451
|
Chen B, He Y, Xia L, Guo LL, Zheng JL. Cortical plasticity between the pain and pain-free phases in patients with episodic tension-type headache. J Headache Pain 2016; 17:105. [PMID: 27844456 PMCID: PMC5108736 DOI: 10.1186/s10194-016-0698-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/09/2016] [Indexed: 02/08/2023] Open
Abstract
Background State-related brain structural alterations in patients with episodic tension-type headache (ETTH) are unclear. We aimed to conduct a longitudinal study to explore dynamic gray matter (GM) changes between the pain and pain-free phases in ETTH. Methods We recruited 40 treatment-naïve ETTH patients and 40 healthy controls. All participants underwent brain structural scans on a 3.0-T MRI system. ETTH patients were scanned in and out of pain phases. Voxel-based morphometry analysis was used to determine the differences in regional gray matter density (GMD) between groups. Additional regression analysis was used to identify any associations between regional GMD and clinical symptoms. Results ETTH patients exhibited reduced GMD in the bilateral primary somatosensory cortex, and increased GMD in the bilateral anterior cingulate cortex (ACC) and anterior insula for the in pain phase compared with the out of pain phase. The out of pain phase of ETTH patients exhibited no regions with higher or lower GMD compared with healthy controls. GMD in the left ACC and left anterior insula was negatively correlated with headache days. GMD in the left ACC was negatively correlated with anxiety and depressive symptoms in ETTH patients. Conclusions This is the first study to demonstrate dynamic and reversible GMD changes between the pain and pain-free phases in ETTH patients. However, this balance might be disrupted by increased headache days and progressive anxiety and depressive symptoms.
Collapse
Affiliation(s)
- Bing Chen
- Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China
| | - Yuan He
- Department of Gastrointestinal Surgery, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, People's Republic of China
| | - Lei Xia
- Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China
| | - Li-Li Guo
- Department of Medical Imaging, Huai'an First People's Hospital Affiliated to Nanjing Medical University, Huai'an, People's Republic of China
| | - Jin-Long Zheng
- Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China.
| |
Collapse
|
452
|
Pain modulation from the brain during diabetic neuropathy: Uncovering the role of the rostroventromedial medulla. Neurobiol Dis 2016; 96:346-356. [PMID: 27717882 DOI: 10.1016/j.nbd.2016.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/06/2016] [Accepted: 10/01/2016] [Indexed: 01/17/2023] Open
Abstract
Diabetic neuropathy has a profound impact in the quality of life of patients who frequently complain of pain. The mechanisms underlying diabetic neuropathic pain (DNP) are no longer ascribed only to damage of peripheral nerves. The effects of diabetes at the central nervous system are currently considered causes of DPN. Management of DNP may be achieved by antidepressants that act on serotonin (5-HT) uptake, namely specific serotonin reuptake inhibitors. The rostroventromedial medulla (RVM) is a key pain control center involved in descending pain modulation at the spinal cord through local release of 5-HT and plays a peculiar role in the balance of bidirectional control (i.e. inhibitory and facilitatory) from the brain to the spinal cord. This review discusses recently uncovered neurobiological mechanisms that mediate nociceptive modulation from the RVM during diabetes installation. In early phases of the disease, facilitation of pain modulation from the RVM prevails through a triplet of mechanisms which include increase in serotonin expression at the RVM and consequent rise of serotonin levels at the spinal cord and upregulation of local facilitatory 5HT3 receptors, enhancement of spontaneous activity of facilitatory RVM neurons and up-regulation of the expression of transient receptor potential vanilloid type 1 (TRPV1) receptor. With the progression of diabetes the alterations in the RVM increase dramatically, with oxidative stress and neuronal death associated to microglia-mediated inflammation. In a manner similar to other central areas, like the thalamus, the RVM is likely to be a "pain generator/amplifier" during diabetes, accounting to increase DNP. Early interventions in DNP prevention using strategies that simultaneously tackle the exacerbation of 5-HT3 spinal receptors and of microglial RVM activity, namely those that increase the levels of anti-inflammatory cytokines, should be considered in the future of DNP treatment.
Collapse
|
453
|
Bonnard E, Poras H, Fournié-Zaluski MC, Roques BP. Preventive and alleviative effects of the dual enkephalinase inhibitor (Denki) PL265 in a murine model of neuropathic pain. Eur J Pharmacol 2016; 788:176-182. [DOI: 10.1016/j.ejphar.2016.05.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022]
|
454
|
Abstract
INTRODUCTION Recent advances regarding mechanisms of chronic pain emphasize the role of corticolimbic circuitry in predicting risk for chronic pain, independently from site of injury-related parameters. These results compel revisiting the role of peripheral nociceptive signaling in chronic pain. We address this issue by examining what brain circuitry transmit information regarding the intensity of chronic pain and how this information may be related to a common co-morbidity, depression. METHODS Resting state functional MRI was used in a large group of chronic pain patients (n=40 chronic back pain, CBP, and n=44 osteoarthritis, OA patients), and in comparison to healthy subjects (n=88). We used a graph theoretical measure, degree count, to investigate voxel-wise information sharing/transmission in the brain. Degree count, a functional connectivity based measure, identifies the number of voxels functionally connected to every given voxel. Subdividing the chronic pain cohort into discovery, replication, and also for overall group we show that only degree counts of diencephalic voxels centered in the ventral lateral thalamus reflected intensity of chronic pain, independently of depression. RESULTS Pain intensity was reliably associated with degree count of the thalamus, which was correlated negatively with components of the default mode network and positively with the periaqueductal grey (in contrast to healthy controls). Depression scores were not reliably associated with regional degree count. CONCLUSION Collectively the results suggest that, across two types of chronic pain, nociceptive specific information is relayed through the spinothalamic pathway to the lateral thalamus, potentiated by pro-nociceptive descending modulation, and interrupting cortical cognitive processes.
