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Effect of high level of bladder filling on spinal nociception and motoneuronal excitability

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Abstract

To verify whether high level of bladder distension may counteract the inhibitory effect of descending pathways on sacral spinal cord neurons and to investigate which spinal circuitries are possibly involved in such a viscero-somatic interaction. Nociceptive withdrawal reflex (NWR), cutaneous silent period (CSP), and H-reflex were recorded in both lower and upper limbs of twenty-eight healthy subjects. Subjects were examined during baseline (empty bladder, no voiding desire), high level of bladder filling (urgency desire), and control (empty bladder, no voiding desire) sessions. Results showed that the NWR and its related pain perception were reduced in the upper limbs, while only a pain perception reduction in males was observed in the lower limbs. The H-reflex was inhibited in both limbs. No effects were found on the CSP duration. The decrease in both the NWR and its related pain perception in the upper limbs confirms the presence of a bladder distension-induced descending inhibitory modulation on nociception at spinal level. The lack of a similar inhibitory effect in the lower limbs suggests that excitatory nociceptive inputs from bladder afferents counterbalance the inhibitory effect on sacral spinal cord. The lack of the descending inhibitory effect may be a mechanism aimed at forcing the micturition phase to avoid bladder damage caused by bladder sovradistension.

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Abbreviations

PAG:

Periaqueductal gray

NRM:

Nucleus raphe magnum

LC:

Locus coeruleus

CNS:

Central nervous system

NWR:

Nociceptive withdrawal reflex

CSP:

Cutaneous silent period

RT:

Reflex threshold

NRS:

Numerical rating scale

WDR:

Wide dynamic range

DNIC:

Diffuse noxious inhibitory control

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Author notes

    Authors and Affiliations

    1. Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 40100, Latina, Italy

      Gaia Fragiotta, Francesca Cortese, Gianluca Coppola, Santo Mastroianni, Francesco Pierelli & Mariano Serrao

    2. Department of Neurophysiology of Vision and Neurophtalmology, G.B. Bietti Eye Foundation-IRCCS, Rome, Italy

      Gianluca Coppola

    3. Unit of Urology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy

      Antonio Carbone, Antonio Luigi Pastore & Giovanni Palleschi

    4. Fondazione Don Gnocchi, Milan, Italy

      Carmela Conte

    5. IRCCS Mediterranean Neurological Institute NEUROMED, Pozzilli (Isernia), Italy

      Armando Perrotta & Francesco Pierelli

    Authors
    1. Gaia Fragiotta
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    2. Francesca Cortese
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    3. Gianluca Coppola
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    4. Antonio Carbone
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    5. Antonio Luigi Pastore
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    6. Giovanni Palleschi
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    7. Santo Mastroianni
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    8. Carmela Conte
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    9. Armando Perrotta
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    10. Francesco Pierelli
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    11. Mariano Serrao
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    Correspondence to Mariano Serrao.

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    Authors declare no conflict of interest.

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    Gaia Fragiotta and Francesca Cortese have equally contributed to this work.

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    Fragiotta, G., Cortese, F., Coppola, G. et al. Effect of high level of bladder filling on spinal nociception and motoneuronal excitability. Exp Brain Res 233, 3459–3466 (2015). https://doi.org/10.1007/s00221-015-4416-4

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    • DOI: https://doi.org/10.1007/s00221-015-4416-4

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