Abstract

Chronic pain is known to induce an amplified aversive reaction to peripheral nociceptive inputs. This enhanced affective response constitutes a key pathologic feature of chronic pain syndromes such as fibromyalgia. However, the neural mechanisms that underlie this important aspect of pain processing remain poorly understood, hindering the development of treatments. Here, we show that a single dose of ketamine can produce a persistent reduction in the aversive response to noxious stimuli in rodent chronic pain models, long after the termination of its anti-nociceptive effects. Furthermore, we demonstrated that this anti-aversive property is mediated by prolonged suppression of the hyperactivity of neurons in the anterior cingulate cortex (ACC), a brain region well known to regulate pain affect. Therefore, our results indicate that it is feasible to dissociate the affective from the sensory component of pain, and demonstrate the potential for low-dose ketamine to be an important therapy for chronic pain syndromes.

Highlights

  • Chronic pain is known to induce an amplified aversive reaction to peripheral nociceptive inputs

  • During conditioning (10 min), one of the chambers was paired with repeated noxious mechanical stimulations (pin prick (PP)) of the hind paw, whereas the opposite chamber was not paired with noxious stimulations (NP)

  • The aversive response to pain was quantified by a conditioned place aversion (CPA) score, which was calculated by subtracting the time rats stayed in the Pin prick (PP) chamber during the test phase from the preconditioning phase[8,27]

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Summary

Introduction

Chronic pain is known to induce an amplified aversive reaction to peripheral nociceptive inputs. In chronic pain syndromes such as fibromyalgia or persistent postoperative pain, patients develop magnified aversive responses, out of proportion to the intensity of peripheral nociceptive inputs in a wide-spread, anatomically nonspecific manner[2,3,4,5,6] This generalized, anatomically nonspecific, enhancement of aversion leads to severe disability, and it suggests a pathological imbalance between the affective and sensory components in chronic pain conditions. The anterior cingulate cortex (ACC) has been shown to play a key role in the aversive reactions to pain[11,12,13,14,15,16,17,18,19,20,21] Neurons in this region are known to undergo synaptic plasticity in the chronic pain state, resulting in enhanced output projections and an increased aversive response[7,8]. Our results indicate that ketamine can be a novel therapy to selectively inhibit the affective symptoms of chronic pain

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