Collapse
|
455
|
Podvin S, Yaksh T, Hook V. The Emerging Role of Spinal Dynorphin in Chronic Pain: A Therapeutic Perspective. Annu Rev Pharmacol Toxicol 2016; 56:511-33. [PMID: 26738478 DOI: 10.1146/annurev-pharmtox-010715-103042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Notable findings point to the significance of the dynorphin peptide neurotransmitter in chronic pain. Spinal dynorphin neuropeptide levels are elevated during development of chronic pain and sustained during persistent chronic pain. Importantly, knockout of the dynorphin gene prevents development of chronic pain in mice, but acute nociception is unaffected. Intrathecal (IT) administration of opioid and nonopioid dynorphin peptides initiates allodynia through a nonopioid receptor mechanism; furthermore, antidynorphin antibodies administered by the IT route attenuate chronic pain. Thus, this review presents the compelling evidence in the field that supports the role of dynorphin in facilitating the development of a persistent pain state. These observations illustrate the importance of elucidating the control mechanisms responsible for the upregulation of spinal dynorphin in chronic pain. Also, spinal dynorphin regulation of downstream signaling molecules may be implicated in hyperpathic states. Therapeutic strategies to block the upregulation of spinal dynorphin may provide a nonaddictive approach to improve the devastating condition of chronic pain that occurs in numerous human diseases.
Collapse
Affiliation(s)
- Sonia Podvin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California 92093;
| | | | - Vivian Hook
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California 92093; .,Department of Neurosciences, and.,Department of Pharmacology, University of California, San Diego School of Medicine, La Jolla, California 92093
| |
Collapse
|
456
|
Wang N, Li SG, Lin XX, Su YL, Qi WJ, Wang JY, Luo F. Increasing Pain Sensation Eliminates the Inhibitory Effect of Depression on Evoked Pain in Rats. Front Behav Neurosci 2016; 10:183. [PMID: 27733820 PMCID: PMC5039174 DOI: 10.3389/fnbeh.2016.00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Although previous studies have suggested that depression may be associated with inhibition of evoked pain but facilitation of spontaneous pain, the mechanisms underlying these relationships are unclear. The present study investigated whether the difference between evoked and spontaneous pain on sensory (descending inhibition) and affective (avoidance motivation) components contributes to the divergent effects of depression on them. Depressive-like behavior was produced in male Wistar rats by unpredictable chronic mild stress (UCMS). Tone-laser conditioning and formalin-induced conditioned place avoidance (F-CPA) were used to explore avoidance motivation in evoked and spontaneous pain, respectively. Behavioral pharmacology experiments were conducted to examine descending inhibition of both evoked (thermal stimulation) and spontaneous pain behavior (formalin pain). The results revealed that the inhibitory effect of depression on evoked pain was eliminated following repeated thermal stimuli. Avoidance behavior in the tone-laser conditioning task was reduced in UCMS rats, relative to controls. However, avoidance motivation for formalin pain in the UCMS group was similar to controls. 5-HT1A receptor antagonism interfered with inhibition of pain responses over time. The present study demonstrated that the inhibitory effect of depression on evoked pain dissipates with increased nociception and that the sensory-discriminative and affective-motivational components of pain are jointly involved in the divergent effects of depression on pain.
Collapse
Affiliation(s)
- Ning Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Sheng-Guang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Xiao-Xiao Lin
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China; University of Chinese Academy of SciencesBeijing, China
| | - Yuan-Lin Su
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Wei-Jing Qi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Jin-Yan Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China; University of Chinese Academy of SciencesBeijing, China
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China; University of Chinese Academy of SciencesBeijing, China
| |
Collapse
|
457
|
Abstract
This article reviews possible ways that traumatic brain injury (TBI) can induce migraine-type post-traumatic headaches (PTHs) in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD), are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.
Collapse
|
458
|
Abstract
The issues specific to trigeminal pain include the complexity of the region, the problematic impact on daily function and significant psychological impact (J Dent, 43, 2015, 1203). By nature of the geography of the pain (affecting the face, eyes, scalp, nose, mouth), it may interfere with just about every social function we take for granted and enjoy (J Orofac Pain, 25, 2011, 333). The trigeminal nerve is the largest sensory nerve in the body, protecting the essential organs that underpin our very existence (brain, eyes, nose, mouth). It is no wonder that pain within the trigeminal system in the face is often overwhelming and inescapable for the affected individual.
Collapse
Affiliation(s)
- T Renton
- Oral Surgery, Kings College London, London, UK
| |
Collapse
|
459
|
Horing B, McCubbin JA, Moore D, Muth ER. Resting blood pressure differentially predicts time course in a tonic pain experiment. Psychophysiology 2016; 53:1600-7. [PMID: 27424846 DOI: 10.1111/psyp.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/12/2016] [Indexed: 11/26/2022]
Abstract
Resting blood pressure (BP) shows a negative relationship with pain sensitivity (BP-related hypoalgesia). In chronic pain conditions, this relationship is inverted. The precise mechanisms responsible for the inversion are unknown. Using a tonic pain protocol, we report findings closely resembling this inversion in healthy participants. Resting BP and state measures of anxiety and mood were assessed from 33 participants (21 female). Participants then immersed their dominant hand in painfully hot water (47 °C) for five trials of 1-min duration, with 30-s intertrial intervals. Throughout the trials, participants continually registered their pain. After a 35-min intermission, the trial sequence was repeated. A disassociation of the negative relationship of resting systolic BP (as per Trial 1) was found using hierarchical linear modeling (p < .001, R(2) = .07). The disassociation unfolds over each consecutive trial, with an increasingly positive relationship. In Sequence 2, the initially negative relationship is almost completely absent. Furthermore, the association of BP and pain was found to be moderated by anxiety, such that only persons with low anxiety exhibited BP hypoalgesia. Our findings expand the existing literature by incorporating anxiety as a moderator of BP hypoalgesia. Furthermore, the protocol emulates the changing relationship between BP and pain observed in chronic pain patients. The protocol has potential as a model for chronic pain; however, future research should determine if similar physiological systems are involved. The finding holds potential diagnostic or prognostic relevance for certain clinical pain conditions, especially those involving dysfunction of the descending modulation of pain.
