Effects on nociceptive threshold and blood pressure of intrathecally administered morphine and alpha-adrenergic agonists

Synthesis and biological evaluation of imidazoline derivatives as potential CNS and CVS agents

A series of substituted imidazoline derivatives were synthesized and characterized. Compounds were tested in-vivo for their antihypertensive, analgesic, antiaggressive, depressant, antidepressant, and ALD₅₀ activities. The compounds 3a, 3c, 4c, 5a, and 6c showed cardiovascular as well as central nervous system activities and are potential candidate as drug among all fifteen compounds tested. All these compounds have shown better activity for antihypertensive, analgesic, antiaggressive, and depressant-antidepressant, properties than reference compounds clonidine, morphine, diazepam, and imipramine respectively. Most of the compounds have shown ALD₅₀ > 500 mg/kg with maximum in 4a and 5a (>1000 mg/kg).

Centhaquin attenuates hyperalgesia and non-evoked guarding in a rat model of postoperative pain primarily through α2B-adrenoceptors

Centhaquin has been shown to produce antinociception in the mouse hot plate and tail flick assays through the opioid, the α2A and α2B adrenoceptors. Present study was conducted to determine the effects of centhaquin in a rat model of postoperative pain. Involvement of opioid, and adrenergic receptors was assessed by pretreating rats with antagonists at the opioid (naloxone), α2-(atipamezole) or α2B-(imiloxan) adrenergic receptors. Postoperative pain was induced by hind paw plantar incision in male Sprague Dawley rats. Antihyperalgesic effects were determined by measurement of paw withdrawal latencies and withdrawal force, using dynamic von Frey filaments; attenuation of non-evoked guarding was measured by assigning pain scores to spontaneous behaviors. Rotarod test was used to determine motor impairment. Animals received saline, centhaquin or antagonist plus centhaquin. Centhaquin produced dose-dependent antihyperalgesic effect and attenuation of non-evoked guarding behavior, versus saline treated rats (P<0.05). Naloxone partially blocked while atipamezole and imiloxan significantly reversed centhaquin's antihyperalgesic effects (P<0.05). Attenuation of non-evoked guarding behavior was also blocked, but was not statistically significant. Imiloxan produced a greater block compared to atipamezole while naloxone had no significant effect. Rotarod testing indicated that centhaquin did not cause motor impairment. This is the first report demonstrating centhaquin antinociception in the rat postoperative pain model. Opioid, α2 adrenergic, and particularly α2B adrenergic receptors are involved in mediating antihyperalgesia while attenuation of nonevoked guarding is mediated by α2B/α2 adrenergic receptors. Centhaquin could be an effective non-sedating alternative in treating postoperative pain in ambulatory surgeries.

Analgesic synergy between opioid and α2 -adrenoceptors

Opioid and α2 -adrenoceptor agonists are potent analgesic drugs and their analgesic effects can synergize when co-administered. These supra-additive interactions are potentially beneficial clinically; by increasing efficacy and/or reducing the total drug required to produce sufficient pain relief, undesired side effects can be minimized. However, combination therapies of opioids and α2 -adrenoceptor agonists remain underutilized clinically, in spite of a large body of preclinical evidence describing their synergistic interaction. One possible obstacle to the translation of preclinical findings to clinical applications is a lack of understanding of the mechanisms underlying the synergistic interactions between these two drug classes. In this review, we provide a detailed overview of the interactions between different opioid and α2 -adrenoceptor agonist combinations in preclinical studies. These studies have identified the spinal cord as an important site of action of synergistic interactions, provided insights into which receptors mediate these interactions and explored downstream signalling events enabling synergy. It is now well documented that the activation of both μ and δ opioid receptors can produce synergy with α2 -adrenoceptor agonists and that α2 -adrenoceptor agonists can mediate synergy through either the α2A or the α2C adrenoceptor subtypes. Current hypotheses surrounding the cellular mechanisms mediating opioid-adrenoceptor synergy, including PKC signalling and receptor oligomerization, and the evidence supporting them are presented. Finally, the implications of these findings for clinical applications and drug discovery are discussed.

LINKED ARTICLES

This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2.

ST91 [2-(2,6-diethylphenylamino)-2-imidazoline hydrochloride]-mediated spinal antinociception and synergy with opioids persists in the absence of functional alpha-2A- or alpha-2C-adrenergic receptors

Agonists acting at alpha2-adrenergic receptors (alpha2ARs) produce antinociception and synergize with opioids. The alpha2ARs are divided into three subtypes, alpha(2A)AR, alpha(2B)AR, and alpha(2C)AR. Most alpha2AR agonists require alpha(2A)AR activation to produce antinociception and opioid synergy. The same subtype also mediates the side effect of sedation, which limits the clinical utility of these compounds. Identification of a non-alpha(2A)AR-mediated antinociceptive agent would enhance the therapeutic utility of alpha2AR agonists in pain management. Previous studies have suggested that the alpha2AR agonist ST91 [2-(2,6-diethylphenylamino)-2-imidazoline hydrochloride] has a nonsedating, non-alpha(2A)AR mechanism of action. We examined the pharmacology of spinal ST91 and its interaction with the delta-opioid agonist deltorphin II (Tyr-D-Ala-Phe-Glu-Val-Val-Gly amide) in mice lacking either functional alpha(2A)ARs or alpha(2C)ARs. All drugs were administered by direct lumbar puncture, and drug interactions were evaluated using isobolographic analysis. In contrast to the majority of alpha2AR agonists, ST91 potency was only moderately reduced (3-fold) in the absence of the alpha(2A)AR. Studies with the alpha2AR subtype-preferring antagonists BRL-44408 (2-[2H-(1-methyl-1,3-dihydroisoindole)methyl]-4,5-dihydroimidazole maleate) and prazosin [[4-(4-amino-6,7-dimethoxy-quinazolin-2-yl) piperazin-1-yl]-(2-furyl)methanone] and the pan-alpha2AR antagonist SKF-86466 (6-chloro-2,3,4,5-tetrahydro-3-methyl-1-H-3-benzazepine) suggest a shift from alpha(2A)AR to the other alpha2AR subtype(s) in the absence of alpha(2A)AR. Antinociceptive synergy with deltorphin II was preserved in the absence of either alpha(2A)AR or alpha(2C)AR. In conclusion, ST91 activates both alpha(2A)AR and non-alpha(2A)AR subtypes to produce spinal antinociception and opioid synergy. This study confirms that the spinal pharmacology of ST91 differs from that of other alpha2AR agonists and extends those data to include spinal synergy with opioid agonists. The unique profile of ST91 may be advantageous in pain management.

