Peripheral and central aspects of trigeminal nociceptive systems.

Three aspects of trigeminal pain are considered: the peripheral mechanisms of pain from teeth and from the cornea, and the role of the trigeminal brainstem nuclei in pain. Pain is probably the only sensation that can be evoked by stimulation of dentin or dental pulp in man. Five nerve-endings enter dentinal tubules from the pulp but do not extend into the outer dentine, which is nevertheless sensitive. In teeth of limited growth in experimental animals, the dental pulp is supplied by A beta, A delta and C fibres and these are associated with two categories of receptor: one responds to cooling and to other stimuli that cause displacement of the contents of the dentinal tubules such as probing and drying the dentine, and the other group responds most vigorously to heating. Some cold sensitive units have A beta fibres and the evidence suggests that stimulation of these is capable of evoking both muscle reflexes and pain and, near threshold, 'pre-pain' sensations. Thermal stimulation of the cornea produces sensations of pain and, with less intense stimuli, irritation, Mechanical stimulation also produces pain but it is not clear whether, below the pain threshold, such stimuli produce touch sensation or some other sensation related to pain. Histologically, the nerve-endings in the corneal epithelium consist of fine, bare processes closely associated with the surface of the epithelial cells. Recordings in experimental animals have shown that many of the receptors respond to several different forms of stimulus and their properties correlate well with those predicted from psychophysical experiments in man. The results of trigeminal tractotomy in man and recordings from the trigeminal brainstem nuclei in anaesthetized animals, have generally indicated that nucleus caudalis is the main relay in the pain pathway from the face and associated structures. Recent observations have, however, shown that tractotomy does not produce complete analgesia of this region and responses to thermal stimulation of teeth and noxious stimulation of other oro-facial tissues have been recorded from the more rostral parts of the brainstem nuclear complex. The surgical procedures employed to set up an animal for stereotaxic recording may induce long-lasting depression in the excitability of neurons in these nuclei, which masks some of their properties. The mechanism of this depression has not been established.