Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord.

The activation of α2-adrenoceptors has attracted attention as a therapeutic target for neuropathic pain, which remains a clinical challenge. In the present study, we examined the interaction between α2-adrenergic and cholinergic signaling in a rat model of neuropathic pain induced by spinal nerve ligation (SNL). Intrathecal administration of dexmedetomidine, which is a selective α2-adrenoceptor agonist (0.1-1.0 μg), dose-dependently suppressed hyperalgesia in SNL rats but did not alter paw withdrawal thresholds in normal rats. The analgesic effect of dexmedetomidine was abolished by intrathecal pretreatment with idazoxan (30 μg) and atropine (30 μg), which antagonize the α2-adrenoreceptor and muscarinic receptor, respectively. In vivo microdialysis in the lumbar spinal dorsal horn revealed that acetylcholine concentrations increased after dexmedetomidine perfusion (1 μM), but only in SNL rats. The combination of an ineffective dose of intrathecal dexmedetomidine with intraperitoneal donepezil, which is a cholinesterase inhibitor, decreased neuropathic hypersensitivity. These results suggest that plasticity of the spinal noradrenergic-cholinergic axis only occurs in neuropathic pain states. Thus, drug combinations that strengthen the noradrenergic-cholinergic interaction may provide therapeutic benefit in neuropathic pain.