Microglia and Pain: A Manual Therapy Perspective: Part I

I am going to post, in digestible blogpost-sized chunks, a piece I've written for an ortho newsletter, which I'm pleased to report has been accepted by the editor for inclusion sometime in the fall.

MICROGLIA AND PAIN: A MANUAL THERAPY PERSPECTIVE




"The human nervous system is a hierarchy, culminating in the brain, of 100 billion or more neurons of 10,000 types, 1-10 trillion neuroglial cells, 100 trillion chemical synapses, 160,000 km of neuronal processes, thousands of neuronal clusters and fibers tracts, hundreds of functional regions, dozens of functional subsystems, 7 central regions, and 3 main divisions. All of these parts form a coherent, bodily pervasive, diversified, complex epithelium with interdependent connectivity of neurons, mostly neither sensory nor motor but anatomically and functionally intermediate. The key organizing principles of the system are centralization and integration. The nervous system performs two roles: regulation and initiation. In the first, it counteracts: responsively and homeostatically, gathering stimuli from outside and inside the body (including the brain), assessing their short-term and long-range significance, generating activity from faster breathing to stock trading, even to functional plasticity in learning or after brain damage. In the other, it acts: endogenously… replacing one state of neural activity with another, generating activity from doing nothing at all to creative thinking and extraordinary achievement... Although the divisions and regions of the nervous system are identical in all normally developed humans, their genetic specification and personal history are unique, as are the permutations and combinations of their unified function. Each human nervous system is unprecedented. The work of each… is unpredictable, ever-different, surprising, startling, at times horrifying, but not infrequently magnificent." - Jay B. Angevine, Nervous System Organization, Vol.3 of Encyclopedia of the Human Brain

Introduction

Learning about pain can take a manual therapist down strange new paths.

Were manual therapy a city, one would find oneself on a comfortably broad avenue that constitutes all the accumulated wisdom of manual therapy - one would see a large population of peers moving around, or camped along both sides of the street. One can live one’s whole life here, and never venture beyond the edge of town.

In a very short paper I want to take you not just past the edge of town, but way out into the country-side, some of it still wild frontier. I want to try to convey, as Jay Angevine’s quote above conveyed to me, a sense of the vastness of what we must begin to learn to map in our own minds, if we are to ever understand what it is we deal with every day of our lives as we confront pain in our patients. For pain certainly stems from processes within the system described above.


Glia are not all of a kind

From a neuroresearch perspective, the brain/CNS gets most of the attention; spinal cord and peripheral nerves are considered as tentacles out from it. The body itself (the 98% of our physicality that is non-neural, non-neuronal) is mostly ignored - it is not part of the nervous system - instead it viewed as that which is acted upon by the nervous system. This seems backwards to us, at first, but in time this perspective starts to make sense. (After awhile, from a pain standpoint, it is the only perspective that makes sense.)

What is in the brain? Neurons and glia – lots of glia, lots of blood vessels. Neurons, even at 100 billion strong, are outnumbered at least ten to one by various kinds of glia. Neurons are huge compared to glia. Because glia are much smaller, it takes many more of them to make up a good half of brain volume. And microglia are the smallest of all, equal in numbers to neurons.

Where do glia come from? They form from the same precursor cells as neurons do, for the most part. The origins of microglia, however, are still a bit murky. Conventional thought has them as being from the early embryonic hemopoietic system, invading the brain early on before the blood-brain barrier is properly in place, then kept at bay via chemically controlled conditions by the other glia, just waiting to “activate.” Other researchers (a minority) think that they come from the same precursor cells as neurons and the other glia. This debate is still not quite settled, but it is agreed that they function as the nervous system’s “immune system.”