibers in streptozotocin-diabetic rats were not different from those in control C-fibers. These data suggest that the changes in mechanical stimulus-response function of C-fibers are different in inflammatory compared to neuropathic mechanical hyperalgesia. These differences may underlie some of the differences in clinical features between inflammatory and neuropathic hyperalgesias.

Sensitization of C-fibres by prostaglandin E2 in the rat is inhibited by guanosine 5'-O-(2-thiodiphosphate), 2',5'-dideoxyadenosine and Walsh inhibitor peptide

Behavioral studies have shown that mechanical hyperalgesia induced by intradermal injection of prostaglandin E2 is blocked by inhibitors of the cAMP second messenger system. Similarly, injection of prostaglandin E2 also induces a decrease in mechanical threshold and an increase in the number of action potentials elicited by test stimuli in most C-fibre nociceptors. This change is called sensitization. To further evaluate the degree of correlation between primary afferent sensitization and mechanical hyperalgesia, we conducted a study to evaluate the effect of agents known to block the cAMP second messenger system and behavioral manifestations of mechanical hyperalgesia following injection of prostaglandin E2. The agents tested were guanosine 5'-O-(2-thiodiphosphate), an inhibitor of stimulatory guanine nucleotide-binding regulatory proteins; 2',5'-dideoxyadenosine, an inhibitor of adenylyl cyclase; and Walsh Inhibitor Peptide, an inhibitor of cAMP-dependent protein kinase. Single fibre electrophysiologic studies of 138 C-fibres, innervating the dorsum of the hind paw, was done in male Sprague-Dawley rats. The number of spikes evoked by a 10 s application of a threshold von Frey hair were determined before and after intradermal injection of test agents administered alone and in combination with prostaglandin E2. Injection of prostaglandin E2 with the test agent vehicle (saline or distilled water) resulted in a significant decrease in von Frey hair threshold and an increase in the number of spikes generated in response to threshold von Frey hairs. In contrast, co-injection of prostaglandin E2 with guanosine-5'-O-(2-thiodiphosphate), 2',5'-dideoxyadenosine or Walsh inhibitor peptide did not result in a significant decrease in von Frey hair mechanical threshold or increase in the number of spikes generated to the threshold stimuli, compared with vehicle/prostaglandin E2. It is suggested that guanosine 5'-O-(2-thiodiphosphate), 2',5'-dideoxyadenosine and Walsh inhibitor protein inhibited prostaglandin E2 sensitization of primary afferent C-fibres by inhibiting a stimulatory guanine nucleotide-binding regulatory protein, adenylyl cyclase, and protein kinase A, respectively. These results support the hypothesis that primary afferent sensitization by prostaglandin E2 underlies prostaglandin E2-induced hyperalgesia.

Activation of 5-HT2A receptors potentiates pain produced by inflammatory mediators

Previous results from our laboratory indicate that serotonin (5-HT) potentiates pain produced by other inflammatory mediators. To characterize the receptor subtype(s) mediating this synergistic effect of 5-HT, selective 5-HT agonists were injected, alone or with noradrenaline (NA) or prostaglandin E2 (PGE2), into the plantar surface of the paws of rats. The behavioural response (favouring, elevation and licking the paw) was recorded using the rating scale developed to quantify formalin-induced pain. The 5-HT1A and 5-HT3 agonists, 8-OH-DPAT and 2-methyl-5-HT, respectively, produced only transient responses by themselves and did not interact with PGE2 or NA. The 5-HT2 agonists, alpha-methyl-5-HT and DOI, also produced transient responses alone, but induced lifting and licking of the injected paw lasting more than 30 min when combined with PGE2 or NA. The lifting and licking response produced by 5-HT plus PGE2 was not altered by intraplantar pretreatment with the 5-HT1A and 5-HT3 antagonists, BMY 7378 and tropisetron, but was attenuated by the 5-HT2A/2C antagonist ketanserin. The pain response produced by alpha-methyl-5-HT plus PGE2 was blocked by pretreatment with the 5-HT2A/2C antagonists ketanserin and ritanserin, and the 5-HT2A antagonist spiperone (MPE50 values 1.4, 7.7 and 0.06 nmol, respectively). The second phase of the response to intraplantar formalin was also attenuated by ketanserin, ritanserin and spiperone (MPE50 values 11.3, 21.8 and 0.23 nmol, respectively). These data imply that 5-HT2A antagonists may be effective peripherally acting analgesics or analgesic adjuncts in pain associated with 5-HT release from platelets, such acute injury and, perhaps, some chronic pain states.

Mechanism of prostaglandin E2-induced substance P release from cultured sensory neurons

Hyperalgesia (tenderness) is a prominent feature of the inflammatory response. It is thought to be mediated, in part, by humoral factors such as prostaglandin E2, which act directly to sensitize primary afferent nociceptors. Prostaglandin E2 also interacts with nociceptors to induce a release of substance P, which can feed back to enhance the inflammatory response and also induce a long-lasting hyperalgesia. This study examined the mechanism of prostaglandin E2-induced substance P release from cultured adult rat dorsal root ganglion cells. Release studies were performed by bathing cultures with Tyrode solution +/- test agents and substance P was measured by radioimmunoassay. Substance P release induced by 100 nM prostaglandin E2 was inhibited by the prostaglandin antagonist, SC19220, and modulated by the guanine nucleotide analogs, guanosine-5'-[gamma-thio]triphosphate and guanosine-5'-[beta-thio]diphosphate, which stimulate and inhibit, respectively, stimulatory G-proteins. Substance P release was found to be Ca(2+)-dependent, requiring an influx of Ca2+ via N-type voltage-sensitive Ca2+ channels, since it was blocked by omega-conotoxin, but not nifedipine. The results suggest that prostaglandin E2 acts via a G-protein-coupled binding site on dissociated dorsal root ganglion cells to induce a Ca(2+)-dependent release of substance P, and provide further insight into the possible mechanisms underlying hyperalgesia associated with inflammation.

