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Pesonen AK, Koskinen MK, Vuorenhela N, Halonen R, Mäkituuri S, Selin M, Luokkala S, Suutari A, Hovatta I. The effect of REM-sleep disruption on affective processing: A systematic review of human and animal experimental studies. Neurosci Biobehav Rev 2024; 162:105714. [PMID: 38729279 DOI: 10.1016/j.neubiorev.2024.105714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/15/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
Evidence on the importance of rapid-eye-movement sleep (REMS) in processing emotions is accumulating. The focus of this systematic review is the outcomes of experimental REMS deprivation (REMSD), which is the most common method in animal models and human studies on REMSD. This review revealed that variations in the applied REMSD methods were substantial. Animal models used longer deprivation protocols compared with studies in humans, which mostly reported acute deprivation effects after one night. Studies on animal models showed that REMSD causes aggressive behavior, increased pain sensitivity, reduced sexual behavior, and compromised consolidation of fear memories. Animal models also revealed that REMSD during critical developmental periods elicits lasting consequences on affective-related behavior. The few human studies revealed increases in pain sensitivity and suggest stronger consolidation of emotional memories after REMSD. As pharmacological interventions (such as selective serotonin reuptake inhibitors [SSRIs]) may suppress REMS for long periods, there is a clear gap in knowledge regarding the effects and mechanisms of chronic REMS suppression in humans.
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Affiliation(s)
- Anu-Katriina Pesonen
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland.
| | - Maija-Kreetta Koskinen
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Neea Vuorenhela
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Risto Halonen
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Saara Mäkituuri
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Maikki Selin
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Sanni Luokkala
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Alma Suutari
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
| | - Iiris Hovatta
- SleepWell Research Program and Department of Psychology and Logopedics Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, 00014, Finland
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Zhu K, Chen S, Qin X, Bai W, Hao J, Xu X, Guo H, Bai H, Yang Z, Wang S, Zhao Z, Ji T, Kong D, Zhang W. Exploring the therapeutic potential of cannabidiol for sleep deprivation-induced hyperalgesia. Neuropharmacology 2024; 249:109893. [PMID: 38428482 DOI: 10.1016/j.neuropharm.2024.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Hyperalgesia resulting from sleep deprivation (SD) poses a significant a global public health challenge with limited treatment options. The nucleus accumbens (NAc) plays a crucial role in the modulation of pain and sleep, with its activity regulated by two distinct types of medium spiny neurons (MSNs) expressing dopamine 1 or dopamine 2 (D1-or D2) receptors (referred to as D1-MSNs and D2-MSNs, respectively). However, the specific involvement of the NAc in SD-induced hyperalgesia remains uncertain. Cannabidiol (CBD), a nonpsychoactive phytocannabinoid, has demonstrated analgesic effects in clinical and preclinical studies. Nevertheless, its potency in addressing this particular issue remains to be determined. Here, we report that SD induced a pronounced pronociceptive effect attributed to the heightened intrinsic excitability of D2-MSNs within the NAc in Male C57BL/6N mice. CBD (30 mg/kg, i.p.) exhibited an anti-hyperalgesic effect. CBD significantly improved the thresholds for thermal and mechanical pain and increased wakefulness by reducing delta power. Additionally, CBD inhibited the intrinsic excitability of D2-MSNs both in vitro and in vivo. Bilateral microinjection of the selective D2 receptor antagonist raclopride into the NAc partially reversed the antinociceptive effect of CBD. Thus, these findings strongly suggested that SD activates NAc D2-MSNs, contributing heightened to pain sensitivity. CBD exhibits antinociceptive effects by activating D2R, thereby inhibiting the excitability of D2-MSNs and promoting wakefulness under SD conditions.
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Affiliation(s)
- Kangsheng Zhu
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China; Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Siruan Chen
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Xia Qin
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Wanjun Bai
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China
| | - Jie Hao
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Xiaolei Xu
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, 050000, China
| | - Han Guo
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Hui Bai
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050017, China
| | - Zuxiao Yang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China
| | - Sheng Wang
- Hebei Key Laboratory of Neurophysiology, Shijiazhuang, Hebei, 050017, China
| | - Zongmao Zhao
- Department of Neurosurgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Tengfei Ji
- Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Dezhi Kong
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China.
| | - Wei Zhang
- Department of Pharmacology of Chinese Materia Medica, Institution of Chinese Integrative Medicine, School of Chinese Integrative Medicine, The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, Hebei, 050017, China.
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3
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Alexandre C, Miracca G, Holanda VD, Sharma A, Kourbanova K, Ferreira A, Bicca MA, Zeng X, Nassar VA, Lee S, Kaur S, Sarma SV, Sacré P, Scammell TE, Woolf CJ, Latremoliere A. Nociceptor spontaneous activity is responsible for fragmenting non-rapid eye movement sleep in mouse models of neuropathic pain. Sci Transl Med 2024; 16:eadg3036. [PMID: 38630850 PMCID: PMC11106840 DOI: 10.1126/scitranslmed.adg3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
Spontaneous pain, a major complaint of patients with neuropathic pain, has eluded study because there is no reliable marker in either preclinical models or clinical studies. Here, we performed a comprehensive electroencephalogram/electromyogram analysis of sleep in several mouse models of chronic pain: neuropathic (spared nerve injury and chronic constriction injury), inflammatory (Freund's complete adjuvant and carrageenan, plantar incision) and chemical pain (capsaicin). We find that peripheral axonal injury drives fragmentation of sleep by increasing brief arousals from non-rapid eye movement sleep (NREMS) without changing total sleep amount. In contrast to neuropathic pain, inflammatory or chemical pain did not increase brief arousals. NREMS fragmentation was reduced by the analgesics gabapentin and carbamazepine, and it resolved when pain sensitivity returned to normal in a transient neuropathic pain model (sciatic nerve crush). Genetic silencing of peripheral sensory neurons or ablation of CGRP+ neurons in the parabrachial nucleus prevented sleep fragmentation, whereas pharmacological blockade of skin sensory fibers was ineffective, indicating that the neural activity driving the arousals originates ectopically in primary nociceptor neurons and is relayed through the lateral parabrachial nucleus. These findings identify NREMS fragmentation by brief arousals as an effective proxy to measure spontaneous neuropathic pain in mice.
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Affiliation(s)
- Chloe Alexandre
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Giulia Miracca
- Department of Neurology, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Victor Duarte Holanda
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ashley Sharma
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Kamila Kourbanova
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ashley Ferreira
- Department of Neurology, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Maíra A. Bicca
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Xiangsunze Zeng
- FM Kirby Neurobiology Center, Boston Children’s Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Victoria A. Nassar
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Seungkyu Lee
- FM Kirby Neurobiology Center, Boston Children’s Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Satvinder Kaur
- Department of Neurology, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Sridevi V. Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Pierre Sacré
- Department of Electrical Engineering and Computer Science, School of Engineering, University of Liège, Liège, Belgium
| | - Thomas E. Scammell
- Department of Neurology, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Alban Latremoliere
- Department of Neurosurgery, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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4
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Liu W, Wang W, Wang Z, Xing Y. Ventral tegmental area dopaminergic circuits participates in stress-induced chronic postsurgical pain in male mice. BMC Neurosci 2024; 25:3. [PMID: 38195391 PMCID: PMC10775611 DOI: 10.1186/s12868-023-00842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Chronic postsurgical pain (CPP) markedly impairs patients' quality of life. Research has shown that chronic stress may extend incisional nociception in male mice. Dopaminergic (DAergic) neurons in the ventral tegmental area (VTA) are integral to stress-related mental disorders (including major depressive disorder, anxiety disorders, and PTSD) and pain. However, the impact of chronic social defeat stress (CSDS) on mesolimbic dopamine (DA) transmission in the development of CPP is yet to be established. It remains uncertain whether the dopamine signals in the rostral anterior cingulate cortex (rACC), which regulate pain, derive from the VTA. This study aims to explore the role of VTA-rACC dopaminergic circuits in a mouse model of CPP induced by CSDS. METHODS We conducted CSDS on C57BL/6 J wild-type male mice (n = 12-16 mice/group) and DAT-cre male mice (n = 10-12 mice/group). After 10 days of CSDS, a left posterior plantar incision was made to establish a mouse model of CPP. Paw withdrawal thresholds (PWTs) were evaluated using Von-Frey fibre stimulation. The open field test (OFT) and elevated plus maze test (EPM) were used to assess pain-related negative emotions. We used immunofluorescence staining and Western Blot to analyse D1, D2, c-Fos, and TH expression. DAergic fibre projections in the VTA-rACC neural pathway were traced using retrograde tracing and immunofluorescence staining. Optogenetics and Chemogenetics were employed to manipulate DAergic neurons in the VTA and their axons in the rACC. RESULTS The ipsilateral PWTs in male C57BL/6 J mice significantly decreased after surgery, returning to baseline after seven days. Conversely, in CSDS mice, ipsilateral PWTs remained reduced for at least 30 days post-incision. A significant reduction in TH-positive neurons expressing c-Fos in the VTA of CPP mice was observed 15 days post-incision. Activating DAergic neurons significantly improved ipsilateral PWTs and locomotor performance in the OFT and EPM in CPP mice post-incision. Additionally, D1 expression in the rACC was found to decrease in CPP mice, and this reduction counteracted the increase in PWTs caused by activating DAergic neuron axon terminals in the rACC. CONCLUSION CSDS results in chronicity of postsurgical nociception and anxiety-like negative emotions, with alterations in DA transmission playing a role in CPP. Specific activation of DAergic neurons mitigates nociceptive responses and anxiety-like bahaviors, possibly mediated by D1 receptors in the rACC.
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Affiliation(s)
- Weizhen Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Wang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Ziliang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Ying Xing
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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Wei SN, Zhang H, Lu Y, Yu HJ, Ma T, Wang SN, Yang K, Tian ML, Huang AH, Wang W, Li FS, Li YW. Microglial voltage-dependent anion channel 1 signaling modulates sleep deprivation-induced transition to chronic postsurgical pain. Sleep 2023; 46:zsad039. [PMID: 36827092 DOI: 10.1093/sleep/zsad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
STUDY OBJECTIVES This study verified that sleep deprivation before and after skin/muscle incision and retraction (SMIR) surgery increased the risk of chronic pain and investigated the underlying roles of microglial voltage-dependent anion channel 1 (VDAC1) signaling. METHODS Adult mice received 6 hours of total sleep deprivation from 1 day prior to SMIR until the third day after surgery. Mechanical and heat-evoked pain was assessed before and within 21 days after surgery. Microglial activation and changes in VDAC1 expression and oligomerization were measured. Minocycline was injected to observe the effects of inhibiting microglial activation on pain maintenance. The VDAC1 inhibitor 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS) and oligomerization inhibitor VBIT-4 were used to determine the roles of VDAC1 signaling on microglial adenosine 5' triphosphate (ATP) release, inflammation (IL-1β and CCL2), and chronicity of pain. RESULTS Sleep deprivation significantly increased the pain duration after SMIR surgery, activated microglia, and enhanced VDAC1 signaling in the spinal cord. Minocycline inhibited microglial activation and alleviated sleep deprivation-induced pain maintenance. Lipopolysaccharide (LPS)-induced microglial activation was accompanied by increased VDAC1 expression and oligomerization, and more VDAC1 was observed on the cell membrane surface compared with control. DIDS and VBIT-4 rescued LPS-induced microglial ATP release and IL-1β and CCL2 expression. DIDS and VBIT-4 reversed sleep loss-induced microglial activation and pain chronicity in mice, similar to the effects of minocycline. No synergistic effects were found for minocycline plus VBIT-4 or DIDS. CONCLUSIONS Perioperative sleep deprivation activated spinal microglia and increases the risk of chronic postsurgical pain in mice. VDAC1 signaling regulates microglial activation-related ATP release, inflammation, and chronicity of pain.
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Affiliation(s)
- Shi-Nan Wei
- The Postgraduate Training Base of Jinzhou Medical University, Beijing, China
- Department of Anesthesiology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Hao Zhang
- Department of Anesthesiology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yan Lu
- Department of Neurology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Hui-Jie Yu
- Department of Nuclear Radiation Injury and Monitoring, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Tao Ma
- Department of Anesthesiology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Si-Nian Wang
- Department of Nuclear Radiation Injury and Monitoring, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Kun Yang
- The Postgraduate Training Base of Jinzhou Medical University, Beijing, China
| | - Mou-Li Tian
- Department of Anesthesiology, Changzheng Hospital Affiliate to the Naval Medical University, Shanghai, China
| | - Ai-Hua Huang
- Department of Neurology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wei Wang
- Department of Anesthesiology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Feng-Sheng Li
- Department of Nuclear Radiation Injury and Monitoring, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yong-Wang Li
- Department of Anesthesiology, The Third people's Hospital of Longgang District, Shenzhen, China
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Liu H, Wei H, Qian S, Liu J, Xu W, Luo X, Fang J, Liu Q, Cai F. Effects of dexmedetomidine on postoperative sleep quality: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:88. [PMID: 36944937 PMCID: PMC10029163 DOI: 10.1186/s12871-023-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
STUDY OBJECTIVES To assess the effect of dexmedetomidine (DEX) on postoperative sleep quality using polysomnography (PSG) to identify possible interventions for postoperative sleep disturbances. METHODS An electronic search of PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science was conducted from database inception to November 20, 2022. Randomized controlled trials (RCTs) on the effect of DEX administration on postoperative sleep quality using PSG or its derivatives were included. No language restrictions were applied. The sleep efficiency index (SEI), arousal index (AI), percentages of stage N1, N2 and N3 of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were measured in our meta-analysis. RESULTS Five studies, involving 381 participants were included. Administration of DEX significantly improved SEI, lowered AI, decreased the duration of stage N1 sleep and increased the duration of stage N2 sleep compared to placebo groups. There were no significant differences in the duration of stage N3 sleep and REM sleep. DEX administration lowered the postoperative Visual Analogue Scale (VAS) score and improved the Ramsay sedation score with no adverse effect on postoperative delirium (POD). However, high heterogeneity was observed in most of the primary and secondary outcomes. CONCLUSIONS Our study provides support for the perioperative administration of DEX to improve postoperative sleep quality. The optimal dosage and overall effect of DEX on postoperative sleep quality require further investigation using large-scale randomized controlled trials.
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Affiliation(s)
- Huizi Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Hanwei Wei
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Shaojie Qian
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jintao Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Weicai Xu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Xiaopan Luo
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Junbiao Fang
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Qiaoyan Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Fang Cai
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
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7
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Bella A, Diego AM, Finn DP, Roche M. Stress-induced changes in nociceptive responding post-surgery in preclinical rodent models. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1106143. [PMID: 36703943 PMCID: PMC9871907 DOI: 10.3389/fpain.2022.1106143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
Chronic post-surgical pain affects up to 85% of individuals depending on the type of surgery, the extent of inflammation, tissue and/or nerve damage. Pre-surgical stress is associated with greater pain intensity, prolonged recovery and is one of the main risk factors for the development of chronic post-surgical pain. Clinically valid animal models provide an important means of examining the mechanisms underlying the effects of stress on post-surgical pain and identifying potential novel therapeutic targets. This review discusses the current data from preclinical animal studies examining the effect of stress on post-surgical pain, the potential underlying mechanisms and gaps in the knowledge that require further investigation.
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Affiliation(s)
- Ariadni Bella
- Physiology, School of Medicine, University of Galway, Galway, Ireland,Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Alba M. Diego
- Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
| | - David P. Finn
- Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway, Ireland
| | - Michelle Roche
- Physiology, School of Medicine, University of Galway, Galway, Ireland,Centre for Pain Research, University of Galway, Galway, Ireland,Galway Neuroscience Centre, University of Galway, Galway, Ireland,Correspondence: Michelle Roche
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8
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Yang H, Zhang Y, Duan Q, Ni K, Jiao Y, Zhu J, Sun J, Zhang W, Ma Z. Dehydrocorydaline alleviates sleep deprivation-induced persistent postoperative pain in adolescent mice through inhibiting microglial P2Y 12 receptor expression in the spinal cord. Mol Pain 2023; 19:17448069231216234. [PMID: 37940138 DOI: 10.1177/17448069231216234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
During adolescence, a second period of central nervous system (CNS) plasticity that follows the fetal period, which involves sleep deprivation (SD), becomes apparent. SD during adolescence may result in abnormal development of neural circuits, causing imbalance in neuronal excitation and inhibition, which not only results in pain, but increases the chances of developing emotion disorders in adulthood, such as anxiety and depression. The quantity of surgeries during adolescence is also consistently on the rise, yet the impact and underlying mechanism of preoperative SD on postoperative pain remain unexplored. This study demonstrates that preoperative SD induces upregulation of the P2Y12 receptor, which is exclusively expressed on spinal microglia, and phosphorylation of its downstream signaling pathway p38Mitogen-activated protein/Nuclear transcription factor-κB (p38MAPK/NF-κB)in spinal microglia, thereby promoting microglia activation and microglial transformation into the proinflammatory M1 phenotype, resulting in increased expression of proinflammatory cytokines that exacerbate persisting postoperative incisional pain in adolescent mice. Both intrathecal minocycline (a microglia activation inhibitor) and MRS2395 (a P2Y12 receptor blocker) effectively suppressed microglial activation and proinflammatory cytokine expression. Interestingly, supplementation with dehydrocorydaline (DHC), an extract of Rhizoma Corydalis, inhibited the P2Y12/p38MAPK/NF-κB signaling pathway, microglia activation, and expression of pro-inflammatory cytokines in the model mice. Taken together, the results indicate that the P2Y12 receptor and microglial activation are important factors in persistent postoperative pain caused by preoperative SD in adolescent mice and that DHC has analgesic effects by acting on these targets.
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Affiliation(s)
- Haikou Yang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anesthesiology, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center, Huai'an, China
| | - Yufeng Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anesthesiology, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center, Huai'an, China
| | - Qingling Duan
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kun Ni
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Jiao
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jixiang Zhu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian Sun
- Department of Anesthesiology, Affiliated Hospital of Yang Zhou University Medical College, Huai'an Maternal and Child Health Care Center, Huai'an, China
| | - Wei Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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9
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Huang Y, Hao J, Yang X, Xu L, Liu Y, Sun Y, Gu X, Zhang W, Ma Z. Pretreatment of the ROS Inhibitor Phenyl-N-tert-butylnitrone Alleviates Sleep Deprivation-Induced Hyperalgesia by Suppressing Microglia Activation and NLRP3 Inflammasome Activity in the Spinal Dorsal Cord. Neurochem Res 2023; 48:305-314. [PMID: 36104611 PMCID: PMC9823061 DOI: 10.1007/s11064-022-03751-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 01/11/2023]
Abstract
Sleep deprivation, a common perioperative period health problem, causes ocular discomfort and affects postsurgical pain. However, the mechanism of sleep deprivation-induced increased pain sensitivity is elusive. This study aims to explore the role of ROS in sleep deprivation (SD)-induced hyperalgesia and the underlying mechanism. A 48-h continuous SD was performed prior to the hind paw incision pain modeling in mice. We measured ROS levels, microglial activation, DNA damage and protein levels of iNOS, NLRP3, p-P65 and P65 in mouse spinal dorsal cord. The involvement of ROS in SD-induced prolongation of postsurgical pain was further confirmed by intrathecal injection of ROS inhibitor, phenyl-N-tert-butylnitrone (PBN). Pretreatment of 48-h SD in mice significantly prolonged postsurgical pain recovery, manifesting as lowered paw withdrawal mechanical threshold and paw withdrawal thermal latency. It caused ROS increase and upregulation of iNOS on both Day 1 and 7 in mouse spinal dorsal cord. In addition, upregulation of NLRP3 and p-P65, microglial activation and DNA damage were observed in mice pretreated with 48-h SD prior to the incision. Notably, intrathecal injection of PBN significantly reversed the harmful effects of SD on postsurgical pain recovery, hyperalgesia, microglial activation and DNA damage via the NF-κB signaling pathway. Collectively, ROS increase is responsible for SD-induced hyperalgesia through activating microglial, triggering DNA damage and enhancing NLRP3 inflammasome activity in the spinal dorsal cord.
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Affiliation(s)
- Yulin Huang
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China
| | - Jing Hao
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China
| | - Xuli Yang
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China
| | - Li Xu
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China
| | - Yue Liu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yu'e Sun
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoping Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Zhang
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China.
| | - Zhengliang Ma
- Nanjing Drum Tower Hospital Clinical College, Nanjing Medical University, Nanjing, China.
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10
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Li L, Zhang H, Zheng Z, Ma N, Zhang Y, Liu Y, Zhang J, Su S, Zang W, Shao J, Cao J. Perioperative sleep deprivation activates the paraventricular thalamic nucleus resulting in persistent postoperative incisional pain in mice. Front Neuroanat 2022; 16:1074310. [PMID: 36620195 PMCID: PMC9813598 DOI: 10.3389/fnana.2022.1074310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background The duration of postsurgical pain is closely correlated with perioperative stress. Most patients suffer short-term sleep disorder/deprivation before and/or after surgery, which leads to extended postsurgical pain by an undetermined mechanism. The paraventricular thalamus (PVT) is a critical area that contributes to the regulation of feeding, awakening, and emotional states. However, whether the middle PVT is involved in postoperative pain or the extension of postoperative pain caused by perioperative sleep deprivation has not yet been investigated. Methods We established a model of postoperative pain by plantar incision with perioperative rapid eye movement sleep deprivation (REMSD) 6 h/day for 3 consecutive days in mice. The excitability of the CaMKIIα+ neurons in the middle PVT (mPVTCaMKIIα) was detected by immunofluorescence and fiber photometry. The activation/inhibition of mPVTCaMKIIα neurons was conducted by chemogenetics. Results REMSD prolonged the duration of postsurgical pain and increased the excitability of mPVTCaMKIIα neurons. In addition, mPVTCaMKIIα neurons showed increased excitability in response to nociceptive stimuli or painful conditions. However, REMSD did not delay postsurgical pain recovery following the ablation of CaMKIIα neurons in the mPVT. The activation of mPVTCaMKIIα neurons prolonged the duration of postsurgical pain and elicited anxiety-like behaviors. In contrast, inhibition of mPVTCaMKIIα neurons reduced the postsurgical pain after REMSD. Conclusion Our data revealed that the CaMKIIα neurons in the mPVT are involved in the extension of the postsurgical pain duration induced by REMSD, and represented a novel potential target to treat postoperative pain induced by REMSD.
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Affiliation(s)
- Lei Li
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Huijie Zhang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenli Zheng
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China,Department of Medical Record Management, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Nan Ma
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yidan Zhang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yaping Liu
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China,Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Jingjing Zhang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Songxue Su
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Weidong Zang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China,Neuroscience Research Institute, Zhengzhou University Academy of Medical Sciences, Zhengzhou, Henan, China
| | - Jinping Shao
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China,Neuroscience Research Institute, Zhengzhou University Academy of Medical Sciences, Zhengzhou, Henan, China,*Correspondence: Jinping Shao,
| | - Jing Cao
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China,Neuroscience Research Institute, Zhengzhou University Academy of Medical Sciences, Zhengzhou, Henan, China,Jing Cao,
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11
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Strain MM, Tongkhuya S, Wienandt N, Alsadoon F, Chavez R, Daniels J, Garza T, Trevino AV, Wells K, Stark T, Clifford J, Sosanya NM. Exploring combat stress exposure effects on burn pain in a female rodent model. BMC Neurosci 2022; 23:73. [PMID: 36474149 PMCID: PMC9724288 DOI: 10.1186/s12868-022-00759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/27/2022] [Indexed: 12/12/2022] Open
Abstract
In the military, constant physiological and psychological stress encountered by Soldiers can lead to development of the combat and operational stress reaction (COSR), which can effect pain management. Similar effects are seen in other populations subjected to high levels of stress. Using a model of COSR, our lab recently showed that four weeks of stress prior to an injury increases pain sensitivity in male rats. With the roles of women in the military expanding and recent studies indicating sex differences in stress and pain processing, this study sought to investigate how different amounts of prior stress exposure affects thermal injury-induced mechanosensitivity in a female rat model of COSR. Adult female Sprague Dawley rats were exposed to the unpredictable combat stress (UPCS) procedure for either 2 or 4 weeks. The UPCS procedure included exposure to one stressor each day for four days. The stressors include: (1) sound stress for 30 min, (2) restraint stress for 4 h, (3) cold stress for 4 h, and (4) forced swim stress for 15 min. The order of stressors was randomized weekly. Mechanical and thermal sensitivity was tested twice weekly. After the UPCS procedure, a sub-set of rats received a thermal injury while under anesthesia. The development of mechanical allodynia and thermal hyperalgesia was examined for 14 days post-burn. UPCS exposure increased mechanosensitivity after two weeks. Interestingly, with more stress exposure, females seemed to habituate to the stress, causing the stress-induced changes in mechanosensitivity to decrease by week three of UPCS. If thermal injury induction occurred during peak stress-induced mechanosensitivity, after two weeks, this resulted in increased mechanical allodynia in the injured hind paw compared to thermal injury alone. This data indicates a susceptibility to increased nociceptive sensitization when injury is sustained at peak stress reactivity. Additionally, this data indicates a sex difference in the timing of peak stress. Post-mortem examination of the prefrontal cortex (PFC) showed altered expression of p-TrkB in 4-week stressed animals given a thermal injury, suggesting a compensatory mechanism. Future work will examine treatment options for preventing stress-induced pain to maintain the effectiveness and readiness of the Warfighter.
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Affiliation(s)
- Misty M. Strain
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Sirima Tongkhuya
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Nathan Wienandt
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Farah Alsadoon
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Roger Chavez
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Jamar Daniels
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Thomas Garza
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Alex V. Trevino
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Kenney Wells
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Thomas Stark
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - John Clifford
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
| | - Natasha M. Sosanya
- grid.420328.f0000 0001 2110 0308Pain and Sensory Trauma Care, Combat Research Team 5 (CRT5), US Army Institute of Surgical Research (USAISR), JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234-4504 USA
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12
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Guo M, Wu Y, Zheng D, Chen L, Xiong B, Wu J, Li K, Wang L, Lin K, Zhang Z, Manyande A, Xu F, Wang J, Peng M. Preoperative Acute Sleep Deprivation Causes Postoperative Pain Hypersensitivity and Abnormal Cerebral Function. Neurosci Bull 2022; 38:1491-1507. [PMID: 36282466 PMCID: PMC9723009 DOI: 10.1007/s12264-022-00955-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
Preoperative sleep loss can amplify post-operative mechanical hyperalgesia. However, the underlying mechanisms are still largely unknown. In the current study, rats were randomly allocated to a control group and an acute sleep deprivation (ASD) group which experienced 6 h ASD before surgery. Then the variations in cerebral function and activity were investigated with multi-modal techniques, such as nuclear magnetic resonance, functional magnetic resonance imaging, c-Fos immunofluorescence, and electrophysiology. The results indicated that ASD induced hyperalgesia, and the metabolic kinetics were remarkably decreased in the striatum and midbrain. The functional connectivity (FC) between the nucleus accumbens (NAc, a subregion of the ventral striatum) and the ventrolateral periaqueductal gray (vLPAG) was significantly reduced, and the c-Fos expression in the NAc and the vLPAG was suppressed. Furthermore, the electrophysiological recordings demonstrated that both the neuronal activity in the NAc and the vLPAG, and the coherence of the NAc-vLPAG were suppressed in both resting and task states. This study showed that neuronal activity in the NAc and the vLPAG were weakened and the FC between the NAc and the vLPAG was also suppressed in rats with ASD-induced hyperalgesia. This study highlights the importance of preoperative sleep management for surgical patients.
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Affiliation(s)
- Meimei Guo
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yuxiang Wu
- Department of Health and Kinesiology, School of Physical Education, Jianghan University, Wuhan, 430056, China
| | - Danhao Zheng
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Lei Chen
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Bingrui Xiong
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jinfeng Wu
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Ke Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li Wang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, W1S 3PR, UK
| | - Fuqiang Xu
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Jie Wang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China.
