The dark side of opioids in pain management: basic science explains clinical observation

Abstract. Introduction:. In the past 2 decades, opioids have been used increasingly for the treatment of persistent pain, and doses have tended to creep up. As basic science elucidates mechanisms of pain and analgesia, the cross talk between central pain and opioid actions becomes clearer. Objective...

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Main Authors: Cyril Rivat, Jane Ballantyne
Format: Article
Language:English
Published: Wolters Kluwer 2016-08-01
Series:PAIN Reports
Online Access:http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000570
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spelling doaj-e72f7dc70007458dbb4dff0a1b1b2f002020-11-24T22:03:57ZengWolters KluwerPAIN Reports2471-25312016-08-0112e57010.1097/PR9.0000000000000570201608300-00003The dark side of opioids in pain management: basic science explains clinical observationCyril Rivat0Jane Ballantyne1aUniversité de Montpellier, Montpellier, France, Institut des Neurosciences de Montpellier, INSERM U1051, Montpellier, FrancebDepartment of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USAAbstract. Introduction:. In the past 2 decades, opioids have been used increasingly for the treatment of persistent pain, and doses have tended to creep up. As basic science elucidates mechanisms of pain and analgesia, the cross talk between central pain and opioid actions becomes clearer. Objectives:. We aimed to examine the published literature on basic science explaining pronociceptive opioid actions, and apply this knowledge to clinical observation. Methods:. We reviewed the existing literature on the pronociceptive actions of opioids, both preclinical and clinical studies. Results:. Basic science provides a rationale for the clinical observation that opioids sometimes increase rather than decrease pain. Central sensitization (hyperalgesia) underlies pain chronification, but can also be produced by high dose and high potency opioids. Many of the same mechanisms account for both central pain and opioid hyperalgesia. Conclusion:. Newly revealed basic mechanisms suggest possible avenues for drug development and new drug therapies that could alter pain sensitization through endogenous and exogenous opioid mechanisms. Recent changes in practice such as the introduction of titration-to-effect for opioids have resulted in higher doses used in the clinic setting than ever seen previously. New basic science knowledge hints that these newer dosing practices may need to be reexamined. When pain worsens in a patient taking opioids, can we be assured that this is not because of the opioids, and can we alter this negative effect of opioids through different dosing strategies or new drug intervention?http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000570
collection DOAJ
language English
format Article
sources DOAJ
author Cyril Rivat
Jane Ballantyne
spellingShingle Cyril Rivat
Jane Ballantyne
The dark side of opioids in pain management: basic science explains clinical observation
PAIN Reports
author_facet Cyril Rivat
Jane Ballantyne
author_sort Cyril Rivat
title The dark side of opioids in pain management: basic science explains clinical observation
title_short The dark side of opioids in pain management: basic science explains clinical observation
title_full The dark side of opioids in pain management: basic science explains clinical observation
title_fullStr The dark side of opioids in pain management: basic science explains clinical observation
title_full_unstemmed The dark side of opioids in pain management: basic science explains clinical observation
title_sort dark side of opioids in pain management: basic science explains clinical observation
publisher Wolters Kluwer
series PAIN Reports
issn 2471-2531
publishDate 2016-08-01
description Abstract. Introduction:. In the past 2 decades, opioids have been used increasingly for the treatment of persistent pain, and doses have tended to creep up. As basic science elucidates mechanisms of pain and analgesia, the cross talk between central pain and opioid actions becomes clearer. Objectives:. We aimed to examine the published literature on basic science explaining pronociceptive opioid actions, and apply this knowledge to clinical observation. Methods:. We reviewed the existing literature on the pronociceptive actions of opioids, both preclinical and clinical studies. Results:. Basic science provides a rationale for the clinical observation that opioids sometimes increase rather than decrease pain. Central sensitization (hyperalgesia) underlies pain chronification, but can also be produced by high dose and high potency opioids. Many of the same mechanisms account for both central pain and opioid hyperalgesia. Conclusion:. Newly revealed basic mechanisms suggest possible avenues for drug development and new drug therapies that could alter pain sensitization through endogenous and exogenous opioid mechanisms. Recent changes in practice such as the introduction of titration-to-effect for opioids have resulted in higher doses used in the clinic setting than ever seen previously. New basic science knowledge hints that these newer dosing practices may need to be reexamined. When pain worsens in a patient taking opioids, can we be assured that this is not because of the opioids, and can we alter this negative effect of opioids through different dosing strategies or new drug intervention?
url http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000570
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