Noradrenergic agonist administration into the central nucleus of the amygdala increases the tail-flick latency in lightly anesthetized rats

The amygdala is a medial forebrain structure with an established role in nociceptive modulation, including the expression of stress-induced hypoalgesia (SIH). Projections from the locus coeruleus increase levels of noradrenaline in the amygdala during acute stress. alpha(2)-Noradrenergic receptor agonists have significant clinical utility as analgesic agents. We therefore hypothesized that alpha(2)-noradrenergic activation of the amygdala may result in behaviorally measurable hypoalgesia. Lightly anesthetized rats underwent microinjection of the alpha(2)-noradrenergic agonist clonidine into the amygdala and intermittent measurement of thermal nociception using the tail-flick latency (TFL). Bilateral microinjection of clonidine into the central nucleus of the amygdala (CeA) resulted in a significant, dose-dependent increase in TFL. This effect was blocked by systemic pre-treatment with the alpha(2)-antagonist yohimbine or by local pre-injection of the alpha(2)-antagonist idazoxan but not by local pre-injection of the alpha(1)-antagonist WB-4101. When injected alone, no antagonist resulted in a significant change in TFL compared with baseline. Clonidine injection into the amygdala but outside the CeA, including the basolateral nucleus of the amygdala, did not significantly alter TFL. These results demonstrate that anatomically and pharmacologically specific activation of alpha(2)-receptors in the CeA in lightly anesthetized rats results in behaviorally measurable antinociception.

Continuous intrathecal clonidine and tizanidine in conscious dogs: analgesic and hemodynamic effects

Alpha-2-adrenergic agonists, such as clonidine, produce antinociception in animal pain models after intrathecal administration. However, clinical usage is limited by cardiovascular side effects. To investigate alternative alpha(2)-adrenergic agonists as analgesics, we implanted six dogs with an intrathecal catheter and infusion pump. After baseline saline infusion, animals received clonidine or tizanidine (crossover study) each week at escalating doses of 125-750 microg/h. Analgesia, blood pressure, heart rate, respiratory rate, sedation, and coordination were evaluated. A 28-day safety study was performed with another nine dogs receiving intrathecal tizanidine (3 or 6 mg/d) or saline. Equal doses of clonidine and tizanidine produce the same antinociception in thermal withdrawal tests. Blood pressure was reduced with 125-500 microg/h of clonidine, but not with tizanidine at any dose. Clonidine 250 microg/h reduced heart rate by 45.8%, and five of six animals had bradyarrhythmias (marked bradycardia), whereas tizanidine decreased heart rate by 15.1% without arrhythmias, even at the largest dose. Respiratory rate decreased with 250 microg/h of clonidine and larger doses. Sedation or incoordination occurred only at the largest dose for either drug. The safety study indicated that 3 mg/d of tizanidine in dogs produced no side effects or histopathologic changes. Tizanidine may be a useful alternative in patients experiencing cardiovascular side effects with intrathecal infusion of clonidine.

IMPLICATIONS

Clonidine is an effective spinal analgesic, but it is dose-limited by cardiovascular side effects. We compared the analgesic properties and side effects of clonidine with those of a similar drug, tizanidine. Continuous spinal infusion of tizanidine produced similar analgesia as clonidine, but with fewer adverse effects on blood pressure and heart rate.

Potentiated opioid analgesia in norepinephrine transporter knock-out mice

Several studies have shown that activation of alpha(2)-adrenergic receptors (alpha(2)ARs) leads to mild analgesic effects. Tricyclic antidepressants (TCAs), such as desipramine (DMI), which block norepinephrine transporters (NETs), also produce mild antinociception. The coadministration of either alpha(2)AR agonists or TCAs with opiates produces synergistically potentiated antinociception. It has been postulated that the analgesic effects of TCAs are determined by their ability to inhibit norepinephrine reuptake via interactions with the NET. To test this idea, we studied mice lacking a functional NET in spontaneous and morphine-induced antinociceptive paradigms. Morphine (10 mg/kg, s.c. ) treatment produced greater analgesia, as assayed in the warm water tail-flick assay, in NET-knock-out (-KO) mice than in wild-type (WT) mice. As anticipated, yohimbine, an inhibitor of alpha(2)ARs, blocked this potentiation. Moreover, a warm water swim-stress paradigm, which is known to induce the release of endogenous opioids, produced greater antinociception in NET-KO than in the WT mice. Naloxone, an inhibitor of opioid receptors, blocked the development of the swim-evoked analgesia in both WT and NET-KO mice, confirming the involvement of the endogenous opioid system. In the NET-KO mice, DMI did not further enhance analgesia but was still able to produce inhibitory effects on the locomotor activity of these mutants, suggesting that the effects of this TCA are not exclusively via interactions with the NET. In summary, these results demonstrate in a genetic model that both endogenous and exogenous opiate-mediated analgesia can be enhanced by elimination of the NET, indicating that the interaction of TCAs with NET mediates these effects.

Synergistic interactions between two alpha(2)-adrenoceptor agonists, dexmedetomidine and ST-91, in two substrains of Sprague-Dawley rats

Several lines of evidence indicate that the antinociception produced by intrathecal administration of the alpha(2)-adrenoceptor agonists dexmedetomidine or ST-91 is mediated by different subtypes of the alpha(2)-adrenoceptor. We recently provided additional pharmacologic evidence for this idea, as well as for differences in the function of these receptors between Harlan and Sasco rats, two widely-used outbred substrains of Sprague-Dawley rat. The present study used isobolographic analysis to further characterize the receptors at which intrathecally administered ST-91 and dexmedetomidine act in these two substrains. The rationale for these studies derives from the assumption that if dexmedetomidine and ST-91 act as agonists at the same receptor then they should interact in an additive manner. However, if they interact in a supra-additive manner, then they must act at different subtypes of the alpha(2)-adrenoceptor. In the tail-flick test, the dose-effect relationship for a 1:3 mixture of dexmedetomidine and ST-91 was shifted significantly to the left of the theoretical dose-additive line in both Harlan and Sasco Sprague-Dawley rats. A similar finding was made in the hot-plate test despite the fact that the dose-response characteristics of the agonists were different in this test. Thus, in Harlan rats, in which ST-91 is a full agonist and dexmedetomidine is essentially inactive, the dose-effect relationship for the mixture of dexmedetomidine and ST-91 was shifted far to the left of the dose-additive line. Similarly, in Sasco rats, in which ST-91 is a partial agonist and dexmedetomidine is inactive, co-administration of the two agonists also shifted the dose-response relationship to the left of the dose-additive line. The consistent finding that these two alpha(2)-adrenoceptor agonists interact in a supra-additive manner provides strong evidence that dexmedetomidine and ST-91 produce antinociception by acting at different alpha(2)-adrenoceptor subtypes in the spinal cord. This conclusion is consistent with the earlier proposal that dexmedetomidine acts predominantly at alpha(2A)-adrenoceptors whereas ST-91 acts predominantly at non-alpha(2A)-adrenoceptors. Recent anatomical evidence indicates that these non-alpha(2A) adrenoceptors may be of the alpha(2C) type. The synergistic combination of an alpha(2A)- and an alpha(2C)-adrenoceptor agonist may provide a unique and highly effective drug combination for the treatment of pain without the sedation produced by an equianalgesic dose of a single alpha(2)-adrenoceptor agonist.

