Differentiation between spinal and supraspinal sites of action of morphine when inhibiting the hindleg flexor reflex in rabbits

Brainstem Modulation of Nociception by Periaqueductal Gray Neurons Expressing the μ-Opioid Receptor in Mice

BACKGROUND

Pharmacologic manipulations directed at the periaqueductal gray have demonstrated the importance of the μ-opioid receptor in modulating reflexive responses to nociception. The authors hypothesized that a supraspinal pathway centered on neurons in the periaqueductal gray containing the μ-opioid receptor could modulate nociceptive and itch behaviors.

METHODS

The study used anatomical, optogenetic, and chemogenetic approaches in male and female mice to manipulate μ-opioid receptor neurons in the periaqueductal gray. Behavioral assays including von Frey, Hargreaves, cold plantar, chloroquine-induced itch, hotplate, formalin-induced injury, capsaicin-induced injury, and open field tests were used. In separate experiments, naloxone was administered in a postsurgical model of latent sensitization.

RESULTS

Activation of μ-opioid receptor neurons in the periaqueductal gray increased jumping (least-squares mean difference of -3.30 s; 95% CI, -6.17 to -0.44; P = 0.023; n = 7 or 8 mice per group), reduced itch responses (least-squares mean difference of 70 scratching bouts; 95% CI, 35 to 105; P < 0.001; n = 8 mice), and elicited modestly antinociceptive effects (least-squares mean difference of -0.7 g on mechanical and -10.24 s on thermal testing; 95% CI, -1.3 to -0.2 and 95% CI, -13.77 to -6.70, and P = 0.005 and P < 0.001, respectively; n = 8 mice). Last, the study uncovered the role of the periaqueductal gray in suppressing hyperalgesia after a postsurgical state of latent sensitization (least-squares mean difference comparing saline and naloxone of -12 jumps; 95% CI, -17 to -7; P < 0.001 for controls; and -2 jumps; 95% CI, -7 to 4; P = 0.706 after optogenetic stimulation; n = 7 to 9 mice per group).

CONCLUSIONS

μ-Opioid receptor neurons in the periaqueductal gray modulate distinct nocifensive behaviors: their activation reduced responses to mechanical and thermal testing, and attenuated scratching behaviors, but facilitated escape responses. The findings emphasize the role of the periaqueductal gray in the behavioral expression of nociception using reflexive and noxious paradigms.

EDITOR’S PERSPECTIVE

The effect of lowering the 5-hydroxytryptamine content of the rat spinal cord on analgesia produced by morphine

1. Injection of 5,6-dihydroxytryptamine (5,6-DHT, 50 mug) into a lateral cerebral ventricle of male rats lowered the 5-hydroxytryptamine (5-HT) content of the lumbar cord to 12.8% and reduced the analgesic effect of low doses of morphine (0.64-1.63 mg/kg), tested by exerting pressure on the foot; after doses of morphine of 1.33-1.63 mg/kg, the analgesic response was reduced or abolished in 33% of the rats, and after 0.64 mg/kg, 58% of the animals failed to respond normally.2. Two days after an I.P. injection of p-chlorophenylalanine (pCPA, 320 mg/kg), the loss of analgesic potency of morphine was more pronounced than after intraventricular 5,6-HDT. The 5-HT content was lowered to about 8% in the lumbar cord, and to 20% or less in pons and medulla.3. The experiments show that interference with the descending tryptaminergic axons innervating the cord is by itself sufficient to reduce analgesia due to morphine, but they do not exclude the possibility that other tryptaminergic neurones take part in the effect of pCPA. The contribution to the analgesic effect of morphine made by the interaction of tryptaminergic axons with the interneurones ;gating' the afferent impulses in the posterior columns is discussed.

Inhibition by spinal mu- and delta-opioid agonists of afferent-evoked substance P release

