Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: a review of experimental studies.

Spinal cord stimulation (SCS) is a widely used clinical technique to treat ischemic pain in peripheral, cardiac and cerebral vascular diseases. The use of this treatment advanced rapidly during the late 80's and 90's, particularly in Europe. Although the clinical benefits of SCS are clear and the success rate remains high, the mechanisms are not yet completely understood. SCS at lumbar spinal segments (L2-L3) produces vasodilation in the lower limbs and feet which is mediated by antidromic activation of sensory fibers and decreased sympathetic outflow. SCS at thoracic spinal segments (T1-T2) induces several benefits including pain relief, reduction in both frequency and severity of angina attacks, and reduced short-acting nitrate intake. The benefits to the heart are not likely due to an increase, or redistribution of local blood flow, rather, they are associated with SCS-induced myocardial protection and normalization of the intrinsic cardiac nervous system. At somewhat lower cervical levels (C3-C6), SCS induces increased blood flow in the upper extremities. SCS at the upper cervical spinal segments (C1-C2) increased cerebral blood flow, which is associated with a decrease in sympathetic activity, an increase in vasomotor center activity and a release of neurohumoral factors. This review will summarize the basic science studies that have contributed to our understanding about mechanisms through which SCS produces beneficial effects when used in the treatment of vascular diseases. Furthermore, this review will particularly focus on the antidromic mechanisms of SCS-induced vasodilation in the lower limbs and feet.

Diminished plantar cutaneous sensation and postural control.

The purpose of this study was to assess the effect of diminished plantar cutaneous sensation induced by cooling on postural control during double- and single-limb quiet standing. 32 healthy adults were tested on an intervention day and control day. The intervention consisted of 10 min. of ice immersion of the plantar aspect of the feet prior to balance testing. Dependent variables were center of pressure velocity and area during double- and single-limb stance with eyes open and closed. Significant interactions were found between sensation and vision for double-limb center of pressure area, with a significant reduction in area of center of pressure excursions after reducing sensation with eyes closed but not with eyes open. The area of center of pressure excursions may have been reduced in an effort to curtail exploratory postural behavior given the altered afferent input from plantar receptors. There were no significant differences for plantar hypoesthesia in single-limb stance.

Topical acetone treatment induces neurogenic oedema on the sensitized mouse ear: an in vivo study using transient receptor potential vanilloid 1 (TRPV1) receptor knockout mice.

OBJECTIVE: The participation of sensory neurons and transient receptor potential vanilloid 1 (TRPV1) receptors in phorbol 12-myristate 13-acetate (PMA)-induced nerve-sensitizing effect was examined. MATERIALS AND METHODS: PMA dissolved in acetone and acetone were applied to the ears of TRPV1 receptor knockout and wild-type mice. Different groups of animals received ibuprofen, anti-interleukin-1 beta (IL-1beta) antibody, resiniferatoxin (RTX) or capsaicin pretreatment. Ear thickness, myeloperoxidase activity and IL-1beta content of the ears were determined. Histological evaluation was performed. RESULTS: PMA exerted potentiating action on contralateral acetone-induced ear oedema, which was inhibited by ibuprofen, topical capsaicin desensitization of the acetone-treated ear as well as by systemic RTX pretreatment. Neither the lack of TRPV1 receptors nor anti-IL-1beta antibody prevented sensitizing effect. CONCLUSIONS: The TRPV1 receptor-independent potentiating action of PMA on contralateral acetone-induced ear oedema is mediated via capsaicin-sensitive afferents and prostanoids are involved. IL-1beta is not essential in this process.

Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.

The "Sensor Glove System" offers an alternate afferent inflow from the hand early after nerve repair in the forearm, mediated through the hearing sense, implying that deprivation of one sense can be compensated by another sense. This sensory "by-pass" was used early after repair of the median nerve with the intention of improving recovery of functional sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. In a prospective multicentre clinical study, one group (n=14) started early after surgery with sensory re-education using the Sensor Glove System and the control group (n=12) received conventional sensory re-education, starting 3 months postoperatively. The patients were checked regularly during a 1-year period, with focus on recovery of tactile gnosis. After 12, months, tactile gnosis was significantly better in the Sensor Glove System group. This highlights the timing for introduction of training after nerve repair, focusing on the importance of immediate sensory re-learning.

