Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes

Almay, B. G. L.; Johansson, Folke; Knorring, Lars von; Terenius, Lars; Wahlström, Agneta

doi:10.1016/0304-3959(78)90037-4

Cited by 206 publications

(38 citation statements)

References 19 publications

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“…[19]. Decreased levels of f-END detected in the cerebrospinal fluid of patients suffering from chronic arthritis or chronic low back pain [20] led to the findings in chronic pain models that peripheral lesions can induce important changes in brain concentrations of opioid peptides involved in the modulation of pain [9]. Similar changes of opioid peptide levels in the central nervous system may be induced by neuropharmacological treatment of experimental animals [21,22].…”

Section: Methodsmentioning

confidence: 68%

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases

Wiedermann

Sacerdote

Mur

et al. 1992

Clinical and Experimental Immunology

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SUMMARYThe neuroendocrine polypeptide hormone beta-endorphin (f-END), which is released from various tissues including the anterior pituitary gland and cells of the immune system, has recently been implicated as having an immunoregulatory role. We used a radioimmunoassay to measure f-END levels in circulating mononuclear leucocytes from normal subjects and patients with various rheumatic diseases. Levels of f-END in leucocytes from patients were lower than in leucocytes from healthy subjects (P< 000 1). Whereas levels of f-END in leucocytes from patients with the various rheumatic disorders were not significantly different, an inverse correlation was found between f-END levels in leucocytes and expression of rheumatoid factor (P < 0 025) and erythrocyte sedimentation rate (P < 0 025). This study demonstrates decreased content of f-END in cells of the immune system related to parameters of inflammatory activity in rheumatic diseases.

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Section: Methodsmentioning

confidence: 68%

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases

Wiedermann

Sacerdote

Mur

et al. 1992

Clinical and Experimental Immunology

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“…However, other studies of adults have failed to confirm this age-effect on CSF-BE [4,8,167]. All in all, the balance of evidence does not favour a simple confounding effect of age on CSF-BE.…”

Section: Agementioning

confidence: 91%

“…Already in 1978, Almay et al reported that levels of unspecific "endorphins" were low in the CSF of patients with predominantly "neuralgic" pain, compared both to patients with what was labelled "psychogenic" pain and to healthy controls [4]. Also, in 1988, Tonelli et al found low CSF-BE in patients scheduled for Spinal Cord Stimulation (SCS), compared to historic controls [238].…”

Section: Neuropeptidesmentioning

confidence: 99%

“…Biomarker CSF candidates in earlier studies have included Cystatin C [75,146], nociceptin [35,195], and different neurotrophins [40,143]. SP and BE are also classical candidates, and on the basis of Paper III and other studies [3,4,138,208,238,244,245], one might perhaps hypothesize that peripheral neuropathic pain and fibromyalgia are characterized by different combined patterns of CSF-BE and CSF-SP: the former would be associated with a tendency to low CSF-BE and normal/low CSF-SP, whereas the latter would be associated with a tendency to normal CSF-BE and high CSF-SP. Hence, CSF-BE and CSF-SP may perhaps in the future be part of a panel of proteins used to discriminate between different pain conditions.…”

Section: Candidate Proteins Vs Proteomicsmentioning

confidence: 99%

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The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Bäckryd¹

2015

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The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain. In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question. In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor. In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses

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“…The activity in the endorphin systems is altered in chronic pain states (1,18), and the endorphins seem to have a physiological role in pain perception (3,11).…”

Section: Introductionmentioning

confidence: 99%

Endorphins in CSF of Chronic Pain Patients, in Relation to Augmenting-Reducing Response in Visual Averaged Evoked Response

Knorring¹,

Almay²,

Johansson³

et al. 1979

Neuropsychobiology

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In 45 consecutive patients with chronic pain, visual averaged evoked responses (VAER) and the levels of fraction 1 endorphins in CSF were investigated. Patients with an augmenter response in VAER, i.e. the maximum amplitude increases when stimulus intensity is increased, were found to have signifìcantly lower levels of fraction 1 endorphins than patients with a reducer response, i.e. the maximum amplitude in VAER decreases when stimulus intensity is increased. The results indicate that the endorphins function as endogenous antinociceptive factors.

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Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes

Cited by 206 publications

References 19 publications

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Endorphins in CSF of Chronic Pain Patients, in Relation to Augmenting-Reducing Response in Visual Averaged Evoked Response

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