Tactile induced analgesia

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Tactile induced analgesia is the phenomenon where concurrent touch and pain on the skin reduces the intensity of pain that is felt.

Contents

Somatosensory afferent fibres

There are four main types of sensory fibres responsible for somatosensation: Aα, Aβ, Aδ and C fibres (more details can be found at the axon page). The Aβ fibres are from cutaneous mechanoreceptors and respond to touch stimuli; the Aδ and C fibres are nociceptor afferents which respond to painful stimuli. The touch fibres have a larger diameter than the pain fibres, which means that they transmit their action potentials much faster than the smaller diameter fibres.

Gate Control Theory

Melzack and Wall

The Gate Control Theory of Pain, first proposed in the 1960s by Melzack and Wall, states that the concurrent activation of tactile afferent nerve fibers inhibits activation of nociceptive afferent fibres. [1] Melzack and Wall suggested that a gating mechanism is present in the dorsal horn of the spinal cord. They suggested that both touch and pain afferent fibres synapse on to 'projection cells' and inhibitory interneurons in the dorsal horn. It is the projection cells which then travel up the spinothalamic tract to the brain. Interactions between these connections is thought to mediate the perception of painful stimuli:

  1. With no input, the inhibitory interneuron stops signals being sent to the brain from the projection neuron, i.e. the gate is closed.
  2. Stimulation of large tactile afferents leads to somatosensory input. The inhibitory interneuron and projection neuron are both activated, but the inhibitory interneuron stops signals travelling to the brain via the projection neuron, i.e. the gate is closed.
  3. Nociception occurs if there is greater stimulation of the smaller pain afferents. The interneuron becomes inactivated, so that the projection neuron can send signals to the brain leading to pain perception, i.e. the gate is open.

The theory shows that rubbing a painful site leads to stimulation of somatosensory input to projector neurons, which reduces the intensity of pain perceived.

Development of the Gate Control Theory

More recently neurophysiological studies in animals have indicated that the wide range dynamic neurons (WDR neurons) in the dorsal horn are the homologue of Wall and Melzack's proposed projector neurons and inhibitory interneurons. [2] The neurons are multimodal (respond to both touch and pain input), with an inhibitory surround receptive field. Experiments looking at the WDR neurons in animals have shown that a strong tactile stimulus in the peripheral inhibitory field could reduce the response to a painful stimulus to the same extent as a weak tactile stimulus closer to the centre of the receptive field. [3] [4] These data show the Gate Control Theory of Pain was correct in the prediction that activation of large tactile afferent fibres inhibit the nociceptive afferent signal being transmitted to the brain.

Interactions between touch and pain

The interactions between touch and pain are mostly inhibitory (as is predicted by the Gate Control Theory). Research shows that there both acute and chronic pain perception is influenced by touch, with both psychophysical changes and differences in brain activation.

Touch and acute pain

The intensity of pain reported is consistently reduced in response to touch. [5] [6] [7] This occurs whether the touch is at the same time as the pain, or even if the touch occurs before the pain. [8] Touch also reduces the activation of cortical areas that respond to painful stimuli. [9]

Touch and chronic pain

Individuals suffering from chronic pain tend to show reduced tactile sensitivity in the affected area. [10] This means that they find it more difficult to distinguish whether there is one or two tactile points on the skin surface when the points are very close together. If patients are trained on the task of discriminating between two tactile points, it is shown that participants report reduced intensity of chronic pain. [11]

Related Research Articles

Nociception is the sensory nervous system's process of encoding noxious stimuli. It deals with a series of events and processes required for an organism to receive a painful stimulus, convert it to a molecular signal, and recognize and characterize the signal to trigger an appropriate defensive response.

<span class="mw-page-title-main">Striatum</span> Nucleus in the basal ganglia of the brain

The striatum, or corpus striatum, is a nucleus in the subcortical basal ganglia of the forebrain. The striatum is a critical component of the motor and reward systems; receives glutamatergic and dopaminergic inputs from different sources; and serves as the primary input to the rest of the basal ganglia.

