Complex temporal changes in 5-hydroxytryptamine synthesis in the central nervous system induced by experimental polyarthritis in the rat

Secondary mechanical allodynia and hyperalgesia depend on descending facilitation mediated by spinal 5-HT₄, 5-HT₆ and 5-HT₇ receptors

In the present study we determined the role of spinal 5-hydroxytriptamine (5-HT) and 5-HT(4/6/7) receptors in the long-term secondary mechanical allodynia and hyperalgesia induced by formalin in the rat. Formalin produced acute nociceptive behaviors (flinching and licking/lifting) followed by long-term secondary mechanical allodynia and hyperalgesia in both paws. In addition, formalin increased the tissue content of 5-HT in the ipsilateral, but not contralateral, dorsal part of the spinal cord compared to control animals. Intrathecal (i.t.) administration of 5,7-dihydroxytriptamine (5,7-DHT), a serotonergic neurotoxin, diminished tissue 5-HT content in the ipsilateral and contralateral dorsal parts of the spinal cord. Accordingly, i.t. 5,7-DHT prevented formalin-induced secondary allodynia and hyperalgesia in both paws. I.t. pre-treatment (-10 min) with ML-10302 (5-HT(4) agonist), EMD-386088 (5-HT(6) agonist) and LP-12 (5-HT(7) agonist) significantly increased secondary mechanical allodynia and hyperalgesia in both paws. In contrast, i.t. pre-treatment (-20 min) with GR-125487 (5-HT(4) antagonist), SB-258585 (5-HT(6) antagonist) and SB-269970 (5-HT(7) antagonist) significantly prevented formalin-induced long-term effects in both paws. In addition, these antagonists prevented the pro-nociceptive effect of ML-10302, EMD-386088 and LP-12, respectively. The i.t. post-treatment (6 days after formalin injection) with GR-125487, SB-258585 and SB-269970 reversed formalin-induced secondary allodynia and hyperalgesia in both paws. These results suggest that spinal 5-HT, released from the serotonergic projections in response to formalin injection, activates pre- or post-synaptic 5-HT(4/6/7) receptors at the dorsal root ganglion/spinal cord promoting the development and maintenance of secondary allodynia and hyperalgesia.

Sensory and vascular changes in a rat monoarthritis model: prophylactic and therapeutic effects of meloxicam

OBJECTIVE AND DESIGN

The objective of this study was to determine the ability of meloxicam prophylaxis and therapy to blunt the effect of complete Freund's adjuvant (CFA) induced monoarthritis.

MATERIALS AND METHODS

First the validity of this animal model was established by examining joint changes at multiple levels after injecting CFA into the tibio-tarsal joint. Next, meloxicam (5 mg/kg) or vehicle was administered on days 0-7 (prophylactic) and on days 7-16 (therapeutic) in separate groups of animals.

RESULTS

The CFA-injected joint demonstrated hallmark histological and structural changes such as pannus formation, bone remodeling, cartilage erosion and immune cell infiltration. Both prophylactic and therapeutic treatment with meloxicam effectively reduced swelling (ankle circumference), oedema and extravasation of Evans blue dye in the affected joint. Moreover, meloxicam reduced loss in range of motion and also reduced mechanical stimulus evoked pain scores. Notably, these effects persisted after discontinuing drug treatment.

CONCLUSION

The present study provides a unique comparison of prophylactic versus therapeutic effects of meloxicam in the CFA-induced model of monoarthritis.

Central serotonin 3 receptors play an important role in the modulation of nociceptive neural activity of trigeminal subnucleus caudalis and nocifensive orofacial behavior in rats with persistent temporomandibular joint inflammation

The role of central serotonin 3 receptors on neural activities recorded from superficial laminae of trigeminal subnucleus caudalis/upper cervical spinal cord junction region was investigated using rats with (Complete Freund's Adjuvant day 7 group) or without (non-Complete Freund's Adjuvant group) persistent temporomandibular joint inflammation evoked by Complete Freund's Adjuvant for 7 days. We identified two types of units, Deep-wide dynamic range units and Skin-wide dynamic range units from extracellular recordings. Deep-wide dynamic range units have mechanoreceptive fields in the deep craniofacial tissues including masseter muscle but do not have cutaneous mechanoreceptive fields. Deep-wide dynamic range unit discharges evoked by the formalin injection into masseter muscle were significantly enhanced in the late phase in Complete Freund's Adjuvant day 7 group. Discharges of Skin-wide dynamic range units evoked by the noxious pinch stimulation to facial skin in Complete Freund's Adjuvant day 7 group were significantly enhanced compared with those in non-Complete Freund's Adjuvant group. Topical administration of central serotonin 3 receptor antagonist, tropisetron, onto trigeminal subnucleus caudalis/upper cervical spinal cord junction region significantly reduced both formalin-evoked Deep-wide dynamic range unit and pinch-evoked Skin-wide dynamic range unit discharges in non-Complete Freund's Adjuvant and Complete Freund's Adjuvant day 7 groups significantly. The inhibitory effects of tropisetron on pinch-evoked Skin-wide dynamic range unit discharges were prolonged in Complete Freund's Adjuvant day 7 group compared with those in non-Complete Freund's Adjuvant group. The role of central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region was also tested by orofacial formalin test in Complete Freund's Adjuvant day 7 group. Intracisternal administration of tropisetron decreased the orofacial nocifensive behavior in the late phase evoked by the injection of formalin into the masseter muscle. These results suggest that central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region are involved in mediating pronociceptive effects in both superficial and deep craniofacial tissues nociception during persistent temporomandibular joint inflammation.

