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Vol 3, No 2 (2004): Polish Palliative Medicine
Artykuły poglądowe
Published online: 2004-04-09
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Peripheral opioid analgesia

Wiebke Janson, Christoph Stein
Advances in Palliative Medicine 2004;3(2):119-130.

open access

Vol 3, No 2 (2004): Polish Palliative Medicine
Artykuły poglądowe
Published online: 2004-04-09

Abstract

Opioids have long been thought to act exclusively within the central nervous system. An increasing number of studies have recently reported the existence of opioid receptors outside the central nervous system and therefore suggested that opioids are also able to produce analgesic effects in the periphery. Such effects are particularly prominent under painful inflammatory conditions both in animals and in humans. During inflammatory processes opioid receptors are transported from dorsal root ganglia towards the peripheral sensory nerve endings. At the same time, immune cells containing endogenous opioid peptides accumulate within the inflamed tissue. Environmental stimuli (e.g. stress) as well as releasing agents (e.g. corticotropin releasing factor, cytokines) can liberate these opioid peptides to interact with the neuronal opioid receptors and elicit local analgesia. The inflammation-induced activation of opioid production and the release of exogenous opioids from immune cells may lead to novel approaches for the development of peripherally acting analgesics. Clinical investigation now focuses on the development of new peripheral opioid agonists as well as on ways to stimulate the endogenous analgesic system in order to induce effective peripheral analgesia with a reduction in the central side effects typically associated with opioids.

Abstract

Opioids have long been thought to act exclusively within the central nervous system. An increasing number of studies have recently reported the existence of opioid receptors outside the central nervous system and therefore suggested that opioids are also able to produce analgesic effects in the periphery. Such effects are particularly prominent under painful inflammatory conditions both in animals and in humans. During inflammatory processes opioid receptors are transported from dorsal root ganglia towards the peripheral sensory nerve endings. At the same time, immune cells containing endogenous opioid peptides accumulate within the inflamed tissue. Environmental stimuli (e.g. stress) as well as releasing agents (e.g. corticotropin releasing factor, cytokines) can liberate these opioid peptides to interact with the neuronal opioid receptors and elicit local analgesia. The inflammation-induced activation of opioid production and the release of exogenous opioids from immune cells may lead to novel approaches for the development of peripherally acting analgesics. Clinical investigation now focuses on the development of new peripheral opioid agonists as well as on ways to stimulate the endogenous analgesic system in order to induce effective peripheral analgesia with a reduction in the central side effects typically associated with opioids.
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Keywords

peripheral opioid analgesia; inflammation; exogenous analgesia; endogenous analgesia; nociceptin/ORL system; endomorphins; immune modulation of pain

About this article
Title

Peripheral opioid analgesia

Journal

Advances in Palliative Medicine

Issue

Vol 3, No 2 (2004): Polish Palliative Medicine

Pages

119-130

Published online

2004-04-09

Bibliographic record

Advances in Palliative Medicine 2004;3(2):119-130.

Keywords

peripheral opioid analgesia
inflammation
exogenous analgesia
endogenous analgesia
nociceptin/ORL system
endomorphins
immune modulation of pain

Authors

Wiebke Janson
Christoph Stein

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