Dual role of osteoblastic proenkephalin derived peptides in skeletal tissues

Proenkephalin encodes a group of small peptides with opiate-like activity, the endogenous opioids, known to function as neurohormones, neuromodulators, and neurotransmitters. Recently, we have demonstrated that in addition to its abundance in fetal brain tissue, proenkephalin is highly expressed in nondifferentiated mesodermal cells of developing fetuses. We identified the skeletal tissues, bone, and cartilage as major sites of proenkephalin expression. To examine the possibility that proenkephalin is involved in bone development we have studied the expression of this gene in bone-derived cells, its modulation by bone active hormones, and the effects of enkephalin-derived peptides on osteoblastic phenotype. Our studies revealed that osteoblastic cells synthesize high levels of proenkephalin mRNA which are translated, and the derived peptides are secreted. Reciprocal interrelationships between osteoblast maturation and proenkephalin expression were established. These results together with our observations demonstrating inhibitory effects of proenkephalin-derived peptides on osteoblastic alkaline phosphatase activity, strongly support the notion that proenkephalin is involved in bone development. A different direction of research by other investigators has established the capability of the opioid system in the periphery to participate in the control of pain. On the basis of these two lines of observation, we would like to present the following hypothesis: The potential of embryonic skeletal tissue to synthesize proenkephalin-derived peptides is retained in the adult in small defined undifferentiated cell populations. This potential is realized in certain situations requiring rapid growth, such as remodeling or fracture repair. We suggest that in these processes, similarly to the situation in the embryo, the undifferentiated dividing cells produce the endogenous opioids. In the adult these peptides may have a dual function, namely participating in the control of tissue regeneration and in the control of pain. © 1994 Wiley-Liss, Inc.     

福尔马林致痛提高大鼠中枢μ阿片受体密度及电针的加强作用

用放射自显影方法观察到;（１）大鼠脚掌注射福尔马林后,某些与镇痛有关的脑区如尾核头部、伏隔核、杏仁核、中央灰质、脚间核、中缝大核、脊髓背角等结构中μ阿片受体密度明显增加（Ｐ＜０．０５,Ｐ＜０．０１）;（２）给予电针抑制痛反应的大鼠,在其大部分上述结构及扣带回、隔区、视前内侧区、内膝体、上丘、中缝背核及中央上核受体密度明显增加;与福尔马林注射组相比,脚间核、中央灰质尾端腹外侧区、腰膨大背角的受体密度进一步增加。从而在受体水平支持伤害性刺激可以激活体内内阿片肽能活动,而电针可以加强这一活动的设想。     

催产素在脊髓水平对电针镇痛的影响

采用玻璃微电极胞外记录和脊髓表面给药的方法观察了催产素（ＯＴ）、抗催产素血清（ＡＯＴＳ）以及电针穴位对背角神经元伤害性诱发放电的影响。结果表明：电针穴位或脊髓表面施加ＯＴ可部分抑制脊髓背角神经元的伤害性诱发放电;在电针的基础上施加ＯＴ则明显加强电针的抑制效应;相反,用ＡＯＴＳ预处理后,电针的抑制作用放取消。提示ＯＴ在脊髓水平参与了对痛觉信息的调制,并与一定频率的针刺镇痛有关。     

左旋四氢巴马汀加强电针对兔大脑皮层牙髓诱发电位的抑制作用

家兔6只,用氨基甲酸乙酯和氯醛糖麻醉,电刺激牙髓,在对侧大脑皮层体感Ⅰ区引导其诱发电位,观察诱发电位各成分与痛的关系。结果观察到,在P1、N1、P2和 N2 4个波中,P1和 P2波相对稳定。其中,P2波(波峰潜伏期:66.1±1.9ms)具有较高的阈值,且不受无镇痛作用的中枢抑制剂安定的影响,而受小剂量镇痛剂度冷丁的抑制,提示 P2波与痛有关。以 P2波的波幅为指标,进一步在12只家兔上观察了 L-THP 和电针及两者合用对诱发电位的影响。结果显示,L-THP 和电针对诱发电位均有抑制作用,且两者在作用强度和时间上存在明显的协同,提示 L-THP 具有加强电针对兔大脑皮层牙髓诱发电位中痛相关成分的抑制作用。     

Genetic background and sex influence somatosensory sensitivity and oxycodone analgesia in the Hybrid Rat Diversity Panel

Opioid use disorder (OUD) is an ongoing public health concern in the United States, and relatively little work has addressed how genetic background contributes to OUD. Understanding the genetic contributions to oxycodone-induced analgesia could provide insight into the early stages of OUD development. Here, we present findings from a behavioral phenotyping protocol using several inbred strains from the Hybrid Rat Diversity Panel. Our behavioral protocol included a modified “up-down” von Frey procedure to measure inherent strain differences in the sensitivity to a mechanical stimulus on the hindpaw. We also performed the tail immersion assay, which measures the latency to display tail withdrawal in response to a hot water bath. Initial withdrawal thresholds were taken in drug-naïve animals to record baseline thermal sensitivity across the strains. Oxycodone-induced analgesia was measured after administration of oxycodone over the course of 2 h. Both mechanical and thermal sensitivity are shaped by genetic factors and display moderate heritability (h² = 0.23–0.40). All strains displayed oxycodone-induced analgesia that peaked at 15–30 min and returned to baseline by 2 h. There were significant differences between the strains in the magnitude and duration of their analgesic response to oxycodone, although the heritability estimates were quite modest (h² = 0.10–0.15). These data demonstrate that genetic background confers differences in mechanical sensitivity, thermal sensitivity, and oxycodone-induced analgesia.     

