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Chronic Pain

Back Clinic Chronic Pain Chiropractic Physical Therapy Team. Everyone feels pain from time to time. Cutting your finger or pulling a muscle, pain is your body’s way of telling you something is wrong. The injury heals, you stop hurting.

Chronic pain works differently. The body keeps hurting weeks, months, or even years after the injury. Doctors define chronic pain as any pain that lasts for 3 to 6 months or more. Chronic pain can affect your day-to-day life and mental health. Pain comes from a series of messages that run through the nervous system. When hurt, the injury turns on pain sensors in that area. They send a message in the form of an electrical signal, which travels from nerve to nerve until it reaches the brain. The brain processes the signal and sends out the message that the body is hurt.

Under normal circumstances, the signal stops when the cause of pain is resolved, the body repairs the wound on the finger or a torn muscle. But with chronic pain, the nerve signals keep firing even after the injury is healed.

Conditions that cause chronic pain can begin without any obvious cause. But for many, it starts after an injury or because of a health condition. Some of the leading causes:

Arthritis

Back problems

Fibromyalgia, a condition in which people feel muscle pain throughout their bodies

Infections

Migraines and other headaches

Nerve damage

Past injuries or surgeries

Symptoms

The pain can range from mild to severe and can continue day after day or come and go. It can feel like:

A dull ache

Burning

Shooting

Soreness

Squeezing

Stiffness

Stinging

Throbbing

For answers to any questions you may have please call Dr. Jimenez at 915-850-0900


Structural and Functional Mechanisms of Mechanoreceptors

Structural and Functional Mechanisms of Mechanoreceptors

We were all taught as children that there are 5 senses: sight, taste, sound, smell, and touch. The initial four senses utilize clear, distinct organs, such as the eyes, taste buds, ears, and nose, but just how does the body sense touch exactly? Touch is experienced over the entire body, both inside and outside. There is not one distinct organ that is responsible for sensing touch. Rather, there are tiny receptors, or nerve endings, around the entire body which sense touch where it occurs and sends signals to the brain with information regarding the type of touch that occurred. As a taste bud on the tongue detects flavor, mechanoreceptors are glands within the skin and on other organs that detect sensations of touch. They’re known as mechanoreceptors because they’re designed to detect mechanical sensations or differences in pressure.

 

Role of Mechanoreceptors

 

A person understands that they have experienced a sensation once the organ responsible for discovering that specific sense sends a message to the brain, which is the primary organ that processes and arranges all of the information. Messages are sent from all areas of the body to the brain through wires referred to as neurons. There are thousands of small neurons that branch out to all areas of the human body, and on the endings of many of these neurons are mechanoreceptors. To demonstrate what happens when you touch an object, we will use an example.

 

Envision a mosquito lands on your arm. The strain of this insect, so light, stimulates mechanoreceptors in that particular area of the arm. Those mechanoreceptors send a message along the neuron they are connected to. The neuron connects all the way to the brain, which receives the message that something is touching your body in the exact location of the specific mechanoreceptor that sent the message. The brain will act with this advice. Maybe it will tell the eyes to look at the region of the arm that detected the signature. And when the eyes tell the brain that there’s a mosquito on the arm, the brain may tell the hand to quickly flick it away. That’s how mechanoreceptors work. The purpose of the article below is to demonstrate as well as discuss in detail the functional organization and molecular determinants of mechanoreceptors.

 

Touch Sense: Functional Organization and Molecular Determinants of Mechanosensitive Receptors

 

Abstract

 

Cutaneous mechanoreceptors are localized in the various layers of the skin where they detect a wide range of mechanical stimuli, including light brush, stretch, vibration and noxious pressure. This variety of stimuli is matched by a diverse array of specialized mechanoreceptors that respond to cutaneous deformation in a specific way and relay these stimuli to higher brain structures. Studies across mechanoreceptors and genetically tractable sensory nerve endings are beginning to uncover touch sensation mechanisms. Work in this field has provided researchers with a more thorough understanding of the circuit organization underlying the perception of touch. Novel ion channels have emerged as candidates for transduction molecules and properties of mechanically gated currents improved our understanding of the mechanisms of adaptation to tactile stimuli. This review highlights the progress made in characterizing functional properties of mechanoreceptors in hairy and glabrous skin and ion channels that detect mechanical inputs and shape mechanoreceptor adaptation.

 

Keywords: mechanoreceptor, mechanosensitive channel, pain, skin, somatosensory system, touch

 

Introduction

 

Touch is the detection of mechanical stimulus impacting the skin, including innocuous and noxious mechanical stimuli. It is an essential sense for the survival and the development of mammals and human. Contact of solid objects and fluids with the skin gives necessary information to the central nervous system that allows exploration and recognition of the environment and initiates locomotion or planned hand movement. Touch is also very important for apprenticeship, social contacts and sexuality. Sense of touch is the least vulnerable sense, although it can be distorted (hyperesthesia, hypoesthesia) in many pathological conditions.1-3

 

Touch responses involve a very precise coding of mechanical information. Cutaneous mechanoreceptors are localized in the various layers of the skin where they detect a wide range of mechanical stimuli, including light brush, stretch, vibration, deflection of hair and noxious pressure. This variety of stimuli is matched by a diverse array of specialized mechanoreceptors that respond to cutaneous deformation in a specific way and relay these stimuli to higher brain structures. Somatosensory neurones of the skin fall into two groups: low-threshold mechanoreceptors (LTMRs) that react to benign pressure and high-threshold mechanoreceptors (HTMRs) that respond to harmful mechanical stimulation. LTMR and HTMR cell bodies reside within dorsal root ganglia (DRG) and cranial sensory ganglia (trigeminal ganglia). Nerve fibers associated with LTMRs and HTMRs are classified as A?-, A?- or C-fibers based on their action potential conduction velocities. C fibers are unmyelinated and have the slowest conduction velocities (~2 m/s), whereas A? and A? fibers are lightly and heavily myelinated, exhibiting intermediate (~12 m/s) and rapid (~20 m/s) conduction velocities, respectively. LTMRs are also classified as slowly, or rapidly adapting responses (SA- and RA-LTMRs) according to their rates of adaptation to sustained mechanical stimulus. They are further distinguished by the cutaneous end organs they innervate and their preferred stimuli.

 

Ability of mechanoreceptors to detect mechanical cues relies on the presence of mechanotransducer ion channels that rapidly transform mechanical forces into electrical signals and depolarise the receptive field. This local depolarisation, called receptor potential, can generate action potentials that propagate toward the central nervous system. However, properties of molecules that mediate mechanotransduction and adaptation to mechanical forces remain unclear.

 

In this review, we provide an overview of mammalian mechanoreceptor properties in innocuous and noxious touch in the hairy and glabrous skin. We also consider the recent knowledge about the properties of mechanically-gated currents in an attempt to explain the mechanism of mechanoreceptor�s adaptation. Finally, we review recent progress made in identifying ion channels and associated proteins responsible for the generation of mechano-gated currents.

 

Innocuous Touch

 

Hair Follicle-Associated LTMRs

 

The hair follicles represent hair shaft-producing mini-organs that detect light touch. Fibers associated with hair follicles respond to hair motion and its direction by firing trains of action potentials at the onset and removal of the stimulus. They are rapidly adapting receptors.

 

Cat and rabbit. In cat and rabbit coat, hair follicles can be divided in three hair follicle types, the Down hair, the Guard hair and the Tylotrichs. The Down hairs (underhair, wool, vellus)4 are the most numerous, the shortest and finest hairs of the coat. They are wavy, colorless and emerged in groups of two to four hairs from a common orifice in the skin. The Guard hairs (monotrichs, overhears, tophair)4 are slightly curved, either pigmented or unpigmented, and emerged singly from the mouths of their follicles. The tylotrichs are the least numerous, the longest and thickest hairs.5,6 They are pigmented or unpigmented, sometimes both and emerged singly from a follicle which is surrounded by a loop of capillary blood vessels. The sensory fibers supply to a hair follicle is located below the sebaceous gland and are attributed to A? or A?-LTMR fibers.7

 

In close apposition to the down hair shaft, just below the level of the sebaceous gland is the ring of lanceolate pilo-Ruffini endings. These sensory nerve endings are positioned in a spiral course around the hair shaft within the connective tissue forming the hair follicle. Within the hair follicle, there are also free nerve endings, some of them forming mechanoreceptors. Frequently, touch corpuscles (see glabrous skin) are surrounding the neck region of tylotrich follicle.

 

Properties of myelinated nerve endings in cat and rabbit hairy skin have been explored intensively in the 1930�1970 period (review in Hamann, 1995).8 Remarkably, Brown and Iggo, studying 772 units with myelinated afferent nerve fibers in the saphenous nerves from cat and rabbit, have classified responses in three receptor types corresponding to the movements of Down hairs (type D receptors), Guard hair (type G receptors) and Tylotrich hair (type T receptor).9 All the afferent nerve fiber responses have been brought together in the Rapidly Adapting receptor of type I (RA I) by opposition to the Pacinian receptor named RA II. RA I mechanoreceptors detect velocity of mechanical stimulus and have sharp border. They do not detect thermal variations. Burgess et al. also described a rapidly adapting field receptor that responds optimally to stroking of the skin or movement of several hairs, which was attributed to stimulation of pilo-Ruffini endings. None of the hair follicle response was attributed to C fiber activity.10

 

Mice. In the dorsal hairy skin of mice, three major types of hair follicles have been described: zigzag (around 72%), awl/auchene (around 23%) and guard or tylotrich (around 5%).11-14 Zigzag and Awl/auchenne hair follicles produce the thinner and shorter hair shafts and are associated with one sebaceous gland. Guard or tylotrich hairs are the longest of the hair follicle types. They are characterized by a large hair bulb associated with two sebaceous glands. Guard and awl/auchene hairs are arranged in an iterative, regularly spaced pattern whereas zigzag hairs densely populate skin areas surrounding the two larger hair follicle types [Fig. 1 (A1, A2 and A3)].

 

Figure 1 Organization and Projections of Cutaneous Mechanoreceptors | El Paso, TX Chiropractor

Figure 1. Organization and projections of cutaneous mechanoreceptors. In hairy skin, light brush and touch are mainly detected by the innervation around the hair follicles: awl/auchenne (A1), zigzag (A2) and guard (A3). Awl/auchene hairs are triply innervated by C-LTMR lanceolate endings (A4), A?-LTMR and A? rapidly adapting-LTMR (A6). Zigzag hair follicles are the shorter hair shafts and are innervated by both C-LTMR (A4) and A? -LTMR lanceolate endings (A5). The longest guard hair follicles are innervated by A? rapidly adapting-LTMR longitudinal lanceolate endings (A6) and are associated with A? slowly adapting-LTMR of touch dome endings (A7). The central projections of all these fibers terminate in distinct, but partially overlapping laminae of the spinal cord dorsal horn (C-LTMR in lamina II, A?-LTMR in lamina III and A?-LTMR in lamina IV and V). The projections of LTMR that innervate the same or adjacent hair follicles are aligned to form a narrow column in the spinal cord dorsal horn (B1 in gray). Only in hairy skin, a subpopulation of C-fibers free ending innervates the epidermis and responds to pleasant touch (A8). These C-touch fibers don�t respond to noxious touch and their pathway travel is not yet known (B2). In glabrous skin, innocuous touch is mediated by four types of LTMRs. The Merkel cell-neurite complex is in the basal layer of the epidermis (C1). This mechanoreceptor consists of an arrangement between many Merkel cells and an enlarged nerve terminal from a single A? fiber. Merkel cells exhibits finger like processes contacting keratinocytes (C2). The Ruffini ending is localized in the dermis. It is a thin cigar-shaped encapsulated sensory endings connected to A? fiber (C3). The Meissner corpuscle connected to A? nerve ending and is located in the dermal papillae. This encapsulated mechanoreceptor consists of packed down supportive cells arranged as horizontal lamellae surrounded by connective tissue (C4). Pacinian corpuscle is the deeper mechanoreceptor. One single A? unmyelinated nerve ending terminates in the center of this large ovoid corpuscle made of concentric lamellae. Projections of these A?-LTMR fibers in the spinal cord are divided in two branches. The principal central branch (B3) ascends in the spinal cord in the ipsilateral dorsal forming cuneate or gracile fascicles (B5) upon medulla level where the primary afferents make their first synapse (B6). The secondary neurons make a sensory decussation (B7) to form a tract on the medial lemniscus which ascends through the brainstem to the midbrain, specifically in the thalamus. Secondary branche of LTMR terminates in the dorsal horn in the lamina II, IV, V and interfere with the pain transmission (B4). Noxious touch is detected by the free nerve ending in the epidermis of both hairy (A9) and glabrous skin (C7). These mechanoreceptors are the ending of A?-HTMR and C-HTMR in close contact with neighboring keratinocytes (C6). A?-hTMR terminate in the lamina I and V; C-HTMR terminate in the lamina I and II (B8). At spinal cord dorsal horn level, primary afferents HTMRs make synapses with secondary neurons which cross the midline and climb to the higher brain structure in the anterolateral fascicle (B9, B10). LTMR, low threshold mechanoreceptor; HTMR, high threshold mechanoreceptor.

 

Recently, Ginty and collaborators used a combination of molecular-genetic labeling and somatotopic retrograde tracing approaches to visualize the organization of peripheral and central axonal endings of the LTMRs in mice.15 Their findings support a model in which individual features of a complex tactile stimulus are extracted by the three hair follicle types and conveyed via the activities of unique combinations of A?-, A?- and C- fibers to dorsal horn.

 

They showed that the genetic labeling of tyrosine hydroxylase positive (TH+) DRG neurones characterize a population of nonpeptidergic, small-diameter sensory neurones and allow for visualization of C-LTMR peripheral endings in the skin. Surprisingly, the axoneal branches of individual C-LTMRs were found to arborise and form longitudinal lanceolate endings that are intimately associated with zigzag (80% of endings) and awl/auchene (20% of endings), but not tylotrich hair follicles [Fig. 1 (A4)]. Longitudinal lanceolate endings have been long thought to belong exclusively to A?-LTMRs and therefore it was unexpected that the endings of C-LTMRs would form longitudinal lanceolate endings.15 These C-LTMRs have an intermediate adaptation in comparison with the slowly and rapidly adapting myelinated mechanoreceptors [Fig. 2 (C1)].

 

Figure 2 Tactile Receptors in Mammals | El Paso, TX Chiropractor

Figure 2. Tactile receptors in mammals: Cutaneous tactile receptors differentiate into innocuous touch supported by multiple receptors with low mechanical threshold (LTMRs) in glabrous and hairy skin and noxious touch supported by high mechanical threshold receptor (HTMRs). They make up nerve free endings that terminate mainly in epidermis. (A) Glabrous skin. A1: Meissner corpuscles detect skin motion and slipping of object in the hand. They are important for handing object and dexterity. Receptors rapidly adapt to stimulus, are connected to A? fibers and sparsely to C fibers and have large receptor field. A2: Ruffini corpuscles detect skin stretch and are important to detect finger position and handing object. Receptor slowly adapt to stimulus and maintained activity as long as the stimulus was applied. Receptors are connected to A? fibers and have large receptive field. A3: Pacinian corpuscles are deeper in the dermis and detect vibration. Receptors are connected to A? fibers; they rapidly adapt to stimulus and have the largest receptive field. (B) Whole skin. B1: Merkel-cell complexes are present in both glabrous skin and around hair. They are densely expressed in the hand and are important for texture perception and finest discrimination between two points. They are responsible for finger precision. Receptors are connected to A? fibers; they slowly adapt to stimulus and have short receptive field. B2: Noxious touch HTMRs with very slow adaptation to the stimulus, i.e., active as long as the nociceptive stimulus is applied. They are formed by the free nerve ending of A? and C-fibers associated to keratinocytes. (C) Hairy skin. C1: Hair follicles are associated with the different hair types. In mice Guard hairs are the longer and sparsely expressed one, awl/auchenne are of medium size and zigzag are the smallest and the most densely expressed hair. They are connected to A? fibers but also to A? and C-LTMRs fibers for awl/auchenne and zizag hair. They detect hair movement including pleasant touch during caress. They adapt rapidly or with intermediate kinetic to stimulus. C2: C-touch nerve endings correspond to a subtype of C fibers terminus with free ending characterized by a low mechanical threshold. They are supposed to encode for pleasant sensation induced by caress. They moderately adapt to stimulus and have short receptive field. Putative mechanosensitive (MS) ion channels expressed in the different tactile receptors are indicated accordingly to preliminary data and summarize present hypothesis under evaluation.

 

A second major population identified concerns the A?-LTMR endings in Awl/Auchenne and zigzag follicles to be compared with the Down hair follicle extensively studied in cat and rabbit. Ginty and collaborators showed that TrkB is expressed at high levels in a subset of medium-diametre DRG neurones. Intracellular recordings using the ex vivo skin-nerve preparation of labeled fibers revealed that they exhibit the physiological properties of fibers previously studied in cat and rabbit: exquisite mechanical sensitivity (Von Frey threshold < 0.07 mN), rapidly adapting responses to suprathreshold stimuli, intermediate conduction velocities (5.8 � 0.9 m/s) and narrow uninflected soma spikes.15 These A?-LTMRs form longitudinal lanceolate endings associated with virtually every zigzag and awl/auchene hair follicle of the trunk [Fig. 1 (A5)].

 

Finally, they showed that the peripheral endings of rapidly adapting A? LTMRs form longitudinal lanceolate endings associated with guard (or tylotrich) and awl/auchene hair follicles [Fig. 1 (A6)].15 In addition, Guard hairs are also associated with a Merkel cell complex forming a touch dome connected to A? slowly adapting LTMR [Fig. 1 (A7)].

 

In summary, virtually all zigzag hair follicles are innervated by both C-LTMR and A?-LTMR lanceolate endings; awl/auchene hairs are triply innervated by A? rapidly adapting-LTMR, A?-LTMR and C-LTMR lanceolate endings; Guard hair follicles are innervated by A? rapidly adapting-LTMR longitudinal lanceolate endings and interact with A? slowly adapting-LTMR of touch dome endings. Thus, each mouse hair follicle receives unique and invariant combinations of LTMR endings corresponding to neurophysiologically distinct mechanosensory end organs. Considering the iterative arrangement of these three hair types, Ginty and collaborators propose that hairy skin consists of iterative repeat of peripheral unit containing, (1) one or two centrally located guard hairs, (2) ~20 surrounding awl/auchenne hairs and (3) ~80 interspersed zigzag hairs [Fig. 2 (C1)].

 

Spinal cord projection. The central projections of A? rapidly adapting-LTMRs, A?-LTMRs and C-LTMRs terminate in distinct, but partially overlapping laminae (II, III, IV) of the spinal cord dorsal horn. In addition, the central terminals of LTMRs that innervate the same or adjacent hair follicles within a peripheral LTMR unit are aligned to form a narrow LTMR column in the spinal cord dorsal horn [Fig. 1 (B1)]. Thus, it appears likely that a wedge, or column of somatotopically organized primary sensory afferent endings in the dorsal horn represents the alignment of the central projections of A?-, A?- and C-LTMRs that innervate the same peripheral unit and detect mechanical stimuli acting upon the same small group of hairs follicles. Based on the numbers of guard, awl/ auchene and zigzag hairs of the trunk and limbs and the numbers of each LTMR subtype, Ginty and collaborators estimate that the mouse dorsal horn contains 2,000�4,000 LTMR columns, which corresponds to the approximate number of peripheral LTMR units.15

 

Furthermore, axones of LTMR subtypes are closely associated with one another, having entwined projections and interdigitated lanceolate endings that innervate the same hair follicle. In addition, because the three hair follicle types exhibit different shapes, sizes and cellular compositions, they are likely to have distinct deflectional or vibrational tuning properties. These findings are consistent with classic neurophysiological measurements in the cat and rabbit indicating that A? RA-LTMRs and A?-LTMRs can be differentially activated by deflection of distinct hair follicle types.16,17

 

In conclusion, touch in hairy skin is the combination of: (1) the relative numbers, unique spatial distributions and distinct morphological and deflectional properties of the three types of hair follicles; (2) the unique combinations of LTMR subtype endings associated with each of the three hair follicle types; and (3) distinct sensitivities, conduction velocities, spike train patterns and adaptation properties of the four main classes of hair-follicle-associated LTMRs that enable the hairy skin mechanosensory system to extract and convey to the CNS the complex combinations of qualities that define a touch.

 

Free-Nerve Endings LTMRs

 

Generally, C-fibers free endings in the skin are HTMRs, but a subpopulation of C-fibers doesn�t respond to noxious touch. This subset of tactile C-fiber (CT) afferents represents a distinct type of unmyelinated, low-threshold mechanoreceptive units existing in the hairy but not glabrous skin of humans and mammals [Fig. 1 (A8)].18,19 CTs are generally associated with the perception of pleasant tactile stimulation in body contact.20,21

 

CT afferents respond to indentation forces in the range 0.3�2.5 mN and are thus as sensitive to skin deformation as many of the A? afferents.19 The adaptation characteristics of CT afferents are thus intermediate in comparison with the slowly and rapidly adapting myelinated mechanoreceptors. The receptive fields of human CT afferents are roughly round or oval in shape. The field consists of one to nine small responsive spots distributed over an area up to 35 mm2.22 The mouse homolog receptors are organized in a pattern of discontinuous patches covering about 50�60% of the area in the hairy skin [Fig. 2 (C2)].23

 

Evidence from patients lacking myelinated tactile afferents indicates that signaling in CT fibers activate the insular cortex. Since this system is poor in encoding discriminative aspects of touch, but well-suited to encoding slow, gentle touch, CT fibers in hairy skin may be part of a system for processing pleasant and socially relevant aspects of touch.24 CT fiber activation may also have a role in pain inhibition and it has recently been proposed that inflammation or trauma may change the sensation conveyed by C-fiber LTMRs from pleasant touch to pain.25,26

 

Which pathway CT-afferents travel is not yet known [Fig. 1 (B2)], but low-threshold tactile inputs to spinothalamic projection cells have been documented,27 lending credence to reports of subtle, contralateral deficits of touch detection in human patients following destruction of these pathways after chordotomy procedures.28

 

LTMRs in Glabrous Skin

 

Merkel cell-neurite complexes and touch dome. Merkel (1875) was the first to give a histological description of clusters of epidermal cells with large lobulated nuclei, making contact with presumed afferent nerve fibers. He assumed that they subserved sense of touch by calling them Tastzellen (tactile cells). In humans, Merkel cell�neurite complexes are enriched in touch sensitive areas of the skin, they are found in the basal layer of the epidermis in fingers, lips and genitals. They also exist in hairy skin at lower density. The Merkel cell�neurite complex consists of a Merkel cell in close apposition to an enlarged nerve terminal from a single myelinated A? fiber [Fig. 1 (C1)] (review in Halata and collaborators).29 At the epidermal side Merkel cell exhibits finger-like processes extending between neighboring keratinocytes [Fig. 1 (C2)]. Merkel cells are keratinocyte-derived epidermal cells.30,31 The term of touch dome was introduced to name the large concentration of Merkel cell complexes in the hairy skin of cat forepaw. A touch dome could have up to 150 Merkel cells innervated by a single A?-fiber and in humans besides A?-fibers, A? and C-fibers were also regularly present.32-34

 

Stimulation of Merkel cell�neurite complexes results in slowly-adapting Type I (SA I) responses, which originate from punctuate receptive fields with sharp borders. There is no spontaneous discharge. These complexes respond to indentation depth of the skin and have the highest spatial resolution (0.5 mm) of the cutaneous mechanoreceptors. They transmit a precise spatial image of tactile stimuli and are proposed to be responsible for shape and texture discrimination [Fig. 2 (B1)]. Mice devoid of Merkel cells cannot detect textured surfaces with their feet while they do so using their whiskers.35

 

Whether the Merkel cell, the sensory neuron or both are sites of mechanotransduction is still a matter of debate. In rats, phototoxic destruction of Merkel cells abolishes SA I response.36 In mice with genetically suppressed-Merkel cells, the SA I response recorded in ex vivo skin/nerve preparation completely disappeared, demonstrating that Merkel cells are required for the proper encoding of Merkel receptor responses.37 However, the mechanical stimulation of isolated Merkel cells in culture by motor driven pressure does not generate mechanically-gated currents.38,39 Keratinocytes may play an important role in the normal functioning of the Merkel cell�neurite complex. The Merkel cell finger-like processes can move with skin deformation and epidermis cell movement, and this may be the first step of mechanical transduction. Clearly, the conditions required to study mechano-sensitivity of Merkel cells have yet to be established.

 

Ruffini endings. Ruffini endings are thin cigar-shaped encapsulated sensory endings connected to A? nerve endings. Ruffini endings are small connective tissue cylinders arranged along dermal collagen strands which are supplied by one to three myelinated nerve fibers of 4�6 �m diametre. Up to three cylinders of different orientation in the dermis may merge to form one receptor [Fig. 1 (C3)]. Structurally, Ruffini endings are similar to Golgi tendon organs. They are broadly expressed in the dermis and have been identified as the slowly adapting type II (SA II) cutaneous mechanoreceptors. Against the background of spontaneous nervous activity, a slowly-adapting regular discharge is elicited by perpendicular low force maintained mechanical stimulation or more effectively by dermal stretch. SA II response originates from large receptive fields with obscure borders. Ruffini receptors contribute to the perception of the direction of object motion through the pattern of skin stretch [Fig. 2 (A2)].

 

In mice, SA I and SA II responses can be separated electrophysiologically in ex-vivo nerve-skin preparation.40 Nandasena and collaborators reported the immunolocalization of aquaporin 1 (AQP1) in the periodontal Ruffini endings of the rat incisors suggesting that AQP1 is involved in the maintenance of the dental osmotic balance necessary for the mechanotransduction.41 The periodontal Ruffini endings also expressed the putative mechanosensitive ion channel ASIC3.42

 

Meissner corpuscles. Meissner corpuscles are localized in the dermal papillae of the glabrous skin, mainly in hand palms and foot soles but also in lips, in tongue, in face, in nipples and in genitals. Anatomically, they consist of an encapsulated nerve ending, the capsule being made of flattened supportive cells arranged as horizontal lamellae embedded in connective tissue. There is one single nerve fiber A? afferents connected per corpuscle [Fig. 1 (C4)]. Any physical deformation of the corpuscle triggers a volley of action potentials that quickly ceases, i.e., they are rapidly adapting receptors. When the stimulus is removed, the corpuscle regains its shape and while doing so produces another volley of action potentials. Due to their superficial location in the dermis, these corpuscles selectively respond to skin motion, tactile detection of slip and vibrations (20�40 Hz). They are sensitive to dynamic skin – for example, between the skin and an object that is being handled [Fig. 2 (A1)].

 

Pacinian corpuscles. Pacinian corpuscles are the deeper mechanoreceptors of the skin and are the most sensitive encapsulated cutaneous mechanoreceptor of skin motion. These large ovoid corpuscles (1 mm in length) made of concentric lamellae of fibrous connective tissue and fibroblasts lined by flat modified Schwann cells are expressed in the deep dermis.43 In the center of the corpuscle, in a fluid-filled cavity called inner bulb, terminates one single A? afferent unmyelinated nerve ending [Fig. 1 (C5)]. They have a large receptive field on the skin�s surface with a particularly sensitive center. The development and function of several rapidly adapting mechanoreceptor types are disrupted in c-Maf mutant mice. In particular, Pacinian corpuscles are severely atrophied.44

 

Pacinian corpuscles display very rapid adaptation in response to the indentation of the skin, the rapidly-adapting II (RA II) nervous discharge that are capable of following high frequency of vibratory stimuli, and allow perception of distant events through transmitted vibrations.45 Pacinian corpuscle afferents respond to sustained indentation with transient activity at the onset and offset of the stimulus. They are also called acceleration detectors because they can detect changes in the strength of the stimulus and, if the rate of change in the stimulus is altered (as happens in vibrations), their response becomes proportional to this change. Pacinian corpuscles sense gross pressure changes and most of all vibrations (150�300 Hz), which they can detect even centimeters away [Fig. 2 (A3)].

 

Tonic response was observed in decapsulated Pacinian corpuscle.46 In addition, intact Pacinian corpuscles respond with sustained activity during constant indentation stimuli, without altering mechanical thresholds or response frequency when GABA-mediated signaling is blocked between lamellate glia and a nerve ending.47 Thus, the non-neuronal components of the Pacinian corpuscle may have dual roles in filtering the mechanical stimulus as well as in modulating the response properties of the sensory neurone.

 

Spinal cord projections. Projections of the A?-LTMRs in the spinal cord are divided in two branches. The principal central branch ascends in the spinal cord in the ipsilateral dorsal columns to the cervical level [Fig. 1 (B3)]. Secondary branches terminate in the dorsal horn in the laminae IV and interfere with the pain transmission, for example. This may attenuate pain as a part of the gate control [Fig. 1 (B4)].48

 

At cervical levels, axones of the principal branch separate in two tracts: the midline tract comprises the gracile fascicle conveying information from the lower half of the body (legs and trunk), and the outer tract comprises the cuneate fascicle conveying information from the upper half of the body (arms and trunk) [Fig. 1 (B5)].

 

Primary tactile afferents make their first synapse with second order neurones at the medulla where fibers from each tract synapse in a nucleus of the same name: the gracile fasciculus axones synapse in the gracile nucleus and the cuneate axones synapse in the cuneate nucleus [Fig. 1 (B6)]. Neurones receiving the synapse provide the secondary afferents and cross the midline immediately to form a tract on the contralateral side of the brainstem�the medial lemniscus�which ascends through the brainstem to the next relay station in the midbrain, specifically, in the thalamus [Fig. 1 (B7)].

 

Molecular specification of LTMRs. Molecular mechanisms controlling the early diversification of LTMRs have been recently partly elucidated. Bourane and collaborators have shown that the neuronal populations expressing the Ret tyrosine kinase receptor (Ret) and its co-receptor GFR?2 in E11�13 embryonic mice DRG selectively coexpress the transcription factor Mafa.49,50 These authors demonstrate that the Mafa/Ret/GFR?2 neurones destined to become three specific types of LTRMs at birth: the SA1 neurones innervating Merkel-cell complexes, the rapidly adapting neurones innervating Meissner corpuscles and the rapidly adapting afferents (RA I) forming lanceolate endings around hair follicles. Ginty and collaborators also report that DRG neurones expressing early-Ret are rapidly adapting mechanoreceptors from Meissner corpuscles, Pacinian corpuscles and lanceolate endings around hair follicles.51 They innervate discrete target zones within the gracile and cuneate nuclei, revealing a modality-specific pattern of mechanosensory neurone axonal projections within the brainstem.

 

Exploration of human skin mechanoreceptors. The technique of �microneurography� described by Hagbarth and Vallbo in 1968 has been applied to study the discharge behavior of single human mechanosensitive endings supplying muscle, joint and skin (see for review Macefield, 2005).52,53 The majority of human skin microneurography studies have characterized the physiology of tactile afferents in the glabrous skin of the hand. Microelectrode recordings from the median and ulnar nerves in human subjects have revealed touch sensation generated by the four classes of LTMRs: Meissner afferents are particularly sensitive to light stroking across the skin, responding to local shear forces and incipient or overt slips within the receptive field. Pacinian afferents are exquisitively sensitive to brisk mechanical transients. Afferents respond vigorously to blowing over the receptive field. A Pacinian corpuscle located in a digit will usually respond to tapping the table supporting the arm. Merkel afferents characteristically have a high dynamic sensitivity to indentation stimuli applied to a discrete area and often respond with an off-discharge during release. Although the Ruffini afferents do respond to forces applied normally to the skin, a unique feature of SA II afferents is their capacity to respond also to lateral skin stretch. Finally, hair units in the forearm have large ovoid or irregular receptive fields composed of multiple sensitive spots that corresponded to individual hairs (each afferent supply ~20 hairs).

 

Mechanical Sensitivity of Keratinocytes

 

Any mechanical stimulus on the skin must be transmitted through keratinocytes that form the epidermis. These ubiquitous cells may perform signaling functions in addition to their supportive or protective roles. For example, keratinocytes secrete ATP, an important sensory signaling molecule, in response to mechanical and osmotic stimuli.54,55 The release of ATP induces intracellular calcium increase by autocrine stimulation of purinergic receptors.55 Furthermore, there is evidence that hypotonicity activates the Rho-kinase signaling pathway and the subsequent F-actin stress fiber formation suggesting that the mechanical deformation of the keratinocytes may mechanically interfere with the neighbor cells such as Merkel cells for innocuous touch and C-fiber free endings for noxious touch [Fig. 1 (C6)].56,57

 

Noxious Touch

 

High threshold mechanoreceptors (HTMRs) are epidermal C- and A? free nerve-endings. They are not associated with specialized structures and are observed in both hairy skin [Fig. 1 (A9)] and glabrous skin [Fig. 1(C7)]. However, the term of free nerve-ending has to be considered prudently since nerve endings are always in close apposition with keratinocyte or Langherans� cell or melanocytes. Ultrastructural analysis of nerve endings reveals the presence of rough endoplasmic reticulum, abundant mitochondria and dense-core vesicle. Adjacent membranes of epidermal cells are thickened and resembling post-synaptic membrane in nervous tissues. Note that the interactions between nerve endings and epidermal cells may be bidirectional since epidermal cells may release mediators as ATP, interleukine (IL6, IL10) and bradykinin and conversely peptidergic nerve endings may release peptides such as CGRP or substance P acting on epidermal cells. HTMRs comprise mechano-nociceptors excited only by noxious mechanical stimuli and polymodal nociceptors that also respond to noxious heat and exogenous chemical [Fig. 2 (B2)].58

 

HTMR afferent fibers terminate on projection neurones in the dorsal horn of the spinal cord. A?-HTMRs contact second order neurones predominantly in the lamina I and V, whereas C-HTMRs terminate in the lamina II [Fig. 1 (B8)]. Second order nociceptive neurones project to the controlateral side of the spinal cord and ascend in the white matter, forming the anterolateral system. These neurones terminate mainly in the thalamus [Fig. 1 (B9 and B10)].

 

Mechano-Currents in Somatosensory Neurones

 

The mechanisms of slow or rapid adaptation of mechanoreceptors are not yet elucidated. It is not clear to what extent mechanoreceptor adaptation is provided by the cellular environment of the sensory nerve ending, the intrinsic properties of the mechanically-gated channels and the properties of the axonal voltage-gated ion channels in sensory neurones (Fig. 2). However, recent progress in the characterization of mechanically-gated currents has demonstrated that different classes of mechanosensitive channels exist in DRG neurones and may explain some aspects of the adaptation of mechanoreceptors.

 

In vitro recording in rodents has shown that the soma of DRG neurons is intrinsically mechanosensitive and express cationic mechano-gated currents.59-64 Gadolinium and ruthenium red fully block mechanosensitive currents, whereas external calcium and magnesium, at physiological concentrations, as well as amiloride and benzamil, cause partial block.60,62,63 FM1-43 acts as a lasting blocker, and the injection of FM1-43 into the hind paw of mice decreases pain sensitivity in the Randall�Selitto test and increases the paw withdrawal threshold assessed with von Frey hairs.65

 

In response to sustained mechanical stimulation, mechanosensitive currents decline through closure. Based on the time constants of current decay, four distinct types of mechanosensitive currents have been distinguished: rapidly adapting currents (~3�6 ms), intermediately adapting currents (~15�30 ms), slowly adapting currents (~200�300 ms) and ultra-slowly adapting currents (~1000 ms).64 All these currents are present with variable incidence in rat DRG neurones innervating the glabrous skin of the hindpaw.64

 

The mechanical sensitivity of mechanosensitive currents can be determined by applying a series of incremental mechanical stimuli, allowing for relatively detailed stimulus-current analysis.66 The stimulus�current relationship is typically sigmoidal, and the maximum amplitude of the current is determined by the number of channels that are simultaneously open.64,67 Interestingly, the rapidly adapting mechanosensitive current has been reported to display low mechanical threshold and half-activation midpoint compared with the ultra-slowly adapting mechanosensitive current.63,65

 

Sensory neurones with non-nociceptive phenotypes preferentially express rapidly adapting mechanosensitive currents with lower mechanical threshold.60,61,63,64,68 Conversely, slowly and ultra-slowly adapting mechanosensitive currents are occasionally reported in putative non-nociceptive cells.64,68 This prompted suggestion that these currents might contribute to the different mechanical thresholds seen in LTMRs and HTMRs in vivo. Although these in vitro experiments should be taken with caution, support for the presence in the soma of the DRG neurones of low- and high-threshold mechanotransducers was also provided by radial stretch-based stimulation of cultured mouse sensory neurones.69 This paradigm revealed two main populations of stretch-sensitive neurones, one that responds to low stimulus amplitude and another one that selectively responds to high stimulus amplitude.

 

These results have important, yet speculative, mechanistic implications: the mechanical threshold of sensory neurones might have little to do with the cellular organization of the mechanoreceptor but may lie in the properties of the mechanically-gated ion channels.

 

The mechanisms that underlie desensitization of mechanosensitive cation currents in rat DRG neurones have been recently unraveled.64,67 It results from two concurrent mechanisms that affect channel properties: adaptation and inactivation. Adaptation was first reported in auditory hair cell studies. It can be described operationally as a simple translation of the transducer channel�s activation curve along the mechanical stimulus axis.70-72 Adaptation allows sensory receptors to maintain their sensitivity to new stimuli in the presence of an existing stimulus. However, a substantial fraction of mechanosensitive currents in DRG neurones cannot be reactivated following conditioning mechanical stimulation, indicating inactivation of some transducer channels.64,67 Therefore, both inactivation and adaptation act in tandem to regulate mechanosensitive currents. These two mechanisms are common to all mechanosensitive currents identified in rat DRG neurones, suggesting that related physicochemical elements determine the kinetics of these channels.64

 

In conclusion, determining the properties of endogenous mechanosensitive currents in vitro is crucial in the quest to identify transduction mechanisms at the molecular level. The variability observed in the mechanical threshold and the adapting kinetics of the different mechanically-gated currents in DRG neurones suggest that intrinsic properties of ion channels may explain, at least in part, mechanical threshold and adaptation kinetics of the mechanoreceptors described in the decades 1960�80 using ex vivo preparations.

 

Putative Mechanosensitive Proteins

 

Mechanosensitive ion currents in somatosensory neurones are well characterized, by contrast, little is known about the identity of molecules that mediate mechanotransduction in mammals. Genetic screens in Drosophila and C. elegans have identified candidate mechanotransduction molecules, including the TRP and degenerin/epithelial Na+ channel (Deg/ENaC) families.73 Recent attempts to elucidate the molecular basis of mechanotransduction in mammals have largely focused on homologs of these candidates. Additionally, many of these candidates are present in cutaneous mechanoreceptors and somatosensory neurones (Fig. 2).

 

Acid-Sensing Ion Channels

 

ASICs belong to a proton-gated subgroup of the degenerin�epithelial Na+ channel family.74 Three members of the ASIC family (ASIC1, ASIC2 and ASIC3) are expressed in mechanoreceptors and nociceptors. The role of ASIC channels has been investigated in behavioral studies using mice with targeted deletion of ASIC channel genes. Deletion of ASIC1 does not alter the function of cutaneous mechanoreceptors but increases mechanical sensitivity of afferents innervating the gut.75 ASIC2 knockout mice exhibit a decreased sensitivity of rapidly adapting cutaneous LTMRs.76 However, subsequent studies reported a lack of effects of knocking out ASIC2 on both visceral mechano-nociception and cutaneous mechanosensation.77 ASIC3 disruption decreases mechano sensitivity of visceral afferents and reduces responses of cutaneous HTMRs to noxious stimuli.76

 

The Transient Receptor Channel

 

THE TRP superfamily is subdivided into six subfamilies in mammals.78 Nearly all TRP subfamilies have members linked to mechanosensation in a variety of cell systems.79 In mammalian sensory neurones, however, TRP channels are best known for sensing thermal information and mediating neurogenic inflammation, and only two TRP channels, TRPV4 and TRPA1, have been implicated in touch responsiveness. Disrupting TRPV4 expression in mice has only modest effects on acute mechanosensory thresholds, but strongly reduces sensitivity to noxious mechanical stimuli.80,81 TRPV4 is a crucial determinant in shaping the response of nociceptive neurones to osmotic stress and to mechanical hyperalgesia during inflammation.82,83 TRPA1 seems to have a role in mechanical hyperalgesia. TRPA1-deficient mice exhibit pain hypersensitivity. TRPA1 contributes to the transduction of mechanical, cold and chemical stimuli in nociceptor sensory neurones but it appears that is not essential for hair-cell transduction.84,85

 

There is no clear evidence indicating that TRP channels and ASICs channels expressed in mammals are mechanically gated. None of these channels expressed heterologously recapitulates the electrical signature of mechanosensitive currents observed in their native environment. This does not rule out the possibility that ASICs and TRPs channels are mechanotransducers, given the uncertainty of whether a mechanotransduction channel may function outside of its cellular context (see section on SLP3).

 

Piezo Proteins

 

Piezo protiens have been recently identified like as promising candidates for mechanosensing proteins by Coste and collaborators.86,87 Vertebrates have two Piezo members, Piezo 1 and Piezo 2, previously known as FAM38A and FAM38B, respectively, which are well conserved throughout multi cellular eukaryotes. Piezo 2 is abundant in DRGs, whereas Piezo 1 is barely detectable. Piezo-induced mechanosensitive currents are prevented inhibited by gadolinium, ruthenium red and GsMTx4 (a toxin from the tarantula Grammostola spatulata).88 Expression of Piezo 1 or Piezo 2 in heterologous systems produces mechanosensitive currents, the kinetics of inactivation of Piezo 2 current being faster than Piezo 1. Similar to endogenous mechanosensitive currents, Piezo-dependent currents have reversal potentials around 0 mV and are cation no selective, with Na+, K+, Ca2+ and Mg2+ all permeating the underlying channel. Likewise, piezo-dependent currents are regulated by membrane potential, with a marked slowing of current kinetics at depolarized potentials.86

 

Piezo proteins are undoubtedly mechanosensing proteins and share many properties of rapidly adapting mechanosensitive currents in sensory neurones. Treatment of cultured DRG neurones with Piezo 2 short interfering RNA decreased the proportion of neurones with rapidly adapting current and decreased the percentage of mechanosensitive neurones.86 Transmembrane domains are located throughout the piezo proteins but no obvious pore-containing motifs or ion channel signatures have been identified. However, mouse Piezo 1 protein purified and reconstituted into asymmetric lipid bilayers and liposome forms ion channels sensitive to ruthenium red.87 An essential step in validating mechanotransduction through Piezo channels is to use in vivo approaches to determine the functional importance in touch signaling. Information was given in Drosophila where deletion of the single Piezo member reduced mechanical response to noxious stimuli, without affecting normal touch.89 Although their structure remains to be determined, this novel family of mechanosensitive proteins is a promising subject for future research, beyond the border of touch sensation. For exemple, a recent study on patients with anemia (hereditary xerocytosis) shows the role of Piezo 1 in maintaining erythrocyte volume homeostasis.90

 

Transmembrane Channel-Like (TMC)

 

A recent study indicates that two proteins, TMC1 and TMC2, are necessary for hair cell mechanotransduction.91 Hereditary deafness due to TMC1 gene mutation was reported in human and mice.92,93 Presence of these channels had not yet been shown in the somatosensory system, but it seems to be a good lead to investigate.

 

Stomatin-Like Protein 3 (SLP3)

 

Additionally to the transduction channels, some accessory proteins linked to the channel have been shown to play a role in touch sensivity. SLP3 is expressed in mammalian DRG neurones. Studies using mutant mice lacking SLP3 had shown change in mechanosensation and mechanosentive currents.94,95 SLP3 precise function remains unknown. It may be a linker between the mechanosensitive channel and the underlying microtubules, as proposed for its C. elegans homolog MEC2.96 Recently GR. Lewin lab has suggested that a tether is synthesized by DRG sensory neurones and links mechanosensitive ion channel to the extracellular matrix.97 Disrupting the link abolishes the RA-mechanosensitive current suggesting that some ion channels are mechanosensitive only when tethered. RA-mechanosensitive currents are also inhibited by laminin-332, a matrix protein produced by keratinocytes, reinforcing the hypothesis of a modulation of the mechanosensitive current by extracellular proteins.98

 

K+ Channel Subfamily

 

In parallel to cationic depolarizing mechanosensitive currents, the presence of repolarizing mechanosensitive K+ currents is under investigation. K+ channels in mechanosensitive cells can step in the current balance and contribute to define the mechanical threshold and the time course of adaptation of mechanoreceptors.

 

KCNK members belong to the two-pore domain K+ channel (K2P) family.99,100 The K2P display a remarkable range of regulation by cellular, physical and pharmacological agents, including pH changes, heat, stretch and membrane deformation. These K2P are active at resting membrane potential. Several KCNK subunits are expressed in somatosensory neurones.101 KCNK2 (TREK-1), KCNK4 (TRAAK) and TREK-2 channels are among the few channels for which a direct mechanical gating by membrane stretch has been shown.102,103

 

Mice with a disrupted KCNK2 gene displayed an enhanced sensitivity to heat and mild mechanical stimuli but a normal withdrawal threshold to noxious mechanical pressure applied to the hindpaw using the Randall�Selitto test.104 KCNK2-deficient mice also displays increased thermal and mechanical hyperalgesia in inflammatory conditions. KCNK4 knockout mice were hypersensitive to mild mechanical stimulation, and this hypersensitivity was increased by additional inactivation of KCNK2.105 Increased mechanosensitivity of these knockout mice could mean that stretch normally activates both depolarizing and repolarizing mechanosensitive currents in a coordinated way, similarly to the unbalance of depolarizing and repolarizing voltage-gated currents.

 

KCNK18 (TRESK) is a major contributor to the background K+ conductance that regulates the resting membrane potential of somatosensory neurones.106 Although it is not known if KCNK18 is directly sensitive to mechanical stimulation, it may play a role in mediating responses to light touch, as well as painful mechanical stimuli. KCNK18 and to a lesser extent KCNK3, are proposed to be the molecular target of hydroxy-?-sanshool, a compound found in Schezuan peppercorns that activates touch receptors and induces a tingling sensation in humans.107,108

 

The voltage dependent K+ channel KCNQ4 (Kv7.4) is crucial for setting the velocity and frequency preference of a subpopulation of rapidly adapting mechanoreceptors in both mice and humans. Mutation of KCNQ4 has been initially associated with a form of hereditary deafness. Interestingly a recent study localizes KCNQ4 in the peripheral nerve endings of cutaneous rapidly adapting hair follicle and Meissner corpuscle. Accordingly, loss of KCNQ4 function leads to a selective enhancement of mechanoreceptor sensitivity to low-frequency vibration. Notably, people with late-onset hearing loss due to dominant mutations of the KCNQ4 gene show enhanced performance in detecting small-amplitude, low-frequency vibration.109

 

Dr-Jimenez_White-Coat_01.png

Dr. Alex Jimenez’s Insight

Touch is considered to be one of the most complex senses in the human body, particularly because there is no specific organ in charge of it. Instead, the sense of touch occurs through sensory receptors, known as mechanoreceptors, which are found across the skin and respond to mechanical pressure or distortion. There are four main types of mechanoreceptors in the glabrous, or hairless, skin of mammals: lamellar corpuscles, tactile corpuscles, Merkel nerve endings and bulbous corpuscles. Mechanoreceptors function in order to allow the detection of touch, in order to monitor the position of the muscles, bones and joints, known as proprioception, and even to detect sounds and the motion of the body. Understanding the mechanisms of structure and function of these mechanoreceptors is a fundamental element in the utilization of treatments and therapies for pain management.

 

Conclusion

 

Touch is a complex sense because it represents different tactile qualities, namely, vibration, shape, texture, pleasure and pain, with different discriminative performances. Up to now, the correspondence between a touch-organ and the psychophysical sense was correlative and class-specific molecular markers are just emerging. The development of rodent tests matching the diversity of touch behavior is now required to facilitate future genomics identification. The use of mice that lack specific subsets of sensory afferent types will greatly facilitate identification of mechanoreceptors and sensory afferent fibers associated with a particular touch modality. Interestingly, a recent paper opens the important question of the genetic basis of mechanosensory traits in human and suggests that single gene mutation could negatively influence touch sensitivity.110 This underlines that the pathophysiology of the human touch deficit is in a large part unknown and would certainly progress by identifying precisely the subset of sensory neurones linked to a touch modality or a touch deficit.

 

In return, progress has been made to define the biophysical properties of the mechano-gated currents.64 The development of new techniques in recent years, allowing monitoring of membrane tension changes, while recording mechano-gated current, has proved valuable experimental method to describe mechanosensitive currents with rapid, intermediate and slow adaptation (reviewed in Delmas and collaborators).66,111 The future will be to determine the role of the current properties in the mechanisms of adaptation of functionally diverse mechanoreceptors and the contribution of mechanosensitive K+ currents to the excitability of LTMRs and HTMRs.

 

The molecular nature of mechano-gated currents in mammals is also a future promising research topic. Future research will progress in two perspectives, first to determine the role of accessory molecule that tether channels to the cytoskeleton and would be required to confer or regulate mechanosensitivity of ion channels of the like of TRP and ASIC/EnaC families. Second, to investigate the large and promising area of the contribution of the Piezo channels by answering key questions, relative to the permeation and gating mechanisms, the subset of sensory neurones and touch modalities involving Piezo and the role of Piezo in non neuronal cells associated with mechanosensation.

