Indiana University-Purdue University Indianapolis (IUPUI) / The glial cell line-derived neurotrophic factor (GDNF) family ligands (GFLs) are peptides implicated in the inflammatory response. They are released in increased amounts during inflammation and induce thermal hyperalgesia. Whether these molecules directly affect the sensitivity of primary nociceptive sensory neurons is unknown. This information could provide a link between increased inflammation-induced release of GFLs and their ability to promote inflammatory hyperalgesia. These molecules bind to one of four GFRα receptor subtypes, and this GFL-GFRα complex often translocates to the receptor tyrosine kinase, Ret. The focus of this dissertation was to determine whether GFLs modulate the stimulated-release of calcitonin gene-related peptide (CGRP). Isolated sensory neurons and freshly dissociated spinal cord tissue were used to examine the enhancement in stimulated-release of CGRP, a measure of sensitization. Exposure of isolated sensory neurons to GDNF, neurturin, and artemin, enhanced the capsaicin stimulated-release of immunoreactive CGRP (iCGRP). Sensitization by GFLs occurred in freshly dissociated spinal cord tissue. Persephin, another member of the GFL family, did not enhance stimulated-release of iCGRP. These results demonstrate that specific GFLs are mediators of neuronal sensitivity. The intracellular signaling pathways responsible for this sensitization were also evaluated. Inhibition of the mitogen activated protein kinase (MAPK)/extracellular signal-related kinase 1/2 (Erk 1/2) pathway selectively abolished the enhancement of CGRP release by GDNF. NTN-induced sensitization was abolished by inhibition of the phosphatidylinositol-3-kinase (PI-3K) pathway. Reduction in Ret abolished the GDNF-induced sensitization, but did not fully inhibit NTN or ART-induced sensitization. Inhibition of other cell surface receptors (neural cell adhesion molecule (NCAM), and Integrin β-1) had distinct effects on the sensitization capability of each of the GFLs. Ret and NCAM inhibition in combination abolished ART-induced sensitization. It was necessary to inhibit Ret, NCAM, and Integrin β-1 to prevent the NTN-induced sensitization. These data demonstrate that the GFLs use distinct signaling mechanisms to induce the sensitization of nociceptive sensory neurons. The work presented in this thesis provides the first evidence for these novel and distinct Ret-independent pathways for GFL-induced actions and provides insight into the mechanism of sensory neuronal sensitization in general.

BACKGROUND: Chronic low back pain (CLBP) is the leading cause of disability in the United States. People suffering from CLBP often have multiple comorbidities including depression, anxiety, and substance use disorder (SUD). Although the opioid epidemic has intensified the search for new treatment options, both pharmacological and other, opioids still remain the most common treatment for chronic pain. Long-term opioid therapy (LTOT) has been shown to lead to opioid-induced hyperalgesia (OIH), an increased sensitivity to painful stimuli. It remains unclear, however, the extent to which reductions in opioid dose impact OIH. METHODS: This is a longitudinal cohort study whose primary aim is to determine how changes in opioid doses are associated with changes in psychosocial and quantitative sensory testing (QST) variables. Participants were 24 adults with CLBP being treated with LTOT and visits were conducted on a monthly basis for six months. All 24 participants were included in the analysis of demographic and psychosocial variables (disability, anxiety, depression, opioid misuse, pain severity, pain interference, and catastrophizing). A subset of 13 participants were included in the analysis of QST variables. RESULTS: We found that pressure pain thresholds at the thumb and the trapezius, and heat pain threshold significantly (p < 0.05) improved between visit 1 and visit 6. We also found that a decrease in morphine equivalent doses (MED) is correlated (coefficient > 0.2) with improvements in punctuate probe rating, pain pressure at the thumb, and maximum cold ratings. DISCUSSION: Our results show that reductions in opioid dose are associated with reduced pain sensitivity, even while the psychosocial variables studied (including subjective pain score, depression, and anxiety) remain stable.

