[Neuropathic pain. Physiopathological mechanisms and therapeutic perspectives].
Neuropathic pain is generally resistant to "classical" analgesic drugs, including opioids, and there is still an urgent need for really effective treatments to alleviate pain caused by lesions of the peripheral and/or central nervous system. The pathophysiological mechanisms underlying neuropathic pain are still poorly known, and treatments are mainly empirical. Antidepressant drugs are generally prescribed first, with positive but limited results in a significant proportion of patients. Anticonvulsant drugs (carbamazepine, phenytoin, lamotrigine) are also used but are often poorly tolerated. Clinical studies and preclinical investigations support the idea that the nature of neuropathic pain, and the underlying mechanisms, are different in the cephalic (trigeminal) territories and the extracephalic (spinal) territories. In order to further investigate these regional differences, we used rat nerve ligature models. Comparison of allodynia/hyperalgesia in the vibrissal territory caused by unilateral ligature of the infraorbital nerve (2nd branch of the trigeminal nerve) with those in the hindpaw ipsilateral to unilateral ligature of the sciatic nerve revealed marked differences in their responses to sodium channel blockers (such as tetrodotoxin), serotonin (5-HT) receptor agonists and calcitonin gene-related peptide (CGRP) receptor antagonists. In particular, 5-HT7 receptor agonists were particularly effective at reducing allodynia in sciatic nerve-ligated rats, but were completely ineffective in infraorbital nerve-ligated rats. Conversely, triptans (5-HT1B/1D receptor agonists) and CGRP-receptor antagonists markedly inhibited cephalic allodynia in infraorbital nerve-ligated rats but failed to relieve neuropathic pain in sciatic nerve-ligated animals. Interestingly, ligature-induced expression of the proinflammatory cytokine interleukin-6 in central tissues showed marked differences in sciatic nerve- and infraorbital nerve-ligated rats, providing direct evidence of differences in the mechanisms underlying extra-cephalic- and cephalic neuropathic pain. Such preclinical studies should contribute to the design of innovative strategies for more effective and well-tolerated treatments for neuropathic pain in cephalic and extra-cephalic territories.
Hamon
Michel
M
INSERM U677, CHU Pitié-Salpêtrière, 91, bld de l'Hôpital, 75013 Paris. michel.hamon@upmc.fr
Kayser
Valérie
V
Bourgoin
Sylvie
S
D000818:Animals; D006801:Humans; D023421:Models, Animal; D009437:Neuralgia / Q000188:drug therapy* / Q000503:physiopathology*; D051381:Rats; D018015:Receptors, Calcitonin Gene-Related Peptide / Q000819:agonists; D017366:Serotonin Receptor Agonists; D026941:Sodium Channel Blockers / Q000494:pharmacology
D018015:Receptors, Calcitonin Gene-Related Peptide; D017366:Serotonin Receptor Agonists; D026941:Sodium Channel Blockers