<span class="mw-page-title-main">Itch</span> Sensation that causes desire or reflex to scratch

Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response patterns are different. Pain creates a withdrawal reflex, whereas itch leads to a scratch reflex.

<span class="mw-page-title-main">Grey column</span>

The grey column refers to a somewhat ridge-shaped mass of grey matter in the spinal cord. This presents as three columns: the anterior grey column, the posterior grey column, and the lateral grey column, all of which are visible in cross-section of the spinal cord.

A mechanoreceptor, also called mechanoceptor, is a sensory receptor that responds to mechanical pressure or distortion. Mechanoreceptors are innervated by sensory neurons that convert mechanical pressure into electrical signals that, in animals, are sent to the central nervous system.

<span class="mw-page-title-main">Nociceptor</span> Sensory neuron that detects pain

A nociceptor is a sensory neuron that responds to damaging or potentially damaging stimuli by sending "possible threat" signals to the spinal cord and the brain. The brain creates the sensation of pain to direct attention to the body part, so the threat can be mitigated; this process is called nociception.

<span class="mw-page-title-main">Periaqueductal gray</span> Nucleus surrounding the cerebral aqueduct

The periaqueductal gray is a brain region that plays a critical role in autonomic function, motivated behavior and behavioural responses to threatening stimuli. PAG is also the primary control center for descending pain modulation. It has enkephalin-producing cells that suppress pain.

<span class="mw-page-title-main">Pretectal area</span> Structure in the midbrain which mediates responses to ambient light

In neuroanatomy, the pretectal area, or pretectum, is a midbrain structure composed of seven nuclei and comprises part of the subcortical visual system. Through reciprocal bilateral projections from the retina, it is involved primarily in mediating behavioral responses to acute changes in ambient light such as the pupillary light reflex, the optokinetic reflex, and temporary changes to the circadian rhythm. In addition to the pretectum's role in the visual system, the anterior pretectal nucleus has been found to mediate somatosensory and nociceptive information.

<span class="mw-page-title-main">Gate control theory</span> Theory about pain and the nervous system

The gate control theory of pain asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from traveling to the central nervous system.

<span class="mw-page-title-main">Allodynia</span> Medical condition

Allodynia is a condition in which pain is caused by a stimulus that does not normally elicit pain. For example, bad sunburn can cause temporary allodynia, and touching sunburned skin, or running cold or warm water over it, can be very painful. It is different from hyperalgesia, an exaggerated response from a normally painful stimulus. The term is from Ancient Greek άλλοςállos "other" and οδύνηodúnē "pain".

<span class="mw-page-title-main">Microneurography</span>

Microneurography is a neurophysiological method employed to visualize and record the traffic of nerve impulses that are conducted in peripheral nerves of waking human subjects. It can also be used in animal recordings. The method has been successfully employed to reveal functional properties of a number of neural systems, e.g. sensory systems related to touch, pain, and muscle sense as well as sympathetic activity controlling the constriction state of blood vessels. To study nerve impulses of an identified nerve, a fine tungsten needle microelectrode is inserted into the nerve and connected to a high input impedance differential amplifier. The exact position of the electrode tip within the nerve is then adjusted in minute steps until the electrode discriminates nerve impulses of interest. A unique feature and a significant strength of the microneurography method is that subjects are fully awake and able to cooperate in tests requiring mental attention, while impulses in a representative nerve fibre or set of nerve fibres are recorded, e.g. when cutaneous sense organs are stimulated or subjects perform voluntary precision movements.