 

The sense of touch, in comparison to that of sight, taste, sound and smell, which utilize specific organs to process these sensations, can occur all throughout the body through tiny receptors known as mechanoreceptors. Different types of mechanoreceptors can be found in various layers of the skin, where they can detect a wide array of mechanical stimulation. The article above describes specific highlights which demonstrate the progress of structural and functional mechanisms of mechanoreceptors associated with the sense of touch. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Back Pain

 

Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

 

 

 

blog picture of cartoon paperboy big news

 

EXTRA IMPORTANT TOPIC: Low Back Pain Management

 

MORE TOPICS: EXTRA EXTRA:�Chronic Pain & Treatments

 

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References
1.�Moriwaki K, Yuge O. Topographical features of cutaneous tactile hypoesthetic and hyperesthetic abnormalities in chronic pain.�Pain.�1999;81:1�6. doi: 10.1016/S0304-3959(98)00257-7.�[PubMed][Cross Ref]
2.�Shim B, Kim DW, Kim BH, Nam TS, Leem JW, Chung JM. Mechanical and heat sensitization of cutaneous nociceptors in rats with experimental peripheral neuropathy.�Neuroscience.�2005;132:193�201. doi: 10.1016/j.neuroscience.2004.12.036.�[PubMed][Cross Ref]
3.�Kleggetveit IP, J�rum E. Large and small fiber dysfunction in peripheral nerve injuries with or without spontaneous pain.�J Pain.�2010;11:1305�10. doi: 10.1016/j.jpain.2010.03.004.�[PubMed][Cross Ref]
4.�Noback CR. Morphology and phylogeny of hair.�Ann N Y Acad Sci.�1951;53:476�92. doi: 10.1111/j.1749-6632.1951.tb31950.x.�[PubMed][Cross Ref]
5.�Straile WE. Atypical guard-hair follicles in the skin of the rabbit.�Nature.�1958;181:1604�5. doi: 10.1038/1811604a0.�[PubMed][Cross Ref]
6.�Straile WE. The morphology of tylotrich follicles in the skin of the rabbit.�Am J Anat.�1961;109:1�13. doi: 10.1002/aja.1001090102.�[PubMed][Cross Ref]
7.�Millard CL, Woolf CJ. Sensory innervation of the hairs of the rat hindlimb: a light microscopic analysis.�J Comp Neurol.�1988;277:183�94. doi: 10.1002/cne.902770203.�[PubMed][Cross Ref]
8.�Hamann W. Mammalian cutaneous mechanoreceptors.�Prog Biophys Mol Biol.�1995;64:81�104. doi: 10.1016/0079-6107(95)00011-9.�[Review]�[PubMed][Cross Ref]
9.�Brown AG, Iggo A. A quantitative study of cutaneous receptors and afferent fibres in the cat and rabbit.�J Physiol.�1967;193:707�33.�[PMC free article][PubMed]
10.�Burgess PR, Petit D, Warren RM. Receptor types in cat hairy skin supplied by myelinated fibers.�J Neurophysiol.�1968;31:833�48.�[PubMed]
11.�Driskell RR, Giangreco A, Jensen KB, Mulder KW, Watt FM. Sox2-positive dermal papilla cells specify hair follicle type in mammalian epidermis.�Development.�2009;136:2815�23. doi: 10.1242/dev.038620.�[PMC free article][PubMed][Cross Ref]
12.�Hussein MA. The overall pattern of hair follicle arrangement in the rat and mouse.�J Anat.�1971;109:307�16.�[PMC free article][PubMed]
13.�Vielkind U, Hardy MH. Changing patterns of cell adhesion molecules during mouse pelage hair follicle development. 2. Follicle morphogenesis in the hair mutants, Tabby and downy.�Acta Anat (Basel)�1996;157:183�94. doi: 10.1159/000147880.�[PubMed][Cross Ref]
14.�Hardy MH, Vielkind U. Changing patterns of cell adhesion molecules during mouse pelage hair follicle development. 1. Follicle morphogenesis in wild-type mice.�Acta Anat (Basel)�1996;157:169�82. doi: 10.1159/000147879.�[PubMed][Cross Ref]
15.�Li L, Rutlin M, Abraira VE, Cassidy C, Kus L, Gong S, et al. The functional organization of cutaneous low-threshold mechanosensory neurons.�Cell.�2011;147:1615�27. doi: 10.1016/j.cell.2011.11.027.[PMC free article][PubMed][Cross Ref]
16.�Brown AG, Iggo A. A quantitative study of cutaneous receptors and afferent fibres in the cat and rabbit.�J Physiol.�1967;193:707�33.�[PMC free article][PubMed]
17.�Burgess PR, Petit D, Warren RM. Receptor types in cat hairy skin supplied by myelinated fibers.�J Neurophysiol.�1968;31:833�48.�[PubMed]
18.�Vallbo A, Olausson H, Wessberg J, Norrsell U. A system of unmyelinated afferents for innocuous mechanoreception in the human skin.�Brain Res.�1993;628:301�4. doi: 10.1016/0006-8993(93)90968-S.[PubMed][Cross Ref]
19.�Vallbo AB, Olausson H, Wessberg J. Unmyelinated afferents constitute a second system coding tactile stimuli of the human hairy skin.�J Neurophysiol.�1999;81:2753�63.�[PubMed]
20.�Hertenstein MJ, Keltner D, App B, Bulleit BA, Jaskolka AR. Touch communicates distinct emotions.�Emotion.�2006;6:528�33. doi: 10.1037/1528-3542.6.3.528.�[PubMed][Cross Ref]
21.�McGlone F, Vallbo AB, Olausson H, Loken L, Wessberg J. Discriminative touch and emotional touch.�Can J Exp Psychol.�2007;61:173�83. doi: 10.1037/cjep2007019.�[PubMed][Cross Ref]
22.�Wessberg J, Olausson H, Fernstr�m KW, Vallbo AB. Receptive field properties of unmyelinated tactile afferents in the human skin.�J Neurophysiol.�2003;89:1567�75. doi: 10.1152/jn.00256.2002.�[PubMed][Cross Ref]
23.�Liu Q, Vrontou S, Rice FL, Zylka MJ, Dong X, Anderson DJ. Molecular genetic visualization of a rare subset of unmyelinated sensory neurons that may detect gentle touch.�Nat Neurosci.�2007;10:946�8. doi: 10.1038/nn1937.�[PubMed][Cross Ref]
24.�Olausson H, Lamarre Y, Backlund H, Morin C, Wallin BG, Starck G, et al. Unmyelinated tactile afferents signal touch and project to insular cortex.�Nat Neurosci.�2002;5:900�4. doi: 10.1038/nn896.[PubMed][Cross Ref]
25.�Olausson H, Wessberg J, Morrison I, McGlone F, Vallbo A. The neurophysiology of unmyelinated tactile afferents.�Neurosci Biobehav Rev.�2010;34:185�91. doi: 10.1016/j.neubiorev.2008.09.011.�[Review][PubMed][Cross Ref]
26.�Kr�mer HH, Lundblad L, Birklein F, Linde M, Karlsson T, Elam M, et al. Activation of the cortical pain network by soft tactile stimulation after injection of sumatriptan.�Pain.�2007;133:72�8. doi: 10.1016/j.pain.2007.03.001.�[PubMed][Cross Ref]
27.�Applebaum AE, Beall JE, Foreman RD, Willis WD. Organization and receptive fields of primate spinothalamic tract neurons.�J Neurophysiol.�1975;38:572�86.�[PubMed]
28.�White JC, Sweet WH. Effectiveness of chordotomy in phantom pain after amputation.�AMA Arch Neurol Psychiatry.�1952;67:315�22.�[PubMed]
29.�Halata Z, Grim M, Bauman KI. Friedrich Sigmund Merkel and his �Merkel cell�, morphology, development, and physiology: review and new results.�Anat Rec A Discov Mol Cell Evol Biol.�2003;271:225�39. doi: 10.1002/ar.a.10029.�[PubMed][Cross Ref]
30.�Morrison KM, Miesegaes GR, Lumpkin EA, Maricich SM. Mammalian Merkel cells are descended from the epidermal lineage.�Dev Biol.�2009;336:76�83. doi: 10.1016/j.ydbio.2009.09.032.[PMC free article][PubMed][Cross Ref]
31.�Van Keymeulen A, Mascre G, Youseff KK, Harel I, Michaux C, De Geest N, et al. Epidermal progenitors give rise to Merkel cells during embryonic development and adult homeostasis.�J Cell Biol.�2009;187:91�100. doi: 10.1083/jcb.200907080.�[PMC free article][PubMed][Cross Ref]
32.�Ebara S, Kumamoto K, Baumann KI, Halata Z. Three-dimensional analyses of touch domes in the hairy skin of the cat paw reveal morphological substrates for complex sensory processing.�Neurosci Res.�2008;61:159�71. doi: 10.1016/j.neures.2008.02.004.�[PubMed][Cross Ref]
33.�Guinard D, Usson Y, Guillermet C, Saxod R. Merkel complexes of human digital skin: three-dimensional imaging with confocal laser microscopy and double immunofluorescence.�J Comp Neurol.�1998;398:98�104. doi: 10.1002/(SICI)1096-9861(19980817)398:1<98::AID-CNE6>3.0.CO;2-4.�[PubMed][Cross Ref]
34.�Reinisch CM, Tschachler E. The touch dome in human skin is supplied by different types of nerve fibers.�Ann Neurol.�2005;58:88�95. doi: 10.1002/ana.20527.�[PubMed][Cross Ref]
35.�Maricich SM, Morrison KM, Mathes EL, Brewer BM. Rodents rely on Merkel cells for texture discrimination tasks.�J Neurosci.�2012;32:3296�300. doi: 10.1523/JNEUROSCI.5307-11.2012.[PMC free article][PubMed][Cross Ref]
36.�Ikeda I, Yamashita Y, Ono T, Ogawa H. Selective phototoxic destruction of rat Merkel cells abolishes responses of slowly adapting type I mechanoreceptor units.�J Physiol.�1994;479:247�56.�[PMC free article][PubMed]
37.�Maricich SM, Wellnitz SA, Nelson AM, Lesniak DR, Gerling GJ, Lumpkin EA, et al. Merkel cells are essential for light-touch responses.�Science.�2009;324:1580�2. doi: 10.1126/science.1172890.[PMC free article][PubMed][Cross Ref]
38.�Diamond J, Holmes M, Nurse CA. Are Merkel cell-neurite reciprocal synapses involved in the initiation of tactile responses in salamander skin?�J Physiol.�1986;376:101�20.�[PMC free article][PubMed]
39.�Yamashita Y, Akaike N, Wakamori M, Ikeda I, Ogawa H. Voltage-dependent currents in isolated single Merkel cells of rats.�J Physiol.�1992;450:143�62.�[PMC free article][PubMed]
40.�Wellnitz SA, Lesniak DR, Gerling GJ, Lumpkin EA. The regularity of sustained firing reveals two populations of slowly adapting touch receptors in mouse hairy skin.�J Neurophysiol.�2010;103:3378�88. doi: 10.1152/jn.00810.2009.�[PMC free article][PubMed][Cross Ref]
41.�Nandasena BG, Suzuki A, Aita M, Kawano Y, Nozawa-Inoue K, Maeda T. Immunolocalization of aquaporin-1 in the mechanoreceptive Ruffini endings in the periodontal ligament.�Brain Res.�2007;1157:32�40. doi: 10.1016/j.brainres.2007.04.033.�[PubMed][Cross Ref]
42.�Rahman F, Harada F, Saito I, Suzuki A, Kawano Y, Izumi K, et al. Detection of acid-sensing ion channel 3 (ASIC3) in periodontal Ruffini endings of mouse incisors.�Neurosci Lett.�2011;488:173�7. doi: 10.1016/j.neulet.2010.11.023.�[PubMed][Cross Ref]
43.�Johnson KO. The roles and functions of cutaneous mechanoreceptors.�Curr Opin Neurobiol.�2001;11:455�61. doi: 10.1016/S0959-4388(00)00234-8.�[Review]�[PubMed][Cross Ref]
44.�Wende H, Lechner SG, Cheret C, Bourane S, Kolanczyk ME, Pattyn A, et al. The transcription factor c-Maf controls touch receptor development and function.�Science.�2012;335:1373�6. doi: 10.1126/science.1214314.�[PubMed][Cross Ref]
45.�Mendelson M, Lowenstein WR. Mechanisms of receptor adaptation.�Science.�1964;144:554�5. doi: 10.1126/science.144.3618.554.�[PubMed][Cross Ref]
46.�Loewenstein WR, Mendelson M. Components of receptor adaptation in a pacinian corpuscle.�J Physiol.�1965;177:377�97.�[PMC free article][PubMed]
47.�Pawson L, Prestia LT, Mahoney GK, G��l� B, Cox PJ, Pack AK. GABAergic/glutamatergic-glial/neuronal interaction contributes to rapid adaptation in pacinian corpuscles.�J Neurosci.�2009;29:2695�705. doi: 10.1523/JNEUROSCI.5974-08.2009.�[PMC free article][PubMed][Cross Ref]
48.�Basbaum AI, Jessell TM. The perception of pain. In: Kandel ER, Schwartz JH, Jessell TM, eds. Principles of neural science. Fourth edition. The McGraw-Hill compagies, 2000: 472-490.
49.�Bourane S, Garces A, Venteo S, Pattyn A, Hubert T, Fichard A, et al. Low-threshold mechanoreceptor subtypes selectively express MafA and are specified by Ret signaling.�Neuron.�2009;64:857�70. doi: 10.1016/j.neuron.2009.12.004.�[PubMed][Cross Ref]
50.�Kramer I, Sigrist M, de Nooij JC, Taniuchi I, Jessell TM, Arber S. A role for Runx transcription factor signaling in dorsal root ganglion sensory neuron diversification.�Neuron.�2006;49:379�93. doi: 10.1016/j.neuron.2006.01.008.�[PubMed][Cross Ref]
51.�Luo W, Enomoto H, Rice FL, Milbrandt J, Ginty DD. Molecular identification of rapidly adapting mechanoreceptors and their developmental dependence on ret signaling.�Neuron.�2009;64:841�56. doi: 10.1016/j.neuron.2009.11.003.�[PMC free article][PubMed][Cross Ref]
52.�Vallbo AB, Hagbarth KE. Activity from skin mechanoreceptors recorded percutaneously in awake human subjects.�Exp Neurol.�1968;21:270�89. doi: 10.1016/0014-4886(68)90041-1.�[PubMed][Cross Ref]
53.�Macefield VG. Physiological characteristics of low-threshold mechanoreceptors in joints, muscle and skin in human subjects.�Clin Exp Pharmacol Physiol.�2005;32:135�44. doi: 10.1111/j.1440-1681.2005.04143.x.�[Review]�[PubMed][Cross Ref]
54.�Koizumi S, Fujishita K, Inoue K, Shigemoto-Mogami Y, Tsuda M, Inoue K. Ca2+ waves in keratinocytes are transmitted to sensory neurons: the involvement of extracellular ATP and P2Y2 receptor activation.�Biochem J.�2004;380:329�38. doi: 10.1042/BJ20031089.�[PMC free article][PubMed][Cross Ref]
55.�Azorin N, Raoux M, Rodat-Despoix L, Merrot T, Delmas P, Crest M. ATP signalling is crucial for the response of human keratinocytes to mechanical stimulation by hypo-osmotic shock.�Exp Dermatol.�2011;20:401�7. doi: 10.1111/j.1600-0625.2010.01219.x.�[PubMed][Cross Ref]
56.�Amano M, Fukata Y, Kaibuchi K. Regulation and functions of Rho-associated kinase.�Exp Cell Res.�2000;261:44�51. doi: 10.1006/excr.2000.5046.�[Review]�[PubMed][Cross Ref]
57.�Koyama T, Oike M, Ito Y. Involvement of Rho-kinase and tyrosine kinase in hypotonic stress-induced ATP release in bovine aortic endothelial cells.�J Physiol.�2001;532:759�69. doi: 10.1111/j.1469-7793.2001.0759e.x.�[PMC free article][PubMed][Cross Ref]
58.�Perl ER. Cutaneous polymodal receptors: characteristics and plasticity.�Prog Brain Res.�1996;113:21�37. doi: 10.1016/S0079-6123(08)61079-1.�[Review]�[PubMed][Cross Ref]
59.�McCarter GC, Reichling DB, Levine JD. Mechanical transduction by rat dorsal root ganglion neurons in vitro.�Neurosci Lett.�1999;273:179�82. doi: 10.1016/S0304-3940(99)00665-5.�[PubMed][Cross Ref]
60.�Drew LJ, Wood JN, Cesare P. Distinct mechanosensitive properties of capsaicin-sensitive and -insensitive sensory neurons.�J Neurosci.�2002;22:RC228.�[PubMed]
61.�Drew LJ, Rohrer DK, Price MP, Blaver KE, Cockayne DA, Cesare P, et al. Acid-sensing ion channels ASIC2 and ASIC3 do not contribute to mechanically activated currents in mammalian sensory neurones.�J Physiol.�2004;556:691�710. doi: 10.1113/jphysiol.2003.058693.�[PMC free article][PubMed][Cross Ref]
62.�McCarter GC, Levine JD. Ionic basis of a mechanotransduction current in adult rat dorsal root ganglion neurons.�Mol Pain.�2006;2:28. doi: 10.1186/1744-8069-2-28.�[PMC free article][PubMed][Cross Ref]
63.�Coste B, Crest M, Delmas P. Pharmacological dissection and distribution of NaN/Nav1.9, T-type Ca2+ currents, and mechanically activated cation currents in different populations of DRG neurons.�J Gen Physiol.�2007;129:57�77. doi: 10.1085/jgp.200609665.�[PMC free article][PubMed][Cross Ref]
64.�Hao J, Delmas P. Multiple desensitization mechanisms of mechanotransducer channels shape firing of mechanosensory neurons.�J Neurosci.�2010;30:13384�95. doi: 10.1523/JNEUROSCI.2926-10.2010.[PubMed][Cross Ref]
65.�Drew LJ, Wood JN. FM1-43 is a permeant blocker of mechanosensitive ion channels in sensory neurons and inhibits behavioural responses to mechanical stimuli.�Mol Pain.�2007;3:1. doi: 10.1186/1744-8069-3-1.�[PMC free article][PubMed][Cross Ref]
66.�Hao J, Delmas P. Recording of mechanosensitive currents using piezoelectrically driven mechanostimulator.�Nat Protoc.�2011;6:979�90. doi: 10.1038/nprot.2011.343.�[PubMed][Cross Ref]
67.�Rugiero F, Drew LJ, Wood JN. Kinetic properties of mechanically activated currents in spinal sensory neurons.�J Physiol.�2010;588:301�14. doi: 10.1113/jphysiol.2009.182360.�[PMC free article][PubMed][Cross Ref]
68.�Hu J, Lewin GR. Mechanosensitive currents in the neurites of cultured mouse sensory neurones.�J Physiol.�2006;577:815�28. doi: 10.1113/jphysiol.2006.117648.�[PMC free article][PubMed][Cross Ref]
69.�Bhattacharya MR, Bautista DM, Wu K, Haeberle H, Lumpkin EA, Julius D. Radial stretch reveals distinct populations of mechanosensitive mammalian somatosensory neurons.�Proc Natl Acad Sci U S A.�2008;105:20015�20. doi: 10.1073/pnas.0810801105.�[PMC free article][PubMed][Cross Ref]
70.�Crawford AC, Evans MG, Fettiplace R. Activation and adaptation of transducer currents in turtle hair cells.�J Physiol.�1989;419:405�34.�[PMC free article][PubMed]
71.�Ricci AJ, Wu YC, Fettiplace R. The endogenous calcium buffer and the time course of transducer adaptation in auditory hair cells.�J Neurosci.�1998;18:8261�77.�[PubMed]
72.�Vollrath MA, Kwan KY, Corey DP. The micromachinery of mechanotransduction in hair cells.�Annu Rev Neurosci.�2007;30:339�65. doi: 10.1146/annurev.neuro.29.051605.112917.�[Review]�[PMC free article][PubMed][Cross Ref]
73.�Goodman MB, Schwarz EM. Transducing touch in Caenorhabditis elegans.�Annu Rev Physiol.�2003;65:429�52. doi: 10.1146/annurev.physiol.65.092101.142659.�[Review]�[PubMed][Cross Ref]
74.�Waldmann R, Lazdunski MH. H(+)-gated cation channels: neuronal acid sensors in the NaC/DEG family of ion channels.�Curr Opin Neurobiol.�1998;8:418�24. doi: 10.1016/S0959-4388(98)80070-6.[Review]�[PubMed][Cross Ref]
75.�Page AJ, Brierley SM, Martin CM, Martinez-Salgado C, Wemmie JA, Brennan TJ, et al. The ion channel ASIC1 contributes to visceral but not cutaneous mechanoreceptor function.�Gastroenterology.�2004;127:1739�47. doi: 10.1053/j.gastro.2004.08.061.�[PubMed][Cross Ref]
76.�Price MP, McIlwrath SL, Xie J, Cheng C, Qiao J, Tarr DE, et al. The DRASIC cation channel contributes to the detection of cutaneous touch and acid stimuli in mice.�Neuron.�2001;32:1071�83. doi: 10.1016/S0896-6273(01)00547-5.�[Erratum in: Neuron 2002 Jul 18;35] [2]�[PubMed][Cross Ref]
77.�Roza C, Puel JL, Kress M, Baron A, Diochot S, Lazdunski M, et al. Knockout of the ASIC2 channel in mice does not impair cutaneous mechanosensation, visceral mechanonociception and hearing.�J Physiol.�2004;558:659�69. doi: 10.1113/jphysiol.2004.066001.�[PMC free article][PubMed][Cross Ref]
78.�Damann N, Voets T, Nilius B. TRPs in our senses.�Curr Biol.�2008;18:R880�9. doi: 10.1016/j.cub.2008.07.063.�[Review]�[PubMed][Cross Ref]
79.�Christensen AP, Corey DP. TRP channels in mechanosensation: direct or indirect activation?�Nat Rev Neurosci.�2007;8:510�21. doi: 10.1038/nrn2149.�[Review]�[PubMed][Cross Ref]
80.�Liedtke W, Tobin DM, Bargmann CI, Friedman JM. Mammalian TRPV4 (VR-OAC) directs behavioral responses to osmotic and mechanical stimuli in Caenorhabditis elegans.�Proc Natl Acad Sci U S A.�2003;100(Suppl 2):14531�6. doi: 10.1073/pnas.2235619100.�[PMC free article][PubMed][Cross Ref]
81.�Suzuki M, Mizuno A, Kodaira K, Imai M. Impaired pressure sensation in mice lacking TRPV4.�J Biol Chem.�2003;278:22664�8. doi: 10.1074/jbc.M302561200.�[PubMed][Cross Ref]
82.�Liedtke W, Choe Y, Mart�-Renom MA, Bell AM, Denis CS, Sali A, et al. Vanilloid receptor-related osmotically activated channel (VR-OAC), a candidate vertebrate osmoreceptor.�Cell.�2000;103:525�35. doi: 10.1016/S0092-8674(00)00143-4.�[PMC free article][PubMed][Cross Ref]
83.�Alessandri-Haber N, Dina OA, Yeh JJ, Parada CA, Reichling DB, Levine JD. Transient receptor potential vanilloid 4 is essential in chemotherapy-induced neuropathic pain in the rat.�J Neurosci.�2004;24:4444�52. doi: 10.1523/JNEUROSCI.0242-04.2004.�[Erratum in: J Neurosci. 2004 Jun;24] [23][PubMed][Cross Ref]
84.�Bautista DM, Jordt SE, Nikai T, Tsuruda PR, Read AJ, Poblete J, et al. TRPA1 mediates the inflammatory actions of environmental irritants and proalgesic agents.�Cell.�2006;124:1269�82. doi: 10.1016/j.cell.2006.02.023.�[PubMed][Cross Ref]
85.�Kwan KY, Allchorne AJ, Vollrath MA, Christensen AP, Zhang DS, Woolf CJ, et al. TRPA1 contributes to cold, mechanical, and chemical nociception but is not essential for hair-cell transduction.�Neuron.�2006;50:277�89. doi: 10.1016/j.neuron.2006.03.042.�[PubMed][Cross Ref]
86.�Coste B, Mathur J, Schmidt M, Earley TJ, Ranade S, Petrus MJ, et al. Piezo1 and Piezo2 are essential components of distinct mechanically activated cation channels.�Science.�2010;330:55�60. doi: 10.1126/science.1193270.�[PMC free article][PubMed][Cross Ref]
87.�Coste B, Xiao B, Santos JS, Syeda R, Grandl J, Spencer KS, et al. Piezo proteins are pore-forming subunits of mechanically activated channels.�Nature.�2012;483:176�81. doi: 10.1038/nature10812.[PMC free article][PubMed][Cross Ref]
88.�Bae C, Sachs F, Gottlieb PA. The mechanosensitive ion channel Piezo1 is inhibited by the peptide GsMTx4.�Biochemistry.�2011;50:6295�300. doi: 10.1021/bi200770q.�[PMC free article][PubMed][Cross Ref]
89.�Kim SE, Coste B, Chadha A, Cook B, Patapoutian A. The role of Drosophila Piezo in mechanical nociception.�Nature.�2012;483:209�12. doi: 10.1038/nature10801.�[PMC free article][PubMed][Cross Ref]
90.�Zarychanski R, Schulz VP, Houston BL, Maksimova Y, Houston DS, Smith B, et al. Mutations in the mechanotransduction protein PIEZO1 are associated with hereditary xerocytosis.�Blood.�2012;120:1908�15. doi: 10.1182/blood-2012-04-422253.�[PMC free article][PubMed][Cross Ref]
91.�Kawashima Y, G�l�oc GS, Kurima K, Labay V, Lelli A, Asai Y, et al. Mechanotransduction in mouse inner ear hair cells requires transmembrane channel-like genes.�J Clin Invest.�2011;121:4796�809. doi: 10.1172/JCI60405.�[PMC free article][PubMed][Cross Ref]
92.�Tlili A, Rebeh IB, Aifa-Hmani M, Dhouib H, Moalla J, Tlili-Chouch�ne J, et al. TMC1 but not TMC2 is responsible for autosomal recessive nonsyndromic hearing impairment in Tunisian families.�Audiol Neurootol.�2008;13:213�8. doi: 10.1159/000115430.�[PubMed][Cross Ref]
93.�Manji SS, Miller KA, Williams LH, Dahl HH. Identification of three novel hearing loss mouse strains with mutations in the Tmc1 gene.�Am J Pathol.�2012;180:1560�9. doi: 10.1016/j.ajpath.2011.12.034.[PubMed][Cross Ref]
94.�Wetzel C, Hu J, Riethmacher D, Benckendorff A, Harder L, Eilers A, et al. A stomatin-domain protein essential for touch sensation in the mouse.�Nature.�2007;445:206�9. doi: 10.1038/nature05394.�[PubMed][Cross Ref]
95.�Martinez-Salgado C, Benckendorff AG, Chiang LY, Wang R, Milenkovic N, Wetzel C, et al. Stomatin and sensory neuron mechanotransduction.�J Neurophysiol.�2007;98:3802�8. doi: 10.1152/jn.00860.2007.[PubMed][Cross Ref]
96.�Huang M, Gu G, Ferguson EL, Chalfie M. A stomatin-like protein necessary for mechanosensation in C. elegans.�Nature.�1995;378:292�5. doi: 10.1038/378292a0.�[PubMed][Cross Ref]
97.�Hu J, Chiang LY, Koch M, Lewin GR. Evidence for a protein tether involved in somatic touch.�EMBO J.�2010;29:855�67. doi: 10.1038/emboj.2009.398.�[PMC free article][PubMed][Cross Ref]
98.�Chiang LY, Poole K, Oliveira BE, Duarte N, Sierra YA, Bruckner-Tuderman L, et al. Laminin-332 coordinates mechanotransduction and growth cone bifurcation in sensory neurons.�Nat Neurosci.�2011;14:993�1000. doi: 10.1038/nn.2873.�[PubMed][Cross Ref]
99.�Lesage F, Guillemare E, Fink M, Duprat F, Lazdunski M, Romey G, et al. TWIK-1, a ubiquitous human weakly inward rectifying K+ channel with a novel structure.�EMBO J.�1996;15:1004�11.[PMC free article][PubMed]
100.�Lesage F. Pharmacology of neuronal background potassium channels.�Neuropharmacology.�2003;44:1�7. doi: 10.1016/S0028-3908(02)00339-8.�[Review]�[PubMed][Cross Ref]
101.�Medhurst AD, Rennie G, Chapman CG, Meadows H, Duckworth MD, Kelsell RE, et al. Distribution analysis of human two pore domain potassium channels in tissues of the central nervous system and periphery.�Brain Res Mol Brain Res.�2001;86:101�14. doi: 10.1016/S0169-328X(00)00263-1.�[PubMed][Cross Ref]
102.�Maingret F, Patel AJ, Lesage F, Lazdunski M, Honor� E. Mechano- or acid stimulation, two interactive modes of activation of the TREK-1 potassium channel.�J Biol Chem.�1999;274:26691�6. doi: 10.1074/jbc.274.38.26691.�[PubMed][Cross Ref]
103.�Maingret F, Fosset M, Lesage F, Lazdunski M, Honor� E. TRAAK is a mammalian neuronal mechano-gated K+ channel.�J Biol Chem.�1999;274:1381�7. doi: 10.1074/jbc.274.3.1381.�[PubMed][Cross Ref]
104.�Alloui A, Zimmermann K, Mamet J, Duprat F, No�l J, Chemin J, et al. TREK-1, a K+ channel involved in polymodal pain perception.�EMBO J.�2006;25:2368�76. doi: 10.1038/sj.emboj.7601116.[PMC free article][PubMed][Cross Ref]
105.�No�l J, Zimmermann K, Busserolles J, Deval E, Alloui A, Diochot S, et al. The mechano-activated K+ channels TRAAK and TREK-1 control both warm and cold perception.�EMBO J.�2009;28:1308�18. doi: 10.1038/emboj.2009.57.�[PMC free article][PubMed][Cross Ref]
106.�Dobler T, Springauf A, Tovornik S, Weber M, Schmitt A, Sedlmeier R, et al. TRESK two-pore-domain K+ channels constitute a significant component of background potassium currents in murine dorsal root ganglion neurones.�J Physiol.�2007;585:867�79. doi: 10.1113/jphysiol.2007.145649.[PMC free article][PubMed][Cross Ref]
107.�Bautista DM, Sigal YM, Milstein AD, Garrison JL, Zorn JA, Tsuruda PR, et al. Pungent agents from Szechuan peppers excite sensory neurons by inhibiting two-pore potassium channels.�Nat Neurosci.�2008;11:772�9. doi: 10.1038/nn.2143.�[PMC free article][PubMed][Cross Ref]
108.�Lennertz RC, Tsunozaki M, Bautista DM, Stucky CL. Physiological basis of tingling paresthesia evoked by hydroxy-alpha-sanshool.�J Neurosci.�2010;30:4353�61. doi: 10.1523/JNEUROSCI.4666-09.2010.�[PMC free article][PubMed][Cross Ref]
109.�Heidenreich M, Lechner SG, Vardanyan V, Wetzel C, Cremers CW, De Leenheer EM, et al. KCNQ4 K(+) channels tune mechanoreceptors for normal touch sensation in mouse and man.�Nat Neurosci.�2012;15:138�45. doi: 10.1038/nn.2985.�[PubMed][Cross Ref]
110.�Frenzel H, Bohlender J, Pinsker K, Wohlleben B, Tank J, Lechner SG, et al. A genetic basis for mechanosensory traits in humans.�PLoS Biol.�2012;10:e1001318. doi: 10.1371/journal.pbio.1001318.[PMC free article][PubMed][Cross Ref]
111.�Delmas P, Hao J, Rodat-Despoix L. Molecular mechanisms of mechanotransduction in mammalian sensory neurons.�Nat Rev Neurosci.�2011;12:139�53. doi: 10.1038/nrn2993.�[PubMed][Cross Ref]
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Understanding Abnormalities of the Pain System in El Paso, Tx

