Zusammenfassung
Im Gegensatz zu Hautschmerz wird Muskelschmerz oft in Körperregionen weit entfernt von der Läsion übertragen. Ein Beispiel sind Triggerpunkte in den Halsmuskeln, die übertragene Schmerzen im Kopf auslösen können. Die Konvergenz-Projektions-Theorie von Ruch ist noch immer das zentrale Konzept für die Erklärung der Schmerzübertragung. Die Grundlage der Theorie ist der konvergente Antrieb eines Hinterhornneurons von zwei unterschiedlichen Versorgungsgebieten; diese Situation führt dazu, daß Neurone im Thalamus den Ursprung der Aktivierung nicht mehr lokalisieren können. Im Grunde genommen ist die Übertragung von Schmerzen nichts anderes als eine Fehllokalisation der Schmerzquelle. Die Konvergenz-Projektions-Theorie kann einige Aspekte der Schmerzübertragung bei Patienten nicht erklären; daher wird in der vorliegenden Arbeit ein weiterer Mechanismus vorgestellt, der in akuten Umschaltvorgängen in Hinterhornneuronen unter dem Einfluß eines Muskelschmerzes besteht. Ergebnisse aus Tierexperimenten deuten darauf hin, daß Hinterhornneurone ineffektive synaptische Verbindungen mit der Körperperipherie besitzen, die bei Einwirkung von Schmerzreizen durchgeschaltet werden und zu einer Fehllokalisation von Schmerzreizen führen. Wahrscheinlich ist das Neuropeptid Substanz P an den Veränderungen der Hinterhornverschaltung bei Muskelschmerz und Übertragung beteiligt.
Abstract
In contrast to pain from the skin, muscle pain is often referred to regions remote from the lesion. For instance, trigger points in neck muscles can elicit pain in the head. The convergence-projection theory of Ruch is still the central concept for the explanation of pain referral. The basis of the theory is that a dorsal horn neuron has convergent input from two different body regions. Because of the convergence, thalamic neurons cannot localize the origin of the dorsal horn activation. Basically, the referral of pain is a mislocalization of pain. Some aspects of muscle pain referral in patients cannot be explained by the convergence-projection theory. Therefore, the present paper presents another mechanism, which consists in acute changes in dorsal horn synaptic connections following nociceptive input from muscle. Results from animal experiments indicate that dorsal horn neurons possess ineffective synaptic connections with the body periphery, which become effective under the influence of a painful stimulus and lead to a mislocalization of pain. The neuropeptide substance P is probably involved in the changes in functional organization that occur in the dorsal horn during muscle pain and its referral.
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Herrn Professor Dr. M. Zimmermann zum 60. Geburtstag gewidmet.
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Mense, S. Neurobiologische Mechanismen der Übertragung von Muskelschmerz. Schmerz 7, 241–249 (1993). https://doi.org/10.1007/BF02529860
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DOI: https://doi.org/10.1007/BF02529860