Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. ... more Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. Berkleye Toronto Hospital, Toronto, Canada Department of Psychology, McGill University and Royal Victoria Hospital, Montreal, H3A 1B1 Canada Faculty of Medicine, McGill University and Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Canada Department of Psychology, McGill University, Montreal, Canada Program in Neurosciences, Florida State University, Tallahassee, FL, USA
Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. ... more Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. Berkleye Toronto Hospital, Toronto, Canada Department of Psychology, McGill University and Royal Victoria Hospital, Montreal, H3A 1B1 Canada Faculty of Medicine, McGill University and Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Canada Department of Psychology, McGill University, Montreal, Canada Program in Neurosciences, Florida State University, Tallahassee, FL, USA
People with osteoarthritis (OA) can have significant pain that interferes with function and quali... more People with osteoarthritis (OA) can have significant pain that interferes with function and quality of life. Women with knee OA have greater pain and greater reductions in function and quality of life than men. In many cases, OA pain is directly related to sensitization and activation of nociceptors in the injured joint and correlates with the degree of joint effusion and synovial thickening. In some patients, however, the pain does not match the degree of injury and continues after removal of the nociceptors with a total joint replacement. Growth of new nociceptors, activation of nociceptors in the subchondral bone exposed after cartilage degradation, and nociceptors innervating synovium sensitized by inflammatory mediators could all augment the peripheral input to the central nervous system and result in pain. Enhanced central excitability and reduced central inhibition could lead to prolonged and enhanced pain that does not directly match the degree of injury. Psychosocial variab...
1. The uterus, cervix, and vaginal canal are innervated by afferent fibers in the hypogastric and... more 1. The uterus, cervix, and vaginal canal are innervated by afferent fibers in the hypogastric and pelvic nerves. Four studies compared the innervation territory and sensitivity to peripheral stimuli of the two sets of fibers in adult virgin rats. 2. Innervation territory was studied anatomically by injecting different fluorescent dyes into different parts of the reproductive, lower urinary, and lower digestive tracts and examining retrogradely labeled neurons in dorsal root ganglia. It was also studied electrophysiologically in anesthetized rats by summing potentials evoked in branches of the two nerves by electrical stimulation of different parts of the reproductive tract. 3. In both studies sensory innervation of the reproductive tract shifted from the pelvic to the hypogastric nerve (i.e., shifted entry into the spinal cord from the L6-S1 to the T13-L3 dorsal root ganglia, respectively) as the dye or stimulating electrode shifted from the vaginal entrance to the uterine horns, wi...
En la decada pasada se ha acumulado cierta evidencia sobre las diferencias de sexo y genero en el... more En la decada pasada se ha acumulado cierta evidencia sobre las diferencias de sexo y genero en el dolor y en su alivio. Estimaciones de prevalencia de la enfermedad, estudios epidemiologicos y la investigacion psicofisica continuan mostrando que el problema del dolor es mayor, mas variado y mas variable en las mujeres que en los hombres, y que los hombres pueden infravalorar el dolor. Ademas, algunas enfermedades dolorosas se expresan de forma diferente entre hombres y mujeres, y ciertos tratamientos (farmacos, somaticos o situacionales) tienen una mayor eficacia en un sexo que en el otro. Esta cada vez mas claro que los factores interactivos geneticos, fisiologicos, anatomicos, neurales, hormonales, psicologicos, de estilo de vida y socioculturales contribuyen a estas diferencias a lo largo de la vida de cada individuo. Aunque los gobiernos y las agencias de investigacion cientifica se han percatado de la importancia de las diferencias de sexo y genero no solo para la salud sino tambien para la economia sanitaria, las diferencias todavia no estan totalmente reconocidas por los sistemas sanitarios en todos los paises. Sin embargo, esta situacion esta mejorando rapidamente, ya que la inclusion de los terminos sexo y genero aumenta no solo en el ambito de la investigacion basica y clinica sino tambien en las historias clinicas de dolor, el desarrollo de farmacos y los ensayos clinicos.
hat indeed is the "significance" of viscerosomatic convergence? It is clear from the four comment... more hat indeed is the "significance" of viscerosomatic convergence? It is clear from the four commentaries (and the comments of four anonymous reviewers) that there are multiple potential and compatible answers to this satisfyingly challenging question. SPECIFICITY OF FUNCTIONAL ORGANIZATION Albe-Fessard reviews substantive classical neurophysiological data, much of it preceding Chernigovskiy's 1967 review book. 8 She concludes that a greater degree of specific functional organization exists among the several somatic pathways that concomitantly code visceral and somatic information than was implied in the focus article. Cervero reviews much of his own, more recent, seminal data to conclude nearly the same thing, although he argues for even more specificity than does Albe-Fessard. Two anonymous reviewers made similar statements. It is undeniable that viscerosomatic convergence is more selective than random or universal. Not all neurons responsive to somatic stimuli are found to be responsive to visceral stimuli, and vice versa. Like Cervero and others studying neurons in the spinal cord, Gis~le Guilbaud and 14 saw this kind of specificity in neuronal responsiveness when we recorded responses of neurons to reproductive organ and somatic stimuli in different parts of the thalamus in and near the ventrobasal complex of female rats. Ventrobasal complex somatic-responsive neurons were less likely to respond to our pelvic visceral stimuli than were neurons surrounding the ventrobasal complex.
