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Analgesic Action of Methylphenidate on Parkinsonian Sensory SymptomsMechanisms and Pathophysiological Implications
Roberto Cantello, MD, PhD;
Marco Aguggia, MD;
Marco Gilli, MD;
Michele, Delsedime;
Alessandro Riccio, MD;
Innocenzo Rainero, MD;
Roberto Mutani, MD
Arch Neurol. 1988;45(9):973-976.
Abstract
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• Intravenous administration of methylphenidate hydrochloride, a central stimulant, was unexpectedly found to exert a potent analgesic effect on primary sensory symptoms in a group of patients with Parkinson's disease. This effect, which has now been studied in a short-term, double-blind, placebo-controlled experiment, subsequently disappeared if patients were pretreated with a β-blocker or with a serotonin antagonist. Cerebrospinal fluid monoamine metabolites were determined in some of these patients, and the 5-hydroxyindoleacetic acid level was found to be significantly lower than in parkinsonian patients without pain and in normal volunteers. Given the mechanism of action of methylphenidate on the central nervous system, the adrenergic and serotoninergic mediation of its analgesic effect, and the demonstration of impaired central serotonin metabolism in the patient group, it is concluded that not only central dopaminergic deficiency but also altered noradrenergic and serotoninergic transmission in the spinal cord are quite likely to play a role in the pathophysiology of pain in Parkinson's disease.
Author Affiliations
From the Department of Neurology, University School of Medicine, Turin, Italy.
Footnotes
Accepted for publication Dec 12, 1987.
Reprint requests to Via Foscolo 6, 10126 Torino, Italy (Dr Cantello).
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