Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Peripheral Opioid Receptor on Masticatory Muscle Pain Control

말초 opioid 수용체에 의한 저작근 통증의 조절 효과

  • Ko, Seok-Ho (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Kang, Soo-Kyung (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Auh, Q-Schick (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Kim, Eun-Cheol (Research Center for Tooth & Periodontal Regeneration (MRC), Kyung Hee University) ;
  • Hong, Jung-Pyo (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Chun, Yang-Hyun (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University)
  • 고석호 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 강수경 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 어규식 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 김은철 (경희대학교 치아와 치주조직재생연구센터(MRC)) ;
  • 홍정표 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 전양현 (경희대학교 치의학전문대학원 안면통증구강내과학교실)
  • Received : 2013.03.25
  • Accepted : 2013.04.19
  • Published : 2013.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into four group; saline injection group (n=10), lidocaine injection group (n=10), morphine 1.5 mg injection group (n=10) and morphine 3 mg injection group (n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 1 hour, 24 hour, 48 hour and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation were significantly different statistically in morphine 3 mg group after 48 hour. (VAS: p<0.01, MGQ: p<0.001, PD: p<0.05) 2. The objective pain evaluation were significantly different statistically in morphine 1.5 mg group after 1 hour. (PPT: p<0.01, PPTol: p<0.05) 3. The morphine 3 mg group were more significantly different than lidocaine group and morphine 1.5 mg group statistically in the McGill pain questionnaire evaluation. (1h: p<0.01, 24h: p<0.01, 48h: p<0.001) Therefore, it was revealed that the morphine 3 mg injection was effective to pain control for masticatory muscle pain patients within 48 hours and more effect than lidocaine injection.

이 연구는 저작근 통증 환자에게 Morphine을 주사하였을 때의 조절 효과를 확인하기 위해서 시행되었으며, 경희대학교 치과대학병원 구강내과에 내원한 환자 중 RDC/TMD로 근막통증으로 진단된 환자들이 지원하였다. 실험군은 총 네 군으로 구성되었으며 saline 주사군, lidocaine 주사군, morphine 1.5mg 주사군, morphine 3.0 mg 주사군에 각각 10명씩 배정하였다. 통증부위에 주사 전, 주사 후 1시간, 24시간, 48시간에 각각 주관적인 통증 평가인 시각유추척도검사, 맥길통증설문지검사 그리고 통증부위표시검사와 객관적인 통증 평가인 압력통증역치검사와 압력통증한계검사를 실시하였다. 검사 후 평가된 자료를 통계 처리하여 다음과 같은 결과를 얻었다. 1. 주관적인 통증평가에서 morphine 3 mg 군은 48시간 후 통계학적으로 유의성 있는 효과가 있었다.(VAS: p<0.01, MGQ: p<0.001, PD: p<0.05) 2. 객관적인 통증평가에서 morphine 1.5 mg 군은 1시간 후 통계학적으로 유의성 있는 효과가 있었다.(PPT: p<0.01, PPTol: p<0.05) 3. 맥길통증설문지에서 lidocaine 군, morphine 1.5 mg 군 그리고 morphine 3 mg 군은 모두 처치 후 1시간부터 효과가 있었으나 상대적으로 morphine 3 mg 군에서 통계학적으로 유의성 있게 더 큰 효과가 있었다.(1h: p<0.01, 24h: p<0.01, 48h: p<0.001) 이상의 연구 결과로 저작근에 통증이 있는 환자에게 morphine 주사 시 주관적인 평가에서 48시간 후 통증 조절 효과가 있었고, morphine 3 mg이 더 효과가 있었으며, 향후 시간 연장에 따른 지속적인 추가 연구가 필요 할 것으로 생각된다.

Keywords

References

  1. Stein C, Lang LJ. Peripheral mechanisms of opioid analgesia. Current Opinion in Pharmacology 2009;9:3 -8. https://doi.org/10.1016/j.coph.2008.12.009
  2. Stein C, Hassan AHS, Przewlocki R, Gramsch C, Peter K, Herz A. Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation. Proc Natl Acad Sci USA 1990;87:5935-5939. https://doi.org/10.1073/pnas.87.15.5935
  3. Przewlocki R, Hassan AHS, Lason W, Epplen C, Herz A, Stein C. Gene expression and localization of opioid peptides in immune cells of inflamed tissue: functional role in antinociception. Neuroscience 1992;48:491-500. https://doi.org/10.1016/0306-4522(92)90509-Z
  4. Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL. Multiple opiate receptor sites on primary afferent fibres. Nature 1980;284:351-353. https://doi.org/10.1038/284351a0
  5. Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993;76:182-191.
