Evidence of a supraspinal opioid analgesic mechanism engaged by lateral hypothalamic electrical stimulation

Neurotensin and pain modulation

Neurotensin (NT) can produce a profound analgesia or enhance pain responses, depending on the circumstances. Recent evidence suggests that this may be due to a dose-dependent recruitment of distinct populations of pain modulatory neurons. NT knockout mice display defects in both basal nociceptive responses and stress-induced analgesia. Stress-induced antinociception is absent in these mice and instead stress induces a hyperalgesic response, suggesting that NT plays a key role in the stress-induced suppression of pain. Cold water swim stress results in increased NT mRNA expression in hypothalamic regions known to project to periaqueductal gray, a key region involved in pain modulation. Thus, stress-induced increases in NT signaling in pain modulatory regions may be responsible for the transition from pain facilitation to analgesia. This review focuses on recent advances that have provided insights into the role of NT in pain modulation.

Selective amino acids changes in the medial and lateral preoptic area in the formalin test in rats

A combination of microdialysis in freely moving rats and capillary zone electrophoresis coupled to laser induced fluorescence detection was used to measure extracellular concentrations of amino acid neurotransmitters in different hypothalamic areas during noxious stimulation. Arginine, glutamate and aspartate were monitored every 30 s before and after a s.c. injection of formalin (5%, 50 microl) or saline (0.9%) in the right hind paw. In the medial and lateral preoptic area, calcium and nerve impulse dependent increases of arginine, glutamate and aspartate were observed during the first 2 min after formalin injection. However, amino acid changes were not detected in the lateral hypothalamus or in the ventromedial nucleus when compared with pre-injection levels or with the levels from animals injected with saline in the hind paw. Flinching behavior was also scored during the first 10 min following the formalin or saline injection. Flinching frequency was maximum at minute 2 after formalin injection, whereas saline injection did not elicited any flinching behavior. These results show that nociceptive stimulation induces rapid and differential amino acids changes in discrete areas of the hypothalamus that can be associated with pain-related behavior.

Antinociceptive effects of brain rewarding system in the developing rabbit: behavioral and electrophysiological analysis

The modulating effects of electrical stimulation (ES) in the reward sites (RSs) of the hypothalamus and adjacent brain areas on the defensive reaction (DR) in response to peripheral noxious stimulation (PNS) and on evoked potentials (EPs) recorded in the thalamic centromedian-parafascicular complex (CM-Pf) to the same PNS have been investigated in 20-40-, 41-60-day old and 3-5-month old rabbits. Previously, RSs were identified by the method of intracranial self-stimulation (ICSS). Behavioral and electrophysiological testings successively performed on each rabbit first awake and then anaesthetized have revealed the ES in all investigated RSs to inhibit DR and EPs. These effects were not observed if the stimulating electrode tip was localized in emotionally neutral brain sites. In behavioral testings, the antinociceptive effect of rewarding stimulation was positively correlated with the ICSS intensity in given brain sites regardless of the age of the rabbits. In electrophysiological testings, a similar dependence of nociceptive EPs inhibition on emotional values of stimulated brain sites (determined as a rate of lever pressings during ICSS) was discovered only in 20-40-day and 3-5-month old rabbits. Stimulation of low emotional value RSs (low rate (LR)-rabbits) exerted a weaker inhibitory influence in 3-5-month old rabbits in comparison with 20-40- and 41-60-day old rabbits both in behavioral and electrophysiological testings. The weakest antinociceptive effect of rewarding stimulation among the rabbits with a high rate of lever pressings (HR-rabbits) was found in 41-60-day olds in electrophysiological testings. In 41-60-day old rabbits, we have observed a discrepancy between the behavioral analgesia and its electrophysiological correlates. It may be suggested that the observed peculiarities of antinociceptive influences produced by RSs ES are determined by the age factors of neurotransmitter brain systems.

