Aminophylline differentiates between the depressant effects of morphine on the spinal nociceptive reflex and on the spinal ascending activity evoked from afferent C fibres

Methylxanthines and pain

Caffeine, an antagonist of adenosine A(1), A(2A) and A(2B) receptors, is known as an adjuvant analgesic in combination with non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen in humans. In preclinical studies, caffeine produces intrinsic antinociceptive effects in several rodent models, and augments the actions of NSAIDs and acetaminophen. Antagonism of adenosine A(2A) and A(2B) receptors, as well as inhibition of cyclooxygenase activity at some sites, may explain intrinsic antinociceptive and adjuvant actions. When combined with morphine, caffeine can augment, inhibit or have no effect depending on the dose, route of administration, nociceptive test and species; inhibition reflects spinal inhibition of adenosine A(1) receptors, while augmentation may reflect the intrinsic effects noted above. Low doses of caffeine given systemically inhibit antinociception by several analgesics (acetaminophen, amitriptyline, oxcarbazepine, cizolirtine), probably reflecting block of a component of action involving adenosine A(1) receptors. Clinical studies have demonstrated adjuvant analgesia, as well as some intrinsic analgesia, in the treatment of headache conditions, but not in the treatment of postoperative pain. Caffeine clearly exhibits complex effects on pain transmission; knowledge of such effects is important for understanding adjuvant analgesia as well as considering situations in which dietary caffeine intake may have an impact on analgesic regimens.

High-dose adenosine infusion provokes oscillations of chest pain without correlation to opioid modulation: A double-blind controlled study

Adenosine is a neuromodulator with both excitatory and inhibitory effects in different organs. High-dose adenosine infusion provokes chest pain in patients and healthy volunteers. This study examines the nature of chest pain and whether it is modified by the mu opioid receptor agonist (beta-endorphin) or a nonselective opioid antagonist (naloxone). Ten healthy volunteers with a mean age of 26 +/- 3 years participated in the study. The study was performed during 3 sessions. During every session the subjects were given a high dose of adenosine infusion (140 microg/kg/min) for 22 minutes. After 5 minutes, the subjects were randomized in a double-blind order on 1 of the 3 categories: (1) as placebo, NaCl bolus for 2 minutes followed by NaCl infusion for 15 minutes; (2) beta-endorphin bolus followed by infusion; and (3) naloxone bolus followed by NaCl infusion. Hemodynamic and pain parameters were monitored. During adenosine infusion, all volunteers experienced chest pain with oscillations of pain intensity. The oscillations continued during beta-endorphin and naloxone. There were no significant differences between hemodynamic and pain parameters during beta-endorphin or naloxone compared to adenosine infusion. High-dose infusion of adenosine provokes chest pain with oscillations of algesia and pain-free intervals. Peripheral opioid administration did not influence the adenosine-provoked chest pain.

PERSPECTIVE

Adenosine-induced oscillations of pain and pain-free intervals could theoretically be a sign of neuronal reflex activity dependent on spatiotemporal summation of adenosine excitatory and inhibitory properties. This could contribute to the complex nature of angina pectoris. Peripheral opioid receptors might not be involved in the oscillations.

Adenosine mediates spinal norepinephrine-produced antinociception as revealed by nociceptive discharges in parafascicular neurons in rats

The effects of intrathecal pretreatment with aminophylline on intrathecal norepinephrine-produced or serotonin-produced suppression of noxiously evoked discharges in thalamic parafascicular neurons were investigated in 35 urethane-anesthetized rats. The results showed that: (1) both intrathecal norepinephrine (15 nmol) or serotonin (20 nmol) produced significant suppression of noxiously evoked discharges in parafascicular neurons; (2) intrathecal aminophylline (120 nmol) blocked the norepinephrine-produced suppression of noxiously evoked discharges, while the same dose of aminophylline exhibited no significant effect on the serotonin-produced suppression of these discharges in parafascicular neurons. The results suggest that spinal norepinephrine-produced, but not serotonin-produced, antinociceptive effects may be mediated by adenosine as one of successive chemical links in the spinal dorsal horn circuitry.