  6. Machelka H. Targeting of opioid-producing leukocytes for pain control. Neuropeptides 2007;41:355 -363. https://doi.org/10.1016/j.npep.2007.06.001
  7. Boogaerts J, Lafont N. Mechanism of action and clinical use of opioids administered by the peripheral perineural route. Cah Anesthesiol 1991;39:91-95.
  8. Nũnéz S, Lee JS, Zhang Y, Bai G, Ro JY. Role of peripheral mu-opioid receptors in inflammatory orofacial muscle pain. Neuroscience 2007;146: 1346- 1354. https://doi.org/10.1016/j.neuroscience.2007.02.024
  9. Modi M, Rastogi S, Kumar A, Buprenorphine with bupivacaine for intraoral nerve blocks to provide postoperative analgesia in outpatients after minor oral surgery. J Oral Maxillofac Surg 2009 Dec;67(12): 2571-2576. https://doi.org/10.1016/j.joms.2009.07.014
  10. Ziegler CM, Wiechnik J, Mühling J. Analgesic effects of intra-articular morphine in patients with temporomandibular joint disorders: a prospective, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg 2010 Mar;68(3):622-627. https://doi.org/10.1016/j.joms.2009.04.049
  11. Piani D, Frei K, Do KQ, Cuenod M, Fontana A, Murine brainmacrophages induce NMDA receptor mediated neurotoxicity in vitro by secreting glutamate. Neurosci. Lett 1991;133:159-162.
  12. Parpura V, Liu F, Jeftinija KV, Haydon PG, Jeftinija SD. Neuroligand-evoked calcium-dependent release of excitatory amino acids from Schwann cells. J. Neurosci 1995;15:5831-5839.
  13. DeGroot J, Zhou S, Carlton SM, Peripheral glutamate release in the hindpaw following low and high intensity sciatic stimulation. Neuroreport 2000;11: 497-502. https://doi.org/10.1097/00001756-200002280-00014
  14. Lawand NB, McNearney T, Westlund KN, Amino acid release into the knee joint: key role in nociception and inflammation. Pain 2000;86:69-74. https://doi.org/10.1016/S0304-3959(99)00311-5
  15. Chun YH, Frank D, Lee JS, Zhang Y, Auh QS, Ro JY. Peripheral AMPA receptors contribute to muscle nociception and c-fos activation. Neuroscience Research 2008;62:97-104. https://doi.org/10.1016/j.neures.2008.06.007
  16. Ro JY, Capra NF, Lee JS, Masri R, Chun YH. Hypertonic saline-induced muscle nociception and c-fos activation are partially mediated by peripheral NMDA receptors. European Journal of Pain 2007;11:398-405. https://doi.org/10.1016/j.ejpain.2006.05.008
  17. Castrillon EE, Cairns BE, Ernberg M et al. Effect of peripheral NMDA receptor blockade with ketamine on chronic myofascial pain in temporomandibular disorder patients: a randomized, double-blinded, placebo-controlled trial. J Orofac Pain 2008 Spring;22 (2):122-130.
  18. Alfredson H, Forsgren S, Thorsen K, Lorentzon RJ. In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper's knee. Orthop Res 2001;19:881-886. https://doi.org/10.1016/S0736-0266(01)00016-X
  19. Rosendal L, Larsson B, Kristiansen J et al. Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise. Pain 2004;112:324-334. https://doi.org/10.1016/j.pain.2004.09.017
  20. Arima T, Svensson P, Arendt-Nielsen L. Capsaicininduced muscle hyperalgesia in the exercised and non-exercised human masseter muscle. J. Orofac. Pain 2000;14:213-223.
  21. Arima T, Arendt-Nielsen L, Minagi S, Svensson P. Effect of capsaicin-evoked jaw-muscle pain on intramuscular blood-flow. Arch. Oral Biol 2009;54:241 -249. https://doi.org/10.1016/j.archoralbio.2008.11.005
  22. Wang K, Arendt-Nielsen L, Svensson P. Capsaicininduced muscle pain alters the excitability of thehumanjaw-stretch reflex. J. Dent. Res 2002;81:650 -654.