Opioid supraspinal analgesic synergy between the amygdala and periaqueductal gray in rats

Analgesia can be elicited following microinjections of morphine, mu-selective agonists and beta-endorphin into the amygdala. These analgesic responses are mediated by opioid synapses in the periaqueductal gray (PAG) since general (naltrexone), mu (beta-funaltrexamine) and delta2 (naltrindole isothiocyanate) opioid antagonists administered into the PAG significantly reduce both morphine and beta-endorphin analgesia elicited from the amygdala. Supraspinal multiplicative opiate analgesic interactions have been observed between the PAG and rostroventromedial medulla (RVM), the PAG and locus coeruleus (LC), and the RVM and LC. The present study further examined the relationship between the amygdala and PAG in analgesic responsiveness by determining whether multiplicative analgesic interactions occur following paired administration of subthreshold doses of morphine into both structures, beta-endorphin into both structures, morphine into one structure and beta-endorphin into the other structure, or morphine and beta-endorphin into one structure. Co-administration of subthreshold doses of morphine into both the amygdala and PAG results in a profound synergistic interaction on the jump test, but not the tail-flick test. Co-administration of subthreshold doses of beta-endorphin into both structures also results in a profound test-specific synergistic interaction. In both cases, the magnitude of the interaction was similar regardless of the site receiving the fixed dose of the opioid, and the site receiving the variable dose of the opioid. Co-administration of beta-endorphin (1 microg) into the amygdala and morphine (1 microg) into the PAG produced a potent interaction, but co-administration of morphine (1 microg) into the amygdala and beta-endorphin (1 microg) into the PAG failed to produce interactive effects. Finally, co-administration of morphine (1 microg) and beta-endorphin (1 microg) into either the amygdala alone or the PAG alone failed to produce an interaction, indicating the importance of regional opioid activation. These data are discussed in terms of the test-specificity of nociceptive processing in the amygdala, in terms of the multiple modulatory mechanisms mediating beta-endorphin analgesia in the PAG, and in terms of whether the interactions are either mediated by anatomical connections between the amygdala and PAG or by mechanisms initiated by these two sites converging at another site or sites.

Lateral hypothalamus: site involved in pain modulation

The present study is an attempt to examine the neuronal circuitry of a supraspinal site engaged in pain modulation. Five physiological measures were postulated as the criteria for defining a central nervous system site engaged in the circuitry of pain modulation. The lateral hypothalamus met these five measures: (i) 81% of the lateral hypothalamus neurons (247/304) responded to noxious stimuli using a single cell recording procedure; (ii) stimulation of the periaqueductal gray-dorsal raphe area or the habenula modulated 98% and 87% of the lateral hypothalamus noxious-evoked activity; (iii) microiontophoretically applied morphine modulated 77% of the lateral hypothalamus noxious evoked activity; (iv) electrical stimulation of the lateral hypothalamus produced behavioral analgesia proportional to the stimulus intensity as assessed by the tail flick assay; and (v) morphine application into the lateral hypothalamus produced behavioral analgesia in a dose-response manner using the tail flick assay. In conclusion, the lateral hypothalamus can be considered one of the pain modulation sites.

Analgesic responses elicited by endogenous enkephalins (protected by mixed peptidase inhibitors) in a variety of morphine-sensitive noxious tests

It has been suggested that the endogenous opioid peptides, methionine and leucine enkephalin, participate only in naloxone-facilitated antinociceptive responses. To reassess this proposal, analgesic effects resulting from complete inhibition of enkephalin metabolism by intracerebroventricular (i.c.v.) administration of the mixed inhibitor RB 38A (R,S)HONHCOCH2CH(CH2 phi)CONHCH(CH2 phi)COOH) were compared to the effects of morphine (i.c.v.) in various assays commonly used to select analgesics: mouse hot plate-test, tail flick test with mice and rats, electrical stimulation of the tail (TES), paw pressure test with rats, and phenylbenzoquinone-induced writhing test with mice. The ED50s of morphine vs. ED50s of RB 38A in the writhing, hot plate (jumping) and tail flick tests with mice were 0.24 nmol vs. 38 nmol, 1 nmol vs. 36 nmol and 3.2 nmol vs. 285 nmol, respectively. RB 38A (ED30 153 nmol) was only 15 times less active in the tail flick test with rats than morphine and only halve as active in the paw pressure test. Noxious TES in rat was very sensitive to the inhibitory action of endogenous opioids protected by RB 38A, particularly the post-vocalization response which was also shown to be alleviated by antidepressants. All the analgesic effects observed were reversed by naloxone. This first direct evidence of analgesia resulting from peptidase inhibition, in the tail flick test with mice and rats, hot plate (paw lick) and TES shows that the pain suppressive effects of endogenous opioid peptides are not restricted to naloxone-facilitated noxious stimuli but occur more generally, in all morphine-sensitive tests. The differential effects of RB 38A in the various assays is likely to be related to the amount of enkephalins released and to the efficiency of peptidase inactivation in particular brain regions implicated in the control of a given nociceptive input. This mechanism could account for the reduction in side-effects compared to those of morphine following chronic administration of RB 38A.

