title: Effect of prior treatment with ultra-low-dose morphine on opioid- and nerve injury-induced hyperalgesia in rats.
abstract: BACKGROUND
  In addition to producing analgesia, opioids can increase sensitivity to pain (opioid-induced hyperalgesia [OIH]) in humans and rodents. Tolerance/OIH is likely mediated by similar mechanisms that lead to development of hyperalgesia after nerve injury (neuropathic pain). OIH may be a reason for loss of opioid efficacy and/or a worsening of pain. Ultra-low-dose (ULD) opioid evokes hyperalgesia independently of analgesia. Tolerance to ULD-OIH develops with repeated dosing in rats.
  
  
  OBJECTIVE
  The effects of ULD opioids were characterized in two distinct situations where hyperalgesia is expected to occur: following acute opioid treatment and after nerve injury.
  
  
  METHODS
  First, ULD morphine was repeatedly administered (2x day for 5 days) by intrathecal (i.t., 0.01 microg) or intraperitoneal (i.p., 20 microg/kg) routes in rats. Second, morphine (0.01 microg i.t.; 20 microg/kg i.p.) was administered (2x day for 5 days) prior to acute morphine (30 microg i.t.; 10 mg/kg i.p). Third, ULD morphine (20 microg/kg/2x day, i.p.) was given either immediately after nerve injury (days 1-28) or when hyperalgesia was manifested (days 7-14). The tail-flick and paw-pressure tests were used in noninjured and nerve-injured rats, respectively.
  
  
  RESULTS
  Tolerance was developed to OIH with repeated ULD morphine by the i.p. route but not the i.t. route. Prior exposure to ULD morphine (i.p.) caused prolongation of morphine analgesia in intact rats and inhibition of the development (but not reversal) of hyperalgesia in nerve-injured rats. Abolishment of OIH (pain desensitization) may diminish activation of pain facilitatory systems due to nerve injury and opioid treatment.
  
  
  CONCLUSIONS
  Although the translational aspect of this preclinical study has limitations, the present data may suggest a new strategy for the pre-emptive use of ULD opioids to prevent the development of neuropathic pain with certain procedures or disease states.
authors.affiliation: Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, USA.
authors.forename: Elzbieta P
authors.initials: EP
authors.lastname: Wala
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sloan
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Holtman
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000818:Animals; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004361:Drug Tolerance; D005260:Female; D006930:Hyperalgesia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007274:Injections, Intraperitoneal; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D020426:Sciatic Neuropathy / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine