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Dedek A, Xu J, Lorenzo LÉ, Godin AG, Kandegedara CM, Glavina G, Landrigan JA, Lombroso PJ, De Koninck Y, Tsai EC, Hildebrand ME. Sexual dimorphism in a neuronal mechanism of spinal hyperexcitability across rodent and human models of pathological pain. Brain 2022; 145:1124-1138. [PMID: 35323848 PMCID: PMC9050559 DOI: 10.1093/brain/awab408] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/03/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
The prevalence and severity of many chronic pain syndromes differ across sex, and recent studies have identified differences in immune signalling within spinal nociceptive circuits as a potential mediator. Although it has been proposed that sex-specific pain mechanisms converge once they reach neurons within the superficial dorsal horn, direct investigations using rodent and human preclinical pain models have been lacking. Here, we discovered that in the Freund’s adjuvant in vivo model of inflammatory pain, where both male and female rats display tactile allodynia, a pathological coupling between KCC2-dependent disinhibition and N-methyl-D-aspartate receptor (NMDAR) potentiation within superficial dorsal horn neurons was observed in male but not female rats. Unlike males, the neuroimmune mediator brain-derived neurotrophic factor (BDNF) failed to downregulate inhibitory signalling elements (KCC2 and STEP61) and upregulate excitatory elements (pFyn, GluN2B and pGluN2B) in female rats, resulting in no effect of ex vivo brain-derived neurotrophic factor on synaptic NMDAR responses in female lamina I neurons. Importantly, this sex difference in spinal pain processing was conserved from rodents to humans. As in rodents, ex vivo spinal treatment with BDNF downregulated markers of disinhibition and upregulated markers of facilitated excitation in superficial dorsal horn neurons from male but not female human organ donors. Ovariectomy in female rats recapitulated the male pathological pain neuronal phenotype, with BDNF driving a coupling between disinhibition and NMDAR potentiation in adult lamina I neurons following the prepubescent elimination of sex hormones in females. This discovery of sexual dimorphism in a central neuronal mechanism of chronic pain across species provides a foundational step towards a better understanding and treatment for pain in both sexes.
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Affiliation(s)
- Annemarie Dedek
- Department of Neuroscience, Carleton University, K1S 5B6 Ontario, Canada.,Neuroscience Program, Ottawa Hospital Research Institute, K1Y 4M9 Ontario, Canada
| | - Jian Xu
- Child Study Center, Yale University School of Medicine, New Haven, CT 06519, USA
| | | | - Antoine G Godin
- CERVO Brain Research Centre, Quebec Mental Health Institute, Quebec G1E 1T2, Canada.,Department of Psychiatry and Neuroscience, Université Laval, Quebec G1V 0A6, Canada
| | - Chaya M Kandegedara
- Department of Neuroscience, Carleton University, K1S 5B6 Ontario, Canada.,Neuroscience Program, Ottawa Hospital Research Institute, K1Y 4M9 Ontario, Canada
| | - Geneviève Glavina
- CERVO Brain Research Centre, Quebec Mental Health Institute, Quebec G1E 1T2, Canada
| | | | - Paul J Lombroso
- Child Study Center, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Yves De Koninck
- CERVO Brain Research Centre, Quebec Mental Health Institute, Quebec G1E 1T2, Canada.,Department of Psychiatry and Neuroscience, Université Laval, Quebec G1V 0A6, Canada
| | - Eve C Tsai
- Neuroscience Program, Ottawa Hospital Research Institute, K1Y 4M9 Ontario, Canada.,Brain and Mind Research Institute, University of Ottawa, Ontario K1N 6N5, Canada.,Department of Surgery, Division of Neurosurgery, The Ottawa Hospital, Ontario K1Y 4E9, Canada
| | - Michael E Hildebrand
- Department of Neuroscience, Carleton University, K1S 5B6 Ontario, Canada.,Neuroscience Program, Ottawa Hospital Research Institute, K1Y 4M9 Ontario, Canada
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Bravo L, Llorca-Torralba M, Berrocoso E, Micó JA. Monoamines as Drug Targets in Chronic Pain: Focusing on Neuropathic Pain. Front Neurosci 2019; 13:1268. [PMID: 31942167 PMCID: PMC6951279 DOI: 10.3389/fnins.2019.01268] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
Monoamines are involved in regulating the endogenous pain system and indeed, peripheral and central monoaminergic dysfunction has been demonstrated in certain types of pain, particularly in neuropathic pain. Accordingly, drugs that modulate the monaminergic system and that were originally designed to treat depression are now considered to be first line treatments for certain types of neuropathic pain (e.g., serotonin and noradrenaline (and also dopamine) reuptake inhibitors). The analgesia induced by these drugs seems to be mediated by inhibiting the reuptake of these monoamines, thereby reinforcing the descending inhibitory pain pathways. Hence, it is of particular interest to study the monoaminergic mechanisms involved in the development and maintenance of chronic pain. Other analgesic drugs may also be used in combination with monoamines to facilitate descending pain inhibition (e.g., gabapentinoids and opioids) and such combinations are often also used to alleviate certain types of chronic pain. By contrast, while NSAIDs are thought to influence the monoaminergic system, they just produce consistent analgesia in inflammatory pain. Thus, in this review we will provide preclinical and clinical evidence of the role of monoamines in the modulation of chronic pain, reviewing how this system is implicated in the analgesic mechanism of action of antidepressants, gabapentinoids, atypical opioids, NSAIDs and histaminergic drugs.
