Knowing the Enemy Is Halfway towards Victory: A Scoping Review on Opioid-Induced Hyperalgesia

Data de publicação:

Autores da FMUP

  • Maria Isabel Torres Martins

    Autor

Participantes de fora da FMUP

  • Sampaio-Cunha, TJ

Unidades de investigação

Abstract

Opioid-induced hyperalgesia (OIH) is a paradoxical effect of opioids that is not consensually recognized in clinical settings. We conducted a revision of clinical and preclinical studies and discuss them side by side to provide an updated and renewed view on OIH. We critically analyze data on the human manifestations of OIH in the context of chronic and post-operative pain. We also discuss how, in the context of cancer pain, though there are no direct evidence of OIH, several inherent conditions to the tumor and chemotherapy provide a substrate for the development of OIH. The review of the clinical data, namely in what concerns the strategies to counter OIH, emphasizes how much OIH rely mechanistically on the existence of mu-opioid receptor (MOR) signaling through opposite, inhibitory/antinociceptive and excitatory/pronociceptive, pathways. The rationale for the maladaptive excitatory signaling of opioids is provided by the emerging growing information on the functional role of alternative splicing and heteromerization of MOR. The crossroads between opioids and neuroinflammation also play a major role in OIH. The latest pre-clinical data in this field brings new insights to new and promising therapeutic targets to address OIH. In conclusion, although OIH remains insufficiently recognized in clinical practice, the appropriate diagnosis can turn it into a treatable pain disorder. Therefore, in times of scarce alternatives to opioids to treat pain, mainly unmanageable chronic pain, increased knowledge and recognition of OIH, likely represent the first steps towards safer and efficient use of opioids as analgesics.

Dados da publicação

ISSN/ISSNe:
2077-0383, 2077-0383

Journal of Clinical Medicine  MDPI AG

Tipo:
Article
Páginas:
6161-
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 6

Citações Recebidas na Scopus: 8

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Keywords

  • opioids; opioid-induced hyperalgesia; neural-inflammatory crosstalk; mu-opioid receptor; opioid signaling; alternative splicing

Proyectos asociados

Dor Crónica Pediátrica: Fatores de risco e sua influência na modulação da dor

Investigador Principal: Maria Isabel Torres Martins

Estudo Clínico Académico . 2021

Opioidergic modulation of descending pain facilitation: Studies in models of neuropathic pain and opioid induced hyperalgesia

Investigador Principal: Maria Isabel Torres Martins

Estudo Clínico Académico . 2021

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