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Pain and Poppies: The Good, the Bad, and the Ugly of Opioid Analgesics.

Abstract
Treating pain is one of the most difficult challenges in medicine and a key facet of disease management. The isolation of morphine by Friedrich Sertürner in 1804 added an essential pharmacological tool in the treatment of pain and spawned the discovery of a new class of drugs known collectively as opioid analgesics. Revered for their potent pain-relieving effects, even Morpheus the god of dreams could not have dreamt that his opium tincture would be both a gift and a burden to humankind. To date, morphine and other opioids remain essential analgesics for alleviating pain. However, their use is plagued by major side effects, such as analgesic tolerance (diminished pain-relieving effects), hyperalgesia (increased pain sensitivity), and drug dependence. This review highlights recent advances in understanding the key causes of these adverse effects and explores the effect of chronic pain on opioid reward.
SIGNIFICANCE STATEMENT:
Chronic pain is pervasive and afflicts >100 million Americans. Treating pain in these individuals is notoriously difficult and often requires opioids, one of the most powerful and effective classes of drugs used for controlling pain. However, their use is plagued by major side effects, such as a loss of pain-relieving effects (analgesic tolerance), paradoxical pain (hyperalgesia), and addiction. Despite the potential side effects, opioids remain the pharmacological cornerstone of modern pain therapy. This review highlights recent breakthroughs in understanding the key causes of these adverse effects and explores the cellular control of opioid systems in reward and aversion. The findings will challenge traditional views of the good, the bad, and the ugly of opioids.
AuthorsTuan Trang, Ream Al-Hasani, Daniela Salvemini, Michael W Salter, Howard Gutstein, Catherine M Cahill
JournalThe Journal of neuroscience : the official journal of the Society for Neuroscience (J Neurosci) Vol. 35 Issue 41 Pg. 13879-88 (Oct 14 2015) ISSN: 1529-2401 [Electronic] United States
PMID26468188 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)
CopyrightCopyright © 2015 the authors 0270-6474/15/3513879-10$15.00/0.
Chemical References
  • Analgesics, Opioid
Topics
  • Analgesics, Opioid (therapeutic use)
  • Animals
  • Central Nervous System (drug effects, physiology)
  • Chronic Pain (drug therapy, pathology)
  • Humans
  • Models, Biological
  • Papaver (chemistry)

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