Our understanding of the mechanisms by which inflammatory injury leads to sustained changes in the function and properties of pain modulatory neurons in the rostral ventromedial medulla (RVM) remains rudimentary. Substance P (SubP) contributes to central sensitization after injury, yet surprisingly little is known about its role in the modulation of nociception by the RVM, where it also exists in high concentrations. Pilot data indicate that SubP has both antinociceptive and pronociceptive actions in the RVM in the uninjured state, but acts to mediate and sustain hyperalgesia after inflammatory injury. These data support four related hypotheses. 1) SubP exerts both pronociceptive and antinociceptive effects in the uninjured state by time-dependent activation of pain inhibitory and pain facilitatory bulbospinal pathways. Behavioral pharmacological studies will establish the dose-dependence and duration of SubP effects in the RVM of rats in the uninjured state, and confirm the role of neurokinin-1 (NK1) receptors. The bulbospinal pathways that mediate the effects of SubP will be determined by challenge with spinally-administered receptor antagonists before and at various times after SubP injection. 2) SubP is released in the RVM in response to inflammatory injury, where it plays a pronociceptive role in the development of hyperalgesia. The role of endogenous SubP released in the RVM after injury will be assessed by NK1 receptor internalization and by microinjection of NK receptor antagonists in the RVM of rats with acute and persistent hyperalgesia induced by complete Freund's adjuvant (CFA). 3) SubP effects reflect the expression of the NK1 receptor by specific types of RVM neurons, a pattern that may change after injury. Tract tracing and immunohistochemistry will identify RVM neurons that express NK1 receptors by their neurotransmitter content and projections to the spinal cord and DLPT. Subsequent studies will determine whether this expression changes after CFA, and will identify the types of RVM neurons in which NK1 receptor internalization (indicative of SubP release) occurs after injury. 4) SubP acts at specific populations of spinally-projecting RVM neurons and, in CFA-treated rats, enhances excitatory inputs to specific types of RVM neurons to mediate hyperalgesia. Whole-cell patch clamp recording from RVM neurons, coupled with retrograde labeling and immunohistochemical staining, will identify which types of RVM neurons express functional NK1 receptors and determine how the actions of SubP change after CFA. Extracellular recordings will determine the effect of SubP on ON, OFF and NEUTRAL cells and its role in the sensitization of these neurons after CFA. These studies will provide a mechanistic framework in which the antinociceptive and pronociceptive effects of SubP are related to specific populations of RVM neurons. These data in turn may enable us to identify their function (pro- vs antinociceptive). Collectively, these results will advance our understanding of the means and mechanisms by which peripheral inflammatory injury alters the responses and function of critical brainstem pain modulatory systems, and inform a more rationale development of centrally-acting analgesics for the relief of persistent pain.
Persistent pain of an inflammatory nature, such as that associated with arthritis or soft tissue injury, exacts a significant financial, emotional and physical toll on its sufferers. The results of these studies will identify how persistent pain changes the function of brainstem pathways that are critically involved in the regulation of nociception and the production of analgesia. Insights gain from this work will guide the development of new, more effective pharmacotherapies or cognitive approaches for the relief of persistent pain.
