The link between analgesia and cardiovascular function: roles for GABA and endogenous opioids

Alterations in a hypothalamic GABA system in the spontaneously hypertensive rat

The density (Bmax) of muscimol and clonazepam binding to hypothalamic membranes from spontaneously hypertensive rats (SHR) was reduced compared to age-matched Wistar Kyoto (WKY) animals in the period 80 - 120 days. There were no significant differences in dissociation constant (Kd) for either ligand at this time. At 30 - 36 days, prior to development of pronounced hypertension, there were no differences in Kd or Bmax for either ligand in SHR and WKY animals. There were also deficits in endogenous hypothalamic GABA concentrations in SHR at 75 and 120 days as compared to WKY. The hypothesis is advanced, that there may be a dysfunction of a hypothalamic GABA system in the SHR rat as hypertension develops.

Effects of pharmacologic increases in brain GABA levels on cocaine-induced changes in extracellular dopamine

Cocaine-induced increases in extracellular dopamine (DA) concentrations were measured using in vivo microdialysis techniques in the nucleus accumbens (NACC) of freely moving rats. In control animals, cocaine increased extracellular DA concentrations approximately 482% 60 min following administration, returning to baseline values 200 min later. When administered 2 h following an acute dose of gamma-vinyl-GABA (GVG, Vigabatrin), cocaine-induced increases in extracellular DA were reduced to approximately 365% of baseline values. Chronic GVG administration further dose-dependently attenuated the effects of cocaine but did not alter the rate of increase or the rate of return to baseline values. These results indicate that GVG, a drug that increases brain GABA concentrations, is effective in attenuating the effect of cocaine on NACC DA. Taken with our earlier findings, these results support the targeting of brain GABAergic systems as a potentially effective pharmacologic treatment strategy for cocaine addiction.

Central analgesic effect of valproate in patients with epilepsy

Clinical practitioners have often observed in the course of their daily work that the pain thresholds of epileptic patients seem to differ from those of healthy subjects. These patients can suffer from quite severe traumatic lesions without apparently experiencing any pain. Previous studies have shown that the absence of pain is due to treatment, since most antiepileptic drugs also have analgesic effects. In the present study, it was proposed to assess the pain thresholds of 15 epileptic patients (with tonic-clonic seizures generalized at outset) treated with valproate, by measuring the leg flexion nociceptive reflex (or RIII reflex) threshold: the stimulation threshold at which this reflex is triggered is known to be correlated with the pain threshold. The results were compared with 15 control subjects. The nociceptive threshold of the patients with valproate treatment was significantly higher than that of the control population. The nociceptive threshold was also in good correlation with the valproate plasma level. These data are discussed from the point of view of the gaba-ergic system and mechanisms possibly involved.

Primary afferent interactions: analysis of calcitonin gene-related peptide-immunoreactive terminals in contact with unlabeled and GABA-immunoreactive profiles in the monkey dorsal horn

The present study analyses the relationship of calcitonin gene-related peptide (CGRP)-immunoreactive primary afferent terminals with unlabeled and GABA-immunoreactive profiles in the primate (Macaca fascicularis) dorsal horn. One-hundred CGRP-immunoreactive terminals located in the superficial dorsal horn were quantitatively analysed and all profiles in apposition or in synaptic contact with these terminals were categorized as either axon terminals or dendrites with or without vesicles. These profiles were then further classified as to whether they were GABA-immunoreactive. All of the CGRP-immunoreactive terminals demonstrated axodendritic interactions; in addition to dendrites without vesicles, approximately half of the CGRP-immunoreactive terminals had dendrites with vesicles as postsynaptic elements. Of the dendrites with vesicles, 25/53 were GABAergic but only 3/67 of the postsynaptic dendrites without vesicles were GABAergic. GABAergic vesicle-containing dendrites were the most prominent CGRP-GABAergic interaction. Axoaxonic and dendroaxonic interactions were a rare occurrence, thus the classical anatomical substrate for primary afferent depolarization involving GABA- and CGRP-immunoreactive terminals could not be substantiated. CGRP-GABAergic interactions often involved diadic and triadic arrangements. These findings are discussed in relation to previously described primary afferent synaptology, primary afferent-GABAergic interactions and spinal cord mechanisms for modulation of noxious input.