Young female athletes experience a higher incidence of ligament injuries than their male counterp... more Young female athletes experience a higher incidence of ligament injuries than their male counterparts, females experience a higher incidence of joint hypermobility syndrome (a risk factor for osteoarthritis development), and post-menopausal females experience a higher prevalence of osteoarthritis than age-matched males. These observations indicate that fluctuating sex hormone levels in young females and loss of ovarian sex hormone production due to menopause likely contribute to observed sex differences in knee joint function and risk for loss of function. In studies of osteoarthritis, however, there is a general lack of appreciation for the heterogeneity of hormonal control in both women and men. Progress in this field is limited by the relatively few preclinical osteoarthritis models, and that most of the work with established models uses only male animals. To elucidate sex differences in osteoarthritis, it is important to examine sex hormone mechanisms in cells from knee tissues ...
The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compare... more The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and obesity on sex differences in knee OA. Observational data suggest that limb alignment can predict the development of radiographic signs of knee OA, potentially due to increased stresses and strains within the joint. However, these data do not indicate how limb alignment could contribute to sex differences in either the development or worsening of knee OA. Similarly, the strength of the knee extensor muscles is compromised in women who develop radiographic and symptomatic signs of knee OA, but the extent to which the decline in muscle function precedes the development of the disease is uncertain. Even less is known about how changes in muscle function might contribute to the worsening of knee OA. Conversely, obesity is a stronger predictor of developing knee OA symptoms in women than in men. The influence of obesity on developing knee OA symptoms is not associated with deviation in limb alignment, but BMI predicts the worsening of the symptoms only in individuals with neutral and valgus (knockkneed) knees. It is more likely, however, that obesity modulates OA through a combination of systemic effects, particularly an increase in inflammatory cytokines, and mechanical factors within the joint. The absence of strong associations of these surrogate measures of the mechanical environment in the knee joint with sex differences in the development and progression of knee OA suggests that a more multifactorial and integrative approach in the study of this disease is needed. We identify gaps in knowledge related to mechanical influences on the sex differences in knee OA.
Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. ... more Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. Berkleye Toronto Hospital, Toronto, Canada Department of Psychology, McGill University and Royal Victoria Hospital, Montreal, H3A 1B1 Canada Faculty of Medicine, McGill University and Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Canada Department of Psychology, McGill University, Montreal, Canada Program in Neurosciences, Florida State University, Tallahassee, FL, USA
Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. ... more Marta Meanaa,1*, Yitzchak M. Binikb, Samir Khaliféc, Sophie Bergeron d, Kelly Pagidasc, Karen J. Berkleye Toronto Hospital, Toronto, Canada Department of Psychology, McGill University and Royal Victoria Hospital, Montreal, H3A 1B1 Canada Faculty of Medicine, McGill University and Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Canada Department of Psychology, McGill University, Montreal, Canada Program in Neurosciences, Florida State University, Tallahassee, FL, USA
People with osteoarthritis (OA) can have significant pain that interferes with function and quali... more People with osteoarthritis (OA) can have significant pain that interferes with function and quality of life. Women with knee OA have greater pain and greater reductions in function and quality of life than men. In many cases, OA pain is directly related to sensitization and activation of nociceptors in the injured joint and correlates with the degree of joint effusion and synovial thickening. In some patients, however, the pain does not match the degree of injury and continues after removal of the nociceptors with a total joint replacement. Growth of new nociceptors, activation of nociceptors in the subchondral bone exposed after cartilage degradation, and nociceptors innervating synovium sensitized by inflammatory mediators could all augment the peripheral input to the central nervous system and result in pain. Enhanced central excitability and reduced central inhibition could lead to prolonged and enhanced pain that does not directly match the degree of injury. Psychosocial variab...
1. The uterus, cervix, and vaginal canal are innervated by afferent fibers in the hypogastric and... more 1. The uterus, cervix, and vaginal canal are innervated by afferent fibers in the hypogastric and pelvic nerves. Four studies compared the innervation territory and sensitivity to peripheral stimuli of the two sets of fibers in adult virgin rats. 2. Innervation territory was studied anatomically by injecting different fluorescent dyes into different parts of the reproductive, lower urinary, and lower digestive tracts and examining retrogradely labeled neurons in dorsal root ganglia. It was also studied electrophysiologically in anesthetized rats by summing potentials evoked in branches of the two nerves by electrical stimulation of different parts of the reproductive tract. 3. In both studies sensory innervation of the reproductive tract shifted from the pelvic to the hypogastric nerve (i.e., shifted entry into the spinal cord from the L6-S1 to the T13-L3 dorsal root ganglia, respectively) as the dye or stimulating electrode shifted from the vaginal entrance to the uterine horns, wi...
