6 Somatosensitivity, viscerosensititvity, proprioception and pain II Somatosensitivity, viscerosensititvity, proprioception and pain II2 Viscerosensitivity Somatosensitivity, viscerosensititvity, proprioception and pain II3 • An information from visceral and cardiovascular system • Linked to the autonomic nervous system • The most of information does not reach higher structures than hypothalamus • The most of information does not reach consciousness Viscerosensitivity Somatosensitivity, viscerosensititvity, proprioception and pain II4 • An information from visceral and cardiovascular system • Linked to the autonomic nervous system • The most of information does not reach higher structures than hypothalamus • The most of information does not reach consciousness Proprioception Somatosensitivity, viscerosensititvity, proprioception and pain II5 • Information from muscles, tendons and joints • Important for precise coordination of movements • Overload protection • More will be discused in lecture about motor system Somatosensory pathways Somatosensitivity, viscerosensititvity, proprioception and pain II6 • Three systems • (Archispinothalamic) – Interconnection of adjacent segments (tr. Spinospinalis) • Paleospinothalamic – tr. Spinoreticularis, tr. Spinotectalis… • Neospinothalamic – tr. Spinothalamicus • Dorsal column system – tr. Spinobulbaris Somatosensory pathways Somatosensitivity, viscerosensititvity, proprioception and pain II7 • Three systems • (Archispinothalamic) – Interconnection of adjacent segments (tr. Spinospinalis) • Paleospinothalamic – tr. Spinoreticularis, tr. Spinotectalis… • Neospinothalamic – tr. Spinothalamicus • Dorsal column system – tr. Spinobulbaris Somatosensory pathways Somatosensitivity, viscerosensititvity, proprioception and pain II8 • Paleospinothalamic – Low resolution – dull, diffuse pain („slow pain“) • Neospinothalamic – High resolution – sharp, localized pain („fast pain“), temperature – Low resolution – touch • Dorsal column system – High resolution – fine touch Somatosensory pathways Somatosensitivity, viscerosensititvity, proprioception and pain II9 • Paleospinothalamic – Low resolution – dull, diffuse pain („slow pain“) • Neospinothalamic – High resolution – sharp, localized pain („fast pain“), temperature – Low resolution – touch • Dorsal column system – High resolution – fine touch Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II10 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II11 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II12 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II13 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II14 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Paleospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II15 • Tr. Spinoreticularis, spinotectalis… • Evolved before neocortex • The primary connection to the subcortical structures • Basic defensive reactions and reflexes - vegetative response, reflex locomotion - opto-acoustic reflexes etc. • Secondarily connected to cortex (after its evolution; tr. Spinoreticulo-thalamicus), but this system has a small resolutions – dull diffuse pain • This tract is not designed for „such a powerful processor as neocortex“ • Approximately half of the fibers cross the midline Somatosensitivity, viscerosensititvity, proprioception and pain II16 http://neuroscience.uth.tmc.edu Paleospinothalamic system Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II17 • Tr. Spinothalamicus • Younger structure primarily connected to neocortex • „High capacity/resolution“ • Detail information about pain stimuli (sharp, localized pain) • Information about temperature • Crude touch sensation • The fibers cross midline at the level of entry segment Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II18 • Tr. Spinothalamicus • Younger structure primarily connected to neocortex • „High capacity/resolution“ • Detail information about pain stimuli (sharp, localized pain) • Information about temperature • Crude touch sensation • The fibers cross midline at the level of entry segment Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II19 • Tr. Spinothalamicus • Younger structure primarily connected to neocortex • „High capacity/resolution“ • Detail information about pain stimuli (sharp, localized pain) • Information about temperature • Crude touch sensation • The fibers cross midline at the level of entry segment Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II20 • Tr. Spinothalamicus • Younger structure primarily connected to neocortex • „High capacity/resolution“ • Detail information about pain stimuli (sharp, localized pain) • Information about temperature • Crude touch