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Current Neuropharmacology 2023As a global health problem, chronic pain is one of the leading causes of disability, and it imposes a huge economic and public health burden on families and society.... (Review)
Review
As a global health problem, chronic pain is one of the leading causes of disability, and it imposes a huge economic and public health burden on families and society. Opioids represent the cornerstone of analgesic drugs. However, opioid tolerance caused by long-term application of opioids is a major factor leading to drug withdrawal, serious side effects caused by dose increases, and even the death of patients, placing an increasing burden on individuals, medicine, and society. Despite efforts to develop methods to prevent and treat opioid tolerance, no effective treatment has yet been found. Therefore, understanding the mechanism underlying opioid tolerance is crucial for finding new prevention and treatment strategies. Noncoding RNAs (ncRNAs) are important parts of mammalian gene transcriptomes, and there are thousands of unique noncoding RNA sequences in cells. With the rapid development of high-throughput genome technology, research on ncRNAs has become a hot topic in biomedical research. In recent years, studies have shown that ncRNAs mediate physiological and pathological processes, including chromatin remodeling, transcription, posttranscriptional modification and signal transduction, which are key regulators of physiological processes in developmental and disease environments and have become biomarkers and potential therapeutic targets for various diseases. An increasing number of studies have found that ncRNAs are closely related to the development of opioid tolerance. In this review, we have summarized the evidence that ncRNAs play an important role in opioid tolerance and that ncRNAs may be novel targets for opioid tolerance.
Topics: Animals; Humans; MicroRNAs; Analgesics, Opioid; Drug Tolerance; RNA, Untranslated; Signal Transduction; Mammals
PubMed: 36453497
DOI: 10.2174/1570159X21666221129122932 -
Current Oncology Reports Aug 2021Opioids are still the most effective and widely used treatments for acute and chronic pain in cancer patients. This review focuses on the impact of opioids and mu-opioid... (Review)
Review
PURPOSE OF REVIEW
Opioids are still the most effective and widely used treatments for acute and chronic pain in cancer patients. This review focuses on the impact of opioids and mu-opioid receptors (MOR) on tumor progression and providing new ideas for targeting the MOR in cancer treatment.
RECENT FINDINGS
Studies estimated that opioids facilitate tumor progression and are related to the worse prognosis in cancer patients. As the primary receptor of opioids, MOR is involved in the regulation of malignant transformation of tumors and participating in proliferation, invasion, metastasis, and angiogenesis. MOR may be a new molecular marker of malignant tumors and thus become a new target for cancer therapy, which may be beneficial to the outcomes of cancer patients.
Topics: Analgesics, Opioid; Animals; Disease Progression; Humans; Immunity; Inflammation; Molecular Targeted Therapy; Neoplasms; Neovascularization, Pathologic; Receptors, Opioid, mu
PubMed: 34342720
DOI: 10.1007/s11912-021-01107-w -
Neuroscience and Biobehavioral Reviews Mar 2022Concomitant use of tobacco and opioids represents a growing public health concern. In fact, the mortality rate due to smoking-related illness approaches 50% among SUD... (Review)
Review
Concomitant use of tobacco and opioids represents a growing public health concern. In fact, the mortality rate due to smoking-related illness approaches 50% among SUD patients. Cumulative evidence demonstrates that the vulnerability to drugs of abuse is influenced by behavioral, environmental, and genetic factors. This review explores the contribution of genetics and neural mechanisms influencing nicotine and opioid reward, respiration, and antinociception, emphasizing the interaction of cholinergic and opioid receptor systems. Despite the substantial evidence demonstrating nicotine-opioid interactions within the brain and on behavior, the currently available pharmacotherapies targeting these systems have shown limited efficacy for smoking cessation on opioid-maintained smokers. Thus, further studies designed to identify novel targets modulating both nicotinic and opioid receptor systems may lead to more efficacious approaches for co-morbid nicotine dependence and opioid use disorder.
Topics: Analgesics, Opioid; Humans; Nicotine; Opioid-Related Disorders; Receptors, Nicotinic; Tobacco Use Disorder
PubMed: 34968525
DOI: 10.1016/j.neubiorev.2021.12.030 -
Current Pain and Headache Reports May 2021Although opioids are excellent analgesics, they are associated with severe short- and long-term side effects that are especially concerning for the treatment of chronic... (Review)
Review
PURPOSE OF REVIEW
Although opioids are excellent analgesics, they are associated with severe short- and long-term side effects that are especially concerning for the treatment of chronic pain. Peripherally acting opioid receptor agonists promise to mitigate the more serious centrally mediated side effects of opioids, and the goal of this paper is to identify and elaborate on recent advances in these peripheral opioid receptor therapeutics.
