Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury.

The mechanisms by which peripheral nerve injuries sometimes lead to causalgia, aberrant burning pain peripheral to the site of nerve damage, are uncertain, although the sympathetic nervous system is known to be involved. Whether such syndromes could be the result of the development of responsiveness by some cutaneous pain receptors (C-fiber nociceptors) to sympathetic efferent activity as a consequence of the nerve injury was tested in an animal model. After nerve damage but not in its absence, sympathetic stimulation and norepinephrine were excitatory for a subset of skin C-fiber nociceptors and enhanced the responsiveness of these nociceptors to tissue-damaging stimulation. These effects were demonstratable within days after nerve lesions, occurred at the cutaneous receptive terminal region, were manifest in sensory fibers that had not degenerated after the injury, and were mediated by alpha 2-adrenergic-like receptors.

Central projections of identified, unmyelinated (C) afferent fibers innervating mammalian skin.

Unmyelinated (C) fibers are the most numerous sensory elements of mammalian peripheral nerve and comprise many of those responsible for initiating pain and temperature reactions; however, direct evidence has been lacking as to where and how these fibers terminate in the central nervous system. A plant lectin (Phaseolus vulgaris leukoagglutinin) was applied intracellularly by iontophoresis as an immunocytochemical marker. This permitted visualization of the central terminations of cutaneous C sensory fibers that had been identified by the nature of stimuli that excited them. The central branch of C-fiber units arborized and terminated mainly in the superficial layers of the spinal dorsal horn in defined patterns that related to their functional attributes. Thus, the superficial dorsal horn seems to act as a processing station for signals from fine sensory fibers.

Pain.

Advances in our understanding of the activation of peripheral damage-sensing neurons (nociceptors) over the past year have been complemented by electrophysiological and imaging studies of central nervous system pain-related centres. The manipulation of gene expression in a reversible and cell type specific way combined with imaging and electrophysiological studies holds promise for helping us to identify the spatial and molecular substrates of pain perception with increasing precision and gives hope for improved analgesic therapies.

Spinal termination of functionally identified primary afferent neurons with slowly conducting myelinated fibers.

Single primary afferent myelinated fibers from cutaneous receptors of cat and monkey were functionally identified by recording from the spinal cord with micropipettes filled with horseradish peroxidase (HRP). Relatively slowly conducting fibers (less than 40 m/sec) from high threshold mechanoreceptors (mechanical nociceptors) and two types of low threshold mechanoreceptor (D-hair and field) were selected for staining. Iontophoresis of the HRP and subsequent histochemical reaction stained the axons recorded from and their collaterals, including terminations, for several millimeters. The termination patterns in the two species proved essentially identical. Ipsilaterally, the mechanical nociceptor fibers terminated principally in the dorsal horn's marginal zone and in the ventral parts of the nucleus proprius (lamina V in the cat). Some of these nociceptors also had terminals in the midline just dorsal to the central canal, contralaterally in the marginal zone, and at the base of the opposite nucleus proprius. In contrast, the D-hair primary afferent axons terminated in the dorsal part of the nucleus proprius overlapping into the innermost portion of the substantia gelatinosa. The field receptor fibers terminated predominantly in the middle part of the nucleus proprius. These results suggest that there is a highly specialized central projection of primary afferent endings which is related to sensory function and not to fiber diameter. The marginal zone and most dorsal parts of the substantia gelatinosa receive direct projections from cutaneous nociceptors but do not have direct input from cutaneous receptors transmitting activity initiated by innocuous stimulation.

Reexamination of the dorsal root projection to the spinal dorsal horn including observations on the differential termination of coarse and fine fibers.