Balanced anesthetic techniques in dogs and cats

The term "balanced anesthesia" refers to the use of a mixture of drugs, such that the advantages of small amounts of drugs are used without having to contend with the disadvantages of large doses of any one drug. In veterinary practice, inhalant drugs are usually administered alone to maintain anesthesia, and balanced anesthetic techniques are rare. Unfortunately, cardiopulmonary function is reduced in dose-dependent fashion by inhalant drugs and deepening the level of anesthesia in order to modify autonomic responses to noxious stimuli may increase morbidity and mortality. This article justifies the use of balanced anesthetic techniques in veterinary practice and describes the advantages gained by the use of nitrous oxide, continuous opioid infusion, epidural/spinal opioid administration, and transdermal opioid administration. These techniques, described in detail in the article, are easy to learn, relatively inexpensive, may decrease patient morbidity and mortality, and will provide the veterinarian with smoother operating conditions.

Activation of coeruleospinal noradrenergic inhibitory controls during withdrawal from morphine in the rat

We previously reported that withdrawal from morphine induces the expression of Fos, a marker of neuronal activity, in spinal cord neurons, particularly in laminae I and II of the superficial dorsal horn, and that the magnitude of Fos expression is increased in rats with a midthoracic spinal transection. We suggested that loss of withdrawal-associated increases in descending inhibitory controls that arise in the brainstem underlie the increased Fos expression after spinal transection. Here, we addressed the origin of the supraspinal inhibition. We injected rats intracerebroventricularly with saline or anti-dopamine-beta-hydroxylase-saporin, a toxin that destroys noradrenergic neurons of the locus coeruleus. Eleven days later, we implanted rats with morphine or placebo pellets, and after 4 d, we precipitated withdrawal with naltrexone. One hour later, the rats were killed, their brains and spinal cords were removed, and transverse sections of the brains and spinal cords were immunoreacted with an antibody to Fos. In placebo-pelleted rats, the toxin injection did not alter behavior and did not induce expression of the Fos protein. However, compared with saline-injected withdrawing rats, the toxin-treated rats that underwent withdrawal demonstrated an intense withdrawal behavior rarely seen in the absence of toxin, namely forepaw fluttering. The rats also had significantly increased Fos-like immunoreactivity in all laminae of the cervical cord and in laminae I and II and the ventral horn of the lumbar cord. No differences were recorded in the sacral cord. We conclude that the effects of spinal transection in rats that withdraw from morphine in part reflect a loss of coeruleospinal noradrenergic inhibitory controls.

Differential effects of two intraventricularly injected alpha 2 agonists, ST-91 and dexmedetomidine, on electroencephalogram, feeding, and electromyogram

Central alpha 2 agonists induce feeding in animals, electroencephalographic (EEG) synchronization, and sedation. Recent observations suggest that the investigational compound ST-91 and dexmedetomidine (DMET) may interact with distinct alpha 2 subclasses at spinal sites. We examined these drugs in brain. To accomplish these aims, ST-91, DMET, or methoxamine (METH), an alpha 1 agonist, were administered into the cerebral ventricles of unanesthetized rats prepared with chronic intracerebroventricular (ICVT) cannulae and cortical EEG electrodes. Behavior, EEG, electromyography (EMG), and feeding were assessed. We found that DMET resulted in dose-dependent (1-32 nmol) sedation, EEG synchronization, and a reduced gastrocnemeus EMG, while ST-91 (up to 153 nmol) had no effect. In contrast, ST-91 (1-153 nmol) resulted in a dose-dependent evocation of feeding, while the effects of DMET on feeding, if any, were obscured by the sedation. All effects were antagonized in a dose-dependent fashion by ICVT yohimbine (an alpha 2 antagonist). ICVT atipamezole (an alpha 2 antagonist), but not prazosin (an alpha 1 antagonist), reversed the effects of DMET. With ST-91, both atipamezole and prazosin had modest, but significant, antagonistic effects. ICVT METH had no effect. The differential physiological actions of these two intracerebroventricularly injected drugs, in concert with previous pharmacological studies, suggest two distinct subclasses of yohimbine-sensitive alpha 2 adrenergic receptors in the brain.

Intrathecal clonidine and tizanidine in conscious dogs: comparison of analgesic and hemodynamic effects

Intrathecal delivery of alpha(2)-adrenergic agonists produces an analgesic effect. However, hemodynamic side effects limit their clinical usage. To more fully characterize the effects on heart rate and arterial blood pressure of alpha(2)-adrenergic agonists, clonidine and tizanidine were injected intrathecally in conscious dogs. Both compounds produced a potent inhibition of thermal foot-withdrawal latencies at 1000 micrograms, which was blocked by the alpha(2)-adrenergic antagonist yohimbine. Tizanidine (250-500 micrograms) did not change heart rate. Clonidine (500 -2000 micrograms) and tizanidine (1000-2000 micrograms) decreased heart rate. The tizanidine effect was inhibited by yohimbine and the alpha(2)/imidazoline antagonist idazoxan, as well as the parasympathetic blocker glycopyrrolate. No drug completely inhibited the clonidine-induced bradycardia. Clonidine had a biphasic effect on arterial blood pressure, a decrease at 500 micrograms and an increase at 2000 micrograms. Tizanidine decreased arterial blood pressure at all doses. The results indicate that, while the analgesic effects of both drugs are similar, the hemodynamic responses differ. While the decrease in heart rate with tizanidine is consistent with alpha(2)-adrenergic binding and vagal action, the bradycardia induced by clonidine is more complex. In addition, the increased arterial blood pressure with high doses of clonidine, which is suggestive of a peripheral vasoconstrictive effect, does not occur with tizanidine.

A comparison of intrathecally administered narcotic and nonnarcotic analgesics for experimental chronic neuropathic pain

The antinociceptive actions of morphine and tizanidine (an alpha 2-adrenergic agonist) administered intrathecally in a rat model of mononeuropathic pain were investigated. Tizanidine increased to normal levels the intensity of a noxious pressure stimulus required to induce paw withdrawal (p < 0.01) and decreased the duration of limb withdrawal from both normal-temperature and cooled floors in a dose-dependent manner (p < 0.01). Tizanidine had virtually no effect on the latency of paw withdrawal from a noxious heat stimulus. In comparison, morphine significantly decreased, in a dose-dependent manner, limb withdrawal from the normal-temperature and cooled floors and increased to cutoff values the withdrawal latencies of both noxious heat and pressure stimuli (p < 0.01). The effect of tizanidine was limited to the hyperalgesic limb and served to normalize reactive latencies, whereas morphine affected both hindlimbs and increased latencies to supranormal cutoff values. These data suggest that intrathecal tizanidine may be more specific than morphine in reversing the allodynia and hyperpathia associated with neuropathic pain states and may be of value in the management of patients with these clinical syndromes.

