Autonomic state in pain and correction

[Diane]

PULMONARY PLEXUSES

P 1307 Gray's:

PULMONARY PLEXUSES
These are anterior and posterior to the other hilar structures of the lungs, the anterior plexus being much smaller. According to Mizeres (1963) they are extensions from the cardiac plexus along the right and left pulmonary arteries. They are formed by vagal and sympathetic branches. Efferent parasympathetic fibres arise from the dorsal vagal nucleus; efferent sympathetic fibres are postganglionic branches of the second to fifth thoracic sympathetic ganglia.

The anterior plumonary plexus is formed by rami from vagal and cervical sympathetic cardiac nerves as well as direct branches from both sources; the posterior plumonary plexus is formed by the rami of vagal cardiac branches from the second to fifth or sixth thoracic sympathetic ganglia, the left plexus also receiving branches from the left recurrent laryngeal nerve. The two plexuses are interconnected; from them nerves enter the lung as networks along branches of the bronchi and pulmonary and bronchial vessels extending as far as the visceral pleura. There are small ganglia within the tracheobronchial tree of the airways with which efferent vagal preganglionic fibres synapse (Coburn 1987). They may act as sites of integration and/or modulation of the input from extrinsic nerves or permit some local control of aspects of airway function by local reflex mechanisms (Allen & Burnstock 1990). In the small intestine interstitial cells have been described in terminal autonomic networks, but have not been seen in thoracic organs, apart perhaps from the oesophagus (Dijkstra 1969). Efferent vagal fibres are bronchoconstrictor, secretomotor to bronchial glands and vasodilator. Efferent sympathetic fibres are bronchodilator and vasomotor.

Lest we forget, the lungs bud off the foregut in the embryo. The esophagus and the trachea are originally one tube, that separates into two.

[Diane]

COELIAC PLEXUS

COELIAC PLEXUS
The coeliac, the largest major autonomic plexus, sited at the level of the last thoracic and first lumbar vertebrae, is a dense network uniting two large coeliac ganglia. It surrounds the coeliac artery and the root of the superior mesenteric artery. It is posterior to the stomach and omental bursa, anterior to the crura of the diaphragm and the commencement of the abdominal aorta and between the suprarenal glands. The plexus and ganglia are joined by the greater and lesser splanchnic nerves of both sides and branches from both the vagus and phrenic nerves. They extend as numerous secondary plexuses along adjacent arteries.

The coeliac ganglia are irregular masses, one on each side, between the suprarenal gland and the coeliac trunk and in front of the crura; the right one is behind the inferior vena cava, the left behind the splenic vessels. The upper part of each is joined by a greater splanchnic nerve; the lower part, more or less detached as the [i]aroticorenal ganglion, receives the lesser splanchnic nerve and forms most of the renal plexus; its position is variable but near the origin of the renal artery from the aorta. (For details consult Norvell 1968). Secondary plexuses from or connected with the coeliac are: the phenic, splenic, hepatic, left gastric, intermesenteric, suprarenal, renal, testicular or ovarian, superior mesenteric and inferior mesenteric.

Phrenic plexus
This accompanies the inferior phrenic artery to the diaphragm, with branches to the suprenal gland. It arises near the upper end of the coeliac ganglion and is larger on the right. It receives one or two phrenic branches. At the junction of the right phrenic plexus with the phrenic nerve is a small phrenic ganglion, distributing branches to the inferior vena cava, suprarenal and hepatic plexuses.

Hepatic plexus
The largest coeliac derivative, this also receives filaments from the left and right vagi and right phrenic nerve. It accompanies the hepatic artery and portal vein and their branches into the liver, where its fibres are confined to the vicinity of the blood vessels. It follows all branches of the hepatic artery. Branches to the gallbladder form a thin cystic plexus; bile ducts are also supplied. Branches accompanying the right gastric artery supply the pylorus. From the gastroduodenal extension of the plexus branches reach the pylorus and the first part of the duodenum. Many follow the right gastro-epiploic artery to supply the right side of the stomach and the greater curvature. The superior pancreaticoduodenal extension of the plexus supplies the descending part of the duodenum, the pancreatic head and the lower part of the bile duct. The hepatic plexus contains afferent and efferent sympathetic and parasympathetic fibres; the vagal constituents are said to be motor to the musculature of the gallbladder and bile ducts and inhibitory to the sphincter of the bile duct. Petkov (1968) identified a distinct nerve to the sphincter in 23 out of 25 human dissections.

