Wallin Johan, Cui Jian-Guo, Yakhnitsa Vadim, Schechtmann Gastón, Meyerson Björn A, Linderoth Bengt
Department of Clinical Neuroscience, Section of Neurosurgery, Karolinska Institutet, S-171 76 Stockholm, Sweden.
Eur J Pain. 2002;6(4):261-72. doi: 10.1053/eujp.2002.0329.
Spinal cord stimulation (SCS) is an effective tool in alleviating neuropathic pain. However, a number of well-selected patients fail to obtain satisfactory pain relief. Previous studies have demonstrated that i.t. baclofen and/or adenosine can enhance the SCS effect, but this combined therapy has been shown to be useful in less than half of the cases and more effective substances are therefore needed. The aim of this experimental study in rats was to examine whether gabapentin or pregabalin attenuates tactile allodynia following partial sciatic nerve injury and whether subeffective doses of these drugs can potentiate the effects of SCS in rats which do not respond to SCS. Mononeuropathy was produced by a photochemically induced ischaemic lesion of the sciatic nerve. Tactile withdrawal thresholds were assessed with von Frey filaments. Effects of increasing doses of gabapentin and pregabalin (i.t. and i.v.) on the withdrawal thresholds were analysed. These drugs were found to reduce tactile allodynia in a dose-dependent manner. In SCS non-responding rats, i.e. where stimulation per se failed to suppress allodynia, a combination of SCS and subeffective doses of the drugs markedly attenuated allodynia. In subsequent acute experiments, extracellular recordings from wide dynamic range neurones in the dorsal horn showed prominent hyperexcitability. The combination of SCS and gabapentin, at the same subeffective dose, clearly enhanced suppression of this hyperexcitability. In conclusion, electrical therapy and pharmacological therapy in neuropathic pain can, when they are inefficient individually, become effective when combined.
脊髓刺激(SCS)是缓解神经性疼痛的一种有效手段。然而,一些精心挑选的患者未能获得满意的疼痛缓解效果。先前的研究表明,鞘内注射巴氯芬和/或腺苷可增强脊髓刺激的效果,但这种联合疗法在不到一半的病例中显示有效,因此需要更有效的药物。本大鼠实验研究的目的是检验加巴喷丁或普瑞巴林是否能减轻坐骨神经部分损伤后的触觉异常性疼痛,以及这些药物的亚有效剂量是否能增强对脊髓刺激无反应的大鼠的脊髓刺激效果。通过光化学诱导的坐骨神经缺血性损伤造成单神经病。用von Frey细丝评估触觉撤防阈值。分析了加巴喷丁和普瑞巴林(鞘内注射和静脉注射)剂量增加对撤防阈值的影响。发现这些药物以剂量依赖的方式减轻触觉异常性疼痛。在对脊髓刺激无反应的大鼠中,即刺激本身未能抑制异常性疼痛的大鼠中,脊髓刺激与药物亚有效剂量的联合明显减轻了异常性疼痛。在随后的急性实验中,对背角广动力范围神经元的细胞外记录显示出明显的兴奋性过高。脊髓刺激与加巴喷丁以相同的亚有效剂量联合使用时,明显增强了对这种兴奋性过高的抑制作用。总之,神经性疼痛的电疗法和药物疗法单独使用无效时,联合使用可能会变得有效。
Biomolecules. 2023-12-16
BMC Complement Med Ther. 2020-3-14