Effects of intrathecal mu, delta, and kappa agonists on thermally evoked cardiovascular and nociceptive reflexes in halothane-anesthetized rats

Despite significant opioid binding in the intermediolateral cell column, the effects of intrathecal injections of mu, delta, and kappa opioid agonists on the cardiovascular response to noxious stimulation have not been examined systematically. The pharmacology of intrathecally administered opioid agonists (mu, morphine, [D-Ala2,N-MePhe4,Gly5-ol]enkephalin (DAGO); delta, metkephamid, [D-Ala2-D-Leu5]enkephalin (DADL), [D-Pen2,D-Pen5]enkephalin (DPDPE); kappa, U50488H and PD117,302) or agonist-antagonist (nalbuphine) on somatomotor (tail-flick) and cardiovascular changes (blood pressure and heart rate) evoked by immersing the tail in 53 degrees C water were examined in rats anesthetized with halothane (0.75%) and in which intrathecal catheters had been chronically implanted. Intrathecal administration of mu and delta, but not kappa agonists or agonist-antagonist produced a dose-dependent block of tail-flick and evoked cardiovascular responses with the order of activity being as follows: DAGO > metkephamid DADL > morphine > DPDPE >> nalbuphine = PD117,302 = U50488H = 0. These effects were reversed readily by the opioid antagonist naloxone. In addition, intrathecal administration of mu and delta but not kappa or agonist-antagonist had little effect on resting heart rate and blood pressure. These data indicate that the agonist occupancy of spinal mu and delta, but not kappa agonists can profoundly modulate the autonomic and somatomotor response evoked by high threshold thermal stimuli.

Alpha-adrenoceptors

Major advances have been made in our understanding of the molecular structure and function of the alpha-adrenoceptors. Many new subtypes of the alpha-adrenoceptor have been identified recently through biochemical and pharmacological techniques and several of these receptors have been cloned and expressed in a variety of vector systems. Currently, at least seven subtypes of the alpha-adrenoceptor have been identified and the molecular structure and biochemical functions of these subtypes are beginning to be understood. The alpha-adrenoceptors belong to the super family of receptors that are coupled to guanine nucleotide regulatory proteins (G-proteins). A variety of G-proteins are involved in the coupling of the various alpha-adrenoceptor subtypes to intracellular second messenger systems, which ultimately produce the end-organ response. The mechanisms by which the alpha-adrenoceptor subtypes recognize different G-proteins, as well as the molecular interactions between receptors and G-proteins, are the topics of current research. Furthermore, the physiological and pathophysiological role that alpha-adrenoceptors play in homeostasis and in a variety of disease states is also being elucidated. These major advances made in alpha-adrenoceptor classification, molecular structure, physiologic function, second messenger systems and therapeutic relevance are the subject of this review.

Noradrenergic and opioid systems interact to alter the detection of noxious thermal stimuli and facial scratching in monkeys

We examined the ability of the alpha 2-adrenoceptor agonist, ST-91, microinjected into the medullary dorsal horn (MDH), to diminish the sensory-discriminative features of noxious heat stimuli in awake behaving monkeys. Two monkeys performed a noxious thermal detection task and the time to detection of small increases in heat served as a measure of the perceived intensity of pain. ST-91 microinjected into the MDH (1.0, 3.0, 10.0 and 30.0 micrograms/0.4 microliter) produced dose-dependent increases in detection time to graded temperature increases (0.4-1.0 degrees C) from a noxious 46 degrees C base line. These dose-dependent effects were attenuated by the systemic administration of the alpha 2-adrenoceptor antagonist, idazoxan (2.0 mg/kg, i.m.), but not by the alpha 1-adrenoceptor antagonist, prazosin (0.5 mg/kg, i.m.) or the opioid-receptor antagonist, naloxone (0.5 mg/kg, i.m.). The effect of ST-91 on detection latency of thermal stimuli was not the result of alterations in attentional, motivational or motoric aspects of the monkeys' behavior, because detection of visual stimuli and non-noxious temperature coolings (36.0-34.5 degrees C) in a similar paradigm were not consistently altered. Microinjection of morphine (3.0 mg) into the MDH also increased detection latency of the noxious heat stimuli. Systemic administration of the opioid-receptor antagonist, naloxone (0.5 mg/kg), and the alpha 2-adrenoceptor antagonist, idazoxan (2.0 mg/kg, i.m.) attenuated these effects of morphine. In a separate experiment, morphine (5.0 micrograms) microinjected into the MDH induced facial scratching behavior. Idazoxan (2.0 mg/kg) was effective at attenuating this scratching behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Actions of epinephrine on neurons in the rat midbrain periaqueductal gray maintained in vitro

The effect of epinephrine (EPI) on the activity of 150 periaqueductal gray (PAG) neurons was examined using extracellular recordings in an in vitro slice preparation. Drop application of EPI inhibited 45%, excited 35%, and had no effect on 20% of PAG neurons. Both the excitatory and inhibitory effects of EPI were of long duration; excitatory responses averaged 17 min and inhibitory responses averaged 11 min in duration. EPI responses could be blocked by specific alpha-1 and alpha-2 receptor antagonists. In 35% of the neurons tested, blockade of synaptic transmission by perfusion with low calcium-high magnesium physiological saline blocked responses to EPI. The effects of EPI were site specific: 77% of the cells in the caudal ventrolateral region of the PAG were inhibited by EPI; in all other regions of PAG equal numbers of cells were excited and inhibited by EPI. It is concluded that: (a) EPI has potent effects on a majority (80%) of PAG neurons; (b) EPI responses are mediated by presynaptic as well as postsynaptic mechanisms; (c) EPI preferentially inhibits neurons in the ventrolateral subdivision of caudal PAG. As this part of PAG contains many neurons that project to the ventral medulla, it is possible that EPI modulates the PAG-medullary functions such as analgesia, autonomic regulation, defense reactions, and sexual behaviors.

Allodynia evoked by intrathecal administration of prostaglandin F2 alpha to conscious mice

The intrathecal administration of prostaglandin F2 alpha to conscious mice resulted in spontaneous agitation and touch-evoked agitation (allodynia) in the animals. The maximum allodynia induced by prostaglandin F2 alpha was observed at 10-15 min after intrathecal injection, and the response did not disappear by 120 min. Prostaglandin F2 alpha produced allodynia over a wide range of dosage from 0.1 pg to 2.5 micrograms/mouse. Dose dependency of prostaglandin F2 alpha for allodynia showed a skewed bell-shaped pattern, and the maximal allodynic effect was observed at 1.0 microgram. This allodynia was dose-dependently relieved by alpha 1-adrenergic (methoxamine), alpha 2-adrenergic (clonidine), and A1-adenosine (RPIA) agonists. Clonidine was 1.5 orders of magnitude more potent than methoxamine in blocking prostaglandin F2 alpha-induced allodynia. The blockade by clonidine was dose-dependently reversed by the alpha 2-adrenergic antagonist yohimbine but not by the alpha 1-adrenergic antagonist prazosin. These results demonstrate that prostaglandin F2 alpha administered intrathecally induces allodynia in conscious mice and that the allodynia involves the alpha 2-adrenergic and A1-adenosine systems. Because this allodynia has a clear resemblance to the characteristics of chronic pain in patients with causalgia and reflex sympathetic dystrophy, prostaglandin F2 alpha may be involved in allodynia observed with these disorders.

