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this.features)));n.length>0&&(0,e.R)(36,{targetFeature:r.featureName,missingDependencies:n}),this.features[r.featureName]=new r(this)}))}catch(t){(0,e.R)(22,t);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,R.Zm)();delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.features,delete this.sharedAggregator;return r.ee.get(this.agentIdentifier).abort(),!1}}}({features:[he,w,N,Ne,_e,_,D,ot,ct,je,nt],loaderType:"spa"})})()})();</script><meta charset="utf-8" /><meta name="viewport" content="width=device-width, initial-scale=1" /><meta http-equiv="Expires" content="0" /><meta name="DCSext.AbsHTMLview" content="1" /><meta name="WT.cg_n" content="pain" /><meta name="WT.cg_s" content="Articles" /><meta name="wkhealth_journal_title" content="PAIN" /><meta name="wkhealth_journal_title_legacy" content="Pain" /><meta name="wkhealth_issue" content="2" /><meta name="wkhealth_article_publication_date" content="November 1992" /><meta name="wkhealth_volume" content="51" /><meta name="wkhealth_ovid_accession_number" content="00006396-199211000-00014" /><meta name="wkhealth_issn" content="0304-3959" /><meta name="wkhealth_title" content="The NMDA-receptor antagonist CPP abolishes neurogenic ‘wind-up pain’ after intrathecal administration in humans" /><meta name="wkhealth_authors" content="Kristensen, Jens Dath;Svensson, Björn;Gordh, Torsten Jr." /><meta name="wkhealth_doi" content="10.1016/0304-3959(92)90266-E" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/pain/abstract/1992/11000/the_nmda_receptor_antagonist_cpp_abolishes.14.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/pain/fulltext/1992/11000/the_nmda_receptor_antagonist_cpp_abolishes.14.aspx" /><meta name="wkhealth_toc_section" content="Clinical note" /><meta name="wkhealth_toc_sub_section" content="PDF Only" /><meta name="wkhealth_eJpId" content="pain:1992:11000:00014" /><meta name="wkhealth_firstpage" content="249" /><meta name="wkhealth_date" content="November 1992" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/pain/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&an=00006396-199211000-00014" /><meta name="Description" content="Summary Involvement of the NMDA receptor system in the transmission of nociceptive information, i" /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="The NMDA-receptor antagonist CPP abolishes neurogenic... : PAIN" /><meta property="og:description" content="DA receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) in a carefully selected patient with severe and intractable neurogenic pain in her left leg. The pain syndrome had components of a continuous deep pain, an allodynia, and a wind-up-like component, including afterdischarge and spread of painful sensations outside the territory of the injured nerve. After intrathecal (i.t.) administration of 200 nmol of CPP the continuous deep pain component and allodynia were unchanged, but the following ‘wind-up’ phenomenon with afterdischarge and spread of the pain sensation in the left half of the body was completely abolished. Another 500 nmol of CPP administered over 2 h did not improve pain relief. Pain thresholds for heat and cold stimulation, measured with a Marstock thermostimulator, did not change. There was no effect on blood pressure, heart rate, sensitivity, reflexes, coordination or motor performance. Psychotomimetic ketamine-like side effects developed 4 h after the last injection of CPP and were probably due to rostral spread of CPP. These early experiences with i.t. administration of NMDA-receptor antagonists to humans indicate that the NMDA-receptor system plays an important role in neurogenic pain and that antagonizing this system may be a useful way to obtain better pain control although psychotomimetic side effects due to rostral spread may be a problem. ∗Correspondence to: Torsten Gordh, Jr., Department of Anaesthesiology, University Hospital, S-751 85 Uppsala, Sweden. Tel.: (94-18) 66–3000; FAX: (94-18) 55–9469. (Received 11 November 1991; revised 29 June 1992; accepted 1 July 1992.) © Lippincott-Raven Publishers...." /><meta property="og:image" content="https://images.journals.lww.com/pain/SocialThumb.00006396.DC.jpeg" /><meta property="og:image:width" content="1000" /><meta property="og:image:height" content="1387" /><meta property="og:url" content="https://journals.lww.com/pain/fulltext/1992/11000/the_nmda_receptor_antagonist_cpp_abolishes.14.aspx" /><meta property="twitter:card" content="summary" /><meta name="robots" content="index, follow, noarchive" /><meta name="WT.sv" content="ZUSE1PEJPWEB02" /><meta name="Title" content="PAIN" /><style id="SPThemeHideForms" type="text/css">body {opacity:0 !important}</style>  <link href="https://fonts.googleapis.com/css?family=Arvo:400,400i,700|Fira+Sans:300,300i,400,400i,500,500i,600,600i,700,700i&display=swap" rel="stylesheet" /> <script> // temporary workaround for Bug 316328:[Stage][Registration][Regression 05.04] - Omniture events are not 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href="https://journals.lww.com/pain/_layouts/oaks.journals/privacy.aspx" target="_blank">Privacy Policy</a> </div> </div> </div> </section> </div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle"></span> </strong> </p> </div> <p