Spinal cord monoamines modulate the antinociceptive effects of vaginal stimulation in rats

Persistent Genital Arousal Disorder: Two Case Studies and Exploration of a Novel Treatment Modality

Persistent genital arousal disorder (PGAD) is characterized by persistent unwanted feelings of sexual arousal that can be debilitating. Despite first being defined >20 years ago, the precise etiology and treatment of this disorder remain elusive. Mechanical disruption of nerves, neurotransmitter changes, and cyst formation have all been considered as etiologies involved with the development of PGAD. With limited and ineffective treatment modalities, many women live with their symptoms untreated or undertreated. To broaden the literature, we present two cases of PGAD and present a novel treatment modality of the disorder with the use of a pessary. Although there was subjective success in dampening the symptoms, they were not completely resolved. These findings open the door for the potential of similar treatments in the future.

Orgasm and Related Disorders Depend on Neural Inhibition Combined With Neural Excitation

INTRODUCTION

Prevalent models of sexual desire, arousal and orgasm postulate that they result from an excitatory process, whereas disorders of sexual desire, arousal and orgasm result from an inhibitory process based on psychosocial, pharmacological, medical, and other factors. But neuronal excitation and active neuronal inhibition normally interact at variable intensities, concurrently and continuously. We propose herein that in conjunction with neuronal excitation, neuronal inhibition enables the generation of the intense, non-aversive pleasure of orgasm. When this interaction breaks down, pathology can result, as in disorders of sexual desire, arousal, and orgasm, and in anhedonia and pain. For perspective, we review some fundamental behavioral and (neuro-) physiological functions of neuronal excitation and inhibition in normal and pathological processes.

OBJECTIVES

To review evidence that the variable balance between neuronal excitation and active neuronal inhibition at different intensities can account for orgasm and its disorders.

METHODS

We selected studies from searches on PubMed, Google Scholar, Dialnet, and SciELO for terms including orgasm, neuronal development, Wallerian degeneration, prenatal stress, parental behavior, sensorimotor, neuronal excitation, neuronal inhibition, sensory deprivation, anhedonia, orgasmic disorder, hypoactive sexual desire disorder, persistent genital arousal disorder, sexual pain.

RESULTS

We provide evidence that the intensity of neuronal inhibition dynamically covaries concurrently with the intensity of neuronal excitation. Differences in these relative intensities can facilitate the understanding of orgasm and disorders of orgasm.

CONCLUSION

Neuronal excitation and neuronal inhibition are normal, continuously active processes of the nervous system that are necessary for survival of neurons and the organism. The ability of genital sensory stimulation to induce concurrent neuronal inhibition enables the stimulation to attain the pleasurable, non-aversive, high intensity of excitation characteristic of orgasm. Excessive or deficient levels of neuronal inhibition relative to neuronal excitation may account for disorders of sexual desire, arousal and orgasm.

International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

BACKGROUND

Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood.

AIM

To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management.

METHODS

A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment.

OUTCOMES

The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed.

RESULTS

The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress.

CLINICAL IMPLICATIONS

The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment.

STRENGTHS AND LIMITATIONS

Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion.

CONCLUSION

We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665-697.

Neurogenesis in the olfactory bulb induced by paced mating in the female rat is opioid dependent

The possibility to control the rate of sexual stimulation that the female rat receives during a mating encounter (pacing) increases the number of newborn neurons that reach the granular layer of the accessory olfactory bulb (AOB). If females mate repeatedly, the increase in the number of neurons is observed in other regions of the AOB and in the main olfactory bulb (MOB). It has also been shown that paced mating induces a reward state mediated by opioids. There is also evidence that opioids modulate neurogenesis. In the present study, we evaluated whether the opioid receptor antagonist naloxone (NX) could reduce the increase in neurogenesis in the AOB induced by paced mating. Ovariectomized female rats were randomly divided in 5 different groups: 1) Control (not mated) treated with saline, 2) control (not mated) treated with naloxone, 3) females that mated without controlling the sexual interaction (no-pacing), 4) females injected with saline before pacing the sexual interaction and 5) females injected with NX before a paced mating session. We found, as previously described, that paced mating induced a higher number of new cells in the granular layer of the AOB. The administration of NX before paced mating, blocked the increase in the number of newborn cells and prevented these cells from differentiating into neurons. These data suggest that opioid peptides play a fundamental role in the neurogenesis induced by paced mating in female rats.

Antagonists of the protein kinase A and mitogen-activated protein kinase systems and of the progestin receptor block the ability of vaginocervical/flank-perineal stimulation to induce female rat sexual behaviour

Brief vaginocervical stimulation using a glass rod (VCS) combined with manual flank-perineal stimulation (FS) rapidly (within 5 min) induced both receptive and proceptive behavioural responses to males in ovariectomised, oestrogen-primed rats. This receptive-proceptive response to males, resulting from a single brief (5-s duration) instance of manual VCS + FS, declined markedly within 4 h. However, the decline was prevented if the females were mounted by males immediately after the manual VCS + FS and 2 h later. We tested the participation of the cAMP-dependent protein kinase A system and the mitogen-activated protein kinase (MAPK) system in the response to VCS + FS by infusing either 100 ng of Rp-adenosine 3',5'-cyclic monophosphorothiate triethylamonium salt (a protein kinase A blocker) or 3.3 microg of PD98059 (a MAPK blocker) i.c.v. 15 min prior to VCS + FS. Both inhibitors blocked the ability of VCS + FS to induce the proceptive-receptive responses to males at all testing intervals. In experiment 2, systemic administration of 5 mg of RU486 1 h before VCS + FS also blocked the ability of VCS + FS to induce the proceptive-receptive responses to males. The present findings suggest that both VCS + FS and mating stimuli provided by males release neurotransmitters and neuromodulators that trigger the protein kinase A and the MAPK signalling systems, which interact with the progestin receptor to rapidly (within 5 min) induce proceptive-receptive behaviour in females.

Paraventricular hypothalamic nucleus stimulation modulates nociceptive responses in dorsal horn wide dynamic range neurons

Effects of different parameters of hypothalamic paraventricular nucleus (PVN) electrical stimulation on somatic responses, in dorsal horn neurons were examined. In anaesthetized rats, single-unit extracellular recordings were made from dorsal horn lumbar segments, which receive afferent input from the toe and hind paw regions. We compared the neuronal responses evoked by electrical stimulation of the receptive field (RF) with the responses preceded by ipsilateral PVN stimulation. Only the responses corresponding to Adelta and C-fiber activation were inhibited when PVN stimulation was delivered. Fast-evoked responses corresponding to Abeta fibers were not modified. The magnitude of inhibition depends on the intensity and duration of the PVN stimulation train and gradually decreases as the time interval between the PVN and RF stimulations increases. The results indicate that PVN modulates nociceptive, but not non-nociceptive neuronal responses at the spinal cord level, and this modulation depends on the parameters of the stimulus utilized to activate PVN neurons.

