IntroductionChronic pain is frequently reported by patients with arthritis [58]. However, there is no correlation between pain and structural joint damage in osteoarthritis [5]. The basis of variability between pathophysiology and pain outcomes is unknown. One possibility is natural variability in pain regulation within the central nervous system (CNS).The ascending spinothalamic pathways that mediate nociception terminate in multiple thalamic nuclei and cortical brain regions [20]. Cortical sites modulate nociception partly by projecting to the basal ganglia including the striatum, which also receives afferent nociceptive inputs from the spinal cord via the globus pallidus [6]. Striatal nuclei, including the caudate, putamen and nucleus accumbens, are the most densely populated regions for opioid receptors in the brain [4,14,34], and are thought to be important for opioid-mediated endogenous analgesia [12,21]. The possibility of opioid mechanisms being involved in determining individual differences in pain states has been a key topic of recent research [28,41,60], but the functional consequences of chronic pain on OpR physiology are largely unknown.Correspondence to: Dr Christopher A Brown, CamPain group, Division of Anaesthesia, Box 93, Addenbrooke's Hospital, Cambridge, CB2 0QQ, cb802@cam.ac.uk. The authors declare no competing financial interests. It has long been known that prolonged nociception results in the release of endogenous opioid peptides and subsequent agonism of OpRs in the CNS [19]. However, a relatively unexplored hypothesis is that chronic pain could potentially adjust OpR physiology to provide more efficient dampening of the pain response as part of a homeostatic control mechanism. There is evidence from animal studies that delta and kappa-OpRs, found in the brain and spinal cord [8,11], can be up-regulated in response to mu-OpR agonism [56], thereby increasing the anti-nociceptive potency of delta-OpR agonists [38,44]. Animal models of chronic inflammatory pain have shown an increase in cell membrane expression of delta-OpRs both postsynaptically [9] and presynaptically [22] in the dorsal spinal cord ipsilateral to the site of injury. Stimulus-evoked translocation of delta-OpRs to neuronal plasma membranes may have evolved as part of a homeostatic mechanism to maintain control of nociceptive transmission [7]. However, evidence for such a mechanism in humans is lacking.
Europe PMC Funders GroupPositron Emission Tomography (PET) receptor binding studies enable assessment of the endogenous opioid system in humans via radiotracers that bind to opioid receptors (OpRs), such as carbon-11 labelled diprenorphine ([ 11 C]-DPN), an antagonist that binds equally well to mu, delta and kappa OpRs [31,33]. Here we measured OpR availability in patients with arthritis and healthy controls with [ 11 C]-DPN PET imaging, to identify relationships between OpR availability and the level of perceived acute and chronic pain. Our analysis revealed associations between the striatum and the perception of both acute a...