Epigenetic Alterations in Prescription Opioid Misuse: New Strategies for Precision Pain Management

Abstract

Prescription opioids are used for some chronic pain conditions. However, generally, long-term therapy has unwanted side effects which may trigger addiction, overdose, and eventually cause deaths. Opioid addiction and chronic pain conditions have both been associated with evidence of genetic and epigenetic alterations. Despite intense research interest, many questions about the contribution of epigenetic changes to this typology of addiction vulnerability and development remain unanswered. The aim of this review was to summarize the epigenetic modifications detected in specific tissues or brain areas and associated with opioid prescription and misuse in patients who have initiated prescribed opioid management for chronic non-cancer pain. The review considers the effects of opioid exposure on the epigenome in central and peripheral tissues in animal models and human subjects and highlights the mechanisms in which opioid epigenetics may be involved. This will improve our current understanding, provide the basis for targeted, personalized pain management, and thus balance opioid risks and benefits in managing chronic pain.

Epigenetic and sex differences in opioid use disorder in chronic pain: A real‐world study linked with OPRM1 DNA methylation

“…Moreover, the cases obtained different psychosocial outcomes (age, employment status), quality of life and drug use (higher MEDD and psychotropic drug prescription) than the controls. These findings highlight the complex interplay among pain, dependence, the environment 29 and sex 8 , 27 , 30 and indicates the possibility of reducing or preventing the negative consequences of chronic pain and OUD. We insist that a successful OUD crisis response should highlight the importance of understanding sex differences in opioids use patterns.…”

“… 4 Taking into account the higher chronic pain prevalence in older women, 5 the socio‐cultural influence in pain response, 6 and the existing gender inequalities in pain management, 7 understanding sex differences seems essential for effective OUD prevention. 8 , 9 …”

Effect of Fu’s subcutaneous needling for cancer pain management: protocol for a pragmatic randomised controlled trial

“… 22 The serious adverse effects and potential addiction risks of opioids provide challenges in pain management. 23 24 Therefore, complementary and alternative therapies have become increasingly popular for symptom control in clinical practice, 25 leading to an acceleration in the development of integrative medicine. 26 In contrast to conventional oncology care, integrative oncology aims to add evidence-based complementary and alternative therapies to the daily care of patients to address their physical and mental problems and improve their quality of life.…”

“…Although there are many guidelines for treating cancer pain, more than 30% of patients have uncontrollable symptoms 22. The serious adverse effects and potential addiction risks of opioids provide challenges in pain management 23 24. Therefore, complementary and alternative therapies have become increasingly popular for symptom control in clinical practice,25 leading to an acceleration in the development of integrative medicine 26.…”

Opioids and opioid receptors; understanding pharmacological mechanisms as a key to therapeutic advances and mitigation of the misuse crisis

“… 78 , 79 , 80 , 81 Of relevance to anaesthesia, epigenetics has a role to play in the perioperative period: there are data showing epigenetic links to several types of pain and also opioid addiction-misuse which may have implications for the opioid misuse crisis. 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 …”