Opioid mu- and delta-receptors are present on the central terminals of primary afferents, where they are thought to inhibit neurotransmitter release. This mechanism may mediate analgesia produced by spinal opiates; however, when they used neurokinin 1 receptor (NK1R) internalization as an indicator of substance P release, Trafton et al. (1999) noted that this evoked internalization was altered only modestly by morphine delivered intrathecally at spinal cord segment S1-S2. We reexamined this issue by studying the effect of opiates on NK1R internalization in spinal cord slices and in vivo. In slices, NK1R internalization evoked by dorsal root stimulation at C-fiber intensity was abolished by the mu agonist [D-Ala2, N-Me-Phe4, Gly-ol5]-enkephalin (DAMGO) (1 microM) and decreased by the delta agonist [D-Phe2,5]-enkephalin (DPDPE) (1 microM). In vivo, hindpaw compression induced NK1R internalization in ipsilateral laminas I-II. This evoked internalization was significantly reduced by morphine (60 nmol), DAMGO (1 nmol), and DPDPE (100 nmol), but not by the kappa agonist trans-(1S,2S)-3,4-dichloro-N-mathyl-N-[2-(1-pyrrolidinyl)cyclohexyl]-benzeneacetamide hydrochloride (200 nmol), delivered at spinal cord segment L2 using intrathecal catheters. These doses of the mu and delta agonists were equi-analgesic as measured by a thermal escape test. Lower doses neither produced analgesia nor inhibited NK1R internalization. In contrast, morphine delivered by percutaneous injections at S1-S2 had only a modest effect on thermal escape, even at higher doses. Morphine decreased NK1R internalization after systemic delivery, but at a dose greater than that necessary to produce equivalent analgesia. All effects were reversed by naloxone. These results indicate that lumbar opiates inhibit noxious stimuli-induced neurotransmitter release from primary afferents at doses that are confirmed behaviorally as analgesic.

Pharmacology and mechanisms of opioid analgesic activity

Opiates by an action at specific receptors can induce a highly selective alteration in the response of humans and animals to strong and otherwise aversive chemical, mechanical or thermal stimuli. Specific investigations in a variety of species from rodent to primate using microinjection techniques to examine the pharmacology of local drug action have shown potent antinociceptive actions to be mediated by a receptor specific action at a number of sites within the brain, including the periaqueductal gray (PAG: mu receptor), the rostral ventral medulla (mu/delta receptor) and the substantia nigra (mu receptor) and within the spinal dorsal horn (mu/delta/kappa receptor). Mechanistic studies have shown these actions in the different sites to be mediated by several discrete mechanisms. For example, in the PAG, the local opiate effect is likely mediated by the indirect activation of bulbospinal pathways, rostral projections to forebrain sites and by a local alteration in afferent input into the brainstem core. In the spinal cord, this effect is mediated by an action presynaptic to the primary afferent and by a post-synaptic effect to hyperpolarize projection neurons. In addition, it is now appreciated that mu and kappa receptors in the periphery can modulate the sensitized state of the small afferent terminal innervating inflamed tissue and exert an anti-hyperalgesic action. After systemic delivery of an opiate, it is thus clear that a wide array of central and peripheral systems serve to explain the powerful analgesic effect exerted by this class of agents.

Effects of morphine on somatocardiac sympathetic reflexes in spinalized cats

The effects of morphine on sympathetic reflexes, recorded in the inferior cardiac nerve, to myelinated A and unmyelinated C afferent stimulation were tested in 17 acutely spinalized cats. Stable sympathetic A and C reflexes of short latency (approximately 30 ms and 140 ms in the case of the ulnar nerve, respectively) could be recorded in the inferior cardiac sympathetic nerve to stimulation of somatic A and C afferents in the ulnar and upper thoracic intercostal nerves, ipsilaterally. Spinal sympathetic A reflexes, which were primarily evoked from stimulation of A delta afferent fibers, could be elicited from more segmental levels than could sympathetic C reflexes. Additionally, smaller reflexes, only from A afferent fiber activation, were identified from stimulations on the contralateral side of the body. Small doses of morphine (0.02 mg kg-1, i.v.) proved to be ineffective at altering sympathetic A and C reflexes, while somewhat larger doses (0.2 mg kg-1, i.v.) produced a clear 62% decrease in C reflexes and a 33% decrease in A reflexes, Dosages of 1 and 2 mg kg-1 severely depressed both A and C reflexes. All of the above effects of morphine administration were completely and immediately reversible by naloxone (i.v.). The results are discussed with regard to the effects of morphine on sympathetic A and C reflexes in CNS intact, anesthetized cats.

Comparison of the effects of ventral medullary lesions on systemic and microinjection morphine analgesia