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Affiliation(s)
- Lidia Bravo
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Meritxell Llorca-Torralba
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Berrocoso
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, Cádiz, Spain
| | - Juan Antonio Micó
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Juan Antonio Micó,
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Zhang G, Chen W, Marvizón JCG. Src family kinases mediate the inhibition of substance P release in the rat spinal cord by μ-opioid receptors and GABA(B) receptors, but not α2 adrenergic receptors. Eur J Neurosci 2010; 32:963-73. [PMID: 20726886 DOI: 10.1111/j.1460-9568.2010.07335.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
GABA(B) , μ-opioid and adrenergic α(2) receptors inhibit substance P release from primary afferent terminals in the dorsal horn. Studies in cell expression systems suggest that μ-opioid and GABA(B) receptors inhibit transmitter release from primary afferents by activating Src family kinases (SFKs), which then phosphorylate and inhibit voltage-gated calcium channels. This study investigated whether SFKs mediate the inhibition of substance P release by these three receptors. Substance P release was measured as neurokinin 1 receptor (NK1R) internalization in spinal cord slices and in vivo. In slices, NK1R internalization induced by high-frequency dorsal root stimulation was inhibited by the μ-opioid agonist DAMGO and the GABA(B) agonist baclofen. This inhibition was reversed by the SFK inhibitor PP1. NK1R internalization induced by low-frequency stimulation was also inhibited by DAMGO, but PP1 did not reverse this effect. In vivo, NK1R internalization induced by noxious mechanical stimulation of the hind paw was inhibited by intrathecal DAMGO and baclofen. This inhibition was reversed by intrathecal PP1, but not by the inactive PP1 analog PP3. PP1 produced no effect by itself. The α(2) adrenergic agonists medetomidine and guanfacine produced a small but statistically significant inhibition of NK1R internalization induced by low-frequency dorsal root stimulation. PP1 did not reverse the inhibition by guanfacine. These results show that SFKs mediate the inhibition of substance P release by μ-opioid and GABA(B) receptors, but not by α(2) receptors, which is probably mediated by the binding of G protein βγ subunits to calcium channels.
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Affiliation(s)
- Guohua Zhang
- Center for Neurobiology of Stress, CURE: Digestive Diseases Research Center, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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Fairbanks CA, Stone LS, Wilcox GL. Pharmacological profiles of alpha 2 adrenergic receptor agonists identified using genetically altered mice and isobolographic analysis. Pharmacol Ther 2009; 123:224-38. [PMID: 19393691 DOI: 10.1016/j.pharmthera.2009.04.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 04/09/2009] [Indexed: 12/24/2022]
Abstract
Endogenous, descending noradrenergic fibers impose analgesic control over spinal afferent circuitry mediating the rostrad transmission of pain signals. These fibers target alpha 2 adrenergic receptors (alpha(2)ARs) on both primary afferent terminals and secondary neurons, and their activation mediates substantial inhibitory control over this transmission, rivaling that of opioid receptors which share a similar pattern of distribution. The terminals of primary afferent nociceptive neurons and secondary spinal dorsal horn neurons express alpha(2A)AR and alpha(2C)AR subtypes, respectively. Spinal delivery of these agents serves to reduce their side effects, which are mediated largely at supraspinal sites, by concentrating the drugs at the spinal level. Targeting these spinal alpha(2)ARs with one of five selective therapeutic agonists, clonidine, dexmedetomidine, brimonidine, ST91 and moxonidine, produces significant antinociception that can work in concert with opioid agonists to yield synergistic antinociception. Application of several genetically altered mouse lines had facilitated identification of the primary receptor subtypes that likely mediate the antinociceptive effects of these agents. This review provides first an anatomical description of the localization of the three subtypes in the central nervous system, second a detailed account of the pharmacological history of each of the six primary agonists, and finally a comprehensive report of the specific interactions of other GPCR agonists with each of the six principal alpha(2)AR agonists featured.
