Effect of transdermal opioids in experimentally induced superficial, deep and hyperalgesic pain.

BACKGROUND AND PURPOSE: Chronic pain and hyperalgesia can be difficult to treat with classical opioids acting predominately at the µ-opioid receptor. Buprenorphine and its active metabolite are believed to act through µ-, κ- and δ-receptors and may therefore possess different analgesic and anti-hyperalgesic effects compared with pure µ-receptor agonists, for example, fentanyl. Here, we have compared the analgesic and anti-hyperalgesic effects of buprenorphine and fentanyl. EXPERIMENTAL APPROACH: Twenty-two healthy volunteers were randomized to treatment with transdermal buprenorphine (20 µg·h(-1), 144 h), fentanyl (25 µg·h(-1), 72 h) or placebo patches in a double-blind, cross-over experimental pain study. The experimental pain tests (phasic pain, sensitization) involved pressure at the tibial bone, cutaneous electrical and thermal stimulation, intramuscular nerve growth factor, UVB light burn injury model and intradermal capsaicin-induced hyperalgesia. Pain testing was carried out at baseline, 24, 48, 72 and 144 h after application of the drugs. KEY RESULTS: Compared with placebo, buprenorphine, but not fentanyl, significantly attenuated pressure at the tibial bone as well as pressure pain in the primary hyperalgesic area induced by UVB light The two drugs were equipotent and better than placebo against cutaneous thermal pain stimulation), but failed to show significant analgesic effect to cutaneous electrical stimulation, nerve growth factor-induced muscle soreness and to capsaicin-induced hyperalgesia. CONCLUSIONS AND IMPLICATIONS: Buprenorphine, but not fentanyl, showed analgesic effects against experimentally induced, bone-associated pain and primary hyperalgesia compared with placebo. These tissue- and modality-differentiated properties may reflect the variable effects of opioid drugs observed in individual patients.

The role of mu-opioid receptors in inflammatory hyperalgesia and alpha 2-adrenoceptor-mediated antihyperalgesia.

The purpose of the present study was to investigate the role of mu-opioid receptor in inflammatory hyperalgesia in intact and in spinalized animals and the interaction between mu-opioid and alpha2-adrenergic receptor in acute pain and inflammatory hyperalgesia. Behavioral responses to mechanical and heat stimuli were studied in mu-opioid receptor knockout mice and wildtype control mice. Thermal nociception was evaluated by measuring paw withdrawal latencies to radiant heat applied to the hindpaws. Mechanical nociception was measured by von Frey monofilament applications to the hindpaws. Intraplantar carrageenan-induced (1 mg/40 microl) mechanical and heat hyperalgesia were compared in micro-opioid knockout and wildtype mice. The effect of systemically administered alpha2-adrenergic receptor agonist dexmedetomidine (1-10 microg/kg) was evaluated on mechanical and thermal withdrawal responses under normal and inflammatory state in knockout and wildtype mice. The role of micro-opioid receptor in descending modulation of nociception was studied by assessing mechanical and heat withdrawal responses before and after mid-thoracic spinalization. Withdrawal responses to radiant heat and von Frey monofilaments were similar in mu-opioid knockout and wildtype mice before and after the carrageenan induced hindpaw inflammation. Also, antinociceptive effects of dexmedetomidine in thermal and mechanical nociceptive tests were similar before carrageenan induced hindpaw inflammation. However, the potency of dexmedetomidine was significantly reduced in carrageenan-induced mechanical hyperalgesia in mu-opioid knockout mice compared to the wildtype control mice. Thermal and mechanical withdrawal responses were similar between mu-opioid knockout and wildtype mice before and after mid-thoracic spinalization. Our observations indicate that the mu-opioid receptors do not play an important role in alpha2-adrenergic receptor agonist-mediated acute antinociception. In addition, micro-opioid receptors are not tonically involved in the modulation of inflammation-induced mechanical and thermal hyperalgesia, and the supraspinal control of spinal reflexes. However, in the presence of inflammation, mu-opioid receptors play an important role in the antihyperalgesic actions of an alpha2-adrenergic receptor agonist.

Sensory processing in the deep spinal dorsal horn of neurokinin-1 receptor knockout mice.

BACKGROUND: The neurokinin-1 receptor and its primary ligand, substance P, are widely recognized as contributing to the spinal processing of nociceptive stimuli, yet the specific function of the neurokinin-1 receptor remains unclear. METHODS: To better clarify these functions, the authors examined the neurophysiologic responses of L4-L5 neurons in the deep dorsal horn to acute mechanical, thermal, and electrical stimuli in knockout and wild-type mice. In addition, the capacity of knockout and wild-type mice to show wind-up to repeated C-fiber stimuli and to show sensitization after cutaneous mustard oil was assessed. RESULTS: A total of 68 nociceptive neurons (35 in knockout, 33 in wild type) in laminae III-V were studied. No differences in the acute responses of neurons in knockout and wild-type mice to graded mechanical, thermal, or electrical stimuli or in the acute responses to mustard oil were observed. However, wind-up to repeated electrical stimulation at C-fiber intensity was significantly attenuated in the knockout mice compared with wild type controls. In addition, mustard oil-induced mechanical hypersensitivity was significantly reduced in the knockout mice. CONCLUSIONS: These results indicate that neurokinin-1 receptors do not play a significant role in the responses of nociceptive neurons in the deep spinal dorsal horn to acute noxious mechanical, thermal, electrical, or chemical stimuli. On the other hand, neurokinin-1 receptors are critical for the central hyperexcitability that is observed in these neurons with repeated C-fiber inputs and to the central sensitization induced by topical mustard oil application.

Nerve injury-induced mechanical but not thermal hyperalgesia is attenuated in neurokinin-1 receptor knockout mice.

Mice lacking the gene encoding for substance P and neurokinin A, or the NK-1 receptor, exhibit alterations in behavior to various acute nociceptive stimuli. However, behavioral responses of NK-1 mutant animals have not been well characterized in models of chronic pain. We studied the behavioral responses of NK-1 knockout and wild-type control mice to thermal and mechanical stimuli before and after inducing chronic neuropathic pain by unilateral ligation of the L5 spinal nerve. Mechanical hyperalgesia was evaluated by determining the frequency of withdrawal to von Frey monofilaments applied to the hind paws. Nerve injury-induced hyperalgesia to thermal stimuli was examined by determining responses to radiant heat and cooling stimuli. The contribution of the sympathetic nervous system to mechanical hyperalgesia was evaluated by administering 3 mg/kg phentolamine, an alpha-adrenergic antagonist, subcutaneously. Following spinal nerve injury, withdrawal frequencies to mechanical stimulation increased in wild-type mice within 1 day and persisted during the 9-week observation period, whereas in the knockout mice, withdrawal frequencies did not increase significantly. In contrast, withdrawal latencies to radiant heat decreased up to 2 weeks after nerve injury in both the NK-1 and the wild-type mice. Similarly, the increase in withdrawal frequency to the cooling stimuli following the nerve injury was not different in the NK-1 knockout and wild-type mice. Mechanical hyperalgesia in the wild-type mice was not reversed by systemic administration of phentolamine, suggesting that the pain is not sympathetically maintained. The results indicate that NK-1 receptors contribute to the development of mechanical, but not thermal, hyperalgesia in neuropathic pain.

Neurokinin-1 receptors are involved in behavioral responses to high-intensity heat stimuli and capsaicin-induced hyperalgesia in mice.

BACKGROUND: The neurokinin-1 (NK-1) receptor and its ligand, substance P, are thought to play important roles in nociception and hyperalgesia. This study evaluated the role of the NK-1 receptor in processing noxious stimuli in normal and inflammatory states. METHODS: Behavioral responses to heat and mechanical and chemical stimuli were studied in NK-1 receptor knockout mice and wild-type control mice. Thermal nociception was evaluated by measuring paw lick or jump latencies to hot plate (52, 55, and 58 degrees C) and paw withdrawal latencies to radiant heat applied to the hind paws. Mechanical nociception was measured by von Frey monofilament applications to the hind paws. Intraplantar capsaicin-induced (10 microg/20 microl) paw licking and mechanical and heat hyperalgesia were compared in NK-1 knockout and wild-type mice. RESULTS: Withdrawal responses to radiant heat (4.3+/-0.18 s for knockout and 4.4+/-0.8 s for wild-type mice) and von Frey monofilaments were similar in knockout and wild-type mice. In the hot plate test, increasing the hot plate temperature from 52 degrees C to 58 degrees C resulted in a decrease in the response latency in the wild-type mice (30.4+/-17.5 s to 15.2+/-6.8 s, P < 0.05), whereas in the knockout mice the response latencies remained constant (28.2+/-19.8 s to 29+/-15.1 s, not significant). Capsaicin-induced paw licking (14.5+/-12.8 s for knockout and 41.3+/-37.3 s for wild-type mice, P < 0.05) and mechanical and heat hyperalgesia were attenuated in the knockout mice. CONCLUSION: NK-1 receptors contribute to the withdrawal responses to high-intensity heat stimuli and to capsaicin-induced mechanical and heat hyperalgesia.

Allodynia induced by regenerating axons is not positively correlated with degree of autotomy in the rat.

We studied in the rat whether the incidence of autotomy correlated positively with severity of tactile allodynia induced by regenerating axons. Before transection and surgical repair of the sciatic nerve, the status of sensory function was studied by stimulating mechanically the central part of the plantar paw with von Frey-hairs. Thereby we determined the threshold to evoke the hindpaw withdrawal reflex. One and 2 months after the nerve transection and repair, the thresholds of the traumatized paws were lower than the pre-trauma thresholds. The contralateral paw withdrawal thresholds did not change during the follow-up time. The results indicated that regenerating axons may cause tactile allodynia and that the severity of this allodynia does not correlate positively with the incidence of autotomy. We found no contralateral allodynia after nerve transection and repair.

Use of paper for treatment of a peripheral nerve trauma in the rat.

Reinnervation of the muscles and skin in the rat hindpaw was studied after transection and attempted repair of the sciatic nerve. Reconnecting the transected nerve with lens cleaning paper was at least as effective in rejoining the transected nerves as traditional microsurgical neurorraphy. Paper induced a slightly bigger fibrous scar around the site of transection than neurorraphy, but this scar did not cause impairment of functional recovery or excessive signs of neuropathic pain. We conclude that a paper graft can be used in restorative surgery of severed peripheral nerves.

Dissociation of mnemonic coding and other functional neuronal processing in the monkey prefrontal cortex.

Single-neuron activity was recorded in the prefrontal cortex of three monkeys during the performance of a spatial delayed alternation (DA) task and during the presentation of a variety of visual, auditory, and somatosensory stimuli. The aim was to study the relationship between mnemonic neuronal processing and other functional neuronal responsiveness at the single-neuron level in the prefrontal cortex. Recordings were performed in both experimental situations from 152 neurons. The majority of the neurons (92%) was recorded in the prefrontal cortex. Nine of the neurons were recorded in the dorsal bank of the anterior cingulate sulcus and two in the premotor cortex. Of the total number of neurons recorded in the prefrontal area, 32% fired in relation to the DA task performance and 39% were responsive to sensory stimulation or to the movements of the monkey outside of the memory task context. Altogether 42% of the recorded neurons were neither activated by the various stimuli nor by the DA task performance. Three types of task-related neuronal activity were recorded: delay related, delay and movement related, and movement related. The majority of the task-related neurons (n = 33, 73%) fired in relation to the delay period. Of the delay-related neurons, 26 (79%) were spatially selective. The number of spatially selective delay-related neurons of the whole population of recorded neurons was 18%. Twelve task-related neurons (27%) fired in relation to the response period of the DA task. Five of these neurons changed their firing rate during the delay period and were classified as delay/movement-related neurons. Contrary to the delay-related neurons, less than half (42%) of the response-related neurons were spatially selective. The majority (70%) of the delay-related neurons could not be activated by any of the sensory stimuli used and did not fire in relation to the movements of the monkey. The remaining portion of the delay-related neurons was activated by stationary and moving visual stimuli or by visual fixation of an object. In contrast to the delay-related neurons, the majority (66%) of the task-related neurons firing in relation to the movement period were also responsive to sensory stimulation outside of the task context. The majority of these neurons responded to visual stimulation, visual fixation of an object, or tracking eye movements. One neuron gave a somatomotor and another a polysensory response. The majority (n = 37, 67%) of all neurons responding to stimulation outside of the task context did not fire in relation to the DA task performance. The majority of their responses was elicited by visual stimuli or was related to visual fixation of an object or to eye movements. Only six neurons fired in relation to auditory, somatosensory, or somatomotor stimulation. This study provides further evidence about the significance of the dorsolateral prefrontal cortex in spatial working memory processing. Although a considerable number of all DA task-related neurons responded to visual, somatosensory, and auditory stimulation or to the movements of the monkey, most delay-related neurons engaged in the spatial DA task did not respond to extrinsic sensory stimulation. These results indicate that most prefrontal neurons firing selectively during the delay phase of the DA task are highly specialized and process only task-related information.

Supraspinal influence on hindlimb withdrawal thresholds and mustard oil-induced secondary allodynia in rats.

We examined the role of supraspinal structures in secondary allodynia induced by mustard oil in awake rats. To produce allodynia (=unpleasent sensation evoked by innocuous stimuli), mustard oil (50%) was applied for 2 min to the skin of the ankle of one hindlimb. Mechanical hypersensitivity of the skin was tested by determining the hindlimb withdrawal threshold to a series of monofilaments applied to the glabrous foot pad (=distal to the mustard oil-treated ankle). In intact rats, mustard oil produced a secondary allodynia in the mustard oil-treated hindlimb as indicated by a decreased withdrawal threshold to mechanical test stimuli applied to the glabrous skin (=outside the mustard oil-treated ankle), whereas the withdrawal threshold in the contralateral (=control) hindlimb was not changed. Following spinalization, mustard oil treatment produced no secondary allodynia, but the interpretation of this finding was complicated by a concomitant bilateral elevation of hindlimb withdrawal thresholds to mechanical skin stimulation. However, the spinalized rats had shorter tail-flick latencies to radiant heat than intact rats. Administration of an opioid antagonist, naloxone (1 mg/kg, SC), had no effect on withdrawal thresholds in spinalized animals. Importantly, microinjection of lidocaine (4%) into the nucleus raphe magnus in rats with an intact spinal cord had a selective antiallodynic effect when the injection volume was 1.0 microl but not when it was 0.5 microl. Lidocaine (4%, 0.5 microl) in the lateral reticular nucleus of the medulla also attenuated the spinal hypersensitivity, however, concomitantly with motor side effects, due to which this finding maybe artificial. It is concluded that brain stem spinal pathways, originating adjacent to but not within the raphe magnus, contribute to the behavioral expression of secondary allodynia induced by neurogenic inflammation of the skin. Furthermore, there is a differential tonic control of various spinal reflexes by the brain stem as indicated by the dissociative effects of spinalization on mechanically induced hindlimb withdrawal vs. heat-induced tail-flick reflex.

Submodality-selective hyperalgesia adjacent to partially injured sciatic nerve in the rat is dependent on capsaicin-sensitive afferent fibers and independent of collateral sprouting or a dorsal root reflex.

We studied submodality dependence of sensory changes produced by unilateral ligation of the sciatic or the saphenous nerve in the rat. We focused especially on sensory changes in the skin area adjacent to the innervation area of the injured nerve. Moreover, we examined the roles of capsaicin-sensitive nociceptive fibers, collateral sprouting and a dorsal root reflex in sensory changes observed behaviorally. Assessment of sensory changes was performed by a pattern of behavioral tests: hot-plate test and hindlimb withdrawal responses induced by radiant heat, hot-water bath, innocuous mechanical stimuli, and noxious mechanical stimuli. In one group, the saphenous nerve ipsilateral to the sciatic ligation was topically treated with capsaicin (1%) at the time of the surgery. A proximal stump of a saphenous nerve strand was orthodromically stimulated to induce a dorsal root reflex (an antidromic volley) in nociceptive fibers of the saphenous nerve trunk. For visualization of plasma extravasation induced by a dorsal root reflex, a dye-labeling (Evans blue) technique was used. A collateral sprouting of nociceptive fibers of the uninjured saphenous nerve was evaluated by determining the plasma extravasation response induced by antidromic stimulation of the saphenous nerve. Three and 10 days following the sciatic constriction injury, the hindlimb withdrawal threshold evoked by noxious mechanical stimulation of the medial side of the paw (the innervation are of the intact saphenous nerve) was significantly decreased. There was no corresponding thermal hyperalgesia adjacent to the injured sciatic nerve. Chronic constriction of the saphenous nerve did not produce any significant hyper- or hypoalgesia to mechanical or thermal stimulation of the uninjured sciatic nerve area. Topical treatment of the ipsilateral (intact) saphenous nerve at the time of the sciatic nerve ligation completely prevented the development of mechanical hyperalgesia in the medial side of the paw (the innervation area of the saphenous nerve). No dorsal root reflex in nociceptive fibers mediating the adjacent hyperalgesia could be evoked. No collateral sprouting of the uninjured nociceptive fibers of the saphenous nerve was observed. The results indicate that the constriction injury of the sciatic nerve produced a selective hyperalgesia to mechanical stimulation in the innervation area of the neighboring saphenous nerve. At the peripheral level, the mechanical hyperalgesia adjacent to the innervation area of the injured nerve was mediated by capsaicin-sensitive nociceptive fibers. Collateral sprouting of nociceptive fibers from the uninjured to the injured innervation area did not contribute to the present sensory findings. The sciatic nerve injury did not induce a dorsal root reflex in nociceptive fibers innervating the hyperalgesic saphenous nerve area.

Different roles of alpha 2-adrenoceptors of the medulla versus the spinal cord in modulation of mustard oil-induced central hyperalgesia in rats.

We attempted to determine the roles of spinal versus medullary alpha 2-adrenoceptors in modulation of central hyperalgesia in rats. Central hyperalgesia was produced by applying mustard oil (50%) to the skin of the ankle of one hindpaw. The threshold for eliciting a hindlimb flexion reflex was determined by applying a series of calibrated monofilaments to the glabrous skin of the hindpaw contralaterally (= control) or ipsilaterally to the mustard oil-treated ankle (= outside the area of primary hyperalgesia). Medetomidine (an alpha 2-adrenoceptor agonist; 1 micrograms), atipamezole (an alpha 2-adrenoceptor antagonist; 2.5 micrograms) or saline was microinjected into the lateral reticular nucleus of the medulla, the nucleus raphe magnus, or intrathecally to the lumbar spinal cord 12 min before the mustard oil treatment. Following saline injections, mustard oil produced a significant decrease of the hindlimb withdrawal threshold in the mustard oil-treated limb but not in the contralateral limb. Atipamezole in the lateral reticular nucleus produced a complete reversal of the hyperalgesia but no effect on the threshold of the intact limb. However, atipamezole in the raphe magnus nucleus or in the lumbar spinal cord did not produce a significant attenuation of the hyperalgesia. Medetomidine in the spinal cord, but not in the lateral reticular nucleus, reversed the hyperalgesia. At this dose range (up to 3 micrograms), medetomidine in the spinal cord of nonhyperalgesic control rats did not produce any significant change in the withdrawal response of hindlimbs or in the tail-flick latency. The results indicate that neurogenic inflammation induces significant plastic changes in the function of alpha 2-adrenergic pain regulatory mechanisms. In rats with mustard oil-induced central hyperalgesia, an alpha 2-adrenoceptor antagonist produces an antihyperalgesic effect due to an action on the caudal ventrolateral medulla, whereas an alpha 2-adrenoceptor agonist produces an enhanced antinociceptive effect due to a direct action on the spinal cord.

Influence of selective alpha 2-adrenergic agents on mustard oil-induced central hyperalgesia in rats.

The effects of systemically administered medetomidine, an alpha 2-adrenoceptor agonist, and atipamezole, an alpha 2-adrenoceptor antagonist, on mustard oil-induced central hyperalgesia were determined in unanesthetized rats. The mechanical threshold for eliciting a hindlimb flexion reflex (a nocifensive response) was determined with a series of calibrated monofilaments. Under control conditions mustard oil produced a significant decrease of the hindlimb withdrawal threshold for mechanical stimuli applied to a distal site in the hindlimb, whereas the corresponding threshold in the (untreated) contralateral side was not changed. Medetomidine administered 12 min prior to mustard oil treatment produced a significant dose-dependent (3-30 micrograms/kg s.c.) attenuation of the mustard oil-induced threshold decrease whereas the withdrawal threshold of the contralateral (untreated) hindlimb was not changed at these low doses. The antinociceptive effect of medetomidine (10 micrograms/kg) administered 12 min prior to the mustard oil treatment was not significantly stronger than the effect of medetomidine administered immediately after the mustard oil treatment. Atipamezole at a high (1000 micrograms/kg) or a low (10 micrograms/kg) dose did not influence the mustard oil-induced threshold decrease, whereas at an intermediate dose (100 micrograms/kg) atipamezole alone had a significant antinociceptive effect on mustard oil-induced hyperalgesia. The results indicate that medetomidine produces a selective attenuation of central hyperalgesia at doses which are sub-antinociceptive in intact rats. A pre-emptive treatment with medetomidine did not produce stronger antinociception than medetomidine treatment after the development of hyperalgesia. An alpha 2-adrenoceptor antagonist, atipamezole, attenuated central hyperalgesia in a non-monotonic fashion.

The role of alpha 2-adrenoceptors of the medullary lateral reticular nucleus in spinal antinociception in rats.

We attempted to find out the role of alpha 2-adrenoceptors of the medullary lateral reticular nucleus (LRN) in antinociception in rats. Spinal antinociception was evaluated using the tail-flick test, and supraspinal antinociception using the hotplate test. Antinociceptive effects were determined following local electric stimulation of the LRN, and following microinjections of medetomidine (an alpha 2-adrenoceptor agonist; 1-10 micrograms), atipamezole (an alpha 2-adrenoceptor antagonist; 20 micrograms) or lidocaine (4%) into the LRN. The experiments were performed using intact and spinalized Hannover-Wistar rats with a unilateral chronic guide cannula. Electric stimulation of the LRN as well as of the periaqueductal gray produced a significant spinal antinociceptive effect in intact rats. Medetomidine (1-10 micrograms), when microinjected into the LRN, produced no significant antinociceptive effect in the tail-flick test in intact rats. However, following spinalization, medetomidine in the LRN (10 micrograms) produced a significant atipamezole-reversible antinociceptive effect in the tail-flick test. In the hot-plate test, medetomidine (10 micrograms) in the LRN produced a significant atipamezole-reversible increase of the paw-lick latency in intact rats. Microinjection of atipamezole (20 micrograms) or lidocaine alone into the LRN produced no significant effects in the tail-flick test. The results are in line with the previous evidence indicating that the LRN and the adjacent ventrolateral medulla is involved in descending inhibition of spinal nocifensive responses. However, alpha 2-adrenoceptors in the LRN do not mediate spinal antinociception but, on the contrary, their activation counteracts antinociception at the spinal cord level.(ABSTRACT TRUNCATED AT 250 WORDS)

Lowered or increased cutaneous sensitivity during movement depends on stimulus intensity.

The effect of active and passive finger movement on cutaneous sensitivity to nonpainful electric stimulation was studied in 7 healthy human subjects. Active and passive finger movement produced a suppression of threshold stimuli, whereas the amplitude discrimination of suprathreshold stimuli was enhanced during passive but not active movement.

The movement-induced modulation in discriminability between cutaneous nonpainful stimuli depends on test stimulus intensity.

The purpose of this study was to find out whether the finger movement-induced modulation of cutaneous discrimination thresholds varies with the intensity level of the test stimulation in various movement conditions. The effect of active and passive finger movement on cutaneous sensitivity to nonpainful electrical stimulation of threshold and suprathreshold intensity was studied in human subjects. The detection threshold and the just-noticeable amplitude difference (discrimination threshold) at two suprathreshold intensities (3 x and 10 x detection threshold) were determined using a forced-choice paradigm before and after (controls) or during finger movement. In one condition the stimuli were applied just prior to the movement. The finger was actively or passively moved at the frequency of 1.5 Hz or 3 Hz, and the test stimuli were applied to the moving finger, except in one condition to the contralateral finger. The contralateral condition was used to rule out vigilance- and attention-related mechanisms as a cause of sensitivity changes. Active as well as passive movement of the finger produced a significant increase in the detection threshold during the movement. Also just prior to the movement the detection threshold was increased. Suprathreshold discrimination thresholds in the moving finger were not significantly changed during or just prior to the active movement, whereas during passive movement the discrimination threshold to suprathreshold level stimulation was significantly decreased. When test stimuli were applied to the finger contralateral to the actively moving finger, neither the detection threshold nor the discrimination between stimuli of suprathreshold intensities were significantly changed.(ABSTRACT TRUNCATED AT 250 WORDS)