En la decada pasada se ha acumulado cierta evidencia sobre las diferencias de sexo y genero en el... more En la decada pasada se ha acumulado cierta evidencia sobre las diferencias de sexo y genero en el dolor y en su alivio. Estimaciones de prevalencia de la enfermedad, estudios epidemiologicos y la investigacion psicofisica continuan mostrando que el problema del dolor es mayor, mas variado y mas variable en las mujeres que en los hombres, y que los hombres pueden infravalorar el dolor. Ademas, algunas enfermedades dolorosas se expresan de forma diferente entre hombres y mujeres, y ciertos tratamientos (farmacos, somaticos o situacionales) tienen una mayor eficacia en un sexo que en el otro. Esta cada vez mas claro que los factores interactivos geneticos, fisiologicos, anatomicos, neurales, hormonales, psicologicos, de estilo de vida y socioculturales contribuyen a estas diferencias a lo largo de la vida de cada individuo. Aunque los gobiernos y las agencias de investigacion cientifica se han percatado de la importancia de las diferencias de sexo y genero no solo para la salud sino tambien para la economia sanitaria, las diferencias todavia no estan totalmente reconocidas por los sistemas sanitarios en todos los paises. Sin embargo, esta situacion esta mejorando rapidamente, ya que la inclusion de los terminos sexo y genero aumenta no solo en el ambito de la investigacion basica y clinica sino tambien en las historias clinicas de dolor, el desarrollo de farmacos y los ensayos clinicos.
hat indeed is the "significance" of viscerosomatic convergence? It is clear from the four comment... more hat indeed is the "significance" of viscerosomatic convergence? It is clear from the four commentaries (and the comments of four anonymous reviewers) that there are multiple potential and compatible answers to this satisfyingly challenging question. SPECIFICITY OF FUNCTIONAL ORGANIZATION Albe-Fessard reviews substantive classical neurophysiological data, much of it preceding Chernigovskiy's 1967 review book. 8 She concludes that a greater degree of specific functional organization exists among the several somatic pathways that concomitantly code visceral and somatic information than was implied in the focus article. Cervero reviews much of his own, more recent, seminal data to conclude nearly the same thing, although he argues for even more specificity than does Albe-Fessard. Two anonymous reviewers made similar statements. It is undeniable that viscerosomatic convergence is more selective than random or universal. Not all neurons responsive to somatic stimuli are found to be responsive to visceral stimuli, and vice versa. Like Cervero and others studying neurons in the spinal cord, Gis~le Guilbaud and 14 saw this kind of specificity in neuronal responsiveness when we recorded responses of neurons to reproductive organ and somatic stimuli in different parts of the thalamus in and near the ventrobasal complex of female rats. Ventrobasal complex somatic-responsive neurons were less likely to respond to our pelvic visceral stimuli than were neurons surrounding the ventrobasal complex.
Young female athletes experience a higher incidence of ligament injuries than their male counterp... more Young female athletes experience a higher incidence of ligament injuries than their male counterparts, females experience a higher incidence of joint hypermobility syndrome (a risk factor for osteoarthritis development), and post-menopausal females experience a higher prevalence of osteoarthritis than age-matched males. These observations indicate that fluctuating sex hormone levels in young females and loss of ovarian sex hormone production due to menopause likely contribute to observed sex differences in knee joint function and risk for loss of function. In studies of osteoarthritis, however, there is a general lack of appreciation for the heterogeneity of hormonal control in both women and men. Progress in this field is limited by the relatively few preclinical osteoarthritis models, and that most of the work with established models uses only male animals. To elucidate sex differences in osteoarthritis, it is important to examine sex hormone mechanisms in cells from knee tissues ...
The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compare... more The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and obesity on sex differences in knee OA. Observational data suggest that limb alignment can predict the development of radiographic signs of knee OA, potentially due to increased stresses and strains within the joint. However, these data do not indicate how limb alignment could contribute to sex differences in either the development or worsening of knee OA. Similarly, the strength of the knee extensor muscles is compromised in women who develop radiographic and symptomatic signs of knee OA, but the extent to which the decline in muscle function precedes the development of the disease is uncertain. Even less is known about how changes in muscle function might contribute to the worsening of knee OA. Conversely, obesity is a stronger predictor of developing knee OA symptoms in women than in men. The influence of obesity on developing knee OA symptoms is not associated with deviation in limb alignment, but BMI predicts the worsening of the symptoms only in individuals with neutral and valgus (knockkneed) knees. It is more likely, however, that obesity modulates OA through a combination of systemic effects, particularly an increase in inflammatory cytokines, and mechanical factors within the joint. The absence of strong associations of these surrogate measures of the mechanical environment in the knee joint with sex differences in the development and progression of knee OA suggests that a more multifactorial and integrative approach in the study of this disease is needed. We identify gaps in knowledge related to mechanical influences on the sex differences in knee OA.
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