통증, 내장기능, 뇌, 마음의 관계에서 풀리지 않는 나의 의문

[문형철]

풀리지 않는 나의 의문이 있다.

메타인지조차다 명확하지 않은 나의 의문..

Somatic disease and pain, visceral disease and pain, brain, mind

somatic problem은 visceral, brain에 어떻게 영향을 주는가? 언제 영향을 주는가?

visceral problem은 somatic, brain에 언제, 어떻게 영향을 주는가?

brain, interneuron등은 어떻게 작용하는가?

mind는 이것들에 어떤 영향을 미치는가?

풀어야 할 과제다.

panic bird..

primary and secondary hyperalgesia are two different things.pdf

Descending control of persistent pain.pdf

Descending control of nociception.pdf

The Involvement of the Nociceptin Receptor in the antinocic.pdf

Psychological stress and fibromyalgia.pdf

STRESS RESPONSE AND ANAESTHESIA.pdf

Central nervous system involvement in functional GI disorde.pdf

FIBROMYALGIA, syndorme and disease mechanism.pdf

Descending Inhibitory Systems.pdf

Brain Res Brain Res Rev. 2004 Nov;46(3):295-309.

Descending control of persistent pain: inhibitory or facilitatory?

Vanegas H, Schaible HG.

Instituto Venezolano de Investigaciones Cientificas (IVIC), Apartado 21827, Caracas 1020A, Venezuela. hvanegas@ivic.ve

Abstract

The periaqueductal gray matter (PAG) and the nucleus raphe magnus and adjacent structures of the rostral ventromedial medulla (RVM), with their projections to the spinal dorsal horn, constitute the "efferent channel" of a pain-control system that "descends" from the brain onto the spinal cord. Considerable evidence has recently emerged regarding participation of this system in persistent pain conditions such as inflammation and neuropathy. Herein, this evidence is reviewed and organized to support the idea that persistent nociception simultaneously triggers descending facilitation and inhibition. In models of inflammation, descending inhibition predominates over facilitation in pain circuits with input from the inflamed tissue, and thus attenuates primary hyperalgesia, while descending facilitation predominates over inhibition in pain circuits with input from neighboring tissues, and thus facilitates secondary hyperalgesia. Both descending facilitation and inhibition mainly stem from RVM. The formalin-induced primary hyperalgesia, although considered a model for inflammation, is mainly facilitated from RVM. Also, formalin-induced secondary hyperalgesia is facilitated by RVM. Again, formalin triggers a concomitant but concealed descending inhibition. The (primary) hyperalgesia and allodynia of the neuropathic syndrome are also facilitated from RVM. Simultaneously, there is an inhibition of secondary neuronal pools that is partly supported from the PAG. Because in all these models of peripheral damage descending facilitation and inhibition are triggered simultaneously, it will be important to elucidate why inhibition predominates in some neuronal pools and facilitation in others. Therapies that enhance descending inhibition and/or attenuate descending facilitation are furthermore an important target for research in the future.

Brain Res Rev. 2009 Apr;60(1):214-25. Epub 2008 Dec 25.

Descending control of nociception: Specificity, recruitment and plasticity.

Heinricher MM, Tavares I, Leith JL, Lumb BM.

Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA. heinricm@ohsu.edu

Abstract

The dorsal horn of the spinal cord is the location of the first synapse in pain pathways, and as such, offers a very powerful target for regulation of nociceptive transmission by both local segmental and supraspinal mechanisms. Descending control of spinal nociception originates from many brain regions and plays a critical role in determining the experience of both acute and chronic pain. The earlier concept of descending control as an "analgesia system" is now being replaced with a more nuanced model in which pain input is prioritized relative to other competing behavioral needs and homeostatic demands. Descending control arises from a number of supraspinal sites, including the midline periaqueductal gray-rostral ventromedial medulla (PAG-RVM) system, and the more lateral and caudal dorsal reticular nucleus (DRt) and ventrolateral medulla (VLM). Inhibitory control from the PAG-RVM system preferentially suppresses nociceptive inputs mediated by C-fibers, preserving sensory-discriminative information conveyed by more rapidly conducting A-fibers. Analysis of the circuitry within the RVM reveals that the neural basis for bidirectional control from the midline system is two populations of neurons, ON-cells and OFF-cells, that are differentially recruited by higher structures important in fear, illness and psychological stress to enhance or inhibit pain. Dynamic shifts in the balance between pain inhibiting and facilitating outflows from the brainstem play a role in setting the gain of nociceptive processing as dictated by behavioral priorities, but are also likely to contribute to pathological pain states.

Neurosci Lett. 2004 May 6;361(1-3):225-8.

To the descending pain-control system in rats, inflammation-induced primary and secondary hyperalgesia are two different things.

Vanegas H.

Instituto Venezolano de Investigaciones Cientificas (IVIC), Apartado 21827, Caracas 1020A, Venezuela. hvanegas@ivic.ve

Abstract

The periaqueductal gray matter and the rostral ventromedial medulla (RVM), with its projections to the spinal dorsal horn, constitute the efferent channel of the 'descending pain-control system'. Noxious stimulation of a peripheral tissue causes more pain if this tissue is inflamed (primary hyperalgesia). In such cases, stimulation of neighboring but uninflamed tissues also becomes more painful (secondary hyperalgesia). In animal models of inflammation, the descending pain-control system sends down, simultaneously, inhibitory and facilitatory influences, but inhibition predominates for primary hyperalgesia while facilitation predominates for secondary hyperalgesia. Descending inhibition and facilitation during peripheral inflammation are due not only to previously existing descending modulation, but also to inflammation-induced changes in RVM which involve receptors for NMDA, AMPA, cholecystokinin and neurotensin, as well as synthesis of enkephalins and nitric oxide.

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꼭 해결해보고싶네요ㅎ..

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감사합니다