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Affiliation(s)
- Carolyn A Fairbanks
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
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Giovannoni MP, Ghelardini C, Vergelli C, Dal Piaz V. α2-Agonists as analgesic agents. Med Res Rev 2009; 29:339-68. [DOI: 10.1002/med.20134] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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7
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Ma W, Eisenach JC. Neuronal nitric oxide synthase is upregulated in a subset of primary sensory afferents after nerve injury which are necessary for analgesia from alpha2-adrenoceptor stimulation. Brain Res 2006; 1127:52-8. [PMID: 17113051 PMCID: PMC1831830 DOI: 10.1016/j.brainres.2006.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 09/29/2006] [Accepted: 10/02/2006] [Indexed: 11/21/2022]
Abstract
alpha2-Adrenoceptor (AR) agonists increase in analgesic potency and efficacy after peripheral nerve injury, and their effects are blocked by neuronal nitric oxide synthase (nNOS) inhibitors and M4 muscarinic receptor antagonists only after injury. We tested whether nNOS and M4 muscarinic receptors are co-expressed in the spinal cord, and whether destruction of a subset of sensory afferents which are essential to alpha2-AR analgesia would also destroy nNOS and M4 receptor expression. Male Sprague-Dawley rats underwent left L5 and L6 spinal nerve ligation. Lumbar spinal cord was removed and immunostained for M4 muscarinic receptors and nNOS alone and for co-expression. Others received intrathecal injection of saporin linked to an antibody to the neurotrophin receptor p75(NTR), which eliminates cells expressing this receptor and the analgesic effects of alpha2-AR agonists. nNOS staining of fibers in the superficial dorsal horn was dramatically increased after spinal nerve ligation, and this was abolished by saporin linked anti-p75(NTR) treatment. In contrast, nNOS staining in dorsal horn neurons was unaltered by these manipulations. M4 receptors were present on neurons in the dorsal horn, some of which co-expressed nNOS, but their pattern of expression was not altered by these manipulations. Peripheral nerve injury increases nNOS expression in fibers in the superficial dorsal horn, some of which likely express p75(NTR), and alpha2-AR agonists may reduce injury-induced sensitization by activation of nNOS in these fibers In contrast, changes in nNOS and M4 receptor location on spinal cord neurons are not responsible for increased analgesic potency of alpha2-AR agonists after nerve injury.
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MESH Headings
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists/pharmacology
- Animals
- Disease Models, Animal
- Ganglia, Spinal/drug effects
- Ganglia, Spinal/metabolism
- Ganglia, Spinal/physiopathology
- Ligation
- Male
- Neuralgia/drug therapy
- Neuralgia/metabolism
- Neuralgia/physiopathology
- Neurons, Afferent/drug effects
- Neurons, Afferent/metabolism
- Neurotoxins/pharmacology
- Nitric Oxide/metabolism
- Nitric Oxide Synthase Type I/metabolism
- Nociceptors/cytology
- Nociceptors/drug effects
- Nociceptors/metabolism
- Peripheral Nervous System Diseases/drug therapy
- Peripheral Nervous System Diseases/metabolism
- Peripheral Nervous System Diseases/physiopathology
- Posterior Horn Cells/drug effects
- Posterior Horn Cells/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptor, Muscarinic M4/drug effects
- Receptor, Muscarinic M4/metabolism
- Receptor, Nerve Growth Factor/drug effects
- Receptor, Nerve Growth Factor/metabolism
- Receptors, Adrenergic, alpha-2/metabolism
- Spinal Nerve Roots/drug effects
- Spinal Nerve Roots/metabolism
- Spinal Nerve Roots/physiopathology
- Spinal Nerves/injuries
- Spinal Nerves/metabolism
- Spinal Nerves/physiopathology
- Up-Regulation/drug effects
- Up-Regulation/physiology
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Affiliation(s)
- Weiya Ma
- Department of Anesthesiology and Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA
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Sandrini G, Serrao M, Rossi P, Romaniello A, Cruccu G, Willer JC. The lower limb flexion reflex in humans. Prog Neurobiol 2005; 77:353-95. [PMID: 16386347 DOI: 10.1016/j.pneurobio.2005.11.003] [Citation(s) in RCA: 372] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Revised: 11/08/2005] [Accepted: 11/09/2005] [Indexed: 10/25/2022]
Abstract