Antinociception induced by microinjection of substance P into the A7 catecholamine cell group in the rat

Stimulation of neurons in the ventromedial medulla produces antinociception that is mediated in part by indirect activation of pontospinal noradrenergic neurons. Substance P-containing neurons located in the ventromedial medulla project to the A7 catecholamine cell group and may serve as an excitatory link between these two cell groups. Thus, the antinociception induced by stimulation of the neurons in ventromedial medulla may be mediated by substance P released from these projections which activates spinally projecting noradrenergic neurons in the A7 cell group. This hypothesis was tested by determining whether microinjection of various doses of substance P into the A7 cell group of the rat could induce antinociception. The results indicated that substance P induced dose-dependent antinociception that was more pronounced in the hindlimb ipsilateral to the microinjections. This observation is consistent with anatomical observations that noradrenergic A7 neurons project predominantly to the ipsilateral spinal cord dorsal horn. Moreover, the antinociceptive effects of substance P microinjection appear to be mediated at least in part by activation of spinally projecting noradrenergic neurons in the A7 cell group, because intrathecal injections of the alpha-2 noradrenergic antagonists yohimbine and idazoxan blocked these antinociceptive effects. The results of these experiments support the hypothesis that the antinociception induced by stimulation of neurons in the ventromedial medulla is mediated in part by activation of substance P-containing neurons that project to, and activate, spinally projecting noradrenergic neurons located in the A7 catecholamine cell group.

Alpha 2 receptors mediate the antinociceptive action of 8-OH-DPAT in the hot-plate test in mice

The prototypical 5-HT1A agonist, 8-OH-DPAT, dose-dependently (0.16-10.0 mg/kg, s.c.) elicited a pronounced antinociception in the hot-plate test in mice. This action was not affected by the 5-HT1A antagonists, BMY 7378, (-)-pindolol and (-)-alprenolol nor by selective antagonists at 5-HT1C, 5-HT2 and 5-HT3 receptors. It was also resistant to antagonists at D1, D2, alpha 1 and opioid receptors. In contrast, it was blocked by the alpha 2 antagonists, idazoxan, rauwolscine and yohimbine. L 659,066, a selective alpha 2 antagonist which does not enter the CNS, was ineffective. The action of 8-OH-DPAT was mimicked by the centrally acting alpha 2 agonists, UK 14,304 and guanabenz whereas ST 91, which does not penetrate the blood-brain barrier, was inactive. The action of UK 14,304 and guanabenz was also blocked by idazoxan, rauwolscine and yohimbine but not by L 659,066. These data indicate that the antinociceptive properties of 8-OH-DPAT in the hot-plate test in mice are mediated by CNS-localized alpha 2 receptors, rather than 5-HT1A receptors.

Demonstration of intrathecal and systemic morphine and ST-91 effects on fed canine upper gut motility

We studied the effects of opioid and adrenergic agonists and antagonists given systemically intravenously and intrathecally on postprandial antral and small bowel motility in a chronic conscious dog model. We studied eight dogs with a surgically implanted thoracic spinal intrathecal injection catheter, and six gastrointestinal manometric perfusion catheters. Morphine given intrathecally or intravenously induced propagated clusters of intestinal pressure activity in the fed dogs. The minimal effective dose for morphine was 150 micrograms/kg by the intrathecal route and 450 micrograms/kg by the intravenous route. ST-91 (an alpha 2-adrenergic agonist) profoundly inhibited antral and small intestinal pressure activity with similar minimal effective dose (100 micrograms/kg) and duration of effect for both intravenous and intrathecal routes. Neither naloxone (3000 micrograms/kg) nor combined phentolamine (1500 micrograms/kg) with propranolol (300 micrograms/kg) altered postprandial antral or small intestinal motility. The capacity of pharmacologic agents to block morphine-induced activity fronts when administered in the same compartment (intravenously or intrathecally) was investigated. The minimally effective morphine-antagonist dose for naloxone was similar intrathecally and intravenously (36 micrograms/kg for both routes). ST-91 (100 micrograms/kg) when given intrathecally or intravenously blocked morphine-induced clustered phasic pressure activity while simultaneously abolishing postprandial small intestine phasic pressure activity. These data suggest the presence of opioid and alpha 2-adrenergic receptors in the spinal cord that can modulate gastrointestinal motility in the postprandial state. Pharmacological interactions between these systems occur at spinal and target organ levels.

The role of descending noradrenergic systems in regulation of nociception: the effects of intrathecally administered alpha-adrenoceptor antagonists and clonidine

It has been proposed that descending noradrenergic systems exercise a tonic inhibition of nociception at the spinal level. The recent finding that changes in tail skin temperature (TT) may have a strong effect on the tail-flick latency makes a reevaluation of this hypothesis necessary. The alpha-adrenoceptor agonist clonidine injected intrathecally (i.th.) in a dose of 60 micrograms increased the response temperature in the increasing hot plate test 10 min after injection, and prolonged the tail-flick latency 30-60 min after injection. A considerable part of the change in tail-flick latency was caused by a reduction in TT. The alpha 1-antagonist prazosin (30 and 60 micrograms) tended to increase the response temperature in the increasing hot plate test after 60 min, and to prolong the latency in the tail-flick test. These effects were not statistically significant. Clonidine and prazosin induced sensorimotor impairment and a reduction in body temperature after 30-60 min. The alpha 2-antagonist yohimbine had no effect in the increasing hot plate test, but reduced the tail-flick latency 10 min after drug administration. This reduction could be explained by an increase in TT. The results suggest that the reduced latency in the tail-flick test after i.th. injection of yohimbine is caused by an increase in the tail blood flow, and does not support the hypothesis of a tonic bulbospinal noradrenergic inhibition of nociception. The time course of response latencies suggests that supraspinal mechanisms may be involved in the effects of i.th. clonidine and prazosin in the tail-flick test, while there seems to be a spinally mediated antinociceptive effect of clonidine that can be demonstrated in the increasing hot plate test.

Antinociceptive interactions between intrathecally administered alpha noradrenergic agonists and 5'-N-ethylcarboxamide adenosine

Recently, it has been shown that intrathecal injection of norepinephrine and the mixed A1/A2 adenosine agonist 5'-N-ethylcarboxamide adenosine (NECA) interact in a supra-additive manner to produce antinociception. The present studies were designed to determine whether alpha 1 or alpha 2 noradrenergic receptors are involved in producing the antinociception induced by NECA and norepinephrine. The results indicated that intrathecal injection of NECA (0.97-4.9 nmol), the alpha 2 noradrenergic agonist clonidine (3.8-375 nmol), or the alpha 1 agonist phenylephrine (4.9-73.4 nmol) produced dose-dependent antinociception in rats. Furthermore, intrathecal injection of subeffective doses of NECA and clonidine interacted supra-additively to produce potent antinociception. In contrast, no supra-additive interaction was observed between NECA and phenylephrine. The supra-additive interaction of NECA and clonidine did not appear to result from alterations in cardiovascular tone because changes in blood pressure and nociceptive thresholds were not correlated in time. These results suggest that the noradrenergic component of the supra-additive interaction between adenosine A2 receptor agonists and noradrenergic agonists is mediated by alpha 2 noradrenergic receptors.

