Neurotransmitters involved in nociception

Amines: noradrenaline; serotonin

Endogenous opioid peptides: enkephalins; beta-endorphins; dynorphins Non-opioid peptides: substance P; angiotensin II; vasoactive intestinal peptide (VIP);

cholecystokinin (CCK); oxytocin Excitatory amino acids: glutamate; aspartate Inhibitory amino acids: GABA; glycine Nitric oxide

Table 9.3 Endogenous opioid peptides

Precursor peptide Opioid peptide

Proenkephalin A leu-enkephalin met-enkephalin Proenkephalin B dynorphin dynorphin A(1-8) Pro-opiomelanocortin beta-endorphin

Active receptor Antagonists M __y t delta, mu naloxone m delta, mu naloxone a kappa nalmefene d mu naloxone i mu, delta, kappa naloxone proprioception) exert inhibitory control on small unmyelinated C afferent fibres. This is brought about by postsynaptic inhibition of the dorsal horn neurons, mediated by inhibitory interneurons. Central descending control of the gating system is achieved primarily through the descending inhibitory or endorphin-mediated analgesia system.

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