Oxycodone plus ultra-low-dose naltrexone attenuates neuropathic pain and associated μ-opioid receptor-Gs coupling

Both peripheral nerve injury and chronic opioid treatment can result in hyperalgesia associated with enhanced excitatory neurotransmission at the level of the spinal cord. Chronic opioid administration leads to a shift in mu-opioid receptor (MOR)-G protein coupling from G(i/o) to G(s) that can be prevented by cotreatment with an ultra-low-close opioid antagonist. In this study, using lumbar spinal cord tissue from rats with L-5/L-6 spinal nerve ligation (SNL), we demonstrated that SNL injury induces MOR linkage to Gs in the damaged (ipsilateral) spinal dorsal horn. This MOR-G(s) coupling occurred without changing G(i/o) coupling levels and without changing the expression of MOR or G alpha proteins. Repeated administration of oxycodone alone or in combination with ultra-low-close naltrexone (NTX) was assessed on the SNL-induced MOR-G(s), coupling as well as on neuropathic pain behavior. Repeated spinal oxycoclone exacerbated the SNL-incluced MOR-G(s) coupling, whereas ultralow-dose NTX cotreatment slightly but significantly attenuated this G, coupling. Either spinal or oral administration of oxycodone plus ultra-low-close NTX markedly enhanced the reductions in allodynia and thermal hyperalgesia produced by oxycodone alone and minimized tolerance to these effects. The MOR-G(s) coupling observed in response to SNL may in part contribute to the excitatory neurotransmission in spinal dorsal horn in neuropathic pain states. The antihyperalgesic and antiallodynic effects of oxycodone plus ultra-low-close NTX (Oxytrex, Pain Therapeutics, Inc., San Mateo, CA) suggest a promising new treatment for neuropathic pain. Perspective: The current study investigates whether Oxytrex (oxycodone with an ultra-low dose of naltrexone) alleviates mechanical and thermal hypersensitivities in an animal model of neuropathic pain over a period of 7 days, given locally or systemically. In this report, we first describe an injury-induced shift in mu-opioid receptor coupling from G(i/o) to G(s), suggesting why a mu-opioid agonist may have reduced efficacy in the nerve-injured state. These data present a novel approach to neuropathic pain therapy. (c) 2008 by the American Pain Society.