Introdução: A Neuropatia Periférica Induzida pela Quimioterapia (NPIQ) é um efeito adverso comum e debilitante ocasionado pela infusão de agentes quimioterápicos neurotóxicos como os taxanos, as platinas, alcalóides da vinca, bortezomibe e talidomida. A administração destas medicações aumentam a sobrevida do paciente, porém, aproximadamente, 30% a 40% desenvolvem NPIQ, o que afeta negativamente o tratamento planejado e a qualidade de vida ao interferir nas atividades diárias do paciente. A NPIQ manifesta-se com sintomas sensitivos (parestesia, disestesia, dor entre outros), motores (fraqueza, alterações na marcha e no equilíbrio, dificuldade nas habilidades motoras finas e outros) e neurovegetativos (constipação, retenção urinária, disfunção sexual e alterações na pressão sanguínea). Até o momento não foi concebido um instrumento que avalie a dor neuropática na NPIQ e, além disso, não há instrumento validado com essa finalidade no Brasil. Objetivos: Realizar a tradução e adaptação transcultural do instrumento Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) para a língua portuguesa do Brasil e testar as propriedades psicométricas da versão adaptada em uma amostra de pacientes oncológicos, que apresentavam NPIQ. Métodos: Trata-se de um estudo metodológico com coleta de dados transversal. Para o processo de tradução e adaptação do instrumento, adotou-se o referencial teórico metodológico proposto por Beaton e colaboradores (2000). A coleta de dados ocorreu em dois hospitais referência no tratamento oncológico da cidade de São Paulo. Resultados: Obteve-se uma amostra de 245 participantes, sendo que, 135 (55,1%) apresentavam neoplasia maligna de intestino, 162 (66,1%) usavam um quimioterápico da classe análogos da platina, 125 (51%) manifestavam dormência nas mãos com gravidade média de 6,71 e angústia média de 7,0 (numa escala de 0-10), impactou negativamente nas Atividades de Vida Diária (AVD) como a prática de exercícios, o trabalho e atividades de lazer. Para testar a validade de construto convergente fez-se uma correlação de Spearmam da versão adaptada do CIPNAT com os instrumento NPSI e DN4 e, obteve-se uma moderada correlação. Não foi possível atingir a validade discriminante. A análise fatorial exploratória com rotação varimax identificou dois fatores, sendo estes, sintomas sensitivos e sintomas motores. Em relação a confiabilidade, alcançou-se um alfa de Cronbach de 0,87, considerado satisfatório. O teste-reteste demonstrou uma forte correlação entre a primeira e segunda avaliação pelo CIPNAT, sendo considerado estável. Conclusão: A análise psicométrica do CIPNAT foi adequada. Desta forma, estará disponível um instrumento válido e confiável que rastreia, caracteriza, avalia e mensura a NPIQ e seu impacto nas AVDs para que a enfermagem oncológica promova uma assistência segura e com qualidade / Background: Chemotherapy Induced Peripheral Neuropathy (CIPN) is a common and debilitating adverse effects caused by the infusion of neurotoxic chemotherapeutics such as taxanes, platines, vinca alkaloids, bortezomib and thalidomide. The administration of these medications increase patient survival, however, approximately 30% to 40% develop CIPN, which negatively affects the planned treatment and the quality of life by interfering with daily activities of the patient. The CIPN manifests itself with sensory symptoms (paresthesia, dysesthesia, pain and others), motors (weakness, changes in gait and balance, difficulty with fine motor skills and others) and neurovegetative (constipation, urinary retention, sexual dysfunction and changes in blood pressure). So far, it has not been a tool designed to evaluate the neuropathic pain in CIPN and furthermore, there is no validated instrument for this purpose in Brazil. Aims: To perform the translation and cultural adaptation of Chemotherapy- Induced Peripheral Neuropathy Assessment Tool instrument (CIPNAT) into Portuguese of Brazil and test the psychometric properties of the adapted version in a sample of cancer patients with CIPN. Methods: This is a methodological study with cross data collection. For the process of translation and adaptation of the instrument, it was adopted the methodological theoretical framework proposed by Beaton et al (2000). Data collection occurred in two referral hospitals in the oncological treatment of São Paulo. Results: There was obtained a sample of 245 participants, and that 135 (55.1%) had colorectal neoplasm, 162 (66.1%) used a platinum chemotherapeutic agent, 125 (51%) manifested numbness in the hands with medium gravity of 6.71 and average distress of 7.0 (on a scale of 0-10), impacted negatively on the activities of Daily Living (ADLs) such as exercise, work and leisure activities. To test the convergent validity has made a Spearman\' correlation of the adapted version of CIPNAT with NPSI and DN4 instrument and, was obtained a moderate correlation. Could not achieve the discriminant validity. Exploratory factor analysis with varimax rotation identified two factors, which are, sensory symptoms and motor symptoms. Regarding reliability, it was reached a Cronbach\'s alpha of 0.87, satisfactory. The test-retest showed a strong correlation between the first and second evaluation by CIPNAT and is considered stable. Conclusion: The psychometric analysis of CIPNAT was adequate. Thus, it will be available a valid and reliable instrument that tracks, features, evaluates and measures the CIPN and its impact on ADL for the oncology nursing promotes safe and quality care

A dor neuropática pode ser causada por lesões e/ou disfunções no sistema somatossensorial. Nestes tipos de dores, alterações plásticas ao longo de todo o sistema sensorial nociceptivo estão associadas à cronificação do processo doloroso. A plasticidade observada pode ser resultante da indução e/ou repressão de genes, os quais geralmente são modulados por fatores de transcrição. Um dos principais fatores de transcrição até então conhecido é a proteína ativadora-1 (AP-1), que pode ser estruturalmente formado principalmente por proteínas das famílias Jun e Fos. Entretanto, na dor neuropática, a participação e o papel do AP-1 não estão bem elucidados. Dessa forma, a hipótese deste trabalho é que a ativação do AP-1 contribua para a indução e/ou manutenção da dor neuropática, através da ativação de células gliais e de proteinocinases ativadas por mitógenos (MAPK) e por indução da produção e liberação de mediadores pró-inflamatórios, bem como de metaloproteinases da matriz extracelular (MMP) na medula espinal. Esses fatores contribuem para sensibilização central causada pela SNI, facilitando a transmissão dolorosa. Assim, a inibição do AP-1 seria uma potencial estratégia terapêutica no tratamento da dor neuropática. Foi utilizado o modelo experimental de dor neuropática de lesão limitada do nervo isquiático (SNI, Spared Nerve Injury) em camundongos, os quais receberam injeção intratecal (i.t.) do inibidor de AP-1, SR11302, ou seu veículo (DMSO, tween® 20 e salina). O tratamento com o inibidor de AP-1 reduziu a hipernocicepção mecânica causada pela SNI, e o perfil de redução sugeriu que esse fator de transcrição esteja relacionado com a manutenção da dor neuropática. No sétimo dia após a SNI, observou-se na medula espinal dos camundongos, ativação da microglia, dos astrócitos e das MAPK, além de aumento na expressão de TNF-, interleucina (IL)-6, IL-1, IL-17A, quimiocina derivada de queratinócito (KC), proteína quimiotáxica de monócitos (MCP-1), óxido nítrico (NO), NO sintase induzível e das MMP-2 e -9. Todos esses eventos estão associados à sensibilização central, portanto, contribuem para a facilitação da transmissão nociceptiva. O tratamento com o inibidor de AP-1 SR11302 impediu, pelo menos parcialmente, a ativação das células gliais e das MAPK e bloqueou o aumento na expressão de todos esses mediadores pró-inflamatórios e das MMPs na medula espinal. Assim, o fator de transcrição AP-1 e, consequentemente, suas vias a jusante (downstream) são potenciais alvos farmacológicos no tratamento da dor neuropática. / Neuropathic pain results from nerve damage or dysfunction, which is associated to the painful process of chronification. This process may include participation of the inducible genes, which may be modulated by transcription factors, including the activator protein-1 (AP-1), which can structurally be formed by proteins from Jun and Fos families. However, the participation and the role of AP-1 neuropathic pain remain unclear. Our hypothesis is that the activation of AP-1 would contribute for the induction and/or maintenance of neuropathic pain, by inducing the glial cells activation and mitogen-activated protein kinases, and by inducing the production/release of pro-inflammatory mediators and extracellular matrix metalloproteinase (MMP) in mices spinal cord. All these factors are contributing to SNI-evoked central sensitization, facilitating pain transmission. Thus, inhibition of AP-1 would be a potential drug target in the treatment of neuropathic pain. The