The neuropeptides dynorphin and cholecystokinin (CCK), and their associated pronociceptive effects were investigated in the RVM. Utilizing a nerve-injury model (SNL), RT-PCR analysis revealed increases (p<0.05) of prodynorphin mRNA, and bradyinkin, B1- and B2-receptor mRNA, post-SNL, 14-days, 2-days, and 14-days, respectively. Administration of dynorphin into the RVM produced both acute and long-lasting (>30-days) tactile hypersensitivity. Administration of the B1-antagonist, DALBK and the B2-antagonist, Hoe-140, into the RVM significantly attenuated dynorphin-induced tactile hypersensitivity. Nerve-injury induced tactile hypersensitivity was significantly reversed by RVM administration of dynorphin antiserum or the B2-antagonist, Hoe-140. These data suggest that dynorphin is up-regulated in the RVM in nerve-injury, and via the activation of bradykinin receptors in the RVM, produces abnormal pain. Like dynorphin, CCK is up-regulated in the RVM in nerve-injury, with studies suggesting that elevated levels of CCK in the RVM mediate pronociceptive activity through CCK2 receptor activation, resulting in enhanced spinal nociceptive transmission. At present, it is unknown what key neurotransmitters are mediating this RVM CCK-driven effect at the level of the spinal cord. Here, spinal cerebrospinal fluid (CSF) levels of serotonin (5-HT) and prostaglandin E2 (PGE2) were measured in the lumbar spinal cord in naïve rats following CCK administration into the RVM. Following RVM CCK microinjection, an approximate 5-fold increase in spinal (CSF) PGE2 levels was observed, as compared to baseline controls. PGE2 levels showed a progressive increase with peak levels observed at the 80-minute post-CCK injection timepoint, whereas 5-HT levels in the spinal CSF remained unchanged following CCK administration into the RVM. This release of PGE2 coincided with the timecourse for CCK-induced mechanical hypersensitivity. Administration of the CCK2-antagonist YM022 prior to CCK into the RVM, significantly attenuated (>50%) the release of PGE2 in the spinal cord. The non-selective COX-inhibitor naproxen and the 5-HT3 antagonist ondansetron, both administered intrathecally, significantly attenuated RVM CCK-induced hindpaw tactile hypersensitivity. In summary, these data suggest a bradykinin- or CCK2-receptor antagonist could be used alone or in conjunction with current therapies in the treatment of chronic pain.

Sustained administration of morphine in humans and in animals induces a state of abnormal pain (i.e., hyperalgesia) which may be associated with the development of reduced analgesic efficacy (i.e., tolerance). Evidence suggests that opiate treatment may upregulate cholecystokinin (CCK), a pronociceptive peptide, in the brain and spinal cord. Therefore, we hypothesized that CCK may be upregulated by opiate treatment in the rostral ventromedial medulla (RVM) and to subsequently drive descending facilitation mechanisms to elicit hyperalgesia and antinociceptive tolerance in rats.CCK administered into the RVM of naive rats elicited hyperalgesia which was blocked by either RVM CCK2 receptor antagonist L365,260; or by bilateral lesion of dorsolateral funiculus, a major bulbospinal descending pain modulation pathway from the RVM to spinal cord.Sustained subcutaneous morphine induced hyperalgesia and spinal antinociceptive tolerance. Both effects were reversed by RVM CCK2 antagonist, suggesting that the up-regulation of the endogenous RVM CCK system played a critical role in the expression of these phenomena.Lesion of cells in the RVM which selectively express CCK2 receptors with a saporin construct (CCK-SAP) to inhibit ribosome activity, prevented morphine-induced hyperalgesia and spinal antinociceptive tolerance. These findings suggest that the integrity of the RVM CCK system is required for the development of hyperalgesia and antinociceptive tolerance induced by sustained morphine.The CCK system does not seem to play a role in setting the baseline sensory thresholds in normal rats because neither RVM L365,260 nor CCK-SAP treatment altered baseline sensory thresholds in naive rats.CCK appears to be present exclusively in nerve terminals of RVM neurons in naive rats. There was no obvious change in the levels of CCK-LI, CCK2 receptor, or CCK2 receptor mRNA in the RVM after sustained morphine treatment. However, microdialysis studies showed an approximately 5-fold increase in basal CCK levels in the RVM after sustained morphine treatment.Taken together, our results support the hypothesis that increased release of CCK in the RVM is induced by sustained morphine and drives descending facilitation to mediate morphine-induced paradoxical "pain" and spinal antinociceptive tolerance.

