Serrao Mariano, Cortese Francesca, Fragiotta Gaia, Pastore Antonio Luigi, Palleschi Giovanni, Coppola Gianluca, Carbone Antonio, Pierelli Francesco
Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy.
Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy.
Clin Neurophysiol. 2014 Nov;125(11):2271-2276. doi: 10.1016/j.clinph.2014.03.014. Epub 2014 Mar 24.
To examine the viscerosomatic interaction between bladder afferents and somatic nociception we evaluated the effect of bladder filling on the nociceptive withdrawal reflex (NWR) in 21 healthy subjects.
NWR was evoked in the lower and upper limbs by stimulating the sural and index finger digital nerves, respectively, while simultaneously recording EMG activity in the biceps femoris and biceps brachialis. NWR pain-related perception was quantified on a 10-point pain scale. Bladder filling was evaluated with suprapubic bladder sonography. Subjects were examined during empty bladder, medium and high level of bladder filling sessions.
NWR magnitude in both upper and lower limbs and perceived pain for the upper limb were significantly decreased at higher levels of bladder filling compared to empty bladder sessions.
Reduced NWR magnitude in both upper and lower limbs during bladder filling strongly indicates that bladder control and nociception share common modulatory descending pathways. Bladder afferents may activate these pathways to suppress the micturition reflex, but they may also inhibit spinal reflexes to maintain continence during pain stimuli.
The effect of bladder filling on the NWR may represent a useful tool to investigate interactions between the neural pathways controlling the bladder and pain.
为研究膀胱传入神经与躯体痛觉之间的内脏-躯体相互作用，我们评估了膀胱充盈对21名健康受试者伤害性退缩反射（NWR）的影响。
分别刺激腓肠神经和食指指神经，在下肢和上肢诱发NWR，同时记录股二头肌和肱二头肌的肌电图活动。NWR疼痛相关感觉采用10分制疼痛量表进行量化。通过耻骨上膀胱超声评估膀胱充盈情况。在膀胱空虚、中等充盈和高度充盈阶段对受试者进行检查。
与膀胱空虚阶段相比，在膀胱高度充盈时，上肢和下肢的NWR幅度以及上肢的疼痛感觉均显著降低。
膀胱充盈期间上肢和下肢的NWR幅度降低强烈表明，膀胱控制和痛觉共享共同的调节性下行通路。膀胱传入神经可能激活这些通路以抑制排尿反射，但它们也可能在疼痛刺激期间抑制脊髓反射以维持尿失禁。
膀胱充盈对NWR的影响可能是研究控制膀胱和疼痛的神经通路之间相互作用的有用工具。
