Wang Po-Kai, Cao Jing, Wang Hongzhen, Liang Lingli, Zhang Jun, Lutz Brianna Marie, Shieh Kun-Ruey, Bekker Alex, Tao Yuan-Xiang
Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien, Taiwan.
Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, Henan, China.
J Pain. 2015 Nov;16(11):1186-99. doi: 10.1016/j.jpain.2015.07.006. Epub 2015 Sep 3.
Chronic sleep disturbance-induced stress is known to increase basal pain sensitivity. However, most surgical patients frequently report short-term sleep disturbance/deprivation during the pre- and postoperation periods and have normal pain perception presurgery. Whether this short-term sleep disturbance affects postsurgical pain is elusive. Here, we report that pre- or postexposure to rapid eye movement sleep disturbance (REMSD) for 6 hours daily for 3 consecutive days did not alter basal responses to mechanical, heat, and cold stimuli, but did delay recovery in incision-induced reductions in paw withdrawal threshold to mechanical stimulation and paw withdrawal latencies to heat and cold stimuli on the ipsilateral side of male or female rats. This short-term REMSD led to stress shown by an increase in swim immobility time, a decrease in sucrose consumption, and an increase in the level of corticosterone in serum. Blocking this stress via intrathecal RU38486 or bilateral adrenalectomy abolished REMSD-caused delay in recovery of incision-induced reductions in behavioral responses to mechanical, heat, and cold stimuli. Moreover, this short-term REMSD produced significant reductions in the levels of mu opioid receptor and kappa opioid receptor, but not Kv1.2, in the ipsilateral L4/5 spinal cord and dorsal root ganglia on day 9 after incision (but not after sham surgery).
Our findings show that short-term sleep disturbance either pre- or postsurgery does not alter basal pain perception, but does exacerbate postsurgical pain hypersensitivity. The latter may be related to the reductions of mu and kappa opioid receptors in the spinal cord and dorsal root ganglia caused by REMSD plus incision. Prevention of short-term sleep disturbance may help recovery from postsurgical pain in patients.
已知慢性睡眠障碍引起的应激会增加基础疼痛敏感性。然而,大多数外科手术患者在术前和术后经常报告有短期睡眠障碍/剥夺,且术前疼痛感知正常。这种短期睡眠障碍是否会影响术后疼痛尚不清楚。在此,我们报告,连续3天每天对快速眼动睡眠障碍(REMSD)进行6小时的术前或术后暴露,并未改变对机械、热和冷刺激的基础反应,但确实延迟了雄性或雌性大鼠同侧切口引起的爪部对机械刺激的退缩阈值降低以及对热和冷刺激的爪部退缩潜伏期的恢复。这种短期REMSD导致了应激,表现为游泳不动时间增加、蔗糖消耗量减少以及血清皮质酮水平升高。通过鞘内注射RU38486或双侧肾上腺切除术阻断这种应激,消除了REMSD导致的切口引起的对机械、热和冷刺激的行为反应恢复延迟。此外,这种短期REMSD在切口后第9天(假手术后未出现)使同侧L4/5脊髓和背根神经节中的μ阿片受体和κ阿片受体水平显著降低,但Kv1.2水平未降低。
我们的研究结果表明,术前或术后的短期睡眠障碍不会改变基础疼痛感知,但会加剧术后疼痛超敏反应。后者可能与REMSD加切口导致的脊髓和背根神经节中μ和κ阿片受体减少有关。预防短期睡眠障碍可能有助于患者从术后疼痛中恢复。