Involvement of intra-articular corticotropin-releasing hormone in postoperative pain modulation
Involvement of intra-articular corticotropin-releasing hormone in postoperative pain modulation
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DOI：
10.1097/01.ajp.0000210954.93878.0d
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发表时间：
2007-02-01
影响因子：
2.9
通讯作者：
Schaefer, Michael
中科院分区：
文献类型：
--
作者：
Likar, Rudolf;Mousa, Shaaban A.;Schaefer, Michael
目的：阿片受体在外周神经末梢上表达，阿片肽（β-内啡肽，END）在膝关节创伤后滑膜组织的各种免疫细胞中产生。由于促肾上腺皮质激素释放激素（CRH）通过其受体作用于含有END的免疫细胞，因此这项随机对照试验研究了关节内（IA）注射CRH是否能降低接受关节镜膝关节手术的患者的术后疼痛强度和补充镇痛剂消耗。方法：患者被随机分配到以下IA和IV治疗之一：生理盐水（SAL）组（n = 17）接受等渗SAL IA和CRH 10 μ g IV，CRH组（n = 16）接受CRH 10 μ g IA和SAL IV，CNL组（n = 18）接受CRH 10 μ g+纳洛酮0.12 mg IA和SAL IV。记录患者在休息和运动时的疼痛强度、皮质醇血浆浓度以及补充镇痛剂。免疫组化分析共定位CRH受体和END.Results：IA，但不是IV CRH导致一个显着的，但短暂的减少术后疼痛在休息和运动条件下，皮质醇血浆浓度没有变化。同时给予纳洛酮可逆转静息状态下的疼痛减轻，但运动状态下无此作用。大多数CRH受体表达细胞包含END内synovial tissue.Discussion：总之，这第一次临床试验提供了初步证据，短期内，但不强大的镇痛作用的IA CRH在接受膝关节镜手术的患者。进一步的临床研究将检查不同剂量的IA CRH诱导的镇痛，并支持阿片肽的参与。
Objectives: Opioid receptors are expressed on peripheral nerve endings and opioid peptides (beta-endorphin, END) are produced in various immune cells of synovial tissue after knee trauma. Because corticotropin-releasing hormone (CRH) acts through its receptors on END-containing immune cells, this randomized controlled trial investigated whether the intra-articular (IA) injection of CRH reduces postoperative pain intensity and supplemental analgesic consumption in patients undergoing arthroscopic knee surgery.Methods: Patients were randomly assigned to one of the following IA and IV treatments: group saline (SAL) (n = 17) received isotonic SAL IA and 10 mu g CRH IV; group CRH (n = 16) received 10 mu g CRH IA and SAL IV; group CNL (n = 18) received 10 mu g CRH plus 0.12 mg naloxone IA and SAL IV. Patients pain intensity at rest and during exercise, cortisol plasma concentrations as well as supplemental analgesics were documented. Immunohistochemistry analyzed colocalization of CRH receptors and END.Results: IA but not IV CRH resulted in a significant but short lasting reduction of postoperative pain under both resting and exercise conditions without changes in cortisol plasma concentrations. Coadministration of naloxone reversed this pain reduction under resting but not exercise conditions. The majority of CRH receptor expressing cells contained END within synovial tissue.Discussion: In conclusion, this first clinical trial provides preliminary evidence for a short but not robust analgesic effect of a single dose of IA CRH in patients undergoing arthroscopic knee surgery. Further clinical studies will have to examine different doses of IA CRH-induced analgesia and to support the involvement of opioid peptides.