Spinal administration of receptor-selective drugs as analgesics: new horizons

The processing at the spinal cord levels of sensory information is subject to modulation by a number of local receptor systems, including opioids: alpha 2 adrenergic; and to a lesser extent serotonin, GABAB, neuropeptide Y, cholinergic, adenosine, and the NMDA-glutamate site. The functional utility of these multiple systems are only partially understood, but it appears that (a) they may act individually to alter different aspects of the nociceptive sensory message (b) they could be used synergistically to reduce the incidence of side effects by reducing the dose of agents required to yield analgesic effects, and (c) they may function variably in animals made tolerant to classes of receptor agonists.

Effect of intrathecal tizanidine on antinociception and blood pressure in the rat

Experiments were performed in rats to determine if the alpha 2-adrenergic agonist tizanidine has an antinociceptive effect when injected intrathecally, and whether the analgesia is accompanied by changes in blood pressure. Rats were chronically implanted with catheters in the lumbar subarachnoid space. Antinociception was evaluated in conscious rats with the tail-flick test. Increasing tizanidine doses produced increases in analgesic efficacy, with 25 micrograms producing a significant long-lasting antinociception. This tail-flick analgesia was very similar to that produced by clonidine (25 micrograms) and morphine (8 micrograms) in peak effect and duration. Doses as high as 250 micrograms produced only a transient hind limb motor dysfunction in 43% of the animals. Daily injections of 25 micrograms tizanidine over 5 days produced a decrease in antinociception, with the peak effect at day 5 at 59% of that at day 1. Blood pressure, in rats lightly anesthetized with halothane, was not affected by tizanidine injections up to 250 micrograms. Tizanidine appears to be a promising non-opiate analgesic for intrathecal usage.

The cardiorespiratory effects of intrathecal xylazine in the conscious rabbit

The alpha 2 agonist xylazine produced a dose-dependent decrease in mean arterial blood pressure in conscious rabbits when injected intrathecally (i.t.) through a cannula previously implanted under general anaesthesia. Intrathecal administration of 200 and 400 micrograms of xylazine produced a significant reduction in arterial blood pressure from control values (maximum depressions of 25% and 33%, respectively). There was little effect on cardiac output and arterial carbon-dioxide tension and no effect on respiratory rate, arterial oxygen tension and pulse rate. Intrathecal injection of 100 microliters of 0.9% saline had no effect. Intravenous (i.v.) tolazoline (0.5 mg/kg) abolished xylazine-induced hypotension (200 micrograms) in four rabbits. Contrast radiography revealed that 100 microliters of solution injected i.t. in anaesthetized rabbits spread distally over eight vertebral spaces. There was little rostral spread. It was concluded that xylazine-induced hypotension following i.t. injection was due to local activation of alpha 2 adrenoceptors present in the thoracic spinal cord. It is postulated that spinal alpha 2 adrenoceptors may play an important role in the hypotension recorded in animals after parenteral injection of xylazine.

Epidural clonidine for treatment of postoperative pain after thoracotomy. A double-blind placebo-controlled study

Clonidine has been reported to produce analgesia in humans in different painful conditions. The aim of the present study was to investigate if epidural clonidine produced a clinically important analgesia to severe postoperative pain. Using a controlled, randomized double-blind design, one group of patients received a single dose of epidural clonidine 3 micrograms/kg (n = 10) and a control group epidural 0.9% saline (n = 10), when reporting postoperative pain after thoracotomy performed under standardized anaesthesia. To quantify the effects of the given epidural drugs, the need for supplementary, intravenous pethidine analgesia was recorded. The patients had access to the supplementary analgesic by means of a patient-controlled analgesic-delivery device. The two groups were similar regarding anthropometric and clinical data. Epidural clonidine 3 micrograms/kg did not affect the need for supplementary intravenous pethidine analgesia, as compared to the control group at any time during the first 12 h postoperatively. The side-effects of epidural clonidine were tolerable, and no treatment for arterial hypotension was required. No early or delayed respiratory depression occurred. In conclusion, clonidine 3 micrograms/kg epidurally seems to lack clinically important analgesic effects on severe postoperative pain, at least following thoracotomy.

Central and peripheral inhibition of exocrine pancreatic secretion by alpha-2 adrenergic agonists in the rat

The effect of ST91, a clonidine derivative crossing poorly the blood-brain barrier, was compared to that of clonidine on exocrine pancreatic secretion in rats. The experiments were performed in anaesthetized rats after stimulation by a maximal dose of 2-deoxy-D-glucose, and in conscious rats under basal interdigestive conditions. In anaesthetized rats, the 2-deoxy-D-glucose-induced stimulation of pancreatic secretion was suppressed by clonidine but not by ST91, both injected subcutaneously. This effect of clonidine was not antagonized by prazosin, but was decreased by 70-100% (according to the variables measured) by yohimbine. The alpha-2 antagonists rauwolscine and corynanthine were less efficient than yohimbine, while idazoxan suppressed totally the effect of clonidine. In conscious rats, the basal interdigestive secretion was inhibited by ST91 and by clonidine. After sc injections, the potency of ST91 was about ten times smaller than that of clonidine, whereas after injections in the cerebral ventricles, ST91 was as potent as clonidine to inhibit pancreatic secretion. Most (70-90%) of the inhibition induced by sc ST91 and clonidine in conscious rats was suppressed by yohimbine or by prazosin. It is concluded that both ST91 and clonidine inhibit pancreatic secretion in rats, and that this effect has probably both central and peripheral components. The central effect involves alpha-2 receptors, while the peripheral effect may involve alpha-1 and alpha-2 receptors.

Synergy between the antinociceptive effects of intrathecal clonidine and systemic morphine in the rat

These experiments tested the hypothesis that intrathecal alpha 2-adrenergic antinociception could be potentiated by the concurrent administration of systemic morphine. Thirty-four male rats, implanted with chronic indwelling intrathecal catheters, received a subcutaneous injection of either morphine sulfate or an equal volume of saline, followed by an intrathecal injection of clonidine HCl or an equal volume of vehicle. Antinociception was assessed using the tail-flick test. Tail-flick latencies following subcutaneous morphine plus intrathecal vehicle, or subcutaneous saline plus intrathecal clonidine were not significantly different from baseline. However, the combination of subcutaneous morphine plus intrathecal clonidine produced a significant antinociceptive effect. Such potentiation may prove to be a useful clinical strategy to help maximize analgesia, minimize side effects and attenuate the development of tolerance.

