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Singleton S, Sneddon C, Bakina A, Lambert JJ, Hales TG. Early-life adversity increases morphine tolerance and persistent inflammatory hypersensitivity through upregulation of δ opioid receptors in mice. Pain 2023; 164:2253-2264. [PMID: 37171192 PMCID: PMC10502877 DOI: 10.1097/j.pain.0000000000002925] [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: 01/05/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
ABSTRACT Exposure to severely stressful events during childhood is associated with poor health outcomes in later life, including chronic pain and substance use disorder. However, the mediators and mechanisms are unclear. We investigated the impact of a well-characterized mouse model of early-life adversity, fragmented maternal care (FC) between postnatal day 2 and 9, on nociception, inflammatory hypersensitivity, and responses to morphine. Male and female mice exposed to FC exhibited prolonged basal thermal withdrawal latencies and decreased mechanical sensitivity. In addition, morphine had reduced potency in mice exposed to FC and their development of tolerance to morphine was accelerated. Quantitative PCR analysis in several brain regions and the spinal cords of juvenile and adult mice revealed an impact of FC on the expression of genes encoding opioid peptide precursors and their receptors. These changes included enhanced abundance of δ opioid receptor transcript in the spinal cord. Acute inflammatory hypersensitivity (induced by hind paw administration of complete Freund's adjuvant) was unaffected by exposure to FC. However, after an initial recovery of mechanical hypersensitivity, there was a reappearance in mice exposed to FC by day 15, which was not seen in control mice. Changes in nociception, morphine responses, and hypersensitivity associated with FC were apparent in males and females but were absent from mice lacking δ receptors or β-arrestin2. These findings suggest that exposure to early-life adversity in mice enhances δ receptor expression leading to decreased basal sensitivity to noxious stimuli coupled with accelerated morphine tolerance and enhanced vulnerability to persistent inflammatory hypersensitivity.
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Affiliation(s)
- Sam Singleton
- The Institute of Academic Anaesthesia, Division of Cellular and Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | - Claire Sneddon
- The Institute of Academic Anaesthesia, Division of Cellular and Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | - Alice Bakina
- The Institute of Academic Anaesthesia, Division of Cellular and Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | - Jeremy J. Lambert
- The Institute of Academic Anaesthesia, Division of Cellular and Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | - Tim G. Hales
- The Institute of Academic Anaesthesia, Division of Cellular and Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
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2
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Salberg S, Li CN, Beveridge JK, Noel M, Yamakawa GR, Mychasiuk R. Gene expression changes in the cerebellum are associated with persistent post-injury pain in adolescent rats exposed to early life stress. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100145. [PMID: 38099278 PMCID: PMC10719517 DOI: 10.1016/j.ynpai.2023.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023]
Abstract
Chronic pain develops following injury in approximately 20% of adolescents, at twice the rate in females than males. Adverse childhood experiences also increase the risk for poor health outcomes, such as chronic pain. Emerging literature suggests the cerebellum to be involved in pain processing, however detailed explorations into how the cerebellum contributes to pain are lacking. Therefore, this study aimed to characterise chronic pain outcomes and cerebellar gene expression changes following early life stress and injury in both sexes. The adverse childhood experience of neglect was modelled using a maternal separation (MS) paradigm, which was combined with a subsequent injury (mild traumatic brain injury (mTBI) or plantar incision surgery) in adolescent male and female Sprague-Dawley rats. We measured behavioural nociceptive sensitivity, systemic modulators of pain such as calcitonin gene-related protein (CGRP) and Substance P, as well as gene expression of IL1β, GFAP, GR, MR, GABRA1, CNR1, MAOA, and DAT1 in the cerebellum to examine associations between pain and neuroinflammation, the stress response, inhibitory neurotransmission, and monoaminergic function. We found increases in mechanical nociceptive sensitivity following plantar incision surgery. Sex differences were observed in anxiety-like behaviour and neuroinflammation, whereas systemic pain modulators showed cumulative effects with the addition of stressors. Most interestingly however, the increases in nociceptive sensitivity were associated with the suppressed expression of cerebellar genes that regulate stress, inhibition, cannabinoid function, and dopaminergic function, alongside sex-dependent distinctions for genes involved in inflammation and injury. This study highlights a novel link between nociception and molecular function in the cerebellum. Further investigation into how the cerebellum contributes to pain in males and females will facilitate novel therapeutic insights and opportunities.
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Affiliation(s)
- Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Crystal N. Li
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jaimie K. Beveridge
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, AB, Canada
| | - Glenn R. Yamakawa
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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3
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Salberg S, Macowan M, Yamakawa GR, Beveridge JK, Noel M, Marsland BJ, Mychasiuk R. Gut instinct: Sex differences in the gut microbiome are associated with changes in adolescent nociception following maternal separation in rats. Dev Neurobiol 2023; 83:219-233. [PMID: 37488954 DOI: 10.1002/dneu.22925] [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: 03/27/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
Adolescent chronic pain is a growing public health epidemic. Our understanding of its etiology is limited; however, several factors can increase susceptibility, often developing in response to an acute pain trigger such as a surgical procedure or mild traumatic brain injury (mTBI), or an adverse childhood experience (ACE). Additionally, the prevalence and manifestation of chronic pain is sexually dimorphic, with double the rates in females than males. Despite this, the majority of pre-clinical pain research focuses on males, leaving a gap in mechanistic understanding for females. Given that emerging evidence has linked the gut microbiome and the brain-gut-immune axis to various pain disorders, we aimed to investigate sex-dependent changes in taxonomic and functional gut microbiome features following an ACE and acute injury as chronic pain triggers. Male and female Sprague Dawley rat pups were randomly assigned to either a maternal separation (MS) or no stress paradigm, then further into a sham, mTBI, or surgery condition. Chronically, the von Frey test was used to measure mechanical nociception, and fecal samples were collected for 16S rRNA sequencing. Animals in the surgery group had an increase in pain sensitivity when compared to mTBI and sham groups, and this was complemented by changes to the gut microbiome. In addition, significant sex differences were identified in gut microbiome composition, which were exacerbated in response to MS. Overall, we provide preliminary evidence for sex differences and ACE-induced changes in bacterial composition that, when combined, may be contributing to heterogeneity in pain outcomes.
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Affiliation(s)
- Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Matthew Macowan
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jaimie K Beveridge
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, Alberta, Canada
| | - Benjamin J Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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4
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Salberg S, Doshen A, Yamakawa GR, Miller JV, Noel M, Henderson L, Mychasiuk R. The waiting game: investigating the neurobiological transition from acute to persistent pain in adolescent rats. Cereb Cortex 2023; 33:6382-6393. [PMID: 36610738 PMCID: PMC10183733 DOI: 10.1093/cercor/bhac511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 01/09/2023] Open
Abstract
Persistent postsurgical pain affects 20% of youth undergoing a surgical procedure, with females exhibiting increased prevalence of chronic pain compared with males. This study sought to examine the sexually-dimorphic neurobiological changes underlying the transition from acute to persistent pain following surgery in adolescence. Male and female Sprague Dawley rats were randomly allocated to a sham or injury (plantar-incision surgery) condition and assessed for pain sensitivity while also undergoing magnetic resonance imaging at both an acute and chronic timepoint within adolescence. We found that injury resulted in persistent pain in both sexes, with females displaying most significant sensitivity. Injury resulted in significant gray matter density increases in brain areas including the cerebellum, caudate putamen/insula, and amygdala and decreases in the hippocampus, hypothalamus, nucleus accumbens, and lateral septal nucleus. Gray matter density changes in the hippocampus and lateral septal nucleus were driven by male rats whereas changes in the amygdala and caudate putamen/insula were driven by female rats. Overall, our results indicate persistent behavioral and neurobiological changes following surgery in adolescence, with sexually-dimorphic and age-specific outcomes, highlighting the importance of studying both sexes and adolescents, rather than extrapolating from male adult literature.
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Affiliation(s)
- Sabrina Salberg
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Angela Doshen
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jillian Vinall Miller
- Department of Anesthesiology, Perioperative & Pain Medicine, Cumming School of Medicine, University of Calgary, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Luke Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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Rice T, Sher L. Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies. Psychol Res Behav Manag 2022; 15:3561-3574. [PMID: 36505667 PMCID: PMC9733630 DOI: 10.2147/prbm.s371832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
Children and adolescents with chronic pain are at an increased risk of suicidality. This narrative review article aims to inform clinical practice in the assessment and management of suicidality in youth with chronic pain. The article begins with a survey of the background and prevalence of youth with chronic pain. A review of the current evidence behind the increased risk of suicidality in youth with chronic pain follows. Contextualization of this data with general tenets of child and adolescent suicide risk and risk assessment is provided. Suicidology theory including the interpersonal theory of suicide is overviewed to help clinicians to conceptualize the reviewed data. Guiding parameters for the suicide risk assessment and management planning is presented. Concluding recommendations are made to guide clinical practice in the assessment and management of suicidality in youth with chronic pain.