Understanding Abnormalities of the Pain System in El Paso, Tx

Why does localized damage or injury caused by trauma lead to chronic, intractable pain in certain patients? What’s in charge of the translation of local injury with acute pain into a chronic pain condition? Why does some pain respond to anti-inflammatory drugs and/or medications, whereas other forms of pain require opiates?

 

Pain is an intricate process involving both the peripheral nervous system (PNS) and the central nervous system (CNS). Tissue injury triggers the PNS, which transmits signals via the spinal cord into the brain, in which pain perception occurs. However, what causes the intense experience of pain to develop into an unremitting phenomenon? Can anything be done to prevent it? Evidence indicates that chronic pain results from a combination of mechanisms, such as neurological “memories” of preceding pain.

 

Nociception: The Simplest Pathway

 

Acute or nociceptive pain is characterized as the regular experience of discomfort which occurs in response to very basic damage or injury. It is protective, warning us to move away from the origin of the insult and take care of the trauma. The mechanisms that create nociceptive pain include transduction, which extends the external traumatic stimulation into electrical activity in specialized nociceptive primary afferent nerves. The afferent nerves then conduct the sensory information from the PNS to the CNS.

 

In the CNS, the pain data is transmitted by the primary sensory neurons into central projection cells. After the information is transferred to all those areas of the brain which are responsible for our perception, the actual sensory experience happens. Nociceptive pain is a relatively simple reaction to a particularly simple, acute stimulus. But the mechanics in charge of nociceptive pain cannot identify phenomena, such as pain that persists despite removal or healing of the stimulation, such as in the instance of phantom limb pain.

 

Pain and the Inflammatory Response

 

In circumstances of more severe injury, such as surgical wounds, tissue damage may stimulate an inflammatory reaction. However, other conditions, especially arthritis, can also be characterized by continuing cases of inflammation associated with intense pain symptoms. The mechanisms for this type of pain related to tissue damage and an inflammatory response are different from early-warning nociceptive pain.

 

Observing the incision or site of other damage or injury, a cascade of hyperexcitable events occur in the nervous system. This bodily “wind-up” phenomenon begins at the skin, where it is potentiated along the peripheral nerves, and culminates at a hypersensitivity response along the spinal cord (dorsal horn) and the brain. Inflammatory cells then surround the regions of tissue damage and also produce cytokines and chemokines, substances which are intended to mediate the process of healing and tissue regeneration. But, these agents may also be considered irritants and adjust the properties of the primary sensory neurons surrounding the area of trauma.

 

Thus, the major factors which trigger inflammatory pain include damage to the high-threshold nociceptors, known as peripheral sensitization, changes and alterations of the neurons in the nervous system, and the amplification of the excitability of neurons within the CNS. This represents central sensitization and is accountable for hypersensitivity, where areas adjacent to those of the true injury will experience pain as if these were injured. These tissues can also react to stimulation which normally doesn’t create pain, such as a touch, wearing clothing, light pressure, or even brushing your own hair, as if they were truly painful, referred to as allodynia.

 

Peripheral and Central Sensitization (Video)

 

 

Other Mechanisms of Pain

 

Neuropathic pain results from damage or injury to the nervous system, such as carpal tunnel syndrome, postherpetic neuralgia and diabetic neuropathy. Although some of the mechanisms which seem to cause neuropathic pain overlap with those responsible for inflammatory pain, many of them are different, and thus will need a different approach towards their management.