Metabotropic glutamate receptor 5 and dorsal raphe serotonin release in inflammatory pain in rat

In this study, we evaluated the effects of 2-methyl-6-(phenylethynyl)-pyridine (MPEP), a selective antagonist of metabotropic glutamate subtype 5 receptors (mGlu(5)), delivered through different paths on dorsal raphe serotonin (5-HT) and on thermoceptive responses in rats with inflammatory pain. Intraplantar formalin and carrageenan increased 5-HT (137+/-11% and 212+/-6% of pre-injection baseline, respectively) and reduced nociceptive threshold (23+/-7% and 19+/-3% of pre-injection baseline, respectively). MPEP (2 mg/kg i.p.) further enhanced formalin and carrageenan-induced 5-HT increases (180+/-11% and 260+/-12% of pre-injection baseline, respectively) and reduced thermal hyperalgesia (71+/-8% and 80+/-10% of pre-injection baseline, respectively). MPEP (1 mM) through microdialytic probe into the dorsal raphe did not change formalin- or carrageenan-induced 5-HT increases (147+/-10% and 189+/-10% of pre-injection baseline, respectively) and thermal hyperalgesia (35+/-8% and 25+/-9% of pre-injection baseline, respectively). Finally, MPEP (30 nmol/rat) into the hind paw reduced the formalin- and carrageenan-induced 5-HT increase (108+/-3% and 126+/-7% of pre-injection baseline, respectively) and thermal hyperalgesia (77+/-6% and 117+/-7% of pre-injection baseline, respectively). Dorsal raphe serotonergic neurons activity increased following a peripherally induced inflammatory injury. In these conditions, peripheral but not dorsal raphe mGlu(5) receptors blockade prevented over activation of dorsal raphe serotonergic neurons and reversed thermal hyperalgesia.

The alpha2A-adrenoceptor subtype is not involved in inflammatory hyperalgesia or morphine-induced antinociception

The purpose of the present study was to investigate the role of the alpha(2A)-adrenoceptor subtype in inflammatory hyperalgesia, and in adrenergic-mu-opioid interactions in acute pain and inflammatory hyperalgesia. Behavioral responses to mechanical and thermal stimuli were studied in alpha(2A)-adrenoceptor knockout mice and their wild-type controls. Thermal nociception was evaluated as paw withdrawal latencies to radiant heat applied to the hindpaws. Mechanical nociception was measured using von Frey monofilament applications to the hindpaws. Mechanical and thermal hyperalgesia, induced with intraplantar carrageenan (1 mg/40 microl) were compared in alpha(2A)-adrenoceptor knockout and wild-type mice. The effects of the systemically administered mu-opioid receptor agonist morphine (1-10 mg/kg) were evaluated on mechanical withdrawal responses under normal and inflammatory conditions in knockout and wild-type mice. Withdrawal responses to radiant heat and von Frey monofilaments were similar in alpha(2A)-adrenoceptor knockout and wild-type mice before and after the carrageenan-induced hindpaw inflammation. Also, the antinociceptive effects of morphine in mechanical nociceptive tests were similar before and after carrageenan-induced hindpaw inflammation. Our observations indicate that alpha(2A)-adrenoceptors are not tonically involved in the modulation of inflammation-induced mechanical and thermal hyperalgesia. In addition, alpha(2A)-adrenoceptors do not appear to play an important role in mu-opioid receptor-mediated antinociception or antihyperalgesia.

Neuroendocrinology of autoimmunity

The HPA axis is fundamental for long-term survival and protection from the ravages of autoimmune disease. Continuing investigations suggest that the hypothesis linking susceptibility to autoimmune disease and a hyporesponsive HPA axis is somewhat simplistic. Instead, data from a number of different human diseases and from preclinical studies in a variety of models have suggested a more complicated picture. Alterations in the diurnal rhythms of ACTH, cortisol, and immune parameters appear to be linked to severity of disease. The use of low doses of steroids timed to target disrupted diurnal immune system changes in patients with RA may reduce the unfortunate side effects of long-term steroid use. Studies in cancer patients have related alterations in diurnal cortisol to survival. Whether differences in individual cortisol profiles are predictive of a deterioration in symptoms of autoimmune disease remains to be established. Responsiveness of the HPA axis to subtle challenges such as the dexamethasone suppression test and the related dexamethasone-CRF test suggest that there are different sub-populations of patients with RA and MS and these may have confounded earlier, apparently contradictory, studies. These different responses may be related to the severity of the disease. That these HPA axis differences can be altered beneficially through the use of antidepressants, as has been shown in MS, may impact on future health care strategies. However, reports of negative developments in arthritis associated with SSRI use suggest that the SSRIs may be unsuitable under some circumstances. The link of behavioral differences to alterations in neurotransmitter changes associated with disease is intriguing and opens new avenues of research. These future studies will require input from neuroscientists, neuroendocrinologists, psychologists, and immunologists working with the clinical specialties already involved in treating patients with autoimmune disease. These multidisciplinary studies reflecting the increased importance of hormonal and neurotransmitter involvement with the immune system hold great promise for the future.

