Pain modulating and reward systems: a single brain mechanism?

Medication overuse headache and substance use disorder: A comparison based on basic research and neuroimaging

It has yet to be determined whether medication overuse headache (MOH) is an independent disorder or a combination of primary headache and substance addiction. To further explore the causes of MOH, we compared MOH with substance use disorder (SUD) in terms of the brain regions involved to draw more targeted conclusions. In this review, we selected alcohol use disorder (AUD) as a representative SUD and compared MOH and AUD from two aspects of neuroimaging and basic research. We found that in neuroimaging studies, there were many overlaps between AUD and MOH in the reward circuit, but the extensive cerebral cortex damage in AUD was more serious than that in MOH. This difference was considered to reflect the sensitivity of the cortex structure to alcohol damage. In future research, we will focus on the central amygdala (CeA), prefrontal cortex (PFC), orbital-frontal cortex (OFC), hippocampus, and other brain regions for interventions, which may have unexpected benefits for addiction and headache symptoms in MOH patients.

Chronic Unpredictable Mild Stress Model of Depression: Possible Sources of Poor Reproducibility and Latent Variables

Major depressive disorder (MDD) is one of the most common mood disorders worldwide. A lack of understanding of the exact neurobiological mechanisms of depression complicates the search for new effective drugs. Animal models are an important tool in the search for new approaches to the treatment of this disorder. All animal models of depression have certain advantages and disadvantages. We often hear that the main drawback of the chronic unpredictable mild stress (CUMS) model of depression is its poor reproducibility, but rarely does anyone try to find the real causes and sources of such poor reproducibility. Analyzing the articles available in the PubMed database, we tried to identify the factors that may be the sources of the poor reproducibility of CUMS. Among such factors, there may be chronic sleep deprivation, painful stressors, social stress, the difference in sex and age of animals, different stress susceptibility of different animal strains, handling quality, habituation to stressful factors, various combinations of physical and psychological stressors in the CUMS protocol, the influence of olfactory and auditory stimuli on animals, as well as the possible influence of various other factors that are rarely taken into account by researchers. We assume that careful inspection of these factors will increase the reproducibility of the CUMS model between laboratories and allow to make the interpretation of the obtained results and their comparison between laboratories to be more adequate.

A mu-opioid feedback model of human social behavior

Since the discovery of pain relieving and rewarding properties of opiates such as morphine or heroin, the human mu-opioid system has been a target for medical research on pain processing and addiction. Indeed, pain and pleasure act mutually inhibitory on each other and the mu-opioid system has been suggested as an underlying common neurobiological mechanism. Recently, research interest extended the role of the endogenous mu-opioid system beyond the hedonic value of pain and pleasure towards human social-emotional behavior. Here we propose a mu-opioid feedback model of social behavior. This model is based upon recent findings of opioid modulation of human social learning, bonding and empathy in relation to affiliative and protective tendencies. Fundamental to the model is that the mu-opioid system reinforces socially affiliative or protective behavior in response to positive and negative social experiences with long-term consequences for social behavior and health. The functional implications for stress, anxiety, depression and attachment behaviors are discussed.

Downregulation of M-channels in lateral habenula mediates hyperalgesia during alcohol withdrawal in rats

Hyperalgesia often occurs in alcoholics, especially during abstinence, yet the underlying mechanisms remain elusive. The lateral habenula (LHb) has been implicated in the pathophysiology of pain and alcohol use disorders. Suppression of m-type potassium channels (M-channels) has been found to contribute to the hyperactivity of LHb neurons of rats withdrawn from chronic alcohol administration. Here, we provided evidence that LHb M-channels may contribute to hyperalgesia. Compared to alcohol naïve counterparts, in male Long-Evans rats at 24-hours withdrawal from alcohol administration under the intermittent access paradigm for eight weeks, hyperalgesia was evident (as measured by paw withdrawal latencies in the Hargreaves Test), which was accompanied with higher basal activities of LHb neurons in brain slices, and lower M-channel protein expression. Inhibition of LHb neurons by chemogenetics, or pharmacological activation of M-channels, as well as overexpression of M-channels' subunit KCNQ3, relieved hyperalgesia and decreased relapse-like alcohol consumption. In contrast, chemogenetic activation of LHb neurons induced hyperalgesia in alcohol-naive rats. These data reveal a central role for the LHb in hyperalgesia during alcohol withdrawal, which may be due in part to the suppression of M-channels and, thus, highlights M-channels in the LHb as a potential therapeutic target for hyperalgesia in alcoholics.

Dopaminergic modulation of pain signals in the medial prefrontal cortex: Challenges and perspectives

Chronic pain is a massive socieoeconomic burden and is often refractory to treatment. To devise novel therapeutic interventions, it is important to understand in detail the processing of pain signals in the brain. Recent studies have revealed shared features between the brain's reward and pain systems. Dopamine (DA) is a key neuromodulator in the mesocorticolimbic system that has been implicated not only in motivated behaviours, reinforcement learning and reward processing, but also in the pain axis. The medial prefrontal cortex (mPFC) is an important region for mediating executive functions including attention, judgement, and learning. Studies have revealed that the mPFC undergoes plasticity during the development of chronic pain. The mPFC receives dopaminergic input from the ventral tegmental area (VTA), and stimulation of these inputs has been shown to modulate the plasticity of the mPFC and anxiety and aversive behaviour. Here, we review the role of the mPFC and its dopaminergic modulation in chronic pain.

[Chronic pain : Perception, reward and neural processing]

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

Modulation of pain, nociception, and analgesia by the brain reward center

The midbrain dopamine center comprises a key network for reward, salience, motivation, and mood. Evidence from various clinical and preclinical settings points to the midbrain dopamine circuit as an important modulator of pain perception and pain-induced anxiety and depression. This review summarizes recent findings that shed light to the neuroanatomical, electrophysiological and molecular adaptations that chronic pain conditions promote in the mesolimbic dopamine system. Chronic pain states induce changes in neuronal plasticity and functional connectivity in several parts of the brain reward center, including nucleus accumbens, the ventral tegmental area and the prefrontal cortex. Here, we discuss recent findings on the mechanisms involved in the perception of chronic pain, in pain-induced anxiety and depression, as well as in pain-killer addiction vulnerability. Several new studies also show that the mesolimbic dopamine circuit potently modulates responsiveness to opioids and antidepressants used for the treatment of chronic pain. We discuss recent data supporting a role of the brain reward pathway in treatment efficacy and we summarize novel findings on intracellular adaptations in the brain reward circuit under chronic pain states.

