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Pain management: physiopathology, future research and endpoints
1Service d'Anesthésiologie, Institut Jules Bordet, Bruxelles, Belgium.
Summary
Tissue injury causes peripheral sensitization, leading to hyperalgesia. Cancer pain management faces challenges with opioid tolerance and insensitivity, potentially reversed by ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist.
Area of Science:
- Neuroscience
- Pain Research
- Pharmacology
Background:
- Nociceptive information processing involves peripheral and central mechanisms.
- Tissue injury induces plastic changes, including peripheral sensitization and primary hyperalgesia.
- Substance P and N-methyl-D-aspartate (NMDA) receptors may amplify pain signals.
Purpose of the Study:
- To review nociceptive information processing and associated plastic changes.
- To discuss challenges in cancer pain management, specifically opioid tolerance and insensitivity.
- To explore the role of NMDA receptor antagonists in overcoming opioid resistance.
Main Methods:
- Review of scientific literature on nociception and pain mechanisms.
- Analysis of receptor interactions, including Substance P and NMDA receptors.
- Discussion of clinical observations regarding opioid tolerance and ketamine efficacy.
Main Results:
- Peripheral sensitization explains primary hyperalgesia at the injury site.
- Opioid tolerance may result from receptor down-regulation or desensitization.
- Ketamine, an NMDA antagonist, shows potential in managing opioid-resistant cancer pain.
Conclusions:
- Understanding peripheral and central sensitization is crucial for pain management.
- Opioid tolerance and insensitivity represent shifts in dose-response curves.
- NMDA receptor antagonism offers a novel strategy for refractory cancer pain.