Increase in GABAergic Cells and GABA Levels in the Spinal Cord in Unilateral Inflammation of the Hindlimb in the Rat

The effects of chronic peripheral inflammation on spinal cord gamma-aminobutyric acid (GABA) were examined in the rat. Following the injection of complete Freund's adjuvant in the left hindlimb footpad an increased number of immunoreactive cells occurred in ipsilateral laminae I - III of the dorsal horn from L3 to L5. GABA-immunoreactive cells were more numerous than contralaterally 1 week after the onset of the inflammation, reached maximal numbers after 3 - 4 weeks, and declined thereafter. Differences from control sides were statistically significant except at week 6. GABA levels in homogenates of the ipsilateral lumbar enlargement were increased significantly at 4 weeks. Since increases in GABA occurred in the spinal cord zone of projection of the nerves supplying the inflamed foot, the central response is surmised to result from the increased nociceptive input arriving from the periphery. However, the transmission from primary axons to GABA interneurons is not likely to be monosynaptic since profiles containing glutamate decarboxylase or GABA immunoreactivity are known to be predominantly presynaptic, and rarely postsynaptic, to primary afferent endings in electron micrographs in the rat. The findings support the function attributed to spinal GABA in modulating nociceptive input at segmental level.

Activation of the bulbospinal serotonergic system during experimental tooth movement in the rat

Experimental tooth movement is known to induce characteristic delayed and continuous nociception. Nociceptive somatic stimuli activate endogenous pain control systems such as descending monoaminergic pathways, which modulate the transmission of ascending sensory messages. To test the hypothesis that bulbospinal serotonergic pathways modulate subchronic nociception, we assayed the medulla at the level of the subnucleus caudalis and peri-aqueductal grey by high-performance liquid chromatography with electrochemical detection for the serotonin (5-hydroxytryptamine, 5-HT) and its metabolite (5-hydroxyindoleacetic acid, 5-HIAA) 24 hrs after the onset of experimental tooth movement. Experimental tooth movement significantly increased 5-HT and 5-HIAA levels, and 5-HIAA/5-HT, an index of serotonin turnover, in the medulla, and 5-HIAA level and 5-HIAA/5-HT in the peri-aqueductal grey, indicating that nociception induced by experimental tooth movement activates the bulbospinal serotonergic pathway.

Increased expression of gamma-aminobutyric acid transporters GAT-1 and GAT-3 in the spinal trigeminal nucleus after facial carrageenan injections

The present study aimed to elucidate the distribution of gamma-aminobutyric acid (GABA) transporters in the spinal trigeminal nucleus after carrageenan injections. Dense GAT-1 and GAT-3 but very little GAT-2 immunoreactivity was observed in the normal rat spinal trigeminal nucleus. The GAT-1-positive glial cells in the normal rat spinal trigeminal nucleus contained dense bundles of glial filaments and had features of astrocytes. Some GAT-3-positive cells contained dense bundles of glial filaments and had features of astrocytes, whilst others lacked glial filaments, and contained dense marginated heterochromatin, and had features of oligodendrocyte precursor cells. An increase in immunoreactivity to both transporters was observed on the injected but not the contralateral side 3 days after facial carrageenan injections. In rats given three further weekly injections of carrageenan and killed 3 days after the fourth injection, further increases in GAT-1 and GAT-3 immunoreactivities were observed. Electron microscopy showed that transporter immunoreactivity in the spinal trigeminal nucleus of carrageenan-injected rats was predominantly present in glial processes, showing that the increase in the number of processes observed at light microscopy was due to increased immunoreactivity in glial processes. An increased expression of GABA transporters in the carrageenan-injected spinal trigeminal nucleus could therefore result in a faster removal of GABA from the synaptic cleft of GABAergic axon terminals compared to normal rats. This could result in reduced inhibition/increased activity of the trigeminothalamic neurons in the spinal trigeminal nucleus, and could contribute to hyperalgesia after carrageenan injections.

Antinociceptive effect of clomipramine in monoarthritic rats as revealed by the paw pressure test and the C-fiber-evoked reflex

The antinociceptive effect of clomipramine was studied in monoarthritic rats by using the paw pressure test and the C-fiber-evoked reflex. Monoarthritis was produced by intra-articular injection of complete Freund's adjuvant into the tibio-tarsal joint. Joint circumference as well as vocalization threshold to graded paw pressure were evaluated weekly during a 14-week period after the intra-articular injection. At week 8, monoarthritic and vehicle-injected control rats were given either clomipramine or saline and both the paw pressure threshold and inhibition of the C-fiber-evoked reflex response were evaluated. Results showed that (i) 1.5, 3.0, and 6.0 mg/kg, i.v. of clomipramine induced significantly greater dose-dependent antinociception to paw pressure testing in the monoarthritic group, as compared to the control one; and (ii) 0.75, 1.5, 3.0, and 6.0 mg/kg, i.v. of clomipramine exerted significantly higher dose-dependent inhibition of the C-reflex activity in monoarthritic rats than in controls. Results suggest that the higher sensitivity to clomipramine in monoarthritic rats could be related to adaptive changes occurring in monoamine metabolism or in other neurotransmitter systems during chronic pain.

