PAIN RESEARCH
Online ISSN : 2187-4697
Print ISSN : 0915-8588
ISSN-L : 0915-8588
Volume 18, Issue 3
PAIN RESEARCH
Displaying 1-7 of 7 articles from this issue
Original Article
  • Masato Fukui, Azusa Takishita, Nannan Zhang, Takayuki Nakagawa, Masabu ...
    2003 Volume 18 Issue 3 Pages 115-120
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       Extracellular ATP has been reported to play facilitative roles in nociceptive transmission at peripheral and spinal sites. We examined the effects of ATP and its analogues administered intracerebroventricularly on nociceptive thresholds in rats. Intracerebroventricular (i.c.v.) administration of ATP (10 and 100 nmol/rat), α,β-methylene-ATP (1 – 30 nmol/rat) and 2', 3'-O-(4-benzoylbenzoyl)-ATP (1 – 30 nmol/rat) transiently and dose-dependently elevated the mechanical nociceptive threshold in the paw pressure test. However, i.c.v. administration of β,γ-methylene-ATP (1 – 30 nmol/rat) and UTP (10 and 100 nmol/rat) had no significant effects on the mechanical nociceptive threshold. We also examined the effect of α,β-methylene-ATP on the mechanical hyperalgesia. I.c.v. administration of α,β-methylene-ATP (0.1 – 10 nmol/rat) at 3 hr after intraplantar (i.pl.) injection of 2% carrageenan ⁄ kaolin dose-dependently elevated the mechanical nociceptive threshold of the ipsilateral and contralateral hind paws. The effect was also transient with similar to the effect in normal rats. Antinociceptive effect of α,β-methylene-ATP (10 nmol/rat) was significantly attenuated by subcutaneous (s.c.) pretreatment with propranolol, but not phentolamine or methysergide, at a dose of 10 mg/kg. I.c.v. pretreatment with propranolol, butoxamine, and ((±)-1-[2,3-(dihydro-7-methyl-1H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]- 2-butanol) hydrochloride but not atenolol (100 nmol/rat) significantly attenuated the antinociceptive effect of α,β-methylene-ATP. However, i.c.v. pretreatment with atenolol (100 nmol/rat) and intrathecal (i.t.) pretreatment with propranolol (100 nmol/rat) and phentolamine (100 nmol/rat) did not show any significant effects. Since α,β-methylene-ATP and Bz-ATP are reported to be selective to P2X purinoceptor, these results suggest that P2X purinoceptors play an inhibitory role in nociceptive transmission in the brain. Furthermore, supra­spinal β2-adrenergic receptor is involved in the antinociceptive effect of i.c.v. administered α,β-methylene-ATP.
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  • Nobuyasu Kimura, Seiji Hattori, Kentaro Okuda, Hitoshi Yamamoto, Naozu ...
    2003 Volume 18 Issue 3 Pages 121-126
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
        Introduction: For decades, morphine was the only strong opioid for the treatment of cancer pain in Japan. From March 2002, transdermal fentanyl patch has been applied to cancer patients previously treated with morphine. As a consequence, opioid rotation from morphine to fentanyl patch (DurotepTM patch) became major concern for physicians to control cancer pain in our country. In this article, we would like to introduce why and how we rotate the opioid, incidence of side efffects, and how we control breakthrough pain in our hospital.
        Patients: During the period of March 2002 to July 2002, 12 patients were entrusted to the anesthesiology pain service from difficulty in controlling morphine side effects. Primary cancer of the patients were 4 stomach, 2 gallbladder, 1 liver, 1 pancreas, 1 ovarian, 1 breast, 1 thyroid, and 1 lingual cancer. All patients were given morphine either orally, rectally, or intravenously and were scheduled for opioid rotation. They were all suffering from intractable side effect of morphine, possible digestive tract obstruction, and/or pruritis.
