Adverse effects of chronic opioid therapy for chronic musculoskeletal pain

Crofford, Leslie J.

doi:10.1038/nrrheum.2010.24

Cited by 160 publications

(106 citation statements)

References 49 publications

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“…In addition, long-term administration of analgesic medications (such as opioids) involves a variety of risks [2][3][4][5]. Collectively, while opioid analgesics remain a treatment of choice for the management of cancer pain, and are widely used to treat chronic non-cancer pain [6][7][8], moderate-to long-term opioid use is potentially associated with a variety of adverse impacts [9,10]. One such outcome is a paradoxical amplification of pain sensitivity, a phenomenon termed opioid-induced hyperalgesia (OIH).…”

Section: Introductionmentioning

confidence: 99%

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

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Objective. Opioids are frequently prescribed for chronic low back pain (CLBP), but there are broad individual differences in the benefits and risks of opioid therapy, including the development opioidinduced hyperalgesia. This study examined quantitative sensory testing (QST) data among a group of CLBP patients undergoing sustained oral opioid treatment. We investigated whether individual differences in psychological characteristics were related to opioid-induced changes in pain perception and pain modulation.Design. The six-month, open-label trial evaluated patients with low to high levels of negative affect (e.g., symptoms of distress, depression and anxiety); participants underwent QST at baseline (prior to initiating treatment) and during oral opioid treatment.Setting. A chronic pain management center.Patients. The 31 study participants had chronic discogenic back pain, with a pain intensity rating >3/10. Participants were divided into groups with high vs. low levels of Negative Affect (NA).Results. In the previously-published manuscript describing the clinical outcomes of the trial, high NA patients achieved only about half of the analgesic effect observed in the low NA group (Wasan AD, Michna E, Edwards RR, et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 2015;123:86172). The QST findings reported here suggested that tolerance to experimental (cold pressor) pain and conditioned pain modulation tended to decrease in the high NA group over the course of opioid treatment, while temporal summation of mechanical pain declined in the low NA group.Conclusions. These results reveal that while the low NA group seemed to exhibit a generally adaptive, analgesic pattern of changes during opioid management, the high NA group showed a pattern more consistent with opioid-induced hyperalgesic

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Section: Introductionmentioning

confidence: 99%

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

View full text Add to dashboard Cite

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“…Individuals who discontinue opioid use after repeated exposure develop an abstinence syndrome, in which one of the core symptoms is an increase in pain sensitivity. In patients treated with opioids, this hypersensitivity can increase the probability of abuse (Crofford, 2010). It is thought that the molecular mechanisms underlying opioid-induced hypersensitivity are regulated by plasticity events that converge at the dorsal horn of the spinal cord Drdla et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Pain after Discontinuation of Morphine Treatment Is Associated with Synaptic Increase of GluA4-Containing AMPAR in the Dorsal Horn of the Spinal Cord

Cabañero

Baker

Zhou

et al. 2013

Neuropsychopharmacol

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Withdrawal from prescribed opioids results in increased pain sensitivity, which prolongs the treatment. This pain sensitivity is attributed to neuroplastic changes that converge at the spinal cord dorsal horn. We have recently reported that repeated morphine administration triggers an insertion of GluA2-lacking (Ca 2 þ -permeable) a-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors (AMPAR) in the hippocampus. This finding together with the reported involvement of AMPAR in the mechanisms underlying inflammatory pain led us to hypothesize a role for spinal AMPAR in opioid-induced pain behavior. Mice treated with escalating doses of morphine showed hypersensitivity to mechanical stimulation. Intrathecal administration of a Ca 2 þ -permeable AMPAR selective blocker disrupted morphine-induced mechanical sensitivity. Analysis of the expression and phosphorylation levels of AMPAR subunits (GluA1/2/3/4) in homogenates and in postsynaptic density fractions from spinal cord dorsal horns showed an increase in GluA4 expression and phosphorylation in the postsynaptic density after morphine. Co-immunoprecipitation analyses suggested an increase in GluA4 homomers (Ca 2 þ -permeable AMPAR) and immunohistochemical staining localized the increase in GluA4 levels in laminae III-V. The excitatory postsynaptic currents (EPSCs) recorded in laminae III-V showed enhanced sensitivity to Ca 2 þ -permeable AMPAR blockers in morphinetreated mice. Furthermore, current-voltage relationships of AMPAR-mediated EPSCs showed that rectification index (an indicator of Ca 2 þ -permeable AMPAR contribution) is increased in morphine-treated but not in saline-treated mice. These effects could be reversed by infusion of GluA4 antibody through patch pipette. This is the first direct evidence for a role of GluA4-containing AMPAR in morphineinduced pain and highlights spinal GluA4-containing AMPAR as targets to prevent the morphine-induced pain sensitivity.

