Abstract
Microdialysis is a recognized experimental method in pain research in animals and humans. In the last 20 years a growing number of studies have provided new details on pain pathophysiology and the effect of interventions focused on pain relief such as drug treatment or training using microdialysis either alone or in combination with other methods. This chapter focuses on the use of clinical microdialysis in pain research in healthy subjects and patients and summarizes its application in several key indications such as the evaluation of chronic pain conditions in skeletal muscle, tendon tissue, or the knee, as well as the evaluation of local anesthetics and non-steroidal anti-inflammatory drugs. Thereby, it can be demonstrated that clinical microdialysis contributes to the existing knowledge of pain pathophysiology and has the potential to essentially contribute to decision making in the discovery and evaluation of novel or established pain treatment approaches.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Alfredson H, Thorsen K, Lorentzon R (1999) In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc 7:378–381
Alfredson H, Lorentzon R (2000) Chronic achilles tendinosis: recommendations for treatment and prevention. Sports Med 29:135–146
Alfredson H, Ljung BO, Thorsen K, Lorentzon R (2000) In vivo investigation of ECRB tendons with microdialysis technique–no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand 71:475–479
Alfredson H, Forsgren S, Thorsen K, Fahlström M, Johansson H, Lorentzon R (2001a) Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment? Knee Surg Sports Traumatol Arthrosc 9:123–226
Alfredson H, Forsgren S, Thorsen K, Lorentzon R (2001b) 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. J Orthop Res 19:881–886
Alfredson H, Lorentzon R (2002) Chronic tendon pain: no signs of chemical inflammation but high concentrations of the neurotransmitter glutamate. Implications for treatment? Curr Drug Targets 3:43–54
Alfredson H, Bjur D, Thorsen K, Lorentzon R, Sandström P (2002) High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique. J Orthop Res 20:934–938
Alfredson H, Lorentzon R (2003) Intratendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique. Knee Surg Sports Traumatol Arthrosc 11:196–199
Angst MS, Clark JD, Carvalho B, Tingle M, Schmelz M, Yeomans DC (2008) Cytokine profile in human skin in response to experimental inflammation, noxious stimulation, and administration of a COX-inhibitor: a microdialysis study. Pain 139:15–27
Ashina M, Stallknecht B, Bendtsen L, Pedersen JF, Schifter S, Galbo H, Olesen J (2003) Tender points are not sites of ongoing inflammation -in vivo evidence in patients with chronic tension-type headache. Cephalalgia 23:109–116
Ashina M, Jorgensen M, Stallknecht B, Mork H, Bendtsen L, Pedersen JF, Olesen J, Jensen R (2005) No release of interstitial glutamate in experimental human model of muscle pain. Eur J Pain 9:337–343
Bernards CM, Kopacz DJ (1999) Effect of epinephrine on lidocaine clearance in vivo: a microdialysis study in humans. Anesthesiology 91:962–968
Brunner M, Dehghanyar P, Seigfried B, Martin W, Menke G, Müller M (2005) Favourable dermal penetration of diclofenac after administration to the skin using a novel spray gel formulation. Br J Clin Pharmacol 60:573–577
Brunner M, Davies D, Martin W, Leuratti C, Lackner E, Müller M (2011) A new topical formulation enhances relative diclofenac bioavailability in healthy male subjects. Br J Clin Pharmacol 71:852–859
Burian M, Tegeder I, Seegel M, Geisslinger G (2003) Peripheral and central antihyperalgesic effects of diclofenac in a model of human inflammatory pain. Clin Pharmacol Ther 74:113–120
Carvalho B, Aleshi P, Horstman DJ, Angst MS (2010) Effect of a preemptive femoral nerve block on cytokine release and hyperalgesia in experimentally inflamed skin of human volunteers. Reg Anesth Pain Med 35:514–519
Christensen B, Dandanell S, Kjaer M, Langberg H (2011) Effect of anti-inflammatory medication on the running-induced rise in patella tendon collagen synthesis in humans. J Appl Physiol 110:137–141
Coglianese M, Draper DO, Shurtz J, Mark G (2011) Microdialysis and delivery of iontophoresis-driven lidocaine into the human gastrocnemius muscle. J Athl Train 46:270–276
Cooper SA, Desjardins PJ (2010) The value of the dental impaction pain model in drug development. Methods Mol Biol 617:175–190
Dehghanyar P, Mayer BX, Namiranian K, Mascher H, Müller M, Brunner M (2004) Topical skin penetration of diclofenac after single- and multiple-dose application. Int J Clin Pharmacol Ther 42:353–359
Draper DO, Coglianese M, Castel C (2011) Absorption of iontophoresis-driven 2 % lidocaine with epinephrine in the tissues at 5 mm below the surface of the skin. J Athl Train 46:277–281
Ederoth P, Flisberg P, Ungerstedt U, Nordström CH, Lundberg J (2002) Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia. Acta Anaesthesiol Scand 46:585–591
Flodgren GM, Crenshaw AG, Alfredson H, Fahlström M, Hellström FB, Bronemo L, Djupsjöbacka M (2005) Glutamate and prostaglandin E2 in the trapezius muscle of female subjects with chronic muscle pain and controls determined by microdialysis. Eur J Pain 9:511–515
Flodgren GM, Crenshaw AG, Hellström F, Fahlström M (2010) Combining microdialysis and near-infrared spectroscopy for studying effects of low-load repetitive work on the intramuscular chemistry in trapezius myalgia. J Biomed Biotechnol 513803
Fornai M, Colucci R, Graziani F, Cei S, Antonioli L, Tonelli M, Vassalle C, Blandizzi C, Gabriele M, Del Tacca M (2006) Cyclooxygenase-2 induction after oral surgery does not entirely account for analgesia after selective blockade of cyclooxygenase 2 in the preoperative period. Anesthesiology 104(1):152–157
Gerdle B, Hilgenfeldt U, Larsson B, Kristiansen J, Søgaard K, Rosendal L (2008) Bradykinin and kallidin levels in the trapezius muscle in patients with work-related trapezius myalgia, in patients with whiplash associated pain, and in healthy controls.A microdialysis study of women. Pain 139:578–587
Gerdle B, Söderberg K, Salvador Puigvert L, Rosendal L, Larsson B (2010) Increased interstitial concentrations of pyruvate and lactate in the trapezius muscle of patients with fibromyalgia: a microdialysis study. J Rehabil Med 42:679–687
Ghafouri N, Ghafouri B, Larsson B, Turkina MV, Karlsson L, Fowler CJ, Gerdle B (2011) High levels of N-palmitoylethanolamide and N-stearoylethanolamide in microdialysate samples from myalgic trapezius muscle in women. PLoS One 6:e27257
Giamberardino MA, Affaitati G, Fabrizio A, Costantini R (2011) Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 25:185–198
Gordon SM, Brahim JS, Rowan J, Kent A, Dionne RA (2002) Peripheral prostanoid levels and nonsteroidal anti-inflammatory drug analgesia: replicate clinical trials in a tissue injury model. Clin Pharmacol Ther 72:175–183
Gordon SM, Chuang BP, Wang XM, Hamza MA, Rowan JS, Brahim JS, Dionne RA (2008) The differential effects of bupivacaine and lidocaine on prostaglandin E2 release, cyclooxygenase gene expression and pain in a clinical pain model. Anesth Analg 106:321–327
Groth L, Serup J (1998) Cutaneous microdialysis in man: effects of needle insertion trauma and anaesthesia on skin perfusion, erythema and skin thickness. Acta Derm Venereol 78:5–9
Healey LA (2006) Polymyalgia rheumatica is the result of synovitis. J Clin Rheumatol 12:165–166
Hedenberg-Magnusson B, Ernberg M, Alstergren P, Kopp S (2001) Pain mediation by prostaglandin E2 and leukotriene B4 in the human masseter muscle. Acta Odontol Scand 59:348–355
Helmark IC, Mikkelsen UR, Krogsgaard MR, Belhage B, Petersen MC, Langberg H, Kjaer M (2010a) Early osteoarthritis and microdialysis: a novel in vivo approach for measurements of biochemical markers in the perisynovium and intraarticularly. Knee Surg Sports Traumatol Arthrosc 18:1617–1623
Helmark IC, Mikkelsen UR, Børglum J, Rothe A, Petersen MC, Andersen O, Langberg H, Kjaer M (2010b) Exercise increases interleukin-10 levels both intraarticularly and peri-synovially in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther 12:R126
Högberg E, Wredmark T, Dungner E, Arner P, Felländer-Tsai L (2006a) Changes in metabolism and blood flow following catecholamine stimulation in the synovial membrane measured with microdialysis. Knee Surg Sports Traumatol Arthrosc 14:133–140
Högberg E, Stålman A, Wredmark T, Tsai JA, Arner P, Felländer-Tsai L (2006b) Opioid requirement after arthroscopy is associated with decreasing glucose levels and increasing PGE2 levels in the synovial membrane. Acta Orthop 77:657–661
Kopacz DJ, Bernards CM (2001) Effect of clonidine on lidocaine clearance in vivo: a microdialysis study in humans. Anesthesiology 95:1371–1376
Krämer HH, Schmidt K, Leis S, Schmelz M, Sommer C, Birklein F (2005) Inhibition of neutral endopeptidase (NEP) facilitates neurogenic inflammation. Exp Neurol 195:179–184
Kreiner F, Langberg H, Galbo H (2010) Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica. Arthritis Rheum 62:3768–3775
Kreiner F, Galbo H (2011) Elevated muscle interstitial levels of pain-inducing substances in symptomatic muscles in patients with polymyalgia rheumatica. Pain 152:1127–1132
Langley CK, Aziz Q, Bountra C, Gordon N, Hawkins P, Jones A, Langley G, Nurmikko T, Tracey I (2008) Volunteer studies in pain research–opportunities and challenges to replace animal experiments: the report and recommendations of a focus on alternatives workshop. Neuroimage 42(2):467–473
Larsson B, Rosendal L, Kristiansen J, Sjøgaard G, Søgaard K, Ghafouri B, Abdiu A, Kjaer M, Gerdle B (2008) Responses of algesic and metabolic substances to 8 h of repetitive manual work in myalgic human trapezius muscle. Pain 140:479–490
Latzke D, Marhofer P, Kettner SC, Koppatz K, Turnheim K, Lackner E, Sauermann R, Müller M, Zeitlinger M (2012) Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers. Eur J Clin Pharmacol 68:419–425
Leis S, Weber M, Isselmann A, Schmelz M, Birklein F (2003) Substance-P-induced protein extravasation is bilaterally increased in complex regional pain syndrome. Exp Neurol 183:197–204
Leis S, Weber M, Schmelz M, Birklein F (2004) Facilitated neurogenic inflammation in unaffected limbs of patients with complex regional pain syndrome. Neurosci Lett 359:163–166
Mackey AL, Kjaer M, Dandanell S, Mikkelsen KH, Holm L, Døssing S, Kadi F, Koskinen SO, Jensen CH, Schrøder HD, Langberg H (2007) The influence of anti-inflammatory medication on exercise-induced myogenic precursor cell responses in humans. J Appl Physiol 103:425–431
Mertens P, Ghaemmaghami C, Bert L, Perret-Liaudet A, Sindou M, Renaud B (2000) Amino acids in spinal dorsal horn of patients during surgery for neuropathic pain or spasticity. NeuroReport 11:1795–1798
Mertens P, Ghaemmaghami C, Bert L, Perret-Liaudet A, Guenot M, Naous H, Laganier L, Later R, Sindou M, Renaud B (2001) Microdialysis study of amino acid neurotransmitters in the spinal dorsal horn of patients undergoing microsurgical dorsal root entry zone lesioning. Tech note J Neurosurg 94(1 Suppl):165–173
Mikkelsen UR, Helmark IC, Kjaer M, Langberg H (2008) Prostaglandin synthesis can be inhibited locally by infusion of NSAIDS through microdialysis catheters in human skeletal muscle. J Appl Physiol 104:534–537
Mogil JS (2009) Animal models of pain: progress and challenges. Nat Rev Neurosci 10:283–294
Mogil JS, Davis KD, Derbyshire SW (2010) The necessity of animal models in pain research. Pain 151:12–17
Müller M, Mascher H, Kikuta C, Schäfer S, Brunner M, Dorner G, Eichler HG (1997) Diclofenac concentrations in defined tissue layers after topical administration. Clin Pharmacol Ther 62:293–299
Müller M, Rastelli C, Ferri P, Jansen B, Breiteneder H, Eichler HG (1998) Transdermal penetration of diclofenac after multiple epicutaneous administration. J Rheumatol 25:1833–1836
O’Brien TP, Roszkowski MT, Wolff LF, Hinrichs JE, Hargreaves KM (1996) Effect of a non-steroidal anti-inflammatory drug on tissue levels of immunoreactive prostaglandin E2, immunoreactive leukotriene, and pain after periodontal surgery. J Periodontol 67:1307–1316
