Alterations in endogenous opioid functional measures in chronic back pain.

Abstract

The absence of consistent end organ abnormalities in many chronic pain syndromes has led to a search for maladaptive CNS mechanisms that may explain their clinical presentations and course. Here, we addressed the role of brain regional μ-opioid receptor-mediated neurotransmission, one of the best recognized mechanisms of pain regulation, in chronic back pain in human subjects. We compared μ-opioid receptor availability in vivo at baseline, during pain expectation, and with moderate levels of sustained pain in 16 patients with chronic nonspecific back pain (CNBP) and in 16 age- and gender-matched healthy control subjects, using the μ-opioid receptor-selective radioligand [(11)C]carfentanil and positron emission tomography. We found that CNBP patients showed baseline increases in thalamic μ-opioid receptor availability, contrary to a previously studied sample of patients diagnosed with fibromyalgia. During both pain expectation and sustained pain challenges, CNBP patients showed regional reductions in the capacity to activate this neurotransmitter system compared with their control sample, further associated with clinical pain and affective state ratings. Our results demonstrate heterogeneity in endogenous opioid system functional measures across pain conditions, and alterations in both receptor availability and endogenous opioid function in CNBP that are relevant to the clinical presentation of these patients and the effects of opioid analgesics on μ-opioid receptors.

• Authors: Ilkka K Martikainen, Marta Peciña, Tiffany M Love, Emily B Nuechterlein, Chelsea M Cummiford, Carmen R Green, Richard E Harris, Christian S Stohler, Jon-Kar Zubieta
• Journal: The Journal of neuroscience : the official journal of the Society for Neuroscience (J Neurosci) Vol. 33 Issue 37 Pg. 14729-37 (Sep 11 2013) ISSN: 1529-2401 [Electronic] United States
• PMID: 24027273 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid
• Carbon Radioisotopes
• carfentanil
• Fentanyl

Topics

• Adult
• Analgesics, Opioid (metabolism)
• Analysis of Variance
• Back Pain (diagnostic imaging, pathology)
• Brain (diagnostic imaging, metabolism, pathology)
• Brain Mapping
• Carbon Radioisotopes
• Case-Control Studies
• Chronic Disease
• Female
• Fentanyl (analogs & derivatives)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pain Measurement
• Pain Threshold (drug effects)
• Positron-Emission Tomography
• Synaptic Transmission (drug effects, physiology)