Antinociceptive and nociceptive actions of opioids

Ossipov, Michael H.; Lai, Josephine; King, Tamara; Vanderah, Todd W.; Malan, T. Philip; Hruby, Victor J.; Porreca, Frank

doi:10.1002/neu.20091

Cited by 217 publications

(160 citation statements)

References 220 publications

(337 reference statements)

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“…Factors affecting the block duration in spinal anesthesia among others include: type of the local anesthetic agent as well as the drug dosage and drug adjuvant such as opioids and epinephrine (1). Despite the fact that opioids are the primary medication for moderate to severe pain, their overuse is connected with the advancement of tolerance therefore higher dose is needed for pain relieving; however its mechanism has not completely cleared yet (2)(3)(4). By the way researchers have proposed some theories in regards to opioids receptors and the endogenous opioids peptides (5)(6)(7)(8), it has recently been uncovered that cholecystokinin up-regulates in the rostral ventromedial medulla (RVM) when it get permanently exposed to opioids.…”

Section: Introductionmentioning

confidence: 99%

“…Antiopioid and pronociceptive aspects of cholecystokinin are clear. Cholecystokinin can also activate pain relief mechanisms from the RVM upgrading nociceptive transmission at the spinal cord and induced hyperalgesia (4). In some studies it has been shown that chronic use of opioids is associated with shorter duration of spinal anesthesia when local anesthetics are applied.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

Zirak¹,

Soltani²,

Javdani³

et al. 2014

Razavi Int J Med

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Background: Spinal anesthesia is a common procedure in the anesthesia. In some studies it has been shown that chronic use of opioids is associated with shorter duration of spinal anesthesia when local anesthetics are applied. Objectives: This trial was conducted in order to determine effect of fentanyl on the duration of spinal block by bupivacaine in chronic opium abusers who undergo spinal anesthesia and have lower thresholds for pain. Patients and Methods:This study was a randomized clinical trial in which 50 opium abusers (25 patients in each group) undergoing lower extremity orthopedic surgeries with spinal anesthesia were selected. The patients were randomly divided into two groups. The study group received 15 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl, while the control group received 15mg hyperbaric bupivacaine 0.5% plus 0.25 mL normal saline. Results: All randomly selected cases were male (44.7 ± 13.6 year). The mean duration of sensory block was much longer in the study group (87.8 ± 7.22 minutes) in comparison with the control group (70.47 ± 5.45 minutes) (P < 0.001). There was no statistically significant difference between the two groups regarding their age and duration of surgery. Conclusions: Bupivacaine administration in spinal anesthesia for spinal block has a shortened duration in comparison to the combination of bupivacaine and fentanyl in chronic opium abusers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

Zirak¹,

Soltani²,

Javdani³

et al. 2014

Razavi Int J Med

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“…Opioids exert their primary analgesic effects at both spinal and supraspinal levels [3]. For example, inhibited phosphorylation of the post-synaptic N-methyl-D-aspartate receptor (NMDA-r) in the dorsal horn of the spinal cord decreases its sensitivity to glutamate binding.…”

Section: Opioid Interactions With Nociceptive Pathwaysmentioning

confidence: 99%

Complications of Long-Term Opioid Therapy for Management of Chronic Pain: the Paradox of Opioid-Induced Hyperalgesia

Brush¹

2012

J. Med. Toxicol.

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While opioids remain a valid and effective analgesic strategy for patients suffering from a wide variety of painful conditions, they are not a panacea. Increasingly, physicians must balance patient expectations of adequate pain control with known limitations of opioid pharmaceuticals including adverse effects, tolerance, addiction, withdrawal, and drug diversion. Further complicating the issue over the last decade is a growing body of evidence suggesting chronic opioid use may unexpectedly worsen the perception of pain in some individuals. This syndrome, termed opioid-induced hyperalgesia (OIH), fundamentally changes our understanding of opioid pharmacodynamics and may influence our approach to management of chronic pain. This manuscript describes the concept OIH and provides an overview of basic science and clinical research to date attempting to characterize this syndrome, as well as ascertain its clinical relevance. The potential existence of OIH in humans is framed within the context of our current understanding of opioids and our prescribing patterns so that physicians may begin to incorporate these ideas into their philosophy of pain management as further information develops. Animal studies reliably validate OIH in controlled models. Rigorous research protocols in humans are lacking, and we cannot yet confidently conclude that OIH manifests in clinically significant ways. However, clinicians should consider the possibility of OIH when evaluating outcomes of patients on chronic opioid therapy.Keywords Opioids . Hyperalgesia . Opioid-induced hyperalgesia . Chronic pain Current Opioid ParadigmPhysicians regularly prescribe opioids for control of moderate to severe pain in the acute care setting. This includes administration in emergency, outpatient, and inpatient environments for patients suffering from a variety of acute and chronic painful conditions. Our current paradigm for opioid utilization suggests they provide effective analgesia for short-term use in most patients. Unfortunately, the risk of adverse effects or addiction is not rare and may be difficult to accurately quantify [1]. Regular prescription of opioids also occurs in the long-term care setting for patients with cancer-related pain offering effective pain relief and limited concern for addiction. However, long-term use of opioids for treatment of certain chronic conditions such as back pain, fibromyalgia, or neuropathic pain syndromes sparks more debate regarding therapeutic efficacy, adverse effects, and potential for misuse, abuse, and diversion of prescription opioids. Concerns regarding opioid use for patients with chronic non-cancer pain may relate to a subset of these patients who require significant dose escalation over time, visit multiple providers seeking opioid prescriptions, and report insufficient pain relief despite high dose therapy. These scenarios generate several concerns including the possibility that chronic opioid administration may be an ineffective strategy for long-term analgesia. Emerging evidence suggests t...

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“…The cellular and pharmacological activities of the MOP receptor are modulated by other GPCR systems (2)(3)(4)(5). In some case, such heterologous regulation involves receptor heteromerization (6), which is considered to confer new binding and endocytosis properties to the complex and/or to promote novel signaling pathways or, conversely, to impair signal transduction (7,8).…”

mentioning

confidence: 99%

Heterologous Regulation of Mu-Opioid (MOP) Receptor Mobility in the Membrane of SH-SY5Y Cells

Carayon

Moulédous

Combedazou

et al. 2014

Journal of Biological Chemistry

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Background: MOP receptor function is presumably linked to a specific dynamic organization in the membrane. Results: Inhibition of MOP receptor signaling by NPFF 2 and ␣ 2 receptors is accompanied by diffusion changes, with a particular behavior for heterodimers. Conclusion: MOP receptor function, diffusion, and confinement are subject to specific heterologous regulation by other GPCRs. Significance: Specific GPCR regulation is associated with particular dynamic organization in the membrane.

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Antinociceptive and nociceptive actions of opioids

Cited by 217 publications

References 220 publications

Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

Complications of Long-Term Opioid Therapy for Management of Chronic Pain: the Paradox of Opioid-Induced Hyperalgesia

Heterologous Regulation of Mu-Opioid (MOP) Receptor Mobility in the Membrane of SH-SY5Y Cells

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