Background: The consequences of continued opioid abuse among patients treated with opioid substitution therapy (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Conflicting evidence exists that both implicates and refutes the role of chronic non-cancer pain (CNCP) as a major risk factor for continued opioid abuse within the addiction treatment setting. This thesis aims to 1) evaluate the impact of chronic pain on the treatment outcomes of patients with opioid addiction receiving OST, 2) determine whether a clinical or inflammatory profile exists to distinguish pain in this population, 3) explore the sources of heterogeneity in previous studies examining this question, 4) determine the best therapy for patients with chronic pain, and 5) evaluate the most effective treatment for opioid addiction. We anticipate chronic pain to be an important predictor of continued opioid abuse such that patients with comorbid pain will require careful consideration when managed on OST. Methods: We systematically reviewed the literature to determine the impact of pain in opioid addiction patients receiving methadone maintenance treatment (MMT). We determined the clinical and inflammatory profile of MMT patients using data from the Genetics of Opioid Addiction (GENOA) research collaborative between the Canadian Addiction Treatment Centres (CATC) and the Population Genomic Program. GENOA is a prospective cohort study aimed to determine the genetic, biological, and psychosocial determinants of treatment prognosis for opioid addiction patients receiving MMT. GENOA recruits patients ≥ 18 years of age meeting the DSM-IV criteria for opioid dependence. All GENOA participants are receiving MMT for the management of opioid addiction. Baseline data from the GENOA pilot study (n=235) were used to evaluate the impact of pain on illict opioid use behaviour and determine the clinical and inflammatory profile of patients with comorbid pain. We explored sources of heterogeneity in previous studies using data from the full-phase GENOA study (n=444), examining the prognostic value of different pain measures for predicting illicit opioid use. We then performed a multiple treatment comparison of all opioid substitution and antagonist therapies in efforts to determine the best intervention for improving treatment outcomes for patients with comorbid pain. We lastly determined the most effective treatment for opioid addiction by performing a network meta-analysis using data from a systematic review of opioid maintenance therapy trials. Results: Our initial systematic review confirmed a lack of consensus in the literature, whereby some studies suggest pain increases risk for illicit opioid use and other studies suggest pain has no effect on substance use behaviour. Findings from the analysis of GENOA pilot data confirmed chronic pain to be an important predictor of sustained opioid abuse and also showed patients with pain to have elevated Interferon-Gamma. Using data from the GENOA prospective cohort study we determined the Brief Pain Inventory (a commonly used pain measurement in pervious studies) to be highly sensitive with poor prognostic value. Our final reviews propose 1) there is limited evidence to suggest any OST is superior for managing patients with comorbid pain, and 2) heroin and high-dose methadone are the most effective treatments for improving treatment retention. The final systematic review and network meta-analysis in this thesis also highlights a major problem in the treatment of opioid use disorders, primarily the lack of consensus as to what outcomes matter for determining success in patients with addiction. Conclusion: Patients with comorbid pain and addiction are at high-risk for continued opioid abuse and should be managed closely by clinicians administering OST. Contention in the previous literature likely resulted from the use of pain measurements with poor prognostic value. No OST demonstrated superiority for managing patients with chronic pain. While our findings indicate heroin is the most effective treatment across multiple endpoints, we use this thesis to provide readers with 1) a sense of the feasibility issues associated with heroin administration, 2) a summary of the limitations of this evidence base, and 3) recommendations for how to improve the addiction trials’ design for future research. / Thesis / Doctor of Philosophy (PhD)