  23. Lee JS, Zhang Y, Ro JY. Involvement of neuronal, inducible, and endothelia nitric oxide synthases in capsaicin-induced muscle hypersensitivity. Eur J Pain 2009;13(9):924-928. https://doi.org/10.1016/j.ejpain.2008.11.009
  24. Ro JY, Lee JS, Capra NF, Zhang Y. Role of soluble guanylatecyclase in the trigeminal subnucleus caudalis incapsaicin-induced muscle hypersensitivity. Brain Res 2007;1184:141-148. https://doi.org/10.1016/j.brainres.2007.09.085
  25. Ro JY, Lee JS, Zhang Y. Activation of TRPV1 and TRPA1 leads to muscle nociception and mechanical hyperalgesia. Pain 2009;144:270-277. https://doi.org/10.1016/j.pain.2009.04.021
  26. Chun YH, Ro JY. Electrophysiological characterization of the rat trigeminal caudalis (Vc) neurons following intramuscular injection of capsaicin. Neuroscience Letters 2010;469:289-293. https://doi.org/10.1016/j.neulet.2009.10.012
  27. Arendt-Nielsen L, Svensson P, Sessle BJ, Cairns BE, Wanga K. Interactions between Glutamate and Capsaicin in Inducing Muscle Pain and Sensitization in Humans. Eur J Pain 2008 July;12(5):661-670. https://doi.org/10.1016/j.ejpain.2007.10.013
  28. Mansour A, Fox CA, Burke S, Meng F, Thompson RC, Akil H, Watson SJ. Mu, delta, and kappa opioid receptor mRNA expression in the rat CNS: an in situ hybridization study. J Comp Neurol 1994;350:412-438. https://doi.org/10.1002/cne.903500307
  29. Minami M, Maekawa K, Yabuuchi K, Satoh M. Double in situ hybridization study on coexistence of mu, delta and kappa OR mRNAs with preprotachykinin A mRNA in the rat dorsal root ganglia. Brain Res Mol Brain Res 1995;30:203-210. https://doi.org/10.1016/0169-328X(94)00290-U
  30. Mennicken F, Zhang J, Hoffert C, Ahmad S, Beaudet A, O''Donnell D. Phylogenetic changes in the expression of delta opioid receptors in spinal cord and dorsal root ganglia. J Comp Neurol 2003;465:349-360. https://doi.org/10.1002/cne.10839
  31. Dado RJ, Law PY, Loh HH, Elde R. Immunofluorescent identification of a delta (delta)-opioid receptor on primary afferent nerve terminals. Neuroreport 1993;5:341-344. https://doi.org/10.1097/00001756-199312000-00041
  32. Arvidsson U, Riedl M, Chakrabarti S et al. Wessendorf MW, Elde R. Distribution and targeting of a mu-opioid receptor (MOR1) in brain and spinal cord. J Neurosci 1995;15:3328-3341.
  33. Ji RR, Zhang Q, Law PY, Low HH, Elde R, Hokfelt T. Expression of mu-, delta-, and kappa-opioid receptor-like immunoreactivities in rat dorsal root ganglia after carrageenan-induced inflammation. J Neurosci 1995;5:8156-8166.
  34. Coggeshall RE, Zhou S, Carlton SM. Opioid receptors on peripheral sensory axons. Brain Res 1997;764:126 -132. https://doi.org/10.1016/S0006-8993(97)00446-0
  35. Hassan AH, Ableitner A, Stein C, Herz A. Inflammation of the rat paw enhances axonal transport of opioid receptors in the sciatic nerve and increases their density in the inflamed tissue. Neuroscience 1993;55:185-195. https://doi.org/10.1016/0306-4522(93)90465-R
  36. Mousa SA, Zhang Q, Sitte N, Ji R, Stein C. beta-Endorphincontaining memory-cells and mu-opioid receptors undergo transport to peripheral inflamed tissue. J Neuroimmunol 2001;115:71-78. https://doi.org/10.1016/S0165-5728(01)00271-5
  37. Schäfer M, Imai Y, Uhl GR, Stein C. Inflammation enhances peripheral mu-opioid analgesia, but not mu-opioid receptor transcription in dorsal root ganglia. Eur J Pharmacol 1995;279:165-169. https://doi.org/10.1016/0014-2999(95)00150-J
  38. Antonijevic I, Mousa SA, Schäfer M, Stein C. Perineurial defect and peripheral opioid analgesia in inflammation. J Neurosci 1995;15:165-172.