Collateralization of periaqueductal gray neurons to forebrain or diencephalon and to the medullary nucleus raphe magnus in the rat

Antinociceptive effects elicited from the midbrain may involve both ascending and descending projections from the periaqueductal gray and dorsal raphe nucleus. To investigate the relationship between these different efferent pathways in the rat, we performed a double-labeling study using two retrograde tracers, colloidal gold-coupled wheatgerm agglutinin-apo horseradish peroxidase and a fluorescent dye. One tracer was microinjected in the medullary nucleus raphe magnus; the second was injected into one of several regions rostral to the periaqueductal gray that have been implicated in nociceptive and antinociceptive processes. The results can be grouped into two categories. First, injections into the ventrobasal thalamus, lateral hypothalamus, amygdala, and cerebral cortex labeled neurons in the dorsal raphe nucleus but not in the periaqueductal gray. Up to 90% of these projection neurons were serotonin immunoreactive, and up to 17% were also retrogradely labeled from the nucleus raphe magnus. Second, only injections into the ventrobasal hypothalamus (which included the beta-endorphin-containing arcuate neurons) or into the medial thalamus labeled neurons in the periaqueductal gray itself. Injections into the medial thalamus, but not into the ventrobasal hypothalamus, also labeled neurons in the dorsal raphe nucleus. Up to 20% of the neurons retrogradely labeled from these regions were also retrogradely labeled from nucleus raphe magnus. The presence of large populations of rostrally projecting periaqueductal gray neurons that collateralize to the nucleus raphe magnus implies that activity in ascending projections necessarily accompanies any activation of the periaqueductal gray-nucleus raphe magnus pathway. Possibly, projections from the medial thalamus and medial hypothalamus mediate antinociceptive effects that complement descending inhibition. Finally, possible antidromic activation of these pathways must be considered when interpreting the results of electrical brain stimulation studies.

Brain stimulation-induced feeding alters regional opioid receptor binding in the rat: an in vivo autoradiographic study

Although opioid antagonists block feeding behavior in a variety of animal models, the number and identity of CNS regions in which the inferred endogenous opioid activity mediates feeding have yet to be established. Furthermore, it is not yet clear whether the opioid activity that sustains feeding is a concomitant of the appetitive motivational state or the consummatory response. In an effort to address these issues, an in vivo autoradiographic method was used to visualize CNS regional changes in opioid release during appetitively motivating electrical stimulation in the lateral hypothalamus (ESLH) and during consummatory behavior elicited by such stimulation. Regional decreases in [3H]diprenorphine [(3H]Dpr) binding, suggesting increased release of an endogenous opioid peptide, were observed in the medial prefrontal cortex, medial septum, gustatory cortex, zona incerta, mediodorsal thalamus, and hippocampus of rats receiving ESLH. Decreased binding in the latter 4 structures did not appear when animals were allowed to eat during ESLH, suggesting that the inferred opioid release is associated with appetitive behaviors elicited by ESLH which are suppressed when food is available and consummatory behavior predominates. When animals were allowed to eat during ESLH, [3H]Dpr binding in anterior cingulate cortex decreased substantially, suggesting that feeding behavior specifically triggers opioid release in this region. ESLH and feeding were found to increase [3H]Dpr binding in a number of CNS regions. Alternative explanations for increased binding, including inhibition of tonic opioid release, changes in cerebral blood flow, and opioid receptor up-regulation are discussed.