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Affiliation(s)
- Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Correspondence: Timothy Rice, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue, 13th Floor, Suite A, Office 5, New York, NY, 10025, USA, Tel +1 212 523 5635, Fax +1 212 523 5650, Email
| | - Leo Sher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Catale C, Martini A, Piscitelli RM, Senzasono B, Iacono LL, Mercuri NB, Guatteo E, Carola V. Early-life social stress induces permanent alterations in plasticity and perineuronal nets in the mouse anterior cingulate cortex. Eur J Neurosci 2022; 56:5763-5783. [PMID: 36117291 DOI: 10.1111/ejn.15825] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/13/2022] [Accepted: 09/15/2022] [Indexed: 12/29/2022]
Abstract
Child maltreatment disrupts trajectories of brain development, but the underlying pathways are unclear. Stressful stimuli in early life interfere with maturation of local inhibitory circuitry and deposition of perineuronal nets (PNNs), specialized extracellular matrix structures involved in the closure of critical periods of development. Alterations in cortical PNN and parvalbumin (PV) following early-life stress (ELS) have been detected in human and animal studies. Aberrations in the anterior cingulate cortex (ACC) are the most consistent neuroimaging findings in maltreated people, but the molecular mechanisms linking ELS with ACC dysfunctions are unknown. Here, we employed a mouse model of early social threat to test whether ELS experienced in a sensitive period for ACC maturation could induce long-term aberrations of PNN and PV development in the ACC, with consequences on plasticity and ACC-dependent behavior. We found that ELS increased PNN but not PV expression in the ACC of young adult mice. This was associated with reduced frequency of inhibitory postsynaptic currents and long-term potentiation impairments and expression of intense object phobia. Our findings provide information on the long-term effects of ELS on ACC functionality and PNN formation and present evidence for a novel neurobiological pathway underlying the impact of early adversity on the brain.
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Affiliation(s)
- Clarissa Catale
- Division of Experimental Neuroscience, Neurobiology of Behavior Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessandro Martini
- Division of Experimental Neuroscience, Experimental Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Rosa Maria Piscitelli
- Division of Experimental Neuroscience, Experimental Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Motor Science and Wellness, Parthenope University of Naples, Naples, Italy
| | | | - Luisa Lo Iacono
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Nicola B Mercuri
- Division of Experimental Neuroscience, Experimental Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Ezia Guatteo
- Division of Experimental Neuroscience, Experimental Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Motor Science and Wellness, Parthenope University of Naples, Naples, Italy
| | - Valeria Carola
- Division of Experimental Neuroscience, Neurobiology of Behavior Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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7
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Werthman EH, Colloca L, Oswald LM. Adverse childhood experiences and burn pain: a review of biopsychosocial mechanisms that may influence healing. Pain Rep 2022; 7:e1013. [PMID: 38304399 PMCID: PMC10833651 DOI: 10.1097/pr9.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Adverse childhood experiences (ACEs) affect over half of the adults in the United States and are known to contribute to the development of a wide variety of negative health and behavioral outcomes. The consequences of ACE exposure have been studied in patient populations that include individuals with gynecologic, orthopedic, metabolic, autoimmune, cardiovascular, and gastrointestinal conditions among others. Findings indicate that ACEs not only increase risks for chronic pain but also influence emotional responses to pain in many of these individuals. A growing body of research suggests that these effects may be the result of long-lasting changes induced by ACEs in neurobiological systems during early development. However, one area that is still largely unexplored concerns the effects of ACEs on burn patients, who account for almost 450,000 hospitalizations in the United States annually. Patients with severe burns frequently suffer from persistent pain that affects their well-being long after the acute injury, but considerable variability has been observed in the experience of pain across individuals. A literature search was conducted in CINAHL and PubMed to evaluate the possibility that previously documented ACE-induced changes in biological, psychological, and social processes might contribute to these differences. Findings suggest that better understanding of the role that ACEs play in burn outcomes could lead to improved treatment strategies, but further empirical research is needed to identify the predictors and mechanisms that dictate individual differences in pain outcomes in patients with ACE exposure and to clarify the role that ACE-related alterations play in early healing and recovery from burn injuries.