Collapse
Affiliation(s)
- Bjoern Horing
- Department of Psychology, Clemson University, Clemson, South Carolina, USA.
| | - James A McCubbin
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Dewayne Moore
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| |
Collapse
|
460
|
Frezel N, Sohet F, Daneman R, Basbaum AI, Braz JM. Peripheral and central neuronal ATF3 precedes CD4+ T-cell infiltration in EAE. Exp Neurol 2016; 283:224-34. [PMID: 27343802 DOI: 10.1016/j.expneurol.2016.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 01/04/2023]
Abstract
Experimental allergic encephalomyelitis (EAE), an animal model of multiple sclerosis produced by immunization with myelin oligodendrocyte glycoprotein (MOG) and adjuvants, results from profound T-cell mediated CNS demyelination. EAE is characterized by progressive, ascending motor dysfunction and symptoms of ongoing pain and hypersensitivity, in some cases preceding or concomitant with the motor deficits. In this regard, the EAE model mimics major features of multiple sclerosis, where a central neuropathic pain state is common. Although the latter condition is presumed to arise from a CNS loss of inhibitory controls secondary to the demyelination, dysfunction of sensory neurons may also contribute. Based on our previous studies that demonstrated the utility of monitoring expression of activating transcription factor 3 (ATF3), a sensitive marker of injured sensory neurons, here we followed both ATF3 and CD4+ T cells invasion of sensory ganglia (as well as the CNS) at different stages of the EAE model. We found that ATF3 is induced in peripheral sensory ganglia and brainstem well before the appearance of motor deficits. Unexpectedly, the ATF3 induction always preceded T cell infiltration, typically in adjacent, but non-overlapping regions. Surprisingly, control administration of the pertussis toxin and/or Complete Freund's adjuvants, without MOG, induced ATF3 in sensory neurons. In contrast, T cell infiltration only occurred with MOG. Taken together, our results suggest that the clinical manifestations in the EAE result not only from central demyelination but also from neuronal stress and subsequent pathophysiology of sensory neurons.
Collapse
Affiliation(s)
- Noémie Frezel
- Department Anatomy, University California San Francisco, San Francisco, CA 94158, United States.
| | - Fabien Sohet
- Department Anatomy, University California San Francisco, San Francisco, CA 94158, United States.
| | - Richard Daneman
- Department Anatomy, University California San Francisco, San Francisco, CA 94158, United States.
| | - Allan I Basbaum
- Department Anatomy, University California San Francisco, San Francisco, CA 94158, United States.
| | - Joao M Braz
- Department Anatomy, University California San Francisco, San Francisco, CA 94158, United States.
| |
Collapse
|
461
|
Abstract
The Veterans Health Administration (VHA) provides medical care for Veterans after leaving the military. The combination of multiple deployments and battlefield exposures to physical and psychological trauma results in a higher prevalence and complexity of chronic pain in Veterans than in the general public. The VHA and the Department of Defense work together to develop a single standard of stepped pain management appropriate for all settings from moment of injury or disease onset. This article describes the education, academic detailing, and clinical programs and policies that are transforming pain care in the VHA.
Collapse
Affiliation(s)
- Rollin M Gallagher
- Pain Service, Michael Crescenz VA Medical Center, University and Woodland, Philadelphia, PA 19035, USA; Penn Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
462
|
Conti PCR, Costa YM, Gonçalves DA, Svensson P. Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements? J Oral Rehabil 2016; 43:702-15. [DOI: 10.1111/joor.12410] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Affiliation(s)
- P. C. R. Conti
- Department of Prosthodontics; Bauru School of Dentistry; University of São Paulo; Bauru Brazil
- Bauru Orofacial Pain Group; University of São Paulo; Bauru Brazil
| | - Y. M. Costa
- Bauru Orofacial Pain Group; University of São Paulo; Bauru Brazil
- Section of Head and Face Physiology; Department of Biological Sciences; Bauru School of Dentistry; University of São Paulo; Bauru Brazil
| | - D. A. Gonçalves
- Department of Dental Materials and Prosthodontics; Araraquara Dental School; Sao Paulo State University; Araraquara Brazil
| | - P. Svensson
- Section of Orofacial Pain and Jaw Function; Department of Dentistry; Aarhus University; Aarhus Denmark
- Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON)
| |
Collapse
|
463
|
Andersen HH, Imai Y, Petersen KK, Koenig J, Elberling J, Arendt-Nielsen L. Conditioning pain stimulation does not affect itch induced by intra-epidermal histamine pricks but aggravates neurogenic inflammation in healthy volunteers. Somatosens Mot Res 2016; 33:49-60. [DOI: 10.3109/08990220.2016.1173535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- H. H. Andersen
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Y. Imai
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Clinical Development Department, Clinical Department Center, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - K. K. Petersen
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - J. Koenig
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - J. Elberling
- The Allergy Clinic, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
| | - L. Arendt-Nielsen
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
464
|
Pei P, Liu L, Zhao L, Cui Y, Qu Z, Wang L. Effect of electroacupuncture pretreatment at GB20 on behaviour and the descending pain modulatory system in a rat model of migraine. Acupunct Med 2016; 34:127-35. [PMID: 26438555 PMCID: PMC4853588 DOI: 10.1136/acupmed-2015-010840] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND While electroacupuncture (EA) pretreatment has been found to ameliorate migraine-like symptoms, the underlying mechanisms remain poorly understood. Emerging evidence suggests that the brainstem descending pain modulatory system, comprising the periaqueductal grey (PAG), raphe magnus nucleus (RMg), and trigeminal nucleus caudalis (TNC), may be involved in migraine pathophysiology. We hypothesised that EA would ameliorate migraine-like symptoms via modulation of this descending system. METHODS We used a conscious rat model of migraine induced by repeated electrical stimulation of the dura. Forty male Sprague-Dawley rats were randomly assigned to one of four groups: an EA group, which received EA at GB20 following dural stimulation; a sham acupuncture (SA) group, which received manual acupuncture at a non-acupuncture point following dural stimulation; a Model group, which received dural stimulation but no acupuncture; and a Control group, which received neither dural stimulation nor acupuncture (electrode implantation only). HomeCageScan was used to measure effects on behaviour, and immunofluorescence staining was used to examine neural activation (c-Fos immunoreactivity) in the PAG, RMg, and TNC. RESULTS Compared to the Model group, rats in the EA group showed a significant increase in exploratory, locomotor and eating/drinking behaviour (p<0.01) and a significant decrease in freezing-like resting and grooming behaviour (p<0.05). There was a significant increase in the mean number of c-Fos neurons in the PAG, RMg, and TNC in Model versus Control groups (p<0.001); however, this was significantly attenuated by EA treatment (p<0.001). There were no significant differences between the SA and Model groups in behaviour or c-Fos immunoreactivity. CONCLUSIONS EA pretreatment ameliorates behavioural changes in a rat model of recurrent migraine, possibly via modulation of the brainstem descending pathways.
