Chronic Opioid Therapy and Opioid Tolerance : A New Hypothesis

Author

Goldberg, Joel S.

Source

Pain Research and Treatment

Issue

Vol. 2013, Issue 2013 (31 Dec. 2013), pp.1-6, 6 p.

Publisher

Hindawi Publishing Corporation

Publication Date

2013-01-14

Country of Publication

Egypt

No. of Pages

6

Main Subjects

Diseases
Medicine

Abstract EN

Opioids are efficacious and cost-effective analgesics, but tolerance limits their effectiveness.

This paper does not present any new clinical or experimental data but demonstrates that there exist ascending sensory pathways that contain few opioid receptors.

These pathways are located by brain PET scans and spinal cord autoradiography.

These nonopioid ascending pathways include portions of the ventral spinal thalamic tract originating in Rexed layers VI–VIII, thalamocortical fibers that project to the primary somatosensory cortex (S1), and possibly a midline dorsal column visceral pathway.

One hypothesis is that opioid tolerance and opioid-induced hyperalgesia may be caused by homeostatic upregulation during opioid exposure of nonopioid-dependent ascending pain pathways.

Upregulation of sensory pathways is not a new concept and has been demonstrated in individuals impaired with deafness or blindness.

A second hypothesis is that adjuvant nonopioid therapies may inhibit ascending nonopioid-dependent pathways and support the clinical observations that monotherapy with opioids usually fails.

The uniqueness of opioid tolerance compared to tolerance associated with other central nervous system medications and lack of tolerance from excess hormone production is discussed.

Experimental work that could prove or disprove the concepts as well as flaws in the concepts is discussed.

American Psychological Association (APA)

Goldberg, Joel S.. 2013. Chronic Opioid Therapy and Opioid Tolerance : A New Hypothesis. Pain Research and Treatment،Vol. 2013, no. 2013, pp.1-6.
https://search.emarefa.net/detail/BIM-469690

Modern Language Association (MLA)

Goldberg, Joel S.. Chronic Opioid Therapy and Opioid Tolerance : A New Hypothesis. Pain Research and Treatment No. 2013 (2013), pp.1-6.
https://search.emarefa.net/detail/BIM-469690

American Medical Association (AMA)

Goldberg, Joel S.. Chronic Opioid Therapy and Opioid Tolerance : A New Hypothesis. Pain Research and Treatment. 2013. Vol. 2013, no. 2013, pp.1-6.
https://search.emarefa.net/detail/BIM-469690

Data Type

Journal Articles

Language

English

Notes

Includes bibliographical references

Record ID

BIM-469690