sensation • The fibers cross midline at the level of entry segment Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II21 • Tr. Spinothalamicus • Younger structure primarily connected to neocortex • „High capacity/resolution“ • Detail information about pain stimuli (sharp, localized pain) • Information about temperature • Crude touch sensation • The fibers cross midline at the level of entry segment Neospinothalamic system Somatosensitivity, viscerosensititvity, proprioception and pain II22 http://neuroscience.uth.tmc.edu Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II23 • Tr. Spinobulbaris • The youngest system • High capacity • Tactile sensation • Vibration • Proprioception • Fine motor control • Better object recognition • Adaptive value • The fibers cross midline at the level of medulla oblongata Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II24 • Tr. Spinobulbaris • The youngest system • High capacity • Tactile sensation • Vibration • Proprioception • Fine motor control • Better object recognition • Adaptive value • The fibers cross midline at the level of medulla oblongata Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II25 • Tr. Spinobulbaris • The youngest system • High capacity • Tactile sensation • Vibration • Fine motor control • Better object recognition • Adaptive value • The fibers cross midline at the level of medulla oblongata Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II26 • Tr. Spinobulbaris • The youngest system • High capacity • Tactile sensation • Vibration • Fine motor control • Better object recognition • Adaptive value • The fibers cross midline at the level of medulla oblongata Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II27 • Tr. Spinobulbaris • The youngest system • High capacity • Tactile sensation • Vibration • Fine motor control • Better object recognition • Adaptive value • The fibers cross midline at the level of medulla oblongata Dorsal column system Somatosensitivity, viscerosensititvity, proprioception and pain II28 http://neuroscience.uth.tmc.edu Dermatoms Somatosensitivity, viscerosensititvity, proprioception and pain II29 http://www.slideshare.net/drpsdeb/presentations http://www.slideshare.net/CsillaEgri/presentations • Somatotopic organization somatosensitve nerves Dermatoms Somatosensitivity, viscerosensititvity, proprioception and pain II30 http://www.slideshare.net/drpsdeb/presentations http://www.slideshare.net/CsillaEgri/presentations • Somatotopic organization somatosensitve nerves Trigeminal system Somatosensitivity, viscerosensititvity, proprioception and pain II31 • Spinal TS – Pain, temperature • Main sensory TS – Touch, proprioception http://www.slideshare.net/drpsdeb/presentations Somatosensory pathways Somatosensitivity, viscerosensititvity, proprioception and pain II32 http://neuroscience.uth.tmc.edu/s2/chapter02.html Tr. spinobulbaris http://neuroscience.uth.tmc.edu Trigeminal system Somatosensitivity, viscerosensititvity, proprioception and pain II33 • Spinal TS – Pain, temperature • Main sensory TS – Touch, proprioception Thalamus and neocortex Somatosensitivity, viscerosensititvity, proprioception and pain II34 • Almost all the afferent information gated in the thalamus • Olfaction is an exception • Bilateral connections between neocortex and thalamus http://www.slideshare.net/drpsdeb/presentations Neocortex Somatosensitivity, viscerosensititvity, proprioception and pain II35 • Somatotopic organization • Cortical magnification http://www.shadmehrlab.org/Courses/physfound_files/wang_5.pdfhttp://www.slideshare.net/drpsdeb/presentations Pain Somatosensitivity, viscerosensititvity, proprioception and pain II36 • Distressing feeling associated with real or potential tissue damage • Sensor x psychological component ✓ Physiological pain (nociceptor activation) ✓ Pathological pain (not mediated by nociceptors) • Acute (up to 6months) – „activiting“ • Chronic (more than 6 months) – „devastating“ https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Pain Somatosensitivity, viscerosensititvity, proprioception and pain II37 • Distressing feeling associated with real or potential tissue damage • Sensor x psychological component ✓ Physiological pain (nociceptor activation) ✓ Pathological pain (not mediated by nociceptors) • Acute (up to 6months) – „activiting“ • Chronic (more than 6 months) – „devastating“ https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Pain Somatosensitivity, viscerosensititvity, proprioception and pain II38 • Distressing feeling associated with real or potential tissue damage • Sensor x psychological component ✓ Physiological pain (nociceptor activation) ✓ Pathological pain (not mediated by nociceptors) • Acute (up to 6months) – „activiting“ • Chronic (more than 6 months) – „devastating“ https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Nociceptors Somatosensitivity, viscerosensititvity, proprioception and pain II39 1. Polymodal (free nerve endings) 2. Thermal 3. Mechanosensitive (pressure) • Skin • Viscera ➢ Freen nerve endings ➢ In all connective tissues except of brain • C fibers – paleospinothalamic system ✓ 1., 2. • A fibers –neospinothalamic tract ✓ 1., 2., 3. https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Nociceptors Somatosensitivity, viscerosensititvity, proprioception and pain II40 1. Polymodal (free nerve endings) 2. Thermal 3. Mechanosensitive (pressure) • Skin • Viscera ➢ Freen nerve endings ➢ In all connective tissues except of brain • C fibers – paleospinothalamic system ✓ 1., 2. • A fibers –neospinothalamic tract ✓ 1., 2., 3. https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Nociceptors Somatosensitivity, viscerosensititvity, proprioception and pain II41 1. Polymodal (free nerve endings) 2. Thermal 3. Mechanosensitive (pressure) • Skin • Viscera ➢ Freen nerve endings ➢ In all connective tissues except of brain • C fibers – paleospinothalamic system ✓ 1., 2. • A fibers –neospinothalamic tract ✓ 1., 2., 3. https://www.cheatography.com/uploads/davidpol_1460561912_Pain_Scale__Arvin61r58.png Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II42 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II43 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II44 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II45 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II46 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II47 http://www.slideshare.net/drpsdeb/presentations • Modulation of receptor sensitivity – Increased sensitivity • Local compounds (H+, bradykinin, histamine) • Retrograde compounds (substance P) • Modulation at the segmental level – Sensitization of the posterior spinal horn • By the activity of interneurons, the afferentation is also interconnected contralaterally – Gate control theory • The main mechanism of modulation at the segmental level • Modulation via the reticular formation – Nucleus raphe magnus – Periaqueductal gray • Descendent antinociceptive system • Tonic inhibition tr. Spinothalamicus – Descending facilitation of nociceptors of the posterior horn of the spinal cord • Both inhibitory and facilitating effect • Cortical modulation – Complex effect • anticipation, previous experience, etc. – Via reticular formation/reticulospinal tract – Via corticospinal tract • Modulation of thalamic and spinal activity • Other structures involved in pain modulation • Hypothalamus – limbic component vs. thalamus – somatic component Pain modulations Somatosensitivity, viscerosensititvity, proprioception and pain II48 http://www.slideshare.net/drpsdeb/presentations • Autonomic nervous system – Acute pain activates the SNS and the SNS facilitates nociception – The parasympathetic nervous system inhibits pain • Endogenous opioids – Endorphins - dampening effect (β-endorphin) – Dynorphins – Both dampening and facilitating effect – Enkephalins - unresolved Pain and limbic system Somatosensitivity, viscerosensititvity, proprioception and pain II49 Navratilova E, Porreca F. Reward and motivation in pain and pain relief. Nat Neurosci. 2014;17:1304–1312. NAc – nucleus accumbens ACC – ant. Cingulate cortex. RVM – rostral ventromedial medulla Referred pain Somatosensitivity, viscerosensititvity, proprioception and pain II50 http://www.slideshare.net/drpsdeb/presentations Phantom limb pain Somatosensitivity, viscerosensititvity, proprioception and pain II51 http://www.slideshare.net/drpsdeb/presentations 73. Basic functional comparison of somatosensitivity, viscerosensitivity and proprioception, the importance of sensitivity for immediate and long-term survival Somatosensitivity, viscerosensititvity, proprioception and pain II52 ✓ Somatosensitivty vs. viscerosensitivty vs. proprioception • Definition, fuctional comparison ✓ Somatosensory pathways (three systems) • Function/resolution • Importance for survival (i.e. pain for immediate, proprioceptirn for better adaptation) ✓ Optionaly brief overview of proprioception • Muscle spindles vs. Golgi tendon organs (Motor system I) 74. Pain Somatosensitivity, viscerosensititvity, proprioception and pain II53 ✓ Definition of pain ✓ Classification of pain (physiological, pathological, acute, chronic) ✓ Somatosensory pathways involved in pain perception • Fast vs. slow pain ✓ Pain modulation • Overview of structures involved in pain modulation • Gate control theory ✓ Referred pain vs. phantom limb pain