Chronic pain is a major healthcare concern that directly affects over one hundred million people in the United States alone. While current treatment options like opioids and NSAIDs are effective, they are with significant drawbacks that prevent long term use. It is important to identify and understand new druggable targets for the treatment of pain. Recent findings have demonstrated substance P functions in the RVM to maintain hypersensitivity to noxious heat stimuli in models of persistent peripheral inflammatory injury in a manner dependent on presynaptic NMDA receptors. What remains unclear is how substance P assumes this pronociceptive role following peripheral inflammatory injury. The experiments detailed in this thesis investigated whether the levels and or release of substance P in the RVM was altered following peripheral inflammatory injury. The effect of peripheral inflammatory injury on levels of substance P in the RVM was tested at several time points. The data show that there were no changes in substance P levels in the ipsilateral or contralateral RVM of CFA injected rats compared to their saline controls at any of the time points tested. To assess whether changes in substance P levels occurred in a subset of neurons within the RVM, computer aided densitometry analysis was used to measure substance P immunoreactivity in sections from the RVM of rats treated with CFA or saline. Substance P immunoreactivity was increased in the ipsilateral RVM of the CFA group compared to the corresponding saline sections at the 4 day, but not the 2 week time point. No other changes were observed. Electron microscopy was used to demonstrate the presence of the NMDA receptor and substance P on the same axon terminals within the RVMs of rats treated with either CFA or saline. This colocalization is significant because it identifies NMDA receptors in position to regulate the release of substance P from axon terminals in the RVM. There were no obvious differences in the degree of colocalization between CFA and saline groups. Functional experiments were devised that tested whether substance P release (basal and evoked) in the RVM was increased following peripheral inflammatory injury, and whether said release was regulated by NMDA receptors. The data show that neither basal nor evoked (potassium or veratridine) release was increased following peripheral inflammatory injury. NMDA was able to facilitate the release of substance P in both the CFA and saline treatment groups, but the facilitation was not different between groups. In the absence of any depolarization stimulus, NMDA was unable to elicit any release of substance P beyond basal values. All told, the data show substance P levels in the RVM are not altered by peripheral inflammatory injury. Additionally, neither basal nor evoked release of substance P is altered by peripheral inflammatory injury. The data provide functional and anatomical evidence for modulation of substance P release by glutamate acting at presynaptic NMDA receptors, but do not support the idea of differential modulation of substance P release following peripheral inflammatory injury.

Morphine is the most widely prescribed opiate for alleviation of persistent pain; however, it is becoming increasingly clear that morphine is less potent in women compared to men. Morphine primarily binds mu opioid receptors, which are densely localized in the midbrain periaqueductal gray (PAG). Anatomical and physiological studies conducted in the 1960s identified the PAG, and its projections to the rostral ventromedial medulla (RVM) and spinal cord dorsal horn, as an essential neural circuit mediating opioid-based analgesia. Remarkably, the majority of studies since then were conducted in males with the implicit assumption that this circuit was the same in females; this is not the case. It is now well established that morphine produces greater analgesia in males compared to females in a wide range of vertebrates, however, the mechanism(s) driving this sex difference is not clear. Our recent studies indicate that two factors appear to be contributing to the sexually dimorphic effects of morphine. First, there are sex differences in the anatomy and physiology of the descending inhibitory pathway on which morphine acts to produce analgesia. Specifically, the projections from the PAG to the RVM are sexually dimorphic and activated to a greater degree by both inflammatory pain and systemic morphine in males. In the absence of pain, the PAG-RVM circuit is activated to a greater degree in males compared to females, while this activation steadily declines during the development of tolerance in males only. We also have evidence of a sexually dimorphic expression of mu opioid receptor within the PAG that appears to contribute to sex differences in morphine potency. Microinjection of morphine directly into the PAG produces significantly greater analgesia in males, indicating that the PAG is sufficient for eliciting this sexually dimorphic behavior. Furthermore, mu opioid receptor-expressing PAG neurons are necessary for eliciting a sexually dimorphic response to morphine as lesioning mu opioid receptor-expressing neurons attenuates analgesia in males only. Together, these data indicate that the PAG-RVM pathway and mu opioid receptor expression in the PAG is sexually dimorphic and provides a primary mechanism for sex differences in morphine potency.

Morphine is the most widely prescribed opiate for alleviation of persistent pain; however, it is becoming increasingly clear that morphine is less potent in women compared to men. Morphine primarily binds mu opioid receptors, which are densely localized in the midbrain periaqueductal gray (PAG). Anatomical and physiological studies conducted in the 1960s identified the PAG, and its projections to the rostral ventromedial medulla (RVM) and spinal cord dorsal horn, as an essential neural circuit mediating opioid-based analgesia. Remarkably, the majority of studies since then were conducted in males with the implicit assumption that this circuit was the same in females; this is not the case. It is now well established that morphine produces greater analgesia in males compared to females in a wide range of vertebrates, however, the mechanism(s) driving this sex difference is not clear. Our recent studies indicate that two factors appear to be contributing to the sexually dimorphic effects of morphine. First, there are sex differences in the anatomy and physiology of the descending inhibitory pathway on which morphine acts to produce analgesia. Specifically, the projections from the PAG to the RVM are sexually dimorphic and activated to a greater degree by both inflammatory pain and systemic morphine in males. In the absence of pain, the PAG-RVM circuit is activated to a greater degree in males compared to females, while this activation steadily declines during the development of tolerance in males only. We also have evidence of a sexually dimorphic expression of mu opioid receptor within the PAG that appears to contribute to sex differences in morphine potency. Microinjection of morphine directly into the PAG produces significantly greater analgesia in males, indicating that the PAG is sufficient for eliciting this sexually dimorphic behavior. Furthermore, mu opioid receptor-expressing PAG neurons are necessary for eliciting a sexually dimorphic response to morphine as lesioning mu opioid receptor-expressing neurons attenuates analgesia in males only. Together, these data indicate that the PAG-RVM pathway and mu opioid receptor expression in the PAG is sexually dimorphic and provides a primary mechanism for sex differences in morphine potency.