Descending adrenergic input to the primate spinal cord and its possible role in modulation of spinothalamic cells

The present study focuses on 3 different aspects of the descending adrenergic system in the primate: (1) the distribution of adrenergic fibers and terminals in the spinal cord, (2) the source of this input and (3) the possible physiological effects of this system on spinal nociceptive processing. Antibodies to the enzyme phenylethanolamine-N-methyltransferase (PNMT) were employed to map the distribution of epinephrine-containing axonal profiles in the primate spinal cord. Smooth longitudinally oriented fibers were localized to the outer edge of the lateral funiculus. PNMT-containing axonal enlargements were distributed to the superficial dorsal horn, intermediate gray matter and the region surrounding the central canal at all spinal cord levels. PNMT-immunostained profiles were also observed in the intermediolateral cell column. A double labeling study employing retrograde transport of HRP from the spinal cord and PNMT immunohistochemistry identified a small population of HRP-PNMT-labeled neurons in the 'C1' region at the levels of the medulla and ponto-medullary junction. Thus, these cells are a probable source of adrenergic input to the spinal cord. Electrophysiological studies demonstrated that iontophoresis of epinephrine onto identified primate spinothalamic tract neurons in the lumbar dorsal horn resulted in inhibition of the glutamate-induced firing of these cells. The data from these studies support the hypothesis that adrenergic (PNMT-containing) cells in the caudal brainstem project to all levels of the cord and may contribute to descending modulation of nociceptive processing at these levels.

Diminution by benzodiazepines of the chronotropic responses to noradrenaline in rat isolated atria

The effects of various benzodiazepines on chronotropic responses were assayed in spontaneously beating rat isolated atria. The increases in atrial rate obtained from concentration-response curves to noradrenaline were reduced dose dependently by both the peripheral agonist, Ro 5-4864 5 and 10 microM, and the mixed agonist, diazepam 5, 10 and 50 microM, but not by the central benzodiazepine agonist, clonazepam 10 and 30 microM. The inhibitory effects of the benzodiazepines on the atrial responses to noradrenaline were not counteracted by either the peripheral benzodiazepine antagonist, PK 11195 10 microM, or the central benzodiazepine antagonist, Ro 15-1788 10 and 100 microM. Both 10 microM Ro 5-4864 and 10 microM diazepam also reduced the increases in atrial rate produced by either the phosphodiesterase inhibitor, 3-isobutyl-1-methylxanthine, or the adenylate cyclase activator, forskolin. On the contrary, diazepam and Ro 5-4864 did not modify the chronotropic responses of the atria either to direct exposure to CaCl2 or to the calcium agonist, BAY K 8644. The increases in the intracellular levels of cAMP induced by noradrenaline were not modified by Ro 5-4864 and were even increased by 50% in the presence of diazepam. It is concluded that benzodiazepines probably reduce the chronotropic responses to noradrenaline in rat isolated atria through the interaction with the cAMP-linked chain of events that follows the activation of beta-adrenoceptors.