animals received inhalatory anesthesia (2% isoflurane) and were submitted to an experimental model of neuropathic pain Spared Nerve Injury (SNI). The animals were treated intrathecally (i.t.) with AP-1 inhibitor SR11302 or vehicle (DMSO, tween®20 and saline). Treatment with AP-1 inhibitor reduced the SNI-induced mechanical hypernociception, suggesting that this transcription factor is related to the maintenance of neuropathic pain. On the seventh day after SNI, there was in the spinal cord of mice microglia, astrocytes and MAPK activation, increased of expression of TNF-, interleukin (IL)-6, IL-1, IL-17A, keratinocyte-derived chemokine (KC), monocyte chemoattractant protein-1 (MCP-1), nitric oxide (NO) and inducible NO synthase, and increased the expression of MMP-2 and -9. All of these effects are related with central sensitization, thus facilitating nociceptive transmission. However, treatment with SR11302 prevented, at least partially, activation of MAPK and glial cells, as well as prevented the increase in expression of all these pro-inflammatory mediators and MMPs in the spinal cord. Thus, inhibition of AP-1 and hence its way downstream is a potential pharmacological target in the treatment of neuropathic pain.

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.

La spasticité et la douleur neuropathique sont deux symptômes apparaissant fréquemment après une lésion médullaire. La spasticité est définie comme une augmentation du tonus musculaire qui provoque des contractures, tandis que la douleur neuropathique se caractérise par des sensations douloureuses survenant suite à une lésion du système nerveux.Ces deux symptômes résultent en partie d’une désinhibition des réseaux neuronaux sous-lésionnels lié à une diminution de l’expression du cotransporteur potassium-chlorure type 2 (KCC2). Pour être efficace,l’inhibition nécessite l’action de cette protéine qui extrait les ions chlorure des neurones.L’objectif de la présente thèse est donc d’identifier des médicaments capables d’activer KCC2 afin de restaurer l’inhibition dans le but de traiter la spasticité et la douleur neuropathique.Dans un premier temps, nos résultats ont montré que l’activation de récepteurs sérotoninergiques 5-HT2A avec le TCB-2 rétablit l’expression de KCC2 dans la corne dorsale après une lésion médullaire ou névrectomie. Or le TCB-2 réduit seulement la douleur neuropathique après la lésion spinale.Par la suite, nous avons identifié la prochlorperazine comme une molécule augmentant l’activité de KCC2. Si la prochlorperazine est efficace contre la spasticité, elle a néanmoins un effet plus modeste envers l’allodynie mécanique suite à une lésion médullaire.Enfin, nous avons démontré que la diminution de KCC2,ainsi que l’hyperexcitabilité des motoneurones suite à la lésion, dépendent de l’activation des calpaïnes.Cette thèse valide KCC2 comme une cible thérapeutique dans le traitement de la spasticité et la douleur neuropathique suite à une lésion médullaire. / Spasticity and neuropathic pain are two symptoms that arise frequently after a spinal cord injury. Spasticity is defined as an increase of the muscle tone contributing to cramps, whereas neuropathic pain consists of painful responses caused by a damaged nervous system. Both symptoms arise, in part, due to a loss of inhibition in the sublesional neural networks, linked to a downregulation of the expression of potassium-chloride cotransporter type 2 (KCC2). For inhibition to be efficient, the action of this protein, which extrudes chloride ions from neurons, is needed.The objective of this thesis is, therefore, to identify drugs capable of activating KCC2 to recover inhibition with the objective of treating spasticity and neuropathic pain.First, our results have proven that the activation of serotonin receptors 5-HT2A with TCB-2 restores KCC2 expression in the dorsal horn after a spinal cord or peripheral nerve injury. However, TCB-2 reduces neuropathic pain after a spinal cord injury exclusively.In the next stage of the work, we have identified prochlorperazine as an enhancer of KCC2 activity. Prochlorperazine is efficient against spasticity, although it only showed a modest reduction of mechanical hyperalgesia in animals with a spinal cord injury.Lastly, we have proven that KCC2 downregulation and motoneuron hyperexcitability after a spinal cord injury depend on the overactivation of calpains.This thesis validates KCC2 as a druggable target to treat spasticity and neuropathic pain after spinal cord injury.