Alcohol dependence as a chronic pain disorder

Dysregulation of pain neurocircuitry and neurochemistry has been increasingly recognized as playing a critical role in a diverse spectrum of diseases including migraine, fibromyalgia, depression, and PTSD. Evidence presented here supports the hypothesis that alcohol dependence is among the pathologies arising from aberrant neurobiological substrates of pain. In this review, we explore the possible influence of alcohol analgesia and hyperalgesia in promoting alcohol misuse and dependence. We examine evidence that neuroanatomical sites involved in the negative emotional states of alcohol dependence also play an important role in pain transmission and may be functionally altered under chronic pain conditions. We also consider possible genetic links between pain transmission and alcohol dependence. We propose an allostatic load model in which episodes of alcohol intoxication and withdrawal, traumatic stressors, and injury are each capable of dysregulating an overlapping set of neural substrates to engender sensory and affective pain states that are integral to alcohol dependence and comorbid conditions such as anxiety, depression, and chronic pain.

Viewing pictures of a romantic partner reduces experimental pain: involvement of neural reward systems

The early stages of a new romantic relationship are characterized by intense feelings of euphoria, well-being, and preoccupation with the romantic partner. Neuroimaging research has linked those feelings to activation of reward systems in the human brain. The results of those studies may be relevant to pain management in humans, as basic animal research has shown that pharmacologic activation of reward systems can substantially reduce pain. Indeed, viewing pictures of a romantic partner was recently demonstrated to reduce experimental thermal pain. We hypothesized that pain relief evoked by viewing pictures of a romantic partner would be associated with neural activations in reward-processing centers. In this functional magnetic resonance imaging (fMRI) study, we examined fifteen individuals in the first nine months of a new, romantic relationship. Participants completed three tasks under periods of moderate and high thermal pain: 1) viewing pictures of their romantic partner, 2) viewing pictures of an equally attractive and familiar acquaintance, and 3) a word-association distraction task previously demonstrated to reduce pain. The partner and distraction tasks both significantly reduced self-reported pain, although only the partner task was associated with activation of reward systems. Greater analgesia while viewing pictures of a romantic partner was associated with increased activity in several reward-processing regions, including the caudate head, nucleus accumbens, lateral orbitofrontal cortex, amygdala, and dorsolateral prefrontal cortex – regions not associated with distraction-induced analgesia. The results suggest that the activation of neural reward systems via non-pharmacologic means can reduce the experience of pain.

Opioid mediation of starch and sugar preference in the rat

In our prior studies, administration of the opioid receptor antagonist naltrexone did not block conditioned preferences for a flavor paired with a preferred sugar solution over a flavor paired with saccharin. This may be because both training solutions were sweet, and their attractiveness was reduced by naltrexone. The present study compared the effects of naltrexone on preferences for flavors paired with sugar or starch drinks that have distinctive tastes to rats. Experiment 1 assessed naltrexone's effect on the preference for unflavored 8% cornstarch and 8% sucrose aqueous solutions/suspensions. The food-restricted rats displayed a significant sucrose preference which increased following systemic treatment with naltrexone (1 or 3mg/kg) even though total intake of both solutions declined. In Experiment 2, rats were trained to drink flavored (cherry or grape) starch and sucrose solutions in separate one-bottle sessions. In a two-bottle choice test with both flavors presented in a sucrose-starch mixture, the rats significantly preferred the starch-paired flavor. Naltrexone treatment blocked the expression of this starch-conditioned preference. In Experiment 3, rats were treated with saline or naltrexone throughout one-bottle training with flavored sucrose and starch solutions. In a subsequent choice test, both the saline and naltrexone groups displayed significant preferences for the starch-paired flavor, indicating that opioid antagonism failed to alter the acquisition of this conditioned preference. In summary, novel outcomes of this study included the increased rather than the predicted decrease in sucrose preference produced by naltrexone. Also, starch unexpectedly conditioned the stronger flavor preference, although this can be explained by the differential post-oral reinforcing actions of starch and sucrose, and naltrexone blocked the expression, but not the acquisition, of this preference. These findings suggest that the reward value of starch in liquid form is more dependent upon opioid signaling than is that of sugar.

Neuropharmacology of learned flavor preferences

Innate and learned flavor preferences influence food and fluid choices in animals. Two primary forms of learned preferences involve flavor-flavor and flavor-nutrient associations in which a particular flavor element (e.g., odor) is paired with an innately preferred flavor element (e.g., sweet taste) or with a positive post-oral nutrient consequence. This review summarizes recent findings related to the neurochemical basis of learned flavor preferences. Systemic and central injections of dopamine receptor antagonists implicate brain dopamine signaling in both flavor-flavor and flavor-nutrient conditioning by the taste and post-oral effects of sugars. Dopamine signaling in the nucleus accumbens, amygdala and lateral hypothalamus is involved in one or both forms of conditioning and selective effects are produced by D1-like and D2-like receptor antagonism. Opioid receptor antagonism, despite its suppressive action on sugar intake and reward, has little effect on the acquisition or expression of flavor preferences conditioned by the sweet taste or post-oral actions of sugars. Other studies indicate that flavor preference conditioning by sugars is differentially influenced by glutamate receptor antagonism, cannabinoid receptor antagonism and benzodiazepine receptor activation.

Hedonic and motivational roles of opioids in food reward: implications for overeating disorders

Food reward can be driven by separable mechanisms of hedonic impact (food 'liking') and incentive motivation (food 'wanting'). Brain mu-opioid systems contribute crucially to both forms of food reward. Yet, opioid signals for food 'liking' and 'wanting' diverge in anatomical substrates, in pathways connecting these sites, and in the firing profiles of single neurons. Divergent neural control of hedonic and motivational processes raises the possibility for joint or separable modulation of food intake in human disorders associated with excessive eating and obesity. Early findings confirm an important role for 'liking' and 'wanting' in human appetitive behaviors, and suggest the intriguing possibility that exaggerated signals for 'wanting,' and perhaps 'liking,' may contribute to forms of overeating.