- Institute of Neuroscience and Brain Disease; Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Mian Peng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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13
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Rugg CM, Cheah JW, Vomer RP, Lau B. Opiate Use Patterns Among Collegiate Athletes. Cureus 2022; 14:e31152. [DOI: 10.7759/cureus.31152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
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14
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Lynch CP, Cha ED, Patel MR, Jacob KC, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Anterior Cervical Discectomy and Fusion Results in Clinically Significant Improvements in Patients With Preoperative Sleep Difficulties. Int J Spine Surg 2022; 16:1046-1053. [PMID: 35835574 PMCID: PMC9807043 DOI: 10.14444/8333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). METHODS A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. MCID achievement was determined by comparing postoperative PROM improvement from baseline to previously established values. Logistic regression assessed responses to each individual question of the preoperative PHQ-9 as predictors of MCID achievement in each other PROMs. RESULTS Sixty-six ACDF patients were included with a mean age of 47.2 years. Herniated nucleus pulposus was the most common preoperative spinal diagnosis (95.6%). The mean operative duration was 50.3 minutes, the mean estimated blood loss was 27.5 mL, and most patients were discharged on postoperative day 0 (81.8%). A majority of patients achieved MCID for all measures except SF-12 PCS. PHQ-9 question 3 significantly predicted MCID achievement for VAS neck (P = 0.045), VAS arm (P = 0.049), and SF-12 PCS (P = 0.037). No other PHQ-9 items or overall PHQ-9 scores significantly predicted MCID achievement. CONCLUSION Question 3 of the PHQ-9 regarding "trouble falling asleep, staying asleep, or sleeping too much" significantly predicted clinically meaningful improvement in neck pain, arm pain, and physical function following ACDF, although overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery. CLINICAL RELEVANCE Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D.K. Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N. Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite #300, Chicago, IL 60612, USA;
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15
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Cheah JW, Freshman RD, Mah CD, Kinjo S, Lansdown DA, Feeley BT, Zhang AL, Ma CB. Orthopedic sleep and novel analgesia pathway: a prospective randomized controlled trial to advance recovery after shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:S143-S151. [PMID: 35413431 DOI: 10.1016/j.jse.2022.02.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lack of sleep is associated with adverse effects on postsurgical pain and recovery. We hypothesized that a multimodal sleep pathway, including nonpharmacologic sleep hygiene interventions and the use of zolpidem and melatonin, could improve patient analgesia and sleep after total shoulder arthroplasty. METHODS We performed a prospective randomized controlled study in which patients undergoing anatomic and reverse total shoulder arthroplasty were treated with or without an interventional multimodal sleep pathway. This pathway included nursing-directed nonpharmacologic measures that promote sleep hygiene and pharmacologic interventions with low-dose zolpidem and melatonin at bedtime. All patients underwent a standardized multimodal analgesia protocol with scheduled acetaminophen, naproxen, and gabapentin, as well as a single-shot interscalene regional nerve block. RESULTS This study enrolled 125 patients (64 in control group and 61 in interventional group) with similar demographic characteristics. The interventional group showed less oral morphine milligram equivalent (MME) consumption on postoperative day (POD) 0 (44.8 ± 36.1 MMEs vs. 60.9 ± 42.1 MMEs, P = .01) and showed a trend toward lower POD 0 visual analog scale pain scores (2.6 ± 1.8 vs. 3.3 ± 3.0, P = .06). Visual analog scale pain scores and MME consumption were similar on POD 1. The interventional group showed a longer objective sleep duration by quantitative wrist actigraphy (5.9 ± 3.1 hours vs. 4.6 ± 2.7 hours, P = .008), with better sleep quality assessed by the Leeds Sleep Evaluation Questionnaire (0-100 scale; 50.3 ± 26.8 vs. 38.5 ± 27.8, P = .01). The 2 groups showed similar satisfaction with pain management (89.2% vs. 79.6%, P = .16) and sleep management (82.1% vs. 76.8%, P = .48). There was no difference in the length of inpatient stay (32.2 ± 14.8 hours vs. 34.1 ± 12.8 hours, P = .44). CONCLUSION In the setting of a regional and multimodal analgesia recovery plan for shoulder arthroplasty patients undergoing inpatient observation, the use of an interventional sleep pathway appears to be safe and beneficial, with improved analgesia, reduced opioid use, increased sleep duration, and improved reported sleep quality during the postoperative recovery period.
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Affiliation(s)
- Jonathan W Cheah
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA; Stanford University, Palo Alto, CA, USA.
| | - Ryan D Freshman
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Cheri D Mah
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Sakura Kinjo
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
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16
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Wang W, Liu WZ, Wang ZL, Duan DX, Wang XY, Liu SJ, Wang ZJ, Xing GG, Xing Y. Spinal microglial activation promotes perioperative social defeat stress-induced prolonged postoperative pain in a sex-dependent manner. Brain Behav Immun 2022; 100:88-104. [PMID: 34808295 DOI: 10.1016/j.bbi.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022] Open
Abstract
Prolonged postsurgical pain, which is associated with multiple risk factors in the perioperative stage, is a common medical and social problem worldwide. Suitable animal models should be established to elucidate the mechanisms underlying the perioperative prolonged postsurgical pain. In this study, standard and modified social defeat stress mice models, including chronic social defeat stress (CSDS), chronic nondiscriminatory social defeat stress (CNSDS) and vicarious social defeat stress (VSDS), were applied to explore the effect of perioperative social defeat stress on postsurgical pain in male and female mice. Our results showed that exposure to preoperative CSDS could induce prolonged postsurgical pain in defeated mice regardless of susceptibility or resilience differentiated by the social interaction test. Similar prolongation of incision-induced mechanical hypersensitivity was also observed in both sexes upon exposing to CNSDS or VSDS in the preoperative period. Moreover, we found that using the modified CNSDS or VSDS models at different recovery stages after surgery could still promote abnormal pain without sex differences. Further studies revealed the key role of spinal microglial activation in the stress-induced transition from acute to prolonged postoperative pain in male but not female mice. Together, these data indicate that perioperative social defeat stress is a vital risk factor for developing prolonged postoperative pain in both sexes, but the promotion of stress-induced prolonged postoperative pain by spinal microglial activation is sexually dimorphic in mice.
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Affiliation(s)
- Wang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Wei-Zhen Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Zi-Liang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Dong-Xiao Duan
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Xue-Yun Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Shi-Jin Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Zhi-Ju Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Guo-Gang Xing
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100191, China.
| | - Ying Xing
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China.
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17
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Li X, Tao YX. Intrathecal administration of the fat-mass and obesity-associated protein inhibitor mitigates neuropathic pain in female rats. TRANSLATIONAL PERIOPERATIVE AND PAIN MEDICINE 2022; 9:478-487. [PMID: 36545239 PMCID: PMC9764434 DOI: 10.31480/2330-4871/163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Several intracellular signals are involved in the sexual dimorphism of chronic pain. Our previous studies demonstrated that the fat-mass and obesity-associated protein (FTO), a demethylase of RNA N6-methyladenosine, in the injured dorsal root ganglion (DRG) contributed to the development and maintenance of nerve injury-induced nociceptive hypersensitivity in male rats and male mice. However, whether these effects of DRG FTO are in a sex-dependent manner is still unknown. The present study sought to investigate the effect of intrathecal administration of a specific FTO inhibitor, meclofenamic acid (MA), on chronic constriction injury (CCI)-induced nociceptive hypersensitivity in female rats. Intrathecal injection of MA attenuated the CCI-induced mechanical allodynia, heat hyperalgesia, and cold hyperalgesia in both the induction and maintenance periods, without changing acute/basal pain and locomotor function, in female rats. Intrathecal MA also blocked the CCI-induced hyperactivations of neurons and astrocytes in the ipsilateral L4 and L5 dorsal horns of female rats. Mechanistically, intrathecal MA prevented the CCI-induced increase in the histone methyltransferase G9a expression and reversed the G9a-controlled downregulation of mu-opioid receptor and Kv1.2 proteins in the ipsilateral L4 and L5 DRGs of female rats. These findings indicate that the effects of the FTO inhibitor on nerve injury-induced nociceptive hypersensitivity in female rats are similar to those in male rats reported previously. Our data also further confirm the role of DRG FTO in neuropathic pain and suggest potential clinical application of the FTO inhibitors for the prevention and treatment of this disorder in both men and women.
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Affiliation(s)
- Xiang Li
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Yuan-Xiang Tao
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA,Department of Physiology, Pharmacology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ07103, USA,Departments of Cell Biology & Molecular Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
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18
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Su L, Bai X, Niu T, Zhuang X, Dong B, Wang G, Yu Y. P2Y1 purinergic receptor inhibition attenuated remifentanil-induced postoperative hyperalgesia via decreasing NMDA receptor phosphorylation in dorsal root ganglion. Brain Res Bull 2021; 177:352-362. [PMID: 34653560 DOI: 10.1016/j.brainresbull.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Remifentanil-induced postoperative hyperalgesia is an intractable side effect of the clinical use of remifentanil, the mechanism of which remains obscure, especially in the peripheral nervous system. N-methyl-D-aspartate receptor (NMDAR) phosphorylation in dorsal root ganglion (DRG) plays a pronociceptive role in neuropathic pain. The contribution of the P2Y1 purinergic receptor (P2Y1R) in DRG to pain hypersensitivity derived from various origins and P2Y1R upregulation-induced NMDAR activation in neurons have also been uncovered. This study aimed to investigate whether P2Y1R participates in nociceptive processing in the DRG and spinal cord in remifentanil-induced postoperative hyperalgesia. METHODS Rats with remifentanil-induced postoperative hyperalgesia were intrathecally injected with NMDAR antagonist MK801 or P2Y1R antagonist MRS2179 at 10 min prior to remifentanil infusion. Mechanical allodynia, heat hyperalgesia, and cold hyperalgesia were measured at -24 h, 2 h, 6 h, 24 h, and 48 h following remifentanil infusion. The P2Y1R expression and NMDAR expression and phosphorylation in DRG ipsilateral to the incision were detected by Western blot and immunofluorescence. RESULTS Incision and remifentanil induced mechanical allodynia, heat hyperalgesia, and cold hyperalgesia accompanied by upregulated P2Y1R expression, increased NMDAR subunit NR1 expression and phosphorylation at Ser896, and NR2B expression and phosphorylation at Tyr1472 in DRG. Inhibition of NMDAR phosphorylation by MK801 effectively attenuated remifentanil-induced postoperative hyperalgesia. Furthermore, P2Y1R blockade by MRS2179 not only lessened remifentanil-evoked postoperative hypersensitivity to mechanical, heat, and cold stimuli, but also suppressed the increases in NR1 and NR2B expression and phosphorylation in DRG induced by incision and remifentanil. CONCLUSION The process by which P2Y1R mediates NMDAR expression and phosphorylation represents a mechanism of remifentanil-induced postoperative hyperalgesia in the DRG and/or spinal cord.