 

The process of peripheral and central sensitization is maintained, at least theoretically and experimentally, during the excitatory neurotransmitter, glutamate, which is believed to be released when the N-methyl-D-aspartate (NMDA) receptor is activated.

 

The nervous system is made up of either inhibitory or excitatory neurotransmitters. Most of what permits our nervous system to respond appropriately to damage or injury is the fine-tuning or inhibition of a variety of processes. The overexcitation of the nervous system is seen to be an issue in a number of different disorders. For instance, overactivation of an NMDA receptor can also be related to affective disorders, sympathetic abnormalities, and even opiate tolerance.

 

Even ordinary nociceptive pain, to some degree, activates the NMDA receptor and is believed to lead to glutamate release. Nonetheless, in neuropathic pain, oversensitivity to the NMDA receptor is key.

 

With other types of chronic pain, such as fibromyalgia and tension-type headaches, some of the mechanisms active in inflammatory and neuropathic pain may also create similar abnormalities in the pain system, including central sensitization, higher excitability of the somatosensory pathways, and reductions in central nervous system inhibitory mechanisms.

 

Peripheral Sensitization

 

Cyclo-oxygenase (COX) also plays an essential function in both peripheral and central sensitizations. COX-2 is one of the enzymes which are induced during the inflammatory process; COX-2 converts arachidonic acid into prostaglandins, which increase the sensitivity of peripheral nociceptor terminals. Virtually, peripheral inflammation also causes COX-2 to be produced from the CNS. Signals from peripheral nociceptors are partially responsible for this upregulation, but there also seems to be a humoral component to the transduction of the pain signals across the blood-brain barrier.

 

For instance, in experimental models, COX-2 is generated from the CNS even if animals receive a sensory nerve block prior to peripheral inflammatory stimulation. The COX-2 that is expressed over the dorsal horn neurons of the spinal cord releases prostaglandins, which act on the central terminals, or the presynaptic terminals of nociceptive sensory fibers, to increase transmitter release. Additionally, they act postsynaptically on the dorsal horn neurons to produce direct depolarization. And finally, they inhibit the activity of glycine receptor, and this is an inhibitory transmitter. Therefore, the prostaglandins create an increase in excitability of central neurons.

 

Peripheral and Central Sensitization | El Paso, TX Chiropractor

 

Brain Plasticity and Central Sensitization

 

Central sensitization describes changes which happen in the brain in reaction to repeated nerve stimulation. After repeated stimuli, amounts of hormones and brain electric signals change as neurons develop a “memory’ for reacting to those signs. Constant stimulation creates a more powerful brain memory, so the brain will respond more rapidly and effectively when undergoing the identical stimulation in the future. The consequent modifications in brain wiring and reaction are referred to as neural plasticity, which describe the capability of the brain to alter itself readily, or central sensitization. Therefore, the brain is activated or sensitized by previous or repeated stimuli to become more excitable.

 

The fluctuations of central sensitization occur after repeated encounters with pain. Research in animals indicates that repeated exposure to a painful stimulation will change the animal’s pain threshold and lead to a stronger pain response. Researchers think that these modifications can explain the persistent pain that could occur even after successful back surgery. Although a herniated disc may be removed from a pinched nerve, pain may continue as a memory of the nerve compression. Newborns undergoing circumcision without anesthesia will react more profoundly to future painful stimulation, such as routine injections, vaccinations, and other painful processes. These children haven’t only a higher hemodynamic reaction, known as tachycardia and tachypnea, but they will also develop enhanced crying too.

 

This neurological memory of pain was studied extensively. In a report on his previous research studies, Woolf noted that the improved reflex excitability following peripheral tissue damage or injury doesn’t rely on continuing peripheral input signals; rather, hours after a peripheral trauma, spinal dorsal horn neuron receptive fields continued to enlarge. Researchers also have documented the significance of the spinal NMDA receptor to the induction and maintenance of central sensitization.

 

Mechanism of Central Sensitization | El Paso, TX Chiropractor

 

Cortical Reorganization | El Paso, TX Chiropractor

 

Significance for Pain Management

 

Once central sensitization is established, bigger doses of analgesics are often required to suppress it. Preemptive analgesia, or therapy before pain progresses, may lower the effects of all of these stimulation on the CNS. Woolf demonstrated that the morphine dose required to stop central hyperexcitability, given before short noxious electrical stimulation in rats, was one tenth the dose required to abolish activity after it had grown. This translates to clinical practice.

 

In a clinical trial of 60 patients undergoing abdominal hysterectomy, individuals who received 10 mg of morphine intravenously at the time of induction of anesthesia required significantly less morphine for postoperative pain control. Furthermore, pain sensitivity around the wound, referred to as secondary hyperalgesia, was also reduced in the morphine pretreated group. Preemptive analgesia was used with comparable success in an assortment of surgical settings, including prespinal operation and postorthopaedic operation.

 

A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children, if administered in the induction of anesthesia. Furthermore, children with sufficient analgesia with acetaminophen experienced significantly less postoperative nausea and vomiting.

 

NMDA receptor antagonists have imparted postoperative analgesia when administered preoperatively. Various reports exist in the literature supporting the use of ketamine and dextromethorphan in the preoperative period. In patients undergoing anterior cruciate ligament reconstruction, 24-hour patient-controlled analgesia opioid consumption was significantly less in the preoperative dextromethorphan category versus the placebo group.

 

In double-blind, placebo-controlled research studies, gabapentin was indicated as a premedicant analgesic for patients undergoing mastectomy and hysterectomy. Preoperative oral gabapentin reduced pain scores and postoperative analgesic consumption without gap in side effects as compared with placebo.

 

Preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has demonstrated a significant decrease in opioid use postoperatively. COX-2s are preferable due to their relative lack of platelet effects and significant gastrointestinal safety profile when compared with conventional NSAIDs. Celecoxib, rofecoxib, valdecoxib, and parecoxib, outside the United States, administered preoperatively reduce postoperative narcotic use by more than 40 percent, with many patients using less than half of the opioids compared with placebo.

 

Blocking nerve conduction in the preoperative period appears to prevent the development of central sensitization. Phantom limb syndrome (PLS) has been attributed to a spinal wind-up phenomenon.�Patients with amputation
often have burning or tingling pain in the body part removed. One possible cause is that nerve fibers at the stump are stimulated and the brain interprets the signals as originating in the amputated portion. The other is the rearrangement within the cortical areas so that area say for the hand now responds to signals from other parts of the body but still interprets them as coming for the amputated hand.

 

However, for patients undergoing lower-extremity amputation under epidural anesthesia, not one of the 11 patients who received lumbar epidural blockade with bupivacaine and morphine for 72 hours before operation developed PLS. For people who underwent general anesthesia without prior lumbar epidural blockade, 5 of 14 patients had PLS at 6 weeks and 3 continued to experience PLS at 1 year.

 

Woolf and Chong have noted that perfect preoperative, intraoperative, and postoperative treatment comprises of “NSAIDs to reduce the activation/centralization of nociceptors, local anesthetics to block sensory inflow, and centrally acting drugs such as opiates.” Decreasing perioperative pain with preemptive techniques enhances satisfaction, hastens discharge, spares opioid use, along with diminished constipation, sedation, nausea, and urinary retention, and may even stop the development of chronic pain. Anesthesiologists and surgeons should consider integrating these techniques in their everyday practices.

 

When pain occurs as a result of damage or injury in consequence of surgery, the spinal cord can attain a hyperexcitable state wherein excessive pain reactions occur that may persist for days, weeks or even years.

 

Why does localized injury resulting from trauma result in chronic, intractable pain in some patients? Tissue injury leads to a constellation of changes in spinal excitability, including elevated spontaneous firing, greater response amplitude and length, decreased threshold, enhanced discharge to repeated stimulation, and expanded receptive fields. The persistence of these changes, which are collectively termed central sensitization, appears to be fundamental to the prolonged enhancement of pain sensitivity which defines chronic pain. Numerous drugs and/or medications as well as local anesthetic neural blockade may limit the magnitude of the central nervous system (CNS) windup, as evidenced by diminished pain and diminished opioid consumption in the preemptive analgesic models.

 

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Dr. Alex Jimenez’s Insight

Chiropractic care is an alternate treatment option which utilizes spinal adjustments and manual manipulations to safely and effectively restore as well as maintain the proper alignment of the spine. Research studies have determined that spinal misalignments, or subluxations, can lead to chronic pain. Chiropractic care is commonly utilized for pain management, even if the symptoms are not associated to an injury and/or condition in the musculoskeletal and nervous system. By carefully re-aligning the spine, a chiropractor can help reduce stress and pressure from the structures surrounding the main component of out body’s foundation, ultimately providing pain relief.

 

Enteric Nervous System Function and Pain

 

When it comes to the diminished use of drugs and/or medications, including opioids, in order to prevent side-effects like gastrointestinal health issues, the proper function of the enteric nervous system may be at play.

 

The enteric nervous system (ENS) or intrinsic nervous system is one of the key branches of the autonomic nervous system (ANS) and consists of a mesh-like system of nerves which modulates the role of the gastrointestinal tract. It’s capable of acting independently of the sympathetic and parasympathetic nervous systems, even though it might be affected by them. The ENS can also be called the second brain.�It is derived from neural crest cells.

 

The enteric nervous system in humans is made up of some 500 million neurons, including the numerous types of Dogiel cells, approximately one two-hundredth of the amount of neurons in the brain. The enteric nervous system is inserted into the lining of the gastrointestinal system, beginning at the esophagus and extending down to the anus. Dogiel cells, also known as cells of Dogiel, refers to some kind of multipolar adrenal tissues within the prevertebral sympathetic ganglia.

 

Cells of Dogiel | El Paso, TX Chiropractor

 

The ENS is capable of autonomous functions, such as the coordination of reflexes; even though it receives considerable innervation in the autonomic nervous system, it does and can operate independently of the brain and the spinal cord.�The enteric nervous system has been described as the “second brain” for a number of reasons. The enteric nervous system may operate autonomously. It normally communicates with the central nervous system (CNS) via the parasympathetic, or via the vagus nerve, and the sympathetic, that is through the prevertebral ganglia, nervous systems. However, vertebrate studies reveal that when the vagus nerve is severed, the enteric nervous system continues to function.

 

In vertebrates, the enteric nervous system includes efferent neurons, afferent neurons, and interneurons, all of which make the enteric nervous system capable of carrying reflexes and acting as an integrating center in the absence of CNS input. The sensory neurons report on mechanical and chemical conditions. The enteric nervous system has the ability to change its response based on such factors as nutrient and bulk composition. In addition, ENS contains support cells that are much like astroglia of the brain and a diffusion barrier around the capillaries surrounding ganglia that’s like the blood-brain barrier of blood vessels.

 

The enteric nervous system (ENS) plays a pivotal role in inflammatory and nociceptive processes. Drugs and/or medications that interact with the ENS have recently raised considerable interest because of their capacity to regulate numerous aspects of the gut physiology and pathophysiology. In particular, experiments in animals have demonstrated that�proteinase-activated receptors (PARs) may be essential to neurogenic inflammation in the intestine. Moreover, PAR2 agonists seem to induce intestinal hypersensitivity and hyperalgesic states, suggesting a role for this receptor in visceral pain perception.

 

Furthermore, PARs, together with the proteinases that activate them, represent exciting new targets for therapeutic intervention on the ENS. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Sciatica

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

 

 

 

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EXTRA IMPORTANT TOPIC: Chiropractor Sciatica Symptoms

 

 

MORE TOPICS: EXTRA EXTRA: El Paso Back Clinic | Back Pain Care & Treatments

Pain Modulation Pathway Mechanisms in El Paso, TX

Pain Modulation Pathway Mechanisms in El Paso, TX

Most, if not all, ailments of the body trigger pain. Pain is interpreted and sensed in the brain. Pain is modulated by two key types of drugs which operate on the brain: analgesics and anesthetics. The term analgesic refers to a medication that relieves pain without loss of consciousness. The expression central anesthesia refers to a medication that depresses the CNS. It’s distinguished by the lack of all perception of sensory modalities, for instance, loss of consciousness without loss of critical functions.

 

Opiate Analgesia (OA)

 

The most successful clinically used drugs for producing temporary analgesia and relief from pain are the opioid family, which includes morphine, and heroin. There are currently no additional powerful pain therapeutic options to opiates. Several side effects caused by opiate use include tolerance and drug dependence or addiction. In general, these drugs modulate the incoming pain information in the spine and central nervous system, in addition to relieve pain temporarily, and can also be called opiate producing analgesia (OA). Opiate antagonist is a drug that antagonizes the opioid effects, such as naloxone or maltroxone, etc.. They are competitive antagonists of opiate receptors. However, the brain has a neuronal circuit and endogenous substances which modulate pain.

 

Endogenous Opioids

 

Opioidergic neurotransmission is located throughout the brain and spinal cord and is believed to influence many functions of the central nervous system, or CNS, such as nociception, cardiovascular functions, thermoregulation, respiration, neuroendocrine functions, neuroimmune functions, food consumption, sexual activity, competitive locomotor behaviour as well as memory and learning. Opioids exert marked effects on mood and motivation and produce a sense of euphoria.

 

Three classes of opioid receptors are identified: ?-mu, ?-delta and ?-kappa. All 3 classes are widely dispersed in the brain. The genes encoding each one of these have been cloned and found to function as members of the G protein receptors. Moreover, three major types of endogenous opioid peptides that interact with the above opiate receptors have been recognized in the central nervous system, including, ?-endorphins, enkephalins and the dynorphins. These 3 opioid peptides are derived from a large protein receptor by three different genes, such as the proopiomelanocortin, or POMC, gene, the proenkephalin gene and the prodynorphin gene.�The opioid peptides modulate nociceptive input in two ways: first, they block neurotransmitter release by inhibiting Ca2+ influx into the presynaptic terminal, or second, they open potassium channels, which hyperpolarizes neurons and inhibits spike activity. They act on various receptors within the brain and spinal cord.

 

Enkephalins are considered the putative ligands for the ? receptors, ? endorphins for its ?-receptors, and dynorphins for the ? receptors. The various types of opioid receptors are distributed differently within the peripheral and central nervous system, or CNS. There’s evidence for functional differences in these receptors in various structures. This explains why many undesirable side effects occur after opiate treatments. For instance, mu (?) receptors are widespread in the brain stem parabrachial nuclei, where a respiratory center and inhibition of these neurons may cause what’s known as respiratory depression.

 

Endogenous Opioids Diagram 4 | El Paso, TX Chiropractor

 

Central or peripheral terminals of nociceptive afferent fibers feature opiate receptors in which exogenous and endogenous opioids could act to modulate the capability to transmit nociceptive information. Additionally, high densities of opiate receptors are found in periaqueductal gray, or PAG, nucleus raphe magnus, or NRM, and dorsal raphe, or DR, from the rostral ventral medulla, in the spinal cord, caudate nucleus, or CN, septal nucleus, hypothalamus, habenula and hippocampus.�Systemically administered opioids at analgesic dosages activate spinal and supraspinal mechanisms via ?, ?, and ? type opioid receptors and regulate pain signals to modulate symptoms.

 

Neuronal Circuits and Pain Modulation

 

For many decades it was suggested that somewhere in the central nervous system there is a circuit which can modulate incoming pain details. The gate control theory and the ascending/descending pain transmission system are two suggestions of such a circuit. Below, we will discuss both in further detail.

 

Gate Control Theory

 

The initial pain modulatory mechanism known as the gate control theory, has been proposed by Melzack and Wall in the mid 1960’s. The notion of the gate control theory is that non-painful input closes the gates to painful input, which results in avoidance of the pain sensation from travel into the CNS, for example, non-noxious input, or stimulation, suppresses pain.

 

The theory implies that collaterals of the large sensory fibers carrying cutaneous sensory input activate inhibitory interneurons, which inhibit and regulate pain transmission data carried from the pain fibers. Non-noxious input inhibits pain, or sensory input, and closes the gate to noxious input. The gate control theory demonstrates that in the spinal cord level, non-noxious stimulation will create presynaptic inhibition on dorsal root nociceptor fibers that synapse on nociceptors spinal neurons (T). This presynaptic inhibition will also prevent incoming noxious information from reaching the CNS, for example, it will shut the gate to incoming toxic information.

 

Gate Control Theory Diagram 1 | El Paso, TX Chiropractor

 

The gate control theory was the rationale for the idea behind the production and utilization of the transcutaneous electrical nerve stimulation, or TENS, for pain relief. In order to be effective, the TENS unit generates two different present frequencies below the pain threshold that can be taken by the patient. This process has found a degree of achievement in chronic pain treatment.

 

Pain Modulation: Gate Control Theory

 

 

Stimulation Produced Analgesia (SPA)

 

Evidence for an inherent analgesia system was found by intracranial electrical stimulation of certain discrete brain regions. These areas would be the periaqueductal gray, or PAG, and nucleus raphe magnus, or NRM, dorsal raphe, or DR, caudate nucleus, or CN, septal nucleus, or Spt, along with other nuclei. Such stimulation or sensory signals, inhibits pain, making analgesia without behavioral suppression, while the touch, temperature and pressure sensation stays intact. According to research studies, SPA, or stimulation produced analgesia, is more pronounced and continues for a longer period of time after stimulation in humans than in experimental animals. Additionally, during SPA, the subjects, however, still respond to nonpainful stimulation like temperature and touch within the circumscribed region of analgesia. The most effective CNS, or central nervous system regions for SPA to occur, would be in the PAG and the raphe nuclei, or RN.

