In the first part of this three-part article I explored the notion that pharmacological intervention, aimed at eliminating abnormal sensations such as hyperalgesia or paraesthesia arising as a direct result of nerve injury, activates adaptive responses that ensure adequacy of neurotransmission, regardless of whether such transmission ultimately evokes normal or abnormal sensations. Thus, by their nature, such adaptive responses will act to oppose and surmount any drug-induced intervention designed to diminish pain through attenuation of signal conduction. A corollary of this hypothesis is that even the most sophisticated novel pharmacological entities, when used to block the pain signal, represent substrates for evoking a repertoire of failsafe mechanisms that have evolved throughout a history of challenge and response. In Part II, I explore in greater depth how activation of these responses may explain why the treatment of neuropathic pains, particularly with opioids, can be so frustrating. Opioid analgesia and cholecystokinin CCK as an anti-analgesic peptide Numerous reports have indicated that CCK antagonizes opioid antinociceptive effects. Indeed, administered by peripheral or central (intracerebroventricular (i.c.v.), intrathecal (i.t.)) routes, CCK can reduce morphine-, PL017-or ohmefentanyl-(two selective µ-agonists), and β-endorphininduced analgesia, as well as the morphineinduced depression of the nociceptive flexion reflex in rats. 19-27 In the mouse tail-flick test, CCK attenuates the analgesic effects of morphine. 28 In addition, in the same species, CCK administered i.t. antagonizes the inhibition of tail flick by i.c.v. β-endorphin. 29 Furthermore, the inhibitory effect of morphine and [D-Ala 2-Me)Phe 4-Glyol 5 ] enkephalin (DAMGO) on C-fibre-evoked activity of rat spinal nociceptive neurones can be reduced by CCK. 30-33 Thus, from these data, it can be concluded that CCK has the pharmacological property of reducing the antinociceptive effects of endogenous opioids.