Fluoxetine-induced changes in tactile sensation and sexual functioning among clinically depressed women

Sexual side effects resulting from serotonin specific reuptake inhibitors (SSRIs) use may be mediated by a number of peripheral mechanisms, including alterations in tactile sensitivity. It was hypothesized that sexual difficulties resulting from SSRI use arise in part from an over-sensitivity or under-sensitivity of tactile sensation. Tactile sensitivity was examined on the index finger and lower lip in clinically depressed women at baseline (pre-medication), week 1, week 4, and week 8 of drug treatment (fluoxetine group n = 12, control n = 13). Analyses indicated that fluoxetine treatment resulted in decreased orgasm functioning. Fluoxetine-induced sexual changes were not mediated by tactile sensation. An independent association was found between sexual arousal functioning and finger sensation. Novel to this study, an independent association was found between sexual desire and finger sensation.

The Monoamine Reuptake Inhibitor Milnacipran Does Not Affect Nociception to Acute Visceral Distension in Rats

The role of antidepressants in the treatment of visceral pain has not been extensively examined. Milnacipran, an antidepressant that inhibits monoamine reuptake, is widely used in the treatment of depression and fibromyalgia. In this study, we sought to determine the activity of milnacipran against acute visceral nociception. Female virgin rats were studied 7 days after bilateral ovariectomy. For uterine cervical distension (UCD), two metal rods were inserted into the cervical osses under general anesthesia for manual distension. Colorectal distension (CRD) was performed by insertion of a balloon catheter into the descending colon and rectum, followed by manual inflation. Two electrodes were inserted into the rectus abdominus muscle for recording UCD- or CRD-induced reflex contraction, which was quantified by electromyography (EMG). A dose response for milnacipran, administered intrathecally or i.v., was obtained for UCD and CRD stimulation. Milnacipran failed to inhibit the UCD-induced EMG response, whether administered i.v. or intrathecally. Similarly, i.v. milnacipran, administered either acutely or chronically, failed to inhibit the CRD-induced EMG response. CRD and UCD are well established animal models for the study of acute visceral pain. Milnacipran, although it provides some unique advantages compared with other antidepressants, is unlikely to produce analgesia after acute administration in the setting of acute visceral pain.

IMPLICATIONS

Neither intrathecal nor i.v. milnacipran, a monoamine reuptake inhibitor, inhibits an acute visceral pain response induced by colorectal or uterine cervical distension.

Neural pathways mediating vaginal function: the vagus nerves and spinal cord oxytocin

The initial observations, made in our laboratory with Knut Larsson, of the ability of vaginocervical stimulation (VCS) to block withdrawal responses to foot pinch in rats has led to findings of multiple behavioral, autonomic, and neuroendocrine effects of this potent stimulus in rats and also in women. It has led to an understanding of: (1) the neuroanatomical and neurochemical basis of a novel and potent pain-blocking mechanism; (2) likely neuroanatomical pathways mediating both the Ferguson reflex and a specific autonomic response - the pupil-dilating effect of VCS; (3) a role for oxytocin as a putative central nervous system neurotransmitter that stimulates autonomic sympathetic preganglionic neurons within the spinal cord; and (4) a novel pathway that can convey sensory activity from the cervix, adequate to induce orgasm, via the vagus nerves. This latter pathway bypasses the spinal cord and projects directly to the medulla oblongata, and thus can convey genital afferent activity despite complete spinal cord injury at any level.

Vaginocervical stimulation releases oxytocin within the spinal cord in rats

Vaginocervical stimulation (VS) significantly elevated the concentration of oxytocin (OT) in spinal cord superfusates of 8 intact urethane-anesthetized rats measured 10-15 min after VS (median [interquartile range]: 1.7 [1.00-3.37] pg/ml) compared to that measured 10-15 min before VS (1.1 [1.01-1.40] pg/ml). When VS was administered once (n = 8), it produced a 55% increase over baseline values; when administered a second time 45 min later (n = 6), it produced only a 22% increase over pre-VS values. The effects of estrogen on the VS-induced release of OT were then investigated using ovariectomized rats that were treated either with estradiol benzoate (EB; 10 microg/100 g bw) (n = 6) or with an oil vehicle (n = 6) subcutaneously for 3 days. The EB treatment significantly elevated the basal levels of OT released into spinal cord superfusates above vehicle control levels. Within 5-10 min after the onset of VS, OT concentrations in the superfusates were significantly higher in EB-treated than in vehicle-treated rats. The vehicle-treated rats did not show a significant elevation in OT concentration following VS. To rule out the possibility that the posterior pituitary gland was the source of this OT, the effect of hypophysectomy (HYPOX) was assessed on the VS-induced release of OT into spinal cord superfusates and plasma. The concentration of OT in spinal cord superfusates of both the HYPOX (n = 5) and intact rats (n = 6) increased significantly from 5.8 [4.4-6.5] pg/ml pre-VS to 7.9 [6.7-10.3] pg/ml immediately after VS, and from 4.4 [3.8-5] pg/ml pre-VS to 5.1 [4.6-5.7] pg/ml immediately after VS, respectively. There was no significant difference in baseline levels of OT in cerebrospinal fluid between the two groups. By contrast, plasma OT levels, while significantly elevated in response to VS from 3.42 [2.9-5.34] pg/ml baseline to 7.25 [5.33-15.77] pg/ml in the intact group, failed to respond significantly to VS in the HYPOX group (n = 5). The present findings provide evidence of a direct estrogen-dependent release of OT within the spinal cord in response to VS, presumably via descending oxytocinergic neurons.

The maternal spinal cord: biochemical and physiological correlates of steroid-activated antinociceptive processes

Physiological gestation, as well as the simulation of the associated changes in estrogen and progesterone, is associated with significant elevations in nociceptive response thresholds. This is mediated by spinal cord kappa- and delta-opIoid systems. The predominant spinal mu-opioid system does not appear to participate. One hallmark of pregnancy- and hormonally-induced antinociception is the multiplicative interaction among its components. Approximately 40% results from spinal kappa/delta analgesic synergy on which is superimposed an additional increment (approximately 60%) of synergy that results from the interaction between descending spinal alpha 2-noradrenergic and spinal kappa/delta activities. An intact hypogastric nerve is required for the spinal alpha 2-noradrenergic component. This would explain the requirement for an intact hypogastric nerve in order for the antinociception of pregnancy and its hormonal simulation to be fully manifest. The predominant means by which spinal dynorphin-containing neurons adjust to increased demand is increased post-translational processing of dynorphin precursor intermediates which are present at approximately 10x the concentration of mature dynorphin peptides (1-17 and 1-8). This is indicated by the concomitant decline (approximately 50%) in the spinal cord content of dynorphin precursors and increase (approximately 87%) in the content of prohormone convertase 2, a processing enzyme sufficient to generate mature dynorphin peptides from prodynorphin. The presence of 'high gain' multiplicative spinal opioid antinociceptive pathways that can be activated by estrogen and progesterone has hyperalgesic implications as well, i.e. it could result in disproportionately increased pain responsiveness. This might explain, in part, findings that women are more prone to recurrent pain and pain of greater duration and intensity than men. The underlying mechanisms of gestational antinociception could point the way to pain pharmacotherapies that are gender-based.

Brain preparations for maternity--adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation. An overview

Pregnancy, parturition and lactation comprise a continuum of adaptive changes necessary for the development and maintenance of the offspring. The endocrine changes that are driven by the conceptus and are essential for the maintenance of pregnancy and are involved in the preparations for motherhood are outlined. These changes include large increases in the secretion of sex steroid hormones, and the secretion of peptide hormones that are unique to pregnancy. The ability of these pregnancy hormones to alter several aspects of brain function in pregnancy is considered, and the adaptive importance of some of these changes is discussed, for example in metabolic and body fluid adjustments, and the induction of maternal behavior. The importance of sex steroids in determining the timing of the various adaptive changes in preparing for parturition and maternal behavior is emphasized, and the concept that the actions of prolactin and oxytocin, quintessential mammalian motherhood neuropeptides, can serve to coordinate a spectrum of adaptive changes is discussed. The part played by oxytocin neurons and their regulatory mechanisms is reviewed to illustrate how neural systems involved in maternity are prepared in pregnancy via changes in phenotype, synaptic organization and in the relative importance of their different inputs, to function optimally when needed. For oxytocin neurons secreting from the posterior pituitary, important in parturition and essential in lactation, these changes include mechanisms to restrain their premature activation, and adaptations to support synchronized burst firing for pulsatile oxytocin secretion in response to stimulation via afferents from the birth canal, olfactory system or suckled nipples. Within the brain, expression of oxytocin receptors permits centrally released oxytocin to facilitate the expression of maternal behavior. Changes in other neuroendocrine systems are similarly extensive, leading to lactation, suppression of ovulation, reduced stress responses and increased appetite; these changes in lactation are driven by the suckling stimulus. The possible link between these adaptations and changes in cognition and mood in pregnancy and post partum are considered, as well as the dysfunctions that lead to common problems of depression and puerperal psychoses.

Evidence that oxytocin is an endogenous stimulator of autonomic sympathetic preganglionics: the pupillary dilatation response to vaginocervical stimulation in the rat

Vaginocervical mechanostimulation (VS) was shown previously to release oxytocin within the spinal cord and to induce pupillary dilatation. In the present study, (a) injection of oxytocin directly to the spinal cord (10 or 25 microg intrathecally [i.t.] in 5 microl saline) induced pupillary dilatation when observed 1 min after the end of the injection and (b) injection of an oxytocin receptor antagonist ([d(CH2)5-Tyr (Me)2-Orn8]-Vasotocin [OTA]; 25 microg i.t. in 5 microl saline) significantly attenuated the pupillary dilatation response to VS, when VS was applied 3 min after the end of the injection. Since activation of autonomic sympathetic preganglionic neurons in the thoracic spinal cord produces pupillary dilatation, we propose that oxytocin is a central nervous system neurotransmitter that stimulates these neurons directly, or perhaps indirectly, and thus is a mediator of VS-produced pupillary dilatation.

Effects of a kappa agonist, spiradoline mesylate (U62,066E), on activation and vaginocervical-stimulation produced analgesia in rats

Previous research has demonstrated increased pain threshold during copulation, gestation, and parturition in animals. In the laboratory, mechanostimulation of the vaginocervical region in many animals, as well as humans, can increase responsiveness to noxious but not to innocuous stimuli. This increased pain inhibition to vaginocervical stimulation, which mimics natural parturition, is mediated by spinal and supraspinal neuropeptides, including the opiates. The present research was designed to ascertain the possible effects of a kappa opioid agonist on vaginocervical-stimulated analgesia in rats. Initially, the novel kappa-selective agonist, spiradoline mesylate (U62,066E; 0, 0.1, 1.0, 10.0 mg/kg, i.p.), was injected intraperitoneally and general behavioral arousal in an open field apparatus was recorded. Results from this experiment indicate that stimulation with the kappa-selective drug caused significant decreases in behavioral activity at the high dose as compared to saline and the medium and low doses. Next, the effects of U62,066E (0, 0.1, 1.0, 10.0 mg/kg, i.p.) on the analgesia associated with vaginocervical stimulation were determined in a tail flick apparatus. The kappa drug significantly increased antinociceptive thresholds prior to and during vaginocervical stimulation at the 0.1 and 1.0 mg/kg doses. By contrast, the high dose (10.0 mg/kg) of U62,066E decreased vaginocervical stimulation-produced analgesia. Results are discussed in terms of the potential of nonaddictive kappa-selective opioid compounds being utilized in reproductive pain.

Evidence that serotonin affects female sexual functioning via peripheral mechanisms

A review of the literature indicates that serotonin is active in several peripheral mechanisms that are likely to affect female sexual functioning. Serotonin has been found in several regions of the female genital tract in both animals and humans. In the central nervous system (CNS), serotonin acts primarily as a neurotransmitter, but in the periphery, serotonin acts primarily as a vasoconstrictor and vasodilator. Since, in the periphery, the principal component of sexual arousal is vasocongestion of the genital tissue, it is likely that serotonin participates in producing normal sexual arousal. In addition, serotonin administration produces contraction of the smooth muscles of the genito-urinary system and is found in nerves innervating the sexual organs. Taken together, this evidence suggests that peripheral serotonergic activity may be involved in the normal sexual response cycle. In addition, exogenous substances that alter serotonin activity, such as selective serotonin uptake inhibitors (SSRIs) and the atypical antipsychotics, can produce sexual dysfunction. It is possible that sexual side effects seen with these drugs may result, at least in part, from their action on peripheral mechanisms.

Muscarinic mediation of the urethro genital reflex in spinal cord-transected rats

The effects of muscarinic receptor stimulation were tested on the urethro genital reflex (UGR) in anesthetized and spinal cord-transected rats. Drugs were applied directly to the spinal cord. The electromyographic activity (EMG) of the bulbospongiosus (BS) muscle was used for recording UGR. In six animals BS as well as soleus, posterior biceps or peroneus tertius muscle EMG was recorded simultaneously. Muscarine (5, 10, 20, 50 and 100 microg) was applied in 22 animals after cutting L6-S1 dorsal roots. Some observations were made on another six animals, to which an extensive bilateral dorsal rhizotomy (L3-S2) was performed. Rhythmic bursts of similar frequency and size to those seen during UGR were found in BS muscle a few minutes after muscarine application. No rhythmic bursting was found on the hindlimb muscles, but exclusively on BS muscles. The effects of homatropine (25, 50, 100 and 200 microg), an acetylcholine muscarinic receptor antagonist, were tested in 21 rats after UGR was elicited three times at low stimulation intensity (7 mm Hg). Homatropine produced two effects: (i) A significant increase in the latency of UGR. (ii) A facilitation of UGR inhibition. In view of these results it can be speculated that muscarinic receptor stimulation is involved in the elicitation of UGR.