Left gastric plexus
This accompanies its artery along the lesser curvature of the stomach, joining with the vagal gastric branches. Gastric sympathetic nerves are motor to the pyloric sphincter but inhibitory to the gastric mural musculature.

Splenic plexus
This is formed by branches of the coeliac plexus, left coeliac ganglion and right vagus, and accompanies its artery to the spleen, giving off subsidiary plexuses along arterial branches. The fibres are mainly, perhaps wholly, sympathetic and terminate in blood vessels and non-striatred muscle of the splenic capsule and trabeculae.

Suprarenal plexus
This is formed by branches from the coeliac ganglion and plexus and greater splanchnic nerve. Relative to its size, the suprarenal gland has a larger autonomic supply than any other organ. Its fibres are commonly described as myelinated and preganglionic. In rats, however, non-myelinated fibres are ten times as numerous and are considered preganglionic; they end in synapses, often deeply invaginated, with large chromaffin cells, the phaeochromocytes, which are thus homologous with the postganglionic sympathetic neurons (p.1905). A space of 150-200 nm separates the synaptic membranes, which often have electron-dense zones. Small and large vesicles with electron-dense granular contents occur in these endings. Only non-myelinated fibres appear to innervate chomaffin cells, all of which are related to one or more such terminals. Multi-polar neurons also occur in the adrenal medulla; some preganglionic non-myelinated fibres form axodendritic synapses with them. The destination of their axons is not known (Coupland 1965a). A preponderance of non-myelinated fibres has also been described in the human suprarenal plexus (Coupland 1965a, b; Grottel 1968).

Renal plexus
This is dense and formed by rami from the coeliac ganglion and plexus, aorticaorenal ganglion, lowest thoracic splanchnic nerve, first lumbar splanchnic nerve and aortic plexus. Small ganglia occur in the renal plexus, the largest usually behind the start of the renal artery. The plexus continues into the kidney around the arterial branches to supply the vessels, renal glomeruli, and tubules, especially the cortical tubules (Norvell 1968). Renal nerves are mostly vasomotor. From the renal plexus branches supply ureteric and tesicular (or ovarian) plexuses. The ureteric plexus receives, in its upper part, branches from the renal and aortic plexuses, in its intermediate part from the superior hypogastric plexus and hypogastric nerve and in its lower part from the hypogastric nerve and inferior hypogastric plexus. This supply influences the inherent motility of the ureter.

Testicular plexus
This accompanies the testicular artery to the testis. Its upper part receives branches from the renal and aortic plexuses. Distally it is reinforced from the superior and inferior hypogastric plexuses. Its rami pass to the epididymis and ductus deferens.

Ovarian plexus
This accompanies the ovarian artery to the ovary and uterine tube. The upper part is formed by branches from the renal and aortic plexuses; its lower part is reinforced from the superior and inferior hypogastric plexuses.

The nerves in the testicular and ovarian plexuses contain efferent and afferent sympathetic fibres; the efferents are vasomotor and derived from the tenth and eleventh thoracic spinal segments; the parasympathtic fibres, from the inferior hypogastric plexuses, are probably vasodilator.

Superior mesenteric plexus
This is a downward continuation of the coeliac, which receives a branch from the junction of the right vagus and coeliac plexus. It accompanies the superor mestenteric artery into the mesentery, dividiung into secondary plexuses distributed to parts supplied by the artery: pancreatic, jejunal and ileal, ileocolic, right colic, and middle colic. The [i]superior mesenteric ganglion lies superior in the plexus, usually above the superior mesenteric artery's origin. Intestinal sympathetic nerves are motor to the ileocaecal sphincter but inhibitory to the mural musculature; some are vasoconstrictor.

Abdominal aortic plexus (intermesenteric plexus)
This is formed by branches from the coelic plexus and ganglia and receives rami from the first and second lumbar splanchnic nerves. It is on the sides and front of the aorta, between the origins of the superior and inferior mesenteric arteries. It consists of four to 12 intermesenteric nerves, connected by oblique branches. It is continuous above with the coeliac plexus and coeliac and aorticorenal ganglia, below with the superior hypogastric plexus. From it parts of testicular, inferior mesenteric, iliac, and superior hypogastric plexuses arise; it also supplies the inferior vena cava.

Inferior mesenteric plexus
This is chiefly from the aortic plexus but also from the second and lumbar splanchnic nerves. It surrounds the inferior mesenteric artery and is distributed along its branches; thus a left colic plexus supplies the left part of the transverse colon, the descending and the sigmoid colon; a superior rectal plexus supplies the rectum. Near the origin of the inferior mesenteric artery an inferior mesenteric ganglion may occur but more often small ganglia are scattered around the origin of the artery in the proximal part of the plexus. In one study (Southam 12959) an inferior mesenteric ganglion occurred in all of 22 human stillborn infants. The colic sympathetic nerves are inhibitory to mural muscle in the colon and rectum. Branches from parasympathetic pelvic splanchnic nerves ascend occasionally through but usually near the superior hypogastric and inferior mesenteric plexuses to supply the large intestine from the left half of the transverse colon to the rectum (p. 1786); they are motor to the colic musculature. It is to be emphasized that the parasympathetic supply to the distal colon is largely by these direct branches of the pelvic splanchnic nerves, not via the hypogastric and inferior mesenteric plexuses (Mitchell 1935; Woodburne 1956).

Next, superior and inferior hypogastric plexuses.

[Diane]

SUPERIOR HYPOGASTRIC PLEXUS

P. 1308 Gray's

SUPERIOR HYPOGASTRIC PLEXUS
The superior hypogastric plexus is anterior to the aortic bifurcation, the left common iliac vein, medial sacral vessels, fifth lumbar vertebral body and sacral promontory and between the common iliac arteries. Often termed the presacral nerve it is seldom a single nerve, and is prelumbar rather than presacral. It lies in extraperitoneal connective tissue; the parietal peritoneum can easily be stripped off its anterior aspect. It varies in breadth and condensation of its constituent nerves and is often a little to one side of the midline (more often to the left); the attachment of the sigmoid mesocolon, containing superior rectal vessels, is to the left of the lower part of the plexus. Scattered neurons occur in it. The plexus is formed by branches from the aortic plexus and third and fourth lumbar splanchnic nerves. It divides into right and left hypogastric 'nerves' which descend to the two inferior hypogastric plexuses. The superior plexus supplies branches to the ureteric, testicular, ovarian and common iliac plexuses. In addition to sympathetic fibres, it may also contain parasympathetic fibres (from pelvic splanchnic nerves) which descend from the inferior hypogastric plexus; but these fibres usually ascend to the left of the superior hypogastric plexus and across the sigmoid branches of left colic vesssels. These parasympathetic fibres are distributed partly along the inferior mesenteric arterial branches and also as independent retroperitoneal nerves to supply the left part of the transverse colon, left colic flexure, descending and sigmoid colon.

I found a nice visual for the autonomics. There is a click in the upper right to change views, but it only works in reverse, so start of page 12 and work backwards.

Enjoy.

I'm back in this post to announce that I found a small author error in the link I've placed here. On page 2 of 12, the author says (about visceral afferents) "These fibres, originating within the spinal cord, accompany visceral efferent fibres throughout their pathways." I'm here to say, that visceral afferent fibres do NOT originate within the spinal cord; rather they are from neural crest and therefore are more likely to "originate" as part of DRGs, same as all the rest of the sensory system. Only motor fibres originate in the cord. At least that's how I understand origins based on embryology.

