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Plasticity: Implications for opioid and other pharmacological interventions in specific pain states

Dickenson, AH; (1997) Plasticity: Implications for opioid and other pharmacological interventions in specific pain states. BEHAV BRAIN SCI , 20 (3) 392 -403. Green open access

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Abstract

The spinal mechanisms of action of opioids under normal conditions are reasonably well understood. The spinal effects of opioids can be enhanced or reduced depending on pathology and activity in other segmental and nonsegmental pathways. This plasticity will be considered in relation to the control of different pain states using opioids. The complex and contradictory findings on the supraspinal actions of opioids are explicable in terms of heterogeneous descending pathways to different spinal targets using multiple transmitters and receptors - therefore opioids can both increase and decrease activity in descending pathways. These pathways could exhibit considerable plasticity. There is increasing evidence that delta opioid receptor agonists have the potential to replace morphine as major analgesics with reduced side-effect profiles. The concept of preemptive analgesia, based on preventing the induction of some of the negative plastic influences on opioid controls and the detrimental effects of pain, is sound, but experimental verification in the clinical setting is difficult. For example, a delayed compensatory upregulation of inhibitory systems, particularly in inflammation, may counter persistent painful inputs. Combination therapy with opioids may be beneficial in many pain states where either negative influences are blocked or inhibitory controls are enhanced. Finally, developmental aspects of these systems are discussed in connection with the treatment of pain in young children, where inhibitory systems in the spinal cord are immature.

Type: Article
Title: Plasticity: Implications for opioid and other pharmacological interventions in specific pain states
Open access status: An open access version is available from UCL Discovery
Publisher version: http://journals.cambridge.org/action/displayAbstra...
Language: English
Additional information: © 1997 Cambridge University Press
Keywords: analgesia, cholecystokinin, development of pain, excitatory amino acids, hypersensitivity, nociception, opioids, peptides, spinal cord, RAT SPINAL-CORD, DORSAL HORN NEURONS, GENE-RELATED PEPTIDE, CARRAGEENAN-INDUCED INFLAMMATION, NERVOUS-SYSTEM PLASTICITY, NMDA RECEPTOR ANTAGONISTS, ROOT GANGLION NEURONS, AMINO-ACID RECEPTORS, SUBSTANCE-P, ANTINOCICEPTIVE ACTIONS
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Div of Biosciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Div of Biosciences > Neuro, Physiology and Pharmacology
URI: https://discovery.ucl.ac.uk/id/eprint/132410
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