 

Electrical stimulation of PAG or NRM inhibits spinal thalamic cells, or spinal neurons that project monosynaptically to the thalamus, in laminae I, II and V to ensure the noxious information from the nociceptors which are ultimately modulated in the level of the spinal cord. Furthermore, PAG has neuronal connections to the nucleus raphe magnus, or NRM.

 

The activity of the PAG most likely occurs by activation of the descending pathway from NRM and likely also by activation of ascending connections acting on greater subcortical levels of the CNS. In addition, electric stimulation of PAG or NRM produces behavioral analgesia, or stimulation produced analgesia. Stimulation produced analgesia, or SPA causes the release of endorphins which can be blocked by the opiate antagonist naloxone.

 

During PAG and/or RN stimulation, serotonin, also medically referred to as 5-HT, can also be discharged from ascending and descending axons from subcortical nuclei, in spinal trigeminal nuclei and in the spinal cord. This release of 5-HT modulates and regulates pain transmission by inhibiting or blocking incoming neural action. Depletion of 5-HT by electrical lesion of the raphe nuclei or with a neurotoxic lesion made by local injection of a chemical agent such as parachlorophenylalanine, or PCPA, results in blocking the power of opiate, both intracranial and systemic, as well as that of electrical stimulation in order to produce analgesia.

 

To confirm if the electric stimulation produced analgesia via the release of opiate and dopamine, then the region is locally microinjected with morphine or 5-HT. All these microinjections ultimately create analgesia. These processes also provide a way of identifying brain areas related to pain suppression and assist to produce a map of pain centers. The most effective way of producing opiate analgesia, or OA, is by intracerebral injection of morphine into the PAG.

 

The PAG and RN as well as other brain structures in which analgesia is produced, are also rich in opiate receptors. Intracerebral opioid administration produced analgesia and SPA can be blocked by systemic or from local microinjections of naloxone, the morphine antagonist, into the PAG or RN. For that reason, it’s been suggested that the two, both OA and SPA, operate by a frequent mechanism.

 

If OA and SPA behave through the same intrinsic system, then the hypothesis that opiates activate a pain-suppression mechanism is much more likely. As a matter of fact, current evidence suggests that microinjections of an opiate into the PAG activate an efferent brainstem system which inhibits pain transmission at segmental spinal cord levels. These observations imply that analgesia elicited from the periaqueductal gray, or PAG, demands a descending pathway into the spinal cord.

 

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Dr. Alex Jimenez’s Insight

Pain modulation occurs through the process of electrical brain stimulation which occurs due to the activation of descending inhibitory fibers, which regulate or inhibit the input and output of certain neurons. What has been described as opioid and serotonergic antagonists, is believed to reverse both local opiate analgesia and brain-stimuli generated analgesia. The sensory signals or impulses in the central nervous system are ultimately controlled by both ascending and descending inhibitory systems, utilizing endogenous opioids or other endogenous substances, such as serotonin as inhibitory mediators. Pain is a complex perception which can also be influenced by a variety of other factors, including emotional state.

 

Mechanisms of Pain Modulation

 

Ascending and Descending Pain Suppression Mechanism

 

The primary ascending pain fibers, such as the A ? and C fibers, reach the dorsal horn of the spinal cord from peripheral nerve areas in order to innervate the nociceptor neurons in Rexed laminae I & II. Cells from Rexed lamina II make synaptic connections in Rexed layers IV to VII. Cells, particularly within laminae I and VII of the dorsal horn, give rise to ascending spinothalamic tracts. In the spinal level, opiate receptors are located in the presynaptic endings of their nocineurons and in the interneural level layers IV to VII from the dorsal horn.

 

Activation of opiate receptors at the interneuronal level produces hyperpolarization of the neurons, which lead to the the inhibition of activation as well as the release of substance P, a neurotransmitter involved in pain transmission, thus preventing pain transmission. The circuit which consists of the periaqueductal gray, or PAG, matter in the upper brain stem, the locus coeruleus, or LC, the nucleus raphe magnus, or the NRM, and the nucleus reticularis gigantocellularis, or Rgc,� leads to the descending pain suppression pathway, which inhibits incoming pain data at the spinal cord level.

 

As stated before, opioids interact with the opiate receptors in distinct central nervous system levels. These opiate receptors are the normal target regions for hormones and endogenous opiates, such as the endorphins and enkephalins. Due to binding at the receptor in subcortical websites, secondary changes which result in some change in the electrophysiological properties of the neurons and regulation of their ascending pain information.

 

Ascending and Descending Pain Suppression Mechanism Diagram 2 | El Paso, TX Chiropractor

 

Ascending and Descending Pain Suppression Mechanism Diagram 3 | El Paso, TX Chiropractor

 

What activates the PAG to exert its consequences? It was discovered that noxious stimulation triggers neurons in the nucleus reticularis gigantocellularis, or RGC. The nucleus Rgc innervates both PAG and NRM. The PAG sends axons into the NRM, and nerves in the NRM send their axons to the spinal cord. Additionally, bilateral dorsolateral funiculus, or DLF, lesions, referred to as DLFX, block the analgesia produced by both electrical stimulation and by microinjection of opiates directly into the PAG and NRM, but they just attenuate the systemic analgesic effects of opiates. These observations support the hypothesis that discrete descending pathways from the DLF are necessary for both OA and SPA.

 

The DLF is comprised of fibers originating from several brainstem nuclei, which can be serotonergic, or 5-HT, from nerves located inside the nucleus raphe magnus, or NRM; dopaminergic neurons originating from ventral tegmental area, or VTA, and adrenergic neurons originating from the locus coeruleus, or LC. These descending fibers suppress noxious input in the nociceptive spinal cord neurons in laminae I, II, and V.

 

Opiate receptors have also been discovered in the dorsal horn of the spinal cord, chiefly in Rexed laminae I, II, and V, and such spinal opiate receptors mediate inhibitory effects on dorsal horn neurons transmitting nociceptive information. The action of morphine seems to be exerted equally in the spinal cord and brainstem nuclei, including the PAG and NRM. Systemic morphine acts on both brain stem and spinal cord opiate receptors to produce analgesia. Morphine binds the brainstem opiate receptors, which triggers the brainstem descending serotonergic pathway into the spinal cord as well as the DLF, and these have an opioid-mediated synapse at the level of the spinal cord.

 

This observation demonstrates that noxious stimuli, instead of non-noxious stimulus, determine the gate control theory, which are critical for the activation of the descending pain modulation circuit where pain inhibits pain via the descending DLF pathway. In addition, there are ascending connections in the PAG and the raphe nuclei into the PF-CM complex. These thalamic regions are a part of the ascending pain modulation at the diencephalon degree.

 

Stress Induced Analgesia (SIA)

 

Analgesia may be produced in certain stressful circumstances. Exposure to many different stressful or painful events generates an analgesic response. This phenomenon is known as stress induced analgesia, or SIA. Stress induced analgesia has been believed to give insight into the physiological and psychological factors that trigger endogenous pain control and opiate systems. By way of instance, soldiers injured in battle or athletes hurt in sports sometimes report that they don’t feel pain or discomfort during the battle or game, nevertheless, they will go through the pain afterwards once the specific situation has stopped. It’s been demonstrated in animals that electrical shocks cause stress-induced analgesia. Based on these experiments, it is assumed that the pressure the soldiers and the athletes experienced suppressed the pain which they would later experience.

 

It’s believed that endogenous opiates are produced in response to stress and inhibit pain by triggering the midbrain descending system. Furthermore, some SIA exhibited cross tolerance with opiate analgesia, which indicates that this SIA is mediated via opiate receptors. Experiments using different parameters of electrical shock stimulation demonstrate such stress induced analgesia and some of those anxieties that produce analgesia could be blocked by the opioid antagonist naloxone, whereas others were not blocked by naloxone. In conclusion, these observations lead to the decision that both opiate and non-opiate forms of SIA exist.

 

Somatovisceral Reflex

 

The somatovisceral reflex is a reflex in which visceral functions are activated or inhibited by somatic sensory stimulation. In experimental animals, both noxious and innocuous stimulation of somatic afferents are proven to evoke reflex changes in sympathetic efferent activity and, consequently, effector organ function. These phenomena have been shown in such regions as the gastrointestinal tract, urinary tract, adrenal medulla, lymphatic cells, heart and vessels of the brain and peripheral nerves.

 

Most frequently, incisions are elicited experimentally by stimulation of cutaneous afferents, even though some work has also been conducted on muscle and articular afferents, including those of spinal cells. The ultimate responses will represent the integration of multiple tonic and reflex influences and might exhibit laterality and segmental trends as well as variable excitability in line with the afferents involved. Given the complexity and multiplicity of mechanisms involved in the last expression of the reflex response, attempts to extrapolate to clinical situations should most likely be conducted in favor of further systematic physiological studies.

 

The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Sciatica

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

 

 

 

blog picture of cartoon paperboy big news

 

EXTRA IMPORTANT TOPIC: Chiropractor Sciatica Symptoms

 

 

MORE TOPICS: EXTRA EXTRA: El Paso Back Clinic | Back Pain Care & Treatments

Gate Control Theory and Pain Management in El Paso, TX

Gate Control Theory and Pain Management in El Paso, TX

Pain perception varies across different people based on their mood, psychological condition and previous experience, even when pain is brought on by similar physical stimulation and ends in a similar level of damage. In 1965, Ronald Melzack and Patrick Wall summarized a scientific theory about the psychological influence on pain perception; known as the gate control theory.

 

If it wasn’t for this theory, pain perception would still be connected to the intensity of the pain stimulation and the degree of damage caused to the affected tissue. But Melzack and Wall made it clear that pain perception is far more complicated than we believe.

 

Based on the gate control theory, pain signals aren’t free to travel to the brain as soon as they’re generated in the region of the damaged or injured tissues. These first need to encounter specific neural gates found at the level of the spinal cord level, where these gates ascertain whether the pain signals should reach the brain or not. To put it differently, pain is perceived when the gate gives way to the pain signals and it is not as intense or it is not sensed at all when the gate closes for the signs to pass through.

 

This theory provides the explanation for why people find relief by massaging or rubbing a damage, injured or painful site. Although the gate control theory cannot demonstrate the whole picture of the fundamental system which underlies pain, it’s visualized the mechanism of pain perception and it has created a pathway to various pain management treatment approaches.

 

Nerve Fibers in Transmission of Sensory Signals

 

Every organ, or portion of the human body, has its own nerve supply which are in charge of carrying electric impulses generated in reaction to several senses, such as touch, temperature, pressure and pain. These nerves, which make up the peripheral nervous system, transmit these sensory signals, to the central nervous system, or the brain and the spinal cord. These impulses are then translated and perceived as senses. The peripheral nerves send signals to the dorsal horn of the spinal cord and from there, the sensory signals are transmitted into the brain through the spinothalamic tract. Pain is a sensation which alarms a person that a tissue or certain portion of the human body has been damaged or injured.

 

Due to their axonal diameter and their conduction speed, nerve fibers can be categorized into three different types, nerve fibers A, B and C. The C fibers are considered to be the smallest among the three different types. Moreover, there are four subtypes within the A fibers: A-alpha, A-beta, A-gamma and A-delta. From the A fiber subtypes, the A-alpha fibers are the largest and the A-delta fibers are the smallest.

 

Gate Control Theory Diagram 2 | El Paso, TX Chiropractor

 

The A fibers which are larger compared to the A-delta fibers, carry sensations, such as touch, pressure, etc., into the spinal cord. The A-delta fibers as well as the C fibers carry pain signals into the spinal cord. A-delta fibers are faster and carry sharp pain signals while the C fibers are slower and carry diffuse pain signals.

 

When thinking about that the conduction velocity of nerve fibers, the A-alpha fibers, which are the biggest A nerve fibers, have greater conduction speed compared to A-delta fibers and C fibers, which are considered to be the smallest nerve pathways. When a tissue is damaged or injured, the A-delta fibers are activated first, followed by the activation of the C fibers. These nerve fibers have a tendency to carry the pain signals to the spinal cord and then to the brain. However, the pain signals are transmitted through a much more complex process than what is simply explained above.

 

Ascending Tracts | Pain Modulation: Gate Control Theory

 

 

What is the Gate Control Theory of Pain?

 

The gate control theory implies that the sensory signals or impulses which are transmitted by the nerve fibers encounter neural gates at the level of the spinal cord and these will need to get cleared through those gates to reach the brain. Various factors determine how the pain signals ought to be treated in the neurological gates, including:

 

  • The intensity of the pain signals
  • The degree of another sensory signal, such as touch, temperature and pressure, if produced at the site of damage or injury
  • The message from the brain itself to deliver the pain signals or not

 

As previously mentioned, the nerve fibers, both large and small, carrying the sensory signals, end in the dorsal horn of the spinal cord from where the impulses are transmitted into the brain. According to the original postulate of Melzack and Wall, the nerve fibers project to the substantia gelatinosa, or SG, of the dorsal horn and the initial central transmission (T) cells of the spinal cord. The SG consists of inhibitory interneurons that behave as the gate and ascertain which sensory signals should get to the T cells then go further throughout the spinothalamic tract to finally reach the brain.

 

When the pain signals carried by the small nerve fibers, or the A-delta fibers and the C fibers, are somewhat less intense compared to another non-pain sensory signal like touch, temperature and pressure, the inhibitory neurons stop the transmission of the pain signals through the T cells. The non-pain signals override the pain signals and therefore the pain is not perceived by the brain. When the pain signals are somewhat more intense compared to the non-pain signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the pain signals into the spinothalamic tract which carries those impulses to the brain. As a result, the neurological gate is influenced by the relative amount of activity from the large and the small nerve fibers.

 

Gate Control Theory Diagram 1 | El Paso, TX Chiropractor

 

Gate Control Theory Diagram 3 | El Paso, TX Chiropractor

 

How Emotions and Thoughts Affect Pain

 

The gate control theory also suggests that the pain signal transmission could be affected by thoughts and emotions. It’s well known that people do not feel that a chronic pain or, more appropriately, the pain does not disturb them if they concentrate on other activities which interest them. Whereas, people who are depressed or anxious may often feel intense pain and can also find it challenging to cope with. This is due to the fact that the brain sends messages through descending nerve fibers which stop, reduce or enhance the transmission of pain signals through the gate, depending on the emotions and thoughts someone may be going through.

 

Gate Control Theory in Pain Management

 

The gate control theory has caused a radical revolution within the field of pain management. The theory suggested that pain management can be accomplished by influencing the larger nerve fibers that carry non-pain stimulation. The concept has also paved way for more research on cognitive and behavioral strategies to achieve pain relief.

 

Among the most tremendous advances in pain management research is the arrival of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the cornerstone of TENS. In this procedure, the selective stimulation of the large diameter nerve fibers taking non-pain sensory stimulation from a particular region nullifies or reduces the impact of pain signals from the region. TENS is a non-invasive and affordable pain control strategy that has been widely used for the treatment of chronic and intractable pain by various healthcare professionals, which may otherwise have been non-responsive to analgesics and surgical interventions. TENS is tremendously advantageous over pain drugs from the aspect that it does not have the problem of medication interactions and toxicity.

 

For instance, many doctors of chiropractic, or chiropractors, utilize TENS and other electrotherapeutic procedures in their practice. These are generally utilized along with spinal adjustments and manual manipulations to increase circulation as well as to aid in the support of chiropractic care. Several other invasive and noninvasive electrical stimulation techniques are discovered to be helpful in several chronic pain conditions such as arthritic pain, diabetic neuropathy, fibromyalgia, etc.. The theory has also been extensively studied in treating chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of these techniques based on the theory still remains under consideration.

 

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Dr. Alex Jimenez’s Insight

Chiropractic care is widely utilized to benefit patients with chronic pain. Symptoms of persistent pain and discomfort have become a big health issue in the United States where many years of research have found that drugs and/or medications are not necessarily a solution to the problem. The gate control theory, which was first proposed over half a century ago, has offered healthcare professionals new insights on the perception of pain, providing a variety of pain management treatment methods, such as the use of transcutaneous electrical nerve stimulation, or TENS, as well as other electrotherapeutic procedures. Chiropractors can help with pain management through spinal adjustments and manual manipulations, and through the use of TENS.

 

Nevertheless, the gate control theory has radically revolutionized the area of pain research and it has achieved to get numerous studies which aim at presenting a pain-free lifestyle into the patients who suffer from chronic pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Sciatica

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

 

 

 

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Plantar Fasciitis And Chiropractic Treatment | El Paso, TX.

Plantar Fasciitis And Chiropractic Treatment | El Paso, TX.

Feet are important. When you consider what your feet go through, taking 8,000 steps over the course of a day, according to the Illinois Podiatric Medical Association (IPMA), it�s easy to see how 75 percent of all Americans will have some type of foot pain at some point in their lives. Plantar fasciitis is a common and very painful foot condition that can become chronic if not treated. It is also a condition that responds very well to chiropractic care.

