Systemic ATP infusion improves spontaneous pain and tactile allodynia, but not tactile hypesthesia, in patients with postherpetic neuralgia

Moriyama, Michiru; Kitamura, Akira; Ikezaki, Hiroyuki; Nakanishi, Kazuhiro; Kim, Choru; Sakamoto, Atsuhiro; Ogawa, Ryō

doi:10.1007/s00540-004-0240-x

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…The analgesic property of intravenous ATP demonstrated in the present and previous clinical studies [3][4][5][6] appearred to be in contrast to the algogenic or pronociceptive property of peripherally or spinally administered ATP, shown in experimental studies [10]. It is quite conceivable that the analgesic effects of intravenous ATP observed in the present study are those of adenosine via A1 receptor activation, because ATP is extremely rapidly converted to adenosine by ectoenzymes when given intravenously [2,11,12].…”

Section: Discussioncontrasting

confidence: 79%

“…Actually, in our recent double-blind study with ATP, complete abolition of spontaneous pain and/or allodynia lasting for more than 15 months was achieved with a single session of ATP therapy in 2 out of 12 patients with NP post-PE,TE [34]. In addition, patients experiencing pain relief with adenosine or ATP lasting for days (>48 h) are not rare [4,[13][14][15]17,18], and such patients are considered to be good candidates for repetitive treatment with adenosine or ATP infusion [15], which may provide progressively improving pain relief [5,18]. Further, one study has revealed that a significant reduction in the mean pain scale persisted for at least 2 weeks after a single session of adenosine infusion in 23 patients with adenosine-responsive neuropathic pain [17].…”

Section: Discussionmentioning

confidence: 99%

“…infusion of adenosine 5'-triphosphate (ATP) has been used for a variety of clinical indications [2]. There have been a few case reports or studies suggesting that intravenous ATP can alleviate neuropathic pain [3][4][5], as well as chronic intractable pain of non-neuropathic origin [6].…”

Section: Introductionmentioning

confidence: 99%

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Pain-relieving effects of intravenous ATP in chronic intractable orofacial pain: an open-label study

et al. 2007

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Pain-relieving effects of intravenous ATP in chronic intractable orofacial pain: an open-label study

et al. 2007

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“…Therefore, the response to adenosine and ATP may vary among patients because of differences in pathophysiological mechanisms underlying the PHN pain. In recent report of eight PHN patients, spontaneous pain and tactile allodynia were significantly reduced by intravenous ATP infusion at a much lower dose (16.7 mg·kg -1 ·min -1 over 60 min) [73] than the dose we used (100 mg·kg -1 ·min -1 or less over 120-180 min) [21,66,67]. Therefore, dose-response studies may be required to determine an optimal ATP infusion dose for each of the various pain conditions.…”

Section: Atp For Chronic Pain Patientsmentioning

confidence: 87%

“…Therefore, sufficiently high doses of ATP infusion over a long period of time (e.g., 2-3 h) may provide better pain relief than shorter infusions (e.g., 1 h or less). It is noteworthy that in a limited number of cases, permanent abolition of spontaneous pain and allodynia can be achieved with a single adenosine or ATP infusion [10,21,50,52,53,67], and that repeated adenosine or ATP infusions provide progressively improved pain relief in some responders [51,73]. K, ketamine; L, lidocaine; ATP, adenosine triphosphate Positive response to a drug was defined as more than 50% reduction in the Visual Analogue Scale for spontaneous pain a V, C, T, L, and S indicate trigeminal, cervical, thoracic, lumbar, and sacral regions, respectively b The response to ATP was correlated with the response to ketamine but not with the response to lidocaine Modified from [66], with permission, by adding data from three cases including one in [21] Positive drug response Fig.…”

