Age-related changes in nociception and effect of morphine in the Lou rat

Mechanical and thermal thresholds before and after application of a conditioning stimulus in healthy Göttingen Minipigs

Minipigs are widely used in biomedical research for translational studies. However, information about pain elicited by experimental procedures is lacking. Non-invasive methods as quantitative sensory testing and conditioned pain modulation are particularly attractive. Our overarching aim was to explore and refine these methods for assessing post-operative pain in minipigs after myocardial infarction. As first step, we aimed at defining mechanical and thermal thresholds in healthy adults Göttingen Minipigs, evaluating their reliability, and testing their modifications after the application of a conditioning stimulus. Thresholds were assessed at different body sites before and after a painful conditioning stimulus (CS) (cuffed tourniquet) and sham CS (uncuffed tourniquet) in eleven animals. Thresholds' reliability was assessed using interclass correlation coefficient (ICC). The effect of the CS was assessed calculating absolute change, percentage change of the thresholds and standard error of measurement. Baseline mechanical thresholds (Newton) were: left hindlimb 81 [73; 81]; left forearm 81 [72.1; 81]; right forearm 81 [76; 81]; left chest 80.5 [68; 81]; right chest 81 [76.5; 81]; left neck 81 [70.3; 81]; right neck 74.8 [62.3; 80.5]. Reliability of mechanical thresholds was good at right chest (ICC = 0.835) and moderate at left chest (ICC = 0.591), left hindlimb (ICC = 0.606) and left neck (ICC = 0.518). Thermal thresholds showed poor reliability in all the tested sites. A modulatory effect was present at right chest, but it was seen when both a painful CS and a sham CS was applied. Minipigs tendentially showed a pro-nociceptive profile (i.e. conditioning pain facilitation). The measured thresholds are a reference for future trials in this species. Mechanical thresholds showed to be more reliable and, therefore, more useful, than thermal ones. The pain facilitation might be explained by the phenomenon of stress induced hyperalgesia, but this finding needs to be further investigated with a stricter paradigm.

Local Magnesium Sulfate Administration Ameliorates Nociception, Peripheral Inflammation, and Spinal Sensitization in a Rat Model of Incisional Pain

OBJECTIVE

Postoperative pain remains one of the most common complaints after surgery, and appropriate treatments are limited.

METHODS

We therefore investigated the effect of the anti-nociceptive properties of magnesium sulfate (MgSO4), an N-methyl-D-aspartate (NMDA) receptor antagonist, on incision-induced postoperative pain and peripheral and central nervous system inflammation.

RESULTS

We found that local MgSO4 administration dose-dependently increases paw withdrawal latency, indicating reduced peripheral postoperative pain. Furthermore, MgSO4 inhibited the expression of interleukin-1β (IL-1β) and inducible nitric oxide synthase (iNOS) and phosphorylation of the NMDA receptor NR1 subunit in injured paw tissue and significantly attenuated microglial and astrocytic activation in the ipsilateral lumbar spinal cord dorsal horn.

CONCLUSION

Locally administered MgSO4 has potential for development as an adjunctive therapy for preventing central nociceptive sensitization.

Exploitation of Autophagy Inducers in the Management of Dementia: A Systematic Review

The social burden of dementia is remarkable since it affects some 57.4 million people all over the world. Impairment of autophagy in age-related diseases, such as dementia, deserves deep investigation for the detection of novel disease-modifying approaches. Several drugs belonging to different classes were suggested to be effective in managing Alzheimer's disease (AD) by means of autophagy induction. Useful autophagy inducers in AD should be endowed with a direct, measurable effect on autophagy, have a safe tolerability profile, and have the capability to cross the blood-brain barrier, at least with poor penetration. According to the PRISMA 2020 recommendations, we propose here a systematic review to appraise the measurable effectiveness of autophagy inducers in the improvement of cognitive decline and neuropsychiatric symptoms in clinical trials and retrospective studies. The systematic search retrieved 3067 records, 10 of which met the eligibility criteria. The outcomes most influenced by the treatment were cognition and executive functioning, pointing at a role for metformin, resveratrol, masitinib and TPI-287, with an overall tolerable safety profile. Differences in sample power, intervention, patients enrolled, assessment, and measure of outcomes prevents generalization of results. Moreover, the domain of behavioral symptoms was found to be less investigated, thus prompting new prospective studies with homogeneous design. PROSPERO registration: CRD42023393456.

Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety

Chronic migraine is a disabling neurovascular disorder that ranks amongst the top causes of years lived with disability worldwide. The duration and the frequency of migraine affect cognitive and affective domains, inducing worsening of memory, executive functions, orientation and causing anxiety. Population-based studies report a worrying level of resistance to treatments. Therefore, this study aims: 1) to assess efficacy of monoclonal antibodies (mAbs) directed towards the calcitonin gene-related peptide (CGRP) or its receptor (CGRP-R) for chronic migraine resistant to current preventatives; 2) to design a clinical trial protocol to evaluate the efficacy and safety of combination therapy utilizing anti-CGRP/CGRP-R together with onabotulinumtoxin A in patients suffering from resistant chronic migraine; 3) to provide a molecular rationale for combination therapy. A controlled trial is warranted as pooled analysis of real-world data from our group highlighted that combined treatment provides ≥50% reduction vs. baseline (onabotulinumtoxin A) of monthly headache days (MHDs) in up to 58.8% of patients, but there has been only sparse application of this combined therapy to date. The mAbs chosen are: erenumab, because its combination effect with onabotulinumtoxin A improved symptoms in 65% of patients; eptinezumab, due to its faster action. The results highlight that early diagnosis of migraine improves therapeutic outcomes with mAbs alone, confirming their effectiveness and the need for an adequately powered clinical trial evaluating the safety and potential superior effectiveness of eptinezumab/erenumab and onabotulinumtoxin A together.

Pain and aging: A unique challenge in neuroinflammation and behavior

Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.

