Neural control of the lower urinary tract: Peripheral and spinal mechanisms
L. Birder, W. de Groat, I. Mills, J. Morrison, K. Thor, M. Drake
They reference a 2007 article discussed here:Based on recent improvements in understanding of pain processing pathways in the CNS, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception, a condition termed limbic associated pelvic pain has been proposed to explain the concurrence of these various chronic pain conditions. This limbic dysfunction is manifest both as an increased sensitivity to nociceptive afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, which undergoes tonic contraction as a result of limbic efferent stimulation, generating a further sensation of pain. The nociceptive afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle.
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