Advertisement

The Hyperpathic Syndrome: A Challenge to Specificity Theory

  • Patrick D. Wall
Chapter
Part of the Wenner-Gren Center International Symposium Series book series (EMISS, volume 12)

Abstract

Yngve Zotterman influenced our way of thinking in many ways. One was the tactic he shared with his master, Lord Adrian, which was to start in the periphery and to attribute as many sensory phenomena as possible to particular types of afferent fibres. This eminently sensible initial tactic has been carried to an extreme by a number of authors, into the claim that the sole origin of pain is activity in a particular type of fibre, the nociceptor. Since they have assigned the monopoly of extracting this quality of sensory experience to a specific fibre type in the periphery, the only role they can allow to central synaptic processes is to control the amplitude of sensation without affecting its quality or location. The central nervous system is seen to consist of a series of labelled line pain specific pathways whose gain may change but not their information content. The adherents of the specificity theory are wrong for many reasons, one of which is the subject of this paper, the hyperpathic syndrome. Like any syndrome, this consists of a grouping of signs and symptoms, each present in varying degrees in particular cases. It is necessary to propose a theory to explain the syndrome as an entity and not to explain one fraction such as primary hyperalgesia and then to imply that the whole is explained. We have to explain why the following characteristics are grouped together.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Blumberg, H., Janig, W. (1981). Skin nerves with experimentally produced neuromata. In Phantom and Stump Pain. (eds. J. Siegfried, M. Zimmerman ). Springer Verlag, BerlinGoogle Scholar
  2. Campbell, J.N., Meyer, R.A. (1983). Sensitisation of unmyelinated nociceptive afferents in monkey varies with skin type. J. Neurophysiol., 49, 98–110PubMedGoogle Scholar
  3. Devor, M., Schonfeld, D., Seltzer, Z., Wall, P.D. (1979). Two modes of cutaneous reinnervation following peripheral nerve injury. J. Comp. Neur., 185, 211–220PubMedCrossRefGoogle Scholar
  4. Devor, M., Wall, P.D., (1981a). The effect of peripheral nerve injury on receptive fields of cells in cats spinal cord. J. Comp. Neurol., 199, 277–291PubMedCrossRefGoogle Scholar
  5. Devor, M., Wall, P.D. (1981b). Plasticity in the spinal cord sensory map following peripheral nerve injury. J. Neurosci., 1, 679–684PubMedGoogle Scholar
  6. Fitzgerald, M. (1979). The spread of sensitisation of polymodal nociceptors in the rabbit from nearby injury and by antidromic nerve stimulation. J. Physiol., 297, 207–216PubMedCentralPubMedGoogle Scholar
  7. Hannington Kiff, J.G. (1974). Pain Relief. Heinemann, LondonGoogle Scholar
  8. Hardy, J.D., Wolff, H.G., Goodell, H. (1952). Pain sensations and reactions. Williams & Wilkins, BaltimoreGoogle Scholar
  9. Janig, W. and McLachlan, E. (1984). On the fate of sympathetic and sensory neurons projecting into a neuroma of the superficial peroneal nerve in the cat. J. Comp. Neurol., In pressGoogle Scholar
  10. LaMotte, R.H., Thalhammer, J.G., Torebjörk, H.E., Robinson, C.J. (1982). Peripheral neural mechanisms of cutaneous hyperalgiesia following mild injury by heat. J. Neurosci., 2, 765–781Google Scholar
  11. Lewis, T. (1942). Pain. Macmillan, LondonGoogle Scholar