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Affiliation(s)
- Lin Su
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Xiaoqing Bai
- Department of Science and Education, Tianjin Beichen Hospital, No. 7 Beiyi Road, Beichen District, Tianjin 300400, PR China
| | - Tongxiang Niu
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Jinnan Hospital, No. 120 Jingu Road, Jinnan District, Tianjin 300350, PR China
| | - Xinqi Zhuang
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Medical University Second Hospital, No. 23 Pingjiang Road, Hexi District, Tianjin 300211, PR China
| | - Beibei Dong
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China.
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19
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Lin D, Huang X, Sun Y, Wei C, Wu A. Perioperative Sleep Disorder: A Review. Front Med (Lausanne) 2021; 8:640416. [PMID: 34164409 PMCID: PMC8215143 DOI: 10.3389/fmed.2021.640416] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/13/2021] [Indexed: 12/28/2022] Open
Abstract
Patients in the perioperative period usually present with different types and degrees of sleep disorders, which can severely affect their post-operative outcomes. Multiple risk factors may lead to the occurrence of perioperative sleep disorders, including personal factors, psychological factors, surgery factors, and environmental factors. In this review, we summarize the potential risk factors for perioperative sleep disorders during hospitalization. And it also provides an overview of perioperative outcomes and potential therapeutic prevention of perioperative sleep disorders. However, the further search is necessary to investigate the effectiveness and safety of preventions in the clinical practice and push forward the therapies.
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Affiliation(s)
- Dandan Lin
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao Huang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Sun
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Changwei Wei
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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20
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Cai J, Chen Y, Hao X, Zhu X, Tang Y, Wang S, Zhu T. Effect of Intraoperative Dexmedetomidine Dose on Postoperative First Night Sleep Quality in Elderly Surgery Patients: A Retrospective Study With Propensity Score-Matched Analysis. Front Med (Lausanne) 2020; 7:528. [PMID: 33117823 PMCID: PMC7574233 DOI: 10.3389/fmed.2020.00528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Postoperative sleep disorder is common in elderly surgery patients, and it often worsens their recovery after surgery. This study aimed to explore the effect of intraoperative dexmedetomidine dose on postoperative sleep quality. Methods: Based on information regarding dexmedetomidine use during surgery from an electronic medical record system, 4,349 elderly surgery patients were divided into three groups: 1,374 without intraoperative use of dexmedetomidine (Non-DEX), 917 with dexmedetomidine 0.1–0.2 μg/kg/h (Low-DEX), and 2,058 with dexmedetomidine >0.2 μg/kg/h (High-DEX). The numerical rating scale (NRS) for sleep disturbance during the first night after surgery was recorded, and the incidence of NRS ≥ 6 was considered the primary outcome. Results: NRS (P < 0.001) and incidence of severe sleep disturbance (P < 0.001) were lower in patients receiving intraoperative dexmedetomidine than in those without the intraoperative use of dexmedetomidine. Patients in the Low-DEX group had the lowest incidence, followed by those in the High-DEX and Non-DEX groups (6.7% vs. 13.7% vs. 19.5%). After propensity score matching, 906 pairs of elderly surgery patients were included in the Low-DEX and High-DEX groups, and the Low-DEX group had lower NRS (2.7 ± 2.1 vs. 3.1 ± 2.4, P < 0.001) than the High-DEX group. The incidence of severe sleep disturbance was lower in the Low-DEX group than in the High-DEX group (6.6% vs. 12.8%) with an odds rate of 0.48 (95% confidence interval, 0.35 to 0.67). Conclusions: For elderly patients, intraoperative dexmedetomidine use can significantly improve the quality of the first night sleep after surgery. Low-dose (0.1–0.2 μg/kg/h) dexmedetomidine can have an improvement effect on sleep quality, and it is recommended to improve the quality of postoperative sleep.
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Affiliation(s)
- Jingjing Cai
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University & The Research Unit of West China (2018RU012), Chinese Academy of Medical Science, Chengdu, China
| | - Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xuechao Hao
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University & The Research Unit of West China (2018RU012), Chinese Academy of Medical Science, Chengdu, China
| | - Xiwen Zhu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yaxing Tang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Zhu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University & The Research Unit of West China (2018RU012), Chinese Academy of Medical Science, Chengdu, China
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21
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Tian X, Zhu H, Du S, Zhang XQ, Lin F, Ji F, Tsou YH, Li Z, Feng Y, Ticehurst K, Hannaford S, Xu X, Tao YX. Injectable PLGA-Coated Ropivacaine Produces A Long-Lasting Analgesic Effect on Incisional Pain and Neuropathic Pain. THE JOURNAL OF PAIN 2020; 22:180-195. [PMID: 32739615 DOI: 10.1016/j.jpain.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/27/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
Abstract
The management of persistent postsurgical pain and neuropathic pain remains a challenge in the clinic. Local anesthetics have been widely used as simple and effective treatment for these 2 disorders, but the duration of their analgesic effect is short. We here reported a new poly lactic-co-glycolic acid (PLGA)-coated ropivacaine that was continuously released in vitro for at least 6 days. Perisciatic nerve injection of the PLGA-coated ropivacaine attenuated paw incision-induced mechanical allodynia and heat hyperalgesia during the incisional pain period, and spared nerve injury-induced mechanical and cold allodynia for at least 7 days postinjection. This effect was dose-dependent. Perisciatic nerve injection of the PLGA-coated ropivacaine did not produce detectable inflammation, tissue irritation, or damage in the sciatic nerve and surrounding muscles at the injected site, dorsal root ganglion, spinal cord, or brain cortex, although the scores for grasping reflex were mildly and transiently reduced in the higher dosage-treated groups. PERSPECTIVE: Given that PLGA is an FDA-approved medical material, and that ropivacaine is used currently in clinical practice, the injectable PLGA-coated ropivacaine represents a new and highly promising avenue in the management of postsurgical pain and neuropathic pain.
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Affiliation(s)
- Xue Tian
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - He Zhu
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Shibin Du
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Xue-Qing Zhang
- Engineering Research Center of Cell & Therapeutic Antibody Ministry of Education, School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Fuqing Lin
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Fengtao Ji
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Yung-Hao Tsou
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Zhongyu Li
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Kathryn Ticehurst
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Stephen Hannaford
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Xiaoyang Xu
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey; Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Yuan-Xiang Tao
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
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22
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Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship. Interface Focus 2020; 10:20190092. [PMID: 32382403 PMCID: PMC7202382 DOI: 10.1098/rsfs.2019.0092] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
Sleep is highly conserved across evolution, suggesting vital biological functions that are yet to be fully understood. Animals and humans experiencing partial sleep restriction usually exhibit detrimental physiological responses, while total and prolonged sleep loss could lead to death. The perturbation of sleep homeostasis is usually accompanied by an increase in hypothalamic–pituitary–adrenal (HPA) axis activity, leading to a rise in circulating levels of stress hormones (e.g. cortisol in humans, corticosterone in rodents). Such hormones follow a circadian release pattern under undisturbed conditions and participate in the regulation of sleep. The investigation of the consequences of sleep deprivation, from molecular changes to behavioural alterations, has been used to study the fundamental functions of sleep. However, the reciprocal relationship between sleep and the activity of the HPA axis is problematic when investigating sleep using traditional sleep-deprivation protocols that can induce stress per se. This is especially true in studies using rodents in which sleep deprivation is achieved by exogenous, and potentially stressful, sensory–motor stimulations that can undoubtedly confuse their conclusions. While more research is needed to explore the mechanisms underlying sleep loss and health, avoiding stress as a confounding factor in sleep-deprivation studies is therefore crucial. This review examines the evidence of the intricate links between sleep and stress in the context of experimental sleep deprivation, and proposes a more sophisticated research framework for sleep-deprivation procedures that could benefit from recent progress in biotechnological tools for precise neuromodulation, such as chemogenetics and optogenetics, as well as improved automated real-time sleep-scoring algorithms.
