Journal of Korean Neurosurgical Society

  • 제47권6호
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  • Pages.420-423
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  • 2010
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Involvement of Selective Alpha-2 Adrenoreceptor in Sympathetically Maintained Pain

  • Park, Chan-Hong (Department of Anesthesiology and Pain Medicine, Daegu Wooridul Hospital) ;
  • Yong, An (Department of Neurosurgery, Daegu Wooridul Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Hospital)
  • 투고 : 2010.03.23
  • 심사 : 2010.05.23
  • 발행 : 2010.06.28
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초록

Objective : Peripheral nerve injury often leads to neuropathic pain, which is characterized by burning pain, allodynia, and hyperalgesia. The role of the sympathetic nervous system in neuropathic pain is a complex and controversial issue. It is generally accepted that the alpha adrenoreceptor (AR) in sympathetic nerve system plays a significant role in the maintenance of pain. Among alpha adrenoreceptor, alpha-1 receptors play a major role in the sympathetic mediated pain. The primary goal of this study is to test the hypothesis that sympathetically maintained pain involves peripheral alpha-2 receptors in human. Methods : The study was a randomized, prospective, double-blinded, crossover study involving twenty patients. The treatments were : Yohimbine (30 mg mixed in 500 mL normal saline), and Phentolamine (1 mg/kg in 500 mL normal saline) in 500 mL normal saline at 70 mL/hr initially then titrated. The patients underwent infusions on three different appointments, at least one month apart. Thus, all patients received all 2 treatments. Pain measurement was by visual analogue scale, neuropathic pain questionnaire, and McGill pain questionnaire. Results : There were significant decreases in the visual analogue scale, neuropathic score, McGill pain score of yohimnine, and phentolamine. Conclusion : We conclude that alpha-2 adrenoreceptor, along with alpha-2 adrenoreceptor, may be play role in sympathetically maintained pain in human.

