DOI QR코드

DOI QR Code

Effect of Masticatory Muscle Pain Control by Morphine

Morphine에 의한 저작근 통증의 조절 효과

  • Yoo, Sang-Hoon (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Kim, Min-Jae (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Chang, Joo-Yeon (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Kang, Soo-Kyung (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Auh, Q-Schick (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Hong, Jung-Pyo (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University) ;
  • Chun, Yang-Hyun (Department of Orofacial Pain and Oral Medicine, School of Dentistry, Kyung Hee University)
  • 유상훈 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 김민재 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 장주연 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 강수경 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 어규식 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 홍정표 (경희대학교 치의학전문대학원 안면통증구강내과학교실) ;
  • 전양현 (경희대학교 치의학전문대학원 안면통증구강내과학교실)
  • Received : 2012.06.05
  • Accepted : 2012.06.30
  • Published : 2012.09.30

Abstract

This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into three group; saline injection group(n=10), lidocaine injection group(n=10) and morphine injection group(n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 10min, 30min, 60min and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation and the objective pain evaluation were significantly different statistically in within subject effects(p<0.001). 2. The subjective pain drawing evaluation(p<0.001) were significantly different statistically in between subject effects. 3. The objective pressure pain threshold evaluation(p=0.025) were significantly different statistically in between subject effects. 4. The morphine injection group(p=0.001) were more significantly different than the saline injection group statistically in the subject pain drawing evaluation. Therefore, it was considered that the morphine injection was effective to pain control for masticatory muscle pain patients within 60 minute.

이 연구는 Morphine을 이용한 저작근통증의 조절 효과를 확인하기 위해서 시행되었으며, 경희대학교 치과대학병원 구강내과에 내원한 환자 중 RDC/TMD로 진단된 지원자를 saline 주사군, lidocaine 주사군, morphine 주사군 각각 10명씩 배정하였다. 통증부위에 주사 전, 주사 후 10분, 30분, 60분에 각각 주관적인 통증 평가인 시각유추척도검사, 맥길통증설문지검사 그리고 통증부위표시검사와 객관적인 통증 평가인 압력통증역치검사와 압력통증한계검사를 실시하였다. 검사 후 평가된 자료를 통계 처리하여 다음과 같은 결과를 얻었다. 1. 주관적인 통증 평가와 객관적인 통증 평가 모두 집단 내 효과가 있었다. (p<0.001) 2. 주관적인 통증 평가인 통증부위표시검사(p<0.001)에서 집단 간 효과가 있었다. 3. 객관적인 통증 평가인 압력통증역치검사(p=0.025)에서 집단 간 효과가 있었다. 4. 주관적인 통증 평가인 통증부위표시검사는 morphine 주사군(p=0.001)이 saline 주사군에 비해서 효과가 있었다. 이상의 연구결과로 저작근에 통증이 있는 환자에게 morphine 주사 시 60분 이내에는 주관적인 평가에서 통증 조절 효과가 있었으며, 향후 시간 연장에 따른 지속적인 추가 연구가 필요 할 것으로 생각된다.

Keywords

References

  1. Stein C, Lang LJ. Peripheral mechanisms of opioid analgesia. Current Opinion in Pharmacology 2009;9:3- 8. https://doi.org/10.1016/j.coph.2008.12.009
  2. Stein C, Hassan AHS, Przewlocki R, Gramsch C, Peter K, Herz A. Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation. Proc Natl Acad Sci USA 1990;87:5935-9. https://doi.org/10.1073/pnas.87.15.5935
  3. Przewlocki R, Hassan AHS, Lason W, Epplen C, Herz A, Stein C. Gene expression and localization of opioid peptides in immune cells of inflamed tissue: functional role in antinociception. Neuroscience 1992; 48:491-500. https://doi.org/10.1016/0306-4522(92)90509-Z
  4. Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL. Multiple opiate receptor sites on primary afferent fi bres. Nature. 1980;284:351-3. https://doi.org/10.1038/284351a0
  5. Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993;76:182-91.
  6. Machelka H. Targeting of opioid-producing leukocytes for pain control. Neuropeptides. 2007;41:355-63. https://doi.org/10.1016/j.npep.2007.06.001
  7. Boogaerts J, Lafont N. Mechanism of action and clinical use of opioids administered by the peripheral perineural route. Cah Anesthesiol. 1991;39:91-5.
  8. Nunez S, Lee JS, Zhang Y, Bai G, Ro JY. Role of peripheral mu-opioid receptors in inflammatory orofacial muscle pain. Neuroscience 2007;146: 1346- 54. https://doi.org/10.1016/j.neuroscience.2007.02.024
  9. Modi M, Rastogi S, Kumar A, Buprenorphine with bupivacaine for intraoral nerve blocks to provide postoperative analgesia in outpatients after minor oral surgery. J Oral Maxillofac Surg. 2009 Dec;67(12): 2571-6. https://doi.org/10.1016/j.joms.2009.07.014
  10. Ziegler CM, Wiechnik J, Mühling J. Analgesic effects of intra-articular morphine in patients with temporomandibular joint disorders: a prospective, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2010 Mar;68(3):622-7. https://doi.org/10.1016/j.joms.2009.04.049
  11. Piani D, Frei K, Do KQ, Cuenod M, Fontana A, Murine brainmacrophages induce NMDA receptor mediated neurotoxicity in vitro by secreting glutamate. Neurosci. Lett. 1991;133:159-162. https://doi.org/10.1016/0304-3940(91)90559-C
  12. Parpura V, Liu F, Jeftinija KV, Haydon PG, Jeftinija SD. Neuroligand-evoked calcium-dependent release of excitatory amino acids from Schwann cells. J. Neurosci. 1995;15: 5831-5839.
  13. DeGroot J, Zhou S, Carlton SM, Peripheral glutamate release in the hindpaw following low and high intensity sciatic stimulation. NeuroReport. 2000;11:497-502. https://doi.org/10.1097/00001756-200002280-00014
  14. Lawand NB, McNearney T, Westlund KN, Amino acid release into the knee joint: key role in nociception and inflammation. Pain. 2000;86:69-74. https://doi.org/10.1016/S0304-3959(99)00311-5
  15. Chun YH, Frank D, Lee JS, Zhang Y, Auh QS, Ro JY. Peripheral AMPA receptors contribute to muscle nociception and c-fos activation. Neuroscience Research. 2008;62:97-104. https://doi.org/10.1016/j.neures.2008.06.007
  16. Ro JY, Capra NF, Lee JS, Masri R, Chun YH. Hypertonic saline-induced muscle nociception and c-fos activation are partially mediated by peripheral NMDA receptors. European Journal of Pain. 2007;11:398-405. https://doi.org/10.1016/j.ejpain.2006.05.008
  17. Castrillon EE, Cairns BE, Ernberg M, Wang K, Sessle BJ, Arendt-Nielsen L, Svensson P. Effect of peripheral NMDA receptor blockade with ketamine on chronic myofascial pain in temporomandibular disorder patients: a randomized, double-blinded, placebo-controlled trial. J Orofac Pain. 2008 Spring;22 (2):122-30.
  18. Alfredson H, Forsgren S, Thorsen K, Lorentzon RJ. In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper's knee. Orthop Res. 2001;19:881-886. https://doi.org/10.1016/S0736-0266(01)00016-X
  19. Rosendal L, Larsson B, Kristiansen J, Peolsson M, Sogaard K, Kjaer M, Sorensen J, Gerdle B. Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise. Pain. 2004; 112:324-334. https://doi.org/10.1016/j.pain.2004.09.017