Plantar Fasciitis Explained

plantar fasciitis el paso tx.

Plantar fasciitis is caused when the ligament that connects your toes to your heel (the plantar fascia) becomes inflamed, swollen, and weak. This causes the bottom of your foot or heel to hurt when you walk or stand, especially when you first wake or after sitting for a long time.

The pain tends to be sharp and stabbing. It is the most common cause of heel pain and is more prevalent among middle aged people. However, anyone can get it at any age, especially people who spend a lot of time on their feet.

How Chiropractic Helps Plantar Fasciitis

Chiropractic care is a very effective treatment for plantar fasciitis as well as the pain that is caused by the condition. Chiropractic for plantar fasciitis involves a very precise technique that involves adjustments to the feet and ankles as well as spinal alignment. This provides several benefits.

Reduces Stress in the Plantar Fascia � When a ligament is inflamed or stressed the tissue can develop very small tears that cause the pain of plantar fasciitis. Chiropractic adjustments made to the heel and foot take the pressure off of the plantar fascia, allowing it to relax.

Promotes Healing � When the stress on the plantar fascia is reduced through these chiropractic adjustments, the foot can begin to heal. The chiropractor may also recommend specific exercises that stretch the ligament and help it heal. They may also advise the patient of lifestyle changes as well as nutritional adjustments that can help with the pain and condition.

Provides Effective Pain Management � Chiropractic is a very effective way to manage pain throughout the body. Spinal adjustments allow better communication between the brain and nerves, allowing the central nervous system to function more effectively. Condition specific adjustments speak to the root of the problem, not just the symptoms. This means a more effective form of pain management that is longer lasting.

Reduces the Risk of Further Injury � When a person has a condition like plantar fasciitis, they will often adjust their gait in an effort to avoid the pain. This puts stress on other parts of the body and can lead to back pain, sore joints, strained muscles, and other problems. Chiropractic�s whole body approach helps the person realign their body properly so that they stand and walk properly. This helps them avoid further injury and discomfort.

Chiropractic Complements Other Treatments

plantar fasciitis el paso tx.While chiropractic care can be an effective treatment for plantar fasciitis on its own, it is also a very good complement to other treatments for the condition. Patients may use chiropractic in conjunction with physical therapy, massage, and even injections to manage the pain and treat the condition. It can also help with speeding healing and helping to provide better mobility.

Plantar fasciitis can take several months to heal, but by adding chiropractic treatments to your recovery plan, you can feel better faster while more effectively managing your pain. Regular chiropractic treatments can also keep the condition from becoming chronic. By working with your chiropractor and following their recommendations you can reduce your pain and shorten your healing time.

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Chiropractic Care for Cerebral Palsy in El Paso, TX

Chiropractic Care for Cerebral Palsy in El Paso, TX

Chiropractic care for individuals with cerebral palsy is considered (in most cases) a natural form of treatment that helps with several musculoskeletal and nervous system conditions that normally affect individuals with the disorder. Past results have been so successful that chiropractic care is an extremely sought plan of treatment to assist with numerous health issues.

 

What is Chiropractic Care?

 

Chiropractic care, sometimes known as chiropractic intervention, is an alternative treatment option where licensed chiropractors perform various techniques to help decrease pain and discomfort, and also to restore proper musculoskeletal and nervous system functions. According to the American Chiropractic Association, or the ACA, chiropractic care concentrates on musculoskeletal system disorders and nervous system disorders.

 

The Palmer College of Chiropractic reports that “no portion of your body leaks the dominance of your nervous system.” This usually means that misalignments of the spine, or subluxations, as well as other improper functions of the spinal cord along with different regions of the human body can lead to poor health and improper musculoskeletal and nervous system functioning.

 

Treatment includes focusing on various areas of the human body, such as the back, neck, shoulders, upper and lower extremities, and joints in the arms and legs. Chiropractic care may also center on rehabilitation and therapeutic exercises as well as individualized diet programs in order to help increase strength, mobility and flexibility. Treatment is normally performed without any drugs, although some chiropractors have the capacity of prescribing specific medications, if needed.

 

Chiropractic Care and Cerebral Palsy

 

A range of documented case studies show that kids with cerebral palsy who received chiropractic care were able to sit up (when they formerly couldn’t), walk up stairs without help, and use their arms and hands better.

 

For example, Dr. Dan Van Roon, of Van Roon Chiropractic in Massachusetts, wrote that an 8-year-old girl with cerebral palsy, who suffered from frequent seizures and tremors, was treated with chiropractic care after previous clinical efforts, such as physical therapy and acupuncture, proved to be ineffective. Within fourteen days of getting chiropractic care, that comprised of 22 chiropractic adjustments, her mother reported that the child was able to walk upright and walk up stairs by herself (two things she had been incapable of performing).

 

The young girl’s parents also reported that not only were her muscles not as limp, but she gained confidence, walked and also had a large improvement in her emotional and psychological state of being.

 

In another case, Dr. Van Roon wrote that a 7-year-old boy who didn’t start walking until he was 5, also revealed significant improvement after receiving chiropractic care. Before treatment, he had seizures, pain and numbness in his limbs, tremors, throat pain, nosebleeds, anemia and excruciating foot pain. After his first chiropractic care session, he started showing improvement.

 

As treatment progressed, so did the boy’s progress. He gained strength, began walking longer distances, and had progress in both sleeping quality and education.

 

Additional areas of improvement reported after kids with cerebral palsy had chiropractic care included a decrease in:

 

  • Pain and muscle stiffness
  • Breathing problems
  • Drooling
  • Muscle contractions
  • Neck pain
  • Musculoskeletal conditions
  • Gait issues
  • Spine issues
  • Anxiety and stress
  • Headaches and chest pain
  • Leg/arm problems
  • Speech problems due to respiratory issues
  • Spasticity
  • Urinary incontinence

 

Common Chiropractic Care Treatment Methods

 

Throughout the initial chiropractic care session, a full medical history should be supplied so that the chiropractor is first familiar with the individual’s medical history. Then, the chiropractor may ask you and/or your child specific questions about pain and any activities which make the symptoms worse, followed by an exam which could include diagnostic tests, such as X-rays or a MRI test, that may include analyzing the individual’s:

 

  • Neurological integrity
  • Range of movement (in the affected region)
  • Muscle tone and strength
  • Abnormalities
  • Misalignment
  • Flexion Distraction therapy, and much more

 

Treatment depends upon medical history and physical exam results. However, common chiropractic care treatment methods include:

 

  • Spine adjustments, which can include spinal adjustments and manual manipulations, the “Activator” technique, and/or the “Gonstead” method
  • Adjustment to joint dysfunctions
  • Massaging
  • Electrical stimulation
  • Traction
  • Heat/cold applications
  • Myofacial release

 

Treatment will consist of a variety of sessions over time. Each session may last anywhere from 30 minutes to an hour, based upon the chiropractor’s techniques and the medical issues and problems. For instance, treatment for lower back pain may require 1 to 3 visits weekly for up to 2 to 3 weeks. Chiropractic care is used in many different settings, like hospitals, clinics, or a private healthcare professional’s office. Most chiropractors run their business from a private office.

 

Furthermore, a chiropractor may utilize or recommend a series of rehabilitation stretches and exercises to improve some of the conditions associated with cerebral palsy. Daily range-of-motion (ROM) exercises are important to prevent or delay contractures which are secondary to spasticity and to keep the mobility of joints and soft tissues. Stretching exercises are performed to increase range of motion. Progressive resistance exercises must be used so as to increase strength. Also, the utilization of age-appropriate play and of adaptive toys and games based on the desired exercises are important to elicit the child’s complete alliance in the case of cerebral palsy. Strengthening knee extensor muscle exercises aids improve crouching and stride length. Postural and motor control training is essential and should follow the developmental sequence of normal kids (that is, neck and head control ought to be achieved, if at all possible, before advancing to back control).

 

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Dr. Alex Jimenez’s Insight

Chiropractic care is an alternative treatment option which utilizes spinal adjustments and manual manipulations to carefully influence the human body’s musculoskeletal and nervous system. Chiropractic interventions focus on improving overall health and wellness by alleviating pain and discomfort associated with neck and back pain as well as for specific health conditions, such as cerebral palsy and fibromyalgia. Several research studies have demonstrated that chiropractic care is a safe and effective, treatment method towards increasing strength and range of motion in individuals with cerebral palsy, improving quality of life and affecting longevity. Because spinal adjustments and rehabilitation improve the way the brain and the rest of the body function together, evidence has shown how chiropractic care can help improve some conditions of cerebral palsy.

 

Things to Know Before Visiting a Chiropractor

 

Sometimes, young children, and parents may get fearful of a few things that happen in a chiropractor’s office, but rest assured these things are normal and there’s no need to stress. For example, when a chiropractor is in the process of performing a chiropractic adjustment, you’ll probably hear a popping noise. This does not mean that any bones are broken. It simply means that the chiropractor released gas from fluids surrounding the joints.

 

The individual may also experience mild discomfort, but typically, visiting a chiropractor should not be painful. If your child cries due to pain or complains that the treatments are excessively painful, don’t be afraid to talk about it with the healthcare professional, and when needed, seek out another one.

 

When choosing a chiropractor, especially for children with cerebral palsy, it’s suggested to locate somebody with experience not just with treating children, but also treating individuals with cerebral palsy. Other factors to consider when picking a chiropractor comprise of:

 

  • Education
  • Training
  • Accreditation or Licensing
  • Expertise working with other healthcare providers and readily coordinating care

 

If you have any questions or need tips on which chiropractor to select, start with your or your child’s primary healthcare provider. You’ll also need to contact your insurance provider, to be sure they pay for chiropractic care. While some insurances will cover it, other insurances may not cover what’s considered “complementary” care. Some insurances may cover the costs of a chiropractor only after your child’s primary care doctor grants a medical referral to a chiropractor. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Sciatica

 

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

 

 

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Sciatica and Other Health Issues Caused by Poor Posture in El Paso, TX

Sciatica and Other Health Issues Caused by Poor Posture in El Paso, TX

Sciatica is a condition characterized by painful symptoms, often originating from the lower back all the way down to the toes. Sciatica is brought on by the irritation of the sciatic nerve. The sciatic nerve begins around the lumbar spine and runs down to the feet. Sciatica can be caused by the irritation of the sciatic nerve anywhere along its length. But the most frequent cause of sciatica is irritation to the sciatic nerve either in the lower back or in the gluteal region caused by poor posture.

 

Sciatica generally presents itself as a very specific collection of symptoms. If you can’t pin-point exactly where your pain is (i.e. if the entire leg just aches or if your symptoms are quite vague), it’s unlikely that you have sciatica. Sciatica typically runs as a band of pain through the low back and the buttocks, and also down the hamstring, occasionally traveling as low as the calf muscle and even the feet and toes. If you experience a sensation similar to pins and needles and/or numbness, the severity of your sciatica is much worse than if you just have pain.

 

Poor Posture Reasons For Sciatica

 

Poor workplace ergonomics can be a significant contributing aspect to the development of sciatica. Further, if you already have sciatica, inadequate workstation ergonomics is very likely to make it worse. A leading ergonomic issue in regard to sciatica is increased back pain that’s brought on by poor posture while sitting and standing. It you embrace a slouched or slumped position, or you lean forward at your desk, you place a tremendous amount of strain on your lumbar spine. This can result in your lower back muscles going into spasm. The sciatic nerve has to operate through those muscles. If they are spasmodic, there is a heightened likelihood that the sciatic nerve will end up irritated and develop symptoms of sciatica.

 

Sitting for extended periods of time is just another issue, for two reasons:

 

  • First, in sitting, your bodyweight is transferred from your upper body to your pelvis, throughout the lumbar spine. This implies that there is a continuous, and dull, compressive force going through the lower spine. Over time, this may result in irritation to the nerves as they leave the spinal cord canal. This is much more of a problem for people who have sciatica. Sciatica will frequently cause inflammation around the nerve root where it exits the spinal canal. This means there’s less “wiggle” room for the nerve to move and continuous compression may impinge this nerve, causing symptoms.
  • Second, the sciatic nerve runs throughout the gluteal region. Especially, it runs through a muscle called the piriformis muscle, which happens to be in about the region of your sitting bone. When you sit, you really literally sit on the piriformis muscles along with the sciatic nerve. Therefore, when you sit you’re compressing the sciatic nerve. Compression that is constant could lead to the piriformis muscle moving into spasm. Similarly to above, in the event the piriformis muscle goes into spasm, the sciatic nerve is very likely to be compacted and irritated, leading to some kind of sciatic symptoms.

 

Furthermore, healthcare professionals say that poor posture may cause more than just back pain and sciatica. Poor posture may actually cause a variety of health issues, according to research studies.

 

Effects of Poor Posture

 

Posture is an important part of preventing issues which range from back pain to fatigue. When the spine is properly aligned, the spine is stabilized and supported, however as you slouch or practice other methods of poor posture, your spine no longer gets the support it needs to remain balanced, leading to many health issues. The following health issues may also present themselves as a result of poor posture.

 

Sore Muscles

 

The most common effect of poor posture includes sore muscles. As you slouch, the muscles have to work harder to keep the spine protected and stabilized. The extra work on these muscles may cause muscle stiffness and fatigue. This can lead to chronic health issues with sore and tight muscles from the neck all the way down to the lower spine. Two big muscle groups which bare the brunt of these problems are the flexors and extensors of the back, which allow you to bend forward and lift objects.

 

Spinal Curvature

 

Among the most serious health issues that could happen with bad posture is developing a severe spinal curvature. As stated by the Chiropractic Resource Organization, the human spine has four natural curves which form an “s” shape. When poor posture is practiced, the spine can experience pressure, gradually influencing the spine curves to modify their positions. The spine is particularly designed to help absorb shock and keep you balanced, but as the spinal column position changes, this capacity becomes compromised.

 

Subluxations

 

Once the spinal curve is altered, one major problem that may occur are subluxations, or spinal misalignments. Vertebral subluxations occurs when a vertebrae becomes misaligneds from the rest of the spine. This also affects the total integrity of the remaining spine. These misalignments can eventually lead to chronic health issues, such as stress and aggravation of neighboring spinal nerves.

 

Blood Vessel Constriction

 

As bad posture changes the alignment of the spine, the consequent movement and subluxations can cause problems with blood vessel constriction. The constriction of the arteries across the spine can cut off blood supply to the cells of their muscles, which may influence nutrient and oxygen supply. Blood vessel constriction can also raise your chances of clot formation and issues using deep vein thrombosis.

 

Nerve Compression

 

One of the most frequent side effects of bad posture is nerve compression. As the spine changes in shape, the resulting movements or subluxations can put stress on the surrounding spinal nerves. Since the nerves which connect to the spine come from all over the body, these pinched nerves can not only cause neck and back pain but might also cause pain in other unrelated regions of the body.

 

In a 2013 study conducted Japan done by Kamitani et al, posture was connected to a decrease in lifespan and in activities of daily living. The study concluded that posture had a significant impact on quality of life as well as life expectancy.

 

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Dr. Alex Jimenez’s Insight

Whether you’re slouching over your laptop, looking down at your mobile phone, bending over to pick up a box or simply sitting behind a desk for an extended amount of time, all of these regular activities can negatively affect your posture. Poor posture can not only cause back pain and symptoms of sciatica, it can manifest into a wide array of health issues if not properly corrected in time. Various research studies have even demonstrated that poor posture can affect longevity and life expectancy. Chiropractic care can help carefully restore the alignment of the spine, to recover the human body from the effects of poor posture.

 

Correcting Poor Posture to Improve Sciatica

 

The first thing that needs to be done to correct poor posture is to find a diagnosis from a healthcare professional, such as a chiropractor or physical therapist. They will be able to aid you with a treatment program and with hands-on therapy to alleviate your symptoms. Chiropractic care is a well-known, alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated to the musculoskeletal and nervous system. Also, an ergonomic evaluation is a good idea. It is best practice to allow an expert to perform an ergonomic assessment for you when you’re injured, as opposed to attempting to do it yourself. This is because of the probability of making things worse when it is not done properly.

But if an ergonomic appraisal isn’t a possibility for you, consider these hints:

  • ?Try to integrate some standing into your daily work day, to decrease the constant pressure on the sciatic nerve.
  • Take regular walks during your working day and consider a stretch to your gluteal area.
  • Make sure your workstation is set up ergonomically to prevent additional exacerbation, paying special attention to the following:

 

  • Ensure you are not leaning forwards;
  • Make sure that your backrest is large enough so that the lumbar support is comfortably supporting the lower spine;
  • Ensure your seat cushion isn’t too tough;
  • Ensure that your feet are well supported;
  • Make sure your office chair is not too low, as this promotes slouching.

 

One last note, sciatica may be a difficult condition to take care of. So where possible, involving a healthcare professional, such as a chiropractor, or doctor of chiropractic, is in your best interests, towards correcting your poor posture and improving symptoms of sciatica, among others.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topics: Back Pain

 

According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.

 

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EXTRA IMPORTANT TOPIC:�Back Pain Chiropractic Care

 

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