Collapse
Affiliation(s)
- Pei Pei
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Lu Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Luopeng Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Yingxue Cui
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Zhengyang Qu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| |
Collapse
|
465
|
Role of the RVM in Descending Pain Regulation Originating from the Cerebrospinal Fluid-Contacting Nucleus. Neurochem Res 2016; 41:1651-61. [DOI: 10.1007/s11064-016-1880-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 01/09/2023]
|
466
|
Silva M, Martins D, Charrua A, Piscitelli F, Tavares I, Morgado C, Di Marzo V. Endovanilloid control of pain modulation by the rostroventromedial medulla in an animal model of diabetic neuropathy. Neuropharmacology 2016; 107:49-57. [PMID: 26965218 DOI: 10.1016/j.neuropharm.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
The involvement of transient receptor vanilloid type-1 (TRPV1) channels in pain modulation by the brain remains understudied. The rostroventromedial medulla (RVM) plays a key role in conveying to the spinal cord pain modulatory influences triggered in higher brain centres, with co-existence of inhibitory (antinociceptive) and facilitatory (pronociceptive) effects. In spite of some reports of TRPV1 expression in the RVM, it remains unknown if endovanilloid signalling plays a direct role in local pain modulation. Here we used a model of diabetic neuropathy, the streptozotocin (STZ)-diabetic rat, to study the role of endovanilloid signalling in RVM-mediated pain modulation during chronic pain. Four weeks after diabetes induction, the levels of TRPV1 mRNA and fatty acid amide hydrolase (FAAH), a crucial enzyme for endovanilloid catabolism, in the RVM of STZ-diabetic rats were higher than control. The RVM of STZ-diabetic rats presented decreased levels of several TRPV1 endogenous ligands, namely anandamide (AEA), palmitoylethanolamide (PEA) and oleoylethanolamide (OEA). Administration of capsaicin (a TRPV1 agonist) into the RVM decreased nociceptive behavioural responses in the inflammatory phase of the formalin test (phase 2). These findings suggest that diabetic neuropathy induces plastic changes of RVM endovanilloid signalling, indicating that TRPV1 may be a putative target for pain modulation in this chronic pain condition.
Collapse
Affiliation(s)
- M Silva
- Departamento de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Portugal; I3S - Instituto de Inovação e investigação em Saúde, Universidade do Porto, Portugal
| | - D Martins
- Departamento de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Portugal; I3S - Instituto de Inovação e investigação em Saúde, Universidade do Porto, Portugal
| | - A Charrua
- I3S - Instituto de Inovação e investigação em Saúde, Universidade do Porto, Portugal; Departmento de Doenças Renais, Urológicas e Infecciosas, Faculdade de Medicina, Universidade do Porto, Portugal
| | - F Piscitelli
- Institute of Biomolecular Chemistry of the National Research Council (ICB-CNR), Naples, Italy
| | - I Tavares
- Departamento de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Portugal; I3S - Instituto de Inovação e investigação em Saúde, Universidade do Porto, Portugal.
| | - C Morgado
- Departamento de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Portugal; I3S - Instituto de Inovação e investigação em Saúde, Universidade do Porto, Portugal
| | - V Di Marzo
- Institute of Biomolecular Chemistry of the National Research Council (ICB-CNR), Naples, Italy
| |
Collapse
|
467
|
Havelin J, Imbert I, Cormier J, Allen J, Porreca F, King T. Central Sensitization and Neuropathic Features of Ongoing Pain in a Rat Model of Advanced Osteoarthritis. THE JOURNAL OF PAIN 2016; 17:374-82. [PMID: 26694132 PMCID: PMC4824638 DOI: 10.1016/j.jpain.2015.12.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED Osteoarthritis (OA) pain is most commonly characterized by movement-triggered joint pain. However, in advanced disease, OA pain becomes persistent, ongoing and resistant to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). The mechanisms underlying ongoing pain in advanced OA are poorly understood. We recently showed that intra-articular (i.a.) injection of monosodium iodoacetate (MIA) into the rat knee joint produces concentration-dependent outcomes. Thus, a low dose of i.a. MIA produces NSAID-sensitive weight asymmetry without evidence of ongoing pain and a high i.a. MIA dose produces weight asymmetry and NSAID-resistant ongoing pain. In the present study, palpation of the ipsilateral hind limb of rats treated 14 days previously with high, but not low, doses of i.a. MIA produced expression of the early oncogene, FOS, in the spinal dorsal horn. Inactivation of descending pain facilitatory pathways using a microinjection of lidocaine within the rostral ventromedial medulla induced conditioned place preference selectively in rats treated with the high dose of MIA. Conditioned place preference to intra-articular lidocaine was blocked by pretreatment with duloxetine (30 mg/kg, intraperitoneally at -30 minutes). These observations are consistent with the likelihood of a neuropathic component of OA that elicits ongoing, NSAID-resistant pain and central sensitization that is mediated, in part, by descending modulatory mechanisms. This model provides a basis for exploration of underlying mechanisms promoting neuropathic components of OA pain and for the identification of mechanisms that might guide drug discovery for treatment of advanced OA pain without the need for joint replacement. PERSPECTIVE Difficulty in managing advanced OA pain often results in joint replacement therapy in these patients. Improved understanding of mechanisms driving NSAID-resistant ongoing OA pain might facilitate development of alternatives to joint replacement therapy. Our findings suggest that central sensitization and neuropathic features contribute to NSAID-resistant ongoing OA joint pain.