Pain sensitivity and individual differences in self-reported sexual behavior

The relationship between sexual behavior and pain sensitivity was assessed in 27 heterosexual men and 20 heterosexual women. Sexual behavior measures included sexual motivation and ratings of subjective sexual arousal to and enjoyment of an auditory stimulus. Pain sensitivity measures were pain threshold and pain tolerance in a cold pressor task. Participants were tested after exposure to a neutral or a sexual audio stimulus. Exposure to the sexual stimulus increased pain sensitivity in women but not in men. However, sexual behavior measures were correlated with pain threshold for both men and women. Specifically, higher pain thresholds were associated with weaker sexual motivation, lower enjoyment potential for sexual interaction, and increased inhibition during intercourse. These results are consistent with findings in laboratory animals, suggesting that differences in sexual behavior may reflect differences in responsiveness to a variety of stimuli.

Sex-related hormonal influences on pain and analgesic responses

Considerable evidence indicates sex-related differences in pain responses and in the effectiveness of various analgesic agents. Specifically, females are at greater risk for experiencing many forms of clinical pain and are more sensitive to experimentally induced pain relative to males. Regarding analgesic responses, nonhuman animal studies indicate greater opioid analgesia for males, while a limited human literature suggests the opposite. Though the mechanisms underlying these effects remain unclear, the influence of gonadal hormones on nociceptive processing represents one plausible pathway whereby such sex differences could emerge. The present article reviews the complex literature concerning sex steroid effects on pain responses and analgesia. First, nonhuman animal research related to hormonal effects on nociceptive sensitivity and analgesic responses is presented. Next, human studies regarding gonadal hormonal influences on experimental pain responses are reviewed. Several potential mechanisms underlying hormonal effects on nociceptive processing are discussed, including hormonal effects to both peripheral and central nervous system pathways involved in pain transmission. Finally, based on these findings we draw several conclusions and make specific recommendations that will guide future research as it attempts to elucidate the magnitude and importance of sex-related hormonal effects on the experience of pain.

Gestational and ovarian sex steroid antinociception: relevance of uterine afferent and spinal alpha(2)-noradrenergic activity

Pregnancy is associated with an antinociception that is multifactorial and results from spinal (kappa/delta) opioid antinociceptive pathways as well as peripheral processes (ovarian sex steroids, uterine afferent neurotransmission). The present results provide the first indication that the full manifestation of pregnancy-induced analgesia also requires a supraspinal component. The analgesia of gestation or its hormonal simulation (via estrogen and progesterone administration; HSP) is substantially attenuated (>/=60%) following blockade of spinal alpha(2) (but not alpha(1)) adrenergic receptors. HSP antinociception is also attenuated by transection of the hypogastric nerve, the magnitude of which is indistinguishable from that produced by spinal alpha(2) receptor blockade. Additionally, hypogastric neurectomy abolishes the component of the antinociception associated with HSP that is mediated by spinal alpha(2) receptors. This suggests that the augmented spinal noradrenergic activity during HSP is not due to activation at the terminal of noradrenergic spinal projection neurons but requires supraspinal activity. It is suggested that enhanced spinal noradrenergic activity amplifies ongoing spinal kappa/delta antinociception as has been observed following the concomitant intrathecal application of alpha(2) and opioid agonists. The current observations underscore the importance of visceral afferent activity as well as its modulation by a female-specific hormonal milieu to the efficacy of endogenous spinal opioid antinociception.

Analgesic synergism between AP5 (an NMDA receptor antagonist) and vaginocervical stimulation in the rat

Vaginocervical stimulation (VS) releases multiple neurotransmitters into superfusates of the spinal cord; these can stimulate both nociceptive (e.g., glutamate, and glycine acting at the NMDA site), and antinociceptive (e.g., GABA, norepinephrine, 5-HT, and glycine acting at the strychnine-sensitive receptor) systems. Although the balance between these two opposing systems can determine the nature, magnitude, and duration of the response to VS, the characteristic prevailing response to VS is analgesia. We hypothesized that by counteracting the nociceptive component of this system, the magnitude and duration of the response to VS would be augmented. In the present study, the NMDA receptor antagonist AP5 [10 microg injected intrathecally (i.t.)] significantly increased the magnitude and duration of the analgesia (measured as tail flick latency to radiant heat) produced by VS (200 g force). At several time points the analgesic effect of AP5 combined with VS was greater than the sum of the effects of AP5 and VS separately, suggesting that they act synergistically. We propose that AP5 potentiates the analgesic effect of VS by two mechanisms: (a) antagonizing the putative pain-producing action of glutamate and glycine acting jointly at the NMDA receptor, and consequently, (b) permitting the unimpeded expression of the analgesic action of inhibitory neurotransmitters released by VS (e.g., glycine at the strychnine-sensitive receptor, and GABA).

The activity of ON and OFF cells at the rostroventromedial medulla is modulated by vagino-cervical stimulation

In anesthetized rats it was tested whether or not the activity of the ON and OFF cells within the rostral ventromedial medulla (RVM) is modulated by the mechanical stimulation of the uterine cervix (VS). ON cells were identified by an abrupt increase in their firing rate before the tail flick in response to a noxious heat. OFF cells were identified by a sudden decrease in their firing rate before the tail flick. All (27 out of 27) identified ON cells decreased their firing rate immediately after VS was applied. The effect of VS on the activity of the cells persisted for the entire stimulation period. On the other hand, all (19 out of 19) identified OFF cells increased their firing rate immediately after VS. The effect of VS on the activity of these cells also persisted for the entire stimulation period. The activity of the neutral cells showed no change, neither during the application of noxious heat, nor during VS. These results suggest that the analgesic-like effect produced by VS can be mediated by the activity of the antinociceptive circuit at the RVM. Alternatively, it can be suggested that the afferent inflow from the genital tract can induce the activity of the antinociceptive circuit at RVM, either by projections to the periaqueductal gray matter or by direct projections to RVM.

Knee joint inflammation attenuates spinal FOS expression after unilateral paw formalin injection in rat

Carrageenan-induced knee joint inflammation evoked a transient spinal FOS protein expression in neurons localized in the apical region of laminae I-III with peak activity observed 2 h after inflammation. Consistent with previously published observations, paw formalin injection evoked a distinct pattern of FOS protein expression in L3-L5 spinal segments. The majority of FOS-positive neurons were localized in the superficial dorsal horn (laminae I-II). Laminae V and VI contained moderate numbers of labeled neurons and only a few labeled nuclei were visible in laminae VII-X. In contrast, ipsilateral paw formalin injection, if administered 4 h after carrageenan-induced knee inflammation, evoked significantly fewer FOS positive neurons in all laminar and segmental levels analyzed as compared with formalin injected animals but without previous knee joint inflammation. These data indicate that primary acute or subacute nociceptive input may evoke central processes that are characterized by an inducible form of central inhibition which then may serve to modulate the subsequent spinal effect of superimposed nociceptive peripheral stimulation.

