Intrathecal administration of 5-HT(3) receptor agonist modulates jaw muscle activity evoked by injection of mustard oil into the temporomandibular joint in the rat

Preclinical orofacial pain assays and measures and chronic primary orofacial pain research: where we are and where we need to go

Chronic primary orofacial pain (OFP) conditions such as painful temporomandibular disorders (pTMDs; i.e., myofascial pain and arthralgia), idiopathic trigeminal neuralgia (TN), and burning mouth syndrome (BMS) are seemingly idiopathic, but evidence support complex and multifactorial etiology and pathophysiology. Important fragments of this complex array of factors have been identified over the years largely with the help of preclinical studies. However, findings have yet to translate into better pain care for chronic OFP patients. The need to develop preclinical assays that better simulate the etiology, pathophysiology, and clinical symptoms of OFP patients and to assess OFP measures consistent with their clinical symptoms is a challenge that needs to be overcome to support this translation process. In this review, we describe rodent assays and OFP pain measures that can be used in support of chronic primary OFP research, in specific pTMDs, TN, and BMS. We discuss their suitability and limitations considering the current knowledge of the etiology and pathophysiology of these conditions and suggest possible future directions. Our goal is to foster the development of innovative animal models with greater translatability and potential to lead to better care for patients living with chronic primary OFP.

Effects of 5-hydroxytryptamine on substantia gelatinosa neurons of the trigeminal subnucleus caudalis in immature mice

Serotonin (5-hydroxytryptamine, 5-HT) is involved in the descending modulation of nociceptive transmission in the spinal dorsal horn. The trigeminal subnucleus caudalis (Vc; medullary dorsal horn) processes nociceptive input from the orofacial region, and 5-HT-containing axons are numerous in the superficial layers of the Vc. This study examined the actions of 5-HT on the substantia gelatinosa (SG) neurons of the Vc, using gramicidin-perforated patch-clamp recording in brainstem slice preparations from immature mice. In order to clarify the possible mechanisms underlying 5-HT actions in the SG of the Vc, the direct membrane effects of 5-HT and effects of 5-HT receptor subtype agonists were examined. 5-HT induced a hyperpolarization in the majority (64/115, 56%) of the SG neurons tested. Thirty nine (34%) SG neurons showed no response, and 12 (10%) neurons responded with depolarization. The hyperpolarizing response to 5-HT was concentration-dependent (0.1-30 μM; n=7), not desensitized by repeated application (n=22), and significantly attenuated by Ba(2+) (K(+) channel blocker; n=8). The 5-HT-induced hyperpolarization was maintained in the presence of TTX (Na(+) channel blocker), CNQX (non-NMDA glutamate receptor antagonist), AP5 (NMDA glutamate receptor antagonist), picrotoxin (GABA(A) receptor antagonist), and strychnine (glycine receptor antagonist), indicating direct postsynaptic action of 5-HT on SG neurons (n=7). The 5-HT-induced hyperpolarizing effects were mimicked by 8-OH-DPAT (5-HT(1A) receptor agonist) and α-methyl-5-HT (5-HT(2) receptor agonist) and blocked by WAY-100635 (5-HT(1A) receptor antagonist) and ketanserin (5-HT(2) receptor antagonist). Single-cell RT-PCR also revealed the presence of mRNA for 5-HT(1A) and 5-HT(2C) subtypes in the SG neurons. These results suggest that 5-HT acts directly on SG neurons and 5-HT-induced hyperpolarization is mediated, in part, by 5-HT(1A) receptors and 5-HT(2) receptors, as well as by the activation of K(+) channels, indicating an important role for 5-HT in the modulation of orofacial nociceptive processing at the level of the SG of the Vc in mice.

Activation of central 5HT2A receptors reduces the craniofacial nociception of rats

