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Related Concept Videos

Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioid Receptors: Overview01:22

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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Nociception01:44

Nociception

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Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
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Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
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Opioid-induced hyperalgesia: is it a clinically relevant phenomenon?

Craig K Svensson1

  • 1Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, West Lafayette, IN, USA.

The International Journal of Pharmacy Practice
|April 29, 2022
PubMed
Summary

Opioid-induced hyperalgesia (OIH) is debated for long-term opioid use. Current evidence from clinical trials does not support OIH as a clinically relevant reason to stop prescribing opioids for chronic pain.

Keywords:
fentanylopioid-induced hyperalgesiaremifentaniltolerancewithdrawal pain

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Area of Science:

  • Pharmacology and Pain Management
  • Clinical Trial Analysis

Background:

  • Opioid-induced hyperalgesia (OIH) is a controversial side effect influencing long-term opioid therapy decisions.
  • The clinical relevance of OIH is questioned, particularly regarding its role in promoting opioid deprescribing for chronic pain management.

Purpose of the Study:

  • To critically evaluate the evidence for clinically relevant opioid-induced hyperalgesia (OIH) in randomized clinical trials.
  • To assess whether OIH is a valid rationale for deprescribing opioids in patients with chronic pain.

Main Methods:

  • Review and analysis of randomized clinical trials investigating opioid-induced hyperalgesia (OIH) in acute and chronic pain settings.
  • Examination of trial designs for their ability to differentiate OIH from tolerance, withdrawal, and disease progression.
  • Assessment of patient-reported pain and analgesic consumption data in relevant studies.

Main Results:

  • Existing studies investigating OIH through experimentally induced pain lack the methodological rigor to distinguish it from other opioid-related phenomena.
  • Patient-reported outcomes, including pain levels and analgesic use, do not consistently support the presence of clinically significant OIH.
  • There is currently insufficient high-quality clinical trial evidence to establish OIH as a clinically relevant phenomenon.

Conclusions:

  • The potential for opioid-induced hyperalgesia (OIH) is not a scientifically sound reason to discontinue long-term opioid therapy for chronic pain.
  • While other valid reasons exist to limit long-term opioid use, OIH's clinical significance remains unproven in rigorous trials.