Neural mechanisms accounting for the increase in blood pressure and heart rate during vagino-cervical stimulation

The rise in blood pressure and heart rate produced by the mechanical stimulation of the uterine cervix (VS) was examined after adrenalectomy, after pelvic or hypogastric neurectomies or after spinal cord transection in anesthetized rats. Neither adrenalectomy, nor hypogastric neurectomy prevented the rise in heart rate and blood pressure produced by VS. After the spinal cord transection at T6 level, VS was still able to produce the rise in blood pressure. However, the rise in blood pressure was significantly lower than that produced in the same animals before the transection. No changes in heart rate were produced by VS after spinal cord transection. This result can be explained because this level of transection prevents the reach of the afferent inflow to the superior cervical ganglia. Pelvic neurectomy abolished completely the effects of VS on blood pressure and heart rate. Low intensity (1-2 times the threshold) electrical stimulation of the pelvic nerve produced a rise in blood pressure. Even though heart rate increased during electrical stimulation, the change in heart rate was not statistically different from the pre-stimulation value. These results suggest that the changes in blood pressure and heart rate produced by VS represent a neuronal reflex response mediated by the pelvic nerve. The fact that the effects of VS on blood pressure persist in spinal cord-transected animals suggests that the reflex is integrated at the spinal level. However, the cardiovascular responses to VS were significantly lower than before transection, suggesting that supraspinal centers are also involved in the reflex.

Vagotomy blocks responses to vaginocervical stimulation after genitospinal neurectomy in rats

To ascertain whether any effects of vaginocervical stimulation (VS) are mediated by the vagus nerve, all known afferent nerves from the reproductive tract to the spinal cord were transected and the rats were tested for residual responses to VS. After combined bilateral transection of the pelvic, hypogastric, and pudendal nerves (NX), the following responses to VS were greatly reduced or abolished: lordosis to flank-perineum palpation, leg extension, immobilization, and blockage of both tail withdrawal to radiant heat and leg withdrawal to foot pinch. However, after these nerve cuts, the following persisted as significant residual responses to VS: 1) analgesia [measured as increase in vocalization threshold (VOCT) to tailshock], 2) pupil dilatation (PD), and 3) increase in heart rate (HR). Subsequent bilateral subdiaphragmatic vagotomy (VX) significantly reduced the magnitude of PD and abolished the analgesia. By contrast, VX produced no significant effect on the HR increase to VS. The above findings provide evidence that brain-mediated responses to vaginocervical stimulation can be elicited via the vagus nerves.

Changes in pain threshold during the reproductive cycle of the female rat

Responsiveness to pain was determined in female rats across the whole reproductive cycle using the tail-flick test. When tested immediately after mating, pain thresholds were unaltered, whereas 10 min later animals typically demonstrated hyperalgesia (Experiment 1). They also demonstrated hyperalgesia during most of pregnancy, and had significantly lower pain thresholds than the unmated controls except for the 24 h before parturition, when a sudden increase in tail-flick latencies was recorded (Experiment 2). Pain thresholds were also significantly lower throughout the nursing period but increased significantly when dams were separated from their litters for 6 h, and returned to premating baseline values within 24 h of weaning (Experiment 3). These findings confirm and extend earlier reports that female reproductive state may significantly modify responsiveness to noxious stimuli, and it is suggested that differences between the results of this and previous studies may be at least partly explained by the relatively stress-free test procedure adopted here.

Inhibition of withdrawal responses by pelvic nerve electrical stimulation

In urethane-anesthetized rats, the compound action potential of the pelvic nerve was found to consist of three different waves, two in the A delta fiber and one in the C-fiber range of conduction velocity. Electrical stimulation of the pelvic nerve produced a complete inhibition of the withdrawal response to noxious foot pinch or foot compression. The electromyographic (EMG) activity of the contralateral posterior biceps muscle was used to record the withdrawal response. The withdrawal response inhibition was related to the duration and the frequency of electrical stimulation. Low (5-10 Hz) and high (100-300 Hz) frequencies were ineffective in inhibiting the withdrawal response, whereas intermediate frequencies (20-80 Hz) produced a complete inhibition of the withdrawal response. Short (300 ms) trains of stimulation inhibited the withdrawal response only during the stimulation period. Longer trains of stimulation (500 ms-10 s) produced long-lasting inhibition of the response to noxious stimulation. The inhibition persisted for up to 20 s after the end of electrical stimulation of the pelvic nerve. A delta fiber stimulation was adequate to inhibit the withdrawal response in most (15 out of 17) of the animals. However, A delta plus C-fiber stimulation was needed to inhibit the response to noxious stimulation in two animals. In addition to inhibiting the response to noxious stimulation, pelvic nerve electrical stimulation reflexively activated abdominal muscles. On the basis of present findings using electrical stimulation, it can be suggested that, in the rat, A delta and C-visceral afferents of the pelvic nerve mediate the analgesic effect of vaginocervical probing pelvic and A delta afferents the contraction of abdominal muscles in the fetus-expulsion reflex.

Vaginocervical stimulation attenuates hindpaw shock-induced substance P release into spinal cord superfusates in rats

The present study was designed to elucidate the mechanism in the spinal cord by which vaginocervical stimulation (VS) attenuates responses to noxious stimulation. This was accomplished by testing the hypothesis that VS reduces noxious stimulation-induced release of substance P at the level of the spinal cord. Noxious foot shock significantly increased the release of substance P (measured using radioimmunoassay) into superfusates of the lumbosacral spinal cord region in urethane-anesthetized rats. VS applied concurrently with foot shock significantly attenuated the release of substance P compared to the foot shock-only condition. In addition, substance P levels were significantly lower after the VS-only condition than after the no stimulation or foot shock-only conditions. These findings indicate that VS may produce analgesia, at least in part, by suppressing the release of substance P within the spinal cord.