Evaluation of bupivacaine liposome injectable suspension efficacy in single-use vials over five days of multiple use

OBJECTIVE

To test the anesthetic effect of a bupivacaine liposome injectable suspension (BLIS), used in a multiple-dose manner for up to 5 consecutive days.

STUDY DESIGN

Prospective, randomized, experimental study.

ANIMALS

A total of 30 male and female Sprague-Dawley rats (Rattus norvegicus), aged 97 (75-130) days and weighing 337.2 (219.6-465.9) g, mean (range).

METHODS

Rats were assigned to one of five BLIS vial groups, in which drug was administered from a newly opened vial or 1, 2, 3 and 4 days after the vial was opened. The vials were refrigerated between uses. A 14 gauge needle attached to an injection plug was used to puncture each vial once and was not removed; BLIS was withdrawn from the injection plug in a multiple-dose fashion. A dose rate of 0.4 mL kg^-1 was administered subcutaneously into the left pelvic limb paw. Antinociception was evaluated using a paw pressure test on both injected and uninjected paws before (time 0, baseline) and 1, 24, 48 and 72 hours after injection.

RESULTS

Age of BLIS vial had no significant effect on anesthetic efficacy (p = 0.97). Across all groups, paw withdrawal latency averaged 5.23 ± 0.24 seconds at baseline (before BLIS injection), increased to 16.45 ± 0.65 seconds at 1 hour after BLIS injection, declined to 7.50 ± 0.76 seconds at 24 hours after BLIS injection, and further declined thereafter (p < 0.001). There was no significant change in paw withdrawal latency in the uninjected paw over time.

CONCLUSIONS AND CLINICAL RELEVANCE

BLIS single-use vials retained efficacy when used up to 5 days in a multiple-dose fashion. Because anesthetic effects declined substantially after 24 hours, multimodal pain management remains important for providing analgesia care.

Evaluating the impact of age and inflammatory duration on behavioral assessments of nociception

Pain is a prevalent issue for elderly individuals. Unfortunately, it remains unclear how acute and chronic pain differs as a function of age, and surprisingly, there is even disagreement on how the sensory and affective dimensions of pain change with age. Therefore, the current investigation evaluated such age differences with behavioral methodology using a preclinical model of arthritis. The primary factors of interest were age and chronicity of pain using behavioral assessments designed to measure sensory and affective dimensions of pain processing. Mechanical and thermal paw withdrawal thresholds demonstrated unique outcomes associated with sensory processing across age. The processing of pain affect measured by the Place Escape/Avoidance Paradigm (PEAP testing) also demonstrated age related effects. Overall, younger animals appeared more sensitive to nociceptive stimuli than older animals. However, the results from the current study suggest that chronicity of pain can be impactful for how older animals process pain related affect and avoidance. The finding of unique patterns of pain across age and duration of pain highlights the clinical literature. Future research should aim to elucidate mechanisms for affective processing of chronic pain in older subjects.

Effects of Aging on Formalin-Induced Pain Behavior and Analgesic Activity of Gabapentin in C57BL/6 Mice

Improved living conditions have induced an increase of lifespan often accompanied by comorbidities, responsible for pain, and by cognitive impairment and dementia, impairing communication capabilities. In most cases, the elderly do not receive pain relief because of underdiagnosis and of aging-induced changes of systems affecting nociceptive response. Unrelieved pain is involved in the development of behavioral symptoms, as agitation, representing a difficult challenge in this fragile population. Aged C57BL/6 mice and amyloid precursor protein (APP) mice display behavioral disturbances that mimic behavioral and psychological symptoms of dementia (BPSD). Therefore, this original study focuses on the influence of aging on nociception to provide insight into the occurrence of BPSD. We have investigated how aging can affect nociception after formalin administration and gabapentin effect in C57BL/6 mice, since it represents one of the treatments of choice for chronic neuropathic pain. Based on our results, changes of nociceptive behavior in response to an algogen stimulus occur during aging. Formalin-induced behavioral pattern in older C57BL/6 mice presents a temporal shift and an increase in the peak amplitudes. Our data show that the effectiveness of gabapentin is influenced by the age of the animal; though preliminary, the latter provide evidence upon which formalin test induced long-lasting mechanical allodynia might be a reliable as rapid and viable persistent pain model. The disclosed differences in effectiveness of gabapentin according to age can form the rational basis to deepen the study of pain treatment in the elderly.

Opioid-Induced Hyperalgesia Is Associated with Dysregulation of Circadian Rhythm and Adaptive Immune Pathways in the Mouse Trigeminal Ganglia and Nucleus Accumbens

The benefits of opioid-based treatments to mitigate chronic pain can be hindered by the side effects of opioid-induced hyperalgesia (OIH) that can lead to higher consumption and risk of addiction. The present study advances the understanding of the molecular mechanisms associated with OIH by comparing mice presenting OIH symptoms in response to chronic morphine exposure (OIH treatment) relative to control mice (CON treatment). Using RNA-Seq profiles, gene networks were inferred in the trigeminal ganglia (TG), a central nervous system region associated with pain signaling, and in the nucleus accumbens (NAc), a region associated with reward dependency. The biological process of nucleic acid processing was over-represented among the 122 genes that exhibited a region-dependent treatment effect. Within the 187 genes that exhibited a region-independent treatment effect, circadian rhythm processes were enriched among the genes over-expressed in OIH relative to CON mice. This enrichment was supported by the differential expression of the period circadian clock 2 and 3 genes (Per2 and Per3). Transcriptional regulators in the PAR bZip family that are influenced by the circadian clock and that modulate neurotransmission associated with pain and drug addiction were also over-expressed in OIH relative to CON mice. Also notable was the under-expression in OIH relative to CON mice of the Toll-like receptor, nuclear factor-kappa beta, and interferon gamma genes and enrichment of the adaptive immune processes. The results from the present study offer insights to advance the effective use of opioids for pain management while minimizing hyperalgesia.

