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Neural Mechanisms and Pathways in Craniofacial Pain

Published online by Cambridge University Press:  02 December 2014

Barry J. Sessle
Barry J. Sessle*
Affiliation:
Faculty of Dentistry, and Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract

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Many free nerve endings of small-diameter afferents (A-delta or C nerve fibres) respond to craniofacial noxious stimuli and a number of neurochemicals are involved in their activation or sensitization. The small-diameter nociceptive afferents project to the trigeminal (V) brainstem complex where they can excite nociceptive neurones that have been categorized as either nociceptive-specific (NS) or wide dynamic range (WDR). These neurones project to other brainstem regions or to the contralateral thalamus. The lateral and medial thalamus contain NS and WDR neurones which have properties and connections with the overlying cerebral cortex or other thalamic regions indicative of a role for most of them in the sensory-discriminative, affective or other dimensions of pain. Some of the V brainstem NS and WDR neurones respond exclusively to cutaneous sensory inputs and have features indicating their involvement in acute superficial craniofacial pain. Many of the neurones, however, receive convergent inputs from afferents supplying other craniofacial tissues (e.g. cerebrovascular, muscle) as well as skin, and are likely involved in deep pain, as well as spread and referral that is typically seen in headache and several craniofacial pain conditions involving deep tissues. Convergence may also be an important factor underlying the neuroplastic changes in V neuronal properties that may occur with peripheral injury or inflammation. These changes include a prolonged enhancement of the cutaneous as well as deep afferent inputs to most NS and WDR neurones and expansion of their cutaneous or deep mechanoreceptive field and increased EMG activity in the jaw musculature. They involve NMDA, non-NMDA and opioid neurochemical mechanisms within peripheral tissues as well as within the CNS. Such modulatory effects on brainstem neuronal properties reflect the functional plasticity of the central V system, and may be involved in the development of headache and other conditions that manifest craniofacial pain.

Résumé

RÉSUMÉ

Plusieurs terminaisons nerveuses libres des afférents de petit diamètre (fibres nerveuses A-delta ou C) répondent à des stimuli crâniofaciaux douloureux. Plusieurs substances neurochimiques sont impliquées dans leur activation ou leur sensibilisation. Les afférents nociceptifs de petit diamètre ont des projections au complexe du trijumeau (V) dans le tronc cérébral où ils peuvent exciter les neurones nociceptifs qui ont été classés comme nociceptifs-spécifiques (NS) ou comme ayant un spectre dynamique étendu (WDR). Ces neurones projettent à d’autres régions du tronc cérébral ou au thalamus contralatéral. Le thalamus latéral et médian contient des neurones NS et WDR qui ont des propriétés et des connections avec le cortex cérébral sus-jacent ou avec d’autres régions thalamiques, ce qui indique que la plupart ont un rôle dans les aspects sensitifs-discriminatifs, affectifs ou autres de la douleur. Certains des neurones NS et WDR du complexe V du tronc cérébral répondent exclusivement aux influx sensitifs cutanés et ont des caractéristiques indiquant leur implication dans la douleur crâniofaciale superficielle aiguë. Cependant, plusieurs des neurones reçoivent des influx convergents d’afférents innervant d’autres tissus crâniofaciaux (i.e. tissus cérébrovasculaires, musculaires) ainsi que la peau et sont probablement impliqués dans la douleur profonde, incluant la douleur étendue et référée qui est observée typiquement dans la céphalée et dans plusieurs autres pathologies crâniofaciales douloureuses impliquant les tissus profonds. La convergence pourrait également être un facteur important, sous-jacent aux changements neuroplastiques dans les propriétés nerveuses du complexe V qui pourraient survenir lors d’un traumatisme périphérique ou de l’inflammation. Ces changements incluent un rehaussement prolongé des influx des afférents cutanés et profonds à la plupart des neurones NS et WDR, une expansion de leur champ mécanoréceptif cutané ou profond et une augmentation de l’activité ÉMG de la musculature de la mâchoire. Ils impliquent des mécanismes neurochimiques NMDA, non-NMDA et opioïdes dans les tissus périphériques ainsi que dans le SNC. De tels effets modulateurs sur les propriétés des neurones du tronc cérébral reflètent la plasticité fonctionnelle du système V central et peuvent être impliqués dans le développement de la céphalée et d’autres conditions qui se manifestent par de la douleur crâniofaciale.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 3 , November 1999 , pp. 7 - 11
Copyright
Copyright © The Canadian Journal of Neurological 1999

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