  12. Loh, L., Nathan, P.W., Schott, G.D., Wilson, P.G. (1980). Effects of regional guanethidiine infusion in certain painful states. J.Neurol. Neurosurg. & Psychiat., 43, 446–451CrossRefGoogle Scholar
  13. Lindblom, U., Meyerson, B.A. (1975). Influence on touch, vibration and cutaneous pain of dorsal column stimulation in man. Pain, 1, 257–270PubMedCrossRefGoogle Scholar
  14. Malliani, A., Pagni, M., Lombardi, F. (1984). Visceral versus somatic mechanisms. In Textbook of Pain. (eds. P.D. Wall., R. Melzack ). Churchill Livingstone, LondonGoogle Scholar
  15. McMahon, S.B., Wall, P.D. (1983). A system of rat spinal cord lamina 1 cells projecting through the contralateral dorsolateral funiculus. J. Comp. Neurol., 214, 217–223Google Scholar
  16. Melzack, R., Wall, P.D., Ty, T.C. (1982). Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries. Pain, 14, 33–44PubMedCrossRefGoogle Scholar
  17. Meyer, G.A., Fields, H.L. (1972). Causalgia treated by selective large fibre stimulation of peripheral nerve. Brain, 95, 163–168PubMedCrossRefGoogle Scholar
  18. Noordenbos, W. (1969). Pain. Elsevier, AmsterdamGoogle Scholar
  19. Noordenbos, W., Wall, P.D. (1981). Implications of the failure of nerve resection and graft to cure chronic pain produced by nerve lesions. J. Neurol. Neurosurg. Psychiat., 44, 1068–1073PubMedCentralPubMedCrossRefGoogle Scholar
  20. Pagni, C.A. (1984). Central pain due to spinal cord and brain stem damage. In, Textbook of Pain. (eds. P.D. Wall., R. Melzack ). Churchill Livingstone, LondonGoogle Scholar
  21. Procacci, M., Zoppi, M. (1984). Heart Pain. In, Textbook of Pain. (eds. P.D. Wall., R. Melzack ). Churchill Livingstone, LondonGoogle Scholar
  22. Travell, J.G., Simons, D.G. (1983). Myofascial pain and dysfunction. Williams & Wilkins, BaltimoreGoogle Scholar
  23. Wall, P.D., Devor, M. (1981). The effect of peripheral nerve injury on dorsal root potentials and on transmission of afferent signals into the spinal cord. Brain Res., 209, 95–111PubMedCrossRefGoogle Scholar
  24. Wall, P.D., Devor, M. (1981). The effect of peripheral nerve injury on dorsal root potentials and on transmission of afferent signals into the spinal cord. Brain Res., 209, 95–111PubMedCrossRefGoogle Scholar
  25. Wall, P.D., Fitzgerald, M., Woolf, C.J. (1982). Effects of capsaicin on receptive fields and on inhibitions in rat spinal cord. Exp. Neurol., 78, 425–436PubMedCrossRefGoogle Scholar
  26. Wall, P.D. and Gutnick, M. (1974). Properties of afferent nerve impulses originating from a neuroma. Nature, 248, 740–743PubMedCrossRefGoogle Scholar
  27. Wall, P.D., Mills R.G., Fitzgerald, M., Gibson, S.G. (1982). Chronic blockade of sciatic nerve transmission by tetrodotoxin does not produce central changes in the dorsal horn of the spinal cord of the rat. Neuroci. Lett., 30, 315–320CrossRefGoogle Scholar
  28. Wall, P.D., Sweet, W.H. (1967). Temporary abolition of pain in man. Science, 155, 108–109PubMedCrossRefGoogle Scholar
  29. White, J.C., Sweet, W.H. (1969). Pain and the Neurosurgeon. C.C. Thomas, SpringfieldGoogle Scholar
  30. Woolf, C.J., Wall, P.D. (1982). Chronic peripheral nerve section diminishes the primary afferent A-fibre mediated inhibition of rat dorsal horn neurones. Brain Res., 242, 77–85PubMedCrossRefGoogle Scholar

Copyright information

© The Wenner-Gren Center 1984

Authors and Affiliations

  • Patrick D. Wall
    • 1
  1. 1.Cerebral Functions Group, Department of AnatomyUniversity College LondonLondonUK

Personalised recommendations