Molecular biology of temporomandibular joint disorders: proposed mechanisms of disease

PURPOSE

The biologic processes of temporomandibular joint adaptation and disease are poorly understood. However, recent technologic advances have provided methods that allow sophisticated studies of the molecular mechanisms that are relevant to the pathophysiology of degenerative temporomandibular joint diseases. This review examines current models of the molecular events that may underlie both adaptive and pathologic responses of the articular tissues of the temporomandibular joint to mechanical stress. It is hoped that an increased understanding of these complex biologic processes will lead to improved diagnostic and therapeutic approaches directed to the management of temporomandibular disorders.

Pathogenesis of degenerative joint disease in the human temporomandibular joint

The wide range of disease prevalences reported in epidemiological studies of temporomandibular degenerative joint disease reflects the fact that diagnoses are frequently guided by the presence or absence of non-specific signs and symptoms. Treatment is aimed at alleviating the disease symptoms rather than being guided by an understanding of the underlying disease processes. Much of our current understanding of disease processes in the temporomandibular joint is based on the study of other articular joints. Although it is likely that the molecular basis of pathogenesis is similar to that of other joints, additional study of the temporomandibular joint is required due to its unique structure and function. This review summarizes the unique structural and molecular features of the temporomandibular joint and the epidemiology of degenerative temporomandibular joint disease. As is discussed in this review, recent research has provided a better understanding of the molecular basis of degenerative joint disease processes, including insights into: the regulation of cytokine expression and activation, arachidonic acid metabolism, neural contributions to inflammation, mechanisms of extracellular matrix degradation, modulation of cell adhesion in inflammatory states, and the roles of free radicals and heat shock proteins in degenerative joint disease. Finally, the multiple cellular and molecular mechanisms involved in disease initiation and progression, along with factors that may modify the adaptive capacity of the joint, are presented as the basis for the rational design of new and more effective therapy.

Behavioural effects of intraplantar injection of inflammatory mediators in the rat

The behavioural response to intraplantar injection of inflammatory mediators was examined using the rating scale developed to assess formalin-induced pain. Serotonin, bradykinin, prostaglandin E2, substance P and histamine induced dose-dependent favouring of the injected paw. Serotonin, bradykinin and prostaglandin E2 also induced transient dose-dependent paw elevation (lifting) and licking. Noradrenaline produced only a weak favouring response. Serotonin produced a synergistic increase in lifting and licking when combined with any of the other mediators, while all other combinations of agents taken two at a time showed additivity. There was apparent antagonism between some combinations in the favouring response; this may reflect overestimation of the baseline. The data indicate that (i) the overt spontaneous behaviour of rats can be used to evaluate spontaneous pain, (ii) the favouring response and the lifting and licking responses are qualitatively different, the former being similar to hyperalgesia and the latter possibility representing overt pain, (iii) hyperalgesia and overt pain are related, but the generation of overt pain involves specific mechanisms in addition to those required to induce hyperalgesia, and (iv) serotonin may function to enhance the pain-producing effects of inflammatory mediators, even when they lack intrinsic activity. The data show that some inflammatory mediators produce transient overt pain when high doses are injected into normal tissue in rats. Combination of inflammatory mediators with low doses of serotonin produced a synergistic increase in the pain response. The data suggest that serotonin released from platelets in injured tissue plays a central role in the pain associated with injury, and that serotonin antagonists may have promise as peripherally acting analgesics or analgesic adjuncts by blocking a synergistic process involved in algogenesis.

Responses of neurons in thalamic ventrobasal complex of rats to graded distension of uterus and vagina and to uterine suprafusion with bradykinin and prostaglandin F2 alpha

This study examined the responses of somatic-responsive neurons in and near the ventrobasal complex (VB) of halothane/nitrous oxide-anesthetized and paralyzed estrous virgin rats to increasing levels of distension of the uterine horn and vaginal canal and to uterine suprafusion with PGF2 alpha and bradykinin (BK). While individual responses of single neurons to uterine and vaginal distensions were idiosyncratic, as a group the neurons responded in a graded fashion to graded distensions, producing stimulus-responses functions nearly identical to those produced by conscious rats making escape responses to the same stimuli [Berkley and Wood, Soc. Neurosci, Abstr., 15 (1989) 979; Berkley et al., Soc. Neurosci. Abstr., 16 (1990) 416]. In addition, most neurons responded vigorously to PGF2 alpha and BK, with responses to BK but not PGF2 alpha, reliably preceding the 'giant' uterine contractions that were also produced by these algogenic agents. These results indicate that certain neurons in and near VB may as a group be involved in some aspect of pain arising from female reproductive organs. The responses of these neurons to somatic and possibly other visceral stimuli, however, point to their potential additional involvement in other aspects of visceral and somatic nociception.