[Diane]

INFERIOR HYPOGASTRIC PLEXUSES

P 1309, Gray's

INFERIOR HYPOGASTRIC PLEXUSES
The superior hypogastric plexus divides caudally into right asnd left hypogastric 'nerves', each descending in extraperitoneal connective tissue into the pelvis, medial to each internal iliac artery and its branches to become the inferior hypogastric plexus. Each nerve may be single or an elongated plexus of anastomosing filaments. (Hypogastric nerves can scarcely be distinguished from their continuations, the inferior hypogastric plexuses. The latter are joined by pelvic splanchnic nerves, a distinction minimized by the fact that both nerves and plexuses contain sympathetic and parasympathetic fibres. Some authorities prefer to describe a superior hypogastric plexus dividing into two inferior plexuses.) From each hypogastric nerve branches may pass to the testicular, ovarian and ureteric plexus or to the internal iliac plexuses and to the sigmoid colon; each nerve may be joined initially by the lowest lumbar splanchnic nerve from last lumbar sympathetic ganglion.

Inferior hypogastric (pelvic) plexus
This is in the extraperitoneal connective tissue. In males it is lateral to: the rectum, seminal vesicle, prostate and the posterior part of the urinary bladder. In females each plexus is lateral to: the rectum, uterine cervix, vaginal fornix and the posterior party of the urinary bladder, extending into the broad uterine ligament. Lateral to it are the internal iliac vessels and their branches and tributaries, the levator ani, coccygeus and obturator internus. Posterior are the sacral and coccygeal plexuses and above are the superior vesical and obliterated umbilical arteries. The plexuses contain numerous small ganglia. Each is formed by a hypogastric nerve, conveying most of the sympathetic fibres of the plexus, the remaining few arriving via branches from the ganglia. Parasympathetic fibres are derived from pelvic splanchic nerves. Preganglionic efferent sympathetic fibres originate in the lower three thoracic and upper two lumbar spinal segments, some relaying in ganglia of the lumbar and sacral parts of the sympathetic trunk, others synapsing in the lower part of the aortic plexus and in the superior and inferior hypogastric plexuses. Preganglionic parasympathetic fibres originate in the second to fourth sacral spinal segments, reach the plexus in the pelvic splanchic nerves and synapse in it or in walls of viscera supplied by its branches. Numerous branches are distributed to the pelvic and some abdominal viscera, either directly or along their arteries.

Parasympathetic fibres ascend in the hypogastric plexuses or as separate filaments to reach the inferior mesenteric plexus by way of the aortic plexus. By this route the descending and sigmoid parts of the colon recieve parasympathetic innervation.

Middle rectal plexus
This is formed by fibres from the upper part of the inferior hypogastric plexus to the rectum passing directly or along the middle rectal artery. It connects above with the superior rectal plexus and extends below to the internal anal sphincter. The rectal and anal nerve supply is from:

• The superior rectal plexus

• the middle rectal plexus

• the inferior rectal (haemorrhoidal) nerves, branches of the pudendal nerve.

The parasympathetic preganglionic fibres from the rectal plexuses synapse with postganglionic neurons in the well-developed myenteric plexus, while sympathetic afferents pass through it without interruption. Efferent sympathetic fibres in the rectal plexuses inhibit the explusive musculature and stimulate the sphincter. Pain impulses traverse the sympathetic and parasympathetic fibres but the parasympathetic afferent and efferent fibres are more active in normal defaecation. Inferior rectal nerves supply motor fibres to the striated external anal sphincter and sensory (somatic) fibres to the lower (ectodermal) part of the anal canal (p. 194).

