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Activity in the ventrolateral periaqueductal gray (vlPAG) has been shown to be antinociceptive and is considered to be a major component in the expression of opioid drug-induced analgesia. Canonically, opioids disinhibit vlPAG activity, which modulates neuronal responses in the rostroventral medulla (RVM) and ultimately gates spinal outflow of nociceptive information via serotonergic and opioidergic mechanisms in the spinal dorsal horn. Fundamental pharmacological studies, however, indicate that spinal noradrenergic signaling is consistently implicated in opioid antinociception, suggesting that there is a gap in our knowledge of how the vlPAG may control the release of antinociceptive neuromodulators in the dorsal horn through different output regions. Although the locus coeruleus (LC) has been shown to modulate nociception, its role in and recruitment by the canonical descending circuitry is unclear. Using genetically-encoded and anatomically-targeted viral tools, immunohistochemistry, and acute pain behavior assays in conjunction with intrathecal pharmacology in mice, we show that activity in the vlPAG is necessary for the expression of systemic morphine analgesia at low doses, and that both systemic morphine-induced and PAG-driven antinociception require opioidergic and noradrenergic signaling in the spinal cord. Additionally, we find that vlPAG projection neurons send branching axons to both the RVM and LC, which may account for the LC activation we observed in both opioid-induced and PAG-driven antinociception. These findings reveal a previously underappreciated architecture of the descending pain modulatory circuitry and advance our understanding of the circuit mechanisms by which morphine produces analgesia. Grant support from NIDA R00 DA034648, Rita Allen Foundation (non-profit), Klingenstein-Simons Foundation (non-profit).
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