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Intact carrageenan-induced thermal hyperalgesia in mice lacking inducible nitric oxide synthase.

To date, the exact role of inducible nitric oxide synthase (iNOS) in inflammatory pain remains controversial. In the present study, we combined a pharmacological strategy (using a selective iNOS inhibitor) with a genomic strategy (using mice lacking the iNOS gene) to address the function of iNOS in the central mechanism of carrageenan-induced persistent inflammatory pain. In the wild type mice, intrathecal administration of L-N(6)-(1-iminoethyl)-lysine, a selective iNOS inhibitor, significantly inhibited thermal hyperalgesia in the late phase but not in the early phase of carrageenan inflammation. Moreover, iNOS mRNA expression in the lumbar enlargement segments of the spinal cord was dramatically induced at 24 h (late phase) after injection of carrageenan into a hind paw. Interestingly, targeted disruption of iNOS gene did not affect carrageenan-induced thermal hyperalgesia in either the early (2-6 h) or late phase. In the lumbar enlargement segments of iNOS knockout mice, nitric oxide synthase (NOS) enzyme activity remained at a similar level to that of the wild type mice at 24 h after carrageenan injection. We found that intrathecal administration of 7-nitroindazole (a selective neuronal NOS inhibitor), but not L-N(5)-(1-iminoethyl)-ornithine (a selective endothelial NOS inhibitor), significantly reduced carrageenan-induced thermal hyperalgesia in both the early phase and the late phase in iNOS knockout mice. We also found that expression of neuronal NOS but not endothelial NOS in the lumbar enlargement segments was significantly increased in iNOS knockout mice compared with wild type mice at 24 h after carrageenan injection. Our results indicate that neuronal NOS might compensate for the function of iNOS in the late phase of carrageenan-induced inflammatory pain in iNOS knockout mice. This suggests that iNOS may be sufficient, but not essential, for the late phase of the carrageenan-induced thermal hyperalgesia.

Animals↗

[Computer tomography of the cervical spinal canal following intrathecal enhancement: cervical CT myelography. Studies on technic and the initial results (author' transl)].

Computer tomography of the cervical spinal canal was carried out in 54 patients after the intrathecal injection of metrizamide (CT myelography). In 43 patients this was done after conventional myelography, in eleven it was the primary examination. In 32 patients the examination proved normal and in 22 abnormal. Correlation between the CT findings and conventional myelography was excellent. Quite small intraspinal structures both normal and abnormal, could be demonstrated. CT myelography is particularly valuable for determining the special relationships within the vertebral canal. The procedure can supplement and confirm conventional myelography, for instance round the foramen magnum. Under certain circumstances it may be regarded as the method of choice, since it is simpler for the patient and less likely to produce complications due to the contrast medium.

Adolescent↗

Control of immune-mediated disease of the central nervous system requires the use of a neuroactive agent: elucidation by the action of mitoxantrone.

Mitoxantrone was used as an immunosuppressive probe to elucidate a means for the control of experimental allergic encephalomyelitis (EAE) induced in Biozzi AB/H mice following injection of spinal cord homogenate emulsified in Freund's adjuvant. A single i.p. injection of 2.5 mg/kg of mitoxantrone, 1-2 days before the anticipated onset of EAE, failed to prevent the majority of animals from developing clinical disease, whereas when the compound was injected directly into the central nervous system (CNS), at this time point, significantly increased therapeutic benefit was evident, with most animals failing to develop clinical EAE. Although the clinical use of intrathecal mitoxantrone is strongly contraindicated, these data suggest that increased therapeutic benefit may be achieved in immune-mediated disease of the CNS by targeting immunosuppressive doses of suitable agents, on lymphocyte activation within the CNS. In addition, direct administration of immunosuppressive doses into the CNS may reduce potentially unwanted (side) effects in the periphery.

Animals↗

Further evidence for possible analgesic mechanism of electroacupuncture: effects on neuropeptides and serotonergic neurons in rat spinal cord.