        Methods: Direct conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 was basical­ly enforced, however, varied depending on patient status. We also gave intravenous morphine using patient controlled analgesia (PCA) for rescue in several patients with severe breakthrough pain. Numeric rating scale (NRS), nausea score and drowsiness score was obtained for 72 hours during the rotation. Constipation was not evaluated as this study was designed for only 72 hours.
        Results: The median Numeric rating scale (NRS) at rest decreased from 4.5 to 3.0 at 72 hours after the rotation, however not significant. Nausea was present in 10 patients, and resolved completely in 6 patients. There were no significant increase in drowsiness score. One patient with pruritis, possibly due to morphine, dis­appeared soon after the end of rotation.
        Conclusion: Opioid rotation to transdermal fentanyl patch, under discreet assessment and rotation planning, is beneficial for cancer pain relief in patients requiring strong opioid analgesics if they were naive to previously given morphine.
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  • Risa Watanabe, Taiko Kitamura, Jinzo Yamada
    2003 Volume 18 Issue 3 Pages 127-136
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       Neurons in the reticular formation of the brainstem are thought to participate in transmission of nociceptive information. However, the role of the reticular formation for the pain mechanism remained to be disclosed. In the present study, extracellular single-unit activities were recorded from the nucleus reticularis magnocellularis and adjacent areas (RF) elicited by electrical, mechanical and thermal noxious stimuli of the rat sciatic nerve.
       Multiple-spikes responding to single electrical stimulation were recorded in the single neuron in RF, which responded to pinch. They were grouped into three types: 1) The latency of Fast type was not over 30 msec, although the intensity of electrical stimulation increased, 2) the latency of Slow type was over 200 msec, although the intensity was low, and 3) Mixed type had components of both Fast type and Slow type. Considering the latency and intensity, Fast type, Slow type and Mixed type received information carried via Aδ-fibers, C-fiber and Aδ- and C-fibers, respectively. In Fast type, Aδ-fibers terminated to the single neuron of lamina V, which axon terminated to the single neuron of RF.Since the diameter of Aδ-fibers was different,multiple spikes were obtained with the gradually increased intensity. In Slow type, the neuron of lamina I received C-fibers and sent information via the several interneurons in laminae III-IV to the neuron of lamina V, which axon terminated to the single neuron of RF. Since the diameter of C-fibers was different, multiple spikes were obtained with the gradually increased intensity. As the above-mentioned manner, in Mixed type, the neuron of lamina V received information from both Aδ- and C-fibers and projected to the single neuron of RF. Neurons with the spontaneous spikes had tendency to be reacted by pinch but not by thermal stimulation. Neurons without the spontaneous spikes were reacted by both pinch and thermal stimulation.
       It seems that the single neuron of RF receiving various information from the peripheral nerve activates the ascending reticular activating system and/or descending pain inhibitory system.
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  • Tatsunori Ikemoto, Takahiro Ushida, Shigeki Tanaka, Kazuo Morio, S. Va ...
    2003 Volume 18 Issue 3 Pages 137-144
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       We employed functional magneto-resonance imaging to compare the pattern of brain activation evoked by painful and non-painful mechanical stimulation in normal volunteers and patients with neuropathic pain. Stimulation was performed using von Frey filaments. In normal volunteers, painful stimulation caused significant activation in the inferior parietal lobule (area 40), primary motor area (area 4), cingulate gyrus (area 24/31), middle temporal Gyrus (area 21/37), thalamus, and cerebellum. In the non-pain condition, SI, parietal lobule and frontal lobe were activated. In the patients, stimulation in the area of allodynia, in the non-pain condition elicited painful feelings and caused a wider area of activity when compared to the area of activity when the palm of unaffected side was stimulated. The activation was promoted in the frontal and occipital lobes, cingulate gyrus, and cerebellum. These findings suggest that neuropathic pain patients exhibit differences in the pain perception that may reflect chronical activation of the appropriate functional brain areas.