Primary afferent fibers in the lumbar, sacral, and caudal spinal segments of several mammals (rat, cat, monkey) were stained by applying horseradish peroxidase to the proximal part of cut dorsal rootlets and reacting the tissue histochemically after several hours of survival. The stained fibers' pattern of termination in the dorsal horn was similar in all three species, with many bouton-like enlargements in the ipsilateral marginal zone, substantia gelatinosa, and nucleus proprius, as well as a few projections at each level to the dorsal commissure and contralaterally to the ventral border of the nucleus proprius. Partial lesions of dorsal rootlets in monkey revealed that the thin fibers comprising the lateral division end principally in the marginal zone and substantial gelatinosa, while the thick fibers of the medial division terminate in the nucleus proprius and deeper regions, contributing little to the substantia gelatinosa and marginal zone. On the basis of the termination patterns observed for whole and partly sectioned rootlets, the superficial dorsal horn can be divided into at least four regions. (1) The marginal zone (lamina I of cat) appears to receive terminations from intermediate (smaller myelinated) fibers; (2) the outer substantia gelatinosa (outer lamina II) receives many terminations from the very finest afferent fibers; (3) the inner substantia gelatinosa (inner lamina II) receives endings from some of the finest fibers and also from intermediate (smaller myelinated) fibers; and (4) the superficial part of the nucleus proprius (lamina III) receives endings from intermediate and large diameter dorsal root fibers.

Excitation of marginal and substantia gelatinosa neurons in the primate spinal cord: indications of their place in dorsal horn functional organization.

Electrophysiological recordings were made from superficial parts of the spinal dorsal horn in monkeys, using dye-filled micropipette electrodes to permit iontophoretic marking of the recording sites for subsequent histological recovery. Focal field potentials and unitary activity evoked by dorsal root volleys including slowly-conducting components (both myelinated and unmyelinated) were found in the posteromarginal zone and the substantia gelatinosa (SG). Unitary potentials identified as being of the type recorded from cellular regions were separated into categories according to which group of slowly-conducting fibers and which kinds of cutaneous stimulation evoked the discharge. Recording locations for units excited by volleys in myelinated fibers conducting under 35 m/sec, by the types of skin stimulation activating either high-threshold mechanoreceptors (nociceptors) or cooling thermoreceptors, and giving no evidence of suprathreshold C-fiber excitation were centered on the posteromarginal zone. In contrast, recording loci for units exhibiting a strong C-fiber excitation and responses to cutaneous stimulation known to effectively excite C-fiber polymodal nociceptors or C-mechanoreceptors were centered in the SG. There appeared varying degrees of convergence of primary afferent input to the neuronal units, although most showed substantial specificity in their afferent excitation. On the bases of these results and consideration of existing morphological data, it is proposed that the marginal zone is a major synaptic termination region for the afferent fibers from high-threshold mechanoreceptors, cooling thermoreceptors, and perhaps other receptors with fine myelinated peripheral fibers. The SG, on the other hand, is suggested to be the terminal region for all types of unmyelinated primary afferent sensory neurons, and to have the complex role of integrating and distributing this input.

Fine structure of myelinated mechanical nociceptor endings in cat hairy skin.

High-threshold mechanoreceptors (mechanical nociceptors) with myelinated axons were electrophysiologically identified in hairy skin of the cat as described by Burgess and Perl ('67). Such elements possess receptive fields consisting of a number of punctate areas from which maximal firing can be elicited by intense (skin-damaging) mechanical stimuli. The spots of the receptive field are separated from each other by unresponsive regions, i.e., by skin areas from which responses cannot be evoked by stimuli effective at the spots. Fine steel pins were inserted to bracket closely a number of the spotlike responsive areas for each of several units. After aldehyde perfusion of the animal, osmification of the tissue and embedding in plastic, the marked skin zones were examined in semithin and ultrathin sections at the light and electron microscopic level. Near each delineated area, a thinly myelinated axon was found that could be traced to the papillary layer where it loses its myelin sheath. Unmyelinated axons accompanied by thin Schwann cell processes were then traced and found to penetrate the epidermal basal lamina in one of the papillae. At the epidermal penetration site, the axons contained both clear round, and large, dense core vesicles; at this level, the surrounding Schwann cell cytoplasm exhibited numerous pinocytotic vesicles. The zone of penetration may constitute the receptive apparatus. Some of these axons have been traced within the basal epidermal layer where they become surrounded by keratinocytes, lose their Schwann sheath, and apparently terminate. This overall morphological pattern was consistently present in the demarked areas of focal responsiveness, and was rare in the surrounding skin; this and its difference from other cutaneous neural endings suggest that the intraepidermal axon-Schwann cel complex constitutes the receptive structure for myelinated mechanical nociceptors. It is suggested that such complexes are the sense organs responsible for initiating the sensation of pricking pain produced by localized mechanical injury of the skin.

