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Martin AM, Pinto SM, Tang X, Hoffman JM, Wittine L, Walker WC, Schwartz DJ, Kane G, Takagishi SC, Nakase-Richardson R. Associations between early sleep-disordered breathing following moderate-to-severe traumatic brain injury and long-term chronic pain status: a Traumatic Brain Injury Model Systems study. J Clin Sleep Med 2023; 19:135-143. [PMID: 36591795 PMCID: PMC9806770 DOI: 10.5664/jcsm.10278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES To explore the relationship between polysomnography-derived respiratory indices and chronic pain status among individuals following traumatic brain injury (TBI). METHODS Participants (n = 66) with moderate to severe TBI underwent polysomnography during inpatient acute rehabilitation and their chronic pain status was assessed at 1- to 2-year follow-up as part of the TBI Model Systems Pain Collaborative Study. Pairwise comparisons across pain cohorts (ie, chronic pain, no history of pain) were made to explore differences on polysomnography indices. RESULTS Among our total sample, approximately three-quarters (74.2%) received sleep apnea diagnoses utilizing American Academy of Sleep Medicine criteria, with 61.9% of those endorsing a history of chronic pain. Of those endorsing chronic pain, the average pain score was 4.8 (standard deviation = 2.1), with a mean interference score of 5.3 (2.7). Pairwise comparisons revealed that those endorsing a chronic pain experience at follow-up experienced categorically worse indicators of sleep-related breathing disorders during acute rehabilitation relative to those who did not endorse chronic pain. Important differences were observed with elevations on central (chronic pain: 2.6; no pain: 0.8 per hour) and obstructive apnea (chronic pain: 15.7; no pain: 11.1 per hour) events, as well as oxygen desaturation indices (chronic pain: 19.6; no pain: 7.9 per hour). CONCLUSIONS Sleep-disordered breathing appears worse among those who endorse chronic pain following moderate-to-severe TBI, but additional research is needed to understand its relation to postinjury pain. Prospective investigation is necessary to determine how clinical decisions (eg, opioid therapy) and intervention (eg, positive airway pressure) may mutually influence outcomes. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS); URL: https://clinicaltrials.gov/ct2/show/NCT03033901; Identifier: NCT03033901. CITATION Martin AM, Pinto SM, Tang X, et al. Associations between early sleep-disordered breathing following moderate-to-severe traumatic brain injury and long-term chronic pain status: a Traumatic Brain Injury Model Systems study. J Clin Sleep Med. 2023;19(1):135-143.
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Affiliation(s)
- Aaron M. Martin
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, Florida
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida
| | - Shanti M. Pinto
- Department of Physical Medicine and Rehabilitation, Utah Southwestern, Dallas, Texas
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina
| | - Xinyu Tang
- Tampa VA Research and Education Foundation, Inc., Tampa, Florida
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lara Wittine
- Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel J. Schwartz
- Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Georgia Kane
- Department of Neurology, University of South Florida, Tampa, Florida
- Headache Center of Excellence, James A. Haley Veterans’ Hospital, Tampa, Florida
| | - S. Curtis Takagishi
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, Florida
- Headache Center of Excellence, James A. Haley Veterans’ Hospital, Tampa, Florida
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, Florida
- Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida
- Defense Health Agency Traumatic Brain Injury Center of Excellence at James A. Haley Veterans Hospital, Tampa, Florida
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Lee SJ, Logsdon AF, Yagi M, Baskin BM, Peskind ER, Raskind MM, Cook DG, Schindler AG. The dynorphin/kappa opioid receptor mediates adverse immunological and behavioral outcomes induced by repetitive blast trauma. J Neuroinflammation 2022; 19:288. [PMID: 36463243 PMCID: PMC9719647 DOI: 10.1186/s12974-022-02643-3] [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: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Adverse pathophysiological and behavioral outcomes related to mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), and chronic pain are common following blast exposure and contribute to decreased quality of life, but underlying mechanisms and prophylactic/treatment options remain limited. The