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Affiliation(s)
- Emily H. Werthman
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- The Johns Hopkins Bayview Medical Center, The Johns Hopkins Burn Center, Baltimore, MD, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
- Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, USA
| | - Lynn M. Oswald
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, MD, USA
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Fabianová K, Babeľová J, Fabian D, Popovičová A, Martončíková M, Raček A, Račeková E. Maternal High-Energy Diet during Pregnancy and Lactation Impairs Neurogenesis and Alters the Behavior of Adult Offspring in a Phenotype-Dependent Manner. Int J Mol Sci 2022; 23:ijms23105564. [PMID: 35628378 PMCID: PMC9146615 DOI: 10.3390/ijms23105564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Obesity is one of the biggest and most costly health challenges the modern world encounters. Substantial evidence suggests that the risk of metabolic syndrome or obesity formation may be affected at a very early stage of development, in particular through fetal and/or neonatal overfeeding. Outcomes from epidemiological studies indicate that maternal nutrition during pregnancy and lactation has a profound impact on adult neurogenesis in the offspring. In the present study, an intergenerational dietary model employing overfeeding of experimental mice during prenatal and early postnatal development was applied to acquire mice with various body conditions. We investigated the impact of the maternal high-energy diet during pregnancy and lactation on adult neurogenesis in the olfactory neurogenic region involving the subventricular zone (SVZ) and the rostral migratory stream (RMS) and some behavioral tasks including memory, anxiety and nociception. Our findings show that a maternal high-energy diet administered during pregnancy and lactation modifies proliferation and differentiation, and induced degeneration of cells in the SVZ/RMS of offspring, but only in mice where extreme phenotype, such as significant overweight/adiposity or obesity is manifested. Thereafter, a maternal high-energy diet enhances anxiety-related behavior in offspring regardless of its body condition and impairs learning and memory in offspring with an extreme phenotype.
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Affiliation(s)
- Kamila Fabianová
- Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4, 040 01 Košice, Slovakia; (A.P.); (M.M.); (A.R.); (E.R.)
- Correspondence:
| | - Janka Babeľová
- Centre of Biosciences, Institute of Animal Physiology, Slovak Academy of Sciences, Šoltésovej 4-6, 040 01 Košice, Slovakia; (J.B.); (D.F.)
| | - Dušan Fabian
- Centre of Biosciences, Institute of Animal Physiology, Slovak Academy of Sciences, Šoltésovej 4-6, 040 01 Košice, Slovakia; (J.B.); (D.F.)
| | - Alexandra Popovičová
- Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4, 040 01 Košice, Slovakia; (A.P.); (M.M.); (A.R.); (E.R.)
| | - Marcela Martončíková
- Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4, 040 01 Košice, Slovakia; (A.P.); (M.M.); (A.R.); (E.R.)
| | - Adam Raček
- Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4, 040 01 Košice, Slovakia; (A.P.); (M.M.); (A.R.); (E.R.)
| | - Enikő Račeková
- Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4, 040 01 Košice, Slovakia; (A.P.); (M.M.); (A.R.); (E.R.)
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Walker SM. Developmental Mechanisms of CPSP: Clinical Observations and Translational Laboratory Evaluations. Can J Pain 2021; 6:49-60. [PMID: 35910395 PMCID: PMC9331197 DOI: 10.1080/24740527.2021.1999796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Understanding mechanisms that underly the transition from acute to chronic pain and identifying potential targets for preventing or minimizing this progression have specific relevance for chronic postsurgical pain (CPSP). Though it is clear that multiple psychosocial, family, and environmental factors may influence CPSP, this review will focus on parallels between clinical observations and translational laboratory studies investigating the acute and long-term effects of surgical injury on nociceptive pathways. This includes data related to alterations in sensitivity at different points along nociceptive pathways from the periphery to the brain; age- and sex-dependent mechanisms underlying the transition from acute to persistent pain; potential targets for preventive interventions; and the impact of prior surgical injury. Ongoing preclinical studies evaluating age- and sex-dependent mechanisms will also inform comparative efficacy and preclinical safety assessments of potential preventive pharmacological interventions aimed at reducing the risk of CPSP. In future clinical studies, more detailed and longitudinal peri-operative phenotyping with patient- and parent-reported chronic pain core outcomes, alongside more specialized evaluations of somatosensory function, modulation, and circuitry, may enhance understanding of individual variability in postsurgical pain trajectories and improve recognition and management of CPSP.
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Affiliation(s)
- Suellen M. Walker
- Clinical Neurosciences (Pain Research), Developmental Neurosciences, UCL GOS Institute of Child Health, London, UK; Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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