Collapse
Affiliation(s)
- Joshua Havelin
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Ian Imbert
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Jennifer Cormier
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Joshua Allen
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, Arizona
| | - Tamara King
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine.
| |
Collapse
|
468
|
Harada E, Tokuoka H, Fujikoshi S, Funai J, Wohlreich MM, Ossipov MH, Iwata N. Is duloxetine's effect on painful physical symptoms in depression an indirect result of improvement of depressive symptoms? Pooled analyses of three randomized controlled trials. Pain 2016; 157:577-584. [PMID: 26882344 PMCID: PMC4751744 DOI: 10.1097/j.pain.0000000000000406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/06/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
In treating Major Depressive Disorder with associated painful physical symptoms (PPS), the effect of duloxetine on PPS has been shown to decompose into a direct effect on PPS and an indirect effect on PPS via depressive symptoms (DS) improvement. To evaluate the changes in relative contributions of the direct and indirect effects over time, we analyzed pooled data from 3 randomized double-blind studies comparing duloxetine 60 mg/d with placebo in patients with major depressive disorder and PPS. Changes from baseline in Montgomery-Åsberg Depression Rating Scale total and Brief Pain Inventory-Short Form average pain score were assessed over 8 weeks. Path analysis examined the (1) direct effect of treatment on PPS and/or indirect effect on PPS via DS improvement and (2) direct effect of treatment on DS and/or indirect effect on DS via PPS improvement. At week 1, the direct effect of duloxetine on PPS (75.3%) was greater than the indirect effect through DS improvement (24.7%) but became less (22.6%) than the indirect effect (77.4%) by week 8. Initially, the direct effect of duloxetine on PPS was markedly greater than its indirect effect, whereas later the indirect effect predominated. Conversely, at week 1, the direct effect of treatment on DS (46.4%) was less than the indirect effect (53.6%), and by week 8 it superseded (62.6%) the indirect effect (37.4%). Thus, duloxetine would relieve PPS directly in the initial phase and indirectly via improving DS in the later phase.
Collapse
Affiliation(s)
- Eiji Harada
- Medical Science, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Jumpei Funai
- Science Communications, Eli Lilly Japan K.K., Kobe, Hyogo, Japan
| | | | | | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
469
|
Ellingson LD, Stegner AJ, Schwabacher IJ, Koltyn KF, Cook DB. Exercise Strengthens Central Nervous System Modulation of Pain in Fibromyalgia. Brain Sci 2016; 6:brainsci6010008. [PMID: 26927193 PMCID: PMC4810178 DOI: 10.3390/brainsci6010008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 01/01/2023] Open
Abstract
To begin to elucidate the mechanisms underlying the benefits of exercise for chronic pain, we assessed the influence of exercise on brain responses to pain in fibromyalgia (FM). Complete data were collected for nine female FM patients and nine pain-free controls (CO) who underwent two functional neuroimaging scans, following exercise (EX) and following quiet rest (QR). Brain responses and pain ratings to noxious heat stimuli were compared within and between groups. For pain ratings, there was a significant (p < 0.05) Condition by Run interaction characterized by moderately lower pain ratings post EX compared to QR (d = 0.39–0.41) for FM but similar to ratings in CO (d = 0.10–0.26), thereby demonstrating that exercise decreased pain sensitivity in FM patients to a level that was analogous to pain-free controls. Brain responses demonstrated a significant within-group difference in FM patients, characterized by less brain activity bilaterally in the anterior insula following QR as compared to EX. There was also a significant Group by Condition interaction with FM patients showing less activity in the left dorsolateral prefrontal cortex following QR as compared to post-EX and CO following both conditions. These results suggest that exercise appeared to stimulate brain regions involved in descending pain inhibition in FM patients, decreasing their sensitivity to pain. Thus, exercise may benefit patients with FM via improving the functional capacity of the pain modulatory system.
Collapse
Affiliation(s)
- Laura D Ellingson
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA.
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Isaac J Schwabacher
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Kelli F Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| |
Collapse
|
470
|
You HJ, Lei J, Xiao Y, Ye G, Sun ZH, Yang L, Niu N. Pre-emptive analgesia and its supraspinal mechanisms: enhanced descending inhibition and decreased descending facilitation by dexmedetomidine. J Physiol 2016; 594:1875-90. [PMID: 26732231 DOI: 10.1113/jp271991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/04/2016] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS Despite the clinical importance of pre-emptive analgesia, the mechanisms by which it attenuates pain associated with central sensitization are poorly understood. We find that fentanyl and the α2-adrenoceptor agonist dexmedetomidine (Dex) differ significantly in their modulatory actions on noxious mechanical and noxious heat-evoked nociception in vivo. Unlike fentanyl, Dex modified descending control of nociception by decreasing the threshold for descending inhibition and/or increasing the threshold for descending facilitation. Dex exhibited after-actions on activities of thalamus in prolongation of noxious heat-evoked paw withdrawal latency that persisted for at least 7 days. This study provides insight into the organization of thalamic modulation in pre-emptive analgesia. ABSTRACT We investigated and compared the antinociceptive effects of intraperitoneal administration of fentanyl (2-60 μg kg(-1)) and dexmedetomidine (Dex, 1-10 μg kg(-1); a highly selective α2-adrenoceptor agonist) in the regulation of nociception assessed by measuring noxious paw withdrawal reflexes in rats. Fentanyl elevated noxious mechanical paw withdrawal threshold and prolonged paw withdrawal heat latency within 1-1.5 h (P < 0.05). Dex failed to affect the mechanical paw withdrawal threshold, yet significantly prolonged the paw withdrawal heat latency in a bi-phasic manner; a short transient 1-1.5 h period followed by a second, slowly developing increase in latency that persisted for at least 7 days (P < 0.05). Lesion of the dorsolateral funiculus (DLF) did not influence fentanyl-induced antinociceptive effects, indicating peripheral and spinal antinociceptive mechanisms. By contrast, the Dex-induced second, but not the first, phase of the prolonged paw withdrawal heat latency was significantly blocked by the lesion of either DLF or thalamic ventromedial (VM) nuclei, and was attenuated by intracerebral administration of either atipamezole (α2-adrenoceptor antagonist) or WAY-100635 (5-HT1A receptor antagonist) into the VM nuclei (P < 0.05). Upon intramuscular 5.8% saline-induced muscle nociception, pre-emptive injection of fentanyl enhanced mechanical hyperalgesia and blocked heat hypoalgesia, whereas Dex significantly prevented the occurrence of mechanical hyperalgesia and enhanced heat hypoalgesia. It is suggested that Dex, but not fentanyl, significantly enhances descending inhibition and/or decreases descending facilitation to modulate pain and nociception. The present study provides novel insight into thalamus-mediated mechanisms in pre-emptive analgesia.