Opiocortin and catecholamine projections to raphe nuclei

Afferent projections to the nucleus raphe magnus (NRM) and dorsal raphe nucleus (DRN) were identified using retrograde transport of horseradish peroxidase conjugated wheat germ agglutinin (HRP-WGA). Neurons were labeled in important nociceptive regions including periaqueductal gray (PAG), arcuate nucleus, lateral hypothalamus and medial thalamic nuclei following both injections. We have immunocytochemically identified opiocortin/WGA neurons in the arcuate nucleus following NRM and DRN injections. Dual stained catecholamine/WGA perikarya were found in zona incerta, locus coeruleus, substantia nigra, nucleus tractus solitarius and adjacent A2, C2 and C3, lateral paragigantocellular reticular nucleus/C1 and lateral reticular nucleus/A1 following DRN injections and in zona incerta, substantia nigra, nucleus tractus solitarius/A2 and lateral reticular nucleus/A1 after NRM injections. These results provide further evidence for opiocortin and catecholamine modulation of analgesia.

Neuronal and neurochemical mechanisms of hypothalamic inhibition of the nociceptive reflex

Using cats anesthetized with chloralose-Nembutal we have studied the effect of high frequency stimulation of the medial and lateral structures of the posterior, tuberal, and anterior hypothalamus, and also of the central gray matter of the midbrain on the nociceptive jaw-opening reflex induced by tooth pulp stimulation. We recorded the EMG response of the digastric muscle as the index of the nociceptive reflex. We have shown that the EMG response of the nociceptive reflex is effectively suppressed on stimulation of all hypothalamic structures and the central gray matter, the threshold of the suppressive action being lower on stimulation of the central gray matter. The effects of the hypothalamic suppression of the nociceptive reflex were eliminated almost completely after naloxone administration, with the exception of the central gray matter, which is slightly more resistant to the action of this agent. After bilateral electrolytic destruction of the central gray matter the antinociceptive effect of the hypothalamus was retained, decreasing only insignificantly, The effect of complete suppression of the amplitude of the EMG response, similar to the effect of stimulation of the hypothalamus and the central gray matter, was also observed after intravenous administration of phenapidine, an opiate agonist with a marked central analgesic action. The neuronal and neurochemical mechanisms of hypothalamic suppression of the nociceptive jaw-opening reflex are discussed.

The nature of posterior hypothalamic projections to cardiorespiratory centers in the brainstem

Focal electrical stimulation of the midlateral posterior hypothalamus in the rat produces rapid shallow respiration accompanied by a rise in arterial blood pressure. Stimulation of presumably intrinsic neurons only by glutamate induces slower deeper respiration associated with a fall in blood pressure.

Serotonin and/or an excitatory amino acid in the medial medulla mediates stimulation-produced antinociception from the lateral hypothalamus in the rat

Several lines of evidence have demonstrated a role for the lateral hypothalamus (LH) in an endogenous system of descending inhibition. Descending inhibition from the LH relies, at least in part, on a relay(s) in the midbrain and/or medulla. The medullary nucleus raphe magnus (NRM) serves as one such relay. The present study, in rats lightly anesthetized with pentobarbital, was undertaken to systematically examine the transmitter(s) in the medial medulla mediating descending inhibition of the nociceptive tail flick (TF) reflex produced by focal electrical stimulation in the LH. The microinjection of pharmacologic receptor antagonists (5 micrograms) into the NRM revealed that the glutamate receptor antagonists, gamma-D-glutamylglycine and 2-amino-5-phosphonovalerate produced the largest increases in stimulation thresholds in the LH for inhibition of the TF reflex (107.6% and 102.6%, respectively). Methysergide, a serotonin receptor antagonist, also produced a significant increase (81.5%) in the stimulation threshold in the LH for inhibition of the TF reflex. The opioid receptor antagonist, naloxone, however, was without effect, producing only a 4.0% increase in the LH stimulation threshold. These results suggest that serotonin and/or an excitatory amino acid are transmitters at the bulbar relay in the medial medulla mediating descending inhibition of the TF reflex produced by focal electrical stimulation in the LH.

Analgesia produced by injection of lidocaine into the lateral hypothalamus

The local anesthetic lidocaine was injected into the lateral hypothalamus (LH) of awake, freely moving rats immediately prior to pain testing with either the formalin or the foot-flick test. Regional anesthesia of the LH resulted in a significant bilateral reduction of pain scores in the formalin test but had no effect in the foot-flick test. The decreased pain in the formalin test was not due to the diffusion of lidocaine into areas surrounding the LH or other possible artifacts. The results provide further evidence of hypothalamic involvement in pain perception and indicate that different neural systems subserve different types of pain.