La gestion de la douleur neuropathique reste un challenge en médecine, malgré le nombre de traitements actuellement disponible. L'expérimentation animale a généré beaucoup d'informations concernant la douleur, mais ces connaissances demeurent insuffisantes pour développer de nouveaux analgésiques plus efficaces tout en restant sécuritaires. La douleur est un symptôme clinique complexe avec de multiples origines, et les mécanismes de douleur centraux et périphériques dépendent de l'évolution de la pathologie. Il est donc essentiel d'investiguer plus profondément les mécanismes moléculaires responsables de l'initiation et du maintien de la douleur, afin de cibler de nouvelles voies de transmission de la nociception plus prometteuses pour soulager la neuropathie et développer de meilleures stratégies thérapeutiques. Ce projet s'est donc intéressé plus particulièrement à la famille des tachykinines issues du gène TAC1 (substance P, ses précurseurs et métabolites, et neurokinine A sont les peptides ciblés pour ce projet de recherche), une famille de neuropeptides qui joue un rôle critique dans la transmission nociceptive. Pour réaliser cette étude, nous avons d'abord développé une stratégie de quantification afin de quantifier les expressions des différents neuropeptides bioactifs cibles, par HPLCMS/ MS. Puisqu'il existe différentes stratégies de quantification des peptides par HPLCMS/ MS, une méthode analytique fiable et robuste était nécessaire pour répondre aux objectifs de recherche. Nous avons développé une méthode utilisant la quantification relative avec un étalon interne stable marqué isotopiquement. En effet, pour quantifier les neuropeptides d'intérêt de l'étude, c'est la stratégie qui s'est avérée la plus reproductible et précise. Suite à la mise au point de la stratégie de quantification, nous avons utilisé des modèles animaux, souvent nécessaires pour faire progresser la recherche scientifique sur la compréhension de la douleur / The management of neuropathic pain remains a challenge in medicine, despite the availability of numerous drugs. Animal experimentation has generated a tremendous amount of information about pain, but this knowledge is still insufficient for new more efficient and safe analgesics. Pain is a complex clinical symptom with multiple origins, and peripheral and central pain mechanisms depend on the pathology evolution. Thus, it is essential to further investigate the mechanisms responsible for the initiation and maintenance of pain in order to develop better effective therapies. This project is particularly focused on the tachykinin family encoded by TAC1 gene (substance P, its precursors and metabolites, neurokinin A), a family of neuropeptides that plays a critical role in nociceptive transmission. We initially developed a quantification strategy in order to study the targeted bioactive neuropeptide expression modulation by HPLC-MS and HPLC-MS/MS. And it is critical to develop reliable and robust analytical methods to reach the objectives. So, we developed a method using relative quantification with stable isotopic labeled internal standards. In fact, in order to quantify target neuropeptides, this strategy was the most reproducible and accurate. Following the development of the relative quantification strategy, we used validated animal models, fundamental to better knowledges of painful molecular mechanisms

Proporção significativa dos doentes que preenchem os critérios atuais que caracterizam a síndrome fibromiálgica apresenta dor assimétrica e alterações do exame da sensibilidade distintas dos doentes com a apresentação clássica, \"simétrica\", de fibromialgia (SFM). Denomina-se esta entidade clínica como Síndrome Dolorosa Disfuncional com Sensibilidade Exteroceptiva Assimétrica (SFM-SDDSEA). Este grupo de doentes apresenta particularidades quanto ao resultado do tratamento e impactos negativos na qualidade de vida significativamente distintos daqueles com o quadro de fibromialgia \"clássica\". O presente estudo objetivou analisar aspectos clínicos, psicofísicos e neurofisiológicos de amostra de doentes que preenchem os novos critérios diagnósticos da SFM e que apresentam SFM-SDDSEA comparando-os aos dos doentes com SFM \"clássica\" e aos voluntários saudáveis. Método. Foram incluídas 32 doentes (45,9±8,5 anos) do sexo feminino que preencheram os Critérios para o