The effects of aging on hydromorphone-induced thermal antinociception in healthy female cats

Introduction:

This study aimed to evaluate the effects of aging on hydromorphone-induced thermal antinociception in cats.

Methods:

In a prospective, randomized, blinded, controlled design, 10 healthy female cats received each of the following treatments intramuscularly: hydromorphone (0.1 mg/kg) and 0.9% saline (0.05 mL/kg) with a 1-week washout between treatments at 6, 9, and 12 months of age. Skin temperature and thermal thresholds (TTs) were recorded before and up to 12 hours after injection. Data were analyzed using a repeated-measures linear mixed model (α = 0.05).

Results:

After saline treatment, TT was not significantly different from baseline at any time point for any age group. After hydromorphone treatment, TT was significantly higher than baseline at 6 months for up to 1 hour, and at 9 and 12 months for up to 4 hours. Peak TT at 6, 9, and 12 months were 50.4 ± 2.7, 50.9 ± 2.0, and 53.6 ± 2.0°C at 0.5, 1, and 1 hours, respectively. Mean TT was significantly higher after hydromorphone treatment when compared with saline treatment at 9 and 12 months for up to 4 hours but not at 6 months. Magnitude of antinociception was consistently larger at 12 months when compared with 6 months of age. Hydromorphone provided a shorter duration and smaller magnitude of antinociception at 6 months when compared with 9 and 12 months.

Conclusion:

Pediatric cats may require more frequent dosing of hydromorphone than adults.

Nonlinear Inverted-U Shaped Relationship Between Aging and Epidermal Innervation in the Rat Plantar Hind Paw: A Laser Scanning Confocal Microscopy Study

The under-reporting of pain and atypical manifestations of painful syndromes within the elderly population have been well documented, however, the specific relationship between pain and aging remains ambiguous. Previous studies have reported degenerative changes in primary afferents with aging. In this study, we questioned whether there is any change in the density of primary afferent endings within the epidermis of aged animals. Rats were categorically assessed in 4 age groups, each representing a key developmental stage across their life span: juvenile (2 months), adult (7 months); aged (18 months), and senescent (24-26 months). The plantar hind paw skin was removed, post-fixed, cut, and immunostained for protein gene product 9.5 and type IV collagen. Rats in the adult aged groups had significantly increased epidermal nerve densities and total lengths of immunoreactive nerve fibers, compared with juvenile as well as senescent rats. However, the paw withdrawal thresholds to punctate mechanical stimulation progressively increased with age, and did not exhibit a clear relationship with epidermal innervation. We conclude a nonlinear, inverted-U shaped relationship between rat plantar epidermal nerve density with aging, which does not correlate with mechanically-induced paw withdrawal behaviors.

PERSPECTIVE

This article presents age-related decreased epidermal innervation in rat hind paw skin, which partly explains mechanisms underlying decreased pain sensitivity in aged subjects. The report may help clinicians to understand that any compromise of pain-sensing pathway can lead to under-reporting of pain, inadequate analgesia, and slower recovery from a painful condition.

Age-dependent antinociception and behavioral inhibition by morphine

In current clinical practice, morphine is dosed in older patients based on patient-weight, with different calculations for adjustment. However, at present, neither clinical experience nor the literature offers a clear evidence base for the relationship between antinociception, behavioral effects and morphine administration in older patients. In this study, we compared the nociceptive response of 8 and 24 week old rats after subcutaneous administration of morphine per body weight and analyzed their behavior using an advanced multi-conditioning system. Residual morphine in all major tissues was determined. We observed prolonged morphine-induced antinociception in older rats compared to younger rats. Moreover, morphine significantly stimulated locomotor and rearing behavior 180 min after injection, which was significantly higher in the 8 week compared to 24 week old rats. Tissue analysis from animals extracted 240 min post-injection revealed a significantly higher concentration of residual morphine in the brains of older versus younger animals when standardized on tissue weight. However, this effect was not observed when residual morphine was standardized on protein content. Collectively, our data suggest that in older rats morphine exhibits higher antinociception and increased behavioral inhibition compared to younger animals. This effect is likely due to a significantly higher accumulation of morphine in the brain of older animals.

Factors Associated with Higher Reported Pain Levels in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional, Correlational Analysis

BACKGROUND

Chronic musculoskeletal pain is highly prevalent, disabling, and costly, and has many negative effects on quality of life. The aim of this study was to investigate factors associated with higher reported pain levels in patients with chronic musculoskeletal pain among demographic, clinical, and psychological factors, and to evaluate whether insomnia is independently associated with pain intensity in this population.

METHODS

A total of 357 patients with chronic musculoskeletal pain (pain duration ≥ six months) satisfied the study inclusion criteria and were included in the analyses. Patient demographics, clinical, and psychological factors were evaluated with hierarchical multivariate logistic analysis to identify factors associated with severe pain (NRS [numeric rating scale] ≥ 7). Hierarchical linear regression analysis also performed to identify factors associated with pain intensity (0 to 10 NRS).

RESULTS

Multivariate logistic analyses revealed older age (OR [odds ratio] = 1.017, 95% CI [confidence interval] 1.001-1.032, P = 0.034), high anxiety level (OR = 1.162, 95% CI 1.020-1.324, P = 0.024), high pain catastrophizing (OR = 1.043, 95% CI 1.007-1.081, P = 0.018), and severe insomnia (OR = 1.112, 95% CI 1.057-1.170, P<0.001) were significantly associated with severe pain. Hierarchical linear regression analysis showed age (β = 0.106, P = 0.041), pain catastrophizing (β = 0.249, P<0.001), and insomnia (β = 0.286, P<0.001) were significantly associated with pain intensity. The variance in pain intensity explained by the final model was 32.2%.

CONCLUSIONS

Older age, severe insomnia, and high pain catastrophizing were significantly associated with higher reported pain levels. Insomnia was independently associated with pain intensity, even after controlling for various demographic and clinical factors. These factors should be considered when devising pain management strategies for this population.