Distribution of primary afferent fibers within the sacrococcygeal dorsal horn: an autoradiographic study.

The spinal segmental distribution and intersegmental course of primary afferent fibers were studied by injecting (by pressure or iontophoresis) tritiated amino acids (L-proline or L-leucine) into spinal ganglia of coccygeal and sacral segments and autoradiographically analyzing histological sections of the spinal cord, particularly those regions lying dorsal to the central canal. The results from eight cats and three monkeys are described. A heavy projection of primary afferent fibers to the marginal zone (lamina I), the substantia gelatinosa Rolandi (lamina II), and throughout the nucleus proprius (laminae III-IV) was demonstrated. The projections to these three areas appeared to be substantially independent. Primary afferent fibers were found to course rostrally and caudally within the marginal zone, in the midline dorsal to the central canal, in Lissauer's tract, and in the dorsal columns. A crossed projection passed by way of the dorsal commissure to the contralateral marginal zone and to a region ventrolateral to the contralateral nucleus proprius. There was a distinct medial-to-lateral shift in the termination of primary afferent fibers in the substantia gelatinosa and in the dorsal portion of the nucleus proprius. The most medial distribution occurred immediately caudal to the entry zone of the primary afferent fibers, and the most lateral at the cephalad end of the segment immediately rostral to the entry level. Small (iontophoretic) injections revealed circumscribed fields of termination, approximately 40 micrometers by 70 micrometers (dorsoventrally) by 400 micrometers or more (rostrocaudally) in the substantia gelatinosa.

Synaptic complexes formed by functionally defined primary afferent units with fine myelinated fibers.

The individual fine myelinated fibers of cutaneous mechanical nociceptors and "D-hair" receptors were identified by electrophysiological recording with micropipette electrodes in cats and monkeys. Their intraspinal terminations were labeled by iontophoresing horseradish peroxidase intracellularly and subsequent diaminobenzidine histochemistry. These terminations were examined with light and electron microscopy to determine the nature and organization of their synaptic contacts. Myelinated fibers of the mechanical nociceptors became unmyelinated before exhibiting many enlargements that made multiple synaptic contacts in the marginal zone (lamina I) and lamina V. Pre- or postsynaptic contacts were found only on enlargements. In the marginal zone of the cat, enlargements made simple axodendritic contacts or were scalloped, central terminals in glomeruli. In glomeruli, myelinated mechanical nociceptor enlargements were presynaptic to several dendritic appendages and postsynaptic to two different types of profiles. One type was interpreted as a presynaptic axon terminal, the other as a presynaptic, vesicle-containing, dendritic appendage. In lamina V of the cat the nociceptor synaptic complexes were similar, but simpler, and only axonal profiles were found to be presynaptic to them. In the monkey marginal zone and deep nucleus proprius, myelinated nociceptor terminations formed the central element of glomeruli, which consisted of postsynaptic dendritic appendages and presynaptic axon terminals. D-hair axons terminated in large numbers of enlargements in the nucleus proprius (laminae III and IV) and inner substantia gelatinosa (lamina IIi). Their large rounded enlargements formed the central terminals in glomeruli and were presynaptic to both ordinary and vesicle-containing dendritic appendages; the presynaptic dendritic profiles also often contacted each other. Profiles interpreted as axonal in origin were the only terminals presynaptic to the primary ending within the D-hair glomeruli. The results suggest that transfer of primary afferent information occurs only at enlargements of the primary fiber and that each primary fiber enters into more than one kind of synaptic arrangement. They also point out that synaptic glomeruli are common to functionally different types of primary afferent fibers and that the internal organization of glomeruli varies with the kind of primary fiber and the locus of the complex.