RECENT FINDINGS
Peripheral opioid receptor agonists are effective analgesics that at the same time circumvent the problem of centrally mediated opioid side effects by (1) preferentially targeting peripheral opioid receptors that are often the source of the pain and (2) their markedly diminished permeability or activity across the blood-brain barrier. Recent novel bottom-up approaches have been notable for the design of therapeutics that are either active only at inflamed tissue, as in the case of fentanyl-derived pH-sensitive opioid ligands, or too bulky or hydrophilic to cross the blood-brain barrier, as in the case of morphine covalently bound to hyperbranched polyglycerols. Recent innovations in peripheral opioid receptor therapeutics of pH-sensitive opioid ligands and limiting opioid permeability across the blood-brain barrier have had promising results in animal models. While this is grounds for optimism that some of these therapeutics will be efficacious in human subjects at a future date, each drug must undergo individualized testing for specific chronic pain syndromes to establish not only the nuances of each drug's therapeutic effect but also a comprehensive safety profile.
Topics: Analgesics; Analgesics, Opioid; Chronic Pain; Humans; Receptors, Opioid
PubMed: 33970352
DOI: 10.1007/s11916-021-00951-6 -
Otolaryngologic Clinics of North America Oct 2020An increasing number of chronic pain patients presenting for surgery are chronic opioid users. Pain management in the postoperative period can be challenging in this... (Review)
Review
An increasing number of chronic pain patients presenting for surgery are chronic opioid users. Pain management in the postoperative period can be challenging in this population due to the development of tolerance, physical dependence, and hyperalgesia in long-term opioid users. It is common for postoperative pain to be undertreated in these patients, leading to an overall increase in length of hospital stays, health care costs, and decreased patient satisfaction. Identifying opioid-tolerant patients and developing a perioperative pain management plan are important components of a patient's overall recovery after any surgical procedure.
Topics: Analgesics, Opioid; Chronic Pain; Humans; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Perioperative Care
PubMed: 32703693
DOI: 10.1016/j.otc.2020.05.013 -
The Orthopedic Clinics of North America Oct 2023Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is... (Review)
Review
Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is employed, adequate pain management is essential to decrease postoperative complications, such as chronic pain and disability, while minimizing the risk of prolonged opioid use and dependence. Strategies to optimize pain management include regional anesthesia, preoperative dosing of medication, multimodal regimens, long-acting selective opioids at the time of surgery, corticosteroids, and non-pharmacologic therapies.
Topics: Aged; Humans; Wrist Fractures; Pain Management; Postoperative Complications; Analgesics, Opioid; Chronic Pain
PubMed: 37718085
DOI: 10.1016/j.ocl.2023.05.006 -
Addiction (Abingdon, England) Feb 2022Opioid use disorder (OUD) has gained increasing publicity and interest during recent years, with many countries describing problems of epidemic proportions with regard... (Review)
Review
Opioid use disorder (OUD) has gained increasing publicity and interest during recent years, with many countries describing problems of epidemic proportions with regard to opioid use and deaths related to opioids. While opioids are not themselves acutely neurotoxic, the chronic relapsing and remitting nature of this disorder means that individuals are often exposed to exogenous opioids for lengthy periods of time (either illicit or prescribed as treatment). We are increasingly characterizing the effect of such long-term opioid exposure on the brain. This narrative review aims to summarize the literature regarding OUD and the brain from a clinical perspective. Alterations of brain structure and function are discussed, as well as neurological and psychiatric disorders in OUD. Finally, we review current and new directions for assessment and treatment.
Topics: Analgesics, Opioid; Brain; Humans; Opioid-Related Disorders
PubMed: 34228373
DOI: 10.1111/add.15636 -
The Surgical Clinics of North America Oct 2019The current opioid crisis has raised awareness of the risks of misuse, addiction, and overdose with opioid prescribing for pain management in the perioperative and... (Review)
Review
The current opioid crisis has raised awareness of the risks of misuse, addiction, and overdose with opioid prescribing for pain management in the perioperative and nonoperative care of surgical patients. Despite these risks, it is essential for surgical providers to provide safe and adequate functional pain control to enhance recovery. The purpose of this review is to outline the relevance of the US opioid crisis to surgical prescribing, describe strategies for opioid reduction using a stepwise therapy approach, and provide recommendations for improving the safety of opioid prescribing. Additional recommendations for risk assessment and naloxone coprescribing for high-risk patients are addressed.
Topics: Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain; Humans; Opioid-Related Disorders; Pain Management; Pain, Postoperative; United States
PubMed: 31446915
DOI: 10.1016/j.suc.2019.06.002 -
Current Opinion in Supportive and... Jun 2020An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options. (Review)
Review
PURPOSE OF REVIEW
An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.
RECENT FINDINGS
The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.
SUMMARY
All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
Topics: Analgesics, Opioid; Breakthrough Pain; Cancer Pain; Fentanyl; Humans; Neoplasm Metastasis; Pain Management; Pain Measurement; Practice Guidelines as Topic; Severity of Illness Index; Transdermal Patch
PubMed: 32332210
DOI: 10.1097/SPC.0000000000000494 -
The American Journal of Psychiatry Jul 2021
Topics: Analgesics, Opioid; Humans; Opioid-Related Disorders
PubMed: 34270338
DOI: 10.1176/appi.ajp.2021.21050527