456 lines
20 KiB
XML
456 lines
20 KiB
XML
import Article from "@/components/Article";
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import { Metadata } from "next";
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export const metadata: Metadata = {
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title: "Article - Neural Biological Mechanisms | Dr. Feely",
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authors: [{ name: "Richard A. Feely, D.O., FAAO, FCA, FAAMA" }],
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description: `The goal of this article is to provide the clinician with
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information and knowledge of known biological mechanisms involved in somatic
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dysfunction.`,
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};
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const ArticleNeuralBiologicalMechanisms = () => {
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return (
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<Article
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title="Neural Biological Mechanisms"
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author="Richard A. Feely, D.O., FAAO, FCA, FAAMA"
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>
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<p>
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The goal of this article is to provide the clinician with information
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and knowledge of known biological mechanisms involved in somatic
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dysfunction.
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</p>
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<p>The reader will have the ability to describe:</p>
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<ul>
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<li>
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The neural endocrine-immune network and its relationship to somatic
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dysfunction
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</li>
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<li>How somatic dysfunction is endocrine-controlled and maintained</li>
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<li>
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Some of the known mechanisms of how somatic dysfunction is altered
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biomechanically, biochemically, and bioenergetically
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</li>
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</ul>
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<p>
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The human body is a complex interdependent relationship of structure,
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function, and mind. The body possesses complex homeostatic mechanisms
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that maintain equilibrium for self-regulation and self-healing. These
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homeostatic mechanisms represent an integrated network of messenger
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molecules produced by cells in neural, endocrine, and immune systems.
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Their signal coding and messenger molecules communicate through receptor
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complexes located on cell membranes. The critical role of the nervous
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system, especially the lymphatic, forebrain, and hypothalamus,
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influences the output of the endocrine and immune systems.
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</p>
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<h2>Traditionally, the Immune and Nervous Systems</h2>
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<p>
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Traditionally, the immune and nervous systems were considered separate
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and independent, each with its own cell types, cell functions, and
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intercellular regulators. Altered function in each system was related to
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the disease considered specific to that system. We now recognize not
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only the interdependence and interlocking molecular organization but
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also their extensive integration with the endocrine system. The
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conceptual separations between the neural endocrine immune system
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concerning structure, function, and communication have been discarded.
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In their stead is a combination of multiple dimensional network
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contributing to the functional unity of the body.
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</p>
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<p>
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Today, we recognize this multifactorial nature is a result of the
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following interactions of genetic, endocrine, nervous, immune, and
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behavioral-emotional systems. This complex bi-directional interaction
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occurs within the neural-endocrine-immune network. This network forms
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the prime defense against disease and is responsible for the resistance
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of infectious disease as well as cancer. The sensory information from
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external and internal sources is tightly integrated with cognitive and
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emotional processes which influence their neural endocrine immune
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network through the hypothalamic-pituitary-adrenal axis.
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</p>
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<h2>Messengers</h2>
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<p>
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The basis for communication in the neural-endocrine-immune system is the
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numerous messenger molecules that are released in the extracellular
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fluid. These signal codes are small peptides, glycoproteins, amines, and
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steroids. They express their activity through autocrine
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(self-stimulating), paracrine (stimulates local tissue), synaptic, and
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hormonal activity.
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</p>
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<h2>The Endocrine System</h2>
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<p>
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The endocrine system is described as using blood-borne messengers
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operating over long distances by humoral transport. The neural system is
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described as using chemical transmitters released into the neural
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synaptic cleft, separating the pre and post-synaptic specialized nerve
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cells. These common cellular mechanisms are bi-directional in
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communication. Their similar molecular structure of many of the
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messengers and the receptors are combined to transcend the traditional
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borders that separate the neural, endocrine, and immune systems over the
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years.
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</p>
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<p>
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Monitoring the concentration of many of these extracellular messengers.
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The central nervous system, particularly the limbic system and
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hypothalamus, directly modulates the activity of the autonomic nervous
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system and the endocrine systems. See The Network. Both of these systems
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have extensive communication with the immune systems, thereby regulating
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it under neural modulation as well. This combined action is
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multi-dimensional and creates a compensatory reserve that enables the
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body to mount an adaptive response to stressful conditions regardless of
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their origin whether somatic, visceral, or psychogenic.
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</p>
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<h2>Stimuli-Somatic</h2>
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<p>
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Somatic, visceral, and emotional stimuli act as drivers capable of
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influencing the activity via the hypothalamus, the spinal cord,
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pituitary, to the autonomic nervous system, endocrine system, and immune
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system, causing the general adaptive response. Noxious somatic stimuli
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initiate protective reflexes providing the central nervous system with
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warning signs. They influence the release of extracellular messengers
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from the endocrine immune access system just described.