The tempted brain eats: pleasure and desire circuits in obesity and eating disorders

What we eat, when and how much, all are influenced by brain reward mechanisms that generate "liking" and "wanting" for foods. As a corollary, dysfunction in reward circuits might contribute to the recent rise of obesity and eating disorders. Here we assess brain mechanisms known to generate "liking" and "wanting" for foods and evaluate their interaction with regulatory mechanisms of hunger and satiety, relevant to clinical issues. "Liking" mechanisms include hedonic circuits that connect together cubic-millimeter hotspots in forebrain limbic structures such as nucleus accumbens and ventral pallidum (where opioid/endocannabinoid/orexin signals can amplify sensory pleasure). "Wanting" mechanisms include larger opioid networks in nucleus accumbens, striatum, and amygdala that extend beyond the hedonic hotspots, as well as mesolimbic dopamine systems, and corticolimbic glutamate signals that interact with those systems. We focus on ways in which these brain reward circuits might participate in obesity or in eating disorders.

Opioid receptor antagonism in the nucleus accumbens fails to block the expression of sugar-conditioned flavor preferences in rats

In our prior studies, systemic administration of the opioid receptor antagonist naltrexone (NTX) did not block flavor preference conditioning by the sweet taste or post-oral actions of sugar despite reducing intake. Because opioid signaling in the nucleus accumbens (NAc) is implicated in food reward, this study determined if NTX administered into the NAc would block the expression of sugar-conditioned preferences. In Experiment 1, food-restricted rats with bilateral NAc shell or core cannulae were trained to drink a fructose (8%)+saccharin (0.2%) solution mixed with one flavor (CS+) and a less-preferred 0.2% saccharin solution mixed with another flavor (CS-) during one-bottle sessions. Two-bottle tests with the two flavors mixed in saccharin solutions occurred 10 min following total bilateral NAc shell or core doses of 0, 1, 25 and 50 microg of NTX. The rats preferred the CS+ over CS- following vehicle (80%) and all NTX doses in the shell and core. The CS+ preference was reduced to 64% and 72% by 50 microg NTX in the shell and core, although only the core effect was significant. In Experiment 2, food-restricted rats were trained to drink one flavored saccharin solution (CS+) paired with an intragastic (IG) glucose (8%) infusion and a second flavored saccharin solution (CS-) paired with an IG water infusion. In subsequent two-bottle tests, the rats displayed significant preferences for the CS+ (81-91%) that were unaltered by any NTX dose in the shell or core. CS+ intake, however, was reduced by NTX in the shell, but not the core. These data indicate that accumbal opioid antagonism slightly attenuated, but did not block the expression of sugar-conditioned flavor preferences. Therefore, while opioid drugs can have potent effects on sugar intake they appear less effective in altering sugar-conditioned flavor preferences.

'Liking' and 'wanting' food rewards: brain substrates and roles in eating disorders

What brain reward systems mediate motivational 'wanting' and hedonic 'liking' for food rewards? And what roles do those systems play in eating disorders? This article surveys recent findings regarding brain mechanisms of hedonic 'liking', such as the existence of cubic-millimeter hedonic hotspots in nucleus accumbens and ventral pallidum for opioid amplification of sensory pleasure. It also considers brain 'wanting' or incentive salience systems important to appetite, such as mesolimbic dopamine systems and opioid motivation circuits that extend beyond the hedonic hotspots. Finally, it considers some potential ways in which 'wanting' and 'liking' might relate to eating disorders.

Endogenous opioids encode relative taste preference

Endogenous opioid signaling contributes to the neural control of food intake. Opioid signaling is thought to regulate palatability, the reward value of a food item as determined by orosensory cues such as taste and texture. The reward value of a food reflects not only these sensory properties but also the relative value of competing food choices. In the present experiment, we used a consummatory contrast paradigm to manipulate the relative value of a sucrose solution for two groups of rats. Systemic injection of the nonspecific opioid antagonist naltrexone suppressed sucrose intake; for both groups, however, this suppression was selective, occurring only for the relatively more valuable sucrose solution. Our results indicate that endogenous opioid signaling contributes to the encoding of relative reward value.

How palatable food disrupts appetite regulation

Appetite regulation is part of a feedback system that controls the energy balance, involving a complex interplay of hunger and satiety signals, produced in the hypothalamus as well as in peripheral organs. Hunger signals may be generated in peripheral organs (e.g. ghrelin) but most of them are expressed in the hypothalamus (neuropeptide Y, orexins, agouti-related peptide, melanin concentrating hormone, endogenous opiates and dopamine) and are expressed during situations of energy deficiency. Some satiety signals, such as cholecystokinin, glucagon-like peptide 1, peptide YY and enterostatin are released from the digestive tract in response to food intake. Others, such as leptin and insulin, are mobilized in response to perturbations in the nutritional state. Still others are generated in neurones of the hypothalamus (alpha-melanocyte-stimulating hormone and serotonin). Satiety signals act by inhibiting the expression of hunger signals and/or by blunting their effect. Palatable food, i.e. food rich in fat and sugar, up-regulates the expression of hunger signals and satiety signals, at the same time blunting the response to satiety signals and activating the reward system. Hence, palatable food offsets normal appetite regulation, which may explain the increasing problem of obesity worldwide.

Opioids as agents of reward-related feeding: a consideration of the evidence

Gerard Smith was one of the pioneers in the field of neuropeptidergic control of food intake. He established methodology and criteria used to determine whether a neuropeptide acts as an endogenous satiety factor. More recently, he theorized that there are direct and indirect controls of meal size. Direct controls include those that depend upon contact of food with preabsorptive receptors from the tip of the tongue to the end of the small intestine, and indirect controls include those that do not depend upon direct contact of mucosal receptors, such as learning and metabolism. In this review, we consider the evidence that opioids are mediators of reward-related feeding. We address these issues adopting Smith's approach to problem solving, including an evaluation of the opioids as controllers of the meal. We also present a novel concept of "hedonic restriction," resulting in a change in opioid gene expression. Overall, we believe the evidence supporting opioid participation in reward-driven and other types of ingestion is very strong, but much work remains before we understand how opioids contribute to the widely distributed neural network that controls ingestive behavior.

