Ueda Hiroshi, Neyama Hiroyuki
Department of Pharmacology and Therapeutic Innovation, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Neurobiol Pain. 2017 Apr 17;1:16-25. doi: 10.1016/j.ynpai.2017.04.002. eCollection 2017 Jan-Jul.
Treatment for fibromyalgia is an unmet medical need and its pathogenesis is still poorly understood. The present study demonstrated that intermittent psychological stress (IPS), or empathy causes generalized chronic abnormal pain with female predominance. The persistence of the pain phenotype was dependent on the unpredictability of the stressor. The pain was reversed by pregabalin (PGB), duloxetine (DLX) or mirtazapine (Mir), but not by diclofenac or morphine. Differential administration of these existing medicines revealed that the sites of PGB and Mir actions exist in the brain, but not in the spinal cord, while that of DLX is preferentially in the spinal cord. It is interesting to note that the intracerebroventricular injection of PGB or Mir showed potent analgesia for 24 h or longer, though systemic injection of these medicines shows anti-hyperalgesia just for several hours. These results indicate that initial intense actions in the target brain may prevent the forthcoming development of pain memory. IPS-induced abnormal pain was prevented in mice deficient of lysophosphatidic acid receptor 1 (LPA1) gene, and completely cured by the repeated intrathecal treatments with LPA1 antagonist, AM966, which did not show acute action. All these results suggest that IPS model is an experimental animal model, which mimics the pathophysiology and pharmacotherapy in fibromyalgia in clinic, and LPA1 signaling plays crucial roles in the IPS-induced fibromyalgia-like abnormal pain.
纤维肌痛的治疗是一项尚未满足的医疗需求,其发病机制仍知之甚少。本研究表明,间歇性心理应激(IPS)或共情会导致以女性为主的全身性慢性异常疼痛。疼痛表型的持续存在取决于应激源的不可预测性。普瑞巴林(PGB)、度洛西汀(DLX)或米氮平(Mir)可逆转疼痛,但双氯芬酸或吗啡则不能。这些现有药物的不同给药方式表明,PGB和Mir的作用部位在大脑而非脊髓,而DLX的作用部位优先在脊髓。有趣的是,脑室内注射PGB或Mir显示出长达24小时或更长时间的强效镇痛作用,尽管全身注射这些药物仅显示数小时的抗痛觉过敏作用。这些结果表明,在目标大脑中的初始强烈作用可能会阻止即将出现的疼痛记忆的发展。在缺乏溶血磷脂酸受体1(LPA1)基因的小鼠中,IPS诱导的异常疼痛得到预防,并且通过反复鞘内注射LPA1拮抗剂AM966完全治愈,AM966没有显示出急性作用。所有这些结果表明,IPS模型是一种实验动物模型,它模拟了临床上纤维肌痛的病理生理学和药物治疗,并且LPA1信号在IPS诱导的纤维肌痛样异常疼痛中起关键作用。