  20. Arima T, Svensson P, Arendt-Nielsen L. Capsaicininduced muscle hyperalgesia in the exercised and non-exercised human masseter muscle. J. Orofac.Pain. 2000;14:213-223.
  21. Arima T, Arendt-Nielsen L, Minagi S, Svensson P. Effect of capsaicin-evoked jaw-muscle pain on intramuscular blood-flow. Arch. Oral Biol. 2009;54: 241-249. https://doi.org/10.1016/j.archoralbio.2008.11.005
  22. Wang K, Arendt-Nielsen L, Svensson P. Capsaicininduced muscle pain alters the excitability of thehumanjaw-stretch reflex. J. Dent. Res. 2002;81: 650-654. https://doi.org/10.1177/154405910208100915
  23. Lee JS, Zhang Y, Ro JY. Involvement of neuronal, inducible, and endothelia nitric oxide synthases in capsaicin-induced muscle hypersensitivity. Eur. J. Pain. 2009;13(9):924-928. https://doi.org/10.1016/j.ejpain.2008.11.009
  24. Ro JY, Lee JS, Capra NF, Zhang Y. Role of soluble guanylatecyclase in the trigeminal subnucleus caudalis incapsaicin-induced muscle hypersensitivity. Brain Res. 2007;1184:141-148. https://doi.org/10.1016/j.brainres.2007.09.085
  25. Ro JY, Lee JS, Zhang Y. Activation of TRPV1 and TRPA1 leads to muscle nociception and mechanical hyperalgesia. Pain. 2009;144:270-277. https://doi.org/10.1016/j.pain.2009.04.021
  26. Chun YH, Ro JY. Electrophysiological characterization of the rat trigeminal caudalis (Vc) neurons following intramuscular injection of capsaicin. Neuroscience Letters. 2010;469:289-293. https://doi.org/10.1016/j.neulet.2009.10.012
  27. Arendt-Nielsen L, Svensson P, Sessle BJ, Cairns BE, Wanga K. Interactions between Glutamate and Capsaicin in Inducing Muscle Pain and Sensitization in Humans. Eur J Pain. 2008 July;12(5):661-670. https://doi.org/10.1016/j.ejpain.2007.10.013
  28. Mansour A, Fox CA, Burke S, Meng F, Thompson RC, Akil H, Watson SJ. Mu, delta, and kappa opioid receptor mRNA expression in the rat CNS: an in situ hybridization study. J Comp Neurol. 1994;350:412-438. https://doi.org/10.1002/cne.903500307
  29. Minami M, Maekawa K, Yabuuchi K, Satoh M. Double in situ hybridization study on coexistence of mu, delta and kappa OR mRNAs with preprotachykinin A mRNA in the rat dorsal root ganglia. Brain Res Mol Brain Res. 1995;30:203--210. https://doi.org/10.1016/0169-328X(94)00290-U
  30. Mennicken F, Zhang J, Hoffert C, Ahmad S, Beaudet A, O''Donnell D. Phylogenetic changes in the expression of delta opioid receptors in spinal cord and dorsal root ganglia. J Comp Neurol. 2003;465:349-360. https://doi.org/10.1002/cne.10839
  31. Dado RJ, Law PY, Loh HH, Elde R. Immunofluorescent identification of a delta (delta)-opioid receptor on primary afferent nerve terminals. Neuroreport. 1993;5:341-344. https://doi.org/10.1097/00001756-199312000-00041
  32. Arvidsson U, Riedl M, Chakrabarti S, Lee JH, Nakano AH, Dado RJ, Loh HH, Law PY, Wessendorf MW, Elde R. Distribution and targeting of a mu-opioid receptor (MOR1) in brain and spinal cord. J Neurosci. 1995;15:3328-3341.
  33. Ji RR, Zhang Q, Law PY, Low HH, Elde R, Hokfelt T. Expression of mu-, delta-, and kappa-opioid receptor-like immunoreactivities in rat dorsal root ganglia after carrageenan-induced inflammation. J Neurosci 19951;5:8156-8166.
  34. Coggeshall RE, Zhou S, Carlton SM. Opioid receptors on peripheral sensory axons. Brain Res. 1997;764:126- 132. https://doi.org/10.1016/S0006-8993(97)00446-0
  35. Hassan AH, Ableitner A, Stein C, Herz A. Inflammation of the rat paw enhances axonal transport of opioid receptors in the sciatic nerve and increases their density in the inflamed tissue. Neuroscience. 1993;55:185-195. https://doi.org/10.1016/0306-4522(93)90465-R
  36. Mousa SA, Zhang Q, Sitte N, Ji R, Stein C. beta-Endorphincontaining memory-cells and muopioid receptors undergo transport to peripheral inflamed tissue. J Neuroimmunol. 2001;115:71-78. https://doi.org/10.1016/S0165-5728(01)00271-5
  37. Schafer M, Imai Y, Uhl GR, Stein C. Inflammation enhances peripheral mu-opioid analgesia, but not mu-opioid receptor transcription in dorsal root ganglia. Eur J Pharmacol. 1995;279:165-9. https://doi.org/10.1016/0014-2999(95)00150-J
