Introduction. Part I Rational for the Use of Opioids in Nociceptive Transmission. The Nociceptive System, an Elementary Part of the Body's Protective Scheme. Acute Pain - Sequence of Changes in the Body. Differences in Pain Quality. Anatomy of Pain and Analgesia. Significance of C-Fibers in Pain Transmission. Significance of Aß-Fibers in Pain Modulation. Transmission of Pain with Different Qualities. Substance P, a Mediator of Pain and a Member of the Tachykinine Family. Supraspinal Processing of Pain. Transduction of Nociception Via the Spinothalamic Tracts. The Descending Antinociceptive System. Neurophysiology of Pain - Type of Receptor Sites Involved in Therapy. Transduction of Nociceptive Afferences Via Ascending Pathways. Different Therapeutic Approaches in Pain Therapy. Significance of Bradykinins in Inflammatory Pain. Cox Inhibitors in the Alleviation of Pain. The Opioid Receptor System - Main Target in Pain Therapy. Inhibitory and Excitatory Effects of Nociception at the Spinal Cord Level. Neurohormones In Transmission of Nociception. Melanocortins. Cholecystokinins. Calcitonin-Gene-Related Neuropeptide. Galanin. Nitric Monoxide, Mediator for Chronic Pain. The Cannabinoid System. Ion Channel Modulators Resulting in Facilitation/Inhibition of Nociception. The P2X and P2Y Receptor System. The Vanilloid Receptor System. Voltage-Gated Sodium Channels as Ion Conduit Modulators. Non Voltage-Gated Potassium Channels. Ionotropic Glutamate Receptor Ion Channel Modulators. Excitatory Glutamate Receptor; Mediator of Pronociceptive Effects. The Nicotinic/Acetylcholine (NAchR) Receptors. Nerve Growth Factor (NGF) in Mediating Hyperalgesia. Significance of the Immune System and Microglia in Chronic Pain. Reflectory, Segmental Mediation of Pain Afferents. Sequence of Resulting in Neuropathic Pain. Causes of Potentiation and Transition From Acute to Chronic Pain. Neurophysiological Changes Taking Effect During Evolution of Pain. Supraspinal Engrams Relevant in Transition from Acute to Chronic Pain. Preventing Transition from Acute to Chronic Pain - Use of Analgesics with Different pharmacology. Rationale for the Use of Opioids. Reasons for Insufficient Opioid use - The 11 Myths in Opioid Therapy. Alternative Therapeutic Targets in Pain Therapy. Proton Channels as Therapeutic Targets in Pain Therapy. Adjuvant Analgesics in Pain Therapy. Difference in Receptor Activation/Inhibition as Drug Targets. Mechanism of Action of Tricyclic Antidepressants. Pharmacologically Resistant - Psychologically Conditioned Pain. The Malingering Patient with Compensatory Pain Behavior. References. Part II Mechanism of Action of Opioids and Clinical Effects. Conversion of Morphine to Heroin (Diacetylmorphine). Major Classes of Opioid Analgesics in Clinical Practice. Mode of Action of Opiates/Opioids. Overview of the Different Opioid Receptors and their Subtypes. Agonists, Antagonists, their Potency and Mode of Action. Relative Potency and Equianalgesic Doses. Specific Binding Sites for Opioids in the CNS. Reasons for Difference in Potency of Opioids. Intracellular Signaling Following Opioid Binding. G-Protein Coupled Receptors and the Adenylate Cyclase Signaling System, Mediators of Opioid Action. Significance of the Heterotrimeric G-Proteins in Intracellular Transmission. Differences in Clinical Effects of Various Opioids. Opioid-Refractory Painful Conditions. Opioid-Related Side Effects. Opioid-Induced Respiratory Depression. Significance of the Different Opioid Receptors in the Mediation of Respiratory Depression. Vigilance, Leading Parameter in Opioid-Related Respiratory Depression. Reasons for Prolongation of Opioid-Related Respiratory Depression in Patients. Difference in Sedative-Hypnotic Effect of Opioids. Difference in the Hypnosedative and Analgesic Effect of Potent Opioids. Potential Epileptogenic Potency of Opioids. The Antitussive Action of Opioids (Blockade of Cough Reflex). Dependence Liability of Opioids - Pharmacological Principles of
This book fills the void to provide a comprehensive review of the theoretical knowledge and scope of opioid pharmacotherapy in pain medicine. While the information provided is obtainable in other major texts already in print, the present format style plus the illustrations will make easy reading and fast accessibility of information on opioids available. Information provided is based on clinical practice rather than pure experimental for use in daily practice.
Stressing key concepts and essential information on pain and its treatment
Providing one-step review of the important concepts in the mode of action of opioids
Summary of symptoms and modalities available for treatment of major pain syndromes
Written for everyone who needs detailed information on practical use on opioid pharmacology
Broad review for everyone preparing for the board examination