A study of the interaction between clonidine and morphine on analgesia and blood pressure during continuous intrathecal infusion in the rat

In the rat, the continuous intrathecal (i.t.) infusion of clonidine (0.4 microgram/hr) significantly increased the tail-flick latency (TF) and the threshold for paw pressure (PP) withdrawal for 5 days and decreased the systolic blood pressure (up to 24 mm Hg) for 7 days. The antinociceptive effect of continuous intrathecal infusion of clonidine (0.4 microgram/hr) in the tail flick and paw pressure tests was not attenuated in rats that were tolerant to morphine. The acute intrathecal administration of clonidine (2.7 micrograms) and morphine (1.0 microgram) resulted in a synergistic interaction in the tail-flick and paw pressure tests. A synergistic interaction was also observed during the continuous intrathecal infusion of morphine (1.25 micrograms/hr) and clonidine (0.2 microgram/hr) in the tail-flick and paw pressure tests. Individually, these doses of morphine and clonidine had no antinociceptive effect. However, intrathecal infusion together yielded peak tail-flick and paw pressure responses comparable to that of 0.4 microgram/hr clonidine alone, without affecting systolic blood pressure. No delay in the onset of tolerance to the analgesic effect was observed with the combination as compared with clonidine (0.4 microgram/hr) alone. The data indicate that clonidine-induced spinal analgesia is independent of endogenous opioid systems linked to mu-receptors in the spinal cord, and that optimization of spinal analgesia (e.g. synergism) can be achieved during continuous intrathecal infusion without affecting cardiovascular activity.

Intraspinal opiates for treatment of intractable pain in the terminally ill cancer patient

The discovery of opiate receptors and then their endogenous ligands in 1974 (Snyder et al., 1974) has elucidated a vast pharmacology of opiates providing a basis for their diverse clinical applications. With the awareness of quality of life as a primary goal in terminal cancer patients, widespread attention has been drawn to the direct delivery of long-term intraspinal analgesics to cancer patients for who all medical pain control regimens have failed (Coombs & Saunders, 1974). Intraspinal administration of opiates and nonopiate analgesics is not only appealing on theoretical grounds but provides a minimally invasive method to insure otherwise unobtainable pain relief while eliminating obtundation and systemic side-effects associated with conventional therapy (Cobb et al., 1984; Harbaugh et al., 1982; Leavens et al., 1982; Malone et al., 1985; Onofrie et al., 1981; Poletti et al., 1981). Although intraspinal opiates have been used in the treatment of postoperative and benign-pain syndromes (Asari et al., 1981; Cousins & Mather, 1984), in our discussion we review the basic science, current techniques and possible future improvements in spinal analgesia in the control of chronic cancer pain.

Prolonged spinal analgesia in the rat with the alpha-adrenoceptor agonist oxymetazoline

The acute intrathecal (i.t.) injection of 50, 100, 200, 250 and 300 nmol of oxymetazoline produced dose-dependent antinociception in rats assessed by tail flick and paw pressure tests. Significant antinociception was observed with all doses of oxymetazoline except 50 nmol in the paw pressure test. The ED50 values for i.t. oxymetazoline in the tail flick and paw pressure tests were 120 nmol (95% CI: 76-178 nmol) and 148 nmol (95% CI: 120-186 nmol), respectively. Oxymetazoline had a long duration of action; a single i.t. dose of 100 nmol significantly elevated tail flick latency and paw pressure threshold for 8 h. The alpha-adrenoceptor antagonist phentolamine, given i.t. 1 h after oxymetazoline, attenuated the antinociceptive effect in a dose-dependent manner. Phentolamine (50 micrograms i.t.) produced almost complete antagonism in the tail flick and paw pressure tests. These data indicate that oxymetazoline produces long lasting antinociception in the rat following i.t. injection, and that the effect is mediated by alpha-adrenoceptors in the spinal cord.

Opioid receptor systems and the endorphins: a review of their spinal organization

A review of the spinal organization of opioid receptor systems and endorphins is presented. The review is a consideration of the physiological mechanisms underlying the effect of spinal opioids, the pharmacology of the opioid receptors that moderate a variety of spinal processing systems, and the endorphin systems that act upon the spinal receptors.

Spinal opiates: a review of their effect on spinal function with emphasis on pain processing

Several opiate receptor systems have been identified in the spinal cord. They produce a powerful analgesia when opioid agonists are administered intrathecally in the intact, unanesthetized animal. These effects appear mediated by an action on opioid receptors which are located presynaptically, in the terminals of primary afferents, and postsynaptically on certain dorsal horn neurons. Based on structure-activity relationships in different tests, quantitative studies of naloxone antagonism and selective cross tolerance, it appears that, in the spinal cord, there are three distinguishable populations of opioid receptors: mu, delta and kappa. Aside from the effects on nociception, these receptors are also associated with a variety of spinal mechanisms related to other aspects of sensory, autonomic and motor functions. Though in some cases these represent important side-effects (e.g. inhibition of the micturition reflex), in others, the subtle effects may have important therapeutic benefits (e.g. relieving spasticity in spinal injured patients).

Haemodynamic effects of clonidine injected epidurally in halothane-anaesthetized dogs

The haemodynamic effects of clonidine administered in the epidural space were studied in 16 halothane-anaesthetized dogs. The animals were randomly assigned to two groups: Group I received three doses of 3 ml of normal saline, Group II received three doses of 3 micrograms X kg-1 of clonidine, through an epidural catheter, whose tip was located between L2-T11. Control haemodynamic measurements were taken one hour after completion of the surgical preparation (period P1); they were repeated every 45 minutes after each incremental dose (periods P2, P3, P4) and 105 minutes after a total cumulative dose of 9 micrograms X kg-1 of clonidine or 9 ml of saline were given (period P5). No significant changes over time were observed in Group I. In Group II clonidine produced statistically significant reductions of systemic blood pressure (BP), mean left ventricular pressure (LV), heart rate (HR), cardiac output (CO) and peak LV dP/dt only after a total clonidine dose of 9 micrograms X kg-1 and these changes were sustained. BP fell 15 per cent, CO 21 per cent, HR 25 per cent, LV 20 per cent and peak LV dP/dt 30 per cent when P5 measurements were compared to control values within Group II (p less than 0.05). These haemodynamic effects of clonidine are likely due to minimal systemic absorption and/or cephalad spread of the drug towards its site of action in the brain stem. The reductions of HR, CO, BP, and isovolemic indices of contractility are likely explained by a reduction of sympathetic outflow at the spinal cord and medulla oblongata levels as well as increased parasympathetic tone.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in micturition volume thresholds in conscious dogs following spinal opiate administration

Micturition difficulties appear as an often-reported side effect of the clinical use of opiates for spinal analgesia. Only a few experimental studies have focused specifically on this problem, especially in an unanesthetized animal model where chronic pharmacological studies can be carried out. The changes in micturition volume thresholds that occurred following spinal intrathecal injections of 1 mg of morphine sulphate were measured in 11 conscious dogs and compared with threshold changes produced in these same dogs by i.v. injections of various doses of morphine sulphate and by intrathecal and i.v. injections of naloxone HCl. In all cases, intrathecal or systemic morphine at doses of 1.0 mg or greater significantly (P less than 0.05) increased the bladder volume at which micturition took place. Naloxone, injected intrathecally to reverse the effects of intrathecal morphine, significantly reduced the micturition volume threshold, in most cases to below control volumes. A 400 microgram dose of naloxone, injected intrathecally without prior injection of morphine, significantly lowered the volume threshold in 9 dogs, even though two of these dogs had elevated thresholds following naloxone injection. The reduction in volume thresholds by i.v. naloxone not preceded by morphine injection was not statistically significant over that of control. These results are interpreted in light of recent findings concerning localization of endogenous opiate receptors within the micturition reflex pathway.

