Relief of pain is rewarding. Using a model of experimental postsurgical pain we show that blockade of afferent input from the injury with local anesthetic elicits conditioned place preference, activates ventral tegmental dopaminergic cells, and increases dopamine release in the nucleus accumbens. Importantly, place preference is associated with increased activity in midbrain dopaminergic neurons and blocked by dopamine antagonists injected into the nucleus accumbens. The data directly support the hypothesis that relief of pain produces negative reinforcement through activation of the mesolimbic reward-valuation circuitry.motivated behavior | incision | in vivo microdialysis | immunohistochemistry | ventral tegmental area R einforcement of behaviors that maximize benefit (positive reinforcement) and reduce loss or injury (negative reinforcement) is crucial for survival. Whereas positive reinforcement can be produced by activation of mesolimbic dopaminergic pathways, the neural circuits that underlie negative reinforcement are not well understood. Ongoing pain can be "unmasked" in animals using conditioned place preference (CPP). Thus, in the presence of ongoing pain, pairing manipulations that are not rewarding in the absence of pain, such as peripheral nerve block (PNB) or intrathecal administration of ω-conotoxin or clonidine, with a previously neutral context elicits CPP (1-3). CPP resulting from pain relief is a measure of negative reinforcement.Human functional imaging studies have shown that offset of an acute noxious stimulus (4, 5) or placebo analgesia (6) activates brain regions that overlap extensively with those implicated in appetitive rewards, in particular the ventral tegmental area (VTA), and its dopaminergic projections to the nucleus accumbens (NAc) (5, 6). Manipulations that disrupt mesolimbic dopamine transmission attenuate food or drug reward-induced CPP (7,8). Electrophysiological recordings from dopaminergic neurons in the VTA demonstrate phasic neuronal activation by primary food or liquid rewards, by rewarding drugs, and reward-predicting cues (9). Similarly, immunohistochemical studies show increased expression of the immediate early gene cFOS in the VTA in response to rewarding drugs, providing further support for an enhanced neuronal activity (10-13). The NAc can be anatomically and functionally divided into core and shell regions that respectively receive projections from the lateral and medial VTA (14). In vivo microdialysis measurements or fast-scan voltammetry demonstrate that appetitive rewards promote an efflux of dopamine in the NAc (15, 16). It has been suggested that NAc neurons signal reward value and participate in behavioral decision making (17-21).We hypothesized that relief of ongoing pain would activate the mesolimbic dopamine pathway and that such activation is necessary for negative reinforcement. We tested this hypothesis directly in rats with incisional injury-induced pain (22) subsequently relieved by peripheral nerve block. ResultsIncision of the skin and underlying...
Neuropathic pain is often “spontaneous” or “stimulus-independent.” Such pain may result from spontaneous discharge in primary afferent nociceptors in injured peripheral nerves. However, whether axotomized primary afferent nociceptors give rise to pain is unclear. The rostral anterior cingulate cortex (rACC) mediates the negative affective component of inflammatory pain. Whether the rACC integrates the aversive component of chronic spontaneous pain arising from nerve injury is not known. Here, we used the principle of negative reinforcement to show that axotomy produces an aversive state reflecting spontaneous pain driven from injured nerves. Additionally, we investigated whether the rACC contributes to the aversiveness of nerve injury induced spontaneous pain. Partial or complete hindpaw denervation was produced by sciatic or sciatic/saphenous axotomy, respectively. Conditioned place preference resulting from presumed pain relief was observed following spinal clonidinein animals with sciatic axotomy but not in sham-operated controls. Similarly, lidocaine administration into the rostral ventromedial medulla (RVM) produced place preference selectively in animals with sciatic/saphenous axotomy. In rats with spinal nerve ligation (SNL) injury lesion of the rACC blocked the reward elicited by RVM lidocaine but did not alter acute stimulus evoked hypersensitivity. Lesion of the rACC did not block cocaine-induced reward indicating that rACC blockade did not impair memory encoding or retrieval but did impair spontaneous aversiveness. These data indicate that spontaneous pain arising from injured nerve fibers produces a tonic aversive state that is mediated by the rACC. Identification of the circuits mediating aversiveness of chronic pain should facilitate the development of improved therapies.
Pain is aversive, and its relief elicits reward mediated by dopaminergic signaling in the nucleus accumbens (NAc), a part of the mesolimbic reward motivation pathway. How the reward pathway is engaged by pain-relieving treatments is not known. Endogenous opioid signaling in the anterior cingulate cortex (ACC), an area encoding pain aversiveness, contributes to pain modulation. We examined whether endogenous ACC opioid neurotransmission is required for relief of pain and subsequent downstream activation of NAc dopamine signaling. Conditioned place preference (CPP) and in vivo microdialysis were used to assess negative reinforcement and NAc dopaminergic transmission. In rats with postsurgical or neuropathic pain, blockade of opioid signaling in the rostral ACC (rACC) inhibited CPP and NAc dopamine release resulting from non-opioid pain-relieving treatments, including peripheral nerve block or spinal clonidine, an ␣ 2 -adrenergic agonist. Conversely, pharmacological activation of rACC opioid receptors of injured, but not pain-free, animals was sufficient to stimulate dopamine release in the NAc and produce CPP. In neuropathic, but not sham-operated, rats, systemic doses of morphine that did not affect withdrawal thresholds elicited CPP and NAc dopamine release, effects that were prevented by blockade of ACC opioid receptors. The data provide a neural explanation for the preferential effects of opioids on pain affect and demonstrate that engagement of NAc dopaminergic transmission by non-opioid pain-relieving treatments depends on upstream ACC opioid circuits. Endogenous opioid signaling in the ACC appears to be both necessary and sufficient for relief of pain aversiveness.
A predominant complaint in patients with neuropathic pain is spontaneous pain, often described as “burning”. Recent studies have demonstrated that negative reinforcement can be used to unmask spontaneous neuropathic pain allowing for mechanistic investigations. Here, ascending pathways that might contribute to evoked and spontaneous components of experimental neuropathic pain model were explored. Desensitization of TRPV1 positive fibers with systemic resiniferatoxin (RTX) abolished spinal nerve ligation (SNL) injury-induced thermal hypersensitivity and spontaneous pain, but had no effect on tactile hypersensitivity. Ablation of spinal NK-1 receptor expressing neurons blocked SNL-induced thermal and tactile hypersensitivity as well as spontaneous pain. Following nerve injury, upregulation of neuropeptide Y (NPY) is observed almost exclusively in large diameter fibers and inactivation of the brainstem target of these fibers in the n. gracilis prevents tactile, but not thermal, hypersensitivity. Blockade of NPY signaling within the n. gracilis failed to block SNL-induced spontaneous pain or thermal hyperalgesia while fully reversing tactile hypersensitivity. Moreover, microinjection of NPY into n. gracilis produced robust tactile hypersensitivity, but failed to induce conditioned place aversion. These data suggest that spontaneous neuropathic pain and thermal hyperalgesia are mediated by TRPV1 positive fibers and spinal NK-1 positive ascending projections. In contrast, the large diameter dorsal column projection can mediate nerve injury-induced tactile hypersensitivity, but does not contribute to spontaneous pain. As inhibition of tactile hypersensitivity can be achieved either by spinal manipulations or by inactivation of signaling within the n. gracilis, the enhanced paw withdrawal response evoked by tactile stimulation does not necessarily reflect “allodynia”.
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