What Causes Chronic Pain

 
Interestingly, a pair of Canadian and English investigators speculated that such pain-suppressing pathways must exit when they devised a new "gate theory of pain" in the midsixties. Their idea was that when pain signals first reach the nervous system they excite activity in a group of small neurons that form a kind of pain "pool." When the total activity of these neurons reaches a certain minimal level, a hypothetical "gate" opens up that allows the pain signals to be sent to higher brain centers. But nearby neurons in contact with the pain cells can suppress activity in the pain pool so that the gate stays closed. The gate-closing cells include large neurons that are stimulated by nonpainful touching or pressing of your skin. The gate could also be closed from above, by brain cells activating a descending pathway to block pain.

The theory explained such everyday behavior as scratching a scab, or rubbing a appraised ankle: the scratching and rubbing excite just those nerve cells sensitive to touch and pressure that can suppress the pain pool cells. The scientists conjectured that brain-based pain control system were activated when people behaved heroically -- ignoring pain to finish a football game, or to help a more severely wounded soldier on the battlefield.

The gate theory aroused both interest and controversy when it was first announced. Most importantly, it stimulated research to find the conjectured pathways and mechanisms. Pain studies got an added boost when investigators made the surprising discovery that the brain itself produces chemicals that can control pain.

The landmark discovery of the pain-suppressing chemicals came about because scientist in Aberdeen, Scotland, and at the John Hopkins University Hospital in Baltimore were curious about how morphine and other opium-derived painkillers, or analgesics, work.

For some time neuroscientists had known that chemicals were important in conducting nerve signals (small bursts of electric current) from cell to cell. In order for the signal from one cell to reach the next in line, the first cell secretes a chemical "neurotransmitter" from the tip of a long fiber that extends from the cell body. The transmitter molecules cross the gap separating the two cells and attach to special receptor sites on the neighboring cell surface. Some neurotransmitters excite the second cell -- allowing it to generate an electrical signal. Other inhibit the second cell -- preventing it from generating a signal.

When investigators in Scotland and at Johns Hopkins injected morphine into experimental animals, they found that the morphine molecules fitted snugly into receptors on certain brain and spinal cord neurons. Why, the scientist wondered, should the human brain -- the product of millions of years of evolution -- come equipped with receptors for a man-made drug? Perhaps there were naturally occurring brain chemicals that behaved exactly like morphine.

The Brain's Own Opiates

Both groups of scientists found not just one pain-suppressing chemical in the brain, but a whole family of such proteins. The Aberdeen investigators called the smaller members of the family enkephalins (meaning "in the head"). In time, the larger proteins were isolated and called endorphins, meaning the "morphine within." The term endorphins is now often used to describe the group as a whole.

The discovery of the endorphins lent weight to the general concept of the gate theory. Endorphins released from brain nerve cells might inhibit spinal cord pain cells through pathways descending from the brain to the spinal cord. Endorphins might also be activated when you rub or scratch your itching skin or aching joints. Laboratory experiments subsequently confirmed that painful stimulation led to the release of endorphins from nerve cells. Some of these chemicals then turned up in cerebrospinal fluid, the liquid that circulates in the spinal cord and brain. Laced with endorphins, the fluid could bring a soothing balm to quiet nerve cells.



The National Institute of Neurological Disorders and Stroke (NINDS) supports and conducts research on brain and nervous system disorders. NINDS is one of the 17 research institutes of the Federal Government's National Institutes of Health, an agency of the Public Health Service within the U.S. Department of Health and Human Services.

Neurological disorders, which number more than 600, strike an estimated 50 million Americans each year. By supporting and conducting neurological research, the NINDS seeks better understanding, diagnosis, treatment and prevention of these disorders. To achieve this goal, the institute relies on both clinical and basic research. Some key areas of NINDS research include AIDS, amyotrophic lateral sclerosis (ALS), Alzheimer's disease, developmental disorders, epilepsy, neurogenetic disorders, head and spinal cord injury, multiple sclerosis, pain, Parkinson's disease, sleep disorders, and stroke.

If you have a personal concern about neurological disorders, please consult with your healthcare provider. For more information on neurological disorders and stroke call the National Institute of Neurological Disorders and Stroke at 1-800-352-9424.

Reproduced with permission (1993-1997), The National Institute of Neurological Disorders and Stroke
Licensed to Medical Strategies, Inc. (MSI)


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