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Genaro K, Fabris D, Arantes ALF, Zuardi AW, Crippa JAS, Prado WA. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats. Front Pharmacol 2017; 8:391. [PMID: 28680401 PMCID: PMC5478794 DOI: 10.3389/fphar.2017.00391] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Pain involves different brain regions and is critically determined by emotional processing. Among other areas, the rostral anterior cingulate cortex (rACC) is implicated in the processing of affective pain. Drugs that interfere with the endocannabinoid system are alternatives for the management of clinical pain. Cannabidiol (CBD), a phytocannabinoid found in Cannabis sativa, has been utilized in preclinical and clinical studies for the treatment of pain. Herein, we evaluate the effects of CBD, injected either systemically or locally into the rACC, on mechanical allodynia in a postoperative pain model and on the negative reinforcement produced by relief of spontaneous incision pain. Additionally, we explored whether CBD underlies the reward of pain relief after systemic or rACC injection. Methods and Results: Male Wistar rats were submitted to a model of incision pain. All rats had mechanical allodynia, which was less intense after intraperitoneal CBD (3 and 10 mg/kg). Conditioned place preference (CPP) paradigm was used to assess negative reinforcement. Intraperitoneal CBD (1 and 3 mg/kg) inverted the CPP produced by peripheral nerve block even at doses that do not change mechanical allodynia. CBD (10 to 40 nmol/0.25 μL) injected into the rACC reduced mechanical allodynia in a dose-dependent manner. CBD (5 nmol/0.25 μL) did not change mechanical allodynia, but reduced peripheral nerve block-induced CPP, and the higher doses inverted the CPP. Additionally, CBD injected systemically or into the rACC at doses that did not change the incision pain evoked by mechanical stimulation significantly produced CPP by itself. Therefore, a non-rewarding dose of CBD in sham-incised rats becomes rewarding in incised rats, presumably because of pain relief or reduction of pain aversiveness. Conclusion: The study provides evidence that CBD influences different dimensions of the response of rats to a surgical incision, and the results establish the rACC as a brain area from which CBD evokes antinociceptive effects in a manner similar to the systemic administration of CBD. In addition, the study gives further support to the notion that the sensorial and affective dimensions of pain may be differentially modulated by CBD.
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Affiliation(s)
- Karina Genaro
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,Department of Psychology and Education, Faculty of Phylosophy, Science and Language Studies of Ribeirão Preto, University of São PauloSão Paulo, Brazil
| | - Débora Fabris
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,Department of Psychology and Education, Faculty of Phylosophy, Science and Language Studies of Ribeirão Preto, University of São PauloSão Paulo, Brazil
| | - Ana L F Arantes
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,Department of Psychology and Education, Faculty of Phylosophy, Science and Language Studies of Ribeirão Preto, University of São PauloSão Paulo, Brazil
| | - Antônio W Zuardi
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,National Institute of Science and Technology for Translational Medicine, Conselho Nacional de Desenvolvimento Cientifico e TecnologicoBrasília, Brazil
| | - José A S Crippa
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,National Institute of Science and Technology for Translational Medicine, Conselho Nacional de Desenvolvimento Cientifico e TecnologicoBrasília, Brazil
| | - Wiliam A Prado
- Department of Psychology and Education, Faculty of Phylosophy, Science and Language Studies of Ribeirão Preto, University of São PauloSão Paulo, Brazil.,Department of Pharmacology, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil
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Witkin LR, Farrar JT, Ashburn MA. Can assessing chronic pain outcomes data improve outcomes? PAIN MEDICINE 2013; 14:779-91. [PMID: 23574493 DOI: 10.1111/pme.12075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This manuscript reviews how patient-reported outcomes data can be used to guide efforts to improve patient outcomes. DESIGN Review Manuscript. SETTING The clinical management of chronic, non-cancer pain. SUBJECTS Adult patients receiving treatment for chronic, non-cancer pain. RESULTS While there have been great advances in the science of pain and various therapeutic medications and interventions, patient outcomes are variable. This manuscript reviews how outcomes data can be used to guide efforts to improve patient outcomes. CONCLUSIONS Patient outcomes can be improved with standardization of the process of patient care, as well as through other quality improvement efforts. The cornerstone to any effort to improve patient outcomes starts with the integration of valid outcomes data collection into ongoing patient care. Outcome measurement tools should provide information on several key domains, yet the process of data collection should not pose a significant burden on either the patient or health care team. Efforts to improve patient outcomes are ongoing, and should be a high priority for every health care team.
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Affiliation(s)
- Lisa R Witkin
- Penn Pain Medicine Center, Department of Anesthesiology and Critical Care, The University of Pennsylvania, Philadelphia, Pennsylvania 19146, USA
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Carleton R, Abrams M, Kachur S, Asmundson G. A comparison of anatomical pain sites from a tertiary care sample: Evidence of disconnect between functional and perceived disability specific to lower back pain. Eur J Pain 2012; 14:410-7. [DOI: 10.1016/j.ejpain.2009.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/02/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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Zvolensky MJ, Cougle JR, Bonn-Miller MO, Norberg MM, Johnson K, Kosiba J, Asmundson GJG. Chronic Pain and Marijuana Use among a Nationally Representative Sample of Adults. Am J Addict 2011; 20:538-42. [DOI: 10.1111/j.1521-0391.2011.00176.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bailey KM, Carleton RN, Vlaeyen JWS, Asmundson GJG. Treatments Addressing Pain-Related Fear and Anxiety in Patients with Chronic Musculoskeletal Pain: A Preliminary Review. Cogn Behav Ther 2009; 39:46-63. [DOI: 10.1080/16506070902980711] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristen M. Bailey
- Department of Psychology and the Anxiety and Illness Behaviours Laboratory, University of Regina , Regina, Saskatchewan, Canada
| | - R. Nicholas Carleton
- Department of Psychology and the Anxiety and Illness Behaviours Laboratory, University of Regina , Regina, Saskatchewan, Canada
| | - Johan W. S. Vlaeyen
- Pain and Disability Research Program, University of Leuven, Tiensestraat , Leuven, Belgium
- Department of Clinical Psychological Science, Maastricht University , Maastricht, the Netherlands
| | - Gordon J. G. Asmundson
- Department of Psychology and the Anxiety and Illness Behaviours Laboratory, University of Regina , Regina, Saskatchewan, Canada
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