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“…They refer to past noxious facts and situations which teach what to avoid in the future and motivate to act in a way to find an objective. People born unable to feel pain, often do not live beyond childhood because the lack of pain protective function, when acute, relatively short experience, with limited period of time, when there is wound and healing or when the disease is cured 37,38 . The role of pain is to delimit a "before" and an "after" about an event.…”

Section: Mental Processes and Cognitive Functionsmentioning

confidence: 99%

Psychobehavioral and psychosocial aspects of neuropathic pain patients

Perissinotti¹,

Portnoi²

2016

Revista Dor

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BACKGROUND AND OBJECTIVES:Identifying and treating psychosocial, intrapsychic, relational, psychiatric and psychobehavioral factors which influence neuropathic pain nature, severity and persistence are object of scientific concern and a lot has been done in this area; however it is clear the need for further emphasis and disclosure of contents for better professional knowledge. This study aimed at outlining the psychobehavioral and psychosocial scenario by means of literature review, through some theories about pain regulation, via cognitive functioning and stress theories, although it is known that the universe of this study is too broad but the idea is to outline a panoramic view of the field. CONTENTS: Incapacity, distress, painful and unhealthy behaviors and of gains are challenging factors for the treatment of neuropathic pain patients. Notions about thinking distortion, especially caused by pain perception leading to catastrophic thoughts and decreasing the efficacy of other non-addressed interventions, as well as aspects of the psychosocial impact influencing the development of chronicity and maintenance of unhealthy patterns. CONCLUSION: Psychological interventions aiming at changing beliefs and dysfunctional behaviors, incapacities and distress, at changing neuropathic pain perception, treatment of mental decompensations such as depression and anxiety and of recurrences, are critical to manage neuropathic pain patients. It is confirmed that knowledge about adaptations in the rewarding circuits is fundamental for psychological, psychotherapeutic and psychosocial interventions to be more effective, thus preventing problems related to pathological maintenance in cases of neuropathic etiology. Keywords: Cognitive functions, Mental processes, Neuropathic pain, Psychobehavioral factors, Psychosocial factors, Stress. RESUMO JUSTIFICATIVA E OBJETIVOS:Identificar e tratar os fatores psicossociais, intrapsíquicos, relacionais, psiquiátricos e psicocomportamentais que influenciem a natureza, gravidade, persistência da dor neuropática, vem sendo objeto de preocupação científica e muito se tem progredido na área, no entanto, é vigente a necessidade de maior ênfase e divulgação dos conteúdos para melhor conhecimento no meio profissional. O presente artigo visou esboçar o panorama da área psicocomportamental e psicossocial, por meio de levantamento da literatura, através de algumas teorias acerca da regulação de dor, via teorias do funcionamento cognitivo e estresse, embora sabidamente o universo de estudo seja muito amplo, pretende esboçar uma visão panorâmica do campo. CONTEÚDO: A incapacidade, o sofrimento, os comportamentos dolorosos e doentios e dos ganhos são fatores de desafio aos tratamentos do doente com dor neuropática. Noções acerca da distorção do pensamento, particularmente, decorrente da percepção da dor induzindo a pensamentos catastróficos reduzindo a eficácia de outras intervenções não abordadas, bem como aspectos da visão do impacto psicossocial que intervêm no desenvolvimento da cronificaçã...

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Adverse effects of chronic opioid therapy for chronic musculoskeletal pain

Cited by 160 publications

References 49 publications

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Pain after Discontinuation of Morphine Treatment Is Associated with Synaptic Increase of GluA4-Containing AMPAR in the Dorsal Horn of the Spinal Cord

Psychobehavioral and psychosocial aspects of neuropathic pain patients

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