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BackgroundNon-specific low back pain (LBP) is one of the most common chronic pain conditions and adverse childhood experiences (ACEs) are known mediators for chronicity of LBP. Sensitization of dorsal horn neurons (DHNs) is a significant element that contributes to chronic LBP. Repeated restraint stress in adult animals is known to cause manifest DHN sensitization when combined with a short-lasting nociceptive input.ObjectiveIn this study, we investigated whether repeated restraint stress in early adolescence leads to a long-term sensitization of DHNs and if an additional mild-nociceptive input by intramuscular nerve growth factor (NGF) leads to further sensitization.MethodsAdolescent Wistar rats were stressed repeatedly in a narrow plastic restrainer, 1 hour per day for 12 consecutive days. Control animals were handled but not restrained. In adulthood, rats were treated with intramuscular injections of saline or NGF (short-lasting mild-nociceptive input) into the lumbar multifidus muscle (L5). Behavioral tests for pain sensitivity were performed before, after stress and inconjunction with intramuscular injections. Rats were transcardially perfused and immunohistochemistry was performed on lumbar (L2) spinal segments.ResultsAdolescent restraint stress significantly lowered the low back pressure pain threshold (PPT) immediately after the stress (pppd=0.87) and increased microglia marker (Iba-1) immunoreactive area in the superficial DHN (pp=0.05).ConclusionsOur adolescence stress model induced behavioral signs of sensitization and enhanced sensitivity to further sensitization and dorsal horn microglia activation by subsequent mild nociceptive input (NGF injection). These findings help to understand certain aspects of how adolescent stress might predispose to exacerbation of pain with an additional insult.

Restraint stress followed by weak nociceptive input from multifidus muscle enhances resting activity and sensitization of rat spinal neurons and mimics aspects of back pain., Background: A single injection of nerve growth factor (NGF) into a low back muscle induces a latent sensitization of rat dorsal horn neurons (DHNs) that primes for a manifest sensitization by a subsequent second NGF injection. Repeated restraint stress also causes a latent DHN sensitization. Objective: In this study, we investigated whether repeated restraint stress followed by a single NGF injection causes a manifest sensitization of DHNs. Methods: Rats were stressed repeatedly in a narrow plastic restrainer (1 hour on 12 consecutive days). Control animals were handled but not restrained. Two days after stress paradigm, behavioral tests and electrophysiological in vivo recordings from single DHNs were performed. Mild nociceptive low back input was induced by a single NGF injection into the lumbar multifidus muscle just before the recording started. Results: Restraint stress slightly lowered the low back pressure pain threshold (Cohen d = 0.83). Subsequent NGF injection increased the proportion of neurons responsive to deep low back input (control + NGF: 14%, stress + NGF: 39%; P = 0.041), mostly for neurons with input from outside the low back (7% vs 26%; P = 0.081). There was an increased proportion of neurons with resting activity (28% vs 55%; P = 0.039), especially in neurons having deep input (0% vs 26%; P = 0.004). Conclusions: The results indicate that stress followed by a short-lasting nociceptive input causes manifest sensitization of DHNs to deep input, mainly from tissue outside the low back associated with an increased resting activity. These findings on neuronal mechanisms in our rodent model suggest how stress might predispose to radiating pain in patients.

Neuropathic pain affects multiple brain functions, including motivational processing. However, little is known about the structural and functional brain changes involved in the transition from an acute to a chronic pain state. Here we combined behavioral phenotyping of pain thresholds with multimodal neuroimaging to longitudinally monitor changes in brain metabolism, structure and connectivity using the spared nerve injury (SNI) mouse model of chronic neuropathic pain. We investigated stimulus-evoked pain responses prior to SNI surgery, and one and twelve weeks following surgery. A progressive development and potentiation of stimulus-evoked pain responses (cold and mechanical allodynia) were detected during the course of pain chronification. Voxel-based morphometry demonstrated striking decreases in volume following pain induction in all brain sites assessed - an effect that reversed over time. Similarly, all global and local network changes that occurred following pain induction disappeared over time, with two notable exceptions: the nucleus accumbens, which played a more dominant role in the global network in a chronic pain state and the prefrontal cortex and hippocampus, which showed lower connectivity. These changes in connectivity were accompanied by enhanced glutamate levels in the hippocampus, but not in the prefrontal cortex. We suggest that hippocampal hyperexcitability may contribute to alterations in synaptic plasticity within the nucleus accumbens, and to pain chronification.