dynorphin/kappa opioid receptor (KOR) system helps regulate behavioral and inflammatory responses to stress and injury; however, it has yet to be investigated as a potential mechanism in either humans or animals exposed to blast. We hypothesized that blast-induced KOR activation mediates adverse outcomes related to inflammation and affective behavioral response. METHODS C57Bl/6 adult male mice were singly or repeatedly exposed to either sham (anesthesia only) or blast delivered by a pneumatic shock tube. The selective KOR antagonist norBNI or vehicle (saline) was administered 72 h prior to repetitive blast or sham exposure. Serum and brain were collected 10 min or 4 h post-exposure for dynorphin A-like immunoreactivity and cytokine measurements, respectively. At 1-month post-exposure, mice were tested in a series of behavioral assays related to adverse outcomes reported by humans with blast trauma. RESULTS Repetitive but not single blast exposure resulted in increased brain dynorphin A-like immunoreactivity. norBNI pretreatment blocked or significantly reduced blast-induced increase in serum and brain cytokines, including IL-6, at 4 h post exposure and aversive/anxiety-like behavioral dysfunction at 1-month post-exposure. CONCLUSIONS Our findings demonstrate a previously unreported role for the dynorphin/KOR system as a mediator of biochemical and behavioral dysfunction following repetitive blast exposure and highlight this system as a potential prophylactic/therapeutic treatment target.
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Affiliation(s)
- Suhjung Janet Lee
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA
| | - Aric F. Logsdon
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA
| | - Mayumi Yagi
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA
| | - Britahny M. Baskin
- grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA
| | - Elaine. R. Peskind
- grid.413919.70000 0004 0420 6540VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - Murray M. Raskind
- grid.413919.70000 0004 0420 6540VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - David G. Cook
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Pharmacology, University of Washington, Seattle, WA 98195 USA
| | - Abigail. G. Schindler
- grid.413919.70000 0004 0420 6540VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, S182, 1660 South Columbian Way, Seattle, WA 98108 USA ,grid.34477.330000000122986657Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195 USA
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Rysztak LG, Jutkiewicz EM. The role of enkephalinergic systems in substance use disorders. Front Syst Neurosci 2022; 16:932546. [PMID: 35993087 PMCID: PMC9391026 DOI: 10.3389/fnsys.2022.932546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022] Open
Abstract
Enkephalin, an endogenous opioid peptide, is highly expressed in the reward pathway and may modulate neurotransmission to regulate reward-related behaviors, such as drug-taking and drug-seeking behaviors. Drugs of abuse also directly increase enkephalin in this pathway, yet it is unknown whether or not changes in the enkephalinergic system after drug administration mediate any specific behaviors. The use of animal models of substance use disorders (SUDs) concurrently with pharmacological, genetic, and molecular tools has allowed researchers to directly investigate the role of enkephalin in promoting these behaviors. In this review, we explore neurochemical mechanisms by which enkephalin levels and enkephalin-mediated signaling are altered by drug administration and interrogate the contribution of enkephalin systems to SUDs. Studies manipulating the receptors that enkephalin targets (e.g., mu and delta opioid receptors mainly) implicate the endogenous opioid peptide in drug-induced neuroadaptations and reward-related behaviors; however, further studies will need to confirm the role of enkephalin directly. Overall, these findings suggest that the enkephalinergic system is involved in multiple aspects of SUDs, such as the primary reinforcing properties of drugs, conditioned reinforcing effects, and sensitization. The idea of dopaminergic-opioidergic interactions in these behaviors remains relatively novel and warrants further research. Continuing work to elucidate the role of enkephalin in mediating neurotransmission in reward circuitry driving behaviors related to SUDs remains crucial.
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Affiliation(s)
- Lauren G. Rysztak
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Emily M. Jutkiewicz
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Emily M. Jutkiewicz,
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