Sequential mediation of norepinephrine-and dopamine-induced antinociception at the spinal level: involvement of different local neuroactive substances

The effects of intrathecally (i.t.) administered opioid antagonist naloxone (Nal), adenosine antagonist aminophylline (Aph), and gamma-aminobutyric acid (GABAA)-receptor antagonist picrotoxin (PTX) or Bicuculline (BIC) on the antinociception produced by i.t. norepinephrine (NE), dopamine (DA), morphine (Mor), 5'-N-ethylcarboxamidoadenosine (NECA, an adenosine agonist) or muscimol (MUS, a selective GABAA-receptor agonist) were studied and compared using the tail-flick test in rats. The results showed that: (1) both i.t. NE (0.3, 0.5 and 1.0 nmol) and DA (5.5, 8.3 and 16.5 nmol) produced significant and dose-dependent increases in tail-flick latencies (antinociception); (2) both Nal (240 nmol) and Aph (120 nmol) blocked the antinociception produced by NE (1.0 nmol); (3) both Nal (240 nmol) and Aph (120 nmol) blocked the antinociception produced by Mor (0.5 nmol), but only Aph (120 nmol) blocked the antinociception produced by NECA (0.5 nmol), while Nal (240 nmol) did not; (4) neither Nal (240 nmol) nor Aph (120 nmol) altered the antinociception produced by DA (16.5 nmol); (5) both i.t. PTX (1.5 nmol) and BIC (0.5 nmol) completely blocked the antinociception produced by DA (16.5 nmol), but showed no effects on that produced by NE (1.0 nmol); and (6) both PTX and BIC blocked the antinociception produced by MUS (1.0 nmol). These results suggest that: (a) endogenous opiate and adenosine may be involved in the mediation of NE-induced, but not DA-induced, antinociception; (b) NE, opioid and adenosine may act in a sequential order in NE-induced antinociception at the spinal level; (c) endogenous GABA may be involved in the mediation of DA-induced antinociception through the GABAA-receptors, but is not involved in NE-induced antinociception at the spinal level.

Interaction of opioids with antidepressant-induced antinociception

The antinociceptive activity of antidepressant drugs is poorly understood. In this study, using the acetic acid writhing test in mice, the antinociception produced by clomipramine (CLO), maprotiline (MAP), imipramine (IMI), and zimelidine (ZIM) was tested and correlated with opioid drugs. All the compounds displayed a significant dose-dependent antinociception, which was not antagonized by naloxone (NX) or naltrexone (NTX). The administration of morphine (M) plus CLO, MAP, IMI or ZIM resulted in a significant additive effect that was antagonized by 1 or 10 mg/kg NX or NTX, except in the case of IMI. This finding suggests that the additive effect seems to be partially due to activation of opioid receptors, except for the case of imipramine. However, aminophylline, a non-selective blocker of A1/A2 adenosine receptors, significantly antagonized the antinociceptive activity of CLO, IMI, MAP and ZIM, demonstrating an interaction at the level of adenosine receptors. This work suggests that the antinociceptive activity of antidepressants could be dependent on critical levels of free 5-HT and NE at receptor(s) site(s) in CNS and on their interaction with opioid and adenosine receptors.

Adenosine and opiate-like substances mediates antinociception at the spinal cord

The effects of intrathecally administered naloxone or aminophylline on the antinociception produced by intrathecal NE, 5-HT, morphine or adenosine receptor agonist, 5'-N-ethylcarboxamidoadenosine (NECA) were observed in rats using the tail-flick test. The results show that: (1) the antinociception produced by NE with doses of 0.5 or 1.0 nmol could be completely blocked by both naloxone (240 nmol) and aminophylline (120 nmol); (2) neither naloxone (240 nmol) nor aminophylline (120 nmol) could alter the antinociception produced by 5-HT with doses of 60 or 120 nmol; and (3) the antinociception produced by morphine (0.5 nmol) could be blocked by both naloxone (240 nmol) and aminophylline (120 nmol), while the antinociception by NECA (0.5 nmol) could be blocked only by aminophylline (120 nmol), but not by naloxone (240 nmol). The results suggest that opiate-like substances (OLS) and adenosine are involved in the mediation of the NE-produced antinociception, but not in 5-HT-produced antinociception. Results also suggest that NE, OLS and adenosine may act in a sequential order in the performance of NE-induced antinociception at the spinal level.