Application of a handheld Pressure Application Measurement device for the characterisation of mechanical nociceptive thresholds in intact pig tails

The assessment of nociceptive thresholds is employed in animals and humans to evaluate changes in sensitivity potentially arising from tissue damage. Its application on the intact pig tail might represent a suitable method to assess changes in nociceptive thresholds arising from tail injury, such as tail docking or tail biting. The Pressure Application Measurement (PAM) device is used here for the first time on the tail of pigs to determine the reliability of the methods and to provide novel data on mechanical nociceptive thresholds (MNT) associated with four different age groups (9, 17, 24 and 32 weeks) and with proximity of the target region to the body of the animal. We recorded an overall acceptable level of intra-individual reliability, with mean values of CV ranging between 30.1 and 32.6%. Across all age groups, the first single measurement of MNT recorded at region 1 (proximal) was significantly higher (P < 0.05) than the following two. This was not observed at tail regions 2 and 3 (more distal). Age had a significant effect (P < 0.05) on the mean thresholds of nociception with increasing age corresponding to higher thresholds. Furthermore, a significant effect of proximity of tail region to the body was observed (P < 0.05), with MNT being higher in the proximal tail region in pigs of 9, 17 and 24 weeks of age. There was also a significant positive correlation (P < 0.05) between mechanical nociceptive thresholds and age/body size of the animals.

To the best of our knowledge, no other investigation of tail nociceptive thresholds has been performed with the PAM device or alternative methods to obtain mechanical nociceptive thresholds in intact tails of pigs of different age/body size. The reliability of the data obtained with the PAM device support its use in the measurement of mechanical nociceptive threshold in pig tails. This methodological approach is possibly suitable for assessing changes in tail stump MNTs after tail injury caused by tail docking and biting.

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Mechanical nociceptive thresholds were quantified for the first time in pig tails.

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The PAM device allowed determining anatomical and age-specific thresholds in pigs.

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A platform for the assessment of painful conditions in pigs is proposed.

The effects of age on pain sensitivity: preclinical studies

OBJECTIVE

Preclinical studies of pain and aging represent an area of research where considerations of age, strain, gender, and method of behavioral assessment are but some of the challenges that must be addressed. The results of studies related to the impact of age on pain sensitivity have ranged from increased to decreased sensitivity to no change. Examining the design of these studies one discovers that cross-sectional designs using animals of different ages have been used to evaluate age-related effects in normal animals as well as animals with inflammatory and neuropathic pain conditions. In the present review a summary of these studies is presented along with a discussion of potential mechanisms responsible for changes that have been described.

OUTCOME MEASURES

The dominant method of behavioral assessment in the majority of studies involving rodents has been reflex-based strategies that unfortunately do not reveal the same effects of experimental manipulations known to affect pain sensitivity in humans. A comparison of results obtained with reflex-based methods versus those obtained with cortically dependent operant methods reveals significant differences.

CONCLUSIONS

Increases in pain sensitivity under different experimental conditions have been suggested to result from age-related anatomical, physiological, and biochemical changes as well as compensatory changes in homeostatic mechanisms and intrinsic plasticity of somatosensory pathways involved in the processing and perception of pain. Other factors that may contribute to the impact of age on pain sensitivity include dysregulation of the hypothalamic-pituitary-adrenal axis and changes in autonomic function that occur with advancing age. In the future translational research in the field of pain and aging will need to focus on establishing clinically relevant animal models and assessment strategies to evaluate the causal relationships between the biological changes associated with advancing age and the varied behavioral changes in pain sensitivity.

Opioid use in the elderly

Pain treatment in the elderly is an important challenge to Western societies due to increasing numbers of old persons, their higher incidence of pain, and their greater susceptibility to adverse effects of pain medication. We provide an overview of the factors liable to influence opioid action in the elderly population. A major challenge for the physician prescribing opioids in the elderly is their greater risk of medication-associated problems. Thus, older patients suffer increased vulnerability to adverse drug effects and interactions, higher rates of polypharmacy, and more comorbidity. These problems are compounded by a relative lack of definitive published information. There is clearly a need for more research in this area. Aging affects opioid pharmacokinetics via altered body composition (distribution volumes) and organ function (liver=metabolism, kidney=excretion). Pharmacodynamics is affected via impaired neurotransmitter/peptide production and changed receptor affinities/populations. Older women may need less morphine analgesia postoperatively, while pain sensitivity tends to increase particularly in older men. However, the net effects of changes in opioid pharmacology with age on clinical opioid analgesia remain unclear, probably due to the significantly greater variability in body function with increasing age. Practical recommendations for opioid prescription in the elderly include meticulous review of indication for opioid use, not only initially but also at regular intervals thereafter. A policy of careful titration should be followed, with conservative choice of dosage on starting. Dosing intervals may need to be lengthened subsequently. Finally, it should be remembered that old persons do not necessarily need less opioid than younger ones.

Effects of morphine on thermal sensitivity in adult and aged rats

There are contradictory data regarding older individuals' sensitivity to pain stimulation and opioid administration. Adult (12-16 months; n = 10) and aged (27-31 months; n = 7) male F344xBN rats were tested in a thermal sensitivity procedure where the animal chooses to remain in one of two compartments with floors maintained at various temperatures ranging from hot (45°C) through neutral (30°C) to cold (15°C). Effects of morphine were determined for three temperature comparisons (ie, hot/neutral, cold/neutral, and hot/cold). Aged rats were more sensitive to cold stimulation during baseline. Morphine produced antinociception during hot thermal stimulation, but had no effect on cold stimulation. The antinociceptive (and locomotor-altering) effects of morphine were attenuated in aged rats. These data demonstrate age-related differences in baseline thermal sensitivity and responsiveness to opioids. Based on behavioral and physiological requirements of this procedure, it is suggested that thermal sensitivity may provide a relevant animal model for the assessment of pain and antinociception.