Morphological features of functionally defined neurons in the marginal zone and substantia gelatinosa of the spinal dorsal horn.

Functional characteristics of spinal neurons located in the marginal zone (lamina I) and substantia gelatinosa (lamina II) were compared to their structural features by intrcellularly staining the source of unitary potentials with horseradish peroxidase (HRP) in unanesthetized, spinal cats. The responses of postsynaptic units to graded electrical volleys in intact dorsal roots and to physiological stimulation revealed that the peripheral excitatory input to neurons of the region is dominated by slowly conducting afferent fibers; often, the input to a given element is largely from a particular class of receptors. One type commonly seen received its principal peripheral excitation from low threshold mechanoreceptors with A delta or C afferent fibers. Mechanoreceptive elements often exhibited a marked, prolonged habituation and many were not excited by afferent volleys. Other units were predominantly excited by nociceptors with myelinated or unmyelinated fibers, or by thermoreceptors with unmyelinated fibers. A few units (principally the thermoreceptive) showed substantial ongoing activity which was modulated by sensory stimulation, but most had little or none. The HRP staining revealed neuronal morphology in fine detail. No relationship between neuronal configuration and physiological response was discerned. Soma location was not always linked to afferent input, although the cell bodies of nociceptive and thermoreceptive neurons tended to be in lamina I or outer lamina II (SGo) while those of the innocuous mechanoreceptive meurons tended to be in inner lamina II (SGi). The locus of a neuron's major dendritic arborization was more closely related to the source(s) of peripheral excitation. Cells excited by nociceptors with myelinated fibers had major dendritic projections in the marginal zone. Cells excited by nociceptors or thermoreceptors with unmyelinated fibers had important dendritic branching in the SGo. Innocuous mechanoreceptive neurons had primary dendritic arborization in the SGi when the input derived from unmyelinated fibers, or in the SGi and extending into the outer nucleus proprius (lamina III) when the afferent drive came from A delta fibers. These findings support the concept that laminae I and II constitute a major termination region for thin primary afferent fibers, myelinated fibers from nociceptors ending principally in lamina I and unmyelinated fibers from nociceptors, thermoreceptors, and mechanoreceptros terminating predominantly in lamina II. Substantial integrative and distributive functions can be expected of such an afferent termination zone.

Reorganization of primary afferent nerve terminals in the spinal dorsal horn of the primate caudal to anterolateral chordotomy.

A primate model has been used to explore the possibility that anterolateral chordotomy may produce intraspinal sprouting or rearrangement of primary afferent nerve terminations that could account for delayed postoperative recovery of sensory function. Monkeys were trained to limit the duration of an electrical stimulus, and the vigor and frequency of their escape responses were used to differentiate painful from nonpainful levels of stimulation. Behavioral testing after chordotomy revealed: 1) contralateral hypalgesia in all animals, with sensory recovery in half of the group, and 2) bilateral decreases in reflexive force in all animals, with reflex recovery in the majority of monkeys. At the terminal experiment, dorsal rootlets caudal to the spinal lesion were labeled bilaterally with HRP, and the distribution of labeled synaptic complexes was determined within the dorsal horn. When compared to controls, animals undergoing chordotomy showed a loss of terminals in the superficial dorsal horn and an increase of synaptic enlargements in deeper layers. These effects were bilateral, but were most pronounced on the side contralateral to chordotomy. Animals with diffuse spinal lesions showed a completely different change in the distribution of primary afferent terminals. Animals with sensory recovery demonstrated a more normal terminal distribution pattern than persistently hypalgesic monkeys, but there was considerable variability in the data, and analysis by different statistical tests yielded varying results.

Failure of acupuncture to produce localized analgesia.