The effects of electrolytic lesions of the nucleus raphe magnus (NRM), nucleus reticularis paragigantocellularis (PGC) and nucleus raphe alatus (NRA) on analgesia elicited in the rat from systemic morphine and morphine microinjection into the periaqueductal gray (PAG) were evaluated using the tail flick test. No consistent change in baseline pain sensitivity was observed following lesions of the NRM, PGC or NRA. To determine the effect of ventral medullary lesions on systemic morphine analgesia, pain sensitivity was assessed prior to and 40 min after 6 mg/kg morphine administration (i.p.) at 2 days preceding lesioning and 5, 12 and 19 days post-lesion. NRM and PGC lesions produced only slight reductions in analgesia at 5 days after surgery. It was observed that large NRM, large PGC, and NRA lesions significantly attenuated analgesia evaluated at 12 days post-lesion. Smaller lesions confined within the NRM or PGC were reliably less effective than the larger lesions in reducing analgesia. In a subsequent study, 5 micrograms morphine in 0.5 microliter saline was microinjected into the ventral PAG at the level of the dorsal raphe. Identical testing procedures were used and the analgesia was assessed at 2 days before lesioning and 5 and 12 days post-lesion. In contrast to the previous study, large NRM lesions abolished analgesia as early as 5 days following lesioning. Small NRM lesions were less effective and PGC lesions were generally ineffective in attenuating analgesia induced by morphine microinjection. We conclude that the NRA may act as a functional unit in the mediation of systemic morphine analgesia. In contrast, analgesia elicited from intracerebral (PAG) morphine microinjection is mediated via the NRM.

A comparison of the sites at which pentazocine and morphine act to produce analgesia

Sites in the brain stem at which microinjected morphine can produce analgesia have been investigated for sensitivity to microinjections of pentazocine, which has been proposed to act at receptors different to those mediating the effects of morphine. Microinjection of 10 micrograms of pentazocine into the periaqueductal grey matter (PAG), the nucleus reticularis gigantocellularis (NRGC) and nucleus reticularis paragigantocellularis (NRPG) produced analgesia as determined by the tail flick response to noxious heat. Microinjection of pentazocine into nucleus raphe magnus (NRM) did not produce any discernible change in the nociceptive threshold measured with the tail flick test. Using the pain pressure test, analgesia was observed following microinjections of pentazocine into NRGC and NRPG, but not following microinjections into PAG or NRM. Morphine (3 and 5 micrograms) microinjected into PAG, NRM, NRGC or NRPG produced analgesia as determined by both heat and pressure tests. The analgesia produced by injection of pentazocine into the NRGC or NRPG was comparable to the analgesia produced by microinjection of 3 micrograms of morphine into these areas. The analgesia produced by injection of pentazocine into PAG was significantly less than that produced by 3 micrograms of morphine injected into PAG. Pretreatment with naloxone did not affect the analgesia produced by microinjection of pentazocine into NRGC or NRPG, but did antagonize the analgesia produced by injection of pentazocine into PAG. Naloxone blocked the analgesic effects of microinjected morphine. Analgesia produced by systemically given pentazocine was significantly reduced following microinjection of naloxone into PAG or NRM but not into NRGC or NRPG. The present data provide further evidence that the effects of pentazocine, a kappa agonist drug may be mediated by mechanisms different to those mediating the action of morphine, a mu agonist.

Microinjection of morphine within nucleus raphe magnus and dorsal horn neurone activities related to nociception in the rat

The hypothesis of an increase by morphine of descending inhibitory controls acting upon the transmission of painful messages at the spinal level has been directly investigated in intact anaesthetized rats. The analgesic efficacy of morphine microinjections (5 micrograms in 0.2 microliter saline) applied within the nucleus raphe magnus (NRM) was examined using the threshold for vocalization after electric shock to the tail as a test: a mean threshold increase of 57% was observed. A few days later, the effects of similar microinjections upon dorsal horn cell activities were studied in acute experiments in the same animals. The response of dorsal horn convergent units induced by the activation of large myelinated (Aa) afferent fibres were unaffected by the microinjection of morphine within the NRM. In the case of the responses of convergent units induced by the activation of unmyelinated (C) afferent fibres, two different results were obtained after microinjection of morphine within the NRM: 8/14 units were not affected and 6/14 were clearly excited. A transient reversal of the excitatory effects was observed after the systemic administration of the opiate antagonist naloxone. The responses of marginal layer cells (lamina 1) were unaffected by the microinjection of morphine within the NRM. These unexpected results are discussed in view of the fact that they conflict with current concepts regarding morphine analgesia.

Antinociceptive action following microinjection of methionine-enkephalin in the nucleus raphe magnus of the rat

The analgesic effect of the microinjection of low doses of methione-enkephalin (20 micrograms in 0.5 microliter) into the caudal brain stem of the unrestrained rat was investigated by means of one vocalisation test. Immediate short duration significant increases in threshold (21%) were seen from sites in the nucleus raphé magnus (NRM). Delayed effects were seen from sites immediately adjacent to this nucleus; sites more lateral produced no significant effect. These results lend further support to the postulated role of NRM in antinociception.

