Wacnik Paul W, Kehl Lois J, Trempe Thomas M, Ramnaraine Margaret L, Beitz Alvin J, Wilcox George L
Department of Pharmacology, Medical School, University of Minnesota, 6-120 Jackson, 321 Church St SE, Minneapolis, MN 55455-0217, USA.
Pain. 2003 Jan;101(1-2):175-86. doi: 10.1016/s0304-3959(02)00312-3.
In this paper we compare two innovative models of movement-related pain: tumor-induced nociception following implantation of fibrosarcoma cells into bone and muscle inflammation-induced nociception following injection of the irritant carrageenan into muscle. Importantly, using the grip force test, an assay of movement-related hyperalgesia, both non-malignant and malignant pain are examined in parallel. Movement-related hyperalgesia, known clinically as a specific type of 'breakthrough pain', is a common feature of bone cancer and is thought to be a predictor of poor response to conventional analgesic pharmacotherapy (Bruera et al., 1995, J. Pain Symptom. Manage. 10 (1995) 348; Mercadaute et al., 1992, Pain 50 (1992) 151; Pain 81 (1999) 129). Implantation of NCTC 2472 sarcoma cells in both humeri or injection of carrageenan (4%) in both triceps of C3H/He mice produced apparent forelimb hyperalgesia that was not associated with mechanical hyperalgesia in the forepaw, whereas carrageenan at 6 and 8% did evoke significant cutaneous hyperalgesia of the forepaw as well. Control groups receiving implants of vehicle or no treatment at all did not manifest this forelimb hyperalgesia. B6C3/F1 mice implanted with non-lysis-inducing G3.26 melanoma cells or vehicle did not manifest significant hyperalgesia when compared to B6C3/F1 mice receiving fibrosarcoma cells, indicating a dependence on bone involvement for induction of hyperalgesia in this model. Histological examination at days 3, 7, and 10 post-implantation showed a clear correlation of tumor growth-induced bone destruction with behavioral hyperalgesia. Morphine was more potent in decreasing the maximal hyperalgesia induced by carrageenan than that induced by tumor implantation. Acutely administered morphine (3-100mg/kg, i.p.) attenuated peak hyperalgesia of carrageenan-injected mice (ED(50) 6.9 mg/kg) and tumor-bearing mice (ED(50) 23.9 mg/kg) in a dose-related manner with a difference in potency of 3.5. Tumor-implanted mice with a level of hyperalgesia comparable to that induced by carrageenan required almost three times more morphine (ED(50) 18.5mg/kg) for equivalent attenuation of forelimb hyperalgesia. These animal models of movement-related hyperalgesia may aid in discerning the peripheral and central mechanisms underlying pain that accompanies bone metastases and distinguishing it from the pain associated with muscular inflammation. Importantly, they may also aid in predicting differences in analgesic efficacy in different types of musculoskeletal pain.
在本文中,我们比较了两种与运动相关疼痛的创新模型:将纤维肉瘤细胞植入骨骼后引发的肿瘤诱导性伤害感受,以及向肌肉注射刺激性角叉菜胶后引发的肌肉炎症诱导性伤害感受。重要的是,通过握力测试这一与运动相关痛觉过敏的检测方法,同时对非恶性和恶性疼痛进行了研究。运动相关痛觉过敏在临床上被称为一种特定类型的“突破性疼痛”,是骨癌的常见特征,并且被认为是对传统镇痛药物治疗反应不佳的一个预测指标(Bruera等人,1995年,《疼痛症状管理杂志》10(1995)348;Mercadaute等人,1992年,《疼痛》50(1992)151;《疼痛》81(1999)129)。在C3H/He小鼠的双侧肱骨中植入NCTC 2472肉瘤细胞或在双侧三头肌中注射角叉菜胶(4%),会产生明显的前肢痛觉过敏,且这与前爪的机械性痛觉过敏无关,而6%和8%的角叉菜胶确实也会引发前爪明显的皮肤痛觉过敏。接受载体植入或根本未接受治疗的对照组并未表现出这种前肢痛觉过敏。与接受纤维肉瘤细胞植入的B6C3/F1小鼠相比,植入非裂解诱导性G3.26黑色素瘤细胞或载体的B6C3/F1小鼠未表现出明显的痛觉过敏,这表明在该模型中痛觉过敏的诱导依赖于骨骼受累情况。植入后第3、7和10天的组织学检查显示,肿瘤生长诱导的骨质破坏与行为性痛觉过敏之间存在明显的相关性。吗啡在减轻角叉菜胶诱导的最大痛觉过敏方面比肿瘤植入诱导的更有效。急性给予吗啡(3 - 100mg/kg,腹腔注射)以剂量相关的方式减轻了注射角叉菜胶小鼠(半数有效剂量[ED(50)]6.9mg/kg)和荷瘤小鼠(ED(50)23.9mg/kg)的峰值痛觉过敏,效力差异为3.5。对于前肢痛觉过敏的等效减轻,痛觉过敏水平与角叉菜胶诱导相当的肿瘤植入小鼠所需的吗啡量几乎是其三倍(ED(50)18.5mg/kg)。这些与运动相关痛觉过敏的动物模型可能有助于识别骨转移伴随疼痛的外周和中枢机制,并将其与肌肉炎症相关的疼痛区分开来。重要的是,它们还可能有助于预测不同类型肌肉骨骼疼痛在镇痛效果上的差异。