Effect of intrathecal administration of serotonin in chronic pain models in rats

The present study examined the effects of intrathecal (i.t.) administration of 5-hydroxytryptamine (5-HT; 0.1-100 microg) on mechanical hyperalgesia associated with neuropathic pain (chronic constriction of the sciatic nerve model and diabetic model) and inflammatory pain (carrageenan and polyarthritic models) in rats. Results demonstrated that the hyperalgesia observed in the mononeuropathic and diabetic rats was attenuated by 5-HT; the active dose, however, was 100- to 1000-fold higher than that required in normal rats, and was moderately effective. In the two experimental models of inflammatory pain, 5-HT was not markedly or similarly active. In the carrageenan model, 5-HT at the highest dose was only weakly effective whereas in the polyarthritic model it was inactive. Together, these results show that 5-HT has antinociceptive effects in several rat pain models, except in the model of diffuse pain (polyarthritic rats). Its antinociceptive effects in these models, however, are slight and differ from those observed in normal rats.

The release of serotonin in rat spinal dorsal horn and periaqueductal gray following carrageenan inflammation

The level of serotonin (5-HT) and its major metabolite 5-hydroxyindoleacetic acid (5-HIAA) in dorsal horn of spinal cord and periaqueductal gray (PAG) were measured using in vivo microdialysis coupled with high performance liquid chromatography and electrochemical detection. Intraplantar injection of carrageenan was used to evoke release. Extracellular concentrations of 5-HT and 5-HIAA in spinal dorsal horn and PAG significantly increased following carrageenan inflammation. The peak occurred at 3h and then gradually returned to baseline at 5-7h. The carrageenan-induced release of 5-HT and 5-HIAA in spinal cord rather than in PAG was decreased by intracerebroventricular (i.c.v.) injection of naloxone, and both in spinal dorsal horn and PAG, the release was increased by i.c.v. injection of bicuculine. These results suggest that activity of 5-HT in spinal cord and PAG increases with carrageenan inflammation; the carrageenan-induced release of 5-HT and 5-HIAA in spinal cord may be tonically modulated by supraspinal opioid and GABA systems, whereas the release in PAG may only be tonically modulated by endogenous GABA system in supraspinal level.

Medullary monoamine levels during experimental tooth movement

We investigated possible influence of nociception induced by experimental tooth movement on the medullary monoaminergic inhibitory systems. Forty-eight hours after the start of the experimental tooth movement, significant increases in dorsal serotonin (5-HT), dopamine (DA), norepinephrine (NE), 5-hydroxyindoleacetic acid (5-HIAA), and dihydroxyphenylacetic acid (DOPAC) levels were detected with ipsilateral dominance. These results suggest that the nociception induced by experimental tooth movement might be under modulation of serotonergic, noradrenergic, and dopaminergic systems.

The analgesic effects of supraspinal mu and delta opioid receptor agonists are potentiated during persistent inflammation

This study examined the antihyperalgesic and antinociceptive effects of opioid receptor agonists microinjected in the rostral ventromedial medulla (RVM) of rats 4 hr, 4 d, and 2 weeks after the induction of an inflammatory injury by injection of complete Freund's adjuvant (CFA) in one hindpaw. Nociceptive sensitivity of the ipsilateral, inflamed and the contralateral, uninflamed hindpaws was determined by the radiant-heat paw withdrawal test. The antihyperalgesic potency of the mu opioid receptor agonist [D-Ala(2),N-Me-Phe(4),Gly(5)-ol]enkephalin (DAMGO), determined for the inflamed hindpaw, was enhanced 4 d and 2 weeks after injury. The antinociceptive potency of DAMGO, determined for the contralateral, uninflamed hindpaw, was also progressively enhanced 4 hr, 4 d, and 2 weeks after injury. The magnitude of enhancement paralleled the chronicity of the injury. The greatest potentiation occurred 2 weeks after injury when the ED(50) value of DAMGO in CFA-treated rats was one-tenth that in saline-treated rats. The antihyperalgesic and antinociceptive effects of the delta opioid receptor agonist [D-Ala(2),Glu(4)]deltorphin were also increased 2 weeks after injury. These results indicate that peripheral inflammatory injury alters the pharmacology of excitatory and inhibitory inputs that modulate the activity of RVM neurons in such a manner as to enhance the effects of opioid agonists in this region. These changes have ramifications not only for the alleviation of hyperalgesia at the site of injury but also for opioid-induced antinociception at sites remote to the injury as revealed by increases in the potency of opioid agonists to suppress nociceptive responses of the contralateral, uninflamed hindpaw.

Alteration of descending modulation of nociception during the course of monoarthritis in the rat

Diffuse noxious inhibitory controls (DNIC), which involve supraspinal structures and modulate the transmission of nociceptive signals, were investigated at different stages during the development of adjuvant-induced monoarthritis in the rat. After behavioral evaluation, recordings of trigeminal convergent neurons were performed in anesthetized animals with acute (24-48 hr) or chronic (3-4 weeks) monoarthritis of the ankle. Inhibitions of C-fiber-evoked neuronal responses during and after the application of noxious conditioning stimuli to the ankle were measured to evaluate DNIC. The conditioning stimuli consisted of mechanical (maximal flexion and graded pressures) and graded thermal stimuli and were applied alternately to normal and arthritic ankles. Behaviorally, the two groups of animals exhibited a similar increased sensitivity to mechanical stimuli applied to the arthritic joint (i.e., an increased ankle-bend score and a decreased vocalization threshold to pressure stimuli). However, they showed different electrophysiological profiles. In the animals with acute monoarthritis, the DNIC-induced inhibitions produced by mechanical or thermal stimulation of the arthritic joint were significantly increased at all intensities compared with the normal joint. In contrast, in the chronic stage of monoarthritis, the DNIC-induced inhibitions triggered by thermal or pressure stimuli were similar for both ankles, except with the most intense mechanical stimuli. This discrepancy between the behavioral and electrophysiological findings suggests that inputs activated during chronic monoarthritis may fail to recruit DNIC and may thus be functionally different from those activated in the acute stage of inflammation.