  39. Stein C, Schafer M, Machelska H. Attacking pain at its source: new perspectives on opioids. Nat Med 2003;9:1003-1008. https://doi.org/10.1038/nm908
  40. Jessell TM, Iversen LL. Opiate analgesics inhibit substance Prelease from rat trigeminal nucleus. Nature 1977;268:549-551. https://doi.org/10.1038/268549a0
  41. Tegeder I, Meier S, Burian M, Schmidt H, Geisslinger G, Lotsch J. Peripheral opioid analgesia in experimental human pain models. Brain 2003;126: 1092-1102. https://doi.org/10.1093/brain/awg115
  42. Bakke M, Hu JW, Sessle BJ. Morphine application to peripheral tissues modulates nociceptive jaw reflex. Neuroreport 1998;9:3315-3319. https://doi.org/10.1097/00001756-199810050-00030
  43. Eisenberg E, Vos BP, Strassman AM. The peripheral antinociceptive effect of morphine in a rat model of facial pain. Neuroscience 1996;72:519-525. https://doi.org/10.1016/0306-4522(95)00565-X
  44. Houghton AK, Valdez JG, Westlund KN. Peripheral morphine administration blocks the development of hyperalgesia and allodynia after bone damage in the rat. Anesthesiology 1998;89:190-201. https://doi.org/10.1097/00000542-199807000-00026
  45. Catheline G, Guilbaud G, Kayser V. Peripheral component in the enhanced antinociceptive effect of systemic U-69,593, a kappa opioid receptor agonist in mononeuropathic rats. Eur J Pharmacol 1998;357:171 -178. https://doi.org/10.1016/S0014-2999(98)00597-4
  46. Truong W, Cheng C, Xu QG, Li XQ, Zochodne DW. Mu opioid receptors and analgesia at the site of a peripheral nerve injury. Ann Neurol 2003;53:366-375. https://doi.org/10.1002/ana.10465
  47. Ko MC, Butelman ER, Woods JH. The role of peripheral mu opioid receptors in the modulation of capsaicin-induced thermal nociception in rhesus monkeys. J Pharmacol Exp Ther 1998;286:150-156.
  48. Duckett JW, Cangiano T, Cubina M, Howe C, Cohen D. Intravesical morphine analgesia after bladder surgery. J Urol 1997;157:1407-1409. https://doi.org/10.1016/S0022-5347(01)65001-8
  49. Likar R, Schafer M, Paulak F et al. Intraarticular morphine analgesia in chronic pain patients with osteoarthritis. Anesth Analg 1997;84:1313-1317.
  50. Rorarius M, Suominen P, Baer G, Pajunen P, Tuimala R, Laippala P. Peripherally administered sufentanil inhibits pain perception after postpartum tubal ligation. Pain 1999;79:83-88. https://doi.org/10.1016/S0304-3959(98)00157-2
  51. Likar R, Sittl R, Gragger K et al. Peripheral morphine analgesia in dental surgery. Pain 1998;76:145-150. https://doi.org/10.1016/S0304-3959(98)00036-0
  52. Likar R, Koppert W, Blatnig H et al. Efficacy of peripheral morphine analgesia in inflamed, noninflamed and perineural tissue of dental surgery patients. J Pain Symptom Manage 2001;21:330-337. https://doi.org/10.1016/S0885-3924(01)00251-2
  53. Eisenach JC, Carpenter R, Curry R. Analgesia from a peripherally active kappa-opioid receptor agonist in patients with chronic pancreatitis. Pain 2003;101:89-95. https://doi.org/10.1016/S0304-3959(02)00259-2
  54. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004;428:125-130. https://doi.org/10.1097/01.blo.0000147701.24029.cc
  55. Grabowska-Gawel A, Gawel K, Hagner W, Biliński PJ. Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. Ortop Traumatol Rehabil 2003;5(6): 758-762.
  56. Rosseland LA, Stubhaug A, Grevbo F, Reikerås O, Breivik H. Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy: A randomized, double-blind controlled clinical study. Acta Anaesthesiol Scand 2003;47:732-738. https://doi.org/10.1034/j.1399-6576.2003.00155.x