Collapse
Affiliation(s)
- Hao-Jun You
- Center for Biomedical Research on Pain (CBRP), College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Jing Lei
- Center for Biomedical Research on Pain (CBRP), College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Ying Xiao
- Center for Biomedical Research on Pain (CBRP), College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, PR China.,Department of Anesthesia, First affiliated hospital of Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Gang Ye
- Department of Pain, Tongji Hospital affiliated to Shanghai Tongji University, Shanghai, 200065, PR China
| | - Zhi-Hong Sun
- College of Life Science, Yan'an University, Yan'an, 716000, PR China
| | - Lan Yang
- Center for Biomedical Research on Pain (CBRP), College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Nan Niu
- Center for Biomedical Research on Pain (CBRP), College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, PR China
| |
Collapse
|
471
|
Davydov DM, Naliboff B, Shahabi L, Shapiro D. Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices. Physiol Behav 2016; 157:102-8. [PMID: 26836276 DOI: 10.1016/j.physbeh.2016.01.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study was conducted to present evidence of differences in autonomic regulation of cardiovascular activity and its role in the severity of specific (disease-related) and non-specific (negative affect and chronic pain-related) symptoms in individuals with Irritable Bowel Syndrome (IBS). METHODS Seventy-eight female patients with IBS and 27 healthy women age 18-62 years were assessed for IBS symptoms, negative affect, and baroreceptor sensitivity (BRS), blood pressure (BP), heart rate, and heart rate variability (HRV) at rest. Direct and indirect regression effects were examined with application of the bootstrap procedure to validate findings. RESULTS IBS was reliably related to lower resting BRS, higher BP, and higher negative affect compared to healthy controls. Longer disease duration (chronicity) was related to BRS decrease coupled with systolic BP increase (95% CIs=-0.14 to -0.01). Three autonomic mechanisms associated with BRS decrease were found to further regulate severity of IBS symptoms. Lower BRS was related to higher IBS severity in general if the effect was transferred through the decrease of low frequency power of HRV (e.g., 95% CIs=-0.039 to -0.001 for abdominal pain severity). However, lower BRS was related to lower IBS severity in general if the effect was transferred through diastolic BP increase (95% CIs=0.01-0.11 for abdominal pain severity). Lower BRS was related to higher abdominal pain severity coupled with high negative affect if the effect was transferred through the decrease of higher frequency power of HRV (95% CIs=-0.026 to -0.003). CONCLUSIONS These findings indicate that different cardiovascular mechanisms are associated with IBS development and the increase and decrease of severity of IBS symptoms. Their assessment suggests ways to personalize treatment of IBS.
Collapse
Affiliation(s)
- Dmitry M Davydov
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 8 Baltiyskaia ul., Moscow 125315, Russia.
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States.
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States.
| | - David Shapiro
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States.
| |
Collapse
|
472
|
Parent A, Tétreault P, Roux M, Belleville K, Longpré JM, Beaudet N, Goffaux P, Sarret P. Descending nociceptive inhibition is modulated in a time-dependent manner in a double-hit model of chronic/tonic pain. Neuroscience 2016; 315:70-8. [DOI: 10.1016/j.neuroscience.2015.11.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
|
473
|
|
474
|
Westhoff MA, Marschall N, Debatin KM. Novel Approaches to Apoptosis-Inducing Therapies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 930:173-204. [PMID: 27558822 DOI: 10.1007/978-3-319-39406-0_8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Induction of apoptotic programmed cell death is one of the underlying principles of most current cancer therapies. In this review, we discuss the limitations and drawbacks of this approach and identify three distinct, but overlapping strategies to avoid these difficulties and further enhance the efficacy of apoptosis-inducing therapies. We postulate that the application of multi-targeted small molecule inhibitor cocktails will reduce the risk of the cancer cell populations developing resistance towards therapy. Following from these considerations regarding population genetics and ecology, we advocate the reconsideration of therapeutic end points to maximise the benefits, in terms of quantity and quality of life, for the patients. Finally, combining both previous points, we also suggest an altered focus on the cellular and molecular targets of therapy, i.e. targeting the (cancer cells') interaction with the tumour microenvironment.
Collapse
Affiliation(s)
- Mike-Andrew Westhoff
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Nicolas Marschall
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstrasse 24, 89075, Ulm, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstrasse 24, 89075, Ulm, Germany.
| |
Collapse
|
475
|
Jaracz J, Gattner K, Jaracz K, Górna K. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management. CNS Drugs 2016; 30:293-304. [PMID: 27048351 PMCID: PMC4839032 DOI: 10.1007/s40263-016-0328-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.
Collapse
Affiliation(s)
- Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland.
| | - Karolina Gattner
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland
| | - Krystyna Jaracz
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Krystyna Górna
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
476
|
Denis DJ, Marouf R, Rainville P, Bouthillier A, Nguyen DK. Effects of insular stimulation on thermal nociception. Eur J Pain 2015; 20:800-10. [PMID: 26471114 DOI: 10.1002/ejp.806] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Electrical stimulation used for brain mapping in the postero-superior insula can evoke pain. The effects of prolonged high frequency insular stimulation on pain thresholds are unknown. OBJECTIVE/HYPOTHESIS Prolonged high frequency insular stimulation, by virtue of its inhibitory properties on networks, could decrease thermal nociception. METHODS Epileptic subjects had electrodes implanted in the insular cortex for the purpose of epileptic focus resection. Thermal and pressure nociceptive thresholds were tested bilaterally on the forearm on two consecutive days. Randomly assigned double-blind high frequency (150 Hz) insular stimulation took place for 10 min before pain testing either on the first day or on the second day. RESULTS Six subjects (three females; mean age of 35 years) were included. Insular stimulation increased heat pain threshold on the ipsilateral (p = 0.003; n = 6) and contralateral sides (p = 0.047; n = 6). Differences in cold pain threshold did not reach statistical significance (ipsilateral: p = 0.341, contralateral: p = 0.143; n = 6), but one subject had a profound decrease in both heat and cold pain responses. Pressure pain threshold was not modified by insular stimulation (ipsilateral: p = 0.1123; contralateral: p = 0.1192; n = 6). Two of the three subjects who had a postero-superior operculo-insulectomy developed central pain with contralateral thermal nociceptive deficit. CONCLUSIONS High frequency inhibitory postero-superior insular stimulation may have the potential to decrease thermal nociception. Together with previous studies, our data support the notion that the integrity of this brain region is necessary for thermal but not pressure nociceptive processing.