Parrot S, Sauvinet V, Xavier JM, Chavagnac D, Mouly-Badina L, Garcia-Larrea L, Mertens P (2004) Capillary electrophoresis combined with microdialysis in the human spinal cord: a new tool for monitoring rapid peroperative changes in amino acid neurotransmitters within the dorsal horn. Electrophoresis 25:1511–1517
Punnett L, Wegman DH (2004) Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol 14:13–23
Rosendal L, Larsson B, Kristiansen J, Peolsson M, Søgaard K, Kjaer M, Sørensen J, Gerdle B (2004) Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise. Pain 112:324–334
Rosendal L, Kristiansen J, Gerdle B, Søgaard K, Peolsson M, Kjaer M, Sörensen J, Larsson B (2005) Increased levels of interstitial potassium but normal levels of muscle IL-6 and LDH in patients with trapezius myalgia. Pain 119:201–209
Roszkowski MT, Swift JQ, Hargreaves KM (1997) Effect of NSAID administration on tissue levels of immunoreactive prostaglandin E2, leukotriene B4, and (S)-flurbiprofen following extraction of impacted third molars. Pain 73:339–345
Shah JP, Phillips TM, Danoff JV, Gerber LH (2005) An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 99:1977–1984
Shah JP, Gilliams EA (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 12:371–384
Sjøgaard G, Rosendal L, Kristiansen J, Blangsted AK, Skotte J, Larsson B, Gerdle B, Saltin B, Søgaard K (2010) Muscle oxygenation and glycolysis in females with trapezius myalgia during stress and repetitive work using microdialysis and NIRS. Eur J Appl Physiol 108:657–669
Stålman A, Tsai JA, Wredmark T, Dungner E, Arner P, Felländer-Tsai L (2008) Local inflammatory and metabolic response in the knee synovium after arthroscopy or arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 24:579–584
Stålman A, Tsai JA, Segerdahl M, Dungner E, Arner P, Felländer-Tsai L (2009) Ketorolac but not morphine exerts inflammatory and metabolic effects in synovial membrane after knee arthroscopy: a double-blind randomized prospective study using the microdialysis technique. Reg Anesth Pain Med 34:557–564
Stålman A, Berglund L, Dungnerc E, Arner P, Felländer-Tsai L (2011) Temperature-sensitive release of prostaglandin E and diminished energy requirements in synovial tissue with postoperative cryotherapy: a prospective randomized study after knee arthroscopy. J Bone Joint Surg Am 93:1961–1968
Stiller CO, Taylor BK, Linderoth B, Gustafsson H, Warsame Afrah A, Brodin E (2003) Microdialysis in pain research. Adv Drug Deliv Rev 55:1065–1079
Stiller CO, Brodin E, Bradley K (2007) In: Westerink B and Cremers T (eds) Microdialysis in pain research Elsevier, London UK
Swift JQ, Garry MG, Roszkowski MT, Hargreaves KM (1993) Effect of flurbiprofen on tissue levels of immunoreactive bradykinin and acute postoperative pain. J Oral Maxillofac Surg 51:112–116
Tegeder I, Muth-Selbach U, Lötsch J, Rüsing G, Oelkers R, Brune K, Meller S, Kelm GR, Sörgel F, Geisslinger G (1999) Application of microdialysis for the determination of muscle and subcutaneous tissue concentrations after oral and topical ibuprofen administration. Clin Pharmacol Ther 65:357–368
Tegeder I, Lötsch J, Kinzig-Schippers M, Sörgel F, Kelm GR, Meller ST, Geisslinger G (2001) Comparison of tissue concentrations after intramuscular and topical administration of ketoprofen. Pharm Res 18:980–986
Weber M, Birklein F, Neundörfer B, Schmelz M (2001) Facilitated neurogenic inflammation in complex regional pain syndrome. Pain 91:251–257
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 American Association of Pharmaceutical Scientists
About this chapter
Cite this chapter
Brunner, M. (2013). Microdialysis in Pain Research. In: Müller, M. (eds) Microdialysis in Drug Development. AAPS Advances in the Pharmaceutical Sciences Series, vol 4. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4815-0_10
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4815-0_10
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4814-3
Online ISBN: 978-1-4614-4815-0
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)