# Pain Outcome Determines the Sensitivity to Peripheral Opioid Antagonism of Morphine, Ibuprofen, and Their Combination in Laparotomized Mice

## TL;DR

This study shows how morphine, ibuprofen, and their combination affect postoperative pain in mice, revealing different mechanisms for each drug's effects.

## Contribution

The study demonstrates that the analgesic effects of morphine and ibuprofen depend on distinct neurobiological mechanisms and peripheral opioid receptors.

## Key findings

- Morphine's effect on mechanical hypersensitivity is reversed by peripheral opioid antagonism, but not its effect on ongoing pain.
- Ibuprofen's effect on mechanical hypersensitivity depends on peripheral opioid receptors and neutrophils.
- The morphine–ibuprofen combination provides synergistic analgesia without increasing opioid-related side effects.

## Abstract

Background/Objectives: Postoperative pain pharmacology is complex. We investigated the sensitivity of analgesic-like effects induced by morphine, ibuprofen, and their combination to peripheral opioid antagonism in a mouse laparotomy model. Methods: Mechanical hypersensitivity was assessed using von Frey filaments, and ongoing pain (abdominal licking and facial expressions) was evaluated using artificial intelligence algorithms. We tested the sensitivity of the analgesic treatments to the opioid antagonist naloxone or its peripherally restricted analog, naloxone methiodide. We also tested the effects of neutrophil depletion using an anti-Ly6G antibody. Gastrointestinal transit and pupillary diameter were measured to assess non-analgesic opioid effects. Results: Morphine reversed all pain-related behaviors; its effect on mechanical hypersensitivity was reversed by peripheral opioid antagonism, whereas its effects on ongoing pain were not. Ibuprofen reduced mechanical hypersensitivity and facial expressions but failed to alter licking. Interestingly, the ibuprofen effect on mechanical hypersensitivity depended on peripheral opioid receptors and neutrophils at the injury site. The morphine–ibuprofen combination produced synergistic analgesia across all endpoints without enhancing opioid-induced gastrointestinal inhibition or mydriasis. Peripheral opioid antagonism reversed the effect of the combination on mechanical hypersensitivity and facial expressions but not on licking. Conclusions: Our results replicate the key clinical phenomena relevant to the postoperative pain context, including the potentiation of morphine analgesia by ibuprofen without the exacerbation of adverse effects. Our results suggest that drug effects on different postoperative pain measures rely on distinct neurobiological mechanisms and are not interchangeable. Therefore, the use of a battery of complementary pain endpoints in preclinical pharmacology studies is advisable.