Les travaux présentés ici visent à déterminer l’implication du récepteur aux opioïdes delta dans des modèles de pathologies chroniques telles que la douleur chronique et l’administration d’opiacés. Nous avons mis en oeuvre des approches génétiques, d’imagerie et comportementales afin de décrire précisément les changements de distribution neuronale du récepteur aux opioïdes delta dans un modèle de douleur neuropathique et dans l’administration chronique de morphine, dans les tissus du système nerveux central et périphérique. Nous avons étudié l’implication des récepteurs aux opioïdes delta périphériques dans l’effet thérapeutique de traitements antiallodyniques dans un modèle de douleur neuropathique, et examiné le rôle des récepteurs aux opioïdes delta dans la sensibilité viscérale et dans les effets thérapeutiques de la Prégabaline. Nos travaux ont permis de décrire précisément les changements et l’implication du récepteur aux opioïdes delta dans plusieurs modèles de pathologies chroniques, dans le but de dégager des pistes thérapeutiques futures. / In this work, we used genetic, imaging and behavioral approaches to describe the changes which the distribution of the delta opioid receptor underwent in models of clinical conditions such as neuropathic pain and chronic opioid exposure, at the peripheral and supraspinal levels. We investigated the role of peripheral delta opioid receptor populations in the antiallodynic effect of chronic treatment by antidepressant and β2 agonist molecules in a model of neuropathic pain. We also described the implication of delta opioid receptors in visceral sensitivity, and their involvement in the pain-relieving effects of Pregabalin in a model of neuropathic pain. Thus, we have brought insight as to the role of delta opioid receptors in these various clinical conditions, and thoroughly described the distribution changes; which may lead the way to therapeutic strategies to treat chronic pain or drug addiction.

The effect of interleukin-1 beta (IL-1β) on the electrical properties of sensory neurons was assessed at comparable levels and exposure times to those found in animal models of neuropathic pain. Experiments involved whole cell current- or voltage-clamp recordings from rat dorsal root ganglion (DRG) neurons in defined medium, neuron enriched cultures. 5-6 days exposure to 100 pM IL-1β produced neuron specific effects. These included an increase in the excitability of medium diameter and small diameter isolectin B4 (IB4)-positive neurons that was comparable to that found after peripheral nerve injury. By contrast, a reduction in excitability was observed in large diameter neurons, while no effect was found in small diameter IB4-negative neurons. Further characterization of changes in medium and small IB4-positive neurons revealed that some, but not all, effects of IL-1β were mediated through its receptor, IL-1RI. Using appropriate voltage protocols and/or ion substitutions, it was found that neuron specific changes in several ionic currents, including alterations in hyperpolarization activated inward current (IH) and decreases in various K+ currents contribute to the increased excitability produced by IL-1β. Overall, these studies revealed that: 1. The effects of long-term exposure of DRG neurons to IL-1β are reflective of the enduring increase in primary afferent excitability reported after peripheral nerve injury. This expands the recognized role of IL-1β in acute inflammatory pain to neuropathic pain. 2. Hyperexcitability in medium neurons exposed to IL-1β likely includes mixed populations of neurons corresponding to nociceptive and non-nociceptive primary afferent fibres and, therefore, has relevance to hyperalgesia and allodynia, respectively. 3. The responsiveness of small IB4-positive neurons, but not IB4-negative, to prolonged IL-1β exposure is consistent with the suggestion that small IB4-negative afferents are involved in inflammatory pain, while small IB4-positive afferents are involved neuropathic pain. 4. The identification of receptor mediated effects and several contributing ionic mechanisms, may have relevance to the development of new therapeutic approaches to neuropathic pain. 5. IL-1β can contribute to increased neuronal excitability by mechanisms that are independent of IL-1RI signalling. This should be taken into account when targeting IL-1β, or more specifically IL-1RI, in the management of neuropathic pain.

