Table Of ContentTopics in Anaesthesia and Critical Care
H.K.F. VAN SAENE, 1. SILVESTRI, M.A. DE LA CAL (EDs)
Infection Control in the Intensive Care Unit
1998,380 pp, ISBN 3-540-75043-6
J. MILIC-EMILI (ED)
Applied Physiology in Respiratory Mechanics
1998,246 pp,ISBN 3-540-75041-X
G. GUARNIERI, F. ISCRA (EDs)
Metabolism and Artificial Nutrition in the Critically III
1999,130 pp, ISBN 88-470-0042-4
J. MILIC -EMILI, U. LUCANGELO, A. PESENTI, W.A. ZIN (EDS)
Basics of Respiratory Mechanism and Artificial Ventilation
1999,268 pp,lSBN 88-470-0046-7
M. TIENGO, V.A. PALADIN I, N. RAWAL (EDs)
Regional Anaesthesia, Analgesia and Pain Management
1999,362 pp, ISBN 88-470-0044-0
1. SALVO, D. VlLlYASAGAR (EDs)
Anaesthesia and Intensive Care in Neonates and Children
1999,324 pp, ISBN 88-470-0043-2
G. BERLOT, H. DELOOZ, A. GULLO (EDs)
Trauma Operative Procedures
1999,210 pp, ISBN 88-470-0045-9
G.L. ArlEE, J.-L. VINCEKT (EDS)
Critical Care Cardiology in the Perioperative Period
2000,214 pp, ISBN 88-470-0133-1
M.A. TIENGO (ED)
Neuroscience: Focus on Acute and Chronic Pain
2000,214 pp, ISBN 88-470-0134-X
Anestesia e Medicina Critica
G. SLAVICH (ED)
Elettrocardiografia Clinica
1997,328 pp, ISBN 3-540-75050-9
G.L. AlATI, B. ALLARIA, G. BERLOT, A. GULLO, A. LUZZANI,
G. MARTINELLI, 1. TORELLI (EDS)
Anestesia e Malattie Concomitanti - Fisiopatologia e clinica del
periodo perioperatorio
1997,382 pp, [SBN 3-540-75048-7
B. AlLARIA, M.V. BALDASSARE, A. GULLO, A. LUZZANI,
G. MANANI, G. MARTINELLI, A. PASETTO, 1. TORELLI (EDs)
Farmacologia Generale e Speciale in Anestesiologia Clinica
1997,312 pp, ISBN 88-470-0001-7
A. GULLO (ED)
Anestesia Clinica
1998,506 pp, ISBN 88-470-0038-6
A. GULLO, 1. GATTINONI
Medicina Intensiva e Perioperatoria
2000,863 pp, ISBN 88-470-0135-8
Neuroscience: Focus on Acute and Chronic Pain
Springer
Milano
Berlin
Heidelberg
New York
Barcelona
Hong Kong
London
Paris
Singapore
Tokyo
M.A. Tiengo (Ed)
Neuroscience:
Focus on Acute and
Chronic Pain
Series edited by
Antonino Gullo
Springer
M.A. TIENGO, MD
Professor Emeritus of Physiopathology and Pain Therapy
State University of Milan, Italy
Series Topics in Anaesthesia and Critical Care edited by
A.GULLO,MD
Department of Clinical Science - Section of Anaesthesia,
Intensive Care and Pain Clinic
University of Trieste, Cattinara Hospital, Trieste, Italy
Springer-Verlag Italia
a member of BertelsmannSpringer Science+Business Media GmbH
© Springer-Verlag Italia, Milano 2001
ISBN-13: 978-88-470-0134-3 e-ISBN-13: 978-88-470-2258-4
DOl: 10.1007/978-88-470-2258-4
Library of Congress Cataloging-in-Publication Data: Applied for
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Preface
Probably no field of medicine has contributed as much to the understanding of
neuroscience as has the study of pain. This has been apparent since the publica-
tion of the first texts on pain, of which I cite only two of the most important. The
first text dates to 1914. Anoci-association by G.W. Crile and W.E. Lower was ded-
icated to the shock caused by surgical intervention; the authors described how
the deleterious effects of this form of shock could be reduced by protecting the
individual from pain through a series of analgesic medicines.
The second text is a classic surely known to everybody. It appeared many years
later, towards the end of the first half of the 1900s. Pain Mechanisms was written
by W.K. Livingston, a medical officer of the US Marines Reserve. Upon its publi-
cation in 1943, the publishing house Macmillan commented: "The tremendous
complexity of the problems related to pain and all sensory perceptions adds to
the difficulty of interpreting clinical observations, but at the same time adds to
its fascinations. Though physiological laboratories have made contributions of
fundamental importance [to the future of clinical medicine], '" the study of the
Central Nervous System [is] still a long way from the point at which [our knowl-
edge] can be used to explain such clinical states as causalgia or phantom limb
pain:' Those who read that stupendous book certainly remember that the clini-
cal section was preceded by one dealing with basic issues in four chapters: (1) the
anatomy of pain, (2) the cutaneous receptor and the concept of specificity, (3) the
physiology of pain, and (4) the psychology of pain. In a masterly way, this book
laid the foundation for the study of pain, and it is still valid today. In its bibliog-
raphy, the book cited the great neurophysiologists Adrian (professor of physiol-
ogy at Cambridge) and Sherrington (professor of physiology at Oxford), both
Nobel Prize recipients, and many other neuroanatomists, neurophysiologists and
psychologists who made fundamental contributions to the study of pain.