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참고문헌

  1. Bonica JJ : Causalgia and other reflex sympathetic dystrophies in Bonica JJ (ed) The Management of Pain, Vol. 2. Philadelphia : Leaand Febiger, 1990, pp220-243
  2. Bridge D, Thompson SW, Rice AS : Mechanisms of neuropathic pain. Br J Anaesth 87 : 12-26, 2001 https://doi.org/10.1093/bja/87.1.12
  3. Chen Y, Michaelis M, Janig W, Devor M : Adrenoreceptor subtype mediating sympathetic-sensory coupling in injured sensory neurons. J Neurophysiol 76 : 3721-3730, 1996
  4. Dennis SG, Melzack R, Gutman S, Boucher F : Pain modulation by adrenergic agents and morphine as measured by three pain tests. Life Sci 26 : 1247-1259, 1980 https://doi.org/10.1016/0024-3205(80)90070-3
  5. Goldstein DS, Grossman E, Listwak S, Folio CJ : Sympathetic reactivity during a yohimbine challenge test in essential hypertension. Hypertension 18 : III40-III48, 1991 https://doi.org/10.1161/01.HYP.18.5_Suppl.III40
  6. Grossman E, Rea RF, Hoffman A, Goldstein DS : Yohimbine increases sympathetic nerve activity and norepinephrine spillover in normal volunteers. Am J Physiol 260 : R142-R147, 1991
  7. Guthrie SK, Hariharan M, Grunhaus LJ : Yohimbine bioavailability in humans. Eur J Clinic Pharmacol 39 : 409-411, 1990 https://doi.org/10.1007/BF00315421
  8. Hord AH, Denson DD, Stowe B, Haygood RM : alpha-1 and alpha- 2 Adrenergic antagonists relieve thermal hyperalgesia in experimental mononeuropathy from chronic constriction injury. Anesth Analg 92 : 1558-1562, 2001
  9. Kim SH, Chung JM : Sympathectomy alleviates mechanical allodynia in an experimental animal model for neuropathy in the rat. Neurosci Lett 134 : 131-134, 1991 https://doi.org/10.1016/0304-3940(91)90524-W
  10. Kim SK, Min BI, Kim JH, Hwang BG, Yoo GY, Park DS, et al. : Effects of alpha1- and alpha2-adrenoreceptor antagonists on cold allodynia in a rat tail model of neuropathic pain. Brain Res 1039 : 207-210, 2005 https://doi.org/10.1016/j.brainres.2005.01.051
  11. Kingery WS, Guo TZ, Davies MF, Limbird L, Maze M : The alpha (2A) adrenoceptor and the sympathetic postganglionic neuron contribute to the development of neuropathic heat hyperalgesia in mice. Pain 85 : 345-358, 2000 https://doi.org/10.1016/S0304-3959(99)00286-9
  12. Korenman EM, Devor M : Ectopic adrenergic sensitivity in damaged peripheral nerve axons in the rat. Exp Neurol 72 : 63-81, 1981 https://doi.org/10.1016/0014-4886(81)90127-8
  13. Lee DH, Liu X, Kim HT, Chung K, Chung JM : Receptor subtype mediating the adrenergic sensitivity of pain behavior and ectopic discharges in neuropathic Lewis rats. J Neurophysiol 81 : 2226- 2233, 1999
  14. Leem JW, Gwak YS, Nam TS, Paik KS : Involvement of alpha2- adrenoceptors in mediating sympathetic excitation of injured dorsal root ganglion neurons in rats with spinal nerve ligation. Neurosci Lett 234 : 39-42, 1997 https://doi.org/10.1016/S0304-3940(97)00658-7
  15. Miranda HF, Sierralta F, Pinardi G : An isobolographic analysis of the adrenergic modulation of diclofenac antinociception. Anesth Analg 93 : 430-435, 2001
  16. Raja SN, Treede RD, Davis KD, Campbell JN : Systemic alphaadrenergic blockade with with phentolamine : a diagnostic test for sympathetically maintained pain. Anesthesiology 74 : 691-698, 1991 https://doi.org/10.1097/00000542-199104000-00012
  17. Ren Y, Zou X, Fang L, Lin Q : Sympathetic modulation of activity in Adelta- and C-primary nociceptive afferents after intradermal injection of capsaicin in rats. J Neurophysiol 93 : 365-377, 2005
  18. Sato J, Perl ER : Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science 251 : 1608-1610, 1991 https://doi.org/10.1126/science.2011742
  19. Sato J, Suzuki S, Iseki T, Kumazawa T : Adrenergic excitation of cutaneous nociceptors in chronically inflamed rats. Neurosci Lett 164 : 225-228, 1993 https://doi.org/10.1016/0304-3940(93)90897-T
  20. Shannon HE, Lutz EA : Yohimbine produces antinociception in the formalin test in rats : involvement of serotonin (1A) receptors. Psychopharmacology (Berl) 149 : 93-97, 2000 https://doi.org/10.1007/s002139900343
  21. Shir Y, Seltzer Z : Effects of sympathectomy in a model of causalgiform pain produced by partial sciatic nerve injury in rats. Pain 45 : 309-320, 1991 https://doi.org/10.1016/0304-3959(91)90056-4
  22. Stokes ME, Davis CS, Koch GG : Categorical Data Analysis Using the SAS System, 2nd ed. Cary, NC : SAS Institute Inc., 2000, pp 487-494
  23. Takano Y, Yaksh TL : Characterization of the pharmacology of intrathecally administered alpha-2 agonists and antagonists in rats. J Pharmacol Exp Ther 261 : 764-772, 1992
  24. Tam SW, Worcel M, Wyllie M : Yohimbine : a clinical review. Pharmacol Ther 91 : 215-243, 2001 https://doi.org/10.1016/S0163-7258(01)00156-5
  25. Tasker RA, Melzack R : Difference alpha-receptor subtypes are involved in clonidine produced analgesia in different pain tests. Life Sci 44 : 9-17, 1989
  26. Tracey DJ, Cunningham JE, Romm MA : Peripheral hyperalgesia in experimental neuropathy : mediation by alpha 2-adrenoreceptors on post-ganglionic sympathetic terminals. Pain 60 : 317-327, 1995 https://doi.org/10.1016/0304-3959(94)00141-Z
  27. Unnerstall JR, Kopajtic TA, Kuhar MJ : Distribution of alpha 2 agonist binding sites in the rat and human central nervous system : analysis of some functional anatomic correlates of the pharmacologic effects of clonidine and related adrenergic agent. Brain Res 1 : 69-101, 1984
  28. Verdugo RJ, Ochoa JL : Sympathetically maintained pain., I. Phentolamine block questions the concept. Neurology 44 : 1003-1010, 1994 https://doi.org/10.1212/WNL.44.6.1003
  29. Vuckovic SM, Tomic MA, Stepanovic Petrovic RM, Ugresic N, Prostran MS, Boskovic B : The effects of alpha2-adrenoceptor agents on anti-hyperalgesic effects of carbamazepine and oxcarbazepine in a rat model of inflammatory pain. Pain 125 : 10-19, 2006 https://doi.org/10.1016/j.pain.2006.04.023
  30. Winter JC, Rabin RA : Yohimbine as a serotonergic agent : evidence from receptor binding and drug discrimination. J Pharmacol Exp Ther 263 : 682-689, 1992
  31. Xie Y, Zhang J, Petersen M, LaMotte RH : Functional changes in dorsal root ganglion cells after chronic nerve constriction in the rat. J Neurophysiol 73 : 1811-1820, 1995

피인용 문헌

  1. Use of sensory-sympathetic coupling indices for diagnosing sympathetically maintained pain with laser Doppler flowmetry vol.38, pp.2, 2010, https://doi.org/10.1134/s0362119712020132