The flexion or flexor reflex (FR) recorded in the lower limbs in humans (LLFR) is a widely investigated neurophysiological tool. It is a polysynaptic and multisegmental spinal response that produces a withdrawal of the stimulated limb and resembles (having several features in common) the hind-paw FR in animals. The FR, in both animals and humans, is mediated by a complex circuitry modulated at spinal and supraspinal level. At rest, the LLFR (usually obtained by stimulating the sural/tibial nerve and by recording from the biceps femoris/tibial anterior muscle) appears as a double burst composed of an early, inconstantly present component, called the RII reflex, and a late, larger and stable component, called the RIII reflex. Numerous studies have shown that the afferents mediating the RII reflex are conveyed by large-diameter, low-threshold, non-nociceptive A-beta fibers, and those mediating the RIII reflex by small-diameter, high-threshold nociceptive A-delta fibers. However, several afferents, including nociceptive and non-nociceptive fibers from skin and muscles, have been found to contribute to LLFR activation. Since the threshold of the RIII reflex has been shown to correspond to the pain threshold and the size of the reflex to be related to the level of pain perception, it has been suggested that the RIII reflex might constitute a useful tool to investigate pain processing at spinal and supraspinal level, pharmacological modulation and pathological pain conditions. As stated in EFNS guidelines, the RIII reflex is the most widely used of all the nociceptive reflexes, and appears to be the most reliable in the assessment of treatment efficacy. However, the RIII reflex use in the clinical evaluation of neuropathic pain is still limited. In addition to its nocifensive function, the LLFR seems to be linked to posture and locomotion. This may be explained by the fact that its neuronal circuitry, made up of a complex pool of interneurons, is interposed in motor control and, during movements, receives both peripheral afferents (flexion reflex afferents, FRAs) and descending commands, forming a multisensorial feedback mechanism and projecting the output to motoneurons. LLFR excitability, mediated by this complex circuitry, is finely modulated in a state- and phase-dependent manner, rather as we observe in the FR in animal models. Several studies have demonstrated that LLFR excitability may be influenced by numerous physiological conditions (menstrual cycle, stress, attention, sleep and so on) and pathological states (spinal lesions, spasticity, Wallenberg's syndrome, fibromyalgia, headaches and so on). Finally, the LLFR is modulated by several drugs and neurotransmitters. In summary, study of the LLFR in humans has proved to be an interesting functional window onto the spinal and supraspinal mechanisms of pain processing and onto the spinal neural control mechanisms operating during posture and locomotion.
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Affiliation(s)
- Giorgio Sandrini
- University Center for Adaptive Disorders and Headache, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Via Mondino 2, 27100 Pavia, Italy.
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Bantel C, Eisenach JC, Duflo F, Tobin JR, Childers SR. Spinal nerve ligation increases alpha2-adrenergic receptor G-protein coupling in the spinal cord. Brain Res 2005; 1038:76-82. [PMID: 15748875 DOI: 10.1016/j.brainres.2005.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 12/31/2004] [Accepted: 01/04/2005] [Indexed: 10/25/2022]
Abstract
Intrathecal and epidural administration of the alpha2-adrenergic receptor agonist clonidine in humans results in analgesia to both acute nociceptive and chronic neuropathic pain. The potency of clonidine increases with hypersensitivity to mechanical stimuli after nerve injury, although the reasons for this change are unknown. In the present study, we tested the hypothesis that peripheral nerve injury alters either spinal alpha2-adrenergic receptor-mediated G-protein activity or alpha2-adrenergic receptor number. Rats were randomized to left spinal nerve ligation (SNL) or sham surgery. Tactile hypersensitivity in the hindpaw was confirmed and lumbar spinal cords were removed for binding assays. To examine agonist-induced G-protein coupling, [35S]GTP gamma S binding experiments were performed in spinal cord membranes and sections using norepinephrine as an alpha2-adrenergic agonist. SNL was associated with an increase in maximal efficacy, but not potency, of norepinephrine-stimulated [35S]GTP gamma S binding in dorsal horn. SNL had no effect on basal [35S]GTP gamma S binding or on muscarinic cholinergic-stimulated [35S]GTP gamma S binding. [35S]GTP gamma S autoradiography showed that this increase in alpha2-adrenergic-activated G-proteins occurred both ipsilateral and contralateral to SNL surgery. SNL did not alter total alpha2-adrenergic receptor number or affinity to [3H]-rauwolscine binding, and displacement studies with the alpha2A-adrenergic antagonist BRL44408 revealed that most of the binding was associated with the alpha2A-adrenergic subtype. These data suggest that the increased potency of clonidine in neuropathic pain could reflect increased efficiency of G-protein coupling from spinal alpha2-adrenergic receptors.