Release of amino acids into regional superfusates of the spinal cord by mechano-stimulation of the reproductive tract

Based on pharmacological evidence that inhibitory amino acids mediate vaginocervical mechano-stimulation produced analgesia (VSPA), we hypothesized that inhibitory amino acids would be released endogenously in the spinal cord in response to vaginocervical mechano-stimulation (VS). This hypothesis was tested by HPLC analysis of the amino acid content of 5-min superfusates of the spinal cord before, during and after VS (400 g force applied against the cervix) in urethane-anesthetized rats. Utilizing an in vivo push-pull superfusion method, artificial cerebrospinal fluid was continuously superfused over the spinal cord through the intrathecal space surrounding the sacral-lower thoracic region. In addition, concentrations of amino acids in the superfusate were measured in response to KCl stimulation (increasing the superfusion medium from 3.4 to 40.0 mM KCl to produce non-specific depolarization), and noxious hind paw mechano-stimulation (pinching the hind paw to produce a sustained flexor response in ipsilateral hind leg). There was a significant increase in the concentration of Gly, Tau, Asp, Glu and Lys in the superfusate in response to VS (n = 8) and to KCl (n = 8), but not to hind paw stimulation (n = 5). Also, GABA concentrations increased in response to KCl, and the concentration of Ala, Ser, Gln, Thr, Arg and Phe increased in response to VS, however, GABA levels were sometimes below the limits of detection. In contrast, there was no significant change in any amino acid concentration in response to hind paw pinch stimulation, and VS did not significantly affect the concentrations of Tyr, His, Ile, Leu, Met, Trp or Val. The present findings support our hypothesis that VS releases inhibitory amino acids in the spinal cord. Moreover, other amino acids, including 'excitatory' amino acids, are released into the superfusate. The profile of amino acid release in response to VS differs from that in response to paw pinch or KCl administration.

Raphe magnus stimulation-induced antinociception in the cat is associated with release of amino acids as well as serotonin in the lumbar dorsal horn

Stimulation in the nucleus raphe magnus (NRM) inhibits transmission of nociceptive information within the spinal cord through activation of bulbospinal pathways. This study used microdialysis in combination with high pressure liquid chromatography to measure the release of serotonin (5HT) and several amino acids, including glutamate, aspartate and glycine, from the lumbar dorsal horn during electrical stimulation within the NRM in the alpha-chloralose anesthetized cat. Observed release of putative neurotransmitters was correlated with inhibition of nociceptive projection neurons recorded from sites within 800 microns rostral or caudal to the dialysis fiber. NRM stimulus parameters considered to preferentially activate myelinated fibers caused inhibition of nociceptive evoked activity, and increased the release of excitatory amino acids and glycine within the spinal cord, with no detectable release of 5HT. When pulse widths were lengthened and unmyelinated fibers were also activated, increases in 5HT in the spinal dialysate were observed as well. Strychnine administered through the dialysis fiber (0.02-1 mM) antagonized NRM-induced inhibition when 5HT release was not detected. Inhibition produced by stimulation that increased 5HT concentrations was relatively strychnine resistant. These results point to a raphe-spinal inhibitory pathway that is not dependent on 5HT, the activation of which results in the spinal release of glycine.

Sustained activation of the triceps surae muscles produced by mechanical stimulation of the genital tract of the female cat

In decerebrate cats, controlled mechanical stimulation of the perivulvar skin, the vaginal wall or the cervix uteri induced visible hind limb extension. Pressing on the cervix uteri produced the greater response. To quantify these responses, the EMG activity and the tension developed by the normally inserted triceps surae muscles were recorded. The activity induced in these muscles by stimulation of the genital canal outlasted the stimulus by many seconds or a few minutes. These effects disappeared after spinalization at the T12 level. We propose that stimulation of the vaginal canal in the female cat may induce bistability of triceps surae motoneurones.

Prolonged inhibition of the flexor reflex by probing the cervix uteri in the cat

In decerebrate or spinal cats, sustained mechanical stimulation of the cervix uteri inhibited the flexor reflex elicited by electrical stimulation of the foot pad during the probing period (160 s). After probing, 3-15 min were required for reflex recovery. No additional inhibition was produced if probing was repeated before recovery, but instead the reflex was facilitated. When probing was applied 5-10 min after reflex recovery the reflex was again abolished. The recovery, however, occurred earlier and was followed by facilitation. Probing the cervix with single mechanical pulses inhibited transiently (140-200 ms) the short latency reflex components, but the components with longer latencies are unaffected or facilitated. Distension of the vaginal wall with a balloon also inhibited the flexor reflex, but a transient, mild facilitation appeared several seconds after the distension. In general, whenever the inhibition decreases, the facilitation predominates. Our findings suggest that cervical probing or vaginal distension triggers both a long-lasting inhibition and a concomitant facilitation in different intraspinal flexor reflex pathways.

Expression of c-fos protein in lumbosacral spinal cord in response to vaginocervical stimulation in rats

The pattern of vaginocervical stimulation-evoked expression of the proto-oncogene c-fos in lumbar 5-sacral 1 segments of the spinal cord of ovariectomized adult rats was mapped using immunocytochemistry. A calibrated force of mechanostimulation was applied to the vaginal cervix of experimental animals and to the perineum of control animals while they were gently restrained. The number of cells expressing c-fos was significantly greater in the experimental than the control animals in laminae I, IV, V-VI and X. The implications of the present findings for elucidating the spinal pathways mediating the various behavioral, neuroendocrine and autonomic effects of vaginocervical stimulation (VS) are discussed.

The segmental distribution of afferent fibers from the vaginal cervix and hypogastric nerve in rats

Injections of horseradish peroxidase-wheat germ agglutinin (HRP-WGA) into the walls of the vagina and cervix (vaginocervical injections) of rats resulted in labeling of dorsal root ganglia (DRG) cells located at T11-L4 and L6-S2. In a second group of animals, exposure of the hypogastric nerve to HRP-WGA resulted in a similar bimodal distribution of labeled cells as compared to vaginocervical injections. In a third group, unilateral hypogastric nerve transection prior to injection of HRP-WGA into the vaginocervical walls resulted in a significant reduction in DRG cells labeled at T13, L1, L2, L6 and S1. Bilateral transection of the hypogastric nerves prior to vaginocervical injections eliminated labeled DRG cells at thoracolumbar levels but not at L6 and S1. Bilateral pelvic neurectomy reduced, but did not eliminate labeled DRG cells at L6 and S1 following vaginocervical injections. These results indicate that the hypogastric nerve constitutes a major sensory pathway from the vaginocervical walls to thoracic, lumbar and sacral levels of the spinal cord. The hypogastric nerve may subserve the transmission of noxious input from the vaginocervical walls as well as the activation of ascending spinal pathways involved in neuroendocrine reflexes during parturition.

Analgesia is produced by uterocervical mechanostimulation in rats: roles of afferent nerves and implications for analgesia of pregnancy and parturition

Afferent activity from the reproductive tract activates intrinsic pain attenuating processes. For example, analgesia results from vaginocervical mechano-stimulation in nonpregnant rats and occurs during pregnancy and parturition. In the present study, the effect of uterocervical mechanostimulation on pain thresholds was investigated in order to determine whether direct stimulation of the uterine cervix could play a role in the analgesia of pregnancy. Uterocervical mechanostimulation was applied to nonpregnant rats via a silastic disc implanted in the uterus. The disc abutted against the cervix and was attached to a thread externalized through the vaginal orifice. Application of a force of 150 g, but not 100 g, produced a significant increase in tail flick latency (110.4 +/- 40.6%, P less than 0.03). This effect was abolished by pelvic neurectomy, but was not altered by hypogastric neurectomy. Stimulation of the uterine cervix in combined pelvic and hypogastric neurectomy rats produced a decrease in tail flick latency. These results indicate that the analgesia that occurs during pregnancy and/or parturition may result, at least in part, from the uterocervical mechanostimulation that occurs during this condition.