Conscious and unconscious sensory inflows allow effective control of the functions of the human brain and aeart at the initial ageing stage

The authors of the present article based their assumption on the concept that the sensory systems are the «windows to the brain» through which various functions of the human organism can be controlled. Comprehension of the fundamental mechanisms of the optimization of the sensory systems, brain, and cardiac functions has increased based on the prolonged sensory flows using conscious and unconscious aromatherapy and multimodal sensory activation. Sensory flow evoked stable systemic responses, including adaptive alteration of psycho-emotional state, attention, memory, sensorimotor reactions, intersensory interaction, visual information processing, statokinetic stability, and autonomic heart rhythm control. The efficacy and expediency of the use of sensory flow for non medicinal correction of vital functions of the human organism at the initial stages of ageing was revealed (AU)

Los autores de este artículo se basan en el concepto de que los sistemas sensoriales son las «ventanas al cerebro» a través de las cuales se pueden controlar varias funciones del organismo humano. La comprensión de los mecanismos fundamentales de la optimización del sistema sensorial, del cerebro, y de las funciones cardíacas ha aumentado gracias a los flujos sensoriales prolongados empleando la aromaterapia consciente y no consciente y la activación sensorial multimodal. El flujo sensorial evocó respuestas sistémicas estables, incluyendo la alteración adaptativa del estado psico-emocional, la atención, la memoria, reacciones sensorimotores, la interacción intersensorial, el procesamiento de la información visual, la estabilidad estatoquinestésica y el control del ritmo cardíaco autonómico. Se observa la eficacia y la conveniencia del empleo del flujo sensorial para la corrección no farmacológica de las funciones vitales del organismo humano en los estadios iniciales del envejecimiento (AU)

Conscious and unconscious sensory inflows allow effective control of the functions of the human brain and heart at the initial ageing stage.

The authors of the present article based their assumption on the concept that the sensory systems are the "windows to the brain" through which various functions of the human organism can be controlled. Comprehension of the fundamental mechanisms of the optimization of the sensory systems, brain, and cardiac functions has increased based on the prolonged sensory flows using conscious and unconscious aromatherapy and multimodal sensory activation. Sensory flow evoked stable systemic responses, including adaptive alteration of psycho-emotional state, attention, memory, sensorimotor reactions, intersensory interaction, visual information processing, statokinetic stability, and autonomic heart rhythm control. The efficacy and expediency of the use of sensory flow for non-medicinal correction of vital functions of the human organism at the initial stages of ageing was revealed.

Phantom limb pain: a case of maladaptive CNS plasticity?

Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain might be a phenomenon of the CNS that is related to plastic changes at several levels of the neuraxis and especially the cortex. Here, we discuss the evidence for putative pathophysiological mechanisms with an emphasis on central, and in particular cortical, changes. We cite both animal and human studies and derive suggestions for innovative interventions aimed at alleviating phantom pain.

Evidence for the involvement of endogenous ATP and P2X receptors in TMJ pain.

Evidence is accumulating which supports a role for ATP in the initiation of pain by acting on P2X receptors expressed on nociceptive afferent nerve terminals. To investigate whether these receptors play a role in temporomandibular (TMJ) pain, we studied the presence of functional P2X receptors in rat TMJ by examining the nociceptive behavioral response to the application of the selective P2X receptor agonist alpha,beta-methylene ATP (alpha,beta-meATP) into the TMJ region of rat. The involvement of endogenous ATP in the development of TMJ inflammatory hyperalgesia was also determined by evaluating the effect of the general P2 receptor antagonist pyridoxal-phosphate-6-azophenyl-2',4'-disulphonic acid (PPADS) on carrageenan-induced TMJ inflammatory hyperalgesia. Application of alpha,beta-meATP into the TMJ region of rats produced significant nociceptive responses that were significantly reduced by the co-application of lidocaine N-ethyl bromide quaternary salt, QX-314, (2%) or of the P2 receptor antagonist PPADS. Co-application of PPADS with carrageenan into the TMJ significantly reduced inflammatory hyperalgesia. The results indicate that functional P2X receptors are present in the TMJ and suggest that endogenous ATP may play a role in TMJ inflammatory pain mechanisms possibly by acting primarily in these receptors.