The pain sensitivity of 49 healthy volunteers has been tested both before and during electro-acupuncture at two or three widely separated places on the body surface. Test areas fell into two categories. The "target" areas were within the part of the body that experienced acupuncturists predicted would be most affected by acupuncture of specified traditional points. "Non-target" control areas fell outside this zone of predicted maximal effect. The subjects and the observers who administered the tests knew that acupuncture anesthesia was being studied, but they did not know which areas were the "targets". Each subject was tested using at least two sensory testing methods. Altogether 4 different tests of pain sensitivity (pinprick discrimination, cold pain ratings, heat pain thresholds and pinch pain thresholds) were used. Small, but statistically highly significant, decreases in pain sensitivity occurred with all 4 tests during acupuncture. However, pain sensitivity fell by the same amount at "target" and "non-target" areas. The variability of the data was sufficiently low that moderate differences between areas would have been detected. The mechanism of "acupuncture anesthesia" is discussed in the light of these negative findings.

Cutaneous polymodal receptors: characteristics and plasticity.

The cutaneous sensory units labeled C-fiber polymodal nociceptors have a broadly coherent set of responsive characteristics. These include; (a) elevated thresholds to mechanical stimulation and to heat; (b) excitation by irritant and algesic chemicals; and (c) sensitization by injury or algesic substances. These characteristics and the match between the signals produced by C-polymodal nociceptors to pain-causing stimuli and human reports of pain indicate a probable causal connection. Nevertheless, there are indications that this population of sensory units may contain functionally-distinct subtypes. Some human C-polymodal nociceptors have been reported to be excited by histamine at low concentrations, whereas much of the population lacks such responsiveness. Further, in vitro studies of the effects of non-steroidal anti-inflammatory agents and low pH on sensitization suggest distinctions in the responsiveness of different elements whose general characteristics place them into the C-polymodal category. The enhanced responsiveness of C-polymodal nociceptors after heat stimulation or exposure to acidity has a probable relationship to the primary hyperalgesia produced after injury to hairy skin or in the presence of inflammation. Furthermore, the alterations of C-polymodal nociceptor characteristics after partial nerve injury and sympathectomy imply a change in phenotype of neurons spared by denervation and are suggestive of a possible relationship to sympathetically related pain and post-sympathetic neuralgias. These evidences of plasticity in responsiveness of a set of sense organs putatively associated with cutaneous pain represent lessons in the adaptability of biological mechanisms, and clues to the pathophysiology of pain.

Species-specific expression of cholecystokinin messenger RNA in rodent dorsal root ganglia.

The expression of cholecystokinin (CCK) messenger RNA (mRNA) was examined in dorsal root ganglia of rat and guinea pig using in situ hybridization histochemistry and RNA (Northern) blot hybridization with synthetic oligodeoxyribonucleotide (oligomer) probes. In guinea pig, CCK mRNA was detected in small and medium-sized neuronal perikarya comprising approximately 10-15% of the total dorsal root ganglia cell population. In contrast, in neurons of rat dorsal root ganglia, CCK mRNA was not detectable. Northern blot analyses revealed a single CCK mRNA species of expected size (0.8 kb) in guinea pig, but not rat, dorsal root ganglia. A 0.8 kb CCK mRNA was, however, detected in cortex of both rat and guinea pig. These data suggest that CCK is normally not synthesized in neurons of rat dorsal root ganglia and that there are species differences in CCK gene expression in mammalian sensory ganglia.

Microelectrode arrays for stimulation of neural slice preparations.

A planar 6 x 6 array of iridium electrodes with four reference electrodes has been developed for use with neural tissue preparations. Precise knowledge of the relative locations of the array elements allows for spatial neurophysiological analyses. The 10 microns diameter platinized iridium electrodes on a 100 microns pitch have been used to stimulate acutely prepared slices of spinal cord from free-ranging rodents. An intracellular recording from a single neuron in the substantia gelatinosa (SG) using the whole-cell, tight-seal technique allowed low noise, high resolution studies of excitatory or inhibitory electrical responses of a given neuron to inputs from the primary afferent fibers or from stimulation by individual electrodes of the array. The resulting maps of responses provide an indication of the interconnectivity of neural processes. The pattern emerging is that of limited interconnectivity in the SG from areas surrounding a recorded neuron but with strong excitatory or inhibitory effects from those oriented in a longitudinal (rostral-caudal) direction relative to the neuron. The observations to date suggest the neurons of the SG are arranged in sets of independent networks, possibly related to sensory modality and input from particular body regions.