Diagnóstico de Fibromialgia do Colégio Americano de Reumatologia (CAR) de 2010 e 31 voluntárias saudáveis (43±2 anos). Dezenove doentes apresentavam quadro clínico \"clássica\" da SFM e 13, SFM-SDDSEA (dor assimétrica e definida como EVA com diferença maior que 40% entre os dois dimídios). Foram utilizados para a avaliação: a Escala Visual Analógica (EVA), a Versão Resumida do Questionário de Dor McGill, a Escala Hospitalar de Ansiedade e Depressão (HAD), o Questionário de Impacto de Fibromialgia (QIF), o Inventário Breve de Dor (IBD), os valores dos limiares de dor à pressão nos pontos dolorosos mensurados com o algiômetro de Fischer (PD), o teste quantitativo de sensibilidade (TQS) e a excitabilidade cortical aferida com estimulação magnética transcraniana (EMT). Resultados. Os doentes com SFM-SDDSEA apresentaram maior escores de interferência da dor nas atividades diárias em relação aos com SFM (54,7±8,9 e 37,6±13,5; respectivamente, p < 0,0001) e maior impacto da dor na qualidade de vida em relação a SFM de acordo com o QIF (73,6±13,9 e 58,3±13,9; respectivamente, p < 0,004). Doentes com SFM-SDDSEA apresentaram limiares de dor à pressão assimétrica, sendo mais baixos no hemicorpo onde a dor era mais intensa (27,74±7,90 e 35,86±8,37; respectivamente, p=0,007). Nos doentes do grupo SFM-SDDSEA, os limiares de dor à pressão do lado mais doloroso foram semelhantes aos dos doentes com SFM (27,77±1,25 e 27,74±2,20; respectivamente, p=0,472), ao passo que os limiares no hemicorpo menos doloroso foram significativamente mais elevados do que os de doentes com SFM (35,86±2,32 e 27,77±1,25; respectivamente, p<0,031). Os doentes com SFM-SDDSEA apresentaram valores maiores de facilitação intracortical no hemisfério contralateral ao hemicorpo em que a dor era mais intensa (1,64±1,06 e 3,35±2,31; respectivamente, p=0,008) e maior amplitude de potencial evocado motor (PEM) à 140% do limiar motor (827±996 e 2134±1495; respectivamente, p=0,005). Conclusões. Doentes com SFM-SDDSEA apresentaram maior impacto dos sintomas dolorosos na qualidade de vida e maior interferência nas atividades diárias, alterações da excitabilidade cortical e limiares de evocação de dor frente aos estímulos pressóricos diferentes daqueles com SFM. Estes resultados indicam que a SFM-SDDSEA constitui entidade clínica à parte, com mecanismos de ocorrência de doença, resposta ao tratamento e prognósticos diferentes da SFM \"clássica\" / Aim of Investigation: A significant proportion of patients fulfilling the diagnostic criteria of fibromyalgia syndrome (FMS) present asymmetrical ongoing pain and abnormalities on the physical examination that are not present in patients with \"classical\" symmetric FMS. From the clinical perspective, this condition has been named FMS-Dysfunctional Pain Syndrome with Asymmetrical Exteroceptive Sensibility (DPSAES). Patients with DPSAES usually present higher negative impact in quality of life when compared to the more \"classic\" FMS patients. The present study aimed at characterizing the clinical, psychophysical and neurophysiological aspects of the FMS-DPSAES patients and compared them to those of \"classic\" FMS patients and healthy controls. Methods: Thirty-two patients (45.9±8.5yo) fulfilling the 2010 American College of Rheumatology FMS Diagnostic Criteria and 31 age-matched healthy controls (HC) (43.0±2.1 yo) were included. Nineteen patients had \"classical\" FMS and 13 had FMS-DPSAES (defined as asymmetrical pain with a more than 40% pain intensity difference between body sides). The following tools were used: The Visual Analogic Scale (VAS), the Short Version of the McGill Pain Questionnaire (MPQ), the Fibromyalgia Impact Questionnaire (FIQ), and the Brief Pain Inventory (BPI). The quantitative sensory test battery was performed and included pressure, thermal and mechanical detection and pain thresholds in both hands and suprathreshold stimulations. Cortical excitability measurements were performed in all participants with the transcranial magnetic stimulation. Results: When compared to patients with \"classical\" FMS patients with DPSAES presented higher scores in pain interference in daily activities (54.73±8.90 and 37.66±13.56; respectively; p < 0.0001); higher negative impact in quality of life (73.67±13.90 and 58.38±13.97; respectively, p < 0.004), and lower pressure pain thresholds on the most painful body side (27.74±7.96 and 35.86±8.37; respectively, p=0.007). Cortical excitability parameters were asymmetrical in FMS-DPSAES patients and showed higher intracortical facilitation (3.35±2.31 and 1.64±1.06; respectively, p=0.008) and higher amplitude of motor evoked potentials in the brain hemisphere contralateral to the more painful body side in FMS-DPSAES (2134±1495 and 827±996; respectively; p=0.005). Conclusions: Patients with FMS-DPSAES had higher negative impact in quality of life, distinct cortical excitability profile changes and different pressure pain thresholds compared to patients with \"classical\" FMS. The current evidence suggests that FMS-DPSAES may be a clinical entitiy distinct from FMS with its own mechanisms, response to treatment and prognosis

A técnica de Mobilização Neural (MOB) é um método não-invasivo que demonstrou clinicamente ser eficaz na redução da sensibilidade à dor e, conseqüentemente, na melhoria da qualidade de vida após a dor neuropática. O presente estudo examinou os efeitos da MOB sobre a sensibilidade dolorosa induzida pela constrição crônica (CCI) do nervo isquiático de ratos. A CCI foi realizada em ratos machos adultos, submetidos posteriormente a dez sessões de MOB, iniciadas 14 dias após a lesão. Durante o tratamento, os animais foram avaliados em testes comportamentais para a nocicepção por meio de comportamentos tais como testes para a alodinia e hiperalgesia térmica e mecânica. Ao término das dez sessões, o nervo isquiático e a medula espinal foram retirados e processados para detecção de NGF e proteína zero por análise de Western Blot. Os DRG´s foram processados para detecção de NGF e GFAP para análise de Werstern Blot e imuno-histoquímica de fluorescência. A MOB reverteu parcialmente a resposta hiperalgesica mecânica e a alodínica desde a segunda sessão, enquanto que a hiperalgesia térmica foi bloqueada desde a quarta sessão de MOB. Com relação aos ensáios de Western Blot, observamos um aumento da densidade óptica para NGF e proteína zero (PO) no nervo isquiático dos animais com CCI após tratamento com MOB. Entretanto, não foi possível observar mudanças estatísticas para o NGF quando analisamos a medula espinal em todos os grupos analisados. Nos ensaios de Western Blot e imuno-histoquímica dos DRG´s observamos uma diminuição da imunorreatividade (IR) para NGF e GFAP nos animais tratados com MOB. Assim, acreditamos que a MOB diminui os sintomas da dor neuropática induzida pela CCI do nervo isquiático, além de favorecer a regeneração do nervo isquiático devido ao aumento local de NGF e Proteína zero. / The Neural Mobilization technique is a noninvasive method that has proved clinically effective in reducing pain sensitivity and consequently in improving quality of life after neuropathic pain. The present study examined the effects of Neural Mobilization (MOB) on pain sensitivity induced by chronic constriction injury (CCI) in rats. The CCI was performed on adult male rats, submitted thereafter to 10 sessions of MOB, each other day, starting 14 days after the CCI injury. Over the treatment period, animals were evaluated for nociception using behavior tests, such as tests for allodynia and thermal and mechanical hyperalgesia. At the end of the sessions, the nerve isquiatic and spinal cord were analyzed using Western Blot assays for neural growth factor (NGF) and protein zero (PO) and the dorsal root ganglia (DRG) were analyzed using Western Blot and immunohistochemistry assays for neural growth factor (NGF) and glial fibrillary acidic protein (GFAP). The results showed that MOB treatment induced an early reduction (in the second session) of the hyperalgesia and allodynia in CCI-injured rats, which persisted until the end of the treatment. On the other hand, only after the 4th session we observed a blockede of thermal sensitivity. Regarding cellular changes, we observed a increase of NGF and PO expression after MOB in the nerve isquiatic when compared to CCI animals. We also observed a decrease of NGF and GFAP expression after MOB in the DRG when compared to CCI animals. In spinal cord no observed statistically difference. Was observed these data provide evidence that MOB treatment reverses pain symptoms in CCI-injured rats and decreases the level of GFAP and NGF in DRG. In addition to promoting the regeneration of the isquiatic nerve due to increased local NGF and protein zero.