Effect of depletion of spinal cord norepinephrine on morphine-induced antinociception

We studied whether antinociception produced by injection of morphine into the nucleus reticularis paragigantocellularis (NRPG) or by superfusion onto the spinal cord involved norepinephrine (NE)-containing neurons that descend from brainstem into the spinal cord. Spinal cord NE concentrations were depleted with the neurotoxin, 6-hydroxydopamine, and antinociception was measured following morphine injection into NRPG or onto spinal cord. Depletion of cord NE by approximately 90% did not attenuate the antinociceptive effect of either 2 or 10 micrograms of morphine injected intrathecally. In contrast, the depletion did significantly attenuate the antinociceptive effect of 2.5 micrograms morphine injected bilaterally into the NRPG. These results suggest that NE-containing neurons descending from brainstem nuclei into the spinal cord are not important in the analgesia produced by injecting morphine directly onto the spinal cord but may be involved with analgesia produced by morphine injection into the NRPG.

Locus coeruleus lesions in the rat enhance the antinociceptive potency of centrally administered clonidine but not morphine

The nucleus locus coeruleus (LC) has been implicated in the descending inhibition of spinal nociceptive dorsal horn neurons, spinal nociceptive reflexes and in the antinociception produced by morphine. To further explore the involvement of the LC in antinociception, bilateral electrolytic lesions in the LC were made in adult male Sprague-Dawley rats. Lesions in the LC did not alter the antinociception produced by morphine (2.5 and 5 micrograms) administered in the periaqueductal gray in either the tail-flick (TF) or hot-plate (HP) tests when tested 7 and 14 days after the lesions. Baseline nociceptive thresholds in the TF and HP tests likewise were not affected at 7 or 14 days post-lesion. In contrast, the antinociceptive potency of clonidine administered intrathecally on day 13 post-lesion was enhanced significantly in the TF test; the antinociceptive ED50 of the LC lesion group was 0.52 micrograms whereas that of the sham lesion group was 2.29 micrograms. The antinociceptive potency of clonidine administered systemically (750 and 500 micrograms/kg, s.c.) was also enhanced in the LC lesion group in the TF but not the HP test. Norepinephrine (NE) in the lumbar spinal cord was correlated negatively and significantly with the extent of destruction of the LC. The lumbar spinal content of NE was reduced maximally at 12 days post-lesion (to 56% of control). The binding of [3H]clonidine in the lumbar spinal cord was slightly greater in the LC lesion than sham lesion group; the Bmax values were 42.4 fmol/mg protein and 35.5 fmol/mg protein for the LC lesion and sham lesion groups, respectively. It is suggested that the LC participates in the descending inhibition of spinal nociceptive transmission and that this inhibition may be mediated in the spinal cord by alpha-2 adrenoceptors located postsynaptically with respect to the NE terminals of the spinopetal LC efferents.

Pharmacology of spinal adrenergic systems which modulate spinal nociceptive processing

Spinopetal pathways may be activated by a variety of brainstem manipulations including microinjections of morphine which are known to modulate spinal nociceptive processing. Based on the ability of these manipulations to release spinal noradrenalin; the ability to reverse the antinociceptive effects by intrathecal adrenergic antagonists and the fact that intrathecal injections of noradrenalin mimic the antinociceptive effect, it appears that the descending modulation may be mediated by descending noradrenergic systems. Examination of the spinal receptor systems with intrathecally administered agents indicates that spinal alpha, but not beta adrenergic receptor agonists produce a powerful analgesia as measured on a variety of reflex and operant measures in mouse, rat, cat, primate and man. On the basis of agonist and antagonist structure-activity relationships it appears that a significant effect can be produced in the absence of any detectable effect on motor function by the occupation of spinal alpha 2 receptors. Distinguishable alpha 1 receptors also appear "analgetically-coupled," but their effects are uniformly contaminated by signs of cutaneous hyperreflexia at doses required to produce analgesia. The ordering of potency with which intrathecal adrenergic antagonists reverse the effects of intrathecal noradrenalin is indistinguishable from that of the reversal by these intrathecal agents of the antinociceptive effects evoked by brainstem morphine. This suggests that the population of spinal receptors acted upon by exogenously administered adrenergic agonists and endogenously released noradrenaline have indistinguishable characteristics.

Effect of alpha 2 adrenergic agents upon central etorphine antinociception in the cat

Systemic (s.c.) administration of alpha 2 agonists clonidine (25-100 micrograms/kg) or guanfacine (50-400 micrograms/kg) elicited antinociception as assessed by the cat tail-flick model and potentiated in a dose-dependent manner the antinociceptive effect of etorphine (2.5 micrograms) administered directly into the periaqueductal gray. Conversely, systemic yohimbine (1 mg/kg) attenuated the effects of central etorphine, and diminished potentiation of etorphine by the alpha 2 agonists. Prior microinjection of clonidine (5 micrograms) or guanfacine (5 micrograms) into the locus coeruleus (LC) reduced the intensity of central etorphine antinociception whereas central yohimbine (20 micrograms) pretreatment increased peak antinociceptive activity and prolonged the duration of etorphine. Thus, systemic alpha 2 agonists are inherently antinociceptive and potentiate central narcotic antinociception; however, the site of interaction between alpha 2 agonists and opiates does not appear to be the LC inasmuch as alpha 2 agonists attenuate the antinociceptive effect of etorphine when administered directly into the LC. A spinal site of action is suggested based upon known LC-spinal projections and our experimental observations.

Absence of antinociceptive effect of alpha-2 agonists microinjected in the periaqueductal gray of the rat

The antinociceptive efficacy of clonidine, St-91, tolazoline, phenylephrine or isoproterenol microinjected in the periaqueductal gray (PAG) in the rat was compared to that of morphine administered in the same site. Morphine (5 micrograms) was antinociceptive in all 3 analgesiometric tests employed (tail-flick, hot-plate and tail-shock vocalization). Clonidine (5-20 micrograms) did not significantly alter nociceptive thresholds, while St-91 (20 micrograms) produced a brief hyperalgesia in the tail-flick test. The alpha-2 antagonist tolazoline (20 micrograms) produced a brief antinociception in the tail-flick test. Phenylephrine and isoproterenol were without effect on nociceptive thresholds. It is suggested that the ventrolateral PAG, although a site of opiate-produced antinociception, is not involved in alpha-2-mediated antinociception.