Collapse
Affiliation(s)
- D J Denis
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (Hôpital Notre-Dame), Canada
| | - R Marouf
- Department of Neuroscience, Université de Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Université de Montréal, Canada
| | - P Rainville
- Department of Neuroscience, Université de Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Université de Montréal, Canada
- Department of Stomatology, Université de Montréal, Canada
- Centre de recherche en neuropsychologie et cognition (CERNEC), Université de Montréal, Canada
- Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Canada
| | - A Bouthillier
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (Hôpital Notre-Dame), Canada
| | - D K Nguyen
- Department of Neuroscience, Université de Montréal, Canada
- Division of Neurology, Department of Medicine, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame), Canada
| |
Collapse
|
477
|
Li D, Lee Y, Kim W, Lee K, Bae H, Kim SK. Analgesic Effects of Bee Venom Derived Phospholipase A(2) in a Mouse Model of Oxaliplatin-Induced Neuropathic Pain. Toxins (Basel) 2015; 7:2422-34. [PMID: 26131771 PMCID: PMC4516921 DOI: 10.3390/toxins7072422] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/11/2015] [Accepted: 06/23/2015] [Indexed: 12/20/2022] Open
Abstract
A single infusion of oxaliplatin, which is widely used to treat metastatic colorectal cancer, induces specific sensory neurotoxicity signs that are triggered or aggravated when exposed to cold or mechanical stimuli. Bee Venom (BV) has been traditionally used in Korea to treat various pain symptoms. Our recent study demonstrated that BV alleviates oxaliplatin-induced cold allodynia in rats, via noradrenergic and serotonergic analgesic pathways. In this study, we have further investigated whether BV derived phospholipase A2 (bvPLA2) attenuates oxaliplatin-induced cold and mechanical allodynia in mice and its mechanism. The behavioral signs of cold and mechanical allodynia were evaluated by acetone and a von Frey hair test on the hind paw, respectively. The significant allodynia signs were observed from one day after an oxaliplatin injection (6 mg/kg, i.p.). Daily administration of bvPLA2 (0.2 mg/kg, i.p.) for five consecutive days markedly attenuated cold and mechanical allodynia, which was more potent than the effect of BV (1 mg/kg, i.p.). The depletion of noradrenaline by an injection of N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine hydrochloride (DSP4, 50 mg/kg, i.p.) blocked the analgesic effect of bvPLA2, whereas the depletion of serotonin by injecting DL-p-chlorophenylalanine (PCPA, 150 mg/kg, i.p.) for three successive days did not. Furthermore, idazoxan (α2-adrenegic receptor antagonist, 1 mg/kg, i.p.) completely blocked bvPLA2-induced anti-allodynic action, whereas prazosin (α1-adrenegic antagonist, 10 mg/kg, i.p.) did not. These results suggest that bvPLA2 treatment strongly alleviates oxaliplatin-induced acute cold and mechanical allodynia in mice through the activation of the noradrenergic system, via α2-adrenegic receptors, but not via the serotonergic system.
Collapse
Affiliation(s)
- Dongxing Li
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| | - Younju Lee
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| | - Woojin Kim
- Department of East-West Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| | - Kyungjin Lee
- Department of Herbology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| | - Sun Kwang Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
- Department of East-West Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdamoon-gu, Seoul 130-701, Korea.
| |
Collapse
|
478
|
Abstract
Neural circuits that determine the perception and modulation of pain remain poorly understood. The prefrontal cortex (PFC) provides top-down control of sensory and affective processes. While animal and human imaging studies have shown that the PFC is involved in pain regulation, its exact role in pain states remains incompletely understood. A key output target for the PFC is the nucleus accumbens (NAc), an important component of the reward circuitry. Interestingly, recent human imaging studies suggest that the projection from the PFC to the NAc is altered in chronic pain. The function of this corticostriatal projection in pain states, however, is not known. Here we show that optogenetic activation of the PFC produces strong antinociceptive effects in a rat model (spared nerve injury model) of persistent neuropathic pain. PFC activation also reduces the affective symptoms of pain. Furthermore, we show that this pain-relieving function of the PFC is likely mediated by projections to the NAc. Thus, our results support a novel role for corticostriatal circuitry in pain regulation.
Collapse
|
479
|
Kirkpatrick DR, McEntire DM, Hambsch ZJ, Kerfeld MJ, Smith TA, Reisbig MD, Youngblood CF, Agrawal DK. Therapeutic Basis of Clinical Pain Modulation. Clin Transl Sci 2015; 8:848-56. [PMID: 25962969 DOI: 10.1111/cts.12282] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pain is a hallmark of almost all bodily ailments and can be modulated by agents, including analgesics and anesthetics that suppress pain signals in the central nervous system. Defects in the modulatory systems, including the endogenous pain-inhibitory pathways, are a major factor in the initiation and chronicity of pain. Thus, pain modulation is particularly applicable to the practice of medicine. This review summarizes the existing literature on pain modulation. Here, we critically reviewed the literature from PubMed on pain modulation published primarily within the past 5 years in high impact journals. Specifically, we have discussed important anatomical landmarks of pain modulation and outlined the endogenous networks and underlying mechanisms of clinically relevant pain modulatory methods. The Gate Control Theory is briefly presented with discussion on the capacity of pain modulation to cause both hyper- and hypoalgesia. An emphasis has been given to highlight key areas in pain research that, because of unanswered questions or therapeutic potential, merit additional scientific scrutiny. The information presented in this paper would be helpful in developing novel therapies, metrics, and interventions for improved patient management.