Cancer breakthrough pain in the presence of cancer-related chronic pain: fact versus perceptions of health-care providers and patients

Cancer breakthrough pain is a flare in pain that "breaks through" well-controlled persistent cancer pain. Although the condition is highly prevalent, the concept of cancer breakthrough pain is not well understood and is therefore underdiagnosed and undertreated. The purpose of this review is to examine the roles the health-care practitioner and patient/family caregiver play in the undertreatment of breakthrough pain. A lack of technical knowledge about pain management and pain assessment, attitudes about opioid addiction, and regulatory guidelines influence the manner in which opioids are prescribed. Patients harbor a variety of fears and misconceptions, such as opioid addiction, tolerance, side effects, and the meaning of pain, which can create a barrier to effective communication with their health-care provider regarding their cancer pain management and specifically their breakthrough pain. Identifying these issues gives health-care professionals and patients an opportunity to develop strategies that can improve the treatment of cancer breakthrough pain.

Cutaneous C-fiber nociceptor responses and nociceptive behaviors in aged Sprague-Dawley rats

The change with age in pain perception in humans and the nociceptive behaviors in animals elicited by noxious stimuli to the skin are not well understood, and little is known about the peripheral neural mechanisms of cutaneous nociception in the aged. We systematically examined cutaneous nociceptor responses and nociceptive behaviors in young (9-14 w) and in aged (127-138 w) Sprague-Dawley rats. C-fiber nociceptors in the skin were identified by mechanical and electrical stimulation, and extracellularly recorded from hind paw skin-saphenous nerve preparations in vitro. In the aged rats, the proportions of mechano-responsive and/or heat-responsive C-nociceptors were significantly lower. The proportion of mechano- and thermo-insensitive units, on the other hand, was significantly increased. In addition, the response threshold to mechanical stimulus tended to be higher and the magnitude of the response tended to be smaller. There were no differences between the two age groups in the response magnitudes of mechano-responsive C-nociceptors to bradykinin, cold or heat. Repetitive electrical stimulation of afferent fibers revealed exaggerated slowing of conduction velocity in mechano-responsive C-fibers in the aged. This showed for the first time that not only receptive properties of afferent terminals but also membrane properties of conducting axons are changed in aged rats. Nociceptive behaviors in response to noxious levels of cold (cold plate test) and heat (Hargreaves' radiant heat test) were facilitated in aged animals, while mechanical sensitivity measured by von Frey hairs remained unchanged. These discrepancies between the changes in peripheral afferents and the behavioral outcomes might be explained by facilitatory changes in the central nervous system.

Augmented mechanical response of muscular thin-fiber receptors in aged rats recorded in vitro

Musculoskeletal pain deteriorates quality of life by disrupting daily activities and is a considerable economic burden to many countries because of the large number of patients. Little is known about the peripheral neural mechanisms of muscular nociception in the aged, although structural and functional changes in the muscle are apparent as a function of age. The aim of the present study was to investigate the activities of aged muscle nociceptors systematically to mechanical, chemical and thermal stimuli, and to compare with the data from young animals. Activities of single C-fibers were recorded from in vitro preparations of extensor digitorum longus muscle-nerve excised from hind legs of aged rats (125-133 weeks). Mechanical threshold measured by a ramp mechanical stimulus in the aged muscle (median; 45.2 mN (IQR; 38.1-59.1 mN), n=29) was significantly lower than that in the younger muscle (median; 65.4 mN (IQR; 46.6-122.0 mN), n=33, p<0.01, Mann-Whitney U-test) reported in our previous study (Taguchi et al., 2005). In addition, the magnitude of the mechanical response during the first 5s of the 10s stimulus was significantly greater in the aged muscle (11.0 spikes (IQR; 6.5-20.5 spikes)) than in the young (7.0 spikes (IQR; 4.0-11.5 spikes), p<0.05, Mann-Whitney U-test). In contrast, the numbers of discharges induced by chemical (pH 5.5, ATP and bradykinin) and thermal (cold and heat) stimuli were not different with the different ages. These results showed an augmented mechanical response in muscle C-afferents in the aged rats.

Pain management in older people

At times providing pain relief in elderly patients can prove troublesome. Their tolerance and perception of pain can differ from that of younger patients, while the incidence of pain is above that found in those of less advanced years.

Conventional approaches to providing pain relief can be successful, but the tolerance to the side-effects of those drugs used to provide pain relief can be less. Furthermore, polypharmacy can have implications for the range of analgesic drugs that can be considered. Fortunately there are an increasing range of medicinal products with reduced potential for side-effects that can be considered when treating older patients with pain.

Aging impairs collateral sprouting of nociceptive axons in the rat

Sprouting of uninjured nociceptive axons was examined in young adult, middle aged and aged rats. Axon sprouting from the spared sural nerve, both into adjacent denervated skin and into end-to-side coapted nerve graft, was significantly higher in young rats than in aged rats. Cross-transplantations of the end-to-side coapted nerve grafts between young and aged rats demonstrated that axon sprouting from young recipient nerves into aged donor nerve grafts was significantly deteriorated, whereas the axon sprouting from aged recipient nerves into young donor nerve grafts was not statistically significantly affected. The levels of laminin polypeptides in peripheral nerves were 50-100% higher in young adult than in aged rats. However, the levels of peripherin, NGF isoforms and TrkA in skin, peripheral nerves and DRG, respectively, were not significantly reduced in aged rats. Therefore, impaired sprouting of nociceptive axons in aged rats is due rather to the alterations in peripheral neural pathways, than to the limited sprouting capacity of aged sensory neurons. Decreased levels of extracellular matrix components might be important in this respect.

