Annika Rosén

RELIABILITY AND RESPONSIVENESS OF THREE DIFFERENT PAIN ASSESSMENTS

The visual analogue scale (VAS) and ordered categorical scales, i.e. numeric rating scales (NRS), are commonly used in the assessment of pain. However, these scales are bounded by fixed endpoints and thus the range of measurement is limited. The disparity in repeated assessments of perceived pain intensity with the VAS, NRS, and electrical stimulation applied as a matching stimulus was studied in 69 patients (48 women and 21 men, 19-72 years) with chronic nociceptive or neurogenic pain. Responsiveness with transcutaneous electrical nerve stimulation (TENS) using the same measurement procedures was evaluated in the same patients. Comparison of results from the three pain assessments showed that the painmatcher is at least as reliable and responsive as VAS and NRS. None of the three measurements showed evidence for systematic disagreement and had only significant random individual disagreement. They also showed evidence for responsiveness.

Effects of sequential removal of rats from a group cage, and of individual housing of rats, on substance P, cholecystokinin and somatostatin levels in the periaqueductal grey and limbic regions.

The effect of specific stressful stimuli on neuropeptide levels was studied in rat brain regions known to be involved in the mediation of stress responses and anxiety. Rats were sequentially removed, one by one with 20-min intervals from group cages and immediately decapitated. A selective increase of the somatostatin level was observed in the amygdala in the rats taken for sacrifice second last and last, compared to the rats taken earlier from the respective group cage (increases by 40 to 69%, p < 0.05 or p < 0.01). Isolation of rats in single cages for 24 h or 1 week before sacrifice, increased the substance P level in the dorsal periaqueductal grey by 26 and 27% (p < 0.05 in both cases), respectively, compared to group housed rats. In group housed rats treated with diazepam (5 mg/kg, s.c.) 140 min before sacrifice, the level of substance P in the rostral hippocampus and dorsal periaqueductal grey was reduced by 40% (p < 0.001) and 28% (p < 0.05), respectively, compared to saline treated controls. In conclusion, handling, as well as a single dose of the anxiolytic drug diazepam, appears to induce rapid, selective and region-specific changes of regional brain peptide levels in the rat. The effects of handling are likely to be related to the acute stress response and are probably not secondary to increased plasma glucocorticoid levels.

Substance P microinjected into the periaqueductal gray matter induces antinociception and is released following morphine administration

The aims of the present study were to investigate, in rats, the behavioral effects of substance P (SP) microinjected into the ventrolateral periaqueductal gray (PAG) and the effects of the neurokinin 1 (NK-1) receptor antagonist [d-Arg1, d-Trp7, 9, Leu11]-substance P (Spantide). The effect of morphine administration on the release of SP in the ventrolateral PAG was also investigated using microdialysis in awake rats. SP microinjected into the ventrolateral part of the PAG induced significant increases in the hindpaw withdrawal latencies (HWLs) to thermal and mechanical stimulation as an antinociceptive response. The NK-1 receptor antagonist blocked these effects but exhibited no antinociceptive effect alone. Subcutaneous administration of morphine increased basal SP-like immunoreactivity (SP-LI) release in the microdialysate obtained from the ventrolateral PAG of freely moving rats. Our results demonstrate that SP injected into the ventrolateral PAG induces an antinociceptive effect via activation of NK-1 receptors. Morphine administered systemically induces the release of SP in the ventrolateral PAG. We suggest that an increased release of SP in the PAG may contribute to opioid antinociception.

Central changes in nociceptin dynorphin B and Met-enkephalin-Arg-Phe in different models of nociception

The newly identified neuropeptide nociceptin/orphanin FQ (NOC) was measured in different rat brain areas related to the descending anti-nociceptive pathways and compared to two opioid peptides, dynorphin B (DYN B) and Met-enkephalinArgPhe (MEAP). Two experimental models of chronic nociception, one neurogenic and one inflammatory, used in this study, reveal how different pathological conditions may influence these endogenous systems. Nerve injury is induced by ligation of the sciatic nerve and inflammation by a carrageenan injection in the gluteal muscle, 2 weeks prior to decapitation. Selected brain areas were dissected out and frozen. NOC-, DYN B- and MEAP-like immunoreactivity (LI) is determined by radioimmunoassay. Nerve injury increased the NOC-LI levels in the cortex cinguli, DYN B-LI levels in the dorsal and the ventral part of the spinal cord, whereas a decrease in the MEAP-LI levels is seen in the dorsal part of the periaqueductal grey (PAG). After inflammation, the NOC-LI levels increased in cortex cinguli, hypothalamus and in the dorsal spinal cord, whereas DYN B-LI levels increased in the dorsal part of the PAG. A general increase in MEAP-LI levels is found after inflammation in all analyzed brain areas except in hippocampus. In conclusion, increased levels of NOC-LI were found in cortex cinguli in both treatment groups and in hypothalamus and spinal cord following carrageenan treatment. The changes in the NOC-LI concentrations were not parallelled by changes in DYN B-LI and MEAP-LI, suggesting that NOC and opioid peptides elicit different reactions in the systems of nociception/antinociception.

Effects of Acute Systemic Treatment with the 5 HT- Uptake Blocker Alaproclate on Tissue Levels and Release of Substance P in Rat Periaqueductal Grey

The effects of acute systemic treatment with alaproclate, a serotonin uptake blocker on regional brain tissue levels of substance P, neurokinin A and cholecystokinin were studied in the rat. The peptide levels of all three peptides were increased (23-35%) in the rat periaqueductal grey 60 min after treatment with alaproclate (20 mumol/kg peroral, p.o.), compared to controls. In the cingulate cortex, the tissue levels of substance P and cholecystokinin were increased (19-32%) after subcutaneous (s.c.) treatment with alaproclate, compared to controls. Higher tissue levels of all three peptides (20-38%) in the periaqueductal grey, and lower levels of substance P and cholecystokinin in the cingulate cortex were found following saline s.c. compared to saline p.o., probably due to different degrees of stress. In microdialysis experiments, a s.c. injection of either saline (2 ml/kg), alaproclate (20 mumol/kg) or morphine (3 mg/kg) was found to slowly increase the substance P release in the periaqueductal grey. Experiments with the selective 5-HT neurotoxin, 5,7-dihydroxytryptamine indicated no neuronal co-existence of substance P and serotonin in the periaqueductal grey and cingulate cortex. In conclusion, acute treatment with the serotonin uptake blocker alaproclate increases both the tissue level and the release of substance P in the periaqueductal grey.

Effect of heterotopic noxious conditioning stimulation on electrical and pressure pain thresholds in two different anatomical regions.

Objectives. The aims of the study were to investigate the influence of heterotopic noxious conditioning stimulation (HNCS) on pain thresholds in the orofacial and spinal regions and to find out whether there are gender differences in this respect. Material and Methods. Thirty healthy subjects (15 of each sex) with a mean (SD) age of 25.1 (4.4) years participated. Pain thresholds to electrical (EPT) and pressure stimuli (PPT) were recorded in the masseter muscle and 1st upper incisor (tooth), as well as in the fingertip, before, during, and 5 and 15 min after a cold pressor task to the contralateral hand immersed in ice-cold water for a maximum of 5 min. Results. With the exception of the EPT in the orofacial region, all pain thresholds increased during the HNCS and then returned to baseline during the 15 min follow-up. The significant changes in EPT were greater in the finger than in the tooth, while the changes in PPT were greater in the masseter muscle than in the finger. Electrical stimuli in the finger induced greater significant changes of pain thresholds than pressure. In the orofacial region, pressure induced greater significant changes in pain thresholds during HNCS than electrical stimuli did. The HNCS induced pain of high intensity and unpleasantness, i.e. varying between 5 and 10 on the numeric rating scale (NRS). There were no gender differences in the response to the HNCS. Conclusion. We conclude that, in general, HNCS induced by cold pressor stimulation increases pain thresholds, but the magnitude of the effect differs between the orofacial region and the finger and is influenced by the tissue and type of test stimuli.

Nociceptin/orphanin FQ into the rat periaqueductal gray decreases the withdrawal latency to heat and loading, an effect reversed by (Nphe1)nociceptin(1-13)NH2

The present study investigated the effect of intraperiaqueductal grey injection of nociceptin/orphanin FQ (N/OFQ) and an antagonist (Nphe(1))nociceptin(1-13)NH(2) on the hindpaw withdrawal response to thermal and mechanical stimulation in rats. N/OFQ (5 nmol) significantly decreased the nociceptive thresholds in both tests and 1, 5 and 10 nmol of (Nphe(1))nociceptin(1-13)NH(2) significantly reversed this effect in a dose dependent way. Our results demonstrate, that N/OFQ has a nociceptive action, possibly through inhibition of PAG neurons. This effect is blocked by the antagonist (Nphe(1))nociceptin(1-13)NH(2) probably via ORL1 receptors in the periaqueductal grey.

Increased β-Endorphin Levels and Generalized Decreased Pain Thresholds in Patients With Limited Jaw Opening and Movement-Evoked Pain From the Temporomandibular Joint

PURPOSE Patients with limited jaw opening and movement-evoked pain from the temporomandibular joint have moderate to severe pain that may be relieved by surgery. The purpose of this study was to investigate if the preoperative state is associated with alterations in plasma β-endorphin (βE) levels and pain thresholds. PATIENTS AND METHODS Eighteen female patients with painful unilateral temporomandibular joint and 18 age-matched healthy women participated. After blood sampling for analysis of plasma βE levels, pressure pain thresholds over the masseter muscles and index fingers were recorded with an electronic algometer. Electrical detection and pain thresholds were recorded with the PainMatcher (Cefar Medical AB, Lund, Sweden) device. Nonparametric statistics, ie, Mann-Whitney U test and Spearman correlation test, was used for statistical analyses. RESULTS The patients showed higher plasma βE levels (P = .013) and lower pressure pain thresholds over the masseter muscle at the painful side (P = .041) and bilaterally over the index fingers compared with the controls (P < .05 for all comparisons). High plasma βE levels correlated to increased electrical detection thresholds (n = 36, r = 0.347, P = .038). CONCLUSIONS This study showed that patients with limited jaw opening and movement-evoked pain from the temporomandibular joint had significantly higher plasma βE levels and lower pressure pain thresholds in the orofacial area and at remote sites compared with pain-free, healthy, age-matched controls. An increased level of βE seems insufficient to inhibit pain and central sensitization. Further studies are warranted to elucidate the relation between βE and pain thresholds secondary to stress, inflammation, and discectomy.

In vitro pharmacological characterization of a novel TRPA1 antagonist and proof of mechanism in a human dental pulp model

AZ465 is a novel selective transient receptor potential cation channel, member A1 (TRPA1) antagonist identified during a focused drug discovery effort. In vitro, AZ465 fully inhibits activation by zinc, O-chlorobenzylidene malononitrile (CS), or cinnamaldehyde of the human TRPA1 channel heterologously expressed in human embryonic kidney cells. Our data using patch-clamp recordings and mouse/human TRPA1 chimeras suggest that AZ465 binds reversibly in the pore region of the human TRPA1 channel. Finally, in an ex vivo model measuring TRPA1 agonist-stimulated release of neuropeptides from human dental pulp biopsies, AZD465 was able to block 50%–60% of CS-induced calcitonin gene-related peptide release, confirming that AZ465 inhibits the native human TRPA1 channel in neuronal tissue.

Expression of 5-HT3 receptors and TTX resistant sodium channels (NaV1.8) on muscle nerve fibers in pain-free humans and patients with chronic myofascial temporomandibular disorders

BackgroundPrevious studies have shown that 5-HT3-antagonists reduce muscle pain, but there are no studies that have investigated the expression of 5-HT3-receptors in human muscles. Also, tetrodotoxin resistant voltage gated sodium-channels (NaV) are involved in peripheral sensitization and found in trigeminal ganglion neurons innervating the rat masseter muscle. This study aimed to investigate the frequency of nerve fibers that express 5-HT3A-receptors alone and in combination with NaV1.8 sodium-channels in human muscles and to compare it between healthy pain-free men and women, the pain-free masseter and tibialis anterior muscles, and patients with myofascial temporomandibular disorders (TMD) and pain-free controls.MethodsThree microbiopsies were obtained from the most bulky part of the tibialis and masseter muscles of seven and six healthy men and seven and six age-matched healthy women, respectively, while traditional open biopsies were obtained from the most painful spot of the masseter of five female patients and from a similar region of the masseter muscle of five healthy, age-matched women. The biopsies were processed by routine immunohistochemical methods. The biopsy sections were incubated with monoclonal antibodies against the specific axonal marker PGP 9.5, and polyclonal antibodies against the 5-HT3A-receptors and NaV1.8 sodium-channels.ResultsA similar percentage of nerve fibers in the healthy masseter (85.2%) and tibialis (88.7%) muscles expressed 5-HT3A-receptors. The expression of NaV1.8 by 5-HT3A positive nerve fibers associated with connective tissue was significantly higher than nerve fibers associated with myocytes (P < .001). In the patients, significantly more fibers per section were found with an average of 3.8 ± 3 fibers per section in the masseter muscle compared to 2.7 ± 0.2 in the healthy controls (P = .024). Further, the frequency of nerve fibers that co-expressed NaV1.8 and 5-HT3A receptors was significantly higher in patients (42.6%) compared to healthy controls (12.0%) (P < .001).ConclusionsThis study showed that the 5-HT3A-receptor is highly expressed in human masseter and tibialis muscles and that there are more nerve fibers that express 5-HT3A-receptors in the masseter of women with myofascial TMD compared to healthy women. These findings indicate that 5-HT3-receptors might be up-regulated in myofascial TMD and could serve as potential biomarkers of chronic muscle pain.