The possible mechanism of electroacupuncture (EAc) in reference to the effects of neuropeptides on serotonergic neurons in rat spinal cord was studied. The tested drugs were administered by intrathecal injection or spinal push-pull perfusion. The results showed that baclofen, substance P (SP) and naloxone administered intrathecally could reduce the tail pressure pain threshold. The pain threshold was increased by met-enkephalin (EK) and EAc. The action of EAc was antagonized by naloxone. The release of 5-HT in the spinal cord evoked by tail pressure pain stimulation (TP) was inhibited by EK, baclofen and EAc. However, naloxone could potentiate the 5-HT release evoked by TP. EAc reversed the naloxone potentiation of TP-evoked 5-HT release. The 5-HT release evoked by exogenous SP, however, was potentiated by EK and EAc. From these results, it is suggested that the influence of EAc on 5-HT release may be due to activation of enkephalin-interneurons, which presynaptically inhibit the primary sensory neurons in the spinal cord.

Acupuncture Therapy↗

Warming 0.5% bupivacaine to 37 degrees C increases duration of spinal anesthesia.

The effect of warming glucose-free 0.5% bupivacaine to 37 degrees C before injection for spinal anesthesia was studied in 20 patients having total knee replacement. Twenty additional patients having spinal anesthesia for the same procedure were given glucose-free 0.5% bupivacaine at room temperature (approximately 20 degrees C). Onset, maximum cephalad spread, quality of sensory anesthesia, and duration and degree of motor blockade were the same in both groups. However, the duration of sensory anesthesia was significantly prolonged in patients who received bupivacaine at 37 degrees C. The mechanism by which warming bupivacaine prolongs the duration of sensory spinal anesthesia is uncertain. However, a decrease in the dissociation constant (pKa) of bupivacaine owing to increasing the temperature to 37 degrees C may account for some of this effect.

Adult↗

Behavioral classification of excitatory amino acid receptors in mouse spinal cord.

Intrathecal injections of excitatory amino acid (EAA) agonists to the spinal cord of mice produces behavioral activation manifest as biting and scratching of the hindquarters. The dose-response relationship of EAA (N-methyl-D-aspartate (NMDA), kainate, quisqualate and glutamate)-induced activation revealed qualitative and quantitative differences in their pattern of action, suggesting that these agonists act at distinct receptors. Evaluation of the blockade of EAA-induced bites by a series of antagonists: DL-2-amino-5-phosphonovalerate (APV), gamma-D-glutamyl glycine (DGG), kynurenate and glutamylaminomethylsulphonate (GAMS), indicated that selective activation of the NMDA, quisqualate and kainate receptors can be demonstrated using this behavior. The NMDA receptors could be subdivided on the basis of different sensitivity to kynurenate and APV. Antagonist-resistant components of both kainate and quisqualate action were also shown. Thus, the biting behavior induced by the administration of intrathecal EAA agonists can be used as a relatively selective behavioral tool for assessing the pharmacological profile of action of excitatory amino acid agonists and antagonists in the spinal cord.

2-Amino-5-phosphonovalerate↗

The mormyrid brainstem. I. Distribution of brainstem neurones projecting to the spinal cord in Gnathonemus petersii. An HRP study.

The sources of the descending spinal tracts were identified in the teleost fish Gnathonemus petersii by retrograde HRP transport. HRP injections were made at two spinal levels, either at level of the caudal end of the dorsal fin, anterior to the electric organ, or at the pectoral fin. In both cases all labeled cells were found in the rhombencephalon and the mesencephalic tegmentum. No labeled cells were observed either in the cerebellum and lateral line lobes or in the dorsal mesencephalon i.e. torus semicircularis and mesencephalic tectum or in the telencephalon. Following caudal spinal injections, the majority of the labeled cells were grouped in a median and a ventrolateral column of the rhombencephalic reticular formation. The latter is composed of three parts corresponding to the nucleus reticularis inferior, medius and superior. Both Mauthner cells, all the cells in the medullary relay nucleus controlling the electric organ discharge and a few cells in the posterior part of the magnocellular octaval nucleus were labeled. In the mesencephalon, four nuclei were identified by HRP labeling: the nucleus of the medial longitudinal fasciculus, the nucleus reticularis mesencephali and the anterior and posterior tegmental mesodiencephalic nuclei. The rostral injections revealed several additional spinal projections from the descending vestibular and tangential nuclei, from the medial part of the magnocellular nucleus and, finally, from the rostral periventricular gray of the mesencephalon. Also, after such injections, a greater number of cells were labeled in the reticular formation, especially in the median column and in the inferior reticular nucleus. The results suggest that the rostral spinal cord has a larger connection with the acoustico-vestibular area and the medullary reticular formation than the caudal spinal cord. In contrast, the mesencephalic nuclei, probably linked to the mesencephalic tectum and the pretectal area, appears to be a coordinating apparatus between the visual system and the trunk/tail musculature. Thus, it appears that teleost fish possess the same basic equipment of descending spinal pathways as higher vertebrates.