Translational nociceptor research as guide to human pain perceptions and pathophysiology

Microneurography is a method for recording single unit action potentials with microelectrodes from the nerves of awake cooperating humans. Although this method is now in use since almost 40 years, its potency has been strengthened by the recent technical developments. A great progress was the discovery that different functional groups of nociceptors are characterized by a distinctly different post-excitatory slowing of their conduction velocities. Microneurography is now powerful enough to analyze the nerve activity pattern of enigmatic sensations such as pruritus. Furthermore, it is the only method providing direct insight in the changes which human nerves undergo with aging. Recently, reliable recordings from patients suffering from painful neuropathies came into reach. It has been shown that different types of neuropathies are characterized by different patterns of abnormal nociceptor functions. Although some of them are characterized by abnormal spontaneous activity in C-nociceptors, others show mainly signs of denervation. Microneurography is, therefore, a tool for translational studies on human nociceptor functions by linking direct animal studies on experimental neuropathies with human diseases.

Pain perception in the elderly patient

In the elderly patient, the barriers to effective treatment of pain are substantial. Even the perception of pain may differ from that in those of less advanced years. Of course, many other factors impinge on the presence of, and treatment of, pain in elderly patients. Issues of physical accessibility to treatment, cost of drugs, the presence of coexisting illness, the use of concomitant medication, and even the ability to understand the complaints of the patient who has cognitive impairment are only some of those factors that contribute to the complexity of the situation.

Safety pharmacology assessment of central nervous system function in juvenile and adult rats: effects of pharmacological reference compounds

INTRODUCTION

Recent EU/US pediatric legislation and FDA/EMEA guidelines recognize the potential differences in safety profiles of drugs in adults versus young patients. Hence safety studies are recommended to investigate key functional domains of e.g. the developing CNS.

METHODS

Selected psychoactive stimulants (caffeine, d-amphetamine, scopolamine) and depressants (baclofen, diazepam, haloperidol, chlorpromazine, imipramine, morphine) were characterized upon single administration with regard to behavioural parameters, locomotor activity, body temperature, pro-/anti-convulsive activity (pentylenetetrazole, PTZ), and nocifensive responses (hotplate) in neonatal (2 weeks), juvenile (4 weeks) and adult rats (8-9 weeks).

RESULTS

In vehicle-treated rats, behavioural patterns matured with age, locomotor activity and handling-induced rise in body temperature were enhanced, whereas PTZ convulsion threshold dose and nocifensive response latency decreased. Single test compound treatment elicited behavioural effects characteristic for psychoactive drugs with stimulating and depressing properties regardless of age. However, incidence of certain behaviours, and magnitude of effects on locomotor activity and body temperature varied with age and became generally more pronounced in adult rats. Pro-/anti-convulsive effects and delayed nocifensive responses did not differ between juvenile and adult rats.

CONCLUSION

CNS effects of selected psychoactive reference compounds were qualitatively similar, but quantitatively different in neonatal, juvenile and adult rats.

Age-related changes in the gastrointestinal tract: a functional and immunohistochemical study in guinea-pig ileum

It is known that there is an age-related increase in gastrointestinal diseases. However, there is a lack of studies dealing with the correlation between age-related changes in function and intrinsic innervation in the gastrointestinal tract. The purpose of this work was to study this subject in the guinea pig ileum, whose functional and structural features are well known in the young age. Ileal longitudinal muscle -- myenteric plexus (LMMP) preparations were obtained from 3-to 24-month-old guinea pigs. Both functional and immunohistochemical techniques were applied. The force of the contraction elicited by excitatory stimuli (electrical stimulation, acetylcholine, substance P, and opioid withdrawal) increased in parallel with an age-dependent reduction in the density of excitatory motor neurones to the longitudinal muscle, whereas other subpopulations of neurones, including inhibitory motor neurones, decreased much more slowly. Although the increase in responsiveness could be related to the age/weight-related increment in muscle bulk, some compensatory modifications to the lowered density of excitatory neurones could also be involved. On the other hand, the acute inhibitory response to morphine remained unaltered in old animals, whilst in vitro tolerance was lower. These results suggest that although age-dependent neuronal loss does not cause dramatic changes in intestinal motility, it is a factor that could contribute to disturbing normal responsiveness and, perhaps, underlie the higher frequency of gastrointestinal diseases encountered in the elderly.

Deletion of the life span determinant p66Shc prevents age-dependent increases in emotionality and pain sensitivity in mice

Oxidative stress has been implicated in the aging process. Previous studies have determined that mice with a targeted mutation of the p66(Shc) gene show reduced oxidative stress and extended life span. This study is the first behavioral characterization of mice carrying a deletion of p66(Shc). Four-, 11- and 24-months-old homozygous knockout and wild-type mice of the 129Sv/Ev strain underwent a battery of behavioral tests. Locomotion and exploratory activity were tested in the open-field test, emotional reactivity was assessed in the elevated plus-maze, while nociception was evaluated by means of the hot-plate test (50 degrees C). In addition, social behavior was assessed in a social interaction test. Our results indicate that pain sensitivity and emotional behavior in wild-type mice increase with age. Deletion of the p66 gene results in an increase in pain threshold and reduced emotionality, differences with wild-type subjects becoming more pronounced with age. Thus reduced oxidative stress throughout the life span is able to prevent some behavioral effects of aging, particularly in response to painful or emotionally arousing stimuli. These data are discussed in relation to recent views, indicating new and complex interactions between oxidative stress and emotional stress.

Effects of aging on current vocalization threshold in mice measured by a novel nociception assay

BACKGROUND

Age-related changes in nociception have been extensively studied in the past decades. However, it remains unclear whether in addition to the increased incidence of chronic illness, age-related changes in nociception contribute to increased prevalence of pain in the elderly. Although a great deal of evidence suggests that nociception thresholds increase with aging, other studies yield disparate results. The aim of this investigation was to longitudinally determine the effect of aging on nociception.

METHODS

The authors developed a nociception assay for mice using electrical stimuli at 2,000, 250, and 5 Hz that reportedly stimulate Abeta, Adelta, and C sensory nerve fibers, respectively. A system was designed to automate a method that elicits and detects pain-avoiding behavior in mice. Using a Latin square design, the authors measured current vocalization thresholds serially over the course of mice's life span.

