Wang Gexin, Tang Bin, Traub Richard J
Department of Biomedical Sciences, University of Maryland Dental School, Baltimore, Maryland, USA.
Gastroenterology. 2007 Nov;133(5):1544-53. doi: 10.1053/j.gastro.2007.08.008. Epub 2007 Aug 2.
BACKGROUND & AIMS: Colonic afferents project to the lumbosacral and thoracolumbar spinal cord via the pelvic and hypogastric/lumbar colonic nerves, respectively. Both spinal regions process inflammatory colonic stimuli. The role of thoracolumbar segments in processing acute colorectal pain is questionable, however, because the lumbosacral spinal cord appears sufficient to process reflex responses to acute pain. Here, we show that activity in pelvic nerve colonic afferents actively modulates thoracolumbar dorsal horn neuron processing of the same colonic stimulus through a supraspinal loop: homovisceral descending modulation.
Dorsal horn neurons were recorded in the rat thoracolumbar spinal cord after acute or chronic pelvic neurectomy and cervical cold block.
Acute pelvic neurectomy or lidocaine inhibition of lumbosacral dorsal roots facilitated the excitatory response of thoracolumbar dorsal horn neurons to colorectal distention (CRD) and decreased the percentage of neurons inhibited by CRD, suggesting colonic input over the pelvic nerve inhibits thoracolumbar processing of the same stimulus. Ectopic activity developed in the proximal pelvic nerve after chronic neurectomy reactivating the inhibitory circuit, inhibiting thoracolumbar neurons. Cervical cold block alleviated the inhibition in intact or chronic neurectomized rats. However, the facilitated response after acute pelvic neurectomy was inhibited by cervical cold block, exposing an underlying descending facilitation. Inhibiting pelvic nerve input after cervical cold block had minimal effect.
These data demonstrate that input over the pelvic nerve modulates the response of thoracolumbar spinal neurons to CRD by a supraspinal loop and that increasing thoracolumbar processing increases visceral hyperalgesia.
结肠传入神经分别通过盆神经和腹下/腰结肠神经投射至腰骶部和胸腰部脊髓。这两个脊髓区域都对结肠炎症刺激进行处理。然而,胸腰段在处理急性结直肠疼痛中的作用存在疑问,因为腰骶部脊髓似乎足以处理对急性疼痛的反射反应。在此,我们表明盆神经结肠传入神经的活动通过一个脊髓上环路:同内脏下行调制,积极调节胸腰段背角神经元对相同结肠刺激的处理。
在急性或慢性盆神经切除术及颈髓冷阻断后,记录大鼠胸腰段脊髓背角神经元。
急性盆神经切除术或利多卡因对腰骶部背根的抑制作用促进了胸腰段背角神经元对结直肠扩张(CRD)的兴奋性反应,并降低了被CRD抑制的神经元百分比,这表明通过盆神经的结肠输入抑制了同一刺激的胸腰段处理。慢性神经切除术后,盆神经近端出现异位活动,重新激活抑制性回路,抑制胸腰段神经元。颈髓冷阻断减轻了完整或慢性神经切除大鼠的抑制作用。然而,急性盆神经切除术后的促进反应被颈髓冷阻断抑制,揭示了潜在的下行促进作用。颈髓冷阻断后抑制盆神经输入的影响最小。
这些数据表明,通过盆神经的输入通过一个脊髓上环路调节胸腰段脊髓神经元对CRD的反应,并且增加胸腰段处理会增加内脏痛觉过敏。