Animals↗

Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report.

OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. METHODS: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.

Administration, Cutaneous↗

Snake venom components enhance pain upon subcutaneous injection: an initial examination of spinal cord mediators.

Snakebites are a relevant public health problem in Central and South America. Snake bite envenomations cause intense pain, not relieved by anti-venom. The fangs of many species are short, causing subcutaneous injection. Fangs of larger species inflict subcutaneous or intramuscular envenomation. To understand pain induced by subcutaneous venom, this study examined spinal mechanisms involved in pain-enhancing effects of subcutaneous Lys49 and Asp49 secretory phospholipase-A(2) (sPLA2), two components of Bothrops asper snake venom showing highly different enzymatic activities. Unilateral intraplantar sPLA2-Lys49 (catalytically inactive) or sPLA2-Asp49 (catalytically active) into rat hindpaws each induced mechanical hyperalgesia (Randall-Selitto test), whereas only catalytically active sPLA2-Asp49 caused mechanical allodynia (von Frey test). Effects induced by both sPLA2s were inhibited by intrathecal fluorocitrate, a reversible glial metabolic inhibitor. In support, immunohistochemical analysis revealed activation of dorsal horn astrocytes and microglia after intraplantar injection of either sPLA2. Spinal proinflammatory cytokines, nitric oxide, and prostanoids each appear to be involved in the pain-enhancing effects of these sPLA2s. Blockade of interleukin-1 (IL1) inhibited hyperalgesia induced by both sPLA2s, while leaving allodynia unaffected. Blockade of tumor necrosis factor reduced responses to sPLA2-Asp49. An inhibitor of neuronal nitric oxide synthase, 7-nitroindazole (7-NI), inhibited hyperalgesia induced by both sPLA2s, without interfering with allodynia induced by sPLA2-Asp49. On the other hand, L-N(6)-(1-iminoethyl)lysine (L-NI), an inhibitor of the inducible nitric oxide synthase, did not alter any sPLA2-induced effect. Lastly, celecoxib, an inhibitor of cyclooxygenase-2, attenuated sPLA2 actions. These data provide the first evidence of spinal mediators involved in pain facilitation induced by subcutaneous venoms.

Animals↗

Pertussis toxin abolishes the antinociception mediated by opioid receptors in rat spinal cord.

Intrathecal injection of pertussis toxin (1 microgram) in rats produced a marked decrease in the antinociceptive effect of the intrathecally administered opioid agonists [D-Ala2,D-Leu5]enkephalin, [D-Ala2,N-Me-Phe4,Gly5-ol]enkephalin and bremazocine. The effect of the toxin was time-dependent, since it was more pronounced at 6 than at 2 days after its injection. The pertussis toxin-catalyzed ADP ribosylation of a 40 KDa substrate in membranes prepared from the spinal cord of toxin-injected rats was strongly reduced as compared to controls. The data indicate that the antinociceptive effect produced by opioid agonists with different receptor preference is initiated at receptor sites which interact with G-protein substrates of pertussis toxin.

Adenosine Diphosphate↗

Effect of intrathecal pretreatment with the neurokinin receptor antagonist CP-99994 on the expression of naloxone-precipitated morphine withdrawal symptoms.

