Unite de Physiopharmacologie du Systeme nerveux, U. 161 INSERM, Paris.
[Role of the spinal serotoninergic, noradrenergic and dopaminergic systems in the mechanism of analgesia]. [French]
Cahiers d Anesthesiologie. 42(6):707-12, 1994.
Abstract:
The aminergic systems arising from the supraspinal structures which innervate the spinal cord are involved in the control of the activity of 1) the sensory neurons 2) the motor neurons 3) at the thoracic level the neurons of vegetative system. During the last two decades numerous publications have been devoted to the study of the role of the serotonergic and the noradrenergic systems. Several groups have also identified a spinal dopaminergic innervation arising from supraspinal structures and suggested that this innervation is, like the two other systems, involved in those controls. All these studies have more particularly suggested that the serotonergic, noradrenergic and dopaminergic fibers which innervate the dorsal horn of the spinal cord play an important role in the control of the transmission of the nociceptive messages and are implicated in the mechanisms of analgesia. Data supporting this hypothesis are reported in the present paper. The criticisms which have been expressed about the hypothesis related to the role of the serotonergic system will be also presented.
Pain treatment of fibromyalgia by acupuncture [letter].
Rheumatology International. 18(1):35-6, 1998.
Abstract:
The lack of objective parameters makes the measurement of pain and the efficacy of pain treatment in patients with chronic pain very difficult. We performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. The parameters corresponded to patients' self-report. Twenty-nine fibromyalgia patients as defined by ACR-criteria (25 women, 4 men) with a mean age of 48.2 +/- 2.0 years and a mean disease duration of 6.1 +/- 1.0 years participated in the study. Pain levels and positive tender points were assessed using the visual analogue scale (VAS, i.e., range 0-100 mm) and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0 +/- 3.4 mm before therapy to 34.5 +/- 4.3 mm after therapy (P < 0.001). Dolorimetry revealed a decreased number of tender points after therapy from 16.0 +/- 0.6 to 11.8 +/- 1.0, P < 0.01. Serotonin levels decreased from 715.8 +/- 225.8 micrograms/10(12) platelets to 352.4 +/- 47.9 micrograms/10(12) platelets (P< 0.01), whereas the serum concentration increased from 134.0 +/- 14.3 ng/ml to 171.2 +/- 14.6 ng/ml (P < 0.01). Substance P levels in serum increased from 43.4 +/- 3.5 pg/ml to 66.9 +/- 8.8 pg/ml (P < 0.01). Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS and dolorimetry. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia.