Different influences of adenosine receptor agonists and antagonists on morphine antinociception in mice

1. Subcutaneous (s.c.) administration of morphine to mice induced a dose-dependent antinociception. 2. Pretreatment of animals with adenosine receptor antagonists NECA (5'-N-ethylcarboxamide-adenosine) and L-PIA (N6-phenylisopropyladenosine) potentiated, while adenosine agonist CHA (N6-cyclohexyladenosine) decreased the morphine response. 3. Adenosine antagonist theophylline decreased, but adenosine receptor antagonist 8-PT (8-phenyltheophylline) increased the antinociception effect of morphine. Inhibitory effect of CHA on morphine antinociception was also reversed by 8-PT pretreatment. 4. NECA or L-PIA induced a high degree of antinociceptive effect in animals pretreated with 8-PT. 5. Dipyridamole pretreatment did not alter the effect of morphine. 6. It is concluded that A-1 and/or A-2 adenosine receptors are involved in morphine antinociception and the adenosine mechanism(s) may exert a modulatory role in this respect.

Adenosine A1 receptors mediate the presynaptic inhibition of calcitonin gene-related peptide release by adenosine in the rat spinal cord

Electrical field stimulation evoked a reproducible outflow of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) from the dorsal half of the rat spinal cord, an effect which was abolished by prior application of capsaicin, tetrodotoxin or removal of extracellular Ca2+. Adenosine (EC50 3.2 microM) and the selective adenosine A1 receptor agonist N6-cyclohexyladenosine (EC50 8.2 nM) inhibited evoked CGRP-LI outflow, while the selective adenosine A2 receptor agonist CGS-21680 was ineffective up to 10 microM. The action of adenosine was prevented by the adenosine A1 receptor selective antagonist 8-cyclopentyl-1,3-dipropylxanthine (30 microM), which did not affect CGRP-LI release on its own.

Adenosine inhibits action potential-dependent release of calcitonin gene-related peptide- and substance P-like immunoreactivities from primary afferents in rat spinal cord

Electrical field stimulation (5 Hz) evoked a prompt outflow of calcitonin gene-related peptide- and substance P-like immunoreactivities (CGRP-LI and SP-LI, respectively) from superfused slices of the dorsal but not ventral half of the rat spinal cord. The evoked outflow was abolished by tetrodotoxin, calcium-free medium or previous exposure to capsaicin, indicating that it is produced through action potentials invading the central terminals of capsaicin-sensitive primary afferents. Adenosine as well as gamma-aminobutyric acid (GABA) or the GABAB receptor agonist (-)-baclofen produced a concentration-dependent inhibition of the evoked CGRP-LI outflow. Adenosine also inhibited the evoked SP-LI outflow. These findings demonstrate that inhibition of transmitter release from primary afferent neurons should be considered as a possible mechanism of the antinociceptive action of adenosine and adenosine analogs.

Chronic morphine treatment causes down-regulation of spinal adenosine A1 receptors in rats

Recent studies suggest that the release of adenosine in the spinal cord may be a significant component of the morphine antinociceptive action. We wanted to know whether the spinal adenosine system is involved in morphine tolerance. Animals were rendered tolerant to morphine, and A1 adenosine receptor binding activity was measured. Treating Sprague-Dawley rats with multiple, increasing doses of morphine i.p. for 6 days resulted in an about 10-fold increase in the median antinociceptive dose (AD50) of morphine to elicit an antinociceptive response. On the other hand, this treatment also caused a 4 to 5-fold increase in the AD50 of cyclopentyladenosine (CPA). When A1 adenosine receptor binding was determined by using [3H]cyclohexyladenosine ([3H]CHA) a significant decrease in binding (P less than 0.05) in the spinal cord but not in the cortex was observed. Scatchard analysis of the [3H]CHA saturation binding data revealed a decrease in Bmax values (from 185.5 fmol/mg to 110.2 fmol/mg) and no significant change in Kd values.