Inhibition of spinal cord interneurons by narcotic microinjection and focal electrical stimulation in the periaqueductal central gray matter

Single cell evoked activity was recorded from spinal cord interneurons in rats prepared with microinjection cannulae or stimulating electrodes in the periaqueductal central gray matter (PAG). Morphine microinjections (4-16 microgram) inhibited the response evoked by a noxious stimulus in 55% of the wide dynamic range neurons tested. Microinjections of etorphine (0.25-0.5 microgram) inhibited 82% of the nociceptive neurons tested. Neither drug inhibited neurons which responded only to innocuous mechanical stimulation. The inhibition of wide dynamic range neurons produced by narcotic microinjection was antagonized by naloxone (1 mg/kg, i.p.) in 7 of 11 cases. Control experiments indicated that the effects obtained with microinjections could not be attributed to the drugs' diffusion to the spinal cord. Focal electrical stimulation of the PAG inhibited the responses to noxious stimuli of 60% of wide dynamic range neurons but was without effect on the responses of neurons that were activated only by innocuous stimuli. These experiments directly demonstrate that narcotic analgesics restricted to an intracerebral site of action activate a neural system which preferentially inhibits the responses of spinal cord wide dynamic range neurons to noxious stimuli. The system has a specificity for nociceptive input since non-nociceptive neurons were unaffected. Directly comparable results were produced by electrical stimulation of the PAG, supporting the concept that stimulation and narcotics modulate the transmission of nociceptive information by similar mechanisms.

Evidence that raphe-spinal neurons mediate opiate and midbrain stimulation-produced analgesias

The present experiments were undertaken to assess the role of neurons in the nucleus raphe magnus (NRM) in mediating opiate and stimulation-produced analgesias. A cannode for both electric stimulation and local opiate microinjection was placed in the midbrain preiaqueductal gray region of decerebrate or chloralose-urethane anesthetized cats. Microelectrodes recorded the responses of medullary NRM neurons. Raphe-spinal neurons were identified by antidromic activation from the cerevical spinal cord. Fifteen of 20 raphe-spinal cells tested were excited by electrical stimulation of the midbrain. Of 49 NRM neurons tested, 26 were excited by either systemic or midbrain injection of opiate agonist. Twelve of 33 NRM cells tested by midbrain microinjection were excited. In 10 the effect was reversed by naloxone. Seventeen raphe-spinal neurons were tested; 5 showed naloxone-reversible excitation to either midbrain or intravenous injection of opiates. NRM neurons respond to auditory and somatic stimuli; at least half respond maximally to somatic stimuli of noxious intensity. These findings are consistent with the hypothesis that the raphe-spinal projection mediates opiate and electrical stimulation-produced effects from midbrain sites. The properties of raphe-spinal neurons suggest that they are part of a negative feedback system which monitors and limits the output of spinal dorsal horn pain-transmission neurons.

Endogenous pain control mechanisms: review and hypothesis

The anatomy, physiology, and pharmacology of an intrinsic neural network that monitors and modulates the activity of pain-transmitting neurons is reviewed. This system can be activated by opiate administration or by electrical stimulation of discrete brainstem sites. Evidence is presented that its pain-suppressing action is mediated in part by endogenous opiatelike compounds (endorphins). This pain suppression system is organized at three levels of the neuraxis: midbrain, medulla, and spinal cord. Activation of neurons in the midbrain periaqueductal gray matter (by electrical stimulation, opiates, and possibly psychological factors) excites neurons of the rostral medulla, some of which contain serotonin. The medullary neurons, in turn, project to and specifically inhibit the firing of trigeminal and spinal pain-transmission neurons. As part of a negative feedback loop, the output of the pain transmission neurons, i.e., pain itself, is an important factor in activating the pain-suppression system. A neural model which incorporates the experimental findings is proposed, and the clinical implications of the model are discussed.

Autoradiographic localization of opiate receptors in rat brain. I. Spinal cord and lower medulla

The localization of opiate receptors in the spinal cord and lower medulla has been elucidated by the autoradiographic identification of stereospecific [3H]diprenorphine (a potent opiate antagonist) binding sites. The opiate receptors were higly localized to: layers I (marginal cell zones) and II (substantia gelatinosa) of the dorsal horn of the spinal cord; the substantia gelationsa of the spinal trigeminal nucleus; components of the vagal system, including the vagus nerve, nucleus tractus solitarius, nucleus commissuralis, nucleus intercalatus, nucleus ambiguus and nucleus originis dorsalis vagus; the area postrema. Examination of [3H]etorphine (a potent opiate agonist) binding sites showed the same distribution. We conclude that, in these brain regions, opiate receptors are (1) highly associated with areas receiving small, afferent primary fibers, (2) strategically placed to modulate noxious stimuli as well as explain some visceral side effects of opiate administration.