Naltrexone does not prevent acquisition or expression of flavor preferences conditioned by fructose in rats

The effects of the general opioid antagonist, naltrexone, on the acquisition and expression of flavor preferences conditioned by the sweet taste of fructose were examined. Food-restricted rats were trained over eight daily alternating one-bottle sessions (2 h) to drink an 8% fructose solution containing one novel flavor (CS+/F) and a less preferred 0.2% saccharin solution containing a different flavor (CS-/S). Four groups of rats were treated daily with either saline (control group) or naltrexone doses of 0.1, 1.0, or 5.0 mg/kg during training. Preferences were assessed in two-bottle tests with the CS+/S and CS-/S flavors presented in 0.2% saccharin solutions following saline injections. Naltrexone dose-dependently reduced fructose and saccharin intakes during training, confirming the drug's well-known suppressive effect on the intake of sweet solutions. Despite their reduced training intakes, the naltrexone groups displayed preferences for the CS+/S over the CS-/S (72-86%) that were similar to that of the control group (78%). The effect of naltrexone on the expression of the CS+/S flavor preference was evaluated by treating control rats with naltrexone (0.1-5 mg/kg) prior to CS+/S vs. CS-/S choice tests. The drug doses produced a dose-dependent reduction in CS+/S intake but did not significantly attenuate the CS+/S preference. These data are consistent with the relative inability of naltrexone to reduce flavor-flavor conditioning by sucrose in sham-feeding rats and flavor-nutrient conditioning in rats receiving intragastric sucrose infusions. In contrast, dopamine antagonists reduce both sucrose- and fructose-conditioned flavor preferences, which indicates the sensitivity of these conditioning paradigms to neuropharmacological manipulations. These data indicate that the endogenous opioid system, unlike the dopamine system, does not play a major role in either the acquisition or expression of flavor preference learning as measured in two-bottle choice tests.

Asymmetric serial interactions between ethanol and cocaine in taste aversion learning

Although the interaction between ethanol and cocaine is well documented, it has generally been limited to situations in which the two drugs are given concurrently. Little exists on the interaction between ethanol and cocaine when one drug is given prior to the other. In Experiment 1, female Long-Evans rats were given five exposures to ethanol (2 g/kg ip) or vehicle prior to taste aversion conditioning with cocaine (32 mg/kg sc) for a total of five conditioning trials. In Experiment 2, rats were given five exposures to cocaine (32 mg/kg sc) or vehicle prior to taste aversion conditioning with ethanol (2 g/kg ip) for a total of five conditioning trials. Ethanol-preexposed, cocaine-conditioned animals (Experiment 1) displayed attenuated aversions to the cocaine-associated solution, drinking significantly greater amounts of saccharin than vehicle-preexposed, conditioned subjects. Conversely, cocaine-preexposed, ethanol-conditioned animals (Experiment 2) displayed robust aversions to the ethanol-associated solution, drinking levels comparable to those consumed by vehicle-preexposed, conditioned subjects and drinking significantly less than controls. Although the basis for these asymmetric effects is not known, they may have implications for abuse vulnerability in that drug history may impact subsequent drug toxicity that, in turn, may alter drug acceptability.

Opioid modulation of taste hedonics within the ventral striatum

There is a long-standing interest in the role of endogenous opioid peptides in feeding behavior and, in particular, in the modulation of food reward and palatability. Since drugs such as heroin, morphine, alcohol, and cannabinoids, interact with this system, there may be important common neural substrates between food and drug reward with regard to the brain's opioid systems. In this paper, we review the proposed functional role of opioid neurotransmission and mu opiate receptors within the nucleus accumbens and surrounding ventral striatum. Opioid compounds, particularly those selective for the mu receptor, induce a potent increase in food intake, sucrose, salt, saccharin, and ethanol intake. We have explored this phenomenon with regard to macronutrient selection, regional specificity, role of output structures, Fos mapping, analysis of motivational state, and enkephalin gene expression. We hypothesize that opioid-mediated mechanisms within ventral striatal medium spiny neurons mediate the affective or hedonic response to food ('liking' or food 'pleasure'). A further refinement of this hypothesis is that activation of ventral striatal opioids specifically encodes positive affect induced by tasty and/or calorically dense foods (such as sugar and fat), and promotes behaviors associated with this enhanced palatability. It is proposed that this brain mechanism was beneficial in evolutionary development for ensuring the consumption of relatively scarce, high-energy food sources. However, in modern times, with unlimited supplies of high-calorie food, it has contributed to the present epidemic of obesity.

Paradoxical effects of the opioid antagonist naltrexone on morphine analgesia, tolerance, and reward in rats

Opioid agonists such as morphine have been found to exert excitatory and inhibitory receptor-mediated effects at low and high doses, respectively. Ultra-low doses of opioid antagonists (naloxone and naltrexone), which selectively inhibit the excitatory effects, have been reported to augment systemic morphine analgesia and inhibit the development of tolerance/physical dependence. This study investigated the site of action of the paradoxical effects of naltrexone and the generality of this effect. The potential of ultra-low doses of naltrexone to influence morphine-induced analgesia was investigated in tests of nociception. Administration of intrathecal (0.05 and 0.1 ng) or systemic (10 ng/kg i.p.) naltrexone augmented the antinociception produced by an acute submaximal dose of intrathecal (5 microg) or systemic (7.5 mg/kg i.p.) morphine in the tail-flick test. Chronic intrathecal (0.005 and 0.05 ng) or systemic (10 ng/kg) naltrexone combined with morphine (15 microg i.t.; 15 mg/kg i.p.) over a 7-day period inhibited the decline in morphine antinociception and prevented the loss of morphine potency. In animals rendered tolerant to intrathecal (15 microg) or systemic (15 mg/kg) morphine, administration of naltrexone (0.05 ng i.t.; 10 and 50 ng/kg i.p.) significantly restored the antinociceptive effect and potency of morphine. Thus, in ultra-low doses, naltrexone paradoxically enhances morphine analgesia and inhibits or reverses tolerance through a spinal action. The potential of naltrexone to influence morphine-induced reward was also investigated using a place preference paradigm. Systemic administration of ultra-low doses of naltrexone (16.7, 20.0, and 25.0 ng/kg) with morphine (1.0 mg/kg) extended the duration of the morphine-induced conditioned place preference. These effects of naltrexone on morphine-induced reward may have implications for chronic treatment with agonist-antagonist combinations.