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Affiliation(s)
- Mathieu Nollet
- Department of Life Sciences, Imperial College London, London, UK.,UK Dementia Research Institute at Imperial College London, London, UK
| | - William Wisden
- Department of Life Sciences, Imperial College London, London, UK.,UK Dementia Research Institute at Imperial College London, London, UK.,Centre for Neurotechnology, Imperial College London, London, UK
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, London, UK.,UK Dementia Research Institute at Imperial College London, London, UK.,Centre for Neurotechnology, Imperial College London, London, UK
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23
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Stroemel-Scheder C, Kundermann B, Lautenbacher S. The effects of recovery sleep on pain perception: A systematic review. Neurosci Biobehav Rev 2020; 113:408-425. [PMID: 32275917 DOI: 10.1016/j.neubiorev.2020.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 01/04/2023]
Abstract
Experimental studies highlight profound effects of sleep disruptions on pain, showing that sleep deprivation (SD) leads to hyperalgesic pain changes. On the other hand, given that sleep helps normalizing bodily functions, a crucial role of restorative sleep in the overnight restoration of the pain system seems likely. Thus, a systematic review of experimental studies on effects of recovery sleep (RS; subsequently to SD) on pain was performed with the aim to check whether RS resets hyperalgesic pain changes occurring due to SD. Empirical animal and human studies including SD-paradigms, RS and pain assessments were searched in three databases (PubMed, Web of Science, PsycINFO) using a predefined algorithm. 29 studies were included in this review. Most results indicated a reset of enhanced pain sensitivity and vulnerability following RS, especially when total SD was implemented and pressure pain or painful symptoms (human studies) were assessed. Further research should focus on whether and how recovery is altered in chronic pain patients, as this yields implications for pain treatment by enhancing or stabilizing RS.
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Affiliation(s)
| | - Bernd Kundermann
- Vitos Clinic for Psychiatry and Psychotherapy Giessen, Giessen, Germany; Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
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24
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Song B, Li Y, Teng X, Li X, Yang Y, Zhu J. Comparison of Morning and Evening Operation Under General Anesthesia on Intraoperative Anesthetic Requirement, Postoperative Sleep Quality, and Pain: A Randomized Controlled Trial. Nat Sci Sleep 2020; 12:467-475. [PMID: 32765143 PMCID: PMC7371604 DOI: 10.2147/nss.s257896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Postoperative sleep disorders can cause serious adverse effects on postoperative outcomes. The purpose of our study was to compare the effects of the timing of surgery under general anesthesia on intraoperative anesthetic drug requirements, postoperative sleep quality and pain in patients. MATERIALS AND METHODS Eighty-four patients who underwent selective laparoscopic abdominal surgeries under general anesthesia were randomly assigned to the Day Group (8:00-12:00) or the Night Group (18:00-22:00). The portable sleep monitor (PSM) was used to determine sleep quality on the night before surgery (Sleep-preop), the first night after surgery (Sleep POD 1), and the third night after surgery (Sleep POD 3). The visual analog scale (VAS) was used to evaluate postoperative pain scores and the Athens Insomnia Scale (AIS) was used for assessing insomnia symptoms. The total dose of general anesthetics required and adverse effects after surgery were also assessed. RESULTS Compared to Sleep-preop, patients presented with a lower sleep efficiency and a higher AIS score during Sleep POD 1 and Sleep POD 3. Furthermore, the Night Group had a significantly lower proportion of rapid eye movement sleep, stable sleep, and unstable sleep than did the Day Group at Sleep POD 1 and Sleep POD 3. The dosage of propofol and remifentanil required in the Day Group was significantly higher than that in the Night Group. Furthermore, patients in the Day Group had better pain relief, with a lower VAS score at 1, 6, 12, and 24 hours after surgery. The incidences of postoperative nausea and vomiting and dizziness were significantly higher in the Night Group than those in the Day Group. CONCLUSION Morning operations required a higher dose of anesthetic drugs than did evening operations, which may be related to the circadian rhythm. The degree of postoperative sleep disorders was greater when the operation was performed in the evening than in the morning, which was also associated with increased pain perception and increased incidence of postoperative adverse effects. Thus, our results suggest that patients with hyperalgesia and sleep disorders may benefit from operations performed in the morning.
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Affiliation(s)
- Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yang Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiufei Teng
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiuyan Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yanchao Yang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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25
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Li Q, Zhu ZY, Lu J, Chao YC, Zhou XX, Huang Y, Chen XM, Su DS, Yu WF, Gu XY. Sleep deprivation of rats increases postsurgical expression and activity of L-type calcium channel in the dorsal root ganglion and slows recovery from postsurgical pain. Acta Neuropathol Commun 2019; 7:217. [PMID: 31870460 PMCID: PMC6929318 DOI: 10.1186/s40478-019-0868-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023] Open
Abstract
Perioperative sleep disturbance is a risk factor for persistent pain after surgery. Clinical studies have shown that patients with insufficient sleep before and after surgery experience more intense and long-lasting postoperative pain. We hypothesize that sleep deprivation alters L-type calcium channels in the dorsal root ganglia (DRG), thus delaying the recovery from post-surgical pain. To verify this hypothesis, and to identify new predictors and therapeutic targets for persistent postoperative pain, we first established a model of postsurgical pain with perioperative sleep deprivation (SD) by administering hind paw plantar incision to sleep deprivation rats. Then we conducted behavioral tests, including tests with von Frey filaments and a laser heat test, to verify sensory pain, measured the expression of L-type calcium channels using western blotting and immunofluorescence of dorsal root ganglia (an important neural target for peripheral nociception), and examined the activity of L-type calcium channels and neuron excitability using electrophysiological measurements. We validated the findings by performing intraperitoneal injections of calcium channel blockers and microinjections of dorsal root ganglion cells with adeno-associated virus. We found that short-term sleep deprivation before and after surgery increased expression and activity of L-type calcium channels in the lumbar dorsal root ganglia, and delayed recovery from postsurgical pain. Blocking these channels reduced impact of sleep deprivation. We conclude that the increased expression and activity of L-type calcium channels is associated with the sleep deprivation-mediated prolongation of postoperative pain. L-type calcium channels are thus a potential target for management of postoperative pain.
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26
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Sun R, Liu Y, Hou B, Lei Y, Bo J, Zhang W, Sun Y, Zhang Y, Zhang Z, Liu Z, Huo W, Mao Y, Ma Z, Gu X. Perioperative activation of spinal α7 nAChR promotes recovery from preoperative stress-induced prolongation of postsurgical pain. Brain Behav Immun 2019; 79:294-308. [PMID: 30797046 DOI: 10.1016/j.bbi.2019.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/20/2019] [Accepted: 02/20/2019] [Indexed: 12/01/2022] Open
Abstract
Preoperative stress could delay the recovery of postoperative pain and has been reported to be a risk factor for chronic postsurgical pain. As stress could facilitate the proinflammatory activation of microglia, we hypothesized that these cells may play a vital role in the development of preoperative stress-induced pain chronification after surgery. Our experiments were conducted in a rat model that consists of a single prolonged stress (SPS) procedure and plantar incision. A previous SPS exposure induced anxiety-like behaviors, prolonged incision-induced mechanical allodynia, and potentiated the activation of spinal microglia. Based on the results from ex vivo experiments, spinal microglia isolated from SPS-exposed rats secreted more proinflammatory cytokines upon challenge with LPS. Our results also demonstrated that microglia played a more important role than astrocytes in the initiation of SPS-induced prolongation of postsurgical pain. We further explored the therapeutic potential of agonism of α7 nAChR, an emerging anti-inflammatory target, for SPS-induced prolongation of postsurgical pain. Multiple intrathecal (i.t.) injections of PHA-543613 (an α7 nAChR agonist) or PNU-120596 (a type II positive allosteric modulator) during the perioperative period shortened the duration of postsurgical pain after SPS and suppressed SPS-potentiated microglia activation, but their effects were abolished by pretreatment with methyllycaconitine (an α7 nAChR antagonist; i.t.). Based on the results from ex vivo experiments, the anti-inflammatory effects of PHA-543613 and PNU-120596 may have been achieved by the direct modulation of microglia. In conclusion, stress-induced priming of spinal microglia played a key role in the initiation of preoperative stress-induced prolongation of postsurgical pain, and PHA-543613 and PNU-120596 may be potential candidates for preventing pain chronification after surgery.
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Affiliation(s)
- Rao Sun
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Liu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Bailing Hou
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yishan Lei
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Jinhua Bo
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Wei Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yu'E Sun
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Ying Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Zuoxia Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Zhe Liu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Wenwen Huo
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yanting Mao
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Zhengliang Ma
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
| | - Xiaoping Gu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
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Toth LA. Interacting Influences of Sleep, Pain, and Analgesic Medications on Sleep Studies in Rodents. Comp Med 2019; 69:571-578. [PMID: 31213217 DOI: 10.30802/aalas-cm-19-000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This overview provides a brief summary of the complex interactions that link sleep, pain, and analgesic medications. Sleep scientists and clinicians are well aware of these relationships and understand that maintaining healthy pain-free subjects in a stable environment is essential to generating interpretable data and valid conclusions. However, these concepts and the data that support bidirectional interactions between sleep and pain may be less known to those who are not sleep scientists yet need such information to protect and advance both animal wellbeing and research validity (for example, veterinarians, IACUC members). Abundant human evidence supports the disruptive effect of pain and the modulatory effects of analgesic drugs on sleep; however, analgesic drugs can alter both sleep and the electroencephalogram, which is the primary objective measure for identifying sleep and evaluating sleep properties in both humans and animals. Consideration of the modulatory and interactive relationships of sleep, pain, and analgesic medications is essential to designing and conducting valid and reproducible sleep research using animal subjects.
