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Detection of Substance P, Calcitonin Gene-Related Peptide and Prostaglandin E2 in Human Epidural Space  

Paek, Sung Hee (Sarangmore Pain Clinic)
Kim, Hae Taek (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu)
Kim, Bong Il (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu)
Publication Information
The Korean Journal of Pain / v.19, no.2, 2006 , pp. 168-174 More about this Journal
Abstract
Background: Several biochemical mediators, such as substance P, calcitonin gene-related peptide (CGRP) and prostaglandin $E_2$, have been demonstrated to be involved in herniated or degenerated disc-induced radiculopathy. The authors tested the hypothesis that these mediators would existed in the epidural space of humans. Methods: Thirty nine patients were divided into two groups; 27 patients, who were diagnosed with spinal stenosis (stenosis group), and 12 scheduled for epidural anesthesia, without a history of back pain (control group). Under fluoroscopic guidance, an epidural catheter was introduced through the caudal space and placed into the anterior and posterior spaces, up to and around the epidural adhesive area, in the stenosis group. In the control group, the catheter was placed into the posterior epidural space through the L3⁣-4 or L4⁣-5 intervertebral space. Epidural irrigation was performed with 10 ml of saline, via an epidural catheter. Aspirated lavage fluid was collected, and the concentrations of biochemical mediators (substance P, CGRP and prostaglandin $E_2$) measured using an enzyme immunoassay kit. Results: Substance P, CGRP and prostaglandin $E_2$ were detected in all the epidural lavage fluids from both groups. The concentrations of substance P and prostaglandin $E_2$ in the stenosis group were higher than those of the control (P < 0.05). However, there was no difference in the CGRP levels between the two groups. In the stenosis group, the concentrations of these three mediators in the anterior epidural space were no different to those in the posterior space. Conclusions: These results suggest that biochemical mediators, such as substance P and prostaglandin $E_2$, in the epidural space might be partly involved in pain mechanism associated with spinal stenosis.
Keywords
calcitonin gene-related peptide; epidural space; prostaglandin $E_2$; substance P; spinal stenosis;
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1 Kuraishi Y, Hirota N, Sato Y, Kaneko S, Satoh M, Takagi H: Noradrenergic inhibition of the release of substance P from the primary efferents in rabbit spinal dorsal horn. Brain Res 1985;359: 177-82   DOI   ScienceOn
2 Kim Bl, Kim JH, Lee JS, Chung JY, Roh WS, Park CH: Anterior epidural irrigation in patient with lumbar spinal stenosis. A case report. Korean J Pain 2004; 17: 330-3   DOI   ScienceOn
3 Sameshima K: Substance P-like immunoreactivity in cerebrospinal fluid in lumbar disc herniation. Nippon Seikeigeka Gakkai Zasshi 1995; 69: 191-7
4 Nilsson J, von Euler AM, Dalsgaard CJ: Stimulation of connec tive tissue cell growth by substance P and substance K. Nature 1985; 315: 61-3   DOI   ScienceOn
5 Beaman DN, Graziano GP, Glover RA, Wojtys EM, Chang V: Substance P innervation of lumbar spine facet joints. Spine 1993;18: 1044-9   DOI   ScienceOn
6 Coderre TJ, Gonzales R, Goldyne ME, West J, Levine JD: Noxious stimulus-induced increase in spinal prostaglandin $E_2$ is noradrenergic terminal-dependent. Neurosci Lett 1990; 115: 253-8   DOI   ScienceOn