Pharmacology of flavor preference conditioning in sham-feeding rats: effects of naltrexone

Relatively little is known about the neurochemical and pharmacological mechanisms involved in flavor preference learning. The present study examined the ability of the opioid antagonist, naltrexone to alter the acquisition and expression of flavor preferences conditioned by the sweet taste of sucrose. This was accomplished by adding a novel flavor (the CS+) to a sucrose solution, and a different flavor (the CS-) to a less-preferred saccharin solution. Rats were trained to drink these solutions with an open gastric fistula (sham-feeding), which minimized postingestive actions. Food-restricted (Experiments 1 and 2A) and ad lib-fed (Experiment 2B) rats were given either limited (Experiment 1) or unlimited (Experiment 2) access to the CS+ and CS- solutions during one-bottle training. Preferences were assessed in two-bottle tests (with the CS+ and CS- flavors presented in mixed sucrose-saccharin solutions) following vehicle or naltrexone (0.1-10 mg/kg, SC) treatment. The rats displayed significant CS+ preferences following vehicle, particularly after unlimited access training. In four of five experiments, naltrexone significantly reduced total intakes during the two-bottle, sham-feeding tests. Except for one instance, however, the drug failed to block the preference for the CS+ flavor over the CS- flavor. The effects of naltrexone (0.1 mg/kg) on the acquisition of flavor preferences were studied in sham-feeding rats under limited (Experiment 3A) and unlimited (Experiment 3B) training access conditions. Rats treated with naltrexone during training displayed similar CS+ preferences as did saline-treated rats, even though they consumed less CS+ during training. The naltrexone-trained rats also displayed smaller reductions in total or CS+ intakes than did saline-trained rats when all rats were treated with a 2.5 mg/kg dose of naltrexone during testing. As in previous studies, these results show that naltrexone significantly reduces the intake of sweet solutions, yet it has little or no effect on the acquisition or expression of flavor preferences conditioned by sucrose in sham-feeding rats.

An examination of the effects of isoenergetic intragastric infusions of pure macronutrients on cold pain perception in healthy human volunteers

Our previous study demonstrated that meals, particularly when rich in fat, significantly reduced the pain induced by the cold pressor stimulus in healthy human subjects. To determine the mechanisms involved, the aim of this study was to bypass the taste and cognitive component of food and to investigate the scope of these analgesic effects with direct intragastric infusion of pure macronutrients in a group of 16 healthy human volunteers (eight male and eight female) on the response to cold-induced pain. All subjects underwent the cold pressor test (CPT) on three occasions in a counterbalanced order: before and after intragastric intubation and infusion of isoenergetic fat (10% intralipid), carbohydrate (CHO-maltodextrin), and a control infusion of isotonic saline. All solutions were of equal volume and administered at room temperature. The CPT was carried out four times on each test day, once before intubation, and 0.5, 1.5, and 2.5 h after intragastric infusion. Radial pulse and blood pressure measurements and visual analogue scales of mood/emotional state were carried out before and after each CPT. There were no significant differences in pain scores between the three test conditions, suggesting that by bypassing the cognitive and taste component of eating, the trigger for any postingestive analgesic effects of food are lost.

Analgesia and abuse potential: an accidental association or a common substrate?

The fact that centrally acting analgesics have abuse potential commensurate with their analgesic activity raises the question of whether these effects are related. The abuse potential of drugs depends on their ability to produce reinforcing effects, which are mediated by a neural system that includes the ventral tegmental dopamine cells and their connections with the ventral striatum. Morphine and amphetamine are both powerful analgesics and have high abuse potential. Their analgesic and reinforcing effects are mediated by similar receptors, similar sites of action, and overlapping neural substrates. These coincidences suggest that reinforcers may produce analgesia by transforming the aversive affective state evoked by pain into a more positive affective state. The implications of this hypothesis and its relation to other known mechanisms of analgesia are discussed. The hypothesis predicts that drugs with reinforcing effects should produce analgesia. A survey of drugs acting through 21 classes of receptors reveals that in 13 classes there is evidence for both analgesic and reinforcing effects that are approximately equipotent. The GABA(A) agonists were found to be the only drugs with confirmed abuse potential that lack analgesic activity. The interpretation of this and several other anomalous cases is discussed.

Food cravings, endogenous opioid peptides, and food intake: a review

Extensive research indicates a strong relationship between endogenous opioid peptides (EOPs) and food intake. In the present paper, we propose that food cravings act as an intervening variable in this opioid-ingestion link. Specifically, we argue that altered EOP activity may elicit food cravings which in turn may influence food consumption. Correlational support for this opioidergic theory of food cravings is provided by examining various clinical conditions (e.g. pregnancy, menstruation, bulimia, stress, depression) which are associated with altered EOP levels, intensified food cravings, and increased food intake.