La douleur neuropathique centrale post accident vasculaire cérébral est une condition débilitante dont le traitement s’avère souvent délicat et infructueux. Le but de ce projet était de reproduire cette condition chez le rat en injectant par stéréotaxie une solution de collagènase produisant une hémorragie localisée dans le noyau ventropostérolatéral du thalamus. Des tests comportementaux évaluant la coordination motrice, la sensibilité mécanique, au chaud et au froid étaient réalisés régulièrement afin d’établir la présence de douleur neuropathique puis les effets de l’administration de kétamine, d’amitriptyline, de gabapentine, et de carbamazepine étaient évalués. L’induction d’une hémorragie intrathalamique conduit à l’apparition d’allodynie mécanique bilatérale persistante ainsi que d’allodynie au froid transitoire chez certains sujets et ce sans modification de la coordination motrice. L’administration de kétamine à forte dose renverse l’allodynie mécanique mais est associée à une altération de la motricité. L’administration de gabapentine renverse également cette allodynie mécanique sans effet notable sur la coordination motrice. Les autres médicaments n’ont pas démontré d’effet significatif. L’évaluation histopathologique des cerveaux montre une lésion bien localisée dans la zone d’intérêt. Ces résultats montrent que l’injection intrathalamique de collagénase peut être utilisée comme un modèle fiable de douleur neuropathique centrale. Si la kétamine semble capable de soulager ce type de douleur, elle est associée à des effets indésirables. En revanche, la gabapentine serait une molécule prometteuse pour le traitement de cette condition. Le rôle des récepteurs NMDA et des canaux calciques voltage dépendants, cibles respectives de la kétamine et de la gabapentine dans le maintien de cette douleur mérite d’être précisé. / Central post stroke pain is a debilitating condition for which treatment is often difficult and unsuccessful. The goal of this project was to reproduce an animal model of this condition by performing a stereotaxic injection of collagenase solution inducing a localized hemorrhage within the ventroposterolateral thalamic nuclei of rats. Behavioral tests to evaluate motor coordination, sentivity to mechanical, hot and cold stimuli were performed regurlarly to establish if neuropathic pain was present. Then, the effects of ketamine, amitriptyline, gabapentin and carbamazepine on such pain were evaluated. Induction of an intrathalamic hemorrhage produced bilateral persistent mechanical allodynia as well as transient cold allodynia in some animals without notable changes in motor coordination. High doses of ketamine did reverse mechanical allodynia but with significant impairment in motor coordination. Similarly gabapentin also reversed mechanical allodynia without undesirable effect on coordination. The others two drugs failed to show any significant effect. Histopathological evaluation of the brain revealed a well localized lesion in the area of interest. These results show that an intrathalamic collagenase injection produced a reliable model of central neuropathic pain. Ketamine was able to reverse mechanical allodynia but with significant side effects. Gabapentin appeared to be a promising drug for the treatment of this condition. The role of NMDA receptors and voltage dependant calcium channels, that target ketamine and gabapentin respectively in the maintenance of this pain, needs to be further defined.