The induction of pain: an integrative review

The highly disagreeable sensation of pain results from an extraordinarily complex and interactive series of mechanisms integrated at all levels of the neuroaxis, from the periphery, via the dorsal horn to higher cerebral structures. Pain is usually elicited by the activation of specific nociceptors ('nociceptive pain'). However, it may also result from injury to sensory fibres, or from damage to the CNS itself ('neuropathic pain'). Although acute and subchronic, nociceptive pain fulfils a warning role, chronic and/or severe nociceptive and neuropathic pain is maladaptive. Recent years have seen a progressive unravelling of the neuroanatomical circuits and cellular mechanisms underlying the induction of pain. In addition to familiar inflammatory mediators, such as prostaglandins and bradykinin, potentially-important, pronociceptive roles have been proposed for a variety of 'exotic' species, including protons, ATP, cytokines, neurotrophins (growth factors) and nitric oxide. Further, both in the periphery and in the CNS, non-neuronal glial and immunecompetent cells have been shown to play a modulatory role in the response to inflammation and injury, and in processes modifying nociception. In the dorsal horn of the spinal cord, wherein the primary processing of nociceptive information occurs, N-methyl-D-aspartate receptors are activated by glutamate released from nocisponsive afferent fibres. Their activation plays a key role in the induction of neuronal sensitization, a process underlying prolonged painful states. In addition, upon peripheral nerve injury, a reduction of inhibitory interneurone tone in the dorsal horn exacerbates sensitized states and further enhance nociception. As concerns the transfer of nociceptive information to the brain, several pathways other than the classical spinothalamic tract are of importance: for example, the postsynaptic dorsal column pathway. In discussing the roles of supraspinal structures in pain sensation, differences between its 'discriminative-sensory' and 'affective-cognitive' dimensions should be emphasized. The purpose of the present article is to provide a global account of mechanisms involved in the induction of pain. Particular attention is focused on cellular aspects and on the consequences of peripheral nerve injury. In the first part of the review, neuronal pathways for the transmission of nociceptive information from peripheral nerve terminals to the dorsal horn, and therefrom to higher centres, are outlined. This neuronal framework is then exploited for a consideration of peripheral, spinal and supraspinal mechanisms involved in the induction of pain by stimulation of peripheral nociceptors, by peripheral nerve injury and by damage to the CNS itself. Finally, a hypothesis is forwarded that neurotrophins may play an important role in central, adaptive mechanisms modulating nociception. An improved understanding of the origins of pain should facilitate the development of novel strategies for its more effective treatment.

Formalin-induced nociception activates a monoaminergic descending inhibitory system

Neural plasticity of afferent pain pathways that is induced by prolonged or repeated noxious stimuli may contribute to activate intrinsic inhibitory mechanisms in CNS. In order to clarify the role of the monoaminergic descending inhibitory system in acute nociception and inflammatory pain, we examined if this inhibitory system would modulate the tonic response to formalin-induced nociception. Yohimbine, alpha2 adrenergic antagonist, or methysergide, serotonin antagonist was administered intrathecally before or after subcutaneous 2% formalin injection into the plantar of the hind paw in rats. In another series of the experiment, the tissue of the spinal dorsal half of the untreated rats and post-formalin-treated rats were sampled and analyses of monoamine levels were carried out by HPLC. The subcutaneous formalin evoked biphasic flinching behavior of the injected paw. Intrathecal pretreatment with yohimbine and methysergide produced a significantly greater increase in the number of flinches than in the control in phase 1, intermediate period and phase 2. Posttreatment with yohimbine and methysergide showed a significantly greater increase in the number of flinches in phase 2. Furthermore, formalin injection induced significant increases in noradrenaline, MHPG, serotonin (5-hydroxytryptamine; 5-HT) and 5-HIAA concentrations in both the ipsi- and contralateral dorsal halves. These results suggest that the pain state produced by formalin-induced chemical and/or inflammatory nociception is under the modulation of the monoaminergic (noradrenergic and serotonergic) descending inhibitory system.

Are ventromedial medulla neuronal properties modified by chronic peripheral inflammation? A single-unit study in the awake, freely moving polyarthritic rat

In the present work, we recorded the neuronal properties of the ventromedial medulla, a brainstem structure involved in the descending spinal control systems related to nociception, in awake, freely moving healthy and polyarthritic rats. These animals were rendered polyarthritic with a subcutaneous administration of the Freund's adjuvant into the tail, and studied at 20 and 30 days post-inoculation. At the ventromedial medulla level, the single-unit activities were recorded by means of a chronically implanted device supporting a 50 microns platinum-iridium wire as the recording electrode. With a total of 308 recorded neurons, we determined that in both healthy rats, i.e. animals having received mineral oil only and arthritic rats, there were ventromedial medulla units with common physiological properties, but also changes. In agreement with the results from anesthetized arthritic rats at spinal and thalamic levels, the systematic analysis of the responses to light touch and mechanical shock revealed that the 'multimodal, multireceptive' units, excited by innocuous and noxious stimuli, were much more responsive to both modalities in arthritic rats. Approximately 7% of these neurons displayed a 'paroxysmal' spontaneous activity, also reported in the literature for other structures. In addition, we recorded a significant number of neurons inhibited or excited-inhibited by innocuous and noxious cutaneous stimulations, and a few with a regular spontaneous activity, also responding, which has never been the case in healthy rats. We conclude that a peripheral chronic inflammation, such as arthritis, can produce changes of the ventromedial medulla neuronal properties, as compared to healthy animals. Consequently, in addition to its classical role in the spinal control of nociception, the ventromedial medulla is able to develop some form of plasticity in the case of persistent pain of peripheral origin.

