Neuronal Mechanisms of Pain with Special Emphasis on Visceral and Deep Somatic Pain
Noxious stimuli applied to the skin appear to be encoded quite specifically by certain types of nociceptive afferent units with group III (A) and IV (C) fibers. The impulse activity of these cutaneous primary afferents converges on spinal “nociceptive-specific” neurones, most of which seem to be located in lamina I of the dorsal horn, and together with the nonnociceptive information from the skin on “wide-dynamic range” (multisensory) neurones in the grey matter, most of which are situated in lamina V, but some also in adjacent laminae and lamina I.
Many of these “nociceptive-specific” and “wide-dynamic range” neurones project with their axons through the anterolateral tract to the nucleus ventralis posterolateralis (VPL) of the thalamus and also to other thalamic nuclei, to the mesencephalon and to the reticular formation of the brain stem. In the VPL of the thalamus, most neurones with nociceptive input have a wide-dynamic range property, very few are nociceptive-specific.
Noxious events leading to deep somatic pain are encoded by thin myelinated (Aδ) and unmyelinated afferent fibers (e.g., from skeletal muscle, tendon and joint capsule). Besides these deep somatic “nociceptive” afferent units, other nonnociptive deep somatic afferent units with fine afferent have been claimed to exist and it is believed that these are involved in functions other than nociception. The specificity of responses of these afferents, with respect to the natural stimuli, is only relative.
For the viscera nociceptive spinal visceral afferents, which are only activated when injurious or potentially injurious events in the visceral domain (which may lead to pain) occur, cannot be unambiguously shown to exist. It seems more likely that the activity in the same population of spinal visceral afferents is involved in nociceptive as well as in nonnociceptive sensory functions, in the regulation of visceral organs and in various types of reflexes.
No neurones in the spinal grey matter have been found which specifically transmit and process information from fine deep somatic and spinal visceral afferents. This information seems to converge not only on many “wide-dynamic range” (multisensory) spinal neurones but also on some “nociceptive-specific” neurones. Only very limited information on thalamic neurones, with respect to the deep somatic and visceral afferent inputs, is available.
With the experimentally evaluated knowledge available, it seems unlikely that the “specificity theory” of Müller and von Frey can be applied to the generation of deep somatic and visceral pain; however, it seems more likely that “intensity” and “pattern mechanisms” are rather more important for the generation of these two types of pain. The way in which the impulses from deep somatic and visceral structures, which are associated with deep somatic and visceral pains, are processed by neuronal mechanisms in the spinal cord, brain stem and thalamus is unknown. It appears probable that “wide-dynamic” range neurones obtaining convergent input from deep somatic structures and viscera are involved in referred pain.
Finally, it should be kept in mind that the experimental work on the problem of the biology of pain is taking place essentially at three methodological levels: the structure and location of the neurones involved the physiology of the synaptic events and the impulse in these neurones and the psychology of pain behaviour. Results obtained with these different approaches leads to the description of three classes of associated but not casually linked phenomena. For example, the activity of “nociceptive-specific” neurones does not cause pain but may be associated with it.
KeywordsVisceral Pain Dorsal Horn Neurone Substantia Gelatinosa Spinothalamic Tract Wide Dynamic Range Neurone
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