Injury to the central or peripheral nervous system is often
associated with persistent pain. After ischemic injury to the spinal
cord, rats develop severe mechanical allodynia-like symptoms,
expressed as a pain-like response to innocuous stimuli. In its
short-lasting phase the allodynia can be relieved with the
γ-aminobutyric acid (GABA)-B receptor agonist baclofen, which
also reverses the hyperexcitability of dorsal horn interneurons to
mechanical stimuli. Furthermore, there is a reduction in GABA
immunoreactivity in the dorsal horn of allodynic rats. Clinical
neuropathic pain of peripheral and central origin often cannot
be relieved by opiates at doses that do not cause side effects.
The loss of sensitivity to opiates may be associated with the
up-regulation of endogenous antiopioid substances, such as the
neuropeptide cholecystokinin (CCK). CCK and its receptor (CCK-R)
protein is normally not detectable in rat dorsal root ganglion cells.
After peripheral nerve section, both CCK and CCK-R are up-regulated
in the dorsal root ganglia. Furthermore, CI 988, an antagonist of the
CCK-B receptor, chronically coadministered with morphine, reduces
autotomy, a behavior that may be a sign of neuropathic pain following
peripheral nerve section. Thus, opiate insensitivity may be due to
the release of CCK from injured primary afferents. Similarly, in the
chronic phase of the spinal ischemic model of central pain, the
allodynia-like symptom is not relieved by systemic morphine, but
is significantly reversed by the CCK-B antagonist. Consequently,
up-regulation of CCK and CCK-R in the CNS may also underlie opiate
drug insensitivity following CNS injury. Thus, dysfunction of
central inhibition involving GABA and endogenous opioids may be
a factor underlying the development of sensory abnormalities
and/or pain following injury to neural tissue.