<span class="mw-page-title-main">Group C nerve fiber</span> One of three classes of nerve fiber in the central nervous system and peripheral nervous system

Group C nerve fibers are one of three classes of nerve fiber in the central nervous system (CNS) and peripheral nervous system (PNS). The C group fibers are unmyelinated and have a small diameter and low conduction velocity, whereas Groups A and B are myelinated. Group C fibers include postganglionic fibers in the autonomic nervous system (ANS), and nerve fibers at the dorsal roots. These fibers carry sensory information.

<span class="mw-page-title-main">Wide dynamic range neuron</span>

The wide dynamic range (WDR) neuron was first discovered by Mendell in 1966. Early studies of this neuron established what is known as the gate control theory of pain. The basic concept is that non-painful stimuli block the pathways for painful stimuli, inhibiting possible painful responses. This theory was supported by the fact that WDR neurons are responsible for responses to both painful and non-painful stimuli, and the idea that these neurons couldn't produce more than one of these responses simultaneously. WDR neurons respond to all types of somatosensory stimuli, make up the majority of the neurons found in the posterior grey column, and have the ability to produce long range responses including those responsible for pain and itch.

Diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM) refers to an endogenous pain modulatory pathway which has often been described as "pain inhibits pain". It occurs when response from a painful stimulus is inhibited by another, often spatially distant, noxious stimulus.

<span class="mw-page-title-main">Rostral ventromedial medulla</span> Group of neurons in medulla of brain

The rostral ventromedial medulla (RVM), or ventromedial nucleus of the spinal cord, is a group of neurons located close to the midline on the floor of the medulla oblongata. The rostral ventromedial medulla sends descending inhibitory and excitatory fibers to the dorsal horn spinal cord neurons. There are 3 categories of neurons in the RVM: on-cells, off-cells, and neutral cells. They are characterized by their response to nociceptive input. Off-cells show a transitory decrease in firing rate right before a nociceptive reflex, and are theorized to be inhibitory. Activation of off-cells, either by morphine or by any other means, results in antinociception. On-cells show a burst of activity immediately preceding nociceptive input, and are theorized to be contributing to the excitatory drive. Neutral cells show no response to nociceptive input.

As long as humans have experienced pain, they have given explanations for its existence and sought soothing agents to dull or cease the painful sensation. Archaeologists have uncovered clay tablets dating back as far as 5,000 BC which reference the cultivation and use of the opium poppy to bring joy and cease pain. In 800 BC, the Greek writer Homer wrote in his epic, The Odyssey, of Telemachus, a man who used opium to soothe his pain and forget his worries. While some cultures researched analgesics and allowed or encouraged their use, others perceived pain to be a necessary, integral sensation. Physicians of the 19th century used pain as a diagnostic tool, theorizing that a greater amount of personally perceived pain was correlated to a greater internal vitality, and as a treatment in and of itself, inflicting pain on their patients to rid the patient of evil and unbalanced humors. This article focuses both on the history of how pain has been perceived across time and culture, but also how malleable an individual's perception of pain can be due to factors like situation, their visual perception of the pain, and previous history with pain.

<span class="mw-page-title-main">Edward Perl</span>

Edward Roy Perl was an American neuroscientist whose research focused on neural mechanisms of and circuitry involved in somatic sensation, principally nociception. Work in his laboratory in the late 1960s established the existence of unique nociceptors. Perl was one of the founding members of the Society for Neuroscience and served as its first president. He was a Sarah Graham Kenan Professor of Cell Biology & Physiology and a member of the UNC Neuroscience Center at the University of North Carolina School of Medicine.

<span class="mw-page-title-main">Spinal interneuron</span> Interneuron relaying signals between sensory and motor neurons in the spinal cord

A spinal interneuron, found in the spinal cord, relays signals between (afferent) sensory neurons, and (efferent) motor neurons. Different classes of spinal interneurons are involved in the process of sensory-motor integration. Most interneurons are found in the grey column, a region of grey matter in the spinal cord.