Collapse
Affiliation(s)
- Daniel R Kirkpatrick
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Dan M McEntire
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Zakary J Hambsch
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Mitchell J Kerfeld
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Tyler A Smith
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Mark D Reisbig
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Charles F Youngblood
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Devendra K Agrawal
- Center for Clinical & Translational Science and Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| |
Collapse
|
480
|
|
481
|
Ford A, Castonguay A, Cottet M, Little JW, Chen Z, Symons-Liguori AM, Doyle T, Egan TM, Vanderah TW, De Koninck Y, Tosh DK, Jacobson KA, Salvemini D. Engagement of the GABA to KCC2 signaling pathway contributes to the analgesic effects of A3AR agonists in neuropathic pain. J Neurosci 2015; 35:6057-67. [PMID: 25878279 PMCID: PMC4397603 DOI: 10.1523/jneurosci.4495-14.2015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 01/18/2023] Open
Abstract
More than 1.5 billion people worldwide suffer from chronic pain, yet current treatment strategies often lack efficacy or have deleterious side effects in patients. Adenosine is an inhibitory neuromodulator that was previously thought to mediate antinociception through the A1 and A2A receptor subtypes. We have since demonstrated that A3AR agonists have potent analgesic actions in preclinical rodent models of neuropathic pain and that A3AR analgesia is independent of adenosine A1 or A2A unwanted effects. Herein, we explored the contribution of the GABA inhibitory system to A3AR-mediated analgesia using well-characterized mouse and rat models of chronic constriction injury (CCI)-induced neuropathic pain. The deregulation of GABA signaling in pathophysiological pain states is well established: GABA signaling can be hampered by a reduction in extracellular GABA synthesis by GAD65 and enhanced extracellular GABA reuptake via the GABA transporter, GAT-1. In neuropathic pain, GABAAR-mediated signaling can be further disrupted by the loss of the KCC2 chloride anion gradient. Here, we demonstrate that A3AR agonists (IB-MECA and MRS5698) reverse neuropathic pain via a spinal mechanism of action that modulates GABA activity. Spinal administration of the GABAA antagonist, bicuculline, disrupted A3AR-mediated analgesia. Furthermore, A3AR-mediated analgesia was associated with reductions in CCI-related GAD65 and GAT-1 serine dephosphorylation as well as an enhancement of KCC2 serine phosphorylation and activity. Our results suggest that A3AR-mediated reversal of neuropathic pain increases modulation of GABA inhibitory neurotransmission both directly and indirectly through protection of KCC2 function, underscoring the unique utility of A3AR agonists in chronic pain.
Collapse
Affiliation(s)
- Amanda Ford
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, St. Louis, Missouri 63104
| | - Annie Castonguay
- Institut Universitaire en Santé Mentale de Québec, Québec City, Quebec G1J 2G3, Canada, Department of Psychiatry & Neuroscience, Université Laval, Québec City, Quebec G1K 7P4, Canada
| | - Martin Cottet
- Institut Universitaire en Santé Mentale de Québec, Québec City, Quebec G1J 2G3, Canada, Department of Psychiatry & Neuroscience, Université Laval, Québec City, Quebec G1K 7P4, Canada
| | - Joshua W Little
- Department of Surgery, Center for Anatomical Science and Education, St. Louis University School of Medicine, St. Louis, Missouri 63104
| | - Zhoumou Chen
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, St. Louis, Missouri 63104
| | - Ashley M Symons-Liguori
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona 85724-5050, and
| | - Timothy Doyle
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, St. Louis, Missouri 63104
| | - Terrance M Egan
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, St. Louis, Missouri 63104
| | - Todd W Vanderah
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona 85724-5050, and
| | - Yves De Koninck
- Institut Universitaire en Santé Mentale de Québec, Québec City, Quebec G1J 2G3, Canada, Department of Psychiatry & Neuroscience, Université Laval, Québec City, Quebec G1K 7P4, Canada
| | - Dilip K Tosh
- Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-0810
| | - Kenneth A Jacobson
- Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-0810
| | - Daniela Salvemini
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, St. Louis, Missouri 63104,
| |
Collapse
|
482
|
|
483
|
Relationship between blood- and cerebrospinal fluid-bound neurotransmitter concentrations and conditioned pain modulation in pain-free and chronic pain subjects. THE JOURNAL OF PAIN 2015; 16:436-44. [PMID: 25659204 DOI: 10.1016/j.jpain.2015.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Descending pain inhibition is an endogenous pain control system thought to depend partially on the activation of bulbospinal monoaminergic pathways. Deficits in descending pain inhibition have been reported in numerous human chronic pain conditions, but there is currently no consensus regarding the neurochemical correlates responsible for this deficit. The aims of this study were to 1) assess the efficacy of descending pain inhibition in pain-free and chronic pain subjects, 2) screen for changes in centrally (ie, cerebrospinal fluid) and peripherally (ie, plasma) acting monoamine concentrations, and 3) explore the relationship between descending pain inhibition and monoamine neurotransmitter concentrations. Our results clearly show a deficit in pain inhibition, along with lower plasma norepinephrine and metanephrine concentrations in chronic pain subjects, compared to pain-free subjects. No differences were found in cerebrospinal fluid neurotransmitter concentrations. Finally, our results revealed a positive relationship between blood-bound norepinephrine and metanephrine concentrations and the efficacy of descending pain inhibition. Thus, basal monoamine levels in blood were related to descending pain inhibition. This finding supports the emerging idea that individual differences in descending pain inhibition may be linked to individual differences in peripheral processes, such as monoamines release in blood, which are possibly related to cardiovascular control. PERSPECTIVES This article presents psychophysical and neurochemical findings that indicate that the latent potential of descending pain inhibitory responses is associated with differential activity in peripheral processes governed by monoamine neurotransmitter release, bringing insights into the relationship between descending pain inhibition and cardiovascular control in humans.
Collapse
|
484
|
Yoon H, Kim MJ, Yoon I, Li DX, Bae H, Kim SK. Nicotinic Acetylcholine Receptors Mediate the Suppressive Effect of an Injection of Diluted Bee Venom into the GV3 Acupoint on Oxaliplatin-Induced Neuropathic Cold Allodynia in Rats. Biol Pharm Bull 2015; 38:710-4. [DOI: 10.1248/bpb.b14-00797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Heera Yoon
- Department of Physiology, College of Korean Medicine, Kyung Hee University
| | - Min Joon Kim
- Department of East-West Medicine, Graduate School, Kyung Hee University
| | - Insoo Yoon
- Department of Physiology, College of Korean Medicine, Kyung Hee University
| | - Dong Xing Li
- Department of Physiology, College of Korean Medicine, Kyung Hee University
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University
| | - Sun Kwang Kim
- Department of East-West Medicine, Graduate School, Kyung Hee University
- Department of Physiology, College of Korean Medicine, Kyung Hee University
| |
Collapse
|
485
|
Affiliation(s)
- Bridget M Lumb
- School of Physiology and Pharmacology, Medical Sciences Building, University of Bristol, University Walk, Bristol, BS8 1TD, UK
| |
Collapse
|