Os venenos do gênero Bothrops induzem efeitos locais caracterizados por hemorragia, necrose, edema e dor intensa. Apesar da importância clínica do fenômeno de dor, os estudos sobre os mecanismos envolvidos na gênese deste fenômeno são ainda escassos. Além disso, não existem dados sobre a capacidade do antiveneno em neutralizar este fenômeno. Neste trabalho foi investigada, a capacidade dos venenos de Bothrops jararaca, Bothrops asper e da miotoxina III (Fosfolipase A2, variante Asp 49), uma toxina isolada do veneno de Bothrops asper, em induzir hiperalgesia em ratos, a mediação química deste fenômeno e a capacidade dos antivenenos em neutralizar esta ação dos venenos. A possível correlação entre a hiperalgesia e a resposta edematogênica causada pelos venenos ou miotoxina foi também avaliada. O limiar de dor foi determinado antes e em diferentes tempos após a administração dos venenos ou toxina, empregando o teste de pressão de pata de rato. Para o estudo da resposta edematogênica, o aumento do volume das patas posteriores foi determinado por pletismografia. Os venenos e a toxina, administrados por via intraplantar, nas doses de 5µg (VBj), 15µg (VBa) ou 10µg (MIII), induziram hiperalgesia e edema, com respostas máxima na 1a (VBj, MIII) ou 2a (VBa) hora, não sendo mais detectadas na 24a hora. Para o estudo da neutralização, foram utilizados o antiveneno botrópico produzido no Instituto Butantan e o antiveneno polivalente produzido no Instituto Clodomiro Picado da Costa Rica, administrados por via endovenosa, 15 min. ou imediatamente antes ou 15 min. após a injeção dos venenos. O AVIB, quando injetado 15 min. antes do VBj, foi capaz de reverter a hiperalgesia induzida pelo veneno. Em relação ao edema, esta inibição foi observada quando o antiveneno foi administrado 15 min. ou imediatamente antes do VBj. Por outro lado, o AVCP não interferiu com a dor e o edema acarretados pelo VBa. Quando o VBj e o VBa foram incubados, in vitro, por 30 min., a 370C com os AV correspondentes, a hiperalgesia e o edema foram abolidos. Estes resultados indicam que a incapacidade do AVCP, quando administrado in vivo, de bloquear a hiperalgesia e o edema induzidos pelo VBa, não é consequência da ausência de anticorpos específicos no antiveneno, uma vez que estes efeitos foram inibidos quando o veneno foi pré-incubado com o antiveneno. Para avaliação da mediação química da hiperalgesia e do edema, os animais foram submetidos a tratamentos com inibidores de síntese, antagonistas de receptores, anticorpos ou drogas depletoras destes mediadores. Os resultados mostraram que o Hoe-140, dexametasona e NDGA inibem a hiperalgesia induzida pelo VBa, enquanto que apenas a prometazina interferiu com o edema causado pelo veneno. A hiperalgesia induzida pela MIII foi revertida pelo tratamento com prometazina, metisergida, Hoe-140, dexametasona e por NDGA, enquanto que o edema foi inibido apenas por prometazina e dexametasona. Estes dados sugerem que: a) a MIII é um importante componente do veneno para a geração de hiperalgesia, b) a bradicinina e os derivados da lipoxigenase são mediadores da dor acarretada pelo VBa e pela MIII, c) histamina e serotonina participam também da hiperalgesia induzida pela miotoxina e d) a histamina é mediador do edema induzido pelo VBa e pela MIII. Com relação à hiperalgesia induzida pelo VBj, somente o tratamento com Hoe-140 diminuiu este fenômeno, indicando a participação da bradicinina. Por outro lado, este tratamento não foi capaz de interferir com o edema induzido por este veneno. Cabe ressaltar que TEIXEIRA et al. (1994) demonstraram a participação de eicosanóides e PAF na hiperalgesia induzida pelo VBj. Os dados em conjunto sugerem ainda, dissociação entre os fenômenos de dor e edema acarretados por ambos os venenos e pela miotoxina. / Bothrops venoms cause pronounced local tissue-damage characterized by hemorrhage, myonecrosis, edema and pain. Venom-induced pain has been poorly investigated, despite its clinical relevance. Furthermore, the ability of antivenom to neutralize hyperalgesia induced by these venoms is not known. In the present study the hyperalgesia and edema induced by Bothrops jararaca (BjV) and Bothrops asper (BaV) venom and by myotoxin III-MIII (Asp49- phospholipase A2), a toxin isolated from BaV, were investigated. The chemical mediators involved in these phenomena and the ability of the antivenom to neutralize the hyperalgesia and edema induced by these venoms were also investigated. Pain threshold was assessed before and at several intervals