Vesical plexus
Coming from the anterior part of the inferior hypogastric plexus, this comprises many filaments which pass along vesical arteries to the bladder. Branches supply the seminal vesicles and deferent ducts. Many small groups of neurons exist among the nerve fibres in the vesical muscular wall. Sympathetic preganglionic fibres in the plexus are from the lower two thoracic and upper two lumbar spinal segments, synapsing with neurons scattered in the superior and inferior hypogastric plexuses and vesical wall. The parasympathetic preganglionic efferent fibres come from the second to fourth sacral spinal segments and synapse near or in the vesical wall with postganglionic neurons which stimulate its detrusor muscle and inhibit its sphincter. Efferent sympathetic nerves are motor to the sphincter and inhibitor to the detrusor muscle; but some maintain that they are mainly vasomotor and that vesical filling and emptying are controlled by parasympathetic nerves.

Prostatic plexus
Continued from the lower part of the inferior hypogastric plexus, this is composed of large nerves entering the base and sides of the prostate and contains neurons. It supplies: the prostate, seminal vesicles, prostatic urethra, ejaculatory ducts, corpora cavernosa, corpus spongiosum, membranous and penile urethra and bulbo-urethral glands. The nerves to the corporea cavernosa form two sets, the greater and lesser cavernous nerves, arising from the front of the plexus to join branches from the pudendal nerve and then passing below the pubic arch. The precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa has been described by Lepor et al (1985) in the adult male pelvis. Lesser cavernous nerves pierce the fibrous penile sheath proximally to supply the erectile tissue of the corpus spongiosum and penile urethra. Greater cavernous nerves proceed on the dorsum penis, connect with the dorsal nerve and supply the erectile tissue, some filaments reaching the erectile tissue of the corpus spongiosum. Sympathetic supplies to the male genital organs produce vasoconstriction, the parasympathetic being vasodilator. Seminal vesicles are supplied from the vesical and prostatic plexuses and inferior hypogastric nerves; extensions pass to the ejaculatory and deferent ducts. Contraction of the seminal vesicles and ejaculation are considered to be due to the sympathetic supply, which also inhibits the vesical musculature and stimulates the sphincter during ejaculation, preventing reflux into the bladder. Others have suggested that contraction of the seminal vesicles is under parasympathetic control (Matthews & Raisman 1969).

Uterovaginal plexus
Uterine nerves arise from the inferior hypogastric plexus, mainly the part in the broad ligament, the utrovaginal plexus, from which branches descend with the vaginal arteries, while others pass directly to the cervix uteri or ascend with or near uterine arteries in the broad ligament. Nerves to the cervix form a plexus in which are small paracervical ganglia, one ganglion sometimes being larger and termed the utrerine cervical ganglion. Nerves ascending with the uterine arteries supply the uterine body and tube, connecting with tubal nerves from the inferior hypogastric plexus and with the ovarian plexus. The uterine nerves ramify in the myometrium and endometrium, generally accompanying the vessels. Efferent preganglionic sympathetic fibres are from the last thoracic and first lumbar spinal segments; the sites of their postganglionic neurons are unknown.Preganglionic parasympathetic fibres arise in the second to fourth sacral segments and relay in the paracervical ganglia. Sympathetic activity may produce uterine contraction and vasoconstriction and parasympathetic activity may produce uterine inhibition and vasodilation, but these activities are complicated by hormonal control of uterine functions.

Vaginal nerves from the lower parts of the inferior hypogastric and uterovaginal plexuses follow the vaginal arteries to supply the vaginal walls, the erectile tissue of the vestibular bulbs and clitoris (canvernous nerves of the clitoris), the urethra and the greater vestibular glands. The nerves contain many parsympathetic fibres which are vasodilator to the erectile tissue.

That's all there is in this section from Gray's. There is a section on enterics which I'm omitting.

I'll slowly bring more here from Burnstock's books, etc. Plese feel free to add material or links you might find on autonomics to this thread.

[Diane]

This Janig book

My copy of The Integrative Action of the Autonomic Nervous System: Neurobiology of Homeostasis by Wilfred Jänig, arrived yesterday. It's nearly brand new, only published this past June. Also quite reasonable as textbooks go, well under $200.

Chapter 4 alone is worth the price. It is titled The Peripheral Sympathetic and Parasympathetic Pathways, and contains 8 "sub"chapters, listed here:

• 4.1 Sympathetic vasoconstrictor pathways
• 4.2 Sympathetic non-vasoconstrictor pathways innervating somatic tissues
• 4.3 Sympathetic non-vasoconstrictor neurons innervating pelvic viscera and colon
• 4.4 Other types of sympathetic neuron
• 4.5 Adrenal medulla
• 4.6 Sympathetic neurons innervating the immune tissue
• 4.7 Proportions of preganglionic neurons in major sympathetic nerves
• 4.8 Parasympathetic systems

I have only browsed so far, but already I'm liking this book more than the Burnstock series on the ANS.. Burnstock simply provided within the covers of each of his books a bunch of already published studies. As an editor he did no editing at all, just collecting and re-publishing. And each book in the series (about a dozen books) cost as least as much as this one.

Janig takes the time to actually sit and synthesize everything. He does not predigest it at all but puts it through his mental blender a bit first, at least. And he's very careful to keep his own speculations separate from what's "known", plus at the end he has a very comprehensive list of what is not yet known.

I think I can trust this book. And as a humble human primate social groomer I very much appreciate that he's done some of the mental map making for me. :thumbs_up

[Diane]

Here is a short excerpt from Jänig's book, based on this article:

Type 1 allostatic overload occurs when energy demand exceeds supply, resulting in activation of the emergency life history stage. This serves to direct the animal away from normal life history stages into a survival mode that decreases allostatic load and regains positive energy balance. The normal life cycle can be resumed when the perturbation passes. Type 2 allostatic overload begins when there is sufficient or even excess energy consumption accompanied by social conflict and other types of social dysfunction. The latter is the case in human society and certain situations affecting animals in captivity. In all cases, secretion of glucocorticosteroids and activity of other mediators of allostasis such as the autonomic nervous system, CNS neurotransmitters, and inflammatory cytokines wax and wane with allostatic load. If allostatic load is chronically high, then pathologies develop. Type 2 allostatic overload does not trigger an escape response, and can only be counteracted through learning and changes in the social structure.

Not the distinction made between types of allostatic load.
1. Type one is stress induced by forces supplied directly from the environment. The creature is fully capable of pressing back as a living organism - responding powerfully, integrally, with the fullest of uninhibited responses.
2. Type two is stress induced by an environment that includes not only a metaphoric "rock" but also a "hard place". The creature has to be politically wise - it can't just rush to meet adversity with all its might, or run from it, instead it has to consider the "cost/benefit" of its response, and respond in some manner that costs personally/physiologically but won't rock the social fabric.

As a human primate social groomer, I think one of the biggest services I can provide is (a) a safe place in which patients can experience their own interoception and subsequent autonomic correction; and (b) some exteroceptively provided manual input to get (a) started.

Much more about this book can be read here.

[Raulan2]

Diane,

With all this vital wiring piercing the diaphgram I would be inclined to predict that the "green light" types delineated on Nick's mechanical peripheral NS deformation thread lately, who can't abdominally breath and whose spines seem so rigid would maybe be nonconsciously guarding/defending their sympathetic chains. I wonder if the postural restoration people have looked into sympathetic nervous system anatomy, reflected on it, allowed it to inform their thinking to any extent?

Yes, we have!!!
Gee what a surprise, This is the main topic of the postural respiration course. Yes we do consider and express mesurements in terms of mesoderm, but I have been trying to tell you all that we are considering the importance of respiration and its effects on "mesodermal posture (function)", but more importantly on the autonomic nervous system and how it influences all systems, including ganglia etc..

[Mary C]

Raulan2

I found your comment today as I was going through the old threads on ANS.

Some French posters keep mentioning Janig but never bring any quotes from his writings. Now I can see why he is so important. This is probably what was missing from the theory in Souchard's RPG. I have not found any mention of autonomics on the RP (Mezieres) site so far.

Mary

[caro]

Have been reading this one with great interest. An oldie but a goodie.