The effects of nitrous oxide on the central endogenous pro-opiomelanocortin system in the rat

The hypothesis that nitrous oxide stimulates the central pro-opiomelanocortin system in vivo was explored in this study. A concentration-dependent stimulation of central pro-opiomelanocortin neuropeptides was demonstrated after exposures to variable concentrations of nitrous oxide with oxygen. Rats exposed to 60% and 80% nitrous oxide with oxygen demonstrated an elevation of beta-endorphin concentration along the neuraxis involved with analgesia; no similar effect was observed in alpha-MSH concentration, neither duration of exposure nor acclimation to the enclosed environment altered this stimulation. The discontinuation of nitrous oxide exposure resulted in the diminution of beta-endorphin concentration to pre-exposure levels in 15-30 min. With an ACTH1-39 antisera, a semiquantitative increase in opiocortin immunoreactivity after exposures to nitrous oxide was demonstrated. In conclusion, the increase in beta-endorphin concentration and immunoreactive ACTH1-39 staining in the cells of origin, areas of fiber projection and terminal fields suggest that nitrous oxide stimulates the central pro-opiomelanocortin system in vivo in the rat.

Spinal monoamine mediation of stimulation-produced antinociception from the lateral hypothalamus

Stimulation-produced antinociception can be evoked from a wide variety of sites in the brain, including the lateral hypothalamus (LH). The present study, in rats lightly anesthetized with pentobarbital, examined descending inhibition of the nociceptive tail flick (TF) reflex produced by focal electrical stimulation in the LH and the neurotransmitter(s), at the level of the lumbar enlargement, mediating the inhibition. Systematic tracking studies demonstrated that stimulation in the diencephalon dorsal to the hypothalamus did not reliably inhibit the TF reflex. Inhibition of the TF reflex was produced, however, throughout the hypothalamus at intensities of stimulation typically between 50 and 200 microA. The area requiring low intensities of stimulation (50-100 microA) to inhibit the TF reflex was a diffuse region of the LH, inferior to the mammillothalamic tract and internal capsule, medial to the supraoptic decussation and including the medial forebrain bundle. Microinjections of S-glutamate (100 mM, 0.5 microliter) in the LH did not inhibit the TF reflex, suggesting that activation of fibers of passage by stimulation was responsible for inhibition of the TF reflex produced from the LH. The intrathecal administration of pharmacologic antagonists (15-30 micrograms; naloxone, methysergide, phentolamine, prazosin or yohimbine) revealed that the alpha-adrenoceptor antagonists phentolamine and yohimbine produced the greatest increases in stimulation thresholds in the LH for inhibition of the TF reflex (83.7% and 89.8%, respectively). The intrathecal administration of methysergide produced a lesser, but statistically significant 11% increase in the stimulation threshold for inhibition of the TF reflex. These results indicate that spinal alpha 2-adrenoceptors primarily mediate the descending inhibition of the TF reflex produced by electrical stimulation in the LH.

Lateral hypothalamic stimulation-produced analgesia: inferred refractory period of directly stimulated neurons and resistance to pimozide antagonism

Electrical stimulation in lateral hypothalamic sites (ESLH) supporting appetitive behavior and reward also diminishes pain and aversion responses that are organized high in the neuraxis. A paired-pulse stimulation technique was used, in two different behavioral paradigms, to infer the absolute refractory periods of LH neurons that mediate this apparent supraspinal analgesia. In both paradigms, recovery from refractoriness--reflected by increased analgesic action--was evident at intrapair intervals of 0.8 msec and greater. This finding suggests that the overlap, if any, between first stage neurons mediating analgesia and appetitive/reward behavior may be restricted to the 'heterogeneous slow population' distinguished by Gratton and Wise. The dopamine antagonist pimozide, at doses known to diminish ESLH-induced feeding and reward (0.25 and 0.5 mg/kg), failed to affect analgesia. Thus, the dopaminergic second stage neurons deemed critical to feeding and reward may not play an important role in analgesia. Finally, ESLH-induced ameliorative action as a case of 'aversion-gating' or a dimension of classical somatosensory analgesia is discussed.