id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pAuthenticatedUserMessage"> </p> </div> </section> </div> </div> </div> <div id="ej-clear-float"> </div> <script type="text/javascript"> function 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NMDA-receptor antagonist CPP abolishes neurogenic ‘wind-up pain’ after intrathecal administration in humans', '11011992', 'Jens Kristensen, Bj\u00F6rn Svensson, and Torsten Gordh', '51', '2', '\u00A9 Lippincott-Raven Publishers.', '00006396-199211000-00014', '', false, ''); } </script> <div id="ArticleContainer"> <article id="ej-abstract-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">Clinical note: PDF Only</div></section><header class="ejp-article-header"><h1 class="ejp-article-title"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">The NMDA-receptor antagonist CPP abolishes neurogenic ‘wind-up pain’ after intrathecal administration in humans</strong></h1></header><section id="ejp-article-authors"><p id="P7">Kristensen, Jens Dath<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a</sup>; Svensson, Björn<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a,b</sup>; Gordh, Torsten Jr.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">∗,a</sup></p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id="AF_ID_d258e50"><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a</sup><em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Department of Anaesthesiology, University Hospital, UppsalaSweden</em></p> <p id="AF_ID_d258e50"><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">b</sup><em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Department of Anatomy, Uppsala University, UppsalaSweden</em></p> <p id="BT_ID_d258e71"><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">∗</sup><em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Correspondence to:</em> Torsten Gordh, Jr., Department of Anaesthesiology, University Hospital, S-751 85 Uppsala, Sweden. Tel.: (94-18) 66–3000; FAX: (94-18) 55–9469.</p> <p id="BT_ID_d258e71">(Received 11 November 1991; revised 29 June 1992; accepted 1 July 1992.)</p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Pain </span><span id="ej-journal-date-volume-issue-pg"><a href="/pain/toc/1992/11000">51(2):p 249-253, November 1992.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.1016/0304-3959(92)90266-E</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-buy" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Buy()" onmouseout="javascript:Tooltip_MouseOut()"><a href="#ContentAccessOptions"><span class="ejp-indicator">Buy</span></a></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.1016/0304-3959(92)90266-E" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="1992-11-01" data-articlePublicationDateString="November 1992" data-receivedDate="" data-revisionReceivedDate="" data-acceptedDate="" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="1484720"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3> </h3> <p>Involvement of the NMDA receptor system in the transmission of nociceptive information, including the development of central sensitization and a wind-up phenomenon, has increased interest in NMDA-receptor antagonists as antinociceptive drugs. This case report describes the use of an NMDA receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) in a carefully selected patient with severe and intractable neurogenic pain in her left leg. The pain syndrome had components of a continuous deep pain, an allodynia, and a wind-up-like component, including afterdischarge and spread of painful sensations outside the territory of the injured nerve. After intrathecal (i.t.) administration of 200 nmol of CPP the continuous deep pain component and allodynia were unchanged, but the following ‘wind-up’ phenomenon with afterdischarge and spread of the pain sensation in the left half of the body was completely abolished. Another 500 nmol of CPP administered over 2 h did not improve pain relief. Pain thresholds for heat and cold stimulation, measured with a Marstock thermostimulator, did not change. There was no effect on blood pressure, heart rate, sensitivity, reflexes, coordination or motor performance. Psychotomimetic ketamine-like side effects developed 4 h after the last injection of CPP and were probably due to rostral spread of CPP.</p> <p>These early experiences with i.t. administration of NMDA-receptor antagonists to humans indicate that the NMDA-receptor system plays an important role in neurogenic pain and that antagonizing this system may be a useful way to obtain better pain control although psychotomimetic side effects due to rostral spread may be a problem.</p> </div> </div> </div></section><section class="ej-article-copyright">© Lippincott-Raven Publishers.</section></article> </div> </div> <section id="ContentAccessOptions" class="article-not-authorized-msg"> <div class="ejp-access-options-wrapper"> <div class="ejp-access-options ejp-access-options--desktop"> <div id="ctl00_ctl29_g_13e12946_57aa_4b01_9005_7562aa8bd837_ctl00_FullTextAccessOptionsContainer" class="ejp-access-options__subscriber-access"> <h3 class="ejp-access-options__subscriber-access-title">Full Text 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