Section: Atp For Chronic Pain Patientsmentioning

confidence: 99%

Clinical application of adenosine and ATP for pain control

2005

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This review summarizes clinical application of adenosine and adenosine 5'-triphosphate (ATP) in pain conditions. Investigations have been performed in patients with acute perioperative pain or chronic neuropathic pain treated with intravenous adenosine or ATP, or intrathecal adenosine. Characteristic central adenosine A1 receptor-mediated pain-relieving effects have been observed after intravenous adenosine infusion in human inflammation/sensitization pain models and in patients with chronic neuropathic pain. Adenosine compounds, in low doses, can reduce allodynia/hyperalgesia more consistently than spontaneous pain, suggesting that these compounds affect neuronal pathophysiological mechanisms involved in central sensitization. Such pain-relieving effects, which are mostly mediated via central adenosine A1 receptor activation, have a slow onset and long duration of action, lasting usually for hours or days and occasionally for months. With acute perioperative pain, treatment with a low-dose infusion of adenosine compounds and the A1 receptor-mediated central antisensitization mechanisms may play only a minor part in the total perioperative pain experience. By administering sufficient doses of adenosine compounds during surgery, however, significant and long-lasting perioperative pain relief can be achieved via central A1 receptor-mediated antinociceptive/analgesic actions as well as via peripheral A2a or A3 receptor-mediated antiinflammatory actions. Thus, adenosine compounds have significant potential for alleviating various types of pain.

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Purinergic control of neuropathic pain

McGaraughty

Jarvis

2006

Drug Development Research

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Understanding the purinergic modulation of neurotransmission has been greatly advanced in recent years by the development of receptor-selective compounds and the ability to manipulate expression of specific receptor subtypes. The use of these tools has resulted in a wealth of evidence demonstrating the importance of adenosine (ADO)-sensitive and adenosine 5 0 -triphosphate (ATP)-sensitive receptors (P1 and P2, respectively) to the development of pathological nociceptive states, including neuropathic pain. It is likely that more than one of these P1 and P2 receptor subtypes is involved in the modulation and/or transmission of pathological nociceptive signals. ATP, acting at sensory neurons in the periphery and spinal cord as well as on glial cells contributes to neural excitability, is pro-nociceptive, and likely participates in the sensitization of the central nervous system during chronic pain. ATP is a nonselective agonist for several ionotropic P2X and metabotropic P2Y receptor subtypes. The homomeric P2X 3 , P2X 4 , P2X 7 , heteromeric P2X 2/3 , and possibly P2Y 2 , P2Y 4 , and P2Y 6 have all been linked to neuropathic pain in preclinical models. In contrast, ADO generally functions as an endogenous inhibitory neuromodulator and produces these effects by activating on a family of G-protein coupled cell surface receptors (A 1 , A 2A , A 2B , A 3 ). Systemic and intrathecal administration of ADO itself, both preclinically and clinically, reduces neuropathic hypersensitivity, and these effects are likely mediated through activity at the A 1 receptor subtype. In order to reduce side effects typically related to the administration of ADO, compounds have been identified to allosterically modulate the A 1 receptor or to limit ADO reuptake. These compounds potently affect neuropathy-related sensitivity with an improved therapeutic window. Thus, advances in the pharmacology of purinergic neurotransmission have led to the development of new strategies to enhance the endogenous actions of ADO and to limit the neuro-excitatory effects of ATP. The contributions of the various purinergic receptors to states of neuropathic pain will be reviewed. Drug Dev.

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Systemic ATP infusion improves spontaneous pain and tactile allodynia, but not tactile hypesthesia, in patients with postherpetic neuralgia

Abstract: This study demonstrated that repetitive intravenous ATP infusion could improve spontaneous continuous pain and paroxysmal pain, as well as improving tactile allodynia, but did not influence tactile hypesthesia.

Cited by 11 publications

References 14 publications

Pain-relieving effects of intravenous ATP in chronic intractable orofacial pain: an open-label study

Pain-relieving effects of intravenous ATP in chronic intractable orofacial pain: an open-label study

Clinical application of adenosine and ATP for pain control

Purinergic control of neuropathic pain

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