after venom injection, using the rat paw pressure test. Edema of paw was measured phethysmographically at the same periods of time. The intraplantar injection of BjV (5µg/paw), BaV (15µg/paw) or MIII (10µg/paw) caused hyperalgesia and edema, whose peak were observed at the 1st (BjV, MIII) or 2nd (BaV) hours after venom/toxin administration, decreasing thereafter. For neutralization studies, the antivenoms produced either at Instituto Butantan from Brazil (AVIB) or Instituto Clodomiro Picado from Costa Rica (AVCP) were administered intravenously 15 min prior to, or immediately before, or 15 min after venoms injection. When the antivenom from Instituto Butantan was injected 15 min. before BjV, the hyperalgesia and edema were abolished. Furthermore, partial inhibition of edema was also observed when the antivenom was injected together with BjV. On the other hand, hyperalgesia and edema induced by BaV were not modified by AVCP. Incubation of BjV and BaV, for 30 min. at 37oC, with the antivenoms in vitro, abolished the hyperalgesia and edema. The inability of the in vivo treatment with antivenom in abolishing hyperalgesia and edema induced by BaV seems not to be related to the lack of neutralizing antibodies in antivenom, because neutralization was achieved in pre-incubation experiments. In order to investigate the chemical mediation of hyperalgesia and edema induced by the venoms or toxin, animals were treated with several drugs. Pretreatment with Hoe-140, dexamethasone and NDGA blocked the hyperalgesia induced by BaV, whereas only promethazine reduced the edema induced by this venom. The MIII-induced hyperalgesia was blocked by promethazine, methysergide, Hoe-140, dexamethasone and NDGA, whereas the edema was reduced only by promethazine and dexamethasone. These results suggest that: a) MIII may contribute to the BaV-induced hyperalgesia, b) bradykinin and leukotrienes mediate the BaV- and MIII-induced pain and MIII; c) histamine and serotonin also participate in the myotoxin-induced hyperalgesia and d) the edema induced by BaV and MIII is mediated by histamine. Pre-treatment of the animals with Hoe-140 abolished BjV-induced hyperalgesia, suggesting that bradykinin may mediate the venom-induced hyperalgesia. However, this treatment did not modify the BjV-induced edema. It is important to stress that previous studies have shown that BjV-induced hyperalgesia is mediated, at least partially, by eicosanoids and PAF (TEIXEIRA et al.,1994). The data presented herein also suggest that distinct mechanisms may be involved in the development of hyperalgesia and edema induced by both venoms and myotoxin III.

O objetivo do presente estudo foi avaliar, em ratos, a eficácia da aplicação conjunta do Ultrassom e do Laser na nocicepção e recuperação funcional do nervo isquiático submetido à lesão por pinçamento. Neste estudo, os ratos foram submetidos ao pinçamento do nervo isquiático (pinça regulável á 5000g durante 5 minutos). Este pinçamento acarretou hiperalgesia mecânica e térmica, alodinia mecânica, além de disfunção motora. O Ultrassom, na dosagem de 1.0 W/cm2 e o Laser, na dosagem de 6 J, causaram antinocicepção e induziram recuperação funcional parcial. A aplicação conjunta de ambos os recursos físicos, além de antinocicepção, acarretou melhor recuperação funcional. Em conclusão, a aplicação conjunta do Ultrassom e Laser é eficaz no controle da nocicepção resultante do pinçamento do nervo isquiático, além de acelerar o processo de regeneração nervosa, favorecendo o restabelecimento da função motora. / The aim of this study was to evaluate, in rats, the effectiveness of the application of the Ultrasound and Laser in nociception and functional recovery of rat sciatic nerve injury. In this study, the sciatic nerve was submitted to crush injury by a forceps especially constructed for this purpose and calibrated for a static load of 5000 g, for 5 minutes. The nerve crushing causes the development of mechanical and thermal hyperalgesia, mechanical allodynia, and motor dysfunction. The Ultrasound, at a dosage of 1.0 W/cm2, and the Laser, at a dose of 6 J, induced antinociception and partial functional recovery. The combined application of both physical resources, in addition to antinociception, resulted in a faster histopathological changes recovery. In conclusion, the application of Ultrasound and Laser is effective in the control of nociception resulting from sciatic nerve crushing, and in accelerating the process of nerve regeneration, favoring the restoration of motor function.

