Martin Thomas J, Kim Susy A, Buechler Nancy L, Porreca Frank, Eisenach James C
Department of Anesthesiology, Wake Forest University School of Medicine, NC 27157, USA.
Anesthesiology. 2007 Feb;106(2):312-22. doi: 10.1097/00000542-200702000-00020.
Neuropathic pain is associated with several sensory abnormalities, including allodynia as well as spontaneous pain. Opioid intake in neuropathic pain patients is motivated by alleviation of both pain and allodynia. However, laboratory animal studies rely almost exclusively on reflexive withdrawal measures of allodynia. The authors examined the pharmacology of self-regulated intake of opioids in rats with or without nerve injury and compared the rate of drug intake to reversal of allodynia.
Rats were implanted with intravenous catheters, and the L5 and L6 spinal nerves were ligated in half of these animals. Rats were then trained to self-administer a commonly abused opioid (heroin) and commonly prescribed opioids (morphine, fentanyl, hydromorphone, and methadone). In addition, rats trained to self-administer heroin were given either clonidine or adenosine spinally before self-administration sessions to assess opioid-sparing effects.
Nerve injury significantly decreased the reinforcing effects of low doses of opioids, and only doses of each opioid that reduced mechanical hypersensitivity maintained self-administration after spinal nerve ligation. The rate of drug consumption was correlated with the duration of the antiallodynic effect for each dose of opioid. Intrathecal administration of clonidine or adenosine reversed mechanical hypersensitivity, but only clonidine reduced heroin self-administration in rats with spinal nerve ligation.
Opioid self-administration is significantly altered by nerve injury, with rate of drug intake being correlated with reversal of allodynia. Intrathecal clonidine, but not adenosine, produces opioid-sparing effects in self-administering rats. The neurobiologic mechanisms that regulate opioid consumption in rats therefore seem to be altered after nerve injury.
神经性疼痛与多种感觉异常相关,包括痛觉过敏以及自发痛。神经性疼痛患者服用阿片类药物是为了缓解疼痛和痛觉过敏。然而,实验室动物研究几乎完全依赖于痛觉过敏的反射性退缩测量。作者研究了有或没有神经损伤的大鼠自我调节阿片类药物摄入的药理学,并将药物摄入率与痛觉过敏的逆转进行了比较。
给大鼠植入静脉导管,其中一半动物的L5和L6脊神经被结扎。然后训练大鼠自我给药一种常见的滥用阿片类药物(海洛因)和常见的处方阿片类药物(吗啡、芬太尼、氢吗啡酮和美沙酮)。此外,在自我给药前,给训练自我给药海洛因的大鼠脊髓注射可乐定或腺苷,以评估阿片类药物节省效应。
神经损伤显著降低了低剂量阿片类药物的强化作用,只有在脊神经结扎后能减轻机械性超敏反应的每种阿片类药物剂量才能维持自我给药。每种阿片类药物剂量的药物消耗率与抗痛觉过敏作用的持续时间相关。鞘内注射可乐定或腺苷可逆转机械性超敏反应,但只有可乐定能减少脊神经结扎大鼠的海洛因自我给药。
神经损伤显著改变了阿片类药物的自我给药,药物摄入率与痛觉过敏的逆转相关。鞘内注射可乐定而非腺苷在自我给药的大鼠中产生阿片类药物节省效应。因此,神经损伤后调节大鼠阿片类药物消耗的神经生物学机制似乎发生了改变。