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</p>
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<p>
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When activated by noxious stimuli such as rises from somatic
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dysfunction, small capillary primary afferent fibers called alpha-gam
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lambda and C-fibers, a-C-fibers or collectively referred to as (B
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afferent system) from peripheral nociceptor endings, release neural
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peptides such as substance P into the surrounding tissue thereby
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initiating neurogenic inflammation.
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</p>
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<p>
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The B afferent fibers systems represent a small subset of small
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capillary primary afferent fibers with high threshold for activation
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that are present in both somatic and visceral tissue. Central processes
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of these fibers stimulate cells in the dorsal horn of the spinal cord.
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Within the dorsal horn, the cells responding to the nociceptive input
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initiate signals carried to the motor nuclei of the ventral horn to
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alter the tonal muscles innervated by that particular spinal segment and
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through the anterior lateral tract of the spinal cord which communicates
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with the brain stem and the hypothalamus.
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</p>
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<p>
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A significant result of the nociceptive input is increased activity in
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the hypothalamic-pituitary-adrenal axis culminating in increased output
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of norepinephrine from the sympathetic nervous system. This reflex can
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be blocked by selectively eliminating the small capillary primary
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afferent fibers. Capsaicin reduces the level of substance P in the
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peripheral nervous system by destroying the small caliber primary
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afferent fibers. This diminishes the hypothalamic response and reduces
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the pituitary adrenal and autonomic responses to somatic stressors. The
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neural-endocrine-immune network is affected by the output of the signals
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from somatic dysfunction by initiating a compensatory shift in
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extracellular messengers that then alters the function of the immune
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system.
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</p>
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<p>
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Collins and Strauss found that modulation of the sympathetic nervous
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system plays an integral part in somatic pain and is a principal
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mechanism of acupuncture's action. The control of somatic sympathetic
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vasomotor activity before and after the placement of acupuncture needles
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resulted in pain relief by reducing sympathetic vasomotor activity.
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</p>
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<p>
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Nakamura, et al. found that afferent pathways of diskogenic low back
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pain are transmitted mainly by sympathetic afferent fibers in the L2
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nerve root and after needle injection, pain dissipated.
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</p>
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<h2>Stimuli-Visceral</h2>
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<p>
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The visceral factors in the cervical, thoracic, abdominal, and pelvic
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areas, as well as peripheral blood vessels, communicate with the brain
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stem and spinal cord through an extensive complement of afferent fibers
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also considered part of the B afferent system. The visceral afferent
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fibers reach their target organs by coursing in the same nerves as the
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efferent autonomic fibers. They follow the routes of the vascular
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system. The visceral sensory fibers, typically small caliber and having
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little or no myelin, have cell bodies located in the thoraco-lumbar
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dorsal root ganglia and in ganglia of several cranial nerves. These
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central processes, neurons, terminate in the superficial and deep
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regions of the dorsal horn of the spinal cord.
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</p>
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<p>
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Spinal trigeminal nucleus and solitary nucleus of the vagus. The
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thoraco-abdominal and pelvic organs have extensive sensory innervations.
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These afferent fibers travel to the central nervous system with efferent
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autonomic fibers. These sensory fibers traveling in the parasympathetic
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nerves such as the vagus carry non-noxious information for reflex
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control of the organ. Those traveling with the sympathetic nerves such
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as the greater splanchnic carry noxious information packets.
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</p>
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<p>
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The neurons of the deeper portions of the dorsal horn receive extensive
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convergence of information from the small caliber sensory axons arising
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in both visceral and somatic sources.
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</p>
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<p>
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A similar convergence of somatic and visceral input is seen in the
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solitary nucleus of the vagus. Neurons responsive to both visceral and
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somatic nociceptive stimuli are located in the spinal cord, brain stem,
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hypothalamus, and thalamus. These dual response neurons provide an
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explanation for the phenomenon of referred pain between visceral and
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somatic sources.
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</p>
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<h2>Stimuli-Emotional</h2>
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<p>
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The emotional factors of the human effecting the neural endocrine immune
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network arise largely from the limbic forebrain system and hypothalamus.
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The major components of the limbic forebrain include large portions of
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associated neocortex, which include the prefrontal area, the cingulate
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cortex, the insular cortex, and the inferior medial aspect of the
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temporal lobe. Hippocampal formation and the amygdala receive extensive
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connections from the frontal parietal and cingulate associational areas
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of the neocortex and in turn project to the hypothalamus from the fornix
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and striaterminalis, influencing the hypophyseotropic and hypothalamic
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nuclei.