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Affiliation(s)
- Carsten Bantel
- Department of Anesthesiology, University of Munster, Germany
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10
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Expression of neuron-associated tumor necrosis factor alpha in the brain is increased during persistent pain. Reg Anesth Pain Med 2002. [DOI: 10.1097/00115550-200207000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Mercadante S, Portenoy RK. Opioid poorly-responsive cancer pain. Part 3. Clinical strategies to improve opioid responsiveness. J Pain Symptom Manage 2001; 21:338-54. [PMID: 11312049 DOI: 10.1016/s0885-3924(01)00250-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Some pain syndromes may be difficult to treat due to a poor response to opioids. This situation demands a range of alternative measures, including the use of adjuvant drugs with independent effects, such as antidepressants, sodium channel-blocking agents, steroids and anti-inflammatory drugs (NSAIDs); drugs that reduce opioid side effects; and drugs that enhance analgesia produced by opioids, such as N-methyl-D-aspartate (NMDA) antagonists, calcium channel antagonists, and clonidine. Other approaches, including opioid trials, neural blockade when necessary, and psychological interventions, also may be useful.
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Affiliation(s)
- S Mercadante
- Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
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12
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Mercadante S, Portenoy RK. Opioid poorly-responsive cancer pain. Part 2: basic mechanisms that could shift dose response for analgesia. J Pain Symptom Manage 2001; 21:255-64. [PMID: 11239748 DOI: 10.1016/s0885-3924(00)00236-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Basic research in experimental pain models may illuminate the phenomenon of cancer pain that is poorly responsive to opioid drugs. Research findings can be valuable in formulating new strategies in clinical practice. This review evaluated experimental observations in terms of the events that occur in cancer patients receiving opioid therapy for pain.
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Affiliation(s)
- S Mercadante
- Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
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Muller A, Koch B, René F, Boutillier AL, See V, Loeffler JP. [Mechanisms of opioid tolerance and opioid dependence]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:866-95. [PMID: 10575502 DOI: 10.1016/s0750-7658(00)88194-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Prescription of opiates to non cancer chronic pain patients is controversial, partly because of the risk of tolerance and dependence development. The two objectives of that review were: a) to identify the factors which may explain the variability of tolerance and dependence in clinical practice; b) to analyse the cellular mechanisms of occurrence of those phenomenons. DATA SOURCES AND EXTRACTION To our own file, we added articles retrieved in the Medline database, using, alone or in combination, following key-words (opiate, tolerance, dependence, opiate receptor, pain treatment, cAMP, cGMP, NO, NMDA, protein kinase, gene). Out of nearly 450 articles, we selected less than 200. DATA SYNTHESIS Tolerance, defined as loss of opioid efficacy with time, is extremely variable and depends on pain mechanisms, intrinsic efficacy and administration modality of the opioid, as well as co-administration of other agents. Physical dependence is a consequence of the intrinsic and extrinsic adaptations concerning structures as locus coeruleus, paragigantocellular nucleus, spinal cord. Acute and chronic application of opiates and withdrawal give rise to cellular adaptations which depend on the nature and efficacy of the opiate, the type of receptor and second messengers, as well as the type of cell line under study. These cellular mechanisms have consequences on neuronal excitability and gene expression. They constitute a model of cellular tolerance and dependence, but cannot explain the subtelties encountered in clinical practice.
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Affiliation(s)
- A Muller
- Clinique de la douleur, hôpital civil, hôpitaux universitaires de Strasbourg, France
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14
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Stone LS, Vulchanova L, Riedl MS, Wang J, Williams FG, Wilcox GL, Elde R. Effects of peripheral nerve injury on alpha-2A and alpha-2C adrenergic receptor immunoreactivity in the rat spinal cord. Neuroscience 1999; 93:1399-407. [PMID: 10501465 DOI: 10.1016/s0306-4522(99)00209-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neuropathic pain resulting from peripheral nerve injury can often be relieved by administration of alpha-adrenergic receptor antagonists. Tonic activation of alpha-adrenergic receptors may therefore facilitate the hyperalgesia and allodynia associated with neuropathic pain. It is currently unclear whether alpha2A- or alpha2c-adrenergic receptor subtypes are involved in the pro-nociceptive actions of alpha-adrenergic receptors under neuropathic conditions. We therefore investigated the effects of peripheral nerve injury on the expression of these subtypes in rat spinal cord using immunohistochemical techniques. In addition, neuropeptide Y immunoreactivity was examined as an internal control because it has previously been shown to be up-regulated following nerve injury. We observed a decrease in alpha2A-adrenergic receptor immunoreactivity in the spinal cord ipsilateral to three models of neuropathic pain: complete sciatic nerve transection, chronic constriction injury of the sciatic nerve and L5/L6 spinal nerve ligation. The extent of this down-regulation was significantly correlated with the magnitude of injury-induced changes in mechanical sensitivity. In contrast, alpha2c-adrenergic receptor immunoreactivity was only increased in the spinal nerve ligation model; these increases did not correlate with changes in mechanical sensitivity. Neuropeptide Y immunoreactivity was up-regulated in all models examined. Increased expression of neuropeptide Y correlated with changes in mechanical sensitivity. The decrease in alpha2A-adrenergic receptor immunoreactivity and the lack of consistent changes in alpha2C-adrenergic receptor immunoreactivity suggest that neither of these receptor subtypes is likely to be responsible for the abnormal adrenergic sensitivity observed following nerve injury. On the contrary, the decrease in alpha2A-adrenergic receptor immunoreactivity following nerve injury may result in an attenuation of the influence of descending inhibitory noradrenergic input into the spinal cord resulting in increased excitatory transmitter release following peripheral stimuli.