Opioid-receptor subtype agonist-induced enhancements of sucrose intake are dependent upon sucrose concentration

Selective mu ([D-Ala2, N-Me-Phe4, Gly-ol5]-enkephalin (DAMGO)), delta1 ([D-Pen2, D-Pen5]-enkephalin (DPDPE)), delta2 ([D-Ala2, Glu4]-Deltorphin (Delt II)), kappa1 (U50488H) and kappa3 (naloxone benzoylhydrazone (NalBzOH)) opioid agonists each stimulate food intake in rats. Whereas studies with selective opioid antagonists implicate mu and kappa1 receptors in the mediation of sucrose intake, studies with selective opioid agonists implicate mu and delta receptors in the mediation of saccharin intake. The present study determined if specific delta1, delta2, kappa1, kappa3 and mu opioid-receptor subtype agonists produced similar alterations in sucrose intake as a function of sucrose concentration (0.5%, 2.5%, 10%) across a 1-h time-course. Each of these agonists significantly increased sucrose intake with variations in pattern, magnitude, and consistency as a function of sucrose concentration. Whereas the mu opioid agonist, DAMGO, and the delta1 opioid agonist, DPDPE, each enhanced sucrose intake at higher (2.5%, 10%), but not lower (0.5%), concentrations, the delta2 opioid agonist, Delt II, increased sucrose intake at lower (0.5%, 2.5%), but not higher (10%), concentrations. Kappa opioid agonists produced less consistent effects. The kappa1 opioid agonist, U50488H, increased sucrose intake at high (10%) concentrations and decreased sucrose intake at low (0.5%) concentrations, and the kappa3 opioid agonist, NalBzOH, inconsistently increased sucrose intake at the 0.5% (20 microg) and 10% (1 microg) concentrations. Thus, these data further implicate mu, delta1, and delta2 opioid mediation of palatable intake, particularly of its orosensory characteristics.

The influence of food on pain perception in healthy human volunteers

The aim of this study was to investigate if food could reduce pain perception in a group of 16 healthy human volunteers (8 male and 8 female), and to explore the differential effects of macronutrient composition on the response to cold-induced pain. All subjects underwent the cold pressor test (CPT) on 3 occasions in a counterbalanced order, before and after administration of isoenergetic high-fat low-carbohydrate (CHO) and high-CHO low-fat meals, and when no meal was given. The CPT was carried out 4 times on each test day, once before the meal, and 0.5, 1.5, and 2.5 h after the meal, and at the equivalent times on the day when no food was given. Radial pulse and blood pressure measurements and visual analogue scales of mood/emotional state were carried out before and after each CPT. Mean pain scores were significantly reduced following both meals compared with the no-food condition. The maximum reduction in pain occurred 1.5 h after ingestion, and a significantly greater effect was exerted by the high-fat low-CHO meal compared with the high-CHO low-fat meal. These results demonstrate that food, particularly when rich in fat, significantly reduces the pain induced by the cold pressor stimulus in healthy human subjects.

Electrical stimulation of the cingulum bundle and surrounding cortical tissue reduces formalin-test pain in the rat

Surgical lesions of the cingulum bundle in humans produce marked decreases in severe pain associated with cancer, reflex sympathetic dystrophy and other forms of chronic pain. Similarly, a temporary block of the anterior cingulum bundle in the rat by microinjection of lidocaine produces significant decreases in formalin-pain and reduces autotomy following peripheral neurectomy. The present study explored the effect of electrical stimulation of the cingulum bundle/surrounding cortical tissue (CB/CT) on tonic pain in the rat. Experiment 1 examined changes in formalin-induced pain responses following a 2.5-min period (30 s/min for 5 min) of electrical stimulation of the CB/CT 15 min prior to the formalin injection. The stimulation produced a significant reduction of first-period and second-period pain responses. Experiment 2 examined changes in formalin-induced pain responses following a 2.5-min period (30 s/min for 5 min) of electrical stimulation of the CB/CT 20 min following the formalin injection. The stimulation produced a dramatic reduction in second-period pain responses which persisted for the duration of the 35-min post-stimulation test period. The fact that either electrical stimulation or surgical section of the CB/CT produces pain relief suggests that this region serves a complex role in pain processing. Since the cingulum bundle has major connections with all other structures of the limbic system, it is possible that electrical stimulation disrupts patterned activity in the system, which is known to play an especially important role in the affective-motivational dimension of pain.

The delta opioid receptor antagonist naltrindole attenuates both alcohol and saccharin intake in rats selectively bred for alcohol preference

This study demonstrates that the selective delta receptor antagonists ICI 174864 and naltrindole (NTI) attenuate alcohol intake in a dose-dependent manner, without altering water intake, in rats selectively bred for alcohol preference. ICI 174864 had a very limited duration of action, as evidenced by the fact that suppression of alcohol intake lasted for only an hour following ICI 174864 administration. NTI, when administered in a dose of 10 mg/kg, suppressed alcohol intake by 28%. Increasing the dose of NTI to 15 mg/kg produced a 44% suppression of alcohol intake, but a further increase to 20 mg/kg did not produce greater suppression than was seen with a dose of 15 mg/kg (46% versus 44%, respectively). This suggests that NTI is maximally effective in suppressing alcohol intake at a dose of 15.0 mg/kg. NTI displayed a long duration of action, as evidenced by attenuation of alcohol drinking that lasted for at least 8 h following drug treatment. Administering the maximally effective dose of NTI (15 mg/kg) in two parts, separated by 4 h, served to prolong the duration of action of NTI and produced an attenuation of alcohol intake, but not water intake, that lasted for at least 28 h. The effect of NTI on alcohol intake was not specific for alcohol, as evidenced by the fact that NTI reduced the intake of saccharin solutions with and without alcohol.

Analysis of central opioid receptor subtype antagonism of hypotonic and hypertonic saline intake in water-deprived rats

Intake of either hypotonic or hypertonic saline solutions is modulated in part by the endogenous opioid system. Morphine and selective mu and delta opioid agonists increase saline intake, while general opioid antagonists reduce saline intake in rats. The present study evaluated whether intracerebroventricular administration of general (naltrexone) and selective mu (beta-funaltrexamine, 5-20 micrograms), mu, (naloxonazine, 50 micrograms), kappa (nor-binaltorphamine, 5-20 micrograms), delta (naltrindole, 20 micrograms), or delta 1 (DALCE, 40 micrograms) opioid receptor subtype antagonists altered water intake and either hypotonic (0.6%) or hypertonic (1.7%) saline intake in water-deprived (24 h) rats over a 3-h time course in a two-bottle choice test. Whereas peripheral naltrexone (0.5-2.5 mg/kg) significantly reduced water intake and hypertonic saline intake, central naltrexone (1-50 micrograms) significantly reduced water intake and hypotonic saline intake. Water intake was significantly reduced following mu and kappa receptor antagonism, but not following mu 1, delta, or delta 1 receptor antagonism. In contrast, neither hypotonic nor hypertonic saline intake was significantly altered by any selective antagonist. These data are discussed in terms of opioid receptor subtype control over saline intake relative to the animal's hydrational state and the roles of palatability and/or salt appetite.

