Studies have shown that long-term (5␣,6␣)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol (morphine) treatment increases the sensitivity to painful heat stimuli (thermal hyperalgesia). The cellular adaptations contributing to sustained morphine-mediated pain sensitization are not fully understood. It was shown previously (J Neurosci 22:6747-6755, 2002) that sustained morphine exposure augments pain neurotransmitter [such as calcitonin gene-related peptide (CGRP)] release in the dorsal horn of the spinal cord in response to the heatsensing transient receptor potential vanilloid 1 receptor agonist 8-methyl-N-vanillyl-6-nonenamide (capsaicin). In the present study, we demonstrate that sustained morphine-mediated augmentation of CGRP release from isolated primary sensory dorsal root ganglion neurons is dependent on protein kinase A and Raf-1 kinase. Our data indicate that, in addition to neural system adaptations, sustained opioid agonist treatment also produces intracellular compensatory adaptations in primary sensory neurons, leading to augmentation of evoked pain neurotransmitter release from these cells.Opioid analgesics such as (5␣,6␣)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol (morphine) are widely used in the treatment of various pain conditions. It is interesting, however, that long-term treatment with opioid analgesics paradoxically increases the sensitivity of patients (Koppert, 2004) and experimental animals to mildly painful and normally innocuous thermal stimuli (thermal hyperalgesia and allodynia). It was suggested that such paradoxical pain sensitization may contribute to the development of antinociceptive tolerance (Mao et al., 1995;Vanderah et al., 2000;Gardell et al., 2002;Ossipov et al., 2005). The molecular mechanisms leading to sustained morphine-mediated thermal hyperalgesia are not fully identified.Painful heat stimuli regulate cation influx into small-diameter primary sensory neurons (nociceptors) by activation of nonselective (mostly calcium-permeable) transient receptor potential ion channels (such as the TRPV1-type vanilloid receptors). In addition to noxious heat, TRPV1 receptors also respond to numerous endogenous (such as protons and inflammatory substances released after tissue injury) and exogenous substances [such as 8-methyl-N-vanillyl-6-nonenamide (capsaicin) and 4-hydroxy-3-methoxy-octahydro-6a- LG, L-glutamine; PS, penicillin-streptomycin; NGF, nerve growth factor; PBS, phosphate-buffered saline; DPN, diprenorphine; NTX, naltrexone; GW5074 (GW), 3-(3,5-dibromo-4-hydroxybenzylidene-5-iodo-1,3-dihydro-indol-2-one; H-89, N-[2-((p-bromocinnamyl)amino)ethyl]-5-isoquinoline sulfonamide, 2HCl; PKI, myristoylated protein kinase A inhibitor 14-22 amide; Mor, morphine; ANOVA, analysis of variance; Cap, capsaicin; MAPK, mitogen-activated protein kinase; B27, 0.1 g/ml biotin, 2.0 g/ml L-carnitine, 15 g/ml D-(ϩ)-galactose, 1 g/ml ethanolamine, 16.1 g/ml putrescine, 0.016 g/ml selenium, 0.02 g/ml corticosterone, 1 g/ml linoleic acid, 0.0063 g/ml progesterone, 0.1 g/ml reti...