The role of peripheral 5HT2A and 5HT1A receptors on the orofacial formalin test in rats with persistent temporomandibular joint inflammation.

The role of peripheral serotonin (5HT) 2A and 5HT1A receptors on the orofacial nocifensive behavioral activities evoked by the injection of formalin into the masseter muscle was evaluated in the rats with persistent temporomandibular joint (TMJ) inflammation evoked by Complete Freund's Adjuvant (CFA). The orofacial nocifensive behavioral activities evoked by the injection of formalin into masseter muscle were significantly enhanced at 1 day (CFA day 1 group) or 7 days (CFA day 7 group) during TMJ inflammation. Pretreatment with local administration of 5HT2A receptor antagonist, ketanserin (0.01, 0.1 mg/rat) into the masseter muscle or systemic administration of ketanserin via i.p. injection (1 mg/kg) reduced the orofacial nocifensive behavioral activities of the late phase evoked by formalin injection into masseter muscle on the side of TMJ inflammation (CFA day 7 group). However, local (0.001-0.1 mg/rat) or systemic (1 mg/kg) administration of 5HT1A receptor antagonist, propranolol, into masseter muscle did not produce the antinociceptive effect in CFA day 7 group. Moreover, local administration of ketanserin (0.1 mg) or propranolol (0.1 mg) into masseter muscle did not inhibit nocifensive orofacial behavior in rats without TMJ inflammation. These data suggest that persistent TMJ inflammation causes the elevation of the orofacial nocifensive behavior, and peripheral 5HT2A receptors play an important role in mediating the deep craniofacial tissue nociception in rats with TMJ inflammation.

Attenuation of knee joint inflammation by peripherally administered endomorphin-1.

Endomorphin-1 is a selective endogenous ligand for the micro-opioid receptor, and this study investigated the effect of endomorphin-1 on rat knee joint inflammation by examining the ability of the neuropeptide to modulate synovial protein extravasation. Acute joint inflammation was induced by intraarticular injection of 2% kaolin followed by 2% carrageenan and the animals allowed to recover for 3 h. Immunohistochemical examination of these inflamed joints revealed endomorphin-1-like immunoreactive nerves in deep synovium with a proportion of the nerve fibers occurring in close proximity to synovial blood vessels. Perfusion of inflamed knees with exogenous endomorphin-1 across the dose range 10-9-10-6 M produced a significant reduction in synovial vascular permeability with the 10-7M dose producing the greatest fall in protein exudation (approx 55%). These effects were blocked by the specific micro-opioid receptor antagonist CTOP. Destruction of knee joint unmyelinated afferent nerve fibers by capsaicin treatment significantly attenuated the anti-inflammatory effects of endomorphin-1, suggesting that the peptide is acting via a neurogenic mechanism. The findings of this study indicate that endomorphin-1 acts peripherally in knee joints to reduce synovial protein extravasation. These anti-inflammatory effects are mediated by micro-opioid receptors located on capsaicin-sensitive afferent nerves.

Twitch-obtaining intramuscular stimulation (TOIMS) in acute partial radial nerve palsy.

Twitch Obtaining Intramuscular Stimulation (TOIMS) is useful in the management of chronic nerve-related pain. The best understanding of the mechanism of action of TOIMS can occur on treating acute nerve-related symptoms. An opportunity to use TOIMS treatments in an acute, partial left radial palsy within 24 hours of onset did occur. Following treatment to the affected triceps and brachioradialis muscles, there was an immediate improvement in the amplitude, area and conduction velocity of the left radial motor and sensory nerves at the lower arm level. There was also improvement in numbness and all symptoms abolished after four treatments. Serial multiple motor unit action potential (multi-MUAP) analysis performed in the triceps and extensor communis (EDC) showed signs of motor unit enlargement. The triceps MUAPs showed an increase in duration and size index (area/amplitude) by the 3rd month. Both parameters stabilized at 18 months. Phases increased at the 6th month only. In EDC, the size index increased progressively by the 3rd month. The duration increased at the 6th month with stabilization by the 18th month. Phases and turns increased on day 3 examination only. EDC showed reduction in the firing rate with time. By relaxing the muscles through the effects of intramuscular exercise and also by improving local ischemia, TOIMS averted prolonged conduction abnormalities and probably a more serious axonal injury.