Carrageenan-induced inflammation of the hind foot provokes a rise of GABA-immunoreactive cells in the rat spinal cord that is prevented by peripheral neurectomy or neonatal capsaicin treatment

An increase in the number of gamma-aminobutyric acid (GABA)-immunoreactive cells is reported in the superficial dorsal horn of the rat spinal cord upon unilateral inflammation of the hind foot caused by subcutaneous carrageenan injection. The rise of GABAergic cells was restricted to the ipsilateral dorsal horn, reaching a peak value of 23.4% over the contralateral side 4 days after carrageenan injection. Sciatic neurectomy or neonatal capsaicin treatment prevented this effect. These findings suggest that dorsal horn GABA is up-regulated by the increase of noxious inflow conveyed by unmyelinated C fibers from the inflamed tissues.

Amino acids and serotonin are released into the lumbar spinal cord of the anesthetized cat following intradermal capsaicin injections

Several amino acids including aspartate, glutamate and glycine and the monoamine serotonin were retrieved from the extracellular space of the dorsal horn of the lumbar spinal cord in the alpha-chloralose anesthetized cat in vivo using a transverse microdialysis probe. Neurotransmitter concentrations were determined using high pressure liquid chromatography in combination with fluorescence (amino acid) or electrochemical (serotonin) detection. Intradermal injection of 3% capsaicin into the hindleg either ipsilateral or contralateral to the dialysis probe was used to evoke release. Extracellular concentrations of aspartate, glutamate and serotonin increased significantly following capsaicin injection into the ipsilateral limb. An almost equal increase in serotonin and a less pronounced, but still significant, increase in aspartate accompanied contralateral capsaicin injection. Glutamate concentrations increased in the dialysate during contralateral capsaicin injection in about half of the animals. These data are consistent with the hypothesis that Asp and Glu are both neurotransmitters released from nociceptive primary afferent fibers and/or interneurons activated by these fibers. In addition, Asp is presumed to be released from intrinsic spinal or descending systems following nociceptive stimulation. Bilateral release of 5HT into the dorsal horn most likely results from non-topographic activation of descending endogenous analgesia pathways.

Potent antinociceptive effects of clonidine systemically administered in an experimental model of clinical pain, the arthritic rat

The effects of various doses of the alpha-2 adrenoceptor agonist clonidine administered systemically (30, 50 and 100 micrograms/kg i.v.), were investigated on the vocalization threshold to paw pressure in normal rats and in rats with Freund's adjuvant-induced arthritis. Previous results have suggested that there is an increase in the activity of the bulbospinal noradrenergic systems in these arthritic animals. In the present study, clonidine led to significant antinociceptive effects in both groups of rats. Clonidine was found to be highly effective in arthritic animals, even at the lower concentration: the elevation in threshold produced by 30 micrograms/kg i.v. was 160% in arthritic vs. 124% in normal rats. The effects of clonidine were prevented dose-dependently by pretreatment with yohimbine or idazoxan 250 to 1000 micrograms/kg i.v., in the two groups of rats, indicating clearly that the dose-dependent effects of i.v. clonidine are mediated by alpha-2 adrenoceptors.

The response of the 5-hydroxyindole oxidation current to noxious stimuli in the spinal cord of anesthetized rats: modification by morphine

The effects of cutaneous noxious heating and of systemic morphine on serotonergic activity in the spinal cord were examined in anesthetized rats. An oxidation current of 5-hydroxyindole signal was seen at 280-300 mV with differential normal pulse voltammetry. Noxious heat stimuli produced a mean signal increase over control values of 15.5 +/- 3.4% at 52 degrees C, and 7.2 +/- 5.5% at 45 degrees C. These increases lasted for 5-10 min. Non-noxious stimuli (37 degrees C) did not affect the 5-hydroxyindole signal. Morphine (0.5, 2.0 and 5.0 mg/kg, i.p.) in the absence of cutaneous stimulation did not change the signal significantly. Systemic morphine alone did not significantly modify the 5-hydroxytryptamine (5-HT) metabolism, as observed in in vivo voltammetry, in the spinal cord of anesthetized rat. However, a low dose of morphine (0.5 mg/kg, i.p.) attenuated the increase in the signal modified by noxious stimuli, and high doses (2.0 or 5.0 mg/kg, i.p.) enhanced it. Both effects of morphine were antagonized by naloxone (0.5 mg/kg, i.v.). It is likely that morphine with noxious stimuli modify the sensitivity of serotonergic descending inhibitory system. It is concluded that noxious heating of the skin increases the 5-HT metabolism in the spinal cord of anesthetized rats and that systemic administration of morphine modulates this 5-HT metabolism.

