Antinociceptive and nociceptive actions of opioids.
Although the opioids are the principal treatment options for moderate to severe pain, their use is also associated with the development of tolerance, defined as the progressive need for higher doses to achieve a constant analgesic effect. The mechanisms which underlie this phenomenon remain unclear. Recent studies revealed that cholecystokinin (CCK) is upregulated in the rostral ventromedial medulla (RVM) during persistent opioid exposure. CCK is both antiopioid and pronociceptive, and activates descending pain facilitation mechanisms from the RVM enhancing nociceptive transmission at the spinal cord and promoting hyperalgesia. The neuroplastic changes elicited by opioid exposure reflect adaptive changes to promote increased pain transmission and consequent diminished antinociception (i.e., tolerance).
Ossipov
Michael H
MH
Departments of Pharmacology, Anesthesiology and Chemistry, University of Arizona, Tucson, Arizona 85724, USA.
Lai
Josephine
J
King
Tamara
T
Vanderah
Todd W
TW
Malan
T Philip
TP
Hruby
Victor J
VJ
Porreca
Frank
F
D000700:Analgesics / Q000378:metabolism* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000378:metabolism* / Q000627:therapeutic use; D000818:Animals; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000378:metabolism*; D010147:Pain Measurement / Q000379:methods*; D011957:Receptors, Opioid / Q000819:agonists / Q000378:metabolism*
D000700:Analgesics; D000701:Analgesics, Opioid; D011957:Receptors, Opioid