RESULTS

For 2,000-Hz (Abeta), 250-Hz (Adelta), and 5-Hz (C) electrical stimuli, current vocalization thresholds first decreases and then increases with aging following a U-shaped pattern (P < 0.001). In addition, average current vocalization thresholds at youth and senescence are significantly higher than those at middle age for the 250-Hz (Adelta) and 5-Hz (C fiber) electrical stimulus (P < 0.05).

CONCLUSIONS

Using a novel and noninjurious nociception assay, the authors showed that over the life span of mice, current vocalization threshold to electrical stimuli changes in a U-shaped pattern. The findings support the notion that age-related changes in nociception are curvilinear, and to properly study and treat pain, the age of subjects should be considered.

Nociceptive threshold and analgesic response to morphine in aged and young adult rats as determined by thermal radiation and intracerebral electrical stimulation

The present experiment compared the nociceptive threshold and analgesic response to morphine in young (4-5 months) and aged (24 months) rats using peripheral thermal stimulation and intracerebral electrical stimulation. Responses to thermal stimuli were assessed using both the classical tail-flick procedure in which latency of response is the dependent variable and a new method in which threshold in calories of heat is the dependent variable. In the intracerebral nociceptive threshold procedure, electrical stimuli were delivered via an electrode implanted in the mesencephalic reticular formation (MRF), a pain pathway, and the animals were trained to terminate the stimulation by turning a cylindrical manipulandum embedded in one wall of the experimental chamber. For the classical tail-flick method, the aged rats required a greater intensity of stimulation to produce a basal response latency that was between 2.5 and 3.5 s. Using the new psychophysical method for determining the tail-flick threshold, the aged rats' basal thresholds were significantly higher than that of the young rats. However, the basal thresholds obtained by direct stimulation of the MRF failed to show a significant age effect, suggesting that the registration of pain is not different between young and aged rats. These age-related differences in baseline tail-flick response may be due to changes in the spinal reflex associated with aging. Although, there was no difference in the analgesic effects of morphine between young and aged rats using the latency of the tail-flick response, evidence for decreased analgesic response was seen using the tail-flick threshold measure and the intracerebral stimulation threshold method.

Age-related impact of neuropathic pain on animal behaviour

The number of old and very old persons is increasing and there is evidence that aging coincides with chronic painful conditions. Pain induces behavioural disorders that have been so far poorly identified in old and even less in very old animals. The aim of this study was to: (1) compare the evolution of pain in senescent animals (37-39 months) to old (20-22 months) and young (4-6 months) Lou/cjall rats after a chronic constriction of the sciatic nerve; (2) evaluate pain during four weeks after surgery with an experimental and an observational approach to determine how the response to noxious stimuli correlates with recorded spontaneous behaviour. Results showed that senescent animals are less sensitive to neuropathic pain than old or young rats while senescent/old rats are more sensitive to acute pain. The correlation between observational and experimental pain scores stresses the reliability of non-invasive measures for pain evaluation in senescent populations. The dichotomy between neuropathic and acute pain perceptions with age needs to be further investigated and would help to better understand the reasons of this uneven pain perception and expression with age.

Effects of ventral hippocampal lesion on thermal and mechanical nociception in neonates and adult rats

The proper maturation of the hippocampus is essential for the development of different behaviours, including memory, pain responses and avoidance. The mechanisms involved in the neurodevelopment of nociception have also been implicated in several neuropsychiatric disorders. The neonatal lesion of the ventral hippocampus (VH) in rats, an animal model of schizophrenia, can be utilized to study the developmental neurobiology of animal behaviour. We examined the nociceptive responses in this animal model at different stages of development. Rat pups were lesioned at postnatal day 7 by injecting ibotenic acid into the VH bilaterally, and then tested for thermal and mechanical nociception at the age of 35, 65 and 180 days. The nociceptive tests used were the hot plate (HP), paw pressure (PP) and tail flick (TF) tests. Another group of adult rats had the same lesion in the VH and then underwent the same tests at 28, 56 and 168 days post-lesions. When compared with sham controls, the rats with neonatal VH lesion showed decreased latency for the HP and PP tests only after puberty. The TF test showed significant increase in latency for both groups at age 65 and 180 days. The adult rats with VH lesion showed no major changes over all periods of testing. These results suggest that early lesion of VH can alter the development of the neural mechanisms involved in the processing of thermal and mechanical nociception.

Sex-related differences in the regeneration of sensory axons and recovery of nociception after peripheral nerve crush in the rat

Sex-related differences regarding the regeneration of nociceptive axons and the recovery of nociception after sural nerve crush injury were examined in rats. The elongation rate of the fastest regenerating sensory axons in females started to increase after the first 6 days. This resulted in about 15% greater axon elongation distance at 8 days after crush in female than in male rats as determined by the nerve pinch test. The number of regenerating sensory axons in female and male rats, however, was not different. The recovery of nociception in the instep started earlier and was more extensive in females than in males during the entire 24-week recovery period, so that the pain sensitive area was finally about 20% larger in females than in males. Although ovariectomy significantly reduced plasma estradiol concentration in female rats, it did not change the elongation distance of regenerating nociceptive axons, which remained significantly greater than in male rats. Elimination of the cells in the distal nerve segment by freezing revealed that a more effective cell support in the distal nerve segment is probably responsible for faster regeneration of nociceptive axons in females than in males, rather than the circulating female sex hormones.

The burden of pain on the shoulders of aging

More than 9% of the world population is older than 60. With age comes additional vulnerability to pain and the accumulation of insults that can engender ongoing misery. Insights into molecular and cellular aspects of pain might help escort people more comfortably into the senior ranks, but research that specifically addresses pain in the elderly is only now gearing up. Although a comprehensive understanding of how aging affects pain--and vice versa--is far off, experts report a good outlook for helping the millions of undertreated older people who experience pain on a daily basis.