C tactile afferents are nerve receptors in mammalian skin that generally respond to nonpainful stimulation such as light touch. For this reason they are classified as ‘low-threshold mechanoreceptors’. As group C nerve fibers, they are unmyelinated and have slow conduction velocities. They are mostly associated with the sensation of pleasant touch, though they may also mediate some forms of pain. CT afferents were discovered by Åke Vallbo using the technique of microneurography.

<span class="mw-page-title-main">Presynaptic inhibition</span>

Presynaptic inhibition is a phenomenon in which an inhibitory neuron provides synaptic input to the axon of another neuron to make it less likely to fire an action potential. Presynaptic inhibition occurs when an inhibitory neurotransmitter, like GABA, acts on GABA receptors on the axon terminal. Or when endocannabinoids act as retrograde messengers by binding to presynaptic CB1 receptors, thereby indirectly modulating GABA and the excitability of dopamine neurons by reducing it and other presynaptic released neurotransmitters. Presynaptic inhibition is ubiquitous among sensory neurons.

References

  1. R., Melzack; P.D., Wall (1965). "Pain Mechanisms: A New Theory". Survey of Anesthesiology. 11 (3699): 89–90. Bibcode:1965Sci...150..971M. doi:10.1126/science.150.3699.971. PMID   5320816.
  2. Le Bars D (October 2002). "The whole body receptive field of dorsal horn multireceptive neurones". Brain Res. Brain Res. Rev. 40 (1–3): 29–44. doi:10.1016/s0165-0173(02)00186-8. PMID   12589904. S2CID   53186033.
  3. Salter MW, Henry JL (1990). "Differential responses of nociceptive vs. non-nociceptive spinall dorsal horn neurons to cutaneously applied vibration in the cat". Pain. 40 (3): 311–322. doi:10.1016/0304-3959(90)91128-6. PMID   2326096. S2CID   40710000.
  4. Salter MW, Henry JL (1990). "Physiologicl characteristics of responses of wide dynamic range spinal neurones to cutaneously applied vibration in the cat". Brain Research. 507 (1): 69–84. doi:10.1016/0006-8993(90)90524-f. PMID   2302582. S2CID   12841536.
  5. Wall PD, Sweet WH (January 1967). "Temporary abolition of pain in man". Science. 155 (3758): 108–9. Bibcode:1967Sci...155..108W. doi:10.1126/science.155.3758.108. PMID   6015561. S2CID   33458415.
  6. Higgens JD, Tursky B, Schwartz GE (May 1971). "Shock-elicited pain and its reduction by concurrent tactile stimulation". Science. 172 (3985): 866–7. Bibcode:1971Sci...172..866H. doi:10.1126/science.172.3985.866. PMID   5572910. S2CID   44780022.
  7. P.D., Wall (1996). "Comments after 30 years of the Gate Control Theory". Pain Forum. 5: 12–22. doi:10.1016/s1082-3174(96)80063-8.
  8. Mancini F, Nash T, Iannetti GD, Haggard P (March 2014). "Pain relief by touch: a quantitative approach". Pain. 155 (3): 635–42. doi:10.1016/j.pain.2013.12.024. PMC   3988987 . PMID   24361816.
  9. Inui K, Tsuji T, Kakigi R (March 2006). "Temporal analysis of cortical mechanisms for pain relief by tactile stimuli in humans". Cereb. Cortex. 16 (3): 355–65. doi: 10.1093/cercor/bhi114 . PMID   15901650.
  10. Moriwaki K, Yuge O (May 1999). "Topographical features of cutaneous tactile hypoesthetic and hyperesthetic abnormalities in chronic pain". Pain. 81 (1–2): 1–6. doi:10.1016/s0304-3959(98)00257-7. PMID   10353487. S2CID   24339479.
  11. Moseley GL, Zalucki NM, Wiech K (July 2008). "Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain". Pain. 137 (3): 600–8. doi:10.1016/j.pain.2007.10.021. PMID   18054437. S2CID   2757963.