Hsu Sheng-Feng, Zeng Yen-Jing, Tsai Shih-Ying, Chen Kuen-Bao, Chen Julia Yi-Ru, Chang Ju-Hsin, Wen Yeong-Ray
Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Acupuncture, China Medical University Hospital Taipei Branch, Taipei, Taiwan.
Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
Life Sci. 2015 May 1;128:15-23. doi: 10.1016/j.lfs.2015.01.035. Epub 2015 Mar 2.
Postoperative pain is a major problem. Electroacupuncture (EA) has been accepted as a useful and low-risk complementary therapy for post-operative pain. Animal studies indicate that surgical incision activates p38 MAPK in the spinal microglia, which critically contributes to post-incisional nociceptive development. How EA affects incision-induced p38 activation is important but yet to be fully elucidated.
Male adult rats received plantar incision (PI) at the right hind paw followed by 30-min EA of 4-Hz, one of two intensities (3 and 10mA), and at right ST36 (Zusanli) acupoint immediately after PI and for 3 successive days. EA analgesia was evaluated by von Frey fibers and Hargreaves' tests. Spinal p38 activation was examined by immunostaining. In separate groups, SB203580, a p38 inhibitor, was intrathecally injected alone or with EA to test the combining effect on nociception and spinal phospho-p38.
EA of 10-mA significantly ameliorated mechanical allodynia, but 3-mA did not. None of them altered thermal hyperalgesia. Repeated EA could not inhibit phospho-p38 in the PI rats, contrarily, EA per se significantly induced phospho-p38 in the normal rats. Intrathecal SB203580 injection dose-dependently prevented PI-induced allodynia. Combination of low-dose SB203580 and 3-mA EA, which were ineffective individually, profoundly reduce post-PI allodynia.
We demonstrated that 10-mA EA exerts a significant inhibition against post-PI mechanical hypersensitivity via a p38-independent pathway. Importantly, co-treatment with low-dose p38 inhibitor and 3-mA EA can counteract spinal phospho-p38 to exert strong analgesic effect. Our finding suggests a novel strategy to improve EA analgesic quality.
术后疼痛是一个主要问题。电针已被公认为是一种用于术后疼痛的有效且低风险的辅助治疗方法。动物研究表明,手术切口可激活脊髓小胶质细胞中的p38丝裂原活化蛋白激酶(p38 MAPK),这对切口后伤害性感受的发展起关键作用。电针如何影响切口诱导的p38激活很重要,但尚未完全阐明。
成年雄性大鼠右后爪接受足底切口(PI),术后立即在右侧足三里穴(ST36)进行30分钟的4Hz电针治疗,强度为3mA或10mA中的一种,并连续3天进行治疗。通过von Frey纤维和哈格里夫斯试验评估电针镇痛效果。通过免疫染色检测脊髓p38激活情况。在不同组中,单独或与电针联合鞘内注射p38抑制剂SB203580,以测试其对伤害感受和脊髓磷酸化p38的联合作用。
10mA的电针显著改善了机械性异常疼痛,但3mA的电针没有。两者均未改变热痛觉过敏。重复电针不能抑制PI大鼠中的磷酸化p38,相反,电针本身在正常大鼠中显著诱导磷酸化p38。鞘内注射SB203580剂量依赖性地预防了PI诱导的异常疼痛。低剂量SB203580和3mA电针单独使用时无效,但联合使用可显著减轻PI后的异常疼痛。
我们证明10mA电针通过p38非依赖性途径对PI后的机械性超敏反应具有显著抑制作用。重要的是,低剂量p38抑制剂与3mA电针联合治疗可抵消脊髓磷酸化p38,发挥强大的镇痛作用。我们的发现提示了一种改善电针镇痛质量的新策略。