Age-related changes in the antinociception induced by taurine in mice

Taurine is a nonessential amino acid that is of medical interest for the nutrition of infants. Taurine has been found in the central nervous system of rodents and humans, and among its potential therapeutic uses, it is interesting to remark its analgesic actions. It is also well known that concentration levels during the fetal and prenatal periods are higher than in adulthood. The data obtained so far indicate that taurine is involved in the development process of the brain and possibly other organs. The taurine levels in old age are still unknown, but it is presumed that they will be different from those of younger animals. Data about age-related alterations and functional modifications of this and other amino acids are still scarce. The aim of the present work was to study the antinociceptive effect of taurine and its relationship with aging in mice. No differences were found between prepubertal and young adult animals; on the contrary, old animals showed significantly reduced sensitivity to the antinociception induced by taurine; in fact, at the tested doses, taurine did not induce antinociception in this group of mice. The mechanism underlying this effect has not been clarified because there are several mechanisms and neurotransmitter systems involved in the antinociception induced by taurine.

Impact of ageing on the antinociceptive effect of reference analgesics in the Lou/c rat

1. Research on the evolution of experimental pain perception and on the achievement of analgesia with ageing has led so far to contradictory results. 2. This study investigated in the rat the impact of ageing on the antinociceptive effect of reference analgesics, acetaminophen (50, 100, 200, 400 mg kg(-1) po), aspirin (50, 100, 200, 400 mg kg(-1) sc), clomipramine (5, 10, 20, 40 mg kg(-1) sc) and morphine (1.25, 2.5, 5, 10 mg kg(-1) sc). 3. Lou/c rats were chosen because they provide a model of healthy ageing and they do not develop obesity with age. Three groups of 40 rats each (mature (4 months), middle-aged (18 months) and old (26 months)), were treated with each drug at 14 days interval. Two tests were used: a thermal test (tail immersion in 48 degrees C water and measurement of reaction latency) and a mechanical test (paw pressure and measurement of struggle threshold). 4. Results confirm the increased mechanical sensitivity to pain and no change in thermal sensitivity for old rats compared to mature and middle-aged animals. They show a marked decrease in the effect of morphine with age and no age-related effect for acetaminophen, aspirin or clomipramine. Plasma levels of morphine and metabolites are not different in the three age groups. 5. It is likely that the influence of age on morphine analgesia is linked mainly to pharmacodynamic rather than pharmacokinetic changes.

Age-related alterations in responses of nucleus basalis magnocellularis neurons to peripheral nociceptive stimuli

The present study investigated the effects of peripheral noxious stimuli on the spontaneous activity of the nucleus basalis magnocellularis (nbM) neurons in young, adult and old rats. Single unit extracellular recordings from the nbM neurons were obtained with glass micropipettes in urethane-anesthetized rats. A total of 104 units were antidromically identified as nbM-cortical neurons. Noxious but not innocuous mechanical stimulation elicited responses in 72% of the 104 neurons. Most of them were excited. The receptive fields were usually very large and bilateral. Most of the neurons also responded to noxious thermal, chemical and electrical stimuli. No marked differences were observed in the incidence of neurons having different spontaneous firing rates, firing patterns and response type among the three age groups. However, the latency of responses evoked by noxious thermal or electrical stimulation and the threshold of excitatory responses evoked by electrical stimulation were increased with aging. The duration and peak-firing rate of excitatory responses evoked by noxious thermal, chemical or electrical stimulation were decreased in old rats. These findings indicate that there might be some functional changes in the nbM neurons and its projection pathway with aging, which impair their responsive ability to peripheral nociceptive stimuli.

Impact of age, gender and cognitive functioning on pain perception

BACKGROUND

Experimental data on nociception in the elderly have so far been contradictory and most of these have been obtained using psychophysical methods with little attention paid simultaneously to the state of cognition and the psychometric performance of the subjects.

OBJECTIVE

The aim of this study was twofold: (1) to evaluate the impact of age on experimental nociception thresholds, and (2) to investigate the interactions of age, sex, cognition and psychometric performance with nociception thresholds.

METHODOLOGY

(1) Two groups, one young and one elderly, of 42 healthy participants each, 21 males and 21 females, were compared as regards nociception thresholds with thermal and mechanical stimuli (heat and pressure detection and tolerance thresholds). (2) The elderly group took cognitive (mini-mental test), psychometric (choice reaction time) and psychophysical tests in auditory (sensibility, tolerance, discrimination) and nociceptive fields.

RESULTS

This study shows that (1) pressure nociception decreases with age especially in males, while thermal thresholds are not modified, and (2) correlations exist between cognitive function, psychometric performance, tolerance to loud sounds and tolerance to mechanical noxious stimuli.

CONCLUSION

Our results suggest that cognitive and psychomotor parameters have to be taken into account when assessing experimental nociception in the elderly. Further studies are needed to evaluate possible report biases and to assess these interactions in old patients with pain and in mildly sensory, cognitive or motor impaired elderly subjects.

Plastic changes in nociceptive transmission of the rat spinal cord with advancing age

To understand characteristics of the pain system in the elderly, we investigated the electrophysiological properties of nociceptive neurons in the lumbar spinal dorsal horn of aged (29-34-mo old) and adult (7-13-mo old) rats. The responses of nociceptive neurons to noxious thermal stimulation, as well as the spontaneous firing rate, were significantly higher in the aged as compared with adult rats. Furthermore, the size of the high-threshold receptive field area of wide dynamic range neurons was larger (P < 0.01) and that of the low-threshold area was smaller (P < 0.05) in aged rats than in adult rats. The increased nociceptive neuronal activity in the aged rats correlated with the finding that the paw withdrawal latency was significantly shorter in the aged rats than those of the adult rats following heat stimulation of the hind paw (P < 0.05). Reversible local anesthetic block of descending pathways resulted in a dramatic increase in neuronal activity in adult rats but had little effect in aged rats. There was also a significant loss of serotoninergic and noradrenergic fibers in the spinal dorsal horn of the aged rats. These results demonstrate an age-related plasticity in spinal nociceptive processing that is related to impairment of descending modulatory pathways.