We assessed the contribution of central 5HT2A receptors to the craniofacial tissue nociception in naïve male rats. First, we tested whether activation of central 5HT2A receptors affected nociceptive neural activities recorded from superficial laminae of the trigeminal subnucleus caudalis (Vc)/upper cervical spinal cord junction (Vc/C2) region. Two types of units, such as deep-nociceptive or skin-wide dynamic range (WDR) units were identified from extracellular recordings. Topical administration of 5HT2A receptor agonist, (+/-)-2,5-dimethoxy-4-iodoamphetamine (DOI) onto the Vc/C2 region significantly reduced deep-nociceptive unit discharges evoked by formalin injection into the masseter muscle. Noxious pinch stimulation to the facial skin-evoked skin-WDR unit discharges was significantly reduced by topical administration of 0.1 mg/rat DOI onto the Vc/C2 region. Second, we tested whether i.c.v. administration of DOI affected Fos-like immunoreactivity (-LI) evoked by formalin injection into the masseter muscle. Fos-LI was significantly induced mainly at the ventrolateral (vl) area of trigeminal subnucleus interpolaris (Vi)/Vc junction (vl-Vi/Vc) region and Vc/C2 region in vehicle-treated rats. Formalin-evoked Fos-LI was significantly reduced in laminae I-II of the Vc/C2, but not vl-Vi/Vc region after i.c.v. administration of DOI. Finally, orofacial nocifensive behavioral activities evoked by formalin injection into the masseter muscle were significantly reduced by intracisternal administration of DOI. These results suggest that 5HT2A receptors in the Vc/C2 region mediate antinociceptive effects in the craniofacial nociception.

Tooth-pulp-evoked rostral spinal trigeminal neuronal excitation is attenuated by the activation of 5-HT3 receptors via GABAergic interneurons in the rat

The effect of iontophoretic application of the 5-HT3 receptor agonist, phenylbiguanide (PBG), on the excitation of the trigeminal spinal nucleus oralis (TSNO) neurons to tooth-pulp (TP) stimulation was examined. The PBG application inhibited the TP-evoked TSNO neuronal excitation, and this inhibition was completely blocked by co-application of a GABAA receptor antagonist, bicuculline. The results suggest that the activation of 5-HT3 receptors elicits GABA release in the TSNO.

Central serotonin 3 receptors play an important role in the modulation of nociceptive neural activity of trigeminal subnucleus caudalis and nocifensive orofacial behavior in rats with persistent temporomandibular joint inflammation

The role of central serotonin 3 receptors on neural activities recorded from superficial laminae of trigeminal subnucleus caudalis/upper cervical spinal cord junction region was investigated using rats with (Complete Freund's Adjuvant day 7 group) or without (non-Complete Freund's Adjuvant group) persistent temporomandibular joint inflammation evoked by Complete Freund's Adjuvant for 7 days. We identified two types of units, Deep-wide dynamic range units and Skin-wide dynamic range units from extracellular recordings. Deep-wide dynamic range units have mechanoreceptive fields in the deep craniofacial tissues including masseter muscle but do not have cutaneous mechanoreceptive fields. Deep-wide dynamic range unit discharges evoked by the formalin injection into masseter muscle were significantly enhanced in the late phase in Complete Freund's Adjuvant day 7 group. Discharges of Skin-wide dynamic range units evoked by the noxious pinch stimulation to facial skin in Complete Freund's Adjuvant day 7 group were significantly enhanced compared with those in non-Complete Freund's Adjuvant group. Topical administration of central serotonin 3 receptor antagonist, tropisetron, onto trigeminal subnucleus caudalis/upper cervical spinal cord junction region significantly reduced both formalin-evoked Deep-wide dynamic range unit and pinch-evoked Skin-wide dynamic range unit discharges in non-Complete Freund's Adjuvant and Complete Freund's Adjuvant day 7 groups significantly. The inhibitory effects of tropisetron on pinch-evoked Skin-wide dynamic range unit discharges were prolonged in Complete Freund's Adjuvant day 7 group compared with those in non-Complete Freund's Adjuvant group. The role of central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region was also tested by orofacial formalin test in Complete Freund's Adjuvant day 7 group. Intracisternal administration of tropisetron decreased the orofacial nocifensive behavior in the late phase evoked by the injection of formalin into the masseter muscle. These results suggest that central serotonin 3 receptors in trigeminal subnucleus caudalis/upper cervical spinal cord junction region are involved in mediating pronociceptive effects in both superficial and deep craniofacial tissues nociception during persistent temporomandibular joint inflammation.