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</p>
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<p>
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This limbic forebrain areas exert considerable influence over the
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pituitary gland as well as the autonomic nervous system affecting growth
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hormone, ACTH, prolactin, and somatostatin. The limbic system also
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increases the sympathetic output from the spinal cord. These alterations
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in the neural-endocrine activity affect the metabolic processes of the
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body, shifting peripheral tissue to a catabolic form of metabolism,
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leading to marked changes in the function of the immune system,
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including stress-induced suppression of immune function. These
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conditions characterize the general adaptive response in life.
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</p>
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<p>
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Highly stressful circumstances in life significantly alter the status of
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the immune system. This can include the death of a loved one, caring for
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a family member with chronic progressive disease, summer vacation,
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change in lifestyle, divorce, new job, etc.
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</p>
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<p>
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The regulation of the neural-endocrine-immune network increases
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susceptibility to various disease states. Overproduction or
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underproduction of extracellular messages in response to either external
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or internal stimuli or as a secondary response to other
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disease-dysfunctional processes result in dysfunction of many aspects of
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the network. The aging process also alters the regulation of the network
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and is associated with various disease-dysfunctional states.
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</p>
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<p>
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Lundberg showed that psychosocial factors significantly associated with
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back pain and shoulder problems were related to psychophysiological
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stress levels, i.e., high psychophysiological stress levels and low work
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satisfaction.
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</p>
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<p>
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He also found that mental and physical stress was found to increase
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physiological stress levels and muscular tension and that mental stress
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is of importance for the development of musculoskeletal symptoms and
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pain. In addition, mental stress is not only induced by high demands but
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also by demands that are too low which happens in many repetitive and
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monotonous work situations. Interestingly enough, women are more prone
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than men to have somatic complaints with repetition and monotonous work.
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</p>
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<h2>The Network</h2>
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<p>
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<strong>SELECTED NEURAL REGULATORS</strong>
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</p>
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<ul>
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<li>Catecholamines: Dopamine, Norepinephrine</li>
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<li>Cholines: Acetylcholine</li>
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<li>Indolamines: Serotonin</li>
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<li>
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Peptides: Substance P, Neuropeptide Y, Calcitonin gene-related,
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Polypeptide, Enkaphalins, Endorphins, Neurotensin, Cholecystokinin,
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Angiotensin II, Vasoactive intestinal polypeptide, Bombesin,
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Adrenocorticotropin, Somatostatin, Corticotropin
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</li>
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<li>Amino Acids: Glutamate, Aspartate, GABA, Glycine</li>
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<li>Dynorphin, Histamine</li>
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<li>Purines: Adenosine</li>
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</ul>
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<h2>CELL TYPES OF THE IMMUNE SYSTEM</h2>
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<ul>
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<li>Thymocytes: Lymphoid Cells of the thymus</li>
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<li>
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T-Cells: Lymphoid cells that mature in the thymus & express the T-cell
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receptor (TCR)
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</li>
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<li>
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Helper T-Cells: Lymphoid cells responding to cell surface antigens by
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secreting cytokines
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</li>
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<li>
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Cytotoxic T-Cells: Lymphoid cells responding to the cell surface
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antigens by lysing cell producing the antigen
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</li>
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<li>
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B-Cells: Lymphoid cells that, when activated, are capable of producing
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immunoglobulins
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</li>
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<li>
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Natural Killer Cells: Lymphoid cells capable of killing tumor cells
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and virus/infected cells
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</li>
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<li>
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Neutrophils: Major Lymphoid cell of the acute inflammatory response
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and effector cells of humoral immunity
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</li>
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<li>
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Basophils: Effector cells of IgE-mediated immunity that secrete
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histamine granules in response to IgE activation
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</li>
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<li>
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Eosinophils: Lymphoid cells containing lysosomal granules that can
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destroy parasites
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</li>
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</ul>
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<h2>NON-LYMPHOID CELL TYPES</h2>
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<ul>
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<li>
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Fibroblast: Connective tissue cell capable of secreting and
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maintaining the collagenous fiber matrix
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</li>
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<li>
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Endothelial Cell: Squamous cell lining of the inner aspect of the
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vascular system
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</li>
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<li>
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Mesangial Cells: Specialized mesenchymal cells found in the renal
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glomerulus
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</li>
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<li>
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Chromaffin Cell: Neural peptides secreting cell found in the adrenal
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medulla
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</li>
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<li>
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Enterochromaffin Cell: Neural peptides secreting cell found in the
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lining of the gastrointestinal system
