Health-Related Quality of Life in Adrenocortical Carcinoma: Development of the Disease-Specific Questionnaire ACC-QOL and Results from the PROFILES Registry.

We aimed to develop a disease-specific adrenocortical carcinoma (ACC) health-related quality of life (HRQoL) questionnaire (ACC-QOL) and assess HRQoL in a population-based cohort of patients with ACC. Development was in line with European Organization for Research and Treatment of Cancer (EORTC) guidelines, though not an EORTC product. In phase I and II, we identified 90 potential HRQoL issues using literature and focus groups, which were reduced to 39 by healthcare professionals. Pilot testing resulted in 28 questions, to be used alongside the EORTC QLQ-C30. In Phase III, 100 patients with ACC were asked to complete the questionnaires twice in the PROFILES registry (3-month interval, respondents: first 67, second 51). Confirmatory factor analysis demonstrated the structural validity of 26 questions with their scale structure (mitotane side-effects, hypercortisolism/hydrocortisone effects, emotional effects). Internal consistency and reliability were good (Cronbach's alpha 0.897, Interclass correlation coefficient 0.860). Responsiveness analysis showed good discriminative ability (AUC 0.788). Patients diagnosed more than 5 years ago reported a good HRQoL compared with the Dutch reference population, but experienced residual fatigue and emotional problems. Patients who underwent recent treatment reported a lower HRQoL and problems in several domains. In conclusion, we developed an ACC-specific HRQoL questionnaire with good psychometric properties.

Study of subchondral bone adaptations in a rodent surgical model of OA using in vivo micro-computed tomography.

OBJECTIVE: To non-invasively investigate the changes to epiphyseal bone occurring in a longitudinal pre-clinical model of osteoarthritis (OA) using in vivo micro-computed tomography (micro-CT). DESIGN: In vivo micro-CT images were acquired using a bench-top micro-CT scanner, which produces three-dimensional data with isotropic voxel spacing of 0.046 mm. Male rodents were scanned prior to surgical destabilization, consisting of anterior cruciate ligament transection and partial medial menisectomy (ACLX). Subsequent scans were performed every 4 weeks post-ACLX, for up to 5 months. Volumetric bone mineral density (vBMD) was measured in specific, anatomically segmented regions within each image. The ACLX rodent data were compared with the contralateral non-operated hind limb of the same animal, as well as a sham-operated group (SHAM) of animals, for each time point. End-point histology compared changes to cartilage and bone between the ACLX and control animals. RESULTS: The micro-CT protocol produced sufficient spatial resolution and signal-to-noise ratio (SNR=19) to quantify subchondral bone pathology, with an acceptable entrance exposure to radiation (0.36 Gy). Significantly lower vBMD was measured in the ACLX group, vs SHAM rodents, at 1, 4, and 5 months post-surgery (P<0.05). Qualitative observations of ACLX joints revealed significant loss of cartilage, subchondral bone cysts, and calcification of tendon similar to changes found in humans. CONCLUSIONS: This study demonstrates in vivo micro-CT as an effective method for investigating the development of rodent knee OA longitudinally. This method can be applied, in future pre-clinical trials, to non-destructively monitor the efficacy of pharmacological interventions.

Sensory neuron and substance P involvement in symptoms of a zymosan-induced rat model of acute bowel inflammation.