The relationship between cardiovascular and pain regulatory systems

An increasing amount of anatomical, physiological, and pharmacological evidence suggest that pain inhibitory circuitry is linked with cardiovascular regulatory systems in man and laboratory animals. Induction of hypertension in rats by different methods (mineralocorticoid treatment, stenosis of renal artery, or social deprivation) is associated with reduced responsiveness to noxious thermal stimuli (hot-plate) or to noxious mechanical stimuli (paw pressure). Genetically hypertension-prone rats derived from the SABRA strain and spontaneously hypertensive rats derived from Wistar/Kyoto strain also display a similar hypoalgesia. Acute increases in blood pressure are associated with reduced sensitivity to painful stimuli. Additionally, the interaction between blood pressure and pain perception has also been supported by the demonstration that various experimental interventions that diminish the magnitude of hypertension also attenuate the hypoalgesia. Recent clinical findings are also in agreement with the laboratory animal findings since sensory and pain thresholds have been shown to be significantly higher in unmedicated essential hypertensive subjects compared to normotensive controls. Thus, the human data corroborate animal data and suggest that a relation between blood pressure and pain sensitivity is likely to be a general phenomenon. It is unlikely that damage to peripheral pain fibers caused by a change in blood pressure contributes to the observed hypoalgesia. Naloxone, which has no effect on blood pressure, returns the pain sensitivity to normal levels. Behavioral tests (open field and motor activity cage) of normotensive and of renal and genetically (SBH and SHR) hypertensive rats exclude the possibility of a general motor deficit in hypertensive rats. Endogenous opioid peptides in central and peripheral nervous systems as well as in endocrine organs are implicated, although non-opioid mechanisms are also evident. Activation of baroreceptor afferents by acute or chronic increases in arterial or venous blood pressure may play an important role in the somatosensory responses associated with the increase in blood pressure. Coordinated cardiovascular-pain regulatory responses may be part of an adaptive mechanism that helps the body to face stressful events.

Effect of intrathecally administered noradrenergic antagonists on nociception in the rat

Recent evidence suggests that some groups of noradrenergic neurons found in the brainstem have axonal connections in the spinal cord dorsal horn and may be involved in the control of pain sensitivity. Such evidence includes the demonstration that intrathecal injection of noradrenergic agonists increases nociceptive threshold (hypoalgesia). The present studies examined whether the descending noradrenergic system is tonically active and, if so, what noradrenergic receptor subtypes mediate the actions of endogenously-released norepinephrine. These studies involved the measurement of nociceptive threshold before and after the intrathecal injection of noradrenergic antagonists having different relative affinities for alpha-noradrenergic receptor subtypes. The intrathecal administration of alpha-noradrenergic antagonists produced a dose-dependent decrease in nociceptive threshold (hyperalgesia). This finding is consistent with the proposal that tonically-active bulbospinal noradrenergic neurons modulate the processing of nociceptive information in the spinal cord. The potency and duration of the hyperalgesia was correlated with the relative potency of the antagonists for the alpha-2 noradrenergic receptor. The relative potencies were as follows: yohimbine greater than phentolamine greater than WB 4101 greater than prazosin. Thus, endogenous norepinephrine which is tonically released from bulbospinal axon terminals may interact preferentially with noradrenergic receptors of the alpha-2 type.

Interactions between cardiovascular and pain regulatory systems

A review of pharmacological, neuroanatomical, electrophysiological, and behavioral data indicates that systems controlling cardiovascular function are closely coupled to systems modulating the perception of pain. This view is directly supported by experiments from our laboratory showing that activation of either the cardiopulmonary baroreceptor reflex arc or the sinoaortic baroreceptor reflex arc induces antinociception. The outcomes of studies using pharmacological treatments, peripheral nerve stimulation, peripheral nerve resection, and CNS lesions are also presented as a preliminary means of characterizing cardiovascular input to pain regulatory systems. The network formed by these systems is proposed to participate in the elaboration of adaptive responses to physical and psychological stressors at various levels of the neuroaxis, and possibly to participate in "diseases of adaptation." In particular, the present analysis suggests that the inhibition of pain brought about by elevations in either arterial or venous blood pressure may provide a form of psychophysiological relief under situations of stress and contribute to the development of essential hypertension in humans.

Antinociceptive action of sodium valproate in the mouse

The antinociceptive action of sodium valproate (VPA) was examined using male NMRI mice. Using the hot-plate assay at 60 degrees C, orally-administered VPA (50-400 mg/kg) produced antinociceptive effects; the ED50 was about 160 mg/kg. Oral doses of VPA (6.3-400 mg/kg) decreased the writhing response elicited by intraperitoneally-injected acetic acid. The antinociceptive effect of VPA, as determined with the writhing test, exhibited complex characteristics, the most pronounced effect occurring at doses of 12.5-50 mg/kg. The antinociceptive effect of VPA in the writhing test was not antagonized by bicuculline or by naloxone. VPA, like other agents which enhance central GABA-ergic mechanisms, might possess analgesic activity.