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Titolo:
Mechanisms of opioid tolerance and dependence
Autore:
Muller, A; Koch, B; Rene, F; Boutillier, AL; See, V; Loeffler, JP;
Indirizzi:
Hop Univ Strasbourg, Hop Civil, Clin de la Douleur, F-67091 Strasbourg, France Hop Univ Strasbourg Strasbourg France F-67091 F-67091 Strasbourg, France
Titolo Testata:
ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION
fascicolo: 8, volume: 18, anno: 1999,
pagine: 866 - 895
SICI:
0750-7658(199910)18:8<866:MOOTAD>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
FRE
Soggetto:
PROTEIN-KINASE-C; RAT LOCUS-COERULEUS; NITRIC-OXIDE SYNTHASE; ELEMENT-BINDING PROTEIN; MESSENGER-RNA LEVELS; CHRONIC MORPHINE TREATMENT; NMDA RECEPTOR ANTAGONISTS; PRIMARY SENSORY NEURONS; IN-SITU HYBRIDIZATION; NG108-15 HYBRID-CELLS;
Keywords:
opioids; tolerance; cