Robbins Meredith T, Ness Timothy J
Department of Anesthesiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
J Pain. 2008 Nov;9(11):991-8. doi: 10.1016/j.jpain.2008.05.006. Epub 2008 Jul 16.
Stress-induced hyperalgesia (SIH), a common clinical observation associated with multiple painful diseases including functional urinary disorders, presently has no mechanistic explanation. Using a footshock treatment, a classic stressor, to magnify physiological responses in a model of urinary bladder pain, we examined one potential group of mediators of SIH, the corticotropin-releasing factor (CRF)-related neuropeptides. Exposure to a footshock treatment produced bladder hypersensitivity in female Sprague-Dawley rats, manifested as significantly more vigorous visceromotor responses (VMRs) to urinary bladder distension (UBD) compared with rats that were exposed to a non-footshock treatment. This bladder hypersensitivity was significantly attenuated by blocking spinal CRF(2) receptors but not CRF(1) receptors. Furthermore, spinal administration of urocortin 2, a CRF(2) receptor agonist, augmented UBD-evoked VMRs in a way similar to what was observed after exposure to Footshock, an effect significantly attenuated by pretreatment with spinal aSVG30, a CRF(2) receptor antagonist. Surprisingly, neither spinal administration of CRF nor the CRF(1) receptor antagonist antalarmin had an effect on bladder nociceptive responses. The results of the present study not only provide further support for a role of stress in the exacerbation of bladder pain but also implicate spinal urocortins and their endogenous receptor, the CRF(2) receptor, as potential mediators of this effect.
This study presents evidence that spinal urocortins and CRF(2) receptors are involved in stress-induced hypersensitivity related to the urinary bladder. This provides a basis for investigating how urocortins mediate SIH, ultimately leading to more effective treatment options for patients with painful bladder syndromes as well as stress-exacerbated chronic pain.
应激诱导的痛觉过敏(SIH)是一种与包括功能性泌尿疾病在内的多种疼痛性疾病相关的常见临床现象,目前尚无机制性解释。我们使用足部电击治疗(一种经典的应激源)来放大膀胱疼痛模型中的生理反应,研究了SIH的一组潜在介质——促肾上腺皮质激素释放因子(CRF)相关神经肽。暴露于足部电击治疗会使雌性Sprague-Dawley大鼠出现膀胱超敏反应,表现为与接受非足部电击治疗的大鼠相比,对膀胱扩张(UBD)的内脏运动反应(VMR)明显更强烈。通过阻断脊髓CRF(2)受体而非CRF(1)受体,这种膀胱超敏反应得到显著减弱。此外,脊髓注射urocortin 2(一种CRF(2)受体激动剂)以类似于暴露于足部电击后观察到的方式增强了UBD诱发的VMR,脊髓注射CRF(2)受体拮抗剂aSVG30预处理可显著减弱这种效应。令人惊讶的是,脊髓注射CRF或CRF(1)受体拮抗剂安他乐对膀胱伤害性反应均无影响。本研究结果不仅进一步支持了应激在加重膀胱疼痛中的作用,还表明脊髓urocortins及其内源性受体CRF(2)受体是这种效应的潜在介质。
本研究提供的证据表明,脊髓urocortins和CRF(2)受体参与了与膀胱相关的应激诱导的超敏反应。这为研究urocortins如何介导SIH提供了基础,最终为膀胱疼痛综合征以及应激加剧的慢性疼痛患者带来更有效的治疗选择。