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Affiliation(s)
- L S Stone
- Graduate Program in Neuroscience, Department of Pharmacology, University of Minnesota, Minneapolis 55455, USA
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Abstract
The past 10 years have brought several new experimental models with which to study chronic neuropathic pain in animals. Consequently, our knowledge about the mechanisms subserving neuropathic pain in humans has improved. However, the first animal model that was used for studying this type of chronic pain was the autotomy-model which can still be considered as a useful tool for pain studies. The present review assesses some of the similarities and differences between autotomy-model and more recent models of experimental traumatic mononeuropathy. In addition, it considers some of the similarities between the results obtained in clinical studies and in autotomy studies.
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Affiliation(s)
- T Kauppila
- Center for Sensory Motor Interaction, University of Aalborg, Denmark
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16
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Eisenach J. Update on spinal cord pharmacology in pain. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1997; 110:124-6. [PMID: 9248560 DOI: 10.1111/j.1399-6576.1997.tb05528.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
MESH Headings
- Acute Disease
- Adrenergic alpha-Agonists/pharmacology
- Adrenergic alpha-Agonists/therapeutic use
- Analgesics/pharmacology
- Analgesics/therapeutic use
- Analgesics, Opioid/pharmacology
- Analgesics, Opioid/therapeutic use
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Cell- and Tissue-Based Therapy
- Cholinesterase Inhibitors/pharmacology
- Cholinesterase Inhibitors/therapeutic use
- Chromaffin Cells/transplantation
- Chronic Disease
- Delayed-Action Preparations
- Humans
- Muscarinic Agonists/pharmacology
- Muscarinic Agonists/therapeutic use
- N-Methylaspartate/antagonists & inhibitors
- Nerve Fibers/drug effects
- Neurotransmitter Agents/physiology
- Nitric Oxide Synthase/physiology
- Nociceptors/drug effects
- Nociceptors/physiology
- Norepinephrine/physiology
- Pain/drug therapy
- Pain/physiopathology
- Rats
- Receptors, Adrenergic, alpha/drug effects
- Receptors, Adrenergic, alpha/physiology
- Receptors, Glutamate/physiology
- Receptors, N-Methyl-D-Aspartate/drug effects
- Receptors, N-Methyl-D-Aspartate/physiology
- Receptors, Opioid/drug effects
- Receptors, Tachykinin/physiology
- Spinal Cord/drug effects
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Affiliation(s)
- J Eisenach
- Department of Anesthesia, Bowman Gray School of Medicine, Winston-Salem, NC, USA
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17
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Muller A, Lemos D. [Cancer pain: beneficial effect of ketamine addition to spinal administration of morphine-clonidine-lidocaine mixture]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1996; 15:271-6. [PMID: 8758581 DOI: 10.1016/s0750-7658(96)80005-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the benefit of ketamine addition to a morphine-clonidine-lidocaine mixture administered continuously by the intrathecal route for the treatment of cancer pain. STUDY DESIGN Case series analysis. PATIENTS AND METHOD Four patients experiencing cancer pain with nociceptive and neuropathic components were treated with a continuous intrathecal administration of a mixture of ketamine (10 mg)-morphine (1-20 mg)-clonidine (30 micrograms)-lidocaine (20 mg) in 12 mL of normal saline, injected daily with an infusor (Baxter) pump. This treatment, associated with oral administration of sustained release morphine (SRM), was extended over 35 to 58 days, until the death of the patients. RESULTS Either the secondary addition of ketamine to the morphine-clonidine-lidocaine mixture after the 40th and 15th days of treatment in patients no 1 and 2 respectively, because of a loss of efficiency of the mixture, or the immediate administration of the association of the four agents in patients no 3 and 4 provided efficient analgesia, unchanged over time, without significant adverse effects and allowed a decrease of the SRM doses. CONCLUSION Ketamine by intrathecal route potentiates analgesia obtained with morphine-clonidine and lidocaine, while impeding the development of a tolerance vis-à-vis the former.