Selective excitation of neurons in the mammalian spinal dorsal horn by aspartate and glutamate in vitro: correlation with location and excitatory input.

The electrical activity of mammalian dorsal horn neurons was recorded with pipette microelectrodes in an in vitro spinal cord slice preparation with dorsal roots intact. Addition of relatively low concentrations of aspartate or glutamate to the superfusion solution or through the recording pipette with small iontophoretic currents excited only a subset of neurons. The majority of these excited neurons were located in the superficial dorsal horn (Rexed's laminae I and II) and a preponderance were excited by the C-fiber components of dorsal root volleys. These findings are consistent with the idea that aspartate or glutamate may function as a synaptic mediator for some neurons terminating in the superficial dorsal horn.

Functional and morphological features of neurons in the midline region of the caudal spinal cord of the cat.

Neurons surrounding and dorsal to the central canal in caudal segments of the cat spinal cord were functionally and morphologically characterized. From electrophysiologically obtained responses these neurons were categorized into 3 functional groups based on excitation by somatic afferent stimulation. Eighteen of 36 units were activated by both low threshold and high threshold primary afferent inputs. Of the remaining 18 units, 9 responded only to innocuous intensities of stimulation and the other 9 were excited selectively by noxious peripheral stimulation. Neurons intracellularly marked with horseradish peroxidase formed a heterogeneous population with respect to perikaryal size, dendritic orientation and dendritic extent, and no evident correlations between functional categories and morphological features were observed in light microscopic analyses. Neurons immediately surrounding the central canal were functionally similar to neurons located in the dorsally adjacent gray matter.

Effects of partial nerve injury on the responses of C-fiber polymodal nociceptors to adrenergic agonists.

The effects of partial division of the great auricular nerve of adult rabbits were evaluated on the responsiveness of cutaneous C-fiber polymodal nociceptors (CPMs) to sympathetic stimulation (SS), close-arterial injections of epinephrine (EPI) and other alpha-adrenergic agonists. In normal unanesthetized rabbits, the two ears were usually at the same temperature. Two to 4 weeks after partial nerve lesions, however, the operated ear was cooler by 1-3 degrees C in the majority of animals, suggestive of increased vasoconstriction and possible denervation supersensitivity. Neither SS nor EPI (50 ng) excited CPM units (n = 23) from intact anesthetized animals. In contrast, 14-27 days after partial nerve lesions, SS (8 out of 38 units) and EPI (12 out of 38 units) were excitatory for a class of CPMs. There was notable variability in the response of different units and of a given unit between first and second trials. Responses consisted of 1-22 impulses for SS and 1-23 impulses for EPI in the 60 s following a trial. Arterial occlusion did not activate responsive units, suggesting that the excitation was not caused by vascular or temperature changes. Selective alpha2-adrenoceptor blockade with yohimbine (0.6-1.0 mg/kg i.v.) or rauwolscine (1.0 mg/kg i.v.) reversibly antagonized the effects of SS and EPI. EPI-responsive units were also excited by norepinephrine (50 ng) and guanabenz (10 microg) but not by clonidine (3 microg) or B-HT 933 (3 microg). The results suggest that circulating EPI, acting via an alpha-adrenoceptor subtype, can play a part in the development and/or maintenance of aberrant pain syndromes such as causalgia and other sympathetically related dystrophies.

Cutaneous sensory receptors.

The range of sensations elicitable from the skin is wide. We review the complex and diverse nature of cutaneous sense organs and the way these cutaneous receptors function as transducers of information from the skin. The discussion touches on the afferent properties of various classes of cutaneous receptors, the conduction velocity of their peripheral nerve fibers, the morphology of the receptor terminal, and the mode of sensation evoked. A brief view of associated features of dorsal root ganglion neurons is also provided.