Effects of morphine upon the lamina V type cells activities in the dorsal horn of the decerebrate cat

The effects of morphine (2 mg/kg i.v.) upon the transmission of nociceptive messages at the spinal level have investigated in decerebrate cats by studying its effects on the activities of lamina V dorsal horn interneurons. In contrast to previous results obtained on the spinal cat, morphine had little or no effects on lamina V type cells in the decerebrate preparation. The mean values for spontaneous activity and responses to natural noxious stimulation were practically identical before and after morphine administration. Moreover, no significant depressive effect was found on responses induced by supramaximal transcutaneous stimulation. However, for this type of activity a depressive effect was revealed, if only the late component of units which presented bimodal responses were considered. We were unable to demonstrate after morphine administration an increase of the descending inhibitory effects induced on lamina V cells by stimulation of the central inferior nucleus of the raphe. Additional experiments using reversible spinalization (by cooling the cord at the thoracic level) suggest that the lack of effect of morphine on decerebrate animals could be explained by the fact that in this preparation, descending inhibitory influences are strongly exacerbated and thus may mask the depressive effects of this drug. These results indicate that the direct electrophysiological evidence of an increase of the descending control systems after morphine administration must be performed in the intact preparation in order to avoid the effects ot their exacerbation in the decerebrate state.

Depressive effects of morphine upon lamina V cells activities in the dorsal horn of the spinal cat

The effects of morphine upon the transmission of nociceptive messages at the spinal level have been investigated in spinal cats by studying its effects on the activities of lamina V dorsal horn interneurons. Morphine (2 mg/kg i.v.) induced a direct depressive action at the spinal level, since it strongly reduced both spontaneous and evoked activities of lamina V cells. The spontaneous firing rate and the responses elicited by natural nociceptive stimulation were decreased by 50%. The responses of these units evoked by supramaximal electrical stimulation were reduced to 67% of their initial value; in this case, the depressive effect was much more prominent on the late component of the long duration responses. The observed depressive effects are specific since they are immediately reversed by administration of opiate antagonists (nalorphine or naloxone).

Monoaminergic mechanisms of stimulation-produced analgesia

The roles played by the cerebral monoamines (dopamine, noradrenaline and serotonin) in stimulation-produced analgesia (SPA) have been investigated in the rat employing the tail flick test. SPA was elicited through bipolar electrodes chronically implanted in the mesencephalic periaqeductal gray matter, an area previously shown to yield potent and reliable analgesic effects. Four approaches were used to alter transmission in monoamine pathways. (1) Depletion of monoamines by administration of tetrabenazine (TBZ), p-chlorophenylalanine (PCPA), alpha-methyl-para-tyrosine (AMPT), or disulfiram. (2) Replacement of depleted monoamine stores by appropiate precursors (5-HTP or L-DOPA) in combination with a peripheral decarboxylase inhibitor. (3) Potentiation of monoamine systems by administration of precursors to previously untreated animals or by administration of a dopamine receptor stimulator, apomorphine. (4) Blockade of catecholamine receptors by haloperidol or of dopamine receptors by pimozide. These four approaches yielded internally consistent results. Depletion of all 3 monoamines (TBZ) led to a powerful inhibition of SPA. Original levels of SPA were restored by injection of either 5-HTP or L-DOPA. Specific depletion of serotonin (PCPA) caused a reduction in SPA, whereas elevation of serotonin levels (5-HTP) caused an increase in SPA. Dopamine receptor blockade (pimozide) decreased SPA, whereas the precursor (L-DOPA) and a dopamine receptor stimulator (apomorphine) increased SPA. On the other hand, selective depletion of noradrenaline (disulfiram) caused an increase in SPA; and at a time when noradrenaline levels are depressed and dopamine levels are elevated (AMPT + L-DOPA), SPA was seen to be particularly enhanced. thus, dopamine and serotonin appear to facilitate SPA, whereas noradrenaline appears to inhibit it. When a general catecholamine receptor blocker (haloperidol) was employed, SPA was diminished, suggesting that the influence of dopamine in SPA is greater than that of noradrenaline. Most of the drugs used in this study significantly altered SPA at doses which left baseline tail flick latency unaffected. It would appear, therefore, that SPA has a neural substrate at least partly independent of that underlying baseline pain responsiveness. Consideration is given to various ascending and descending monoamine system as possible component paths in this neural substrate of SPA. Finally, the present results are discussed in relation to studies by others on the site and mechanism of morphine's analgesic action. Some striking parallels between SPA and morphine analgesia are noted. These suggest the existence of a common pain-inhibitory system in the brain activated by morphine and by focal electrical stimulation.