自由体位分娩加分娩减痛法在初产顺产妇中的临床应用效果

目的:研究和探讨自由体位分娩法和分娩减痛法结合起来在初产顺产妇中的临床应用效果。方法:选取2013年1月至2013年12月已被收治的符合标准的初产顺产妇女360例为研究对象,将其随机分成A1组(自由体位分娩法组)、A2组(分娩减痛法组)和A1+A2组(两种方法结合组),每组120例。观察和比较三组产妇阴道分娩产程时间、疼痛等级评分、出血量、剖宫产率、新生儿Apgar评分情况和产后不良情况发生率。结果:①A1+A2组的分娩产程时间低于A1组及A2组,疼痛等级评分优于A1组和A2组(P均0.05);②A1+A2组的分娩过程中的出血量和剖宫产率均低于A1组及A2组(P0.05);③A1+A2组新生儿Apgar评分情况比A1组及A2组好(P0.05);④A1+A2组产后不良情况的发生率也低(P0.05)。然而以上观察指标A1组与A2组之间的差异均无统计学意义(P0.05)。结论:在临床实践过程中对初产顺产产妇实施自由体位分娩结合分娩减痛法可以显著地改善产妇分娩过程中的不良情况,对新生儿的影响也是积极的。两种方法的综合应用更具有良好的临床效果。     

吗啡皮下自控镇痛泵治疗难治性癌痛的前瞻性多中心随机对照研究

摘要 目的：观察吗啡皮下自控镇痛泵治疗难治性癌痛的临床疗效。方法：采用前瞻性多中心随机对照研究,应用治疗方法分为试验组和对照组,其中试验组使用皮下自控阵痛泵给药,对照组口服吗啡片剂,5 d为一疗程,共计观察3疗程。观察两组患者治疗后疼痛积分改善情况;每疗程吗啡日均用量;疼痛起效时间、最佳缓解时间;镇痛维持时间及剂量稳定天数、爆发痛情况;生活质量改善及不良反应发生率;疗程费用情况。结果：两组患者数字疼痛评分法(numerical rating scale,NRS)评分在治疗后均较镇痛前显著降低（P＜0.05）;在吗啡用量比较方面,试验组吗啡用量显著低于对照组同期用量;试验组在疼痛缓解时间、疼痛最佳缓解时间方面均显著优于对照组;治疗期间试验组平均镇痛维持时间明显长于对照组（P＜0.05）;两组患者治疗后体力状况分析标准(performance status,PS)评分较治疗前显著改善;试验组便秘、嗜睡不良反应发生率显著低于对照组（P＜0.05）。试验组每疗程费用明显低于对照组,具有明显经济优势。结论：吗啡皮下自控镇痛泵给药方式控制难治性癌痛临床疗效确切,止痛效果明显。与对照组比较,疼痛起效时间短,疗程较吗啡用量少,不良反应发生率低,改善了患者生活质量,且减轻了患者经济压力。     

东莨菪碱镇痛作用的研究

腹腔(25或50mg/kg)或侧脑室注射东莨菪碱(1mg/kg),均使大鼠的痛阈升高42—80%,并持续32—36小时之久。当在恒温室内作昼夜连续观察时,对照组的大鼠在深夜20时至次日8时之前,痛刺激反应稍有增强,此时东莨菪碱组的镇痛作用也相应地减弱,而白天的镇痛作用较强,似有昼夜规律的表现。东莨菪碱的镇痛作用与脑内阿片能系统无关,DA 能暂时增强其镇痛作用,毒扁豆碱能拮抗其镇痛作用,所以,东莨菪碱的镇痛作用,主要是阻滞中枢 M-胆碱能系统的作用所致。     

家兔中脑导水管周围灰质中注射八肽胆囊收缩素(CCK-8)拮抗吗啡镇痛和电针镇痛

家兔单侧PAG内注射CCK-83ng,能使静脉注射4mg/kg吗啡引起的镇痛作用降低73％或使电针镇痛效果降低67％。在1.5—6.0ng范围内呈量效关系。无硫的CCK-8无此作用。PAG内注射CCK受体拮抗剂proglumide 4μg可翻转CCK-8的抗吗啡镇痛作用。说明PAG部位注射外源性CCK-8可通过CCK受体对抗阿片镇痛。 PAG内注射CCK-8抗血清可显著增强静脉注射2mg/kg吗啡的镇痛效果。PAG内注射CCK抗血清本身也能引起痛阈轻度升高。说明PAG内有内源性的CCK-8发挥紧张性的抗阿片镇痛作用。