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Affiliation(s)
- Linda A Toth
- Emeritus faculty, Southern Illinois University School of Medicine, Springfield, Illinois;,
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Sosanya NM, Garza TH, Stacey W, Crimmins SL, Christy RJ, Cheppudira BP. Involvement of brain-derived neurotrophic factor (BDNF) in chronic intermittent stress-induced enhanced mechanical allodynia in a rat model of burn pain. BMC Neurosci 2019; 20:17. [PMID: 31014242 PMCID: PMC6480655 DOI: 10.1186/s12868-019-0500-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/10/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Reports show that stressful events before injury exacerbates post-injury pain. The mechanism underlying stress-induced heightened thermal pain is unclear. Here, we examined the effects of chronic intermittent stress (CIS) on nociceptive behaviors and brain-derived nerve growth factor (BDNF) system in the prefrontal cortex (PFC) and hypothalamus of rats with and without thermal injury. RESULTS Unstressed rats showed transient mechanical allodynia during stress exposure. Stressed rats with thermal injury displayed persistent exacerbated mechanical allodynia (P < 0.001). Increased expression of BDNF mRNA in the PFC (P < 0.05), and elevated TrkB and p-TrkB (P < 0.05) protein levels in the hypothalamus were observed in stressed rats with thermal injury but not in stressed or thermally injured rats alone. Furthermore, administration of CTX-B significantly reduced stress-induced exacerbated mechanical allodynia in thermally injured rats (P < 0.001). CONCLUSION These results indicate that BDNF-TrkB signaling in PFC and hypothalamus contributes to CIS-induced exacerbated mechanical allodynia in thermal injury state.
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Affiliation(s)
- Natasha M Sosanya
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA
| | - Thomas H Garza
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA
| | - Winfred Stacey
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA
| | - Stephen L Crimmins
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA
| | - Robert J Christy
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA
| | - Bopaiah P Cheppudira
- Battlefield Pain Management Research Group, United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX, 78234-4504, USA.
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Song B, Li Y, Teng X, Li X, Yang Y, Zhu J. The Effect Of Intraoperative Use Of Dexmedetomidine During The Daytime Operation Vs The Nighttime Operation On Postoperative Sleep Quality And Pain Under General Anesthesia. Nat Sci Sleep 2019; 11:207-215. [PMID: 31686933 PMCID: PMC6783397 DOI: 10.2147/nss.s225041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of our study was to compare the effect of using dexmedetomidine (DEX) during the daytime operation or the nighttime operation under general anesthesia on postoperative sleep quality and pain of patients. METHODS Seventy-five patients scheduled for elective laparoscopic abdominal surgeries under general anesthesia were randomly assigned to receive operation in the Day Group (8:00-12:00) and the Night Group (18:00-22:00). The Portable Sleep Monitor (PSM) was performed on the following 3 nights: the night before surgery (Sleep 1), the first night after surgery (Sleep 2), and the third night after surgery (Sleep 3). Postoperative pain scores using visual analogue scoring scale, subjective sleep quality using the Athens Insomnia Scale, total dose of general anesthetics and PCA pump press numbers were also recorded. RESULTS Intraoperative administration of DEX for patients in the Day Group could improve sleep quality with a higher sleep efficiency and a lower AIS subjective sleep quality than patients in the Night Group at Sleep 2 (P < 0.001 and P = 0.001, respectively) and Sleep 3 (P < 0.001, respectively). There were marked lower rapid eye movement (REM) sleep and Stable sleep in the Night Group than that in the Day Group at Sleep 2 (P < 0.001 and P = 0.032, respectively) and Sleep 3 (P < 0.001, respectively). Patients in the Day Group have better pain relief and less PCA pump press numbers than patients in the Night Group. CONCLUSION Using dexmedetomidine during the daytime operation can better improve postoperative sleep quality and pain than nighttime operation in patients undergoing laparoscopic abdominal surgeries.
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Affiliation(s)
- Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yang Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiufei Teng
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiuyan Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yanchao Yang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Paradoxical Sleep Deprivation Aggravates and Prolongs Incision-Induced Pain Hypersensitivity via BDNF Signaling-Mediated Descending Facilitation in Rats. Neurochem Res 2018; 43:2353-2361. [PMID: 30324331 DOI: 10.1007/s11064-018-2660-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/12/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
The mechanisms underlying the pronociceptive effect of paradoxical sleep deprivation (PSD) are not fully established. The modulation of BDNF signaling-mediated descending facilitation from the rostral ventromedial medulla (RVM) of brain stem has been demonstrated in persistent pain models of inflammatory pain, but not in incisional pain model. Recent study has shown that PSD increases the expression of brain-derived neurotrophic factor (BDNF) in the brainstem structure. Therefore, in the current study, we asked whether the BDNF signaling-mediated descending facilitation was involved in the PSD-induced pronociceptive effect on incisional pain and delay the recovery period of postoperative pain in rats. Our results found that a preoperative 24 h PSD significantly aggravated the pain hypersensitivity after incision and prolonged the duration of postoperative pain. The lesions of ipsilateral dorsolateral funiculus partly reversed the PSD-induced pronociceptive effect on incisional pain. Interestingly, the 24 h PSD, but not incision significantly enhanced the levels of BDNF protein expression in the RVM areas of rats. Furthermore, at 1 day or 4 days after incision, intra-RVM microinjection of a BDNF antibody partly reversed the PSD-induced pronociceptive effects in incisional rats, while it did not change the cumulative pain scores and paw withdrawal thresholds in rats receiving only plantar incision. These findings suggest that the preoperative PSD may aggravate and prolong the incision-induced pain hypersensitivity via BDNF signaling-mediated descending facilitation.
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31
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Hambrecht-Wiedbusch VS, Gabel M, Liu LJ, Imperial JP, Colmenero AV, Vanini G. Preemptive Caffeine Administration Blocks the Increase in Postoperative Pain Caused by Previous Sleep Loss in the Rat: A Potential Role for Preoptic Adenosine A2A Receptors in Sleep-Pain Interactions. Sleep 2018; 40:4037126. [PMID: 28934532 DOI: 10.1093/sleep/zsx116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sleep and pain are reciprocally related, but the precise mechanisms underlying this relationship are poorly understood. This study used a rat model of surgical pain to examine the effect of previous sleep loss on postoperative pain and tested the hypothesis that preoptic adenosinergic mechanisms regulate sleep-pain interactions. Relative to ad libitum sleep, 6 hours of total sleep deprivation prior to a surgical incision significantly enhanced postoperative mechanical hypersensitivity in the affected paw and prolonged the time to recovery from surgery. There were no sex-specific differences in these measures. There were also no changes in adrenocorticotropic hormone and corticosterone levels after sleep deprivation, suggesting that this effect was not mediated by the stress associated with the sleep perturbation. Systemic administration of the nonselective adenosine receptor antagonist caffeine at the onset of sleep deprivation prevented the sleep deprivation-induced increase in postoperative hypersensitivity. Microinjection of the adenosine A2A receptor antagonist ZM 241385 into the median preoptic nucleus (MnPO) blocked the increase in surgical pain levels and duration caused by prior sleep deprivation and eliminated the thermal hyperalgesia induced by sleep deprivation in a group of nonoperated (i.e., without surgical incision) rats. These data show that even a brief sleep disturbance prior to surgery worsens postoperative pain and are consistent with our hypothesis that adenosine A2A receptors in the MnPO contribute to regulate these sleep-pain interactions.
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Affiliation(s)
| | - Maya Gabel
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Linda J Liu
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - John P Imperial
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Giancarlo Vanini
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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Ferdousi M, Finn DP. Stress-induced modulation of pain: Role of the endogenous opioid system. PROGRESS IN BRAIN RESEARCH 2018; 239:121-177. [DOI: 10.1016/bs.pbr.2018.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sosanya NM, Trevino AV, Chavez RL, Christy RJ, Cheppudira BP. Sound-stress-induced altered nociceptive behaviors are associated with increased spinal CRFR2 gene expression in a rat model of burn injury. J Pain Res 2017; 10:2135-2145. [PMID: 28979159 PMCID: PMC5589110 DOI: 10.2147/jpr.s144055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sound stress (SS) elicits behavioral changes, including pain behaviors. However, the neuronal mechanisms underlying SS-induced pain behaviors remain to be explored. The current study examined the effects of SS on nociceptive behaviors and changes in expression of the spinal corticotropin-releasing factor (CRF) system in male Sprague Dawley rats with and without thermal pain. We also studied the effects of SS on plasma corticosterone and fecal output. Rats were exposed to 3 days of SS protocol (n = 12/group). Changes in nociceptive behaviors were assessed using thermal and mechanical pain tests. Following the induction of SS, a subgroup of rats (n = 6/group) was inflicted with thermal injury and on day 14 postburn nociceptive behaviors were reassessed. Spinal CRF receptor mRNA expression was analyzed by semiquantitative reverse transcription polymerase chain reaction (RT-PCR). In addition, plasma corticosterone and spinal CRF concentrations were quantified using enzyme-linked immunosorbent assay (ELISA). Increased defecation was observed in SS rats. SS produced transient mechanical allodynia in naive rats, whereas it exacerbated thermal pain in thermally injured rats. Spinal CRFR2 mRNA expression was unaffected by stress or thermal injury alone, but their combined effect significantly increased its expression. SS had no effect on plasma corticosterone and spinal CRF protein in postburn rats. To conclude, SS is capable of exacerbating postburn thermal pain, which is linked to increased CRFR2 gene expression in the spinal cord. Future studies have to delineate whether attenuation of CRFR2 signaling at the spinal level prevents stress-induced exacerbation of burn pain.