Le projet porte sur l’étude de l’effet de l’eugénol, composant principal du clou de girofle, sur la douleur neuropathique. L’objectif principal du projet était de déterminer la contribution du système nerveux central dans l’effet analgésique de l’eugénol. Lors d’une étude préliminaire, la pénétrabilité de l’eugénol a été évaluée dans le système nerveux central du rat. Des échantillons de sang, de cerveau et de moelle épinière ont été prélevés et les concentrations d’eugénol dans ces différents tissus ont été analysées à l’aide d’un spectromètre de masse. Les résultats ont montré que l’eugénol pénètre bien le système nerveux central avec une distribution plus importante dans la moelle épinière. Après l’induction de la douleur neuropathique à des rats Sprague-Dawley par le modèle de ligatures du nerf sciatique, des injections intrathécales d’eugénol furent réalisées afin d’évaluer l’effet central de l’eugénol. La plus forte dose d’eugénol a atténué l’allodynie secondaire après 15min, 2h et 4h et a aussi amélioré l’hyperalgésie thermique après 2h et 4h. Ces résultats confirment l’hypothèse que l’eugénol atténue les deux aspects de la douleur neuropathique que sont l’allodynie et l’hyperalgésie. Les injections au niveau lombaire permettent de penser que l’eugénol, un agoniste/antagoniste des récepteurs vanilloïdes pourrait diminuer la douleur neuropathique en agissant notamment au niveau des récepteurs vanilloïdes situés dans la corne dorsale de la moelle épinière. / The project is based on the study of the effects of eugenol, the main component of clove oil, on neuropathic pain. The main objective was to determine the central effect of eugenol. In a preliminary study we evaluated the penetrability of eugenol in the central nervous system of rats. Blood, brain and spinal cord samples were collected and concentrations were determined by mass spectrometry. Brain-toplasma and spinal cord-to-plasma ratios suggest that eugenol penetrates the central nervous system of rats relatively well, with a preferential distribution in the spinal cord. Following the induction of neuropathic pain in male Sprague-Dawley rats using the sciatic nerve ligation model, intrathecal injections of eugenol were done to evaluate the central effect of eugenol. Treatment with the high dose of eugenol significantly decreased secondary mechanical allodynia measured by the Von Frey test after 15min, 2h and 4h and improved thermal hyperalgesia measured by the Hargreaves device after 2h and 4h. Results support the hypothesis that eugenol may alleviate neuropathic pain, both allodynia and hyperalgesia. Eugenol, a vanilloid agonist/antagonist may therefore reduce neuropathic pain by acting on vanilloid receptors at the level of the dorsal horn of the spinal cord.

No description available.

There is an unmet medical need for the efficient treatment of neuropathic pain, a condition that affects approximately 10% of the population worldwide. Current therapies need to be improved due to the associated side effects and lack of response in many patients. Moreover, neuropathic pain causes great suffering to patients and puts an economical burden on society. The work presented in this thesis addresses SP1-7, (Arg-Pro-Lys-Pro-Gln-Gln-Phe-OH), a major metabolite of the pronociceptive neuropeptide Substance P (SP). SP is released in the spinal cord following a noxious stimulus and binds to the NK1 receptor. In contrast to SP, the degradation fragment SP1-7 is antinociceptive through binding to specific binding sites distinct from the NK1 receptor. The aim of this thesis was to investigate the impact of SP1-7 on neuropathic pain. To understand how SP1-7 exerts its effect, a series of N-truncated forms of the heptapeptide were biologically evaluated. A set of small high-affinity ligands was evaluated in animal models of neuropathic pain. To confirm a clinical relevance the levels of SP1-7 in human neuropathic pain were assessed incerebrospinal fluid (CSF) collected from neuropathic pain patients. The results showed that SP1-7 could alleviate thermal as well as mechanical hypersensitivity in three different animal models of neuropathic pain. C-terminal amidation was connected with increased efficacy. N-terminal truncation of SP1-7 indicated a necessity of five amino acids in order to retain biological effect. One small high-affinity ligand showed a significant anti-allodynic effect. CSF levels of SP1-7 in neuropathic pain patients were lower compared to controls. Taken together, these findings demonstrate that the formation of SP1-7 may be attenuated in neuropathic pain. C-terminal amidation and a majority of its amino acids are necessary for stability and permeability. Clearly, SP1-7 and SP1-7 mimetics with high affinity to the SP1-7 binding site ameliorate neuropathic pain-like behaviors in animal models of neuropathic pain. Overall, the findings presented in this thesis contribute to new knowledge regarding the role of SP1-7 and related analogues and fragments in neuropathic pain. In a future perspective, this could be essential for the development of efficient strategies for managing patients with neuropathic pain.