7 Malmberg AB, Yaksh TL: The effect of morphine on formalinevoked behaviour and spinal release of excitatory amino acids and prostaglandin $E_2$, using microdialysis in conscious rats. Br J Pharmacol 1995; 114: 1069-75   DOI   ScienceOn
8 Capogna G, Celleno D, Simonetti C, Lupoi D: Anatomy of the lumbar epidural region using magnetic resonance imaging: a study of dimensions and a comparison of two postures. Int J Obstet Anesth 1997; 6: 97-100   DOI   ScienceOn
9 Borenstein DG, Wiesel SW, Boden SD: Low back pain: medical diagnosis and comprehensive management. 2nd ed. Philadelphia, W.B. Saunders Company. 1995, p 14
10 Lee WY, Jeong YS: The effects of epiduroscopy in spinal stenosis. A case report. Korean J Pain 2002; 15: 154-8
11 el-Bohy A, Cavanaugh JM, Getchell ML, Bulas T, Getchell TV, King AI: Localization of substance P and neurofilament immunoreactive fibers in the lumbar facet joint capsule and supraspinous ligament of the rabbit. Brain Res 1988; 460: 379-82   DOI   ScienceOn
12 Oku R, Saroh M, Takagi H: Release of substance P from the spinal dorsal horn is enhanced in polyarthritic rats. Neurosci Lett 1987; 74: 315-9   DOI   ScienceOn
13 Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV, Dommisse GF, Edgar MA, er al: Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 1976; 115: 4-5
14 Porro CA, Cavazzuti M: Spatial and temporal aspects of spinal cord and brain stem activation In formalin pain model. Prog Neurobiol 1993; 41: 565-607   DOI   ScienceOn
15 Neumann S, Doubell TP, Leslie T, Woolf CJ: Inflammatory pain hypersensitivity mediated by phenotypic switch in myelinated primary sensory neurons. Narure 1996; 384: 360-4
16 Rosenow DE: Does neural blockade and other neurosurgical modalities offer a durable pain relief for spinal disorders) Best Pract Res Clin Rheumatol 2002; 16: 155-64   DOI   ScienceOn
17 Dray A, Bevan S: Inflammation and hyperalgesia: highlighting the team effort. Trends Pharmacol Sci 1993; 14: 287-90   DOI   ScienceOn
18 Henry CH, Wolford LM: Substance P and mast cells: preliminary histologic analysis of the human temporomandibular joint. Oral Surg Oral Med Oral Parhol Oral Radiol Endod 2001; 92: 384-9   DOI   ScienceOn
19 Korkala O, Gronblad M, Liesi P, Karaharju E: Immunohistochemical demonstration of nociceptors in the ligamentous structures of the lumbar spine. Spine 1985; 10: 156-7   DOI
20 Yamagata K, Andreasson KI, Kaufmann WE, Barnes CA, Worley PF: Expression of a mitogen-inducible cyelooxygenase in brain neurons: regulation by synaptic activity and glucocorticoids. Neuron 1993; 11: 371-86   DOI   ScienceOn
21 Nishisho T, Tonai T, Tamura Y, Ikata T: Experimental and clinical studies of eicosanoids in cerebrospinal fluid after spinal cord injury. Neurosurgery 1996; 39: 950-6   DOI
22 Narozny M, Zanetti M, Boos N: Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Swiss Med Wkly 2001; 131: 75-80
23 Kallakuri S, Singh A, Chen C, Cavanaugh JM: Demonstration of substance P, calcitonin gene-related peptide, and protein gene product 9.5 containing nerve fibers in human cervical facet joint capsules. Spine 2004; 29: 1182-6   DOI   ScienceOn
24 Igarashi T, Hirabayashi Y, Seo N, Saitoh K, Fukuda H, Suzuki H: Lysis of adhesions and epidural injection of steroid/local anaesthetic eluring epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis. Br J Anaesth 2004; 93: 181-7   DOI   ScienceOn
25 Yule KA, White SR: Migration of 3T3 and lung fibroblasts in response to calcitonin gene-related peptide and bombesin. Exp Lung Res 1999; 25: 261-73   DOI
26 Willingale HL, Gardiner NJ, McLymont N, Giblett S, Grubb BD: Prostanoids synthesized by cyelo-oxygenase isoforms in rat spinal cord and their contribution to the development of neuronal hyperexcitability. Br J Pharmacol 1997; 122: 1593-604   DOI   ScienceOn
