Zusammenfassung
Fragestellung
Lässt sich Muskelschmerz eindeutig aufgrund objektiver (neurobiologischer) Unterschiede vom Hautschmerz abgrenzen?
Methodik
Die Ergebnisse stammen teils aus Experimenten an narkotisierten Ratten, teils aus Untersuchungen an Versuchspersonen oder Patienten mit chronischen Muskelschmerzen.
Ergebnisse
Auf praktisch allen Ebenen des Schmerzweges (angesprochen werden Rückenmark, Kortex, deszendierende schmerzhemmende Bahnen) bestehen deutliche Unterschiede in der Verschaltung oder Verarbeitung der nozizeptiven Information vom Muskel gegenüber der Haut.
Schlussfolgerungen
Wegen der grundlegenden Unterschiede zwischen der Neuroanatomie und den Mechanismen des Muskel- und Hautschmerzes dürfen Ergebnisse aus Untersuchungen des Hautschmerzes nicht ohne weiteres auf den Muskelschmerz übertragen werden. In Zukunft sollten in stärkerem Ausmaß als bisher Medikamente speziell für die Behandlung von Muskelschmerzen entwickelt werden.
Abstract
Background
The bulk of available knowledge about pain mechanisms is derived from studies on cutaneous pain. However, deep somatic pain (from muscle, fascia, tendon, joint) is clinically of much greater importance. The existing subjective differences between muscle and skin pain (e.g. muscle pain is poorly localized and shows referral) suggest that muscle and skin pain do not share the same mechanisms.
Aims of the study
To answer the question if the nociceptive information from muscle has neuroanatomical connections and mechanisms that are distinct from those of cutaneous nociception.
Materials and methods
The results were obtained partly in animal experiments on anaesthetised rats, partly in studies with healthy subjects or fibromyalgia patients.
Results
1. At the spinal level, the excitatory effects of unmyelinated afferent fibres from muscle are subject to a strong segmental inhibition by myelinated afferent fibres, which is largely absent in the effects of cutaneous C fibres. 2. At the cortical level, experimental muscle pain excites other regions than does cutaneous pain. 3. At the level of descending pain-modulating pathways, interruption of the activity in these pathways leads to higher activity of nociceptive neurones caudal to the site of interruption. The activity was higer in neurones with input from deep nociceptors than in cells mediating cutaneous nociception.
Conclusions
The data demonstrate that at all central nervous levels the connections and processing of nociceptive information from muscle and skin are different. The findings regarding descending pain-modulating pathways suggest that a dysfunction of this system could lead to chronic deep pain as in fibromyalgia.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Akopian AN, Sivilotti L, Wood JN (1996) A tetrodotoxin-resistant voltage-gated sodium channel expressed by sensory neurons. Nature 379:257
Basbaum AI, Fields, HL (1984) Endogenous pain control systems: Brainstem spinal pathways and endorphin circuitry. Ann Rev Neurosci 7:309
Carli G., Suman AL, Biasi G, Marcolongo R (2002) Reactivity to superficial and deep stimuli in patients with chronic musculoskeletal pain. Pain 100:259
Curatolo M, Petersen-Felix S, Gerber A, Arendt-Nielsen L (2000) Remifentanil inhibits muscular more than cutaneous pain in humans. Br J Anaesth 85:1
Fields HL, Malick A, Burstein R (1995) Dorsal horn projection targets of ON and OFF cells in the rostral ventromedial medulla. J Neurophysiol 74:1742
Henriksson KG, Mense S (1994) Pain and nociception in fibromyalgia: clinical and neurobiological considerations on aetiology and pathogenesis. Pain Rev 1:245
Hoheisel U, Koch K, Mense, S (1994) Functional reorganization in the rat dorsal horn during an experimental myositis. Pain 59:111
Hoheisel U, Kaske A, Mense S (1998) Relationship between neuronal activity and substance P-immunoreactivity in the rat spinal cord during acute and persistent myositis. Neurosci Lett 257:21
Kosek E, Hansson P (1997) Modulatory influences on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain 70:41
Mense S (1997) Pathophysiologic basis of muscle pain syndromes. Phys Med Rehab Clin North Am 8:23
Mense S (1999) Neurobiologische Grundlagen von Muskelschmerz. Schmerz 13:3
Millan MJ (1999) The induction of pain: an integrative review. Prog Neurobiol 57:1
Molander C, Ygge J, Dalsgaard C-J (1987) Substance P-, somatostatin- and calcitonin gene-related peptide-like immunoreactivity and fluoride resistant acid phosphatase-activity in relation to retrogradely labeled cutaneous, muscular and visceral primary sensory neurons in the rat. Neurosci Lett 74:3
Steffens H, Eek B, Trudrung P, Mense S (2002) Tetrodotoxin block of A-fibre afferents from skin and muscle—a tool to study pure C-fibre effects in the spinal cord. Pflügers Arch, Eur J Physiol DOI 10.1007s00424–002–0970–2 (preliminary internet publication)
Svensson P, Minoshima S, Beydoun A, Morrow TJ, Casey KL (1997) Cerebral processing of acute skin and muscle pain in humans. J Neurophysiol 78:450
Travell JG, Simons DG (1992) Myofascial pain and dysfunction. The Trigger Point Manual, Vol. 2. The lower extremities. Williams and Wilkins, Baltimore London
Tuveson B, Lindblom U, Fruhstorfer H (2003) Experimental muscle pain provokes long-lasting alterations of thermal sensitivity in the referred pain area. Eur J Pain 7:73
Woolf CJ, Thompson SW (1991) The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 44:293
Yu X-M, Mense S (1990) Response properties and descending control of rat dorsal horn neurons with deep receptive fields. Neurosci 39:823
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mense, S. Was ist das Besondere am Muskelschmerz?. Schmerz 17, 459–463 (2003). https://doi.org/10.1007/s00482-003-0264-4
Issue Date:
DOI: https://doi.org/10.1007/s00482-003-0264-4