Tooth-pulp-evoked rostral spinal trigeminal nucleus neuron activity is inhibited by conditioning sciatic nerve stimulation in the rat: possible role of 5-HT3 receptor mediated GABAergic inhibition

The purpose of the present study was to determine whether modulation of the trigeminal spinal nucleus oralis (TSNO) neurons related to tooth-pulp (TP)-evoked jaw-opening reflex (JOR) after electrical stimulation of the sciatic nerve (SN) is mediated by the descending serotonergic (5-HT(3)) inhibitory system activated by inhibitory GABAergic interneurons. In 30 anesthetized rats, the activity of TSNO neurons (87.5%, 35/40) and all digastric muscle electromyograms (dEMG, n=30) in response to TP stimulation (at an intensity of 3.5 times the threshold for JOR) were inhibited by conditioning stimulation of the SN (5.0 mA x 0.5 ms, 1 Hz, conditioning-test intervals; 50 ms). The inhibitory effects were significantly attenuated after intravenous administration of the 5-HT(3) receptor antagonist ICS 205-930 (n=6). Using multibarrel electrodes, iontophoretic application of ICS 205-930 into the TSNO significantly reduced the SN stimulation-induced inhibition of TP-evoked TSNO neuronal excitation (n=6), and in the same neurons, iontophoretic application of the GABA(A) receptor antagonist bicuculline into the TSNO greatly inhibited their effect. On the other hand, we found the expression of 5-HT(3) receptor immunoreactive neurons in the TSNO. These results suggest that SN stimulation may activate the descending serotonergic (5-HT(3)) inhibitory system through activation of inhibitory GABAergic interneurons, which inhibit excitatory responses of the TSNO neurons to TP stimulation.

Modulation of jaw reflexes induced by noxious stimulation to the muscle in anesthetized rats

Previous studies have shown that jaw reflexes and activity patterns of the jaw muscles were modulated in the presence of jaw muscle pain. However, there is no study comparing the modulatory effects on the jaw reflexes induced by noxious stimulation to the jaw muscle. To clarify this, effects of the application of mustard oil (MO), an inflammatory irritant, into the temporalis (jaw-closing) muscle on (1) jaw-opening reflex evoked by tooth pulp stimulation (TP-evoked JOR) as a nociceptive reflex, (2) jaw-opening reflex evoked by inferior alveolar nerve stimulation as a non-nociceptive reflex and (3) jaw-closing reflex evoked by trigeminal mesencephalic nucleus stimulation as a proprioceptive reflex were investigated in anesthetized rats. The MO application induced suppression of all reflexes, and the effect on the TP-evoked JOR was more prominent than on the other reflexes. To elucidate the involvement of endogenous opioid system for the suppressive effect, a systemic administration of naloxone following the MO application was conducted. The MO-induced suppressive effect on the TP-evoked JOR was reversed by the naloxone administration. The results suggest that noxious stimulation to the jaw muscle modulate jaw reflexes particularly for the nociceptive jaw-opening reflex, and the modulatory effect includes both facilitatory and inhibitory aspects. The results also suggest that pain modulatory systems such as the endogenous opioid system play a crucial role in the suppression of the nociceptive transmissions related to nociceptive reflexes, and in some pathological states, defense reflexes may not be evoked properly.

Effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') on the jaw-opening reflex and on the alpha2-adrenoceptors which regulate this reflex in the anesthetized rat

Bruxism, principally jaw clenching, is frequently observed in users of the recreational drug 3,4-methylenedioxymethamphetamine (MDMA). It has been suggested that during bruxism a reduction of the activity of oral protective reflexes occurs. In this study we investigated the effects of intravenously administered MDMA on the digastric electromyographic responses elicited by orofacial electrical stimulation in the rat. We also assessed the effects of either the administration of a single dose (20 mg kg(-1), s.c.) or repeated doses of MDMA (same dose, twice a day, for 4 d) on the jaw-opening reflex (JOR) and on the sensitivity of the alpha(2)-adrenoceptors which, in an inhibitory way, regulate it. Increasing doses of MDMA (1-29440 micro g kg(-1)) induced an incomplete inhibition of JOR and 50% inhibition (ED(50)) at 2550 micro g kg(-1); maximal inhibition was 88%. The repeated treatment with MDMA led to an enhancement of the inhibition of JOR induced by the alpha(2)-agonist, clonidine (ED(50) was reduced by 77%), indicating an increased sensitivity of the alpha(2)-adrenoceptors. This study shows that the intravenous administration of MDMA reduces the JOR while repeated doses of the drug enhance the inhibitory noradrenergic mechanisms which regulate the reflex. The results also allow speculation that a reduction of JOR may underlie the occurrence of episodes of bruxism in MDMA users.