La douleur est un problème de santé publique majeur qui réduit la qualité de vie des patients et engendre un coût élevé pour la société. Malgré les efforts fournis pour développer de nouveaux analgésiques, les opiacés restent le moyen le plus efficace pour réduire la douleur moyenne à intense. Cependant, leur utilisation prolongée est responsable du développement d’une tolérance à leurs effets analgésiques et d’une hypersensibilité à la douleur (hyperalgésie). Il a été proposé que ces phénomènes pourraient résulter de l'activation d’un système anti-opioïde tel que celui des récepteurs RF-amide, mais leurs mécanismes d’action sont encore mal compris. L'objectif de ce projet a ainsi été d'étudier l'implication des récepteurs RF-amide NPFFR1, NPFFR2 et GPR103a dans le développement de l'hyperalgésie induite par les opiacés. Allant du niveau cellulaire, en s’intéressant à l’expression des ARNm, à la modulation de l’activité neuronale induite par le 26RFa, jusqu’à un niveau plus intégré via une approche in vivo et l’étude des seuils nociceptifs et de la douleur chez la souris ; ce travail a permis d’avoir une vision globale des effets du système RF-amide et principalement de GPR103a. En abordant la question des effets secondaires associés aux traitements chroniques opiacés, ce projet pourrait conduire à l'élaboration de stratégies de traitement de la douleur prometteuses. / Pain is a major health problem that reduces quality of life and imparts high social and economic costs. Despite efforts to develop new analgesics, opiates remain the most effective way to reduce severe pain. However, their prolonged use is associated with the development of analgesic tolerance and hypersensitivity to pain (hyperalgesia). It has been proposed that these phenomena would result from the activation of anti-opioid system like RF-amide receptors system, but their mechanism of action is still poorly understood. The objective of this project was to study the involvement of NPFFR1, NPFFR2 and GPR103a receptors in the development of opioidinduced hyperalgesia. This work gave an overall view of the effects of the RF-amide system and mainly of GPR103a, ranging from the cellular level, to the expression of mRNAs, to the modulation of the 26RFa-induced neuronal activity, up to an integrated level via an in vivo approach and the study of nociceptive thresholds and pain in mice. By addressing the issue of side effects associated with opioid chronic treatments, this project may lead to the development of promising strategies for pain treatment.

A técnica de laserterapia é um método não invasivo utilizado por diversas áreas da saúde, e tem se mostrado eficaz no tratamento da diminuição da sensibilidade a dor. O presente estudo visa elucidar os efeitos desta terapia nas alterações moleculares induzida pela constrição crônica (CCI) do nervo isquiático de ratos. Esta técnica é aplicada em dias intercalados e tem a duração de 10 sessões. Ao finalizarmos o tratamento com laserterapia os animais foram eutanasiados e os gânglios das raízes posteriores (DRG L4L6) e o nervo isquiático foram retirados para posterior análise. Os DRGs foram processados para detecção da Substância P (SP) e do receptor de potencial transitório vanilóide tipo I (TRPV1). Ainda submetemos o nervo isquiático para a detecção do fator de crescimento neural (NGF) e proteína zero (P0). Nossos resultados demonstraram uma reversão da hipernocicepção dos animais tratados com LASER. Ainda, observamos um aumento da expressão de SP e TRPV1 nos animais com lesão e uma diminuição após o tratamento com LASER. Com relação aos ensaios referente ao nervo isquiático, podemos observar que houve um aumento da densidade óptica para o NGF e para a P0 após tratamento. Esses resultados podem ser observados de modo qualitativo por meio da técnica de imunohistoquímica de fluorescência. Nossos resultados em conjunto, demonstram a eficácia da laserterapia para reversão da hipernocicepção dos animais com lesão. Ainda, esta técnica é capaz de modular liberação de mediadores que participação do processo álgico, além de induzir a regeneração do nervo isquiático. / The laser therapy technique is a noninvasive method used by several health areas, and has been shown to be effective in treat pain sensitivity. The present study aims to elucidate the effects of this therapy on molecular changes induced by chronic constriction (CCI) in rats. This technique was applied every other day, during 10 sessions. At the end of treatment, the animals were euthanized and the posterior root ganglia (DRG L4-L6) and sciatic nerve were removed for further analysis. The DRG\'s were processed for the detection of Substance P (SP) and transient potential receptor type I (TRPV1). In addition, we submit the sciatic nerve for the detection of neural growth factor (NGF) and zero protein (P0). Our results demonstrated a reversal of hypernociception in animals treated with LASER. Furthermore, we observed an increase in SP and TRPV1 expression in animals with lesion and a decrease after LASER treatment. With respect to the tests referring to the sciatic nerve, we could observe that there was an increase in the optical density for NGF and P0 after treatment. These results can be observed qualitatively by fluorescence immunohistochemistry. Our results together demonstrate the efficacy of laser therapy for the reversal of hypernociception of animals with lesions. Furthermore, this technique is able to modulate the release of mediators that participate in the algic process; in addition, this technique is also able to induce regeneration of sciatic nerve in rats.