The role of multiple opioid receptors in the maintenance of stimulation-induced feeding

Feeding induced by lateral hypothalamic electrical stimulation is sensitive to opioid antagonism and has previously been blocked by naloxone and antibodies to dynorphin A fragments. In the present study, high affinity receptor-selective antagonists were used to determine the particular opioid receptor type(s) that mediates stimulation-induced feeding (SIF). Separate groups of rats were used to conduct i.c.v. dose-response studies with TCTAP (mu), naltrindole (delta) and norbinaltorphimine (kappa). TCTAP, at the highest dose tested (i.e. 5.0 nmol) and norbinaltorphimine, at doses of 10.0 and 50.0 nmol, increased the brain stimulation frequency threshold for eliciting SIF. Naltrindole, at doses up to 50.0 nmol, had no effect. Results of another study, recently conducted in this laboratory, indicate that the present doses of TCTAP and norbinaltorphimine have no effect on thresholds for lateral hypothalamic self-stimulation. This suggests that mu and kappa opioid activity are associated with feeding, rather than the eliciting brain stimulation, and excludes non-specific performance deficits as an explanation of elevated SIF thresholds. In the SIF test, where 5 determinations of threshold are obtained in serial order, naloxone characteristically increases thresholds toward the end of a test while conventional appetite suppressants increase thresholds uniformly throughout a test. TCTAP and norbinaltorphimine produced a 'naloxone-like' pattern of threshold elevation, suggesting that mu and kappa receptors are involved in the process whereby endogenous opioid activity sustains feeding once initiated.

Effects of pedunculopontine tegmental nucleus lesions on morphine-induced conditioned place preference and analgesia in the formalin test

The development of a conditioned place preference to morphine (2 mg/kg; three pairings) and the analgesic effect of morphine (0, 4 or 8 mg/kg) in the formalin test were studied in rats with sham or neurotoxin lesions of the pedunculopontine tegmental nucleus. Lesions were induced by bilateral infusions of N-methyl-D-aspartate (0.5 microliter of 0.1 M solution) or vehicle over 10 min. No anti-seizure medication was administered in the first experiment, whereas animals in the second experiment were injected with diazepam (1 mg/kg) immediately after surgery. In Experiment 1, behaviour in the conditioned place preference and formalin tests was assessed in separate groups of lesioned and control rats. In Experiment 2, the same animals received both sets of tests. In both experiments lesions of the pedunculopontine tegmental nucleus blocked the development of a conditioned place preference to morphine, but had no effect on the behavioural response to formalin, or on its inhibition by morphine. Examination of cholinergic-stained cells found no correlation between the magnitude of behavioural effects and the number of acetylcholine cells destroyed by the lesions. These results confirm that the pedunculopontine tegmental nucleus mediates the development of a morphine-induced conditioned place preference, but not the analgesic effect of morphine.

Interactions among aging, gender, and gonadectomy effects upon naloxone hypophagia in rats

The present study examined the dose-dependent (0.25-5 mg/kg) effects of systemic naloxone upon deprivation-induced intake and high-fat intake as functions of age (4, 8, 14, and 20 months), gender, and gonadectomy in rats. Significant increases in body weight were observed as functions of age and gonadectomy. Whereas aging significantly reduced basal deprivation-induced intake, it generally failed to alter basal high-fat intake. Whereas age, gender, and gonadectomy failed to alter the decreases in deprivation-induced intake following low (0.25-2.5 mg/kg) naloxone doses, sham males displayed significantly greater age-related and gender-related inhibition following the 5 mg/kg dose of naloxone. Young gonadectomized rats displayed significant increases in naloxone's inhibition of deprivation-induced intake as well. More dramatic changes occurred in naloxone's inhibition of high-fat intake. Naloxone's potency increased in sham female rats as a function of age, and decreased in sham males and ovariectomized females as a function of age. Whereas sham males and ovariectomized females were most sensitive to naloxone's inhibition of high-fat intake at young ages, sham females were most sensitive at older ages. These data indicate that effects of age, gender, and gonadectomy upon naloxone-induced hypophagia dissociate as a function of the type of intake. Because selective opioid antagonist studies demonstrate that deprivation-induced intake is mediated by the mu1 receptor and high-fat intake is mediated by kappa and mu2 receptors, it is postulated that the differential effects of aging, gender, and gonadectomy variables upon opioid mediation of the two forms of intake may reflect their interaction with different opioid receptor subtypes.

Opioidergic manipulations affect intake of 3% NaCl in sodium-deficient rats

On six weekly occasions, a 3% NaCl solution was presented along with water to rats for 2 h 1 day after being treated with furosemide, a diuretic/natriuretic drug that causes a strong hunger for 3% NaCl. On some of the days, the sodium-hungry rats were injected with morphine in doses ranging from 0.3 to 10.0 mg/kg. Morphine produced biphasic effects on intake of 3% NaCl, with doses of 0.3-3.0 mg/kg increasing intakes dose dependently and 10.0 mg/kg decreasing intakes. The 3.0-mg/kg dose nearly doubled rats' mean intake of 3% NaCl. In contrast, naltrexone, an opioid receptor antagonist, reduced intake of 3% NaCl about 25-40% across doses ranging from 0.1 to 10.0 mg/kg. At some doses of morphine and naltrexone, NaCl ingestion was affected without significant influence of water intake. Therefore, it can be inferred that endogenous opioidergic systems participate in the control of NaCl drinking by sodium-deficient rats. The range of demonstrations of opioid involvement in the control of ingestion can now be extended to the hunger for hypertonic NaCl induced by sodium depletion.

Central opioid receptor subtype antagonists differentially reduce intake of saccharin and maltose dextrin solutions in rats

Opioid modulation of ingestion includes general opioid antagonism of deprivation-induced water intake and intake of sucrose and saccharin solutions. Previous studies using selective subtype antagonists indicated that opioid effects upon deprivation-induced water intake occurred through the mu2 receptor and that opioid effects upon sucrose intake occurred through kappa and mu2 receptors. The present study compared the effects of intracerebroventricular administration of opioid receptor subtype antagonists upon intakes of a saccharin solution and a maltose dextrin (MD) solution to determine which receptor subtypes were involved in modulation of ingestion of different preferred tastants. Significant reductions in saccharin intake (1 h) occurred following naltrexone (20-50 micrograms: 66%) and naltrindole (delta, 20 micrograms: 75%), whereas [D-Ala2, Leu5, Cys6]-enkephalin (DALCE, delta 1, 40 micrograms: 45%) had transient (5 min) effects. Neither beta-funaltrexamine (B-FNA, mu), naloxonazine (mu1), nor nor-binaltorphamine (Nor-BNI, kappa) significantly altered saccharin intake. Significant reductions in MD intake (1 h) occurred following naltrexone (5-50 micrograms: 69%) and B-FNA (1-20 micrograms: 38%). MD intake was not reduced by naltrindole, DALCE, naloxonazine and Nor-BNI. Peak antagonist effects were delayed (20-25 min) to reflect interference with the maintenance, rather than the initiation of saccharin or MD intake. Comparisons of opioid antagonist effects across intake situations revealed that naltrexone had consistently low ID40 values for saccharin (29 nmol), MD (25 nmol), sucrose (6 nmol) and deprivation (38 nmol) intake. Despite its significant effects relative to naloxonazine, B-FNA had significantly higher ID40 values for saccharin (800 nmol), MD (763 nmol) and sucrose (508 nmol) relative to deprivation (99 nmol) intake, suggesting that mu2 receptors may be mediating maintenance of intake rather than taste effects. Nor-BNI had low ID40 values for intake of sucrose (4 nmol), but not for saccharin (168 nmol), MD (153 nmol) and deprivation (176 nmol), suggesting that kappa receptors may mediate ingestion of sweet-tasting stimuli. That delta (naltrindole: ID40 = 60 nmol), but not delta 1 (DALCE: ID40 = 288 nmol) antagonists consistently reduce saccharin intake suggests a role for the delta 2 receptor subtype in the modulation of hedonic orosensory signals.

Early onset of reduced morphine analgesia by ingestion of sweet solutions

Morphine analgesia can be reduced by prior exposure to food and flavored fluids. The early onset of reduced morphine-induced analgesia (RMA) was studied in 82 male Wistar rats after allowing them access to either a dextrose-saccharin solution or unflavored tap water for 6 or 3 h (Experiment 1, n = 40) or for 3 h, 90, or 45 min (Experiment 2, n = 42). Morphine (4 mg/kg) was injected subcutaneously at the end of the drinking period, and after 25 min a series of tail flick tests was conducted. Morphine produced strong analgesia in all rats that drank unflavored tap water; however, in rats that drank the flavored solution, the analgesic effect of morphine was significantly attenuated following exposures of 6 or 3 h, but not following exposures of 90 or 45 min. Similar quantities of flavored fluid were consumed by groups at all exposure durations; thus, RMA was determined by duration of exposure and not amount consumed. No analgesia attributable to flavor consumption per se was observed. The results suggest that RMA is mediated by endogenous opioid activity in the gustatory and analgesic systems by a mechanism akin to tolerance that requires about 3 h to operate.

Central opioid receptor subtype antagonists differentially alter sucrose and deprivation-induced water intake in rats

The present study compared the effectiveness of centrally-administered opioid receptor subtype antagonists to inhibit intake of either a 10% sucrose solution under ad libitum conditions, or water following 24 h of water deprivation. Full dose-response functions were evaluated over a 1 h period for the following antagonists: naltrexone (general: 1-50 micrograms), nor-binaltorphamine (Nor-BNI, kappa: 1-20 micrograms), beta-funaltrexamine (beta-FNA, mu: 1-20 micrograms), naltrindole (delta 2: 1-20 micrograms), [D-Ala2, Leu5, Cys6]-enkephalin (DALCE, delta 1: 10-40 micrograms) and naloxonazine (mu 1: 10-50 micrograms). Naltrexone significantly and dose-dependently inhibited both sucrose intake (64-67%) and deprivation-induced water intake (53-67%). Nor-BNI significantly and dose-dependently inhibited sucrose intake (53-55%), but failed to significantly affect (28%) deprivation-induced water intake. beta-FNA significantly and dose-dependently inhibited both sucrose intake (31-34%) and deprivation-induced water intake (36-50%). Naltrindole failed to significantly alter either sucrose intake (24%) or deprivation-induced water intake (16%). Whereas DALCE significantly, but transiently (15-20 min) inhibited sucrose intake (28%), it failed to significantly alter deprivation-induced water intake (14%). Naloxonazine significantly, but transiently (5-10 min) stimulated sucrose intake at low doses (26%), but non-significantly reduced sucrose intake at higher doses (20%). Naloxonazine failed to significantly alter deprivation-induced water intake (16% reduction). These data indicate that whereas the kappa and mu 2 binding sites participate in the opioid modulation of sucrose intake, the mu 2 binding site participates in the opioid modulation of deprivation-induced water intake.

Development of tolerance to endogenous opiates activated by 24-h food deprivation

Four experiments assessed the effects of exposure to 24-h food deprivation on the tail-flick latency of rats exposed to a temperature stimulus. Confirming previous studies, Experiment 1 showed that food deprivation gave rise to analgesia, as indicated by increased tail-flick latencies, that was antagonized by naloxone. Experiment 2 found that analgesia was greatly reduced after five exposures to periods of 24-h food deprivation (alternating with 24-h free access to food), indicating the development of tolerance. Experiments 3 and 3a examined the development of tolerance to the analgesic effects of morphine following repeated morphine injections, saline injections, and exposure to 24-h food deprivation plus saline injections. The combined results of both experiments provided evidence that repeated exposures to either morphine or food deprivation, produced greater tolerance to morphine than did exposures to saline. That food deprivation was cross-tolerant with morphine indicated that tolerance to food deprivation-induced analgesia involved opioid mechanisms. The relevance of opioid tolerance to psychobiological models of feeding and to the development of an animal model of anorexia nervosa was discussed.