Adenosine release may mediate spinal analgesia by morphine

Spinal analgesia produced by morphine is blocked by methylxanthine adenosine receptor antagonists. In biochemical studies, morphine releases adenosine from spinal cord synaptosomes prepared from the dorsal spinal cord, as well as from the intact spinal cord in vivo. Adenosine release is reduced by intrathecal and neonatal pretreatment with capsaicin but not by intrathecal pretreatment with 6-hydroxydopamine or 5,7-dihydroxytryptamine, indicating that adenosine originates from small-diameter primary afferent neurons but not descending monoaminergic pathways. In this Viewpoint Jana Sawynok and colleagues review the evidence supporting the hypothesis that the spinal analgesic action of morphine is due to the release of adenosine from primary afferent nerve terminals and subsequent activation of A1 and A2 adenosine receptors.

The role of purines in nociception

The preceding review indicates that there is convincing evidence for the presence of adenosine in and release of adenosine from capsaicin-sensitive small diameter primary afferent neurons in the spinal cord (Fig. 1). Within the dorsal spinal cord, adenosine inhibits the transmission of nociceptive information, although details of mechanisms involved in this action remain to be established. In view of the antinociceptive actions of adenosine analogues, there has been some interest in the possibility of developing adenosine analogues as analgesic agents. However, this goal may be frustrated by this concomitant suppression of motor function, as well as the production of other side effects due to the diverse nature of pharmacological effects seen with adenosine analogues. Release of adenosine from small diameter primary afferent nerve terminals and subsequent activation of extracellular adenosine receptors in the dorsal horn of the spinal cord appears to contribute significantly to the spinal action of opioids. An understanding of spinal mechanisms of actions of adenosine therefore is an important prerequisite for our understanding of the action of this clinically important group of drugs. ATP may be a sensory neurotransmitter released from non-nociceptive large diameter primary afferent neurons (Fig. 1). The subsequent extracellular conversion of released ATP to adenosine may produce suppression of the transmission of noxious sensory information via small diameter primary afferent fibres, and contribute to the phenomenon of vibration induced analgesia. Clearly, the role of purines on spinal cord processing of nociceptive information merits considerable attention.

Involvement of A2 adenosine receptors in spinal mechanisms of antinociception

Preliminary investigations suggest that spinal adenosine induces significant behavioral effects and may interact with descending antinociceptive systems stimulated by morphine administered intracerebroventricularly (i.c.v.). In the present study, rank order potencies for antinociception induced by adenosine agonists administered intrathecally (i.t.) were determined. Interactions of adenosine agonists (i.t.) with morphine (i.c.v.)-induced antinociception were also examined. Dose-dependent antinociception, as measured in tail flick and hot plate assays, was observed in mice administered adenosine or adenosine agonists i.t. Rank order potencies were 5'-N6-ethylcarboxamidoadenosine (NECA) greater than N6-(R-phenylisopropyl)-adenosine (R-PIA) greater than 2-chloroadenosine (CADO) greater than N6-(S-phenylisopropyl)-adenosine (S-PIA) greater than adenosine. Rank order potencies were identical for adenosine agonist (i.t.) synergism with morphine (i.c.v.)-induced antinociception. Further, i.t. injections of NECA or nitrobenzylthioinosine (NBI), an adenosine reuptake inhibitor, were able to potentiate morphine (i.c.v.)-induced antinociception. Hind limb paralysis induced by high doses of adenosine agonists (i.t.) was dissociated from antinociceptive effects. Rank order potencies determined in our studies support involvement of A2 adenosine receptors in spinal mechanisms of antinociception. In addition, these results confirm spinal adenosine interactions with antinociceptive systems stimulated by i.c.v. injections of morphine.