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Affiliation(s)
- Natasha M Sosanya
- United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Alex V Trevino
- United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Roger L Chavez
- United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Robert J Christy
- United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Bopaiah P Cheppudira
- United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
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Contribution of the Suppressor of Variegation 3-9 Homolog 1 in Dorsal Root Ganglia and Spinal Cord Dorsal Horn to Nerve Injury-induced Nociceptive Hypersensitivity. Anesthesiology 2017; 125:765-78. [PMID: 27483126 DOI: 10.1097/aln.0000000000001261] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Peripheral nerve injury-induced gene alterations in the dorsal root ganglion (DRG) and spinal cord likely participate in neuropathic pain genesis. Histone methylation gates gene expression. Whether the suppressor of variegation 3-9 homolog 1 (SUV39H1), a histone methyltransferase, contributes to nerve injury-induced nociceptive hypersensitivity is unknown. METHODS Quantitative real-time reverse transcription polymerase chain reaction analysis, Western blot analysis, or immunohistochemistry were carried out to examine the expression of SUV39H1 mRNA and protein in rat DRG and dorsal horn and its colocalization with DRG μ-opioid receptor (MOR). The effects of a SUV39H1 inhibitor (chaetocin) or SUV39H1 siRNA on fifth lumbar spinal nerve ligation (SNL)-induced DRG MOR down-regulation and nociceptive hypersensitivity were examined. RESULTS SUV39H1 was detected in neuronal nuclei of the DRG and dorsal horn. It was distributed predominantly in small DRG neurons, in which it coexpressed with MOR. The level of SUV39H1 protein in both injured DRG and ipsilateral fifth lumbar dorsal horn was time dependently increased after SNL. SNL also produced an increase in the amount of SUV39H1 mRNA in the injured DRG (n = 6/time point). Intrathecal chaetocin or SUV39H1 siRNA as well as DRG or intraspinal microinjection of SUV39H1 siRNA impaired SNL-induced allodynia and hyperalgesia (n = 5/group/treatment). DRG microinjection of SUV39H1 siRNA also restored SNL-induced DRG MOR down-regulation (n = 6/group). CONCLUSIONS The findings of this study suggest that SUV39H1 contributes to nerve injury-induced allodynia and hyperalgesia through gating MOR expression in the injured DRG. SUV39H1 may be a potential target for the therapeutic treatment of nerve injury-induced nociceptive hypersensitivity.
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Decreased alertness due to sleep loss increases pain sensitivity in mice. Nat Med 2017; 23:768-774. [PMID: 28481358 DOI: 10.1038/nm.4329] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
Extended daytime and nighttime activities are major contributors to the growing sleep deficiency epidemic, as is the high prevalence of sleep disorders like insomnia. The consequences of chronic insufficient sleep for health remain uncertain. Sleep quality and duration predict presence of pain the next day in healthy subjects, suggesting that sleep disturbances alone may worsen pain, and experimental sleep deprivation in humans supports this claim. We demonstrate that sleep loss, but not sleep fragmentation, in healthy mice increases sensitivity to noxious stimuli (referred to as 'pain') without general sensory hyper-responsiveness. Moderate daily repeated sleep loss leads to a progressive accumulation of sleep debt and also to exaggerated pain responses, both of which are rescued after restoration of normal sleep. Caffeine and modafinil, two wake-promoting agents that have no analgesic activity in rested mice, immediately normalize pain sensitivity in sleep-deprived animals, without affecting sleep debt. The reversibility of mild sleep-loss-induced pain by wake-promoting agents reveals an unsuspected role for alertness in setting pain sensitivity. Clinically, insufficient or poor-quality sleep may worsen pain and this enhanced pain may be reduced not by analgesics, whose effectiveness is reduced, but by increasing alertness or providing better sleep.
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Conrad N, Karlik J, Lewandowski Holley A, Wilson AC, Koh J. A Narrative Review: Actigraphy as an Objective Assessment of Perioperative Sleep and Activity in Pediatric Patients. CHILDREN-BASEL 2017; 4:children4040026. [PMID: 28420221 PMCID: PMC5406685 DOI: 10.3390/children4040026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic. The literature search resulted in 13 papers that utilized actigraphic measures. Results of the review demonstrated that actigraphy has been used to identify predictors and risk factors for poor postoperative sleep, examine associations among perioperative pain and sleep patterns, and assess activity and energy expenditure in both inpatient and outpatient settings. We propose expansion of actigraphy research to include assessment of sleep via actigraphy to: predict functional recovery in pediatric populations, to study postoperative sleep in high-risk pediatric patients, to test the efficacy of perioperative interventions, and to assess outcomes in special populations for which self-report data on sleep and activity is difficult to obtain.
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Affiliation(s)
- Nicole Conrad
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
| | - Joelle Karlik
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
| | - Amy Lewandowski Holley
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR 97329, USA.
| | - Anna C Wilson
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR 97329, USA.
| | - Jeffrey Koh
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
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DNA methyltransferase DNMT3a contributes to neuropathic pain by repressing Kcna2 in primary afferent neurons. Nat Commun 2017; 8:14712. [PMID: 28270689 PMCID: PMC5344974 DOI: 10.1038/ncomms14712] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/20/2017] [Indexed: 12/26/2022] Open
Abstract
Nerve injury induces changes in gene transcription in dorsal root ganglion (DRG) neurons, which may contribute to nerve injury-induced neuropathic pain. DNA methylation represses gene expression. Here, we report that peripheral nerve injury increases expression of the DNA methyltransferase DNMT3a in the injured DRG neurons via the activation of the transcription factor octamer transcription factor 1. Blocking this increase prevents nerve injury-induced methylation of the voltage-dependent potassium (Kv) channel subunit Kcna2 promoter region and rescues Kcna2 expression in the injured DRG and attenuates neuropathic pain. Conversely, in the absence of nerve injury, mimicking this increase reduces the Kcna2 promoter activity, diminishes Kcna2 expression, decreases Kv current, increases excitability in DRG neurons and leads to spinal cord central sensitization and neuropathic pain symptoms. These findings suggest that DNMT3a may contribute to neuropathic pain by repressing Kcna2 expression in the DRG.
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy. J Clin Anesth 2016; 36:118-122. [PMID: 28183547 DOI: 10.1016/j.jclinane.2016.10.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/27/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of postoperative dexmedetomidine infusion on sleep quality in patients undergoing abdominal hysterectomy. DESIGN Randomized, double-blind study. SETTING Postoperative recovery area and ward. PATIENTS Sixty patients of American Society of Anesthesiologists physical status I or II scheduled for elective hysterectomy were enrolled. INTERVENTIONS Patients in group C received sufentanil infusion (a continuous dosage of 0.02 μg kg-1 h-1, a bolus dose of 0.02 μg/kg, a 10-minute lockout interval), and patients in group D received combined infusion of sufentanil with dexmedetomidine (a continuous dosage of sufentanil 0.02 μg kg-1 h-1 with dexmedetomidine 0.05 μg kg-1 h-1, a bolus doses of sufentanil 0.02 μg/kg with dexmedetomidine 0.05 μg/kg, a 10-minute lockout interval). MEASUREMENTS Polysomnography (PSG) was performed on the following 3 nights: the night before surgery (PSG1), the first night after surgery (PSG2), and the second night after surgery (PSG3). Postoperative pain scores using visual analog scoring scale, levels of sedation, and cumulative sufentanil consumptions were also recorded. RESULTS After surgery, patients suffered from significant sleep disturbance with a lower sleep efficiency index and subjective sleep quality and a higher arousal index at PSG2 and PSG3. Compared with group C, postoperative administration of dexmedetomidine significantly improved the sleep efficiency index and subjective sleep quality. Although the rapid eye movement and N3 stage sleep did not differ between the 2 groups, the N1 stage and arousal index were lower and the N2 stage in group D at PSG2 and PSG3 was higher. Compared with group C, patients in group D have better pain relief with a lower visual analog scoring scale and cumulative sufentanil consumptions at 6, 24, and 48 hours after surgery. CONCLUSIONS Dexmedetomidine infusion not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing hysterectomy.
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Cao J, Wang PK, Tiwari V, Liang L, Lutz BM, Shieh KR, Zang WD, Kaufman AG, Bekker A, Gao XQ, Tao YX. Short-term pre- and post-operative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception. Mol Pain 2015; 11:73. [PMID: 26626404 PMCID: PMC4667457 DOI: 10.1186/s12990-015-0077-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/12/2015] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Chronic stress has been reported to increase basal pain sensitivity and/or exacerbate existing persistent pain. However, most surgical patients have normal physiological and psychological health status such as normal pain perception before surgery although they do experience short-term stress during pre- and post-operative periods. Whether or not this short-term stress affects persistent postsurgical pain is unclear. RESULTS In this study, we showed that pre- or post-surgical exposure to immobilization 6 h daily for three consecutive days did not change basal responses to mechanical, thermal, or cold stimuli or peak levels of incision-induced hypersensitivity to these stimuli; however, immobilization did prolong the duration of incision-induced hypersensitivity in both male and female rats. These phenomena were also observed in post-surgical exposure to forced swimming 25 min daily for 3 consecutive days. Short-term stress induced by immobilization was demonstrated by an elevation in the level of serum corticosterone, an increase in swim immobility, and a decrease in sucrose consumption. Blocking this short-term stress via intrathecal administration of a selective glucocorticoid receptor antagonist, RU38486, or bilateral adrenalectomy significantly attenuated the prolongation of incision-induced hypersensitivity to mechanical, thermal, and cold stimuli. CONCLUSION Our results indicate that short-term stress during the pre- or post-operative period delays postoperative pain recovery although it does not affect basal pain perception. Prevention of short-term stress may facilitate patients' recovery from postoperative pain.
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Affiliation(s)
- Jing Cao
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, 450001, Henan, China. .,Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
| | - Po-Kai Wang
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA. .,Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Vinod Tiwari
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Lingli Liang
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
| | - Brianna Marie Lutz
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
| | - Kun-Ruey Shieh
- Department of Physiology, School of Medicine, Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Wei-Dong Zang
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, 450001, Henan, China.
| | - Andrew G Kaufman
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
| | - Alex Bekker
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
| | - Xiao-Qun Gao
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, 450001, Henan, China.
| | - Yuan-Xiang Tao
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, 450001, Henan, China. .,Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 S. Orange Ave., MSB, F-548, Newark, NJ, 07103, USA.
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