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</li>
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<li>
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Hepatocyte Liver Cell: Liver cell capable of secreting the acute phase
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proteins
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</li>
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<li>
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Endometrial Cell: Epithelial cell lining the inner surface of the
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uterus
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</li>
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<li>
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Astrocyte: Neuroglial cell found in the central nervous system
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involved in forming the blood-brain barrier
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</li>
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<li>
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Oligodendrocyte: Neuroglial cell forming myelin sheath around axons in
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the central nervous system
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</li>
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<li>
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Osteoblast: Specialized mesenchymal cells capable of secreting the
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osteomatrix for the formation of bones
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</li>
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<li>
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Osteophyte: Connective tissue cell found in bone representing a mature
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form of osteoblast
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</li>
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<li>
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Reticular Cell: Endodermal cell creating a three-dimensional network
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for lymphocytes in the thymus, spleen, and lymph nodes
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</li>
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</ul>
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<h2>IMMUNOREGULATORS</h2>
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<ul>
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<li>Interleukins 1-7</li>
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<li>Interferons alpha, beta, and gamma</li>
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<li>Tumor necrosis factor, beta</li>
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<li>Colony-stimulating factors:</li>
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<ul>
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<li>Granulocyte-stimulating factor</li>
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<li>Macrophage-stimulating factor</li>
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<li>Granulocyte macrophage-stimulating factor</li>
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<li>Interleukin III</li>
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<li>Leukemia inhibiting factor or neuroleukin</li>
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</ul>
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<li>Transforming factor, beta</li>
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</ul>
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<h2>
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ENDOCRINE SUBSTANCES KNOWN TO INTERACT WITH THE NEURAL AND IMMUNE
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SYSTEMS
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</h2>
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<ul>
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<li>Pituitary</li>
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<ul>
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<li>Adrenal Corticotrophin-ACTH</li>
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<li>Thyrotrophin-TSH</li>
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<li>Growth hormone releasing factor-GRH</li>
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<li>Somatostatin-SS-SS</li>
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<li>Prolactin</li>
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</ul>
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<li>Adrenal Medullary Hormones</li>
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<ul>
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<li>Epinephrine</li>
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<li>Norepinephrine</li>
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</ul>
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<li>Adrenal Cortical Hormones</li>
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<ul>
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<li>Cortisol</li>
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<li>Corticosterone</li>
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<li>Aldosterone</li>
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</ul>
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<li>Thyroid Hormones</li>
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<ul>
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<li>Thyroxine</li>
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<li>Triiodothyronine</li>
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</ul>
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<li>Growth Hormones</li>
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<ul>
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<li>Somatotropin</li>
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<li>Somatomammotropin</li>
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<li>Somatomedin</li>
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</ul>
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<li>Thymus</li>
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<ul>
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<li>Thymulin</li>
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<li>Thymosin</li>
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<li>Thymopoietin</li>
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<li>Thalmic factor X</li>
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</ul>
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<li>Others</li>
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<ul>
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<li>Estrogen</li>
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<li>Testosterone</li>
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<li>Insulin</li>
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</ul>
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</ul>
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<h2>References</h2>
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<ul>
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<li>
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Beal, Myron, D.O., FAAO, 1995-96 Yearbook, Osteopathic Vision,
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American Academy of Osteopathy, 1996.
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</li>
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<li>
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A.A. Buerger, Ph.D., Philip E. Greenman, D.O., Empirical Approaches to
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the Validation of Spinal Manipulation, 1985, published by Charles C.
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Thomas.
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</li>
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<li>
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D. Thomas Collins, S. Strauss, “Somatic Sympathetic Vasomotor Changes
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Documented by Medical Thermographic Imaging During Acupuncture
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Analgesia“, Clinical Rheumatology, 1992, 55-59.
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</li>
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<li>
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Richard G. Gillette, Ronald C. Kramis, William J. Roberts, ”
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Sympathetic activation of cat spinal neurons responsive to noxious
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stimulation of deep tissues in the low back“, Pain , 1994, 56, 31-42.
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</li>
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<li>
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Ulf Lundberg, ” Methods and application of stress research“,
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Technology and Health Care, 1995, 3-9.
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</li>
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<li>
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Shin-Ichiro Nakamura, Kazuhisa Takahasi, Yuzuru Takahashi, Masatsune
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Yamagata, Hideshige Moriya, ” The Afferent Pathways of Discogenic Low
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Back Pain“, Bone and Joint Surgery, 1996, July; 78/B, 606-612.
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</li>
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<li>
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Robert C. Ward, Foundations for Osteopathic Medicine, American
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Osteopathic Association, 1997; Williams & Wilkins
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</li>
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</ul>
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</Article>
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);
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};
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export default ArticleNeuralBiologicalMechanisms;
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