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Clinical studies show that anxiety and chronic pain are concomitant. The neural basis for the comorbidity is unclear. The prefrontal cortex (PFC) has been recognized as a critical area for affective disorders and chronic pain modulation. In this study, we examined the role of the PFC in the pathogenesis of anxiety associated with chronic pain in a rat model of neuropathic pain with spare nerve injury (SNI). The SNI rats showed apparent anxiety-like behaviors in both open field (OF) test and elevated-plus maze (EPM) test 8 weeks after surgery. Thus, the number of entries to the central area in the OF decreased to 45% (±5%, n=15) of sham control (n=17), while the overall motor activity (i.e., total distance) was unaffected. In the EPM, the percentage of entries into the open arms significantly (p<0.001) decreased in SNI rats (SNI: 12.58±2.7%, n=15; sham: 30.75±2.82%, n=17), so did the time spent in the open arms (SNI: 4.35±1.45%, n=15; Sham: 11.65±2.18%, n=17). To explore the neural basis for the association between anxiety and chronic pain, local field potentials (LFPs) were recorded from the medial PFC (mPFC) and ventral hippocampus (vHPC). In SNI rats, there were significantly greater increases in both theta-frequency power in the mPFC and theta-frequency synchronization between the mPFC and vHPC, when animals were displaying elevated anxiety-like behaviors in avoiding anxiogenic regions in EPM and OF chamber. Western blot analyses showed a significant elevation of serotonin transporter (SERT) expression in the anxious SNI rats. Inhibition of SERT effectively alleviated anxiety-like behaviors following sub-chronic (15-day) treatment with systemic citalopram (10mg/kg/day, i.p.). Moreover, the anxiety-like behaviors in the SNI rats were also suppressed by direct mPFC application of serotonin. Taken together, we conclude that the plasticity of serotonin transmission in the mPFC likely contribute to the promotion of anxiety state associated with neuropathic pain.

Plastic change of prefrontal cortex mediates anxiety-like behaviors associated with chronic pain in neuropathic rats