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  • Mayumi Okada, Masataka Sunagawa, Shiyu Guo, Tadashi Hisamitsu
    2003 Volume 18 Issue 3 Pages 145-146
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       Saiko-keishi-to (TJ-10), Chinese Herbal medicine extract, is effective for trigeminal neuralgia clinically, but the mechanism is not yet clear. We made the chronic pain model by ligation of trigeminal tertiary branch (mental nerve) in rats and examined the effect of analgesia and about immunocompetence. In preliminary research, it is shown that pain threshold and immunocompetence decreased in this chronic pain model. In the present study, both decrease of the pain threshold in the ligation side and decrease of immunocompetence were restrained in TJ-10 treated group. In tail flick test, pain threshold by TJ-10 administration was not changed. And the TJ-10 administration did not give a change to immunocompetence with an intact rat. As a result, a small regional pain of territory of mental nerve brings large influence in biogenic immunoreactivity, but this suggests possibility competed in TJ-10.
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  • Motohiro Kawasaki, Takahiro Ushida, Tatsunori Ikemoto, Toshikazu Tani, ...
    2003 Volume 18 Issue 3 Pages 157-161
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       The aim of this study was to investigate whether local injection of high-dose lidocaine could attenuate tenderness and motion pain existing in the medial compartmental osteoarthritic knee. Seventeen patients who had tenderness and pain during walking at the medial compartment of degenerative femorotibial joint for more than 6 months were examined in this study. The knee pain during walking was assessed by the visual analog scale (VAS) score and pressure pain thresholds for tenderness at the site of the injection were evaluated by means of a hand-held pressure algometer. As for the treatment, 1 ml of 10% or 1% lidocaine was injected into the periarticular tissue of the most painful tenderness point of the medial femorotibial joint. These pain intensities were measured before (controls), 2 weeks and 4 weeks after the injection. Decreased VAS score (p<0.007) during walking and increased pressure pain thresholds (p<0.004) were observed 2 weeks after injection of 10% lidocaine and compared with respective controls. VAS score was significantly decreased throughout 4 weeks after the injection. At the same time, there was no significant difference before and after injection of 1% lidocaine. These results suggest that injection of 10% lidocaine may produce a more effective and long-term analgesia for pain following osteoarthritis of the knee, as compared with the injection of 1% lidocaine.
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Case Report
  • Masato Kawashima, Shigenari Mashu, Takao Shibaji, L Jorge Zeredo, Kazu ...
    2003 Volume 18 Issue 3 Pages 151-156
    Published: September 30, 2003
    Released on J-STAGE: April 02, 2014
    JOURNAL FREE ACCESS
       Chronic facial pain is highly associated with psychological factors such as depression and stress. In this study, we report a case of chronic facial pain with strong psychological background. The patient, a 47 years old male, was referred to our pain clinic after conventional dental treatments failed to suppress a painful sensation with origin in the upper left first molar. We began to suspect of a psychological component at the report that the pain gradually became stronger after each unsuccessful treatment. A thorough clinical and radiographic examination revealed no organic abnormalities of dental origin or masticatory dysfunction; therefore, psychological tests were performed. Self-rating Depression Scale and Toho Medical Index were in a normal range; however, our interviews revealed that the patient was nervous, with concentrated attention on the oral region. Based upon these results, we diagnosed his pain as atypical facial pain and started drug therapy. When various drugs produced no effect on his pain, we started acupuncture therapy for pain relief and music therapy for mental and physical relaxation. For music listening, we used a reclining chair with speakers on both sides of the headrest and a vibration device on the back. We selected a healing music compact disc based on the patient's preference, and made him listen to it for 30 minutes. After a few sessions, the patient recognized that the pain was reduced during music listening, and became aware that a psychological factor played an important role in his disease. As the patient gradually gained control over his life stressors, the pain was remarkably reduced. We suggest that music listening may be useful in the recognition of psychological factors in pain.
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