Neonatal capsaicin treatment attenuates sensory-induced analgesia and nociception

Neonatal capsaicin treatment (50 mg/kg SC in two-day-old rats) increased thermal pain thresholds in both sexes when measured at different ages, decreased the responsiveness of adult females to specific noxious stimulation, and differentially decreased the magnitude of vaginocervical stimulation (VS)-produced analgesia in nociceptive tests. When adult, "capsaicin" females (n = 37) were significantly greater than controls (n = 24) in vocalization threshold (VT) to electrical tail shock (55.4%) and in paw lick (PL) latency to a hot plate (75.9%). In contrast, neither tail flick (TF) latency nor the leg withdrawal reflex (LWR) to mechanical pressure of the ipsilateral hind paw was affected by neonatal capsaicin. In response to VS, the controls showed a significant increase in thermal (TF, 279%; PL, 411%), mechanical pressure (LWR, 100%) and electrical (VT, 86.8%) pain thresholds. The "capsaicin" females response to VS was significantly less than controls in TF (26.1%), PL (26.0%), and LWR (54.1%) measures, and surprisingly, during VS their VT was significantly decreased below baseline levels 12.2% +/- 4.3. These results suggest that neonatal capsaicin treatment differentially attenuates the analgesia-producing component of VS, while sparing a nociception-inducing component of this stimulus. That is, after neonatal capsaicin treatment, the ability of VS to produce analgesia is reduced; moreover, VS lowers the VT, suggesting that it actually becomes a noxious stimulus in and of itself.

Differential roles of hypogastric and pelvic nerves in the analgesic and motoric effects of vaginocervical stimulation in rats

Bilateral transection of the pelvic and/or hypogastric nerves, which convey afferent activity from the reproductive tract, was performed to ascertain the role of these nerves in the analgesic and motoric effects of vaginocervical mechanostimulation (VS) in rats. Two indices of analgesia were used: tail flick latency to radiant heat (TFL) and vocalization threshold to electrical shock of the tail (Voc-T). Nerve cuts were performed at least one week prior to behavioral testing. Bilateral transection of both the pelvic and hypogastric nerves eliminated the analgesic effects of VS on the TFL and Voc-T tests. Bilateral transection of only the pelvic nerves reduced the number of rats showing maximal VS-induced elevation in TFL, without altering the effect of VS on Voc-T. By contrast, bilateral transection of only the hypogastric nerves attenuated the Voc-T-elevating effect of VS, without reducing the effect of VS on elevating TFL. The effects of VS on producing immobility, hindlimb extension and blockage of hindlimb withdrawal to foot pinch were eliminated by combined bilateral pelvic and hypogastric neurectomy. However, bilateral transection of either nerve alone did not significantly alter the efficacy of VS in producing these effects. These findings indicate that the pelvic and hypogastric nerves contribute to the immobility- and extensor-inducing, and flexor-inhibiting effects of VS, and differentially mediate the analgesia-producing effects of VS.

Dibutyryl cAMP stimulates analgesia in rats bearing a ventricular adrenal medulla transplant

In the present study, a significant increase in pain threshold (current to elicit vocalization to tail shock) was found 15 and 60 min after injection of dibutyryl cyclic AMP (db cAMP) (30 micrograms) into the lateral ventricle in rats bearing a transplant of fetal adrenal medulla (AM). By contrast, no effect on pain threshold was observed in rats bearing an AM transplant but receiving no db cAMP, or in rats receiving db cAMP but not bearing an AM transplant. In primary cultures of rat fetal chromaffin cells, db cAMP increased the number of neuron-like cells that showed both vasoactive intestinal polypeptide (VIP)- and tyrosine hydroxylase (TH)-like immunoreactivity. These findings indicate that db cAMP exerts a pharmacological modulation of the functional activity (i.e. elevation in pain thresholds) of fetal adrenal AM transplants, and induces phenotypic changes in cultured chromaffin cells with expression of a peptide that elevates pain threshold.

Sensory thresholds during the antepartum, intrapartum and postpartum periods

The present exploratory study measured pain and tactile thresholds in response to mechanical stimulation of the hand before labor, during labor, and after parturition in women. In women who had Lamaze childbirth preparation (but not in women who did not have childbirth preparation), pain thresholds were significantly higher during labor (determined up to 8 cm cervical dilatation) than prior to labor and 24 hours postpartum. Tactile thresholds did not change during any of these conditions. These findings support earlier findings in this laboratory that vaginocervical mechanostimulation elevated pain thresholds in human and animal subjects, and more recent findings that pain thresholds increased in rats during delivery of individual young. The present findings suggest that an endogenous process that attenuates the pain of parturition is activated when the cervix dilates during labor.

Inverse relationship between intensity of vaginal self-stimulation-produced analgesia and level of chronic intake of a dietary source of capsaicin

Women who chronically ingest a diet rich in capsaicin, the pungent ingredient in hot chili peppers, showed a significantly lower magnitude of analgesia in response to vaginal self-stimulation than women with relatively low or medium levels of ingestion. Vaginal self-stimulation-produced analgesia was quantified by measuring (on the hand) pain detection thresholds, pain tolerance thresholds and tactile thresholds. Whereas vaginal self-stimulation produced a 32.6-43.8% increase in pain detection and pain tolerance thresholds in the low chili diet group, it produced only a 2.3-7.3% increase in these measures in the high chili diet group. The medium chili diet group showed an intermediate effect on the pain thresholds. Tactile thresholds were not increased by the vaginal self-stimulation. Baseline (no stimulation) pain thresholds did not differ significantly among the three groups. These findings are consistent with earlier studies in laboratory rats, in which capsaicin administered neonatally abolished vaginal stimulation-produced analgesia, but did not affect baseline pain thresholds to mechanostimulation.

Effects of intrathecal antagonists on the antinociception, hypotension, and bradycardia produced by intravenous administration of [D-Ala2]-methionine enkephalinamide (DALA) in the rat

DALA is a synthetic pentapeptide that produces inhibition of the tail-flick reflex evoked by radiant heat, as well as hypotension and bradycardia. Two experiments examined the effects of administration of various receptor antagonists into the subarachnoid space of the lumbar spinal cord on the antinociception produced by IV administration of DALA. Experiment 1 showed that intrathecal administration of 30 micrograms of phentolamine produced a significant reduction in the antinociceptive effect of DALA, while naloxone (30 micrograms), methysergide (30 micrograms), or vehicle control had no effect. Experiment 2 showed that intrathecal administration of combinations of either phentolamine and methysergide, or phentolamine and naloxone, were no more effective in reducing the antinociceptive effect of DALA than administration of phentolamine alone. These data demonstrate the involvement of descending noradrenergic systems in the production of antinociception by IV DALA. Further, they indicate that the antinociception produced by DALA is independent of a direct spinal action of the drug.