Effects of tramadol on motor and sensory responses of the spinal nociceptive system in the rat

The analgesic agent, tramadol, was tested on motor and sensory responses of the nociceptive system in rats. The tail-flick response to radiant heat was dose dependently depressed by tramadol (1-10 mg/kg i.p.), and the antinociceptive effect of the drug was reduced by naloxone in the same range of doses that antagonized the effect of morphine. Tramadol (100 micrograms) microinjected into the periaqueductal grey (PAG) prolonged the tail-flick latency and this effect was abolished by naloxone (0.2 mg/kg i.p.). Aminophylline (25 mg/kg i.p.) did not prevent the antinociceptive effect of tramadol (5 mg/kg i.p.). Tramadol (20 and 40 mg/kg injected i.v.; 100 and 200 micrograms injected intrathecally (i.t.); 100 micrograms injected into the PAG) depressed both the spontaneous activity in ascending axons and their activity due to stimulation of afferent C fibres and co-activation from afferent A delta fibres in the sural nerve. Naloxone injected i.v. at a dose (0.2 mg/kg) that had proven fully effective against the effects of morphine antagonized only the effect on spontaneous activity caused by i.v. injection of tramadol. A high dose of naloxone (1 mg/kg i.v.) not only abolished the depression of spontaneous activity caused by an i.t. injection of tramadol (200 micrograms) but also significantly reduced (but did not abolish) the activity in ascending axons evoked from afferent C fibres while the depression of co-activation from afferent A delta fibres remained unchanged. Aminophylline (50 micrograms i.t.) failed to abolish the depression by tramadol of ascending nociceptive activity. The activity elicited in ascending axons by stimulation of afferent A beta fibres was not changed by i.t. injection of tramadol (200 micrograms), which was evidence that the antinociceptive effect of tramadol is not due to a local anaesthetic action. It is concluded that tramadol produces its antinociceptive and analgesic effects through spinal and supraspinal sites of action. Since the effects of tramadol and morphine differ in some respects, it must be assumed that they are due to binding to different opiate receptors or that some of the effects of tramadol are not mediated by opiate receptors alone.

Cyclic AMP or forskolin rapidly attenuates the depressant effects of opioids on sensory-evoked dorsal-horn responses in mouse spinal cord-ganglion explants

Exposure of fetal mouse spinal cord-ganglion explants to morphine (greater than 0.1 microM) results in naloxone-reversible, dose-dependent depression of sensory-evoked dorsal-horn synaptic-network responses within a few minutes. After chronic opiate exposure (1 microM) for 2-3 days, these dorsal cord responses recover and can then occur even in greater than 10 microM morphine. In the present study, when naive explants were treated with forskolin (10-50 microM)--a selective activate activator of cyclase (AC)--for 10-30 min prior to and during exposure to morphine (0.1-0.3 microM) or D-Ala2-D-Leu5-enkephalin (0.03-0.1 microM), the usual opioid depressant effects on dorsal-horn responses generally failed to occur (10-30 min tests). Dibutyryl cyclic AMP (10 microM) or the more lipid-soluble analog, dioctanoyl cyclic AMP (0.1 mM), produced a similar degree of subsensitivity to opiates as 10 microM forskolin. With high levels of forskolin (50 microM), even concentrations of morphine up to 1-10 microM were far less effective in depressing cord responses. These effects of exogenous cAMP analogs and forskolin on cord-ganglion explants are probably both mediated by increases in intracellular cAMP. The marked decrease in opioid sensitivity of cAMP or forskolin-treated cord-ganglion explants provides significant electrophysiologic data compatible with the hypothesis that neurons may develop tolerance and/or dependence during chronic opioid exposure by a compensatory enhancement of their AC/cAMP system following initial opioid depression of AC activity. Previous evidence relied primarily on behavioral tests and biochemical analyses of cell cultures. It will be of interest to determine if dorsal-horn tissues of cord-ganglion explants do, in fact, develop increased AC/cAMP levels as they express physiologic signs of tolerance during chronic exposure to opioids.

