Lecture 29 - Neuropathic pain and analgesia 2 Flashcards Preview

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Flashcards in Lecture 29 - Neuropathic pain and analgesia 2 Deck (26):

CB1 receptor (for cannabinoids - THC) is one of the most widely expressed ___ in the brain and is also found in peripheral tissues



CB2 receptor is found on

non-neuronal tissues, innune cells including microglia


What is the endogenous mediator of CB1 receptor?



Unlike opioids rceptors Cb1r have a very low density in the ____



What are the 3 main areas where cannabinoids can influence the pain transduction?

1. peripheral nerve transmission - CB1 agonists inhibit

2. Dorsal horn - CB1 agonists inhibit activity of relay neurons
- negative coupling via G protein with N-type Ca2+ channels- leads to decrease in Ca2+ entry and release of excitatory NTs
- hyperpolarisation of postsynaptic neuron due to activation of K+ channels

3. Descending modulatory (inhibitory) control pathway - CB1 agonists enhance activity


Sativex (mixutre of TH and cannabidiol) is used for

analgesic, muscle relexant

adjunctive treatment for symptomatic relief of pan in MS, neuropathic related cancer pain and AIDS neuropathy


Sativex have a __% improvement over basseline and __% over placebo for treatment of MS




What are the other clinical effects of THC?


sleep improvement


psychotropic effects - abuse potential


Glial cells are what percentage of total cells in the brain and SC?


microglia are 5-10% of that


What is the mechanism of inflammation at site of damaged nerve?

cytokines, neurotrophic factors

can activate MICROGLIA and ASTROCYTES located in SC and brain


macrophages, T cells and ___ cells invade lesion site and spread around distal stumps of injured nerve fibres. _____ cells begin to proliferate and dedeffierentiate to guide regenerating axons

macrophages, T cells and mast cells invade lesion site and spread around distal stumps of injured nerve fibres. Schwann cells begin to proliferate and dedeffierentiate to guide regenerating axons


Macrohpages move from the ___ within the sheath to the site of injury



one week after nerve injury, massive ______ activation found in the dorsal horn

one week after nerve injury, massive microglial activation found in the dorsal horn


The activated microglia modulate neuropathic Pain signaling in dorsal horn

How does this happen?

The activated microglia modulate neuropathic pain signaling in dorsal horn

ATP binds to receptors on microglial surface - increase in IC Ca2+ which induced p38 MAPK pathway

This initiates transcription of various neuroinflammatory agents including cytokines, neurotrophic factors and NTs into the synaptic cleft - these cause depolarisaion and sensitisation = PAIN


what does activation of astrocytes do?

prolongation of a pain state

- more neuro-inflammatory agents secreted in the synaptic cleft


What happens to CB1 and CB2 receptors in neuropathic pain and neuro-inflammation?

CB1 and CB2 receptors upregulated in peripheral and central sensory pathways

also upregualted in microglia/macrophage - like in MS


hence what is the role of CB1 and CB2 receptors in disease?

inhibitor NT release and decreas hypersensitivity and decrease inflammation (CB2R expressed on T cells)


Glial cells express CB1 and mainly Cn2R - secrete ___________



What are Cb2R an interesting target for treatment of disorders in which activation of microglial cells is a critical process?

CB2R, although scarce in healthy brain, are up-regulated in idfferent glial elements, mainly reactive microglia cells, in response to infection, inflammation or tissue reponse

This response related to process of microglial recruitment (proliferation and migration) at the lesioned sites AND to generation of several micro-glia derived mediates, both processes being regualted by CBR2


Cannabinoids themselves can inhibit entry of what to the brain?

immune cells

through activation of CB2R can also inhibit generation of pro-inflammatory mediators


CBs are also antioxidant molecules meaning they can...

decrease toxicity of ROS


What is the benefit of SELECTIVE CB2 agonists?

you dont get the psychoactivate side effect as they're not represent in the brain


What applications are relevant for selective CB2 agonists?



neuropathic pain

increase efficacy of opioids


What is syngery or additivity in relation to prescribing drugs?
(which ideally don't share a common receptor)

additivity (a +b) - drug combination leads to mathematically predicable effect of the two drugs

synergy (greater than a + b) - drug combination leads to effects of exaggerated intensity


What is dexmedetomidine?

a2 adrenoceptor agonist

used in intensive care for sedation

acts to inhibit further release of noradrenaline by taking up the receptor


What are some future directions for cannabinoids, conotoxins and combination therapies?

w-conotoxins - potential clinical utility in low doses or in combinatin therapy

Cannabinoids - could be used as CB2 agonsits due t efficacy and lack of CNS side effects

combination therpaies in general to be pursued - decreases side effects and tolerance