Abolition of vagino-cervical stimulation-induced analgesia by capsaicin administered to neonatal, but not adult rats

We have previously reported that vagino-cervical mechanical stimulation (VS or probing) produces analgesia in rats. Neonatal treatment with capsaicin (CAP) has been shown to reduce the concentrations of several neuropeptides in dorsal root ganglia, spinal cord, and autonomic ganglia, via a neurotoxic effect. In the present study, we report that CAP administered in the neonatal period abolishes the analgesic effect of probing in adulthood. In addition, we report that the ability of VS to potentiate the lordosis response to manual stimulation of the flanks is abolished by neonatal CAP treatment. By contrast, rats treated as adults with CAP show the typical VS-produced effects of analgesia and potentiation of the lordosis response. Our results suggest that neonatal, but not adult, CAP treatment depletes a neuropeptide(s) that mediates the analgesia and lordosis-inducing effects of VS.

Differential effects of p-chlorophenylalanine on indoleamines in brainstem nuclei and spinal cord of rats. I. Biochemical and behavioral analysis

The involvement of endogenous serotonergic pathways in the mediation of antinociception has been indicated by electrophysiological, pharmacological and behavioral experiments. However, manipulation of the indole pathway, either by lesioning of raphe nuclei or drug intervention, often produces disparate results. In particular, serotonin (5-HT) synthesis inhibition with p-chlorophenylalanine (PCPA) has been reported to produce either hyperalgesia or analgesia, depending upon the type of pain measurement examined. In the present study, we sought to evaluate the effects of PCPA on (1) behavioral responses to noxious stimulation, and (2) levels of serotonin, tryptophan and 5-hydroxyindoleacetic acid (5-HIAA) in raphe nuclei (pallidus, obscurus, magnus and dorsalis) and spinal cord regions by HPLC with electrochemical detection. Treatment of rats with 400 or 600 mg/kg of PCPA for 3 consecutive days resulted in significant elevations in pain thresholds assessed by tail withdrawal from radiant heat as well as vocalization to electric shock of the tail. The effect of PCPA on vocalization threshold was particularly striking, for the majority of animals showed a nociceptive-specific attenuation of this response. Although the PCPA induced changes in indole content of the various raphe nuclei were not unequivocally dose-dependent, differential reductions of serotonin and 5-HIAA were clearly detected in the various raphe regions. Nuclei raphe pallidus and obscurus were depleted of 5-HT and 5-HIAA to the greatest extent, whereas levels detected in nuclei raphe magnus and dorsalis were reduced by 30-40% from control values. Metabolism of 5-HT and 5-HIAA appeared unaffected by PCPA in all regions examined except the dorsal portion of the spinal cord. These findings collectively suggest that the effects of PCPA are not uniform throughout the central nervous system and raise the possibility that discrepancies in the behavior literature may be attributed to drug-induced changes in some, but not all serotonergic pathways.

Vaginocervical probing elevates blood pressure and induces analgesia by separate mechanisms

Vaginocervical stimulation (VS) applied as a calibrated mechanical probe force against the cervix produced an increase in blood pressure (BP) of greater than 50 mmHg and an increase in heart rate (HR) of greater than 80 beats per minute (bpm). This response was immediate and reached maximum levels within 5-10 seconds. The magnitude of the response was proportional to the force of the VS over a range of 50-600 grams (g). Administration of propranolol (1 mg/kg, IV), a beta-adrenergic receptor antagonist, attenuated the acceleration of HR in response to VS. Administration of chlorisondamine (5 mg/kg, IV), which eliminates both sympathetic and parasympathetic influences, abolished the increase in BP and HR in response to VS, indicating that VS stimulates autonomic activity involved in the control of these two processes and that the tachycardia resulted from vagal withdrawal as well as sympathetic activation. The analgesic effect of VS, as measured by the VS-produced increase in tail flick latency (TFL), was unaffected by any of the drug treatments that abolished the HR and BP elevating effects of VS. Furthermore, elevation of BP by administration of phenylephrine (5 micrograms/kg, IV), to a level comparable to that produced by VS, did not produce analgesia. These results demonstrate that VS produces a profound increase in BP and HR due primarily to an increase in sympathetic activity. In addition, the increase in HR in response to VS appears to be partly due to a decrease in parasympathetic activity. The analgesia produced by VS is independent of the elevation in BP produced by VS.

Nociceptive responses to altered GABAergic activity at the spinal cord

GABA agonists and antagonists were injected intrathecally at the spinal cord, to determine their effect on nociceptive thresholds. Tactile stimulation, applied against the flank by a medium diameter von Frey fiber (5.5 g force), elicited distress vocalizations after, but not before injection of the GABA antagonists, bicuculline MI or picrotoxin (0.25 and 1 microgram dosages). Vocalization threshold to tail shock was significantly reduced by bicuculline MI or picrotoxin. Tail flick withdrawal latency from radiant heat was not altered by GABA antagonists. The GABA agonist, muscimol, significantly elevated vocalization threshold to tail shock at a 5 micrograms dose. At a lower dose level (1 microgram), muscimol significantly reduced vocalization threshold to tail shock. Tail flick latency was significantly prolonged by the 5 micrograms dose of muscimol; however, flaccid paralysis of the hind limbs was also evident. Nociceptive thresholds were not altered by GABA or saline injection. These findings indicate that GABAergic activity contributes to the tonic modulation of nociception at the spinal cord.

Sexual responsiveness and its relationship to vaginal stimulation-produced analgesia in the rat

Increasing amounts of pressure applied to the cervix produce a dose-response-like elevation of pain threshold in rats. This vaginal stimulation-produced analgesia (VSPA) is facilitated in animals given estrogen (E) doses sufficient to induce high levels of sexual receptivity. It has been proposed that enhancement of VSPA may serve to decrease any noxious input associated with multiple intromissions by the male. In this study, the anti-nociceptive effect of VSPA was compared in animals given E doses insufficient to increase receptivity with animals made receptive using subthreshold E levels + progesterone (P) in an attempt to determine if enhancement of VSPA is associated with the receptive state of the animal or the dose of E used. Tail flick latencies and tail shock vocalization thresholds were measured in groups of E, E + P and oil-treated rats during application of 0, 100 and 200 g of force on the cervix. Within oil, E and E + P-treated animals, significant increases in tail flick latencies were observed at 100 and 200 g with respect to baseline (0 g). Moreover, at 100 g of force E treated animals displayed a significant increase in tail flick latency over oil and E + P treated rats. In contrast, tail shock vocalization was increased at 100 and 200 g levels of probing in oil and E + P groups but was not facilitated by E. In the present study, as in previous work, VSPA was potentiated by E; however, this potentiation was not correlated with steroid-induced receptivity.(ABSTRACT TRUNCATED AT 250 WORDS)