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Affiliation(s)
- A Muller
- Département d'anesthésiologie, hôpitaux universitaire de Strasbourg, hôpital civil, France
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18
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Luo L, Wiesenfeld-Hallin Z. Differential effects of pre-treatment with intrathecal or intravenous morphine on the prevention of spinal cord hyperexcitability following sciatic nerve section in the rat. Acta Anaesthesiol Scand 1996; 40:91-5. [PMID: 8904265 DOI: 10.1111/j.1399-6576.1996.tb04393.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effect of intrathecal (i.t.) and intravenous (i.v.) morphine on spinal hyperexcitability following unilateral section of the sciatic nerve was studied in decerebrate, spinalized, unanesthetized rats. Sciatic nerve section evoked a biphasic, prolonged hyperexcitability of the flexor reflex. Either i.v. (0.2, 1 or 10 mg center dot kg-1) or i.t. (3 or 10 mu g) morphine was administered prior to sciatic nerve section. All doses of morphine significantly depressed the baseline flexor reflex and abolished the less intense prolonged second component of reflex hyperexcitability. One and 10, but not 0.2, mg center dot kg-1 i.v. morphine significantly depressed the first phase of spinal cord sensitization. However, both 3 mu g and 10 mu g i.t. morphine were significantly more effective than i.v. morphine in suppressing spinal cord hyperexcitability. The present results suggest that moderate doses of i.t. morphine decrease spinal hyperexcitability following nerve transection more than even extremely large i.v. doses. The poorer effect of i.v. morphine on preventing spinal hyperexcitability may be due to low spinal concentration after systemic administration.
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Affiliation(s)
- L Luo
- Karolinska Institute, Department of Medical Laboratory Sciences and Technology, Section of Clinical Neurophysiology, Huddinge University Hospital, Sweden
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19
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Central Dysesthesia Pain after Traumatic Spinal Cord Injury Is Dependent on N-Methyl-D-aspartate Receptor Activation. Neurosurgery 1995. [DOI: 10.1097/00006123-199512000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Eide PK, Stubhaug A, Stenehjem AE. Central dysesthesia pain after traumatic spinal cord injury is dependent on N-methyl-D-aspartate receptor activation. Neurosurgery 1995; 37:1080-7. [PMID: 8584148 DOI: 10.1227/00006123-199512000-00007] [Citation(s) in RCA: 168] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The role of central N-methyl-D-aspartate (NMDA) receptors in the pathogenesis of central pain was examined in nine patients with central dysesthesia pain after spinal cord injury. The central pain syndrome included spontaneous continuous and intermittent pain as well as evoked pain. Pain was evoked by non-noxious stimulation of the skin (allodynia) and by repeated pricking of the skin (wind-up-like pain). The severity of continuous and evoked pain was examined before and after the intravenous infusion of either the NMDA receptor antagonist ketamine (6 micrograms/kg/min after a bolus dose of 60 micrograms/kg), the mu-opioid receptor agonist alfentanil (0.6 microgram/kg/min after after a bolus dose of 7 micrograms/kg), or placebo (0.9% NaCl). A randomized, double-blind, crossover study design was used. It was found that both continuous and evoked pain were markedly reduced by the blockade of NMDA receptors by ketamine as well as by the activation of mu-opioid receptors by alfentanil. Neither ketamine nor alfentanil significantly changed thresholds for the sensation of heat pain. The reduction of pain was not associated with severe side effects; the most severe side effect of ketamine was bothersome dizziness in one patient, and only modest side effects were caused by alfentanil. The present data provide clinical evidence that the development of central dysesthesia pain after traumatic spinal cord injury is dependent on the activation of central NMDA receptors. The results further indicate that mu-opioid receptors are involved in the control of this type of pain.
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Affiliation(s)
- P K Eide
- Department of Neurosurgery, Ullevål Hospital, Oslo, Norway
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21
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Luo L, Wiesenfeld-Hallin Z. Effects of intrathecal local anesthetics on spinal excitability and on the development of autotomy. Pain 1995; 63:173-179. [PMID: 8628582 DOI: 10.1016/0304-3959(95)00054-v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effect of 500 micrograms intrathecal (i.t.) lidocaine and tocainide injected prior to unilateral sciatic nerve section on the development of autotomy behavior was examined in rats. Neither drug inhibited autotomy compared with saline controls. The effect of lidocaine and tocainide on the flexor reflex in decerebrate, spinalized rats was also examined. Both drugs at 500 micrograms i.t. totally blocked the flexor reflex and hyperexcitability following acute nerve section, with a longer duration of action with tocainide. Recovery from the drugs was followed by a prolonged period of reflex hyperexcitability, even without axotomy. Lower dose lidocaine (100 micrograms) briefly blocked the reflex and recovery was followed by reflex hyperexcitability. Very low dose i.t. lidocaine (1 and 10 micrograms) did not block the flexor reflex, but only induced a prolonged increase in reflex magnitude. The possible mechanisms underlying these observations are discussed. The results suggest that i.t. local anesthetic pretreatment alone may not be beneficial for the prevention of the development of postoperative or neuropathic pain.