Cyclic nucleotides and aminophylline produce different effects on nociceptive motor and sensory responses in the rat spinal cord

The effect of intrathecal (i.t.) and systemic (i.p. and i.v.) administration of morphine, aminophylline, dibutyryl cyclic adenosine monophosphate (DBcAMP) and dibutyryl cyclic guanosine monophosphate (DBcGMP) on motor and sensory responses of the spinal nociceptive system was studied in rats. Motor responses were assessed in the tail-flick test performed on rats with an intact spinal cord, or as flexor reflex activity elicited in the electromyogram of the tibialis anterior muscle by supramaximal electrical stimulation of the sural nerve in rats in which the spinal cord was transected at the lower thoracic level. The sensory response consisted of activity in single ascending axons of the spinal cord evoked by electrical stimulation of afferent C fibres in spinal rats. Morphine (20 micrograms i.t. or 2 mg/kg i.p.) prolonged the tail-flick latency and aminophylline (25 mg/kg i.p. or 50 micrograms i.t.) prevented the antinociceptive effect of morphine. Aminophylline alone, administered by i.t. injection, reduced the tail-flick latency in a dose-dependent way. Morphine (2 mg/kg i.v. or 10 micrograms i.t.) reduced flexor reflex activity, and this reduction was abolished by aminophylline (25 mg/kg i.v. or 50 micrograms i.t.). Morphine (2 mg/kg i.v.) depressed spontaneous and evoked activity in single ascending axons responding to stimulation of afferent C fibres. This depressant effect of morphine was not abolished by aminophylline (50 micrograms i.t.); the depression was antagonized by naloxone (10 micrograms i.t.). DBcAMP (5 to 100 ng i.t.) dose-dependently prolonged the tail-flick latency. The antinociceptive effect of DBcAMP (50 ng i.t.) was prevented by aminophylline (50 micrograms i.t.) or naloxone (5 micrograms i.t.).(ABSTRACT TRUNCATED AT 250 WORDS)

Theophylline-induced potentiation of the antinociceptive action of baclofen

1--Theophylline (35, 50 mg/kg) potentiated the antinociceptive action of intraperitoneally administered baclofen in the tail flick and hot plate tests. Potentiation was most marked when the pretreatment time was 1 h, but some potentiation was still apparent following a 2 h pretreatment. 2--Theophylline alone (50 mg/kg) produced only slight alterations in reaction latency in the two tests. 3--When baclofen was applied directly into the spinal subarachnoid space, a 1 h pretreatment with theophylline produced minimal effects, but a 2 h pretreatment produced an increase in the antinociceptive action of baclofen. 4--These results suggest that theophylline can potentiate the antinociceptive action of baclofen by actions at both supraspinal and spinal sites.

Analgesic effect of intrathecal morphine demonstrated in ascending nociceptive activity in the rat spinal cord an in effectiveness of caerulein and cholecystokinin octapeptide

The effect of intrathecal injections of morphine and the two peptides, caerulein and cholecystokinin octapeptide (CCK-8), on the activity in ascending axons of the spinal cord evoked by electrical stimulation of primary nociceptive afferents was studied in spinal rats with decerebration. Morphine (20 microgram) depressed the spontaneous activity and the activity evoked from either A delta-or C-fibres. The co-activation by A delta-fibre stimulation of ascending axons activated by stimulation of C-fibres and the activity in ascending axons activated by stimulation of afferent A beta-fibres were not influenced by morphine. C-Fibre-evoked ascending activity was also depressed by morphine (10 microgram and 5 microgram). Ascending nociceptive activity was not changed by caerulein (30 ng) and CCK-8 300 ng, but it was depressed by a subsequent injection of morphine (20 microgram). The depressant effects of morphine were abolished by an intravenous injection of concluded that: (i) an intrathecal injection of morphine selectively depressed the ascending nociceptive activity; (ii) the depression produced by morphine is an equivalent for spinal analgesia following intrathecal injection of morphine to man; and (iii) the two components of the spinal nociceptive system, the motor and the sensory path, can independently be influenced by drugs.