  38. Antonijevic I, Mousa SA, Schafer M, Stein C. Perineurial defect and peripheral opioid analgesia in inflammation. J Neurosci. 1995;15:165-72.
  39. Stein C, Schafer M, Machelska H. Attacking pain at its source: new perspectives on opioids. Nat Med. 2003;9:1003-1008. https://doi.org/10.1038/nm908
  40. Jessell TM, Iversen LL. Opiate analgesics inhibit substance Prelease from rat trigeminal nucleus. Nature. 1977;268:549-551. https://doi.org/10.1038/268549a0
  41. Tegeder I, Meier S, Burian M, Schmidt H, Geisslinger G, Lotsch J. Peripheral opioid analgesia in experimental human pain models. Brain. 2003;126:1092- 1102. https://doi.org/10.1093/brain/awg115
  42. Bakke M, Hu JW, Sessle BJ. Morphine application to peripheral tissues modulates nociceptive jaw reflex. Neuroreport. 1998;9:3315-3319. https://doi.org/10.1097/00001756-199810050-00030
  43. Eisenberg E, Vos BP, Strassman AM. The peripheral antinociceptive effect of morphine in a rat model of facial pain. Neuroscience. 1996;72:519-525. https://doi.org/10.1016/0306-4522(95)00565-X
  44. Houghton AK, Valdez JG, Westlund KN. Peripheral morphine administration blocks the development of hyperalgesia and allodynia after bone damage in the rat. Anesthesiology. 1998;89:190-201. https://doi.org/10.1097/00000542-199807000-00026
  45. Catheline G, Guilbaud G, Kayser V. Peripheral component in the enhanced antinociceptive effect of systemic U-69,593, a kappa opioid receptor agonist in mononeuropathic rats. Eur J Pharmacol. 1998;357:171-178. https://doi.org/10.1016/S0014-2999(98)00597-4
  46. Truong W, Cheng C, Xu QG, Li XQ, Zochodne DW. Mu opioid receptors and analgesia at the site of a peripheral nerve injury. Ann Neurol. 2003;53:366-375. https://doi.org/10.1002/ana.10465
  47. Ko MC, Butelman ER, Woods JH. The role of peripheral mu opioid receptors in the modulation of capsaicin-induced thermal nociception in rhesus monkeys. J Pharmacol Exp Ther. 1998;286:150-156.
  48. Duckett JW, Cangiano T, Cubina M, Howe C, Cohen D. Intravesical morphine analgesia after bladder surgery. J Urol. 1997;157:1407-1409. https://doi.org/10.1016/S0022-5347(01)65001-8
  49. Likar R, Schafer M, Paulak F, Sittl R, Pipam W, Schalk H, Geissler D, Bernatzky G. Intraarticular morphine analgesia in chronic pain patients with osteoarthritis. Anesth Analg. 1997;84:1313-1317.
  50. Rorarius M, Suominen P, Baer G, Pajunen P, Tuimala R, Laippala P. Peripherally administered sufentanil inhibits pain perception after postpartum tubal ligation. Pain. 1999;79:83-88. https://doi.org/10.1016/S0304-3959(98)00157-2
  51. Likar R, Sittl R, Gragger K, Pipam W, Blatnig H, Breschan C, Schalk HV, Stein C, Schafer M. Peripheral morphine analgesia in dental surgery. Pain. 1998;76:145-150. https://doi.org/10.1016/S0304-3959(98)00036-0
  52. Likar R, Koppert W, Blatnig H, Chiari F, Sittl R, Stein C, Schafer M. Efficacy of peripheral morphine analgesia in inflamed, noninflamed and perineural tissue of dental surgery patients. J Pain Symptom Manage. 2001;21:330-337. https://doi.org/10.1016/S0885-3924(01)00251-2
  53. Eisenach JC, Carpenter R, Curry R. Analgesia from a peripherally active kappa-opioid receptor agonist in patients with chronic pancreatitis. Pain. 2003;101:89- 95. https://doi.org/10.1016/S0304-3959(02)00259-2
  54. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res. 2004;428:125-130. https://doi.org/10.1097/01.blo.0000147701.24029.cc
  55. Grabowska-Gawel A, Gawel K, Hagner W, Biliński PJ. Morphine or bupivacaine in controlling postoperative pain in patients subjected to knee joint arthroscopy. Ortop Traumatol Rehabil. 2003;5(6): 758-762.
  56. Rosseland LA, Stubhaug A, Grevbo F, Reikerås O, Breivik H. Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy: A randomized, double-blind controlled clinical study. Acta Anaesthesiol Scand. 2003;47:732-738. https://doi.org/10.1034/j.1399-6576.2003.00155.x