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Affiliation(s)
- Lei Luo
- Karolinska Institute, Department of Medical Laboratory Sciences and Technology, Section of Clinical Neurophysiology, Huddinge University Hospital, S-141 86 Huddinge, Sweden
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22
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Luo L, Ji RR, Zhang Q, Iadarola MJ, Hökfelt T, Wiesenfeld-Hallin Z. Effect of administration of high dose intrathecal clonidine or morphine prior to sciatic nerve section on c-Fos expression in rat lumbar spinal cord. Neuroscience 1995; 68:1219-27. [PMID: 8544995 DOI: 10.1016/0306-4522(95)00197-q] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effects of moderate and high intrathecal doses of clonidine, an alpha 2 adrenoceptor agonist, or a high dose of morphine on sciatic nerve section-induced expression of c-Fos-like immunoreactivity was studied in laminae I and II of the dorsal horn and laminae VIII and IX of the ventral horn of rat lumbar spinal cord. c-Fos-like immunoreactivity was examined by immunohistochemistry in normal rats (group 1), rats implanted with an intrathecal catheter with its tip on the lumbar spinal cord (group 2), injected with 10 micrograms (group 3) or 50 micrograms (group 4) clonidine intrathecally 3 h before being killed. In other groups, saline, 10 or 50 micrograms clonidine or 30 micrograms morphine was injected 1 h before unilateral nerve section, and the expression of c-Fos-like immunoreactivity was examined 2 h after axotomy. Few labeled neurons were found in normal controls. The intrathecal catheter itself caused a significant increase in bilateral c-Fos-like immunoreactivity in spinal dorsal and ventral horn compared to normals. The level of c-Fos-like immunoreactivity after 10 or 50 micrograms intrathecal clonidine was similar as in the intrathecal catheter group. Sciatic nerve section caused a significant ipsilateral increase in c-Fos-like immunoreactivity in the dorsal horn compared to the intact side in rats injected with saline. Pretreatment with 10 or 10 micrograms clonidine did not reduce sciatic nerve section-induced expression of c-Fos-like immunoreactivity, but instead caused a significant bilateral increase in c-Fos-like immunoreactivity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Luo
- Department of Medical Laboratory Sciences and Technology, Huddinge University Hospital, Sweden
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23
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Luo L, Wiesenfeld-Hallin Z. The effects of pretreatment with tachykinin antagonists and galanin on the development of spinal cord hyperexcitability following sciatic nerve section in the rat. Neuropeptides 1995; 28:161-6. [PMID: 7540733 DOI: 10.1016/0143-4179(95)90111-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effects of acute section of the sciatic nerve on the excitability of the flexor reflex was examined in decerebrate, spinalized, unanaesthetized rats. In control experiments without drugs, the excitability of the flexor reflex was dramatically increased in two phases following axotomy. An early intense, brief reflex hyperexcitability was followed by a less intense, prolonged period of facilitation. The selective NK1 tachykinin receptor antagonist CP-96,345 injected intrathecally at lower (1.2-2.4 nmol) and higher (12 nmol) doses blocked both components of spinal sensitization. The selective NK2 tachykinin receptor antagonist Men 10376 at a dose of 2.4 nmol also reduced both response components, as did the same dose of the inhibitory neuropeptide galanin. Thus, antagonists of excitatory neuropeptides released during and after nerve section, such as substance P and neurokinin A, can block the spinal response to peripheral nerve injury. Furthermore, the inhibitory neuropeptide galanin also reduced spinal cord sensitization.
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Affiliation(s)
- L Luo
- Karolinska Institute, Department of Medical Laboratory Sciences and Technology, Huddinge University Hospital, Sweden
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24
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Luo L, Wiesenfeld-Hallin Z. Genetic factors may influence the development of spinal reflex hyperexcitability following sciatic nerve section in the rat. Neurosci Lett 1994; 169:122-5. [PMID: 8047265 DOI: 10.1016/0304-3940(94)90371-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We compared changes in the excitability of the hamstring flexor reflex evoked by electrical stimulation of the sciatic nerve before and after section of the peroneal, tibial and sural branches of the nerve in Sprague-Dawley (SD) and spontaneously hypertensive (SHR) rats. In both rat strains, the flexor reflex exhibited a biphasic hyperexcitability lasting over 120 min after nerve section. The initial brief, intense increase in reflex excitability was similar in SD and SHR rats. The second prolonged phase, which may represent hyperalgesia, was significantly greater in SHR than SD rats. These results indicate that genetic differences may have a role in the development of central sensitization.
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Affiliation(s)
- L Luo
- Department of Medical Laboratory Science and Technology, Huddinge University Hospital, Karolinska Institute, Sweden
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