Intestinal inflammation is a painful syndrome with multiple symptoms, including chronic pain. This study examined the possible role of sensory neurons and substance P in symptoms of an animal model of acute intestinal inflammation. The model was induced by injecting ethanol and zymosan into the colon of anesthetized male rats. Three hours later, sections of the colon were stained with hematoxylin and eosin. To determine the role of substance P, 5 mg/kg of the neurokinin-1 receptor (NK-1r) antagonist, CP-96,345, or 300 microg/kg of an antisense oligonucleotide targeted at NK-1r mRNA was administered. Spinal cord sections were examined for internalization of NK-1r, as an indicator of substance P release. Sections of colon revealed infiltration of inflammatory cells following ethanol and zymosan treatment. Plasma extravasation in rats given ethanol and zymosan was significantly greater than in controls given saline only (P<0.0001) or saline and ethanol (P<0.001). In ethanol- and zymosan-treated rats given CP-96,345, plasma extravasation was significantly less than in rats given ethanol and zymosan without the antagonist (P<0.0001). Administration of the antisense oligonucleotide also resulted in lower levels of plasma extravasation compared with controls (P<0.01). Internalization of the NK-1r was observed in neurons of lamina I in the T13-L2 and L6-S2 regions of the spinal cord, as well as in sympathetic preganglionic neurons at the L1 level. This internalization was observed in the absence of any other stimulus besides the inflammation itself. This study implicates substance P and its receptor, the NK-1r, in acute inflammation of the colon.

Bigeminal rhythms, common and uncommon mechanisms.

Bigeminy is an often encountered arrhythmia in clinical practice. There are common and uncommon mechanisms for bigeminy. Typical examples are illustrated with their salient electrocardiographic and clinical features. When one encounters a bigeminal rhythm, an awareness of these numerous possibilities will facilitate arriving at the correct diagnosis, which is where quality patient care begins.

Meloxicam selectively depresses the afterdischarge of rat spinal dorsal horn neurones in response to noxious stimulation.

This study examined the effects of the cyclooxygenase-2 (COX-2) inhibitor, meloxicam, on responses of spinal dorsal horn neurones to synaptic inputs in vivo. Experiments were run using male Sprague-Dawley rats (350-375 g) anesthetized with Na-pentobarbital (50 mg/kg, i.p.) and acutely spinalized at T9. Spinal segments L1-4 were exposed for extracellular single unit recording of on-going and stimulation-evoked activity of eight wide dynamic range neurones. On-going activity was unaffected by meloxicam (0.1 mg/kg, i.v.). However, responses to noxious mechanical stimulation (21 N for 3 s) of the cutaneous receptive field of the hind paw were depressed by meloxicam in particular the afterdischarge (34.50 +/- 6.06% inhibition) in all eight neurones studied. The brief initial discharge in response to stimulation was depressed less (15.31 +/- 4.89% inhibition, n = 7/8). The data indicate that the percent inhibition of the afterdischarge was significantly greater than that of the initial discharge (P < 0.05). Given the selectivity of meloxicam for COX-2, the data suggest that COX-2 may be involved in mediating and/or modulating excitatory effects of nociceptive inputs to dorsal horn neurones, in particular the prolonged stimulation-evoked afterdischarge.

Knockdown of spinal metabotropic glutamate receptor 1 (mGluR(1)) alleviates pain and restores opioid efficacy after nerve injury in rats.

1. Nerve injury often produces long-lasting spontaneous pain, hyperalgesia and allodynia that are refractory to treatment, being only partially relieved by clinical analgesics, and often insensitive to morphine. With the aim of assessing its therapeutic potential, we examined the effect of antisense oligonucleotide knockdown of spinal metabotropic glutamate receptor 1 (mGluR(1)) in neuropathic rats. 2. We chronically infused rats intrathecally with either vehicle, or 50 microg day(-1) antisense or missense oligonucleotides beginning either 3 days prior to or 5 days after nerve injury. Cold, heat and mechanical sensitivity was assessed prior to any treatment and again every few days after nerve injury. 3. Here we show that knockdown of mGluR(1) significantly reduces cold hyperalgesia, heat hyperalgesia and mechanical allodynia in the ipsilateral (injured) hindpaw of neuropathic rats. 4. Moreover, we show that morphine analgesia is reduced in neuropathic rats, but not in sham-operated rats, and that knockdown of mGluR(1) restores the analgesic efficacy of morphine. 5. We also show that neuropathic rats are more sensitive to the excitatory effects of intrathecally injected N-methyl-D-aspartate (NMDA), and have elevated protein kinase C (PKC) activity in the spinal cord dorsal horn, two effects that are reversed by knockdown of mGluR(1). 6. These results suggest that activity at mGluR(1) contributes to neuropathic pain through interactions with spinal NMDA receptors and PKC, and that knockdown of mGluR(1) may be a useful therapy for neuropathic pain in humans, both to alleviate pain directly, and as an adjunct to opioid analgesic treatment.

Development of the psychological impact of tinnitus interview: a clinician-administered measure of tinnitus-related distress.

The development of valid and reliable methods for assessing psychological aspects of tinnitus continues to be an important goal of research. Such assessment methods are potentially useful in clinical and research contexts. Existing self-report measures have a number of disadvantages, and so a need exists to develop a form of assessment that is less open to response bias and the effects of experimental demand. A new approach, the Psychological Impact of Tinnitus Interview (PITI), is described, and some preliminary data on its psychometric properties are reported. The results suggest that the PITI is capable of providing a measure of separate, relatively independent dimensions of tinnitus-related distress--namely, sleep difficulties, general distress, mood, suicidal aspects, and avoidance of or interference with normal activities. This method may lead to more refined measures of these dimensions of tinnitus-related psychological difficulties. The PITI should be regarded as a promising assessment tool for use in experimental settings, pending further work on its content, coding method, and administration.

Adenosine action on interneurons and synaptic transmission onto interneurons in rat hippocampus in vitro.

To investigate the action of adenosine on interneurons as well as on excitatory synaptic transmission onto interneurons in the hippocampus, intracellular recordings were made from electrophysiologically identified interneurons in the CA1 region of the hippocampal slice in vitro. The effects of adenosine and the preferential adenosine A1 receptor agonist, chloroadenosine, were examined. Application of 50 microM adenosine and 20 microM chloroadenosine to the bath produced a hyperpolarization of 5.6+/-1.6 (n=5) and 6.1+/-1.4 mV (n=6), respectively, as well as a decrease in membrane input resistance of 18.1+/-3.5% (n=5) and 18.5+/-1.4% (n=6), respectively. Adenosine depressed the postsynaptic potentials (PSPs) elicited in the interneurons by stimulation of Schaffer collateral fibers by 73+/-6.8% (n=5). The amplitude and the duration of the afterhyperpolarization which followed the spike of the action potential were attenuated by 48+/-6.9% and 31+/-8.6%, respectively (n=5). Chloroadenosine depressed the evoked PSPs in these interneurons by 61.2+/-2.7% (n=6) and depressed the duration and the amplitude of the afterhyperpolarization by 85.2+/-4.5% and by 72.6+/-4.8%, respectively (n=6). The data show that adenosine and chloroadenosine directly inhibit hippocampal CA1 interneurons by blocking the synaptic input, by hyperpolarizing the membrane potential and by depressing the afterhyperpolarization following individual action potential spikes. It is proposed that adenosine A1 receptors are present at pre- and/or postsynaptic sites of interneuron synapses in the hippocampal CA1 region. The present findings demonstrate that adenosine A1 receptor activation in CA1 interneurons is able to modulate the excitatory synaptic input to, and excitability of, these neurons. Thus, as adenosine is released during ischemia and epilepsy, adenosine may protect both interneurons and pyramidal cells from glutamate excitotoxicity through activation of adenosine A1 receptors on these neurons in the hippocampus.

Neuropeptide FF attenuates allodynia in models of chronic inflammation and neuropathy following intrathecal or intracerebroventricular administration.

Experiments were conducted to explore the effects of Neuropeptide FF acting at spinal and supraspinal sites in models of chronic inflammatory or neuropathic pain and of acute pain. Neuropeptide FF was administered intrathecally (i.t.; 10.0, 25.0 and 50.0 nmol) or intracerebroventricularly (i.c.v.; 10.0, 12.5 and 15.0 nmol) either 24 h after inflammation-inducing injections of Freund's Complete Adjuvant in one hind paw or 7 days after unilateral sciatic nerve constriction. Evoked pain was assessed by measuring the withdrawal response threshold (in grams of pressure) to a mechanical stimulus applied to the plantar surface of the injured paw. Neuropeptide FF dose-dependently attenuated the allodynic response (i.e., withdrawal from a normally innocuous stimulus) to mechanical stimulation in the inflammatory and neuropathic model following i.t. (ED50=20.86 nmol and ED50=18.91 nmol, respectively) and i.c.v. (ED50=12.31 nmol and ED50=11.68 nmol, respectively) administration. Pretreatment with naloxone (2.0 mg/kg; s.c.) attenuated the anti-allodynic effect of i.t. or i.c.v. Neuropeptide FF in rats experiencing inflammatory, but not neuropathic pain. In contrast, Neuropeptide FF administered i.t. (10.0, 25.0 and 50.0 nmol) or i.c.v. (10.0, 12.5 and 15.0 nmol) had no effect on the response to acute thermal or mechanical stimulation. Neuropeptide FF injected i.t. or i.c.v. in inflamed or neuropathic rats did not produce any sign of motor dysfunction. These results suggest that Neuropeptide FF acting at spinal and supraspinal sites plays a role in modulating chronic, but not acute pain. Furthermore, the results suggest that the anti-allodynic effect of Neuropeptide FF is mediated indirectly by naloxone-sensitive opioid mechanisms in rats subjected to inflammatory, but not neuropathic pain.

NGF over-expression during development leads to permanent alterations in innervation in the spinal cord and in behavioural responses to sensory stimuli.

Transgenic mice expressing nerve growth factor (NGF) under the control of a myelin basic protein promoter display above normal NGF levels in the spinal white matter from birth to the age of 2 months. These transient high levels of NGF result in a lasting hyper-innervation of the spinal white matter by ectopic Substance P (SP)-immunoreactive (IR) sensory fibres. Ultrastructural studies in adult transgenic mice demonstrated that the SP-containing fibres establish synapses on neuronal dendrites in the white matter and that most such dendrites express SP receptors. The transgenic animals display a stimulus-induced hyperalgesia and allodynia in a test measuring the latency to tail withdrawal following a heat stimulus. The hyperalgesia and allodynia were reversed by systemic administration of SP receptor or NMDA receptor antagonists. Surprisingly, the application of morphine resulted in an increase in withdrawal latency which was greater than that observed in non-transgenic controls.

Adenosine receptor blockade reveals N-methyl-D-aspartate receptor- and voltage-sensitive dendritic spikes in rat hippocampal CA1 pyramidal cells in vitro.

The present study was done to determine the possible effects of endogenous adenosine, present in the extracellular fluid of the hippocampal slice, on pyramidal cells in the CA1 region using intracellular recording techniques. Administration of 5 microM of the adenosine receptor antagonist, 8-sulfophenyltheophylline (n=11), induced a depolarization (2.6+/-0.4 mV, mean+/-S.E.M.) with an increase in input resistance (6.7+/-2.1%) in pyramidal cells, and increased the amplitude of the excitatory postsynaptic potentials elicited by stimulation of Schaffer collateral afferents; 50 microM 8-sulfophenyltheophylline (n=68) produced a similar depolarization (3.4+/-1.7 mV) and an increase in input resistance (26+/-3.0%), but also produced spontaneous, synchronized giant excitatory postsynaptic potentials which could generate bursts of spikes. These effects lasted more than 10 min after washout. In the presence of 20 microM 6-cyano-7-nitro-quinoxaline-2,3-dione, a non-N-methyl-D-aspartate receptor antagonist, and 50 microM D-2-amino-5-phosphonovalerate, an N-methyl-D-aspartate receptor antagonist, 50 microM 8-sulfophenyltheophylline (n=4) induced only depolarization (3.1+/-1.3 mV) and an increase in input resistance (23+/-3.8%). In the presence of 20 microM 6-cyano-7-nitro-quinoxaline-2,3-dione only, 50 microM 8-sulfophenyltheophylline (n=7) induced not only the depolarization with an increase in input resistance, but also the occurrence of small-amplitude (11+/-5.6 mV), fast rising, all-or-none, voltage-sensitive spikes of 2-3 ms duration, which were attributed to a dendritic origin. The latency of these dendritic spikes in response to stimulation of Schaffer collateral afferents lasted up to 21 ms. These dendritic spikes could generate one or more action potentials, depending on the resting membrane potential and the frequency of the dendritic spikes. In the presence of 50 microM 8-sulfophenyltheophylline plus 20 microM 6-cyano-7-nitro-quinoxaline-2,3-dione, 50 microM D-2-amino-5-phosphonovalerate blocked the spontaneous dendritic spikes (n=4). In the presence of 5 microM 8-sulfophenyltheophylline, 200 microM N-methyl-D-aspartate (n=5) increased the occurrence of dendritic spikes. These data indicate that adenosine present in the extracellular fluid of the hippocampal slice tonically inhibits not only (S)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate-mediated synaptic transmission, but also voltage- and N-methyl-D-aspartate receptor-sensitive dendritic spikes. Endogenous adenosine acting on adenosine A(1) receptors is thus visualized as a control to prevent the genesis of synchronized giant excitatory postsynaptic potentials. In our experiments, blockade of this tonic activation of adenosine receptors appears to have altered the origins of action potentials and led to epileptiform firing in CA1 pyramidal cells.

Cellular mechanisms of hyperalgesia and spontaneous pain in a spinalized rat model of peripheral neuropathy: changes in myelinated afferent inputs implicated.

Various hypotheses have been proposed to account for the mechanical hyperalgesia and spontaneous pain seen in animal models of peripheral neuropathy. The purpose of the present study was to determine whether there exists a spinal neuronal correlate to these properties. An experimental neuropathy was induced in male Sprague-Dawley rats by placing a 2-mm PE-90 polyethylene cuff around the sciatic nerve. All rats were subsequently confirmed to exhibit mechanical allodynia in the von Frey test. After induction of anaesthesia with pentobarbital and acute spinalization at T9, electrophysiological experiments were performed, recording extracellular single unit activity from ipsi- and contralateral wide dynamic range dorsal horn neurons in spinal segments L1-4. On-going activity was greater in short-term (11-22 days after cuff implantation) and long-term (42-52 days) cuff-implanted rats; 38 spikes/s in short-term versus 19 spikes/s in controls; 29 spikes/s in long-term ipsi- and contralateral neurons. Receptive fields in controls were always restricted, but in almost all cuff-implanted rats extended over the whole hind paw. Responses to noxious mechanical (pinch) and noxious heat stimulation of the cutaneous receptive field in controls consisted of the typical fast initial discharge followed by an afterdischarge. In all neurons from cuff-implanted rats the initial discharge resembled that in controls. However, the afterdischarge, particularly that in response to noxious pinch, was markedly greater in both magnitude and duration. It is suggested that the greater on-going discharge is the cellular correlate of spontaneous pain, and the potentiation of the afterdischarge in response to noxious stimulation is the correlate of hyperalgesia. Given that acutely spinalized rats were tested, only peripheral and/or spinal mechanisms can be considered to explain these data. Considering all the data, it can be concluded that there is a greater change in fibres mediating noxious mechanical than noxious thermal inputs. Among different hypotheses, the one with which the present data are most compatible is that which proposes that chronic nerve injury or inflammation induces phenotypic changes predominantly in myelinated afferents. There may be a redistribution of membrane-bound ion channels, predominantly sodium channels, which leads to ectopic activity and thus spontaneous discharge of dorsal horn neurons. With regard to mechanical stimulation-evoked synaptic input, the central terminals of myelinated afferents expand into regions of the spinal cord which normally receive their predominant input from unmyelinated nociceptive afferents. This may be coupled with a change in these myelinated afferents so that they now synthesize and release peptides, primarily substance P, from their central terminals with the result that the effects of their chemical mediators of synaptic transmission add to the effects of nociceptive inputs leading to exaggerated responses to painful stimuli, thus the basis of clinical hyperalgesia.

Upregulation of an opioid-mediated antinociceptive mechanism in transgenic mice over-expressing substance P in the spinal cord.

In transgenic mice expressing ectopic substance P fibres in the spinal white matter, a normally innocuous mechanical stimulus induces hyperalgesia and allodynia which are reversed by substance P and N-methyl-D-aspartate receptor antagonists. This period of enhanced excitation is followed by a rebound overshoot in these animals. As previous evidence indicates opioid mechanisms in a similar rebound in normal animals, the present study was done to determine the effects of systemic administration of morphine and the opiate receptor antagonist, naloxone, on the stimulus-induced responses in the tail withdrawal reflex. Once baseline reaction times had been taken, different combinations of saline, naloxone and morphine were administered intraperitoneally to transgenic and control mice of either sex. A mechanical conditioning stimulus of 450g was then applied to the tip of the tail for 2s. This stimulus was innocuous in control mice given saline or naloxone, but provoked a nociceptive response in transgenic mice given these compounds. In control and transgenic mice, following morphine administration there was an antinociceptive effect. In control mice the subsequent mechanical stimulus had no effect. However, in transgenic mice the mechanical stimulus produced a further antinociception. Naloxone blocked the effect of morphine and the subsequent conditioning stimulus in both control and transgenic mice. The results indicate that while morphine is equally effective on the withdrawal reflex in both types of animal, in the transgenic mice morphine reveals an intrinsic, naloxone-sensitive antinociceptive mechanism. The data are interpreted to suggest that over-expression of substance P or some other factor in the spinal cord of transgenic mice is associated with the up-regulation or facilitation of an opiate-mediated intrinsic antinociceptive mechanism. This is a novel observation because the genetic manipulation in this transgenic mouse results in a transient over-expression of nerve growth factor during development that leads to the formation of ectopic primary afferent fibres in the spinal cord containing substance P. These fibres persist indefinitely after the nerve growth factor levels return to normal. Opioid mechanisms, which are likely of dorsal horn origin, do not fall under the direct influence of nerve growth factor mechanisms and therefore the intriguing possibility is raised that opioid mechanisms in the spinal cord are regulated at least in part by substance P-related mechanisms.

Nerve constriction in the rat: model of neuropathic, surgical and central pain.

In preparation for a series of electrophysiological experiments in a model of neuropathic pain, the present spinal reflex study was done to determine the optimal time after sciatic nerve constriction in the rat for tactile allodynia and to determine also the appropriate 'control' for the nerve constriction model. Therefore, this study focused on the magnitude and time course of change in paw withdrawal threshold following unilateral sciatic nerve constriction in the rat. Male Sprague-Dawley rats (375-425g) were used. Nerve constriction was done by placing a 2 mm polyethylene cuff (PE-90) around the left sciatic nerve (n=8). A second group of rats (n=8) received unilateral sham surgery and a third group (n=8) was unoperated. The ipsi- and contralateral hind paw withdrawal thresholds in each of the 3 groups were measured using von Frey hairs. In unoperated rats, the withdrawal threshold of each of the hind paws remained unchanged at approximately 50 g throughout the entire time course of the study, which lasted 145 days. However, in cuff-implanted rats, the withdrawal threshold of the nerve-injured hind paw decreased as soon as 1 day after surgery, reached as low as 1 to 2 g by 5 days and remained low throughout the test period. Threshold in sham-operated rats showed a bilateral decrease starting on days 1-3, which stabilised at about 30 g until about day 40, after which values returned gradually toward the unoperated withdrawal thresholds. In nerve-constricted rats the withdrawal threshold of the hind paw contralateral to the cuff followed the same change seen in sham-operated rats until about day 37, after which the withdrawal threshold matched that of the cuff-implanted hind paw. The data show that the cuff-induced sciatic nerve constriction produces a sustained hypersensitivity to normally innocuous tactile sensory input and that a relatively constant ipsilateral mechanical hyperalgesia can be found from days 5-27. It is also demonstrated that the contralateral hind paw and either hind paw in sham-operated rats are inappropriate as 'controls'. The data in this study suggest that three distinct types of allodynia are expressed. Ipsilateral allodynia may be representative of a model of neuropathic pain. The contralateral allodynia may be a model of central pain, as it likely arises from changes in central sensory processing. Allodynia in sham-operated rats was also expressed bilaterally and may be a model of long-term postoperative pain.

Mediation and modulation by eicosanoids of responses of spinal dorsal horn neurons to glutamate and substance P receptor agonists: results with indomethacin in the rat in vivo.

In view of the widespread use of non-steroidal anti-inflammatory drugs for treatment of inflammatory pain, we determined the effects of the non-steroidal anti-inflammatory drug, indomethacin, on dorsal horn neurons in the rat spinal cord in vivo. At 2.0-12.0 mg/kg (i.v.), indomethacin depressed the responses of spinal dorsal horn neurons to the effects of iontophoretic application of substance P, N-methyl-D-aspartate, quisqualate and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate. As indomethacin inhibits cyclo-oxygenase, these are the first data linking prostanoids and possibly arachidonic acid and other eicosanoids to the effects of substance P and glutamate in the spinal dorsal horn. As responses to iontophoretic application can be assumed to have been postsynaptic and as indomethacin had an effect generalized to all excitatory responses, we suggest a postsynaptic site for cyclo-oxygenase. We also suggest that elements in the cyclo-oxygenase signal transduction pathway may thus mediate at least some of the effects of substance P and glutamate receptor activation. Activation of the cyclo-oxygenase pathway in CNS neurons is Ca2- dependent, and activation of both N-methyl-D-aspartate and substance P receptors increases intracellular Ca2+. This led to the expectation that indomethacin would have a greater effect on responses to N-methyl-D-aspartate than to alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate, but the reverse was observed. Thus, in addition to a mediator role, we hypothesize that an element(s) of the cyclo-oxygenase pathway may regulate the efficacy of excitation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate receptors and perhaps other membrane-bound receptors. The cyclo-oxygenase signal transduction pathway thus appears to play at least two major roles in regulation of sensory processing in the spinal cord. Therefore, non-steroidal anti-inflammatory drugs, via cyclo-oxygenase inhibition, may have multiple actions in control of spinal sensory mechanisms.

Evidence for tonic activation of NK-1 receptors during the second phase of the formalin test in the Rat.

Behavioral, electrophysiological, and autoradiographic experiments were done to study the second nociceptive phase in the formalin test. In initial experiments, this second phase was attenuated by 1-10 mg of the NK-1 receptor antagonist CP-99,994, given subcutaneously 10, 30, or 60 min before formalin (n = 8-10) and by 20 microgram given intrathecally 20 min after formalin (n = 13); the inactive isomer CP-100,263 was ineffective. In electrophysiological experiments on single dorsal horn neurons in vivo, the excitatory responses to subcutaneous formalin injection (50 microliter, 2.5%) were attenuated by subsequent intravenously administration of the NK-1 receptor antagonist CP-96,345 (0.5 mg/kg; n = 8), given 35-40 min after formalin, but not by the inactive enantiomer CP-96,344 (0.5 mg/kg; n = 9). Finally, autoradiographic binding of exogenous [(125)I]BH-substance P in the lumbar cord was reduced at 5 and 25 min after formalin (50 microliter, 1 or 5%), with an intermediate level of reduction at 12 min. These data are interpreted as evidence that the second phase of nociceptive scores in the formalin test is attributable at least partially to tonic activation of NK-1 receptors at the spinal level, whether because of a temporally limited release of substance P, for example only during the first phase, but a slow removal or breakdown of substance P, or, more likely, because of tonic release from primary afferents throughout the second phase. Irrespective of the mechanism, it can be concluded that at least some of the persistent nociceptive effects associated with peripheral inflammation, or at least those provoked by subcutaneous injection of formalin, are mediated via continuous activation of NK-1 receptors at the level of the spinal dorsal horn; this may relate directly to mechanisms underlying prolonged nociceptive pains in humans.

Transgenic mice over-expressing substance P exhibit allodynia and hyperalgesia which are reversed by substance P and N-methyl-D-aspartate receptor antagonists.

A transgenic mouse has been developed which, during development, over-expresses nerve growth factor under the control of a myelin basic protein promoter. These animals display an ectopic network of substance P-containing sensory fibers in the white matter of the spinal cord. To study the functional significance of this model to nociception, these mice were studied in a test measuring the latency to tail withdrawal from a noxious radiant heat stimulus. Baseline reaction times were significantly less in transgenic mice, suggesting thermal allodynia. A mechanical stimulus was then applied to the tip of the tail at either 450 g or 1400 g for 2 s and tail withdrawal readings were taken for another 10 min. In control mice, the 450 g stimulus was without effect, suggesting that it is normally innocuous. In transgenic mice, this stimulus induced a transient decrease in withdrawal latency at 1 min. Thus, transgenic mice exhibited mechanical allodynia. The 1400 g stimulus decreased withdrawal latency in both transgenic and control mice. However, the response was greater in transgenic mice, indicating that they exhibited mechanical hyperalgesia. The neurokinin-1 receptor antagonist CP-96,345, but not the inactive stereoisomer CP-96,344, administered subcutaneously 30 min before the 450 g stimulus, blocked the stimulation-induced allodynia in transgenic mice, and revealed a transient antinociception in transgenic and control mice. Ketamine, an N-methyl-D-aspartate receptor antagonist, given intraperitoneally 10 min before 450 g stimulation, blocked the allodynia in transgenic mice. These results indicate that these transgenic mice display hyperalgesia and allodynia, and that these nociceptive responses are reversed by substance P and N-methyl-D-aspartate receptor antagonists.

Paw withdrawal threshold in the von Frey hair test is influenced by the surface on which the rat stands.

The effect of testing surface on the rat hind paw withdrawal threshold in the von Frey hair test is investigated in this study. The data indicate that wire mesh, which is typically used to apply von Frey hairs, may have an effect on the paw withdrawal threshold. For example, in control rats tested on the wire mesh, variability in the withdrawal threshold was observed between the left and the right hind paws (51.04+/-12.29 and 64.31+/-9.37 g, respectively) and on different days of testing (35.24+/-9.54 and 45.83+/-12.97 g for the left and right hind paws, respectively, 7 days later). In an attempt to reduce this variability, a customized platform was used to measure the von Frey hair-induced paw withdrawal in the rat. It consists of an opaque, flat-surfaced plastic platform with holes through which von Frey hairs are inserted and applied to the plantar surface of the paw. In control rats tested with von Frey hairs using this customized platform, variability in the paw withdrawal thresholds between the left and right hind paws in single rats over time as well as between different rats was reduced (49.86+/-6.97 and 49.29+/-6.56 g for the left and right hind paws, respectively, on day 0; 48.29+/-5.82 and 53.00+/-4.59 g for the left and right hind paws, respectively, 7 days later). Furthermore, in rats in which a 2 mm polyethylene cuff was used to constrict the left common sciatic nerve, the ipsilateral as well as the contralateral hind paw withdrawal thresholds were decreased (2.45+/-0.65 and 26.09+/-5.86 g, respectively, 7 days later). In similar rats tested on the wire mesh, the ipsilateral but not the contralateral paw withdrawal threshold decreased (12.80+/-2.21 and 65.00+/-10.28 g, respectively, at 7 days). The data suggest that the flat surface and opaque properties of the customized platform enable accurate, reliable and repeatable measurements of ipsilateral and contralateral paw withdrawal threshold using von Frey hairs in normal and nerve-injured rats.

A critical analysis of directive counselling as a component of tinnitus retraining therapy.

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.