A. Ekblom

Lack of analgesic effect of systemically administered morphine or pethidine on labour pain

Objective To evaluate the true analgesic effect of morphine and pethidine on labour pain.

Concentration of Substance P, Neurokinin A, Calcitonin Gene- related Peptide, Neuropeptide Y and Vasoactive Intestinal Polypeptide in Synovial Fluid from Knee Joints in Patients Suffering from Rheumatoid Arthritis

We have studied the presence of five neuropeptides in knee joint synovial fluid from either patients suffering from rheumatoid arthritis and pain (n = 18) or being subjected to arthroscopy due to meniscal/cruciate ligament injuries (n = 13). Radioimmunoassay technique was used for peptide analysis using antisera SP2 against substance P (SP), K12 against neurokinin A (NKA), CGRPR8 against calcitonin gene-related peptide (CGRP), NPY1 against neuropeptide Y (NPY) and VIP2 against vasoactive intestinal polypeptide (VIP). No SP could be detected, and lower levels of NKA was found in arthritic joints vs controls. CGRP and NPY was found in higher concentrations in arthritic patients vs controls. VIP was found sporadically in both arthritis and control patients. Our data show some quantitative differences between patients suffering rheumatoid arthritis and pain, and patients with non-inflamed joints without pain; indicating an involvement of peptidergic fibers in arthritis in humans.

Bilateral changes of substance P-, neurokinin A-, calcitonin gene-related peptide- and neuropeptide Y-like immunoreactivity in rat knee joint synovial fluid during acute monoarthritis

It has been hypothesized that the nervous system contributes to the symmetrical response in rheumatoid arthritis. In order to elucidate this, the bilateral concentrations of substance P-like immunoreactivity (SP-LI), neurokinin A-LI (NKA-LI), calcitonin gene-related peptide-LI (CGRP-LI) and neuropeptide Y-LI (NPY-LI) in rat synovial fluid during acute monoarthritis were studied. Equal volumes (0.05 ml) of either Freund adjuvants, carrageenan 2%, substance P 10(-5) M or human recombinant interleukin-1 alpha were injected into the right and saline into the left knee joint. Control rats were given saline bilaterally. Perfusates were obtained from both knees simultaneously at 2, 6 and 24 h after injection and were analysed by specific radioimmunoassays. Increase of SP-, NKA-, CGRP- and NPY-LI in synovial fluid occurred in both knees after injections with the pro-inflammatory substances into the right joints as compared to controls, except for unchanged SP-LI in the right knee joint after 24 h following hrIL-1 alpha injection. There was, however, generally no significant difference in the peptide contents between the right knee (injected with pro-inflammatory substance) as compared to the left knee (given saline) at 2, 6 or 24 h after injection except at three occasions. The results show that experimentally induced monoarthritis induces bilateral changes in synovial fluid peptide content.

Concentrations of neuropeptides substance P, neurokinin A, calcitonin gene-related peptide, neuropeptide Y and vasoactive intestinal polypeptide in synovial fluid of the human temporomandibular joint

Arthroscopy was performed on 18 patients (19 joints) with temporomandibular joint arthropathy. Arthroscopic investigation revealed that 12 patients had disk derangement, including 3 patients with rheumatoid arthritis. Six patients had osteoarthrosis, including one patient with rheumatoid arthritis. Synovial fluid content of substance P-like immunoreactivity (SP-LI), neurokinin A (NKA-LI), calcitonin gene-related peptide (CGRP-LI), neuropeptide Y (NPY-LI) and vasoactive intestinal polypeptide (VIP-LI) were analysed using radioimmunoassay technique. All peptides analysed were found, although in various concentrations, in the different joints. There were no significant differences in concentrations of the peptides in the synovial fluid between patients in the various groups. No significant correlation was found between clinical symptoms and signs, arthroscopic findings, or use of analgesic/anti-inflammatory medication versus concentrations of peptides in the synovial fluid. In comparison with earlier findings in the knee joint significantly higher concentrations of SP-LI, CGRP-LI and NPY-LI were found in the TMJ.

Vibratory stimulation for the relief of pain of dental origin

Abstract The present paper describes the effect of vibratory stimulation on pain of dental origin in 36 patients. The patients were from a clinic for dental surgery and all had suffered pain from pulpal inflammation, apical periodontitis or postoperative pain following extraction of an impacted wisdom tooth for more than 2 days. Vibration at 100 Hz was applied to various points in the facial region or the skull. All the patients except three experienced an effective reduction of the intensity of the pain. In the patients who experienced pain reduction there was usually a best point at which vibration had a greater pain alleviating effect than at other points. At some points the stimulation added to the pain. In 16 patients the stimulation caused a reduction in pain intensity of 75–100%; out of these 12 patients reported a complete relief of pain.

Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain

Abstract The present paper describes the effect of high frequency, low frequency and placebo TENS on acute oro‐facial pain in 62 patients, attending to an emergency clinic for dental surgery; they had all suffered pain for 1–4 days. The patients were randomly assigned to one of three groups receiving either high frequency (100 Hz), low frequency (2 Hz) or placebo TENS. In the two groups receiving TENS (42 patients) 16 patients reported a reduction in pain intensity exceeding 50%; out of these 16 patients, 4 patients reported complete relief of pain. In the placebo group (20 patients) 2 patients reported a pain reduction of more than 50%; out of these 2 patients, none reported a complete pain relief. Mechanical vibratory stimulation augmented the pain reduction obtained by TENS in 5 out of 10 patients.

Effects of Repeated Sensory Stimulation (Electro- acupuncture) and Physical Exercise (Running) on Open- field Behaviour and Concentrations of Neuropeptides in the Hippocampus in WKY and SHR rats

The effects of repeated sensory stimulation (electro‐acupuncture) and physical exercise (running) on open‐field behaviour and on hippocampal concentrations of neuropeptide Y, neurokinin A, substance P, galanin and vasoactive intestinal peptide (VIP)‐like immunoreactivities were studied in WKY (Wistar‐Kyoto) and SHR (spontaneously hypertensive) rats. Significantly higher concentrations of substance P‐like immunoreactivity, neurokinin A‐like immunoreactivity and neuropeptide Y‐like immunoreactivity were found in the hippocampus immediately after 3 weeks of treatment (electro‐acupuncture and running), but not 1 week after the last (tenth) intervention. No changes in galanin‐like immunoreactivity and VIP‐like immunoreactivity were found. The changes in neuropeptide concentrations were similar in the two rat strains. Open‐field behaviour was significantly reduced during the treatment period in both strains. There were significant negative correlations between behaviour and neuropeptide concentrations in SHR rats, suggesting interdependency with sympathetic activity. It is proposed that the effects of electro‐acupuncture and physical exercise in rats are related to increases in neuropeptide Y, neurokinin A and substance P in the hippocampus.

Obstetric outcome following epidural analgesia with bupivacaine-adrenaline 0.25% or bupivacaine 0.125% with sufentanil - a prospective randomized controlled study in 1000 parturients

Background: Epidural analgesia (EDA) is the most efficient method for pain relief during labour, but there is still a debate as to whether it interferes with the normal process of delivery. Some authors argue that the incidence of instrumental deliveries, Caesarean section, malrotation and protracted labour is increased in parturients receiving EDA.

Immunoreactive tachykinins, calcitonin gene-related peptide and neuropeptide Y in human synovial fluid from inflamed knee joints

We have analysed the concentrations of substance P (SP), neurokinin A (NKA), calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) in the synovial fluid from 5 patients suffering from arthritis with inflamed knee joints as well as from 5 healthy control subjects with an earlier traumatic meniscal or cruciate ligament injury. Competitive radioimmunoassay was done using antisera SP2 (SP), K12 (NKA), R8 (CGRP), and NPY1 (NPY). No SP-like immunoreactivity (-LI) was detected in any patient. NKA-LI was found in all control patients but in none of the arthritis patients. CGRP-LI was seen in all arthritis patients as well as in 3/5 control patients, a non-significant difference. NPY-LI was found in a significantly higher concentration in the arthritis group vs the control patients. The results support an involvement of neuropeptides in human joint inflammation.

Effects of electro-acupuncture and physical exercise on regional concentrations of neuropeptides in rat brain

The effects of single or repeated treatments with manual acupuncture (ACU), electro-acupuncture (ELACU) or physical exercise on neuropeptide Y (NPY), neurokinin A (NKA), substance P (SP), galanin (GAL) and vasoactive intestinal peptide (VIP)-like immunoreactivity (-LI) in different regions of the rat brain were studied. Initially the effect of microwave irradiation (MWI) was compared to decapitation on the recovery of neuropeptides, and significantly higher concentrations of SP-LI, NKA-LI and NPY-LI were found in the hippocampus, occipital cortex, pituitary and striatum following MWI. Repeated ELACU treatments significantly increased SP-LI, NKA-LI and NPY-LI in the hippocampus and NPY-LI in the occipital cortex. No changes were found in animals receiving ACU or performing physical exercise.