In morphine-dependent rats pretreated with an intrathecal injection of saline (vehicle), intraarterial injection of 0.5 mg/kg of naloxone produced an immediate increase in blood pressure. Heart rate increased in most rats just after naloxone injection; however, the responses were transient, not lasting more than about 4 min after injection. Naloxone-precipitated behavioral changes were dominated by the appearance of body shakes and escape attempts that were strongly expressed during the first 10 min after naloxone. Pretreatment of morphine-dependent rats with an intrathecal injection of 100 nmol of the neurokinin-1 receptor antagonist CP-99994 significantly inhibited the magnitude and shortened the duration of the pressor response to naloxone. CP-99994 did ot reduce the expression of the associated withdrawal behaviors. Substance P significantly reversed the inhibitory effects of CP-99994 on the expression of the withdrawal-associated pressor response. Intrathecal pretreatment with CP-99994 also produced a dose-dependent inhibition of the expression of the pressor response to local spinal (intrathecal) injection of naloxone (60 micrograms) in morphine dependent rats without significant alteration of the expression of withdrawal-associated behaviors. These results indicate that spinal neurokinin-1 receptors mediate some of the cardiovascular signs of morphine withdrawal and suggest the possibility of developing a novel class of antiopiate withdrawal agents.

Animals↗

Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery.

In a controlled study a single segment combined spinal epidural (CSE) block was compared with spinal or epidural block for major orthopaedic surgery. Seventy-five patients, age 52-86 yr, were randomly assigned to receive one of the three blocks. Bupivacaine 0.5% was used for surgical analgesia. The postoperative pain relief after 4.0 mg epidural morphine was compared with the analgesic effect of 0.2 or 0.4 mg morphine administered intrathecally. With the spinal technique good or excellent surgical analgesia and muscle relaxation were achieved rapidly (11.8 +/- 1.1 min). The time taken to provide an equally effective and reliable block with the CSE technique was no longer (14.9 +/- 2.2 min). For epidural block with the catheter technique more time was required (35.9 +/- 3.9 min) to provide acceptable surgical conditions (P < 0.05). Perioperative sedatives and concomitant analgesics were required more frequently and in larger doses by the patients undergoing surgery with epidural block (P < 0.05) than with CSE or spinal block. Our study demonstrated that the analgesia after surgery provided by 0.2 and 0.4 mg morphine administered intrathecally was comparable to that provided by 4.0 mg of epidural morphine. It is concluded that the analgesia and surgical conditions provided by the spinal and CSE blocks were similar and were superior to those provided by an epidural block.

Aged↗

Prolonged discharge of wide-dynamic-range spinal neurons evoked by formaldehyde injected in their cutaneous receptive fields.

In decerebrate, unanesthetized cats, subcutaneous injection of formaldehyde solutions (0.05 ml, 2.5%) in the receptive fields of spinal wide-dynamic-range neurons elicited an immediate and continuous discharge or burst activity in the neurons that lasted 10 to 55 min. This discharge was reduced by conditioning stimulation of the medial raphe nucleus and was completely abolished by morphine (3 mg/kg, i.v.). Low-threshold cutaneous mechanoreceptive neurons in the dorsal horn and dorsal column nuclei did not show a sustained response.

Animals↗

Enhanced production of monocyte chemoattractant protein-1 in the dorsal root ganglia in a rat model of neuropathic pain: possible involvement in the development of neuropathic pain.

Chemokines are a family of peptides originally identified as the factors regulating the migration of leukocytes in inflammatory and immune responses. Recently, they have been shown to be produced in the central and peripheral nervous systems under various pathological conditions and act on neuronal and glial cells. In this study, we examined the production of monocyte chemoattractant protein-1 (MCP-1), a well-characterized chemokine, in dorsal root ganglia (DRG) in a rat model of neuropathic pain. Partial ligation of the sciatic nerve induced mechanical allodynia in the ipsilateral hindpaw with weaker allodynia in the contralateral one. Immunohistochemical analyses revealed that the number of MCP-1 immunoreactivity (ir)-positive cells was increased in the ipsilateral DRG. The increase started by 4h after the ligation, peaked at 24h and continued to at least 48 h. The weaker but significant increase was observed in the contralateral DRG. Double immunofluorescent staining demonstrated that almost all of the MCP-1ir-positive cells were neuronal cells. In situ hybridization histochemistry showed that MCP-1 mRNA expression was markedly upregulated in the ipsilateral DRG with weaker increase in the contralateral one at 24 h after the ligation, indicating that the elevation in MCP-1ir detected by immunohistochemistry was due to an upregulation of MCP-1 production by the DRG neurons themselves. Furthermore, intrathecal administration of MCP-1 induced mechanical allodynia. These results suggest that MCP-1 produced in the DRG neurons is involved in the development of mechanical allodynia induced by nerve injury.

Animals↗