Intradermal injection of norepinephrine evokes pain in patients with sympathetically maintained pain
Intradermal injection of norepinephrine evokes pain in patients with sympathetically maintained pain
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DOI：
10.1016/s0304-3959(00)00327-4
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发表时间：
2000-11-01
期刊：
影响因子：
7.4
通讯作者：
Campbell, JN
中科院分区：
文献类型：
--
作者：
Ali, Z;Raja, SN;Campbell, JN
有或没有神经参与的组织损伤可能导致持续的疼痛和对外部刺激的痛觉过敏。在一部分患者中，疼痛是由交感神经传出活动（SMP）维持的。我们研究了外周给予生理相关剂量的α-肾上腺素能激动剂去甲肾上腺素（NE）是否会导致SMP患者疼痛。为了确定诱导皮肤血管收缩所需的皮内NE剂量，在激光多普勒探针下将NE（1 nM-10 μ M，30穆尔）注射到7名正常受试者的前臂掌侧。在10 μ M的剂量下，血液的减少是明显的。12名患者（5名男性，7名女性）根据局部麻醉交感神经阻滞引起的疼痛减轻（70 +/-6%）被诊断患有SMP，并被纳入该研究。在痛觉过敏区和镜像对侧皮内注射生理盐水和NE（0.1-10 μ M）后，连续5分钟获得疼痛评级。在局部麻醉交感神经阻滞后疼痛缓解期间进行注射。在8名对照受试者中进行了类似的注射。在患者的患侧，两个最高浓度的NE（1和10 μ M）比盐水引起显著更多的疼痛（P < 0.05，ANOVA）。相反，在未受影响的一侧和对照受试者中没有由NE注射引起的显著疼痛。九名患者中有六名报告了在输注酚妥拉明（1 mg/kg，10分钟）后疼痛和痛觉过敏明显减轻。在酚妥拉明输注后没有接受疼痛缓解的三名患者中，有两名也没有报告NE注射引起的疼痛。我们的结论是NE注射产生疼痛的SMP患者的剂量是在阈值产生血管收缩。这些研究支持皮肤肾上腺素受体在交感神经维持疼痛机制中的作用。(C)2000年国际疼痛研究协会。由Elsevier Science B. V.出版，版权所有。
Tissue injuries, with or without involvement of nerves, may lead to ongoing pain and hyperalgesia to external stimuli. In a subset of patients, the pain is maintained by sympathetic efferent activity (SMP). We investigated if the peripheral administration of the alpha -adrenergic agonist, norepinephrine (NE), in physiologically relevant doses resulted in pain in patients with SMP. To establish the dose of intradermal NE required to induce cutaneous vasoconstriction, NE (1 nM-10 muM, 30 mul) was injected under a laser Doppler probe on the volar forearm of seven normal subjects. A decrease in blood how was evident at a dose of 10 muM Twelve patients (five male, seven female) diagnosed to have SMP based on the decrease in pain by a local anesthetic sympathetic blockade (70 +/- 6%) were enrolled in the study. Pain ratings were obtained continuously for 5 min after intradermal injections of saline and NE (0.1-10 muM) into their hyperalgesic zone and the mirror-image contralateral side. Injections were done during the period of pain relief following a local anesthetic sympathetic blockade. Similar injections were made in eight control subjects. On the affected side of the patients, the two highest concentrations of NE (1 and 10 muM) caused significantly more pain than saline (P < 0.05, ANOVA). In contrast, there was no significant pain induced by the NE injections in the unaffected side and in control subjects. Six of nine patients tested reported a marked decrease in pain and hyperalgesia following infusion of phentolamine (1 mg/kg over 10 min). Two of the three patients who did not receive pain relief following phentolamine infusion also did not report pain to the NE injections. We conclude that NE injections produce pain in SMP patients at doses that are at the threshold for producing vasoconstriction. These studies support a role for cutaneous adrenoceptors in the mechanisms of sympathetically maintained pain. (C) 2000 international Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.