title: Intravenous opioids stimulate norepinephrine and acetylcholine release in spinal cord dorsal horn. Systematic studies in sheep and an observation in a human.
abstract: BACKGROUND
  Opioids produce analgesia by direct effects as well as by activating neural pathways that release nonopioid transmitters. This study tested whether systematically administered opioids activate descending spinal noradrenergic and cholinergic pathways.
  
  
  METHODS
  The effect of intravenous morphine on cerebrospinal fluid and dorsal horn microdialysate concentrations of norepinephrine and acetylcholine was examined in 20 sheep. Animals received either intravenous morphine or fentanyl alone, or morphine plus intravenous naloxone or intrathecal idazoxan.
  
  
  RESULTS
  Intravenous morphine (0, 0.5, 1 mg/kg, intravenous) produced dose-dependent increases in cerebrospinal fluid norepinephrine and acetylcholine, but not epinephrine or dopamine. Morphine's effect was blocked by intravenous naloxone and by intrathecal idazoxan. In microdialysis experiments, intravenous morphine increased the concentration of norepinephrine and acetylcholine, but not epinephrine or dopamine, in the dorsal horn. In contrast, intravenous morphine exerted no effect on any of these monoamines in the ventral horn. Intravenous naloxone and cervical cord transection each blocked morphine's effect on dorsal horn norepinephrine.
  
  
  CONCLUSIONS
  These results support functional studies that indicate that systematically administered opioids cause spinal norepinephrine and acetylcholine release by a naloxone-sensitive mechanism. Idazoxan blockade of morphine's effects on cerebrospinal fluid norepinephrine was unexpected, and suggests that both norepinephrine and acetylcholine release in the spinal cord may be regulated by alpha 2-adrenoceptors. Microdialysis experiments suggest increased norepinephrine and acetylcholine levels in cerebrospinal fluid resulted from intravenous morphine-induced activation of bulbospinal pathways.
authors.affiliation: Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157-1009, USA.
authors.forename: H
authors.initials: H
authors.lastname: Bouaziz
authors.forename: C
authors.initials: C
authors.lastname: Tong
authors.forename: Y
authors.initials: Y
authors.lastname: Yoon
authors.forename: D D
authors.initials: DD
authors.lastname: Hood
authors.forename: J C
authors.initials: JC
authors.lastname: Eisenach
mesh_terms: D000109:Acetylcholine / Q000134:cerebrospinal fluid / Q000378:metabolism*; D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000818:Animals; D003956:Dialysis; D004146:Dioxanes / Q000494:pharmacology; D004298:Dopamine / Q000134:cerebrospinal fluid; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D019329:Idazoxan; D007093:Imidazoles / Q000494:pharmacology; D007275:Injections, Intravenous; D008297:Male; D008832:Microchemistry; D009020:Morphine / Q000494:pharmacology*; D009270:Naloxone / Q000494:pharmacology; D009292:Narcotic Antagonists / Q000494:pharmacology; D009638:Norepinephrine / Q000134:cerebrospinal fluid / Q000378:metabolism*; D018341:Receptors, Adrenergic, alpha-2 / Q000502:physiology; D012756:Sheep; D013116:Spinal Cord / Q000187:drug effects* / Q000378:metabolism*; D013268:Stimulation, Chemical
chemical_list: D000317:Adrenergic alpha-Antagonists; D000701:Analgesics, Opioid; D004146:Dioxanes; D007093:Imidazoles; D009292:Narcotic Antagonists; D018341:Receptors, Adrenergic, alpha-2; D009270:Naloxone; D009020:Morphine; D000109:Acetylcholine; D005283:Fentanyl; D004298:Dopamine; D009638:Norepinephrine; D019329:Idazoxan