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Heat, Cold, and Pain

This page examines the detection of heat, cold, and pain.

Why pain? Because at least some of the receptors of heat and cold — when the stimulus exceeds a certain threshold — transmit signals that the brain interprets as pain.

The Receptors

Few, if any, of the receptors of heat, cold, and pain are specialized transducers (in the way that, for example, the Pacinian corpuscle is). Rather they are sensory neurons whose plasma membrane contains transmembrane proteins that are ion channels that open in response to particular stimuli. A single neuron may contain several types of these ion channels and thus be able to respond to several types of stimuli. Like all sensory spinal neurons, their axons travel to a dorsal root ganglion of the spinal cord, where their cell bodies reside, and then on in to the gray matter of the spinal cord. [View]

Three types of sensory neurons are found in the skin.

Heat

There are several types of ion channels in the skin that respond to temperature. They are all transmembrane proteins in the plasma membrane that open to let in both calcium ions and sodium ions (the latter the source of the action potential). Between them, they cover a range of temperatures.

Knockout mice lacking the TRPV1 receptor not only do not avoid water with capsaicin in it but have a diminished response to heat and to substances that normal elicit itching.

Birds also have TRPV1 receptors. Theirs also respond to heat (and acids), but do not respond to capsaicin. This must explain why birds happily eat hot chili peppers (and so disperse their seeds).

The vampire bat, Desmodus rotundus, expresses normal TRPV1 receptors in the sensory neurons leading to the dorsal root ganglia, and these respond normally to painful heat (> 43°C). However, these bats express a shortened version of TRPV1 (produced by alternative splicing) in their trigeminal nerves that run from the bat's upper lip and nose. The shortened receptors respond to a lower temperature (~30°C) enabling the bats to detect the warmth radiating from the skin of their victims.

Cold

Two candidate receptors:

Pain

When sensory nerve fibers are exposed to extremes, they signal pain. Pain receptors are also called nociceptors.

Processing Pathways

All the neurons in the skin are part of the sensory-somatic branch of the peripheral nervous system. Their axons pass into the dorsal root ganglion, where their cell body is located, and then on in to the gray matter of the spinal cord where they synapse with interneurons. [View]

Several different neurotransmitters have been implicated in pain pathways. Three of them:

Neuropathic Pain

This is pain caused by injury to the nerves themselves such as by mechanical damage, massive inflammation, and growing tumors.

Visceral Pain

The brain can also register pain from stimuli originating in sensory neurons of the autonomic nervous system. This so-called visceral pain is not felt in a discrete location as pain signals transmitted by the sensory-somatic system are.

Treating pain with drugs

The weapons presently available to reduce pain are many in number but few in types. They are

NSAIDs

Inflammation is caused by tissue damage and, among other things, causes pain. Damaged tissue releases prostaglandins and these are potent triggers of pain.

Prostaglandins are 20-carbon organic acids synthesized from unsaturated fatty acids.
Link to illustrated discussion.
There are at least three key enzymes that synthesize prostaglandins: Most NSAIDs block the action of all three cyclooxygenases. They include: Two NSAIDs were introduced in 1999 that selectively inhibit Cox-2 while leaving Cox-1 untouched. It was hoped that these would provide pain relief without the gastrointestinal side effects associated with the broad spectrum NSAIDs. However, the manufacturer of Vioxx® removed it from the market on 30 September 2004 because it increases the risk of heart attacks and strokes.

Acetaminophen (Tylenol®)

This is also a nonsteroidal anti-inflammatory drug but its mode of action is different from the others. It selectively inhibits Cox-3 and provides pain relief without irritating the stomach. It is particularly useful for

Opioids

Opioids are extremely effective pain killers but are also addictive so their use is surrounded by controversy and regulation.

Some examples: Opioids bind to receptors on interneurons in the pain pathways in the central nervous system. The natural ligands for these receptors are two enkephalins — each a pentapeptide (5 amino acids):

The two enkephalins are released at synapses on neurons involved in transmitting pain signals back to the brain. Instead of synapsing with a dendrite or cell body, the enkephalin synapse occurs close to the terminal of a pain-signaling neuron. The enkephalins hyperpolarize the presynaptic membrane thus inhibiting it from transmitting these pain signals.

The drawing shows how this mechanism might work. The activation of enkephalin synapses suppresses the release of the neurotransmitter (substance P) used by the sensory neurons involved in the perception of chronic and/or intense pain.

The ability to perceive pain is vital. However, faced with massive, chronic, intractable pain, it makes sense to have a system that decreases its own sensitivity. Enkephalin synapses provide this intrinsic pain-suppressing system.

Morphine and the other opioids bind these same receptors. This makes them excellent pain killers.

However, they are also highly addictive.

Prospects for future pain relievers

Research is progressing on coupling substance P to a cytotoxin.

The plan:
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3 June 2013