When Professor Antonino Gullo, my great friend and sedulous mentor of
APICE, proposed that I coordinate the session "Neuroscience: focus on acute and
chronic pain", I was more than honored: I was profoundly pleased. This volume
contains the presentations made in that session. The reader has only to browse the
table of contents to realize that the arguments discussed in this volume deal with
salient points which connect neuroscience with the clinical approaches to acute
and chronic pain syndromes. One also immediately notices that the individual
chapters have been written by scientists who are protagonists in these fields.
Some readers may not agree that issues related to the treatment of terminally
ill patients and to the ethics of such care are relevant in a neuroscience text. Let
VI Preface
us not forget that the study of the conscience occupies a central position in neu-
roscience today, and that it involves two "vertices of observation:' to borrow an
expression from Mauro Mancia. There is the neurobiological vertex that consid-
ers the basic conscience, or rather those functions such as wakefulness, attention,
perception, and memory. Associated with this consciousness is a psychological
and psychodynamic vertex, which encompasses the consciousness of superior
order and the consciousness of self in particular, and that also expresses values
of ethics.
My personal contribution to the volume is a commemorative presentation of
Camillo Golgi who, at the dawn of neuroscience, with his black reaction, was able
to visualize neuronal cells and circuits. This discovery then allowed Ramon y
Cajal to trace, for the first time, the neuronal routes of pain and touch with
admirable accuracy and precision.
I wish to thank all my colleagues who accepted the invitation to participate in
the compilation of this volume and who each offered a masterful scientific con-
tribution. I also thank Springer-Verlag for assuming this great editorial responsi-
bility.
Milan, November 2000 M.A. Tiengo
Honorary Member of
International Association
for the Study of Pain
(IASP)
Contents
Chapter 1 - Camillo Golgi: The Dawning of Neuroscience
M.A. Tiengo .......................................................................................................... .
Chapter 2 - Neurochemistry of Pain Circuits: Physiological versus
Pathological Pain
L. Calza .................................................................................................................. 9
Chapter 3 - First Affluent Neuron
G. Carli................................................................................................................... 19
Chapter 4 - The Involvement of the Brainstem Reticular Formation in Pain
Processing
C. Desbois, L. Monconduit, L. Villanueva .......................................................... 27
Chapter 5 - The Thalamus and Pain
M.L. Sotgiu ............................................................................................................ 37
Chapter 6 - Naloxone, but not Estradiol, Affects the Gonadectomy-Induced
Increase in Hippocampal Cholineacetyltransferase Activity in Male Rats
I. Ceccarelli, A. Scaramuzzino, A.M. Aloisi ........................................................ 43
Chapter 7 - Consciousness and Pain
C.R. Chapman, Y. Nakamura............................................................................... 51
Chapter 8 - Visceral Pain Mechanisms
M.A. Giamberardino, J. Vecchiet, G. Affaitati, L. Vecchiet................................ 59
Chapter 9 - PET-Scan and Electrophysiological Assessment
of Neuromodulation Procedures for Pain Control
L. Garda-Larrea, R. Peyron, F. Mauguiere, B. Laurent ..................................... 71
Chapter 10 - Acute Postoperative Pain Service Models
G. Galimberti, P. Di Marco, A. Conti................................................................... 87
VIII Contents
Chapter 11 - Postoperative Functional Pain Management
F. Nicosia ............................................................................................................... 99
Chapter 12 - Timing for Narcotic Drugs in Terminal Illness
S. Mercadante........................................................................................................ 105
Chapter 13 - Ethical Decisions in Terminal Illness
D. Kettler, M. Mohr ............................................................................................... III
Main Symbols ....................................................................................................... 119
Subject Index ........................................................................................................ 121
Contributors
Affaitati G.
Pathophysiology of Pain Laboratory,
Department of Medicine and Science of Aging "G. D' Annunzio",
University of Chieti, Italy
Aloisi A.M.
Institute of Human Physiology, University of Siena, Italy
Calza 1.
Department of Veterinary Morphophysiology and Animal Production,
(DIMORFIPA), University of Bologna, Italy
Carli G.
Institute of Human Physiology, University of Siena, Italy
Ceccarelli I.
Institute of Human Physiology, University of Siena, Italy
Chapman C.R.
Department of Anaesthesiology, University of Washigton, Seattle, USA
ContiA.
Department of Clinical Science - Section of Anaesthesia,
Intensive Care and Pain Clinic, University of Trieste, Cattinara Hospital, Italy
Desbois C.
INSERM, U-161, Paris, France
DiMarco P.
Department of Clinical Science - Section of Anaesthesia,
Intensive Care and Pain Clinic, University of Trieste, Cattinara Hospital, Italy
Galimberti G.
Department of Clinical Science - Section of Anaesthesia,
Intensive Care and Pain Clinic, University of Trieste, Cattinara Hospital, Italy
Garda-Larrea 1.
Functional Neurology Unit, UPRES-EA 1880,
Claude Bernard University, Lyon, and CERMEP, Lyon, France
(affiliated to the Institut Fecieratif de Neurosciences of Lyon)