Relationship between autotomy behaviour and spinal cord monoaminergic levels in rats

In the rat, unilateral neurectomy of the sciatic and saphenous nerves causes autotomy, a self-mutilation behaviour, against the denervated limb that is variable in both its onset and severity. To study some of the possible neurochemical sources of this variability, spinal cord levels of norepinephrine (NE), dopamine (DA), serotonin (5-HT0 and 5-hydroxyindoleacetic acid (5-HIAA) were analysed ipsi- and contralateral to the lesioned side by high performance liquid chromatography at C5-T1 and L1-S1. According to the early or late onset and to the slight or intense autotomy behaviour, the animals were assigned to four different groups: early autotomy, early no autotomy, late autotomy, and late no autotomy. Two sham-operated groups were sacrificed at an early or late stage in the postoperative period. The spinal cord NE content remained unchanged throughout the different experimental situations. The more conspicuous changes observed were: (1) a generalized increase in spinal 5-HT metabolism in all deafferented groups; (2) a significant and selective increase in lumbosacral 5-HT and 5-HIAA levels of the rats that did not self-lesion for 8 weeks after deafferentation and (3) a significant fall (30-45%) in DA levels at denervated spinal segments of the rats that actively self-attacked late in the postoperative period. The data suggests that spinal cord serotonergic and dopaminergic influences play an important role in determining the susceptibility to autotomy (and perhaps chronic pain) after peripheral deafferentation.

Neural changes in acute arthritis in monkeys. IV. Time-course of amino acid release into the lumbar dorsal horn

Extracellular levels of amino acids were measured during the development of experimental arthritis in anesthetized monkeys. Levels of glutamate, aspartate, glycine, serine, glutamine, taurine, cysteic acid and asparagine were each measured in consecutive 30 min samples before, during and for several hours after injection of kaolin and carrageenan into the articular capsule of one knee. Samples were obtained via a microdialysis probe placed in the lumbar dorsal horn ipsilateral to the injected knee and assayed using HPLC with fluorescence detection. Glutamate, aspartate, glycine and serine increased transiently following intra-articular injection of inflammatory agents. During this period glutamine levels decreased. A second phase of release then occurred which included more prolonged changes in amino acid levels that were sometimes of greater magnitude than those immediately following the injection. In animals which were later observed to have depletion of SP in the dorsal horn of the inflamed side, taurine levels increased starting after the Glu, Asp and Gly had plateaued at near baseline concentrations. Thus during the first stages of joint inflammation EAAs are released into the dorsal horn, followed by increased levels of IAAs, possibly representing activation of the descending endogenous analgesia system. This phase is followed by a semiacute response consisting in part of increased extracellular levels of SP and Tau. While SP is presumably part of an ascending nociceptive transmission system, Tau could be part of a second system aimed at reducing excessive neural activity including neural transmission resulting in intense maintained pain.

A limited arthritic model for chronic pain studies in the rat

Freund's adjuvant induced polyarthritis in rats has been used extensively to study pain processes of long duration. There are limitations of this model for chronic studies of pain/arthritis since the severe systemic changes provoke ethical concerns and also affect behaviour, physiology and biochemistry. Attempts to limit adjuvant-induced arthritis by plantar injection of the inoculum have been made. In this model, however, the process evolved to produce widespread polyarthritis if followed for the 6-plus-weeks necessary for chronic studies. Therefore, although it offers the researcher a reliable limited model of inflammation and nociception at the outset, for longer studies it may have all the disadvantages of the polyarthritic rat. The purpose of the present study was to produce a limited arthritic process in rats, stable over 6 weeks and suitable for behavioural and neurochemical studies of various chronic pain treatment methods. Injection (0.05 ml) of complete adjuvant containing 300 micrograms Mycobacterium butyricum in the tibio-tarsal joint produces a predictable monoarthritis, stable clinically and behaviourly from weeks 2 through 6 post injection. As revealed by clinical observations and X-ray examinations, the arthritis produced was limited anatomically, pronounced, prolonged and stable. A marked increase in sensitivity to paw pressure was seen in the affected limb. Animals gained weight and remained active, indicating little systemic disturbance as opposed to polyarthritic rats. We propose this limited model of arthritis as a suitable alternative to the polyarthritic rat for prolonged studies.

Postoperative pain treated by intravenous L-tryptophan: a double-blind study versus placebo in cholecystectomized patients

The effectiveness of intravenous administration (i.v.) of L-tryptophan, which is the precursor of cerebral serotonin, was verified in the treatment of postoperative pain. The study was carried out on 45 female patients, aged between 34 and 61 years, undergoing cholecystectomy who were randomly divided into three groups. Group 1 (age: 50.33 +/- 8.64 years) received 100 ml of 5% mannitol solution i.v.; group 2 (age: 49.80 +/- 11.11 years) 100 ml of a mannitol solution containing 7.5 mg/kg L-tryptophan; and group 3 (age: 53.46 +/- 9.60 years) 100 ml of a mannitol solution containing 15 mg/kg L-tryptophan. Vital capacity (preoperative VC) was measured before surgery. Anesthesia used was isoflurane. Narcotics or neuroleptics were not used. Pain was assessed before treatment (T-0 min), at the end of administration (T-30) and at T-60, 120, 180, 240, 300 and 360 min by the following variables: respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), Scott-Huskisson test (VAS), pain vital capacity (PVC), analgesic vital capacity (AVC), and respiratory restoration factor (RRF) calculated from Bromage's formula (RRF = (AVC - PVC/preoperative VC - PVC) X 100). As regards variables RR, HR, MAP and VAS, differences between the values from T-30 to T-360 and the value at T-0 were calculated. Means and S.E.M. were calculated on the obtained values and on RRF values for each group. The significance of the differences between groups was calculated using Student's t test and Bonferroni's test. Results show a significant decrease of pain in groups 2 and 3 treated with L-tryptophan, in comparison with group 1 (controls). No significant difference was observed between the treated groups, although more lasting pain relief was observed in group 3 in comparison with group 2. Intravenous L-tryptophan showed its effectiveness in the treatment of postoperative pain even when used alone. Its use may be considered for patients with renal failure, in order to strengthen pharmacological analgesia or to prevent postoperative pain by its intraoperative administration.

Simultaneous measurements of tryptophan and its metabolites, kynurenine and serotonin, in the superficial layers of the spinal dorsal horn. A study in normal and arthritic rats

It has been demonstrated that 5-hydroxytryptamine (5-HT) is not the only neuroactive metabolite of tryptophan (TRP) in the CNS. The presence of kynurenine (KYN) and its metabolites has been reported in the brain of several mammalian species and the neuroactive properties of these compounds are now well established. In the present study, we report the identification of KYN in the superficial layers of the rat spinal dorsal horn. KYN was measured simultaneously with TRP. 5-hydroxytryptophan, 5-HT, 5-hydroxyindoleacetic acid and 5-HT-O-sulfate by means of liquid chromatography with coulometric electrode array detection. The results observed in the normal rat and in an animal model of persistent pain, the arthritic rat, are discussed in view of the hypothesis relating to the involvement of the bulbospinal serotonergic system in pain mechanisms and of the possible participation of KYN and its metabolites in these mechanisms.

Formalin nociception in the mouse does not lead to increased spinal serotonin turnover

The mouse formalin test is a model of tonic (continuous), chemical/inflammatory nociception. To test the hypothesis that bulbospinal serotonergic pathways modulate such nociception, whole spinal cords from mice pretreated with probenecid and sacrificed at 15, 30, 45 and 60 min after injection of 5% formalin or 0.9% saline in the hindpaw were assayed by high performance liquid chromatography with electrochemical detection for the serotonin metabolite, 5-hydroxyindoleacetic acid, as an index of turnover. No difference in serotonin turnover was found between formalin and saline groups, indicating that increased spinal serotonin release is not a normal response to formalin nociception in the mouse.

Spontaneous and evoked release of met-enkephalin-like material from the spinal cord of arthritic rats in vivo

Perfusion of the intrathecal space with artificial CSF was achieved in control and arthritic rats under halothane anaesthesia in order to collect the met-enkephalin-like material (MELM) released from the whole spinal cord. On the fourth week following the intradermal injection of Freund's adjuvant to induce arthritis, a marked reduction (-56%) in the spontaneous outflow of MELM was noted in arthritic rats. This effect did not involve changes in the degradation process of MELM, since it persisted when kelatorphan was added to the perfusing fluid in order to inhibit completely the peptidases acting on met-enkephalin. Raising the K+ concentration in the perfusing fluid from 2.4 to 40 mM, as well as moving the hind paws, produced a significant enhancement of MELM release which was (at least) as pronounced in arthritic as in control rats. These results suggest that the basal activity of spinal enkephalinergic neurones, but not that triggered by various stimuli, is reduced in arthritic rats.

Parallel clinical and behavioural studies of adjuvant-induced arthritis in the rat: possible relationship with 'chronic pain'

The course of adjuvant-induced arthritis was followed, over an 11-week postinoculation period, in Sprague-Dawley rats, using both clinical and behavioural methods of study. Clinical observations included body weight, diameters of radiocarpal and tibiotarsal joints and radiological analysis of forepaws, hindpaws and vertebrae. Behavioural observations included those of spontaneous behaviour-mobility, exploring, rearing, penis licking and scratching-and of pain-related tests-the foot-bend procedure and Randall-Selitto test. In general, the time course of the disease could be divided into 4 stages, viz. a preclinical, an acute, a postacute and a recovery stage. The preclinical stage (first week) was characterized by discrete radiological lesions of the forepaws and a slight increase in the threshold for struggle triggered by foot pressure, but, above all, by no change in the other parameters. The acute stage (weeks 2-4) was clearly defined by a pause in body weight gain and by dramatic behavioural changes: a lack of mobility and exploring behaviour, a profound increase in scratching behaviour and signs of hyperalgesia. During this period, hindpaw and forepaw joint diameters increased dramatically. The behavioural modifications peaked at the same time (week 4) as there was an acceleration in the radiological abnormalities (soft tissue swelling, demineralization and erosion of bone extremities and joint space narrowing) which had begun during week 3. During the postacute stage (weeks 5-8), body weight and behavioural reactions began to return towards control values, but joint diameters and radiological scores either continued to increase or remained constant. During the recovery stage (weeks 9-11), behavioural scores and body weight returned to control values while the mean joint diameters remained constant and there was a slight decrease in the radiological scores. In spite of the complexity of the model used in these studies, it appeared quite clear that the acute phase of the disease was characterized by the onset of clinical symptoms and dramatic changes in behaviour, all of which could be related to the occurrence of pain; signs of pain were still present, albeit weaker, in the postacute phase. Such observations, taken together, help to validate adjuvant arthritis as an experimental model of chronic pain in Sprague-Dawley rats.