27 Hood VC, Cruwys SC, Urban L, Kidd BL: Differential role of neurokinin receptors in human lymphocyte and monocyte chemotaxis. Regul Pept 2000; 96: 17-21   DOI   ScienceOn
28 Tuncer Ll, Alacam T, Oral B: Substance P expression is elevated in inflamed human periradicular tissue. J Endod 2004; 30: 329-32   DOI   ScienceOn
29 Dalsgaard CJ, Hultgardh-Nilsson A, Haegerstrand A, Nilsson J: Neuropeptides as growth factors. Possible roles in human diseases. Regul Pept 1989; 25: 1-9   DOI   ScienceOn
30 McCarron RF, Wimpee MW, Hudkins PG, Laros GS: The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine 1987; 12: 760-4   DOI
31 Lee WT, Sohn MK, Park SH, Ahn SK, Lee JE, Park KA: Studies on the changes of c-fos protein in spinal cord and neurotransmitter in dorsal root ganglion of the rat with an experimental peripheral neuropathy. Yonsei Med J 2001; 42: 30-40   DOI
32 The Korean Pain Society: Pain medicine. 2nd ed. Seoul, Koonja Publishing Inc. 2000, pp 8-26, pp 123-43
33 Parris WC, Kambam JR, Naukarn RJ, Rama Sastry BV: Immunoreactive substance P is decreased in saliva of patients with chronic back pain syndromes. Anesth Analg 1990; 70: 63-7   DOI
34 Nakamura-Craig M, Smith TW: Substance P and peripheral inflammatory hyperalgesia. Pain 1989; 38: 91-8   DOI   ScienceOn
35 Fritz JM, Delitto A, Welch WC, Erhard RE: Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil 1998; 79: 700-8   DOI   ScienceOn
36 Brain SD, Williams TJ, Tippins JR, Morris HR, MacIntyre I: Calcitonin gene-related peptide is a potent vasodilator. Nature 1985; 313: 54-6   DOI   ScienceOn
37 Onda A, Yabuki S, Iwabuchi M, Anzai H, Olmarker K, Kikuchi S: Lumbar sympathectomy increases blood flow in a dog model of chronic cauda equina compression. J Spinal Disord Tech 2004;17: 522-5   DOI   ScienceOn
38 Rang HP, Bevan S, Dray A: Nociceptive peripheral neurons: cellular properties. In: Textbook of pain. 3rd ed. Edited by Wall PD, Melzack R: London, Churchill Livingstone. 1994, pp 57-78
39 Marshall LL, Trethewie ER, Curtain CC: Chemical radiculitis. A clinical, physiological and immunological study. Clin Orthop Relar Res 1977; 129: 61-7   DOI
40 Kallakuri S, Cavanaugh JM, Blagoev DC: An immunohistochemical study of innervation of lumbar spinal dura and longitudinal ligaments. Spine 1998; 23: 403-11   DOI   ScienceOn
41 Vanegas H, Schaible HG: Prostaglandins and cyelooxygenases In the spinal cord. Prog Neurobiol 2001; 64: 327-63   DOI   ScienceOn
42 Hokfelt T, Kellerth JO, Nilsson G, Pernow B: Experimental immunohistochemical studies on the localization and distribution of substance P in cat primary sensory neurons. Brain Res 1975;100: 235-52   DOI   ScienceOn
43 Traub RJ: The spinal contribution of substance P to the generation and maintenance of inflammatory hyperalgesia in the rat. Pain 1996; 67: 151-61   DOI   ScienceOn
44 Lieb K, Fiebich BL, Busse-Grawitz M, Hull M, Berger M, Bauer J: Effects of substance P and selected other neuropeptides on the synthesis of interleukin 1$\beta$ and interleukin-6 in human monocytes: a re-examination. J Neuroimmunol 1996; 67: 77-81
45 Muth-Selbach US, Tegeder I, Brune K, Geisslinger G: Acetaminophen inhibits spinal prostaglandin E, release after peripheral noxious stimulation. Anesthesiology 1999; 91: 231-9   DOI   ScienceOn
46 Ackermann PW, Li J, Lundeberg T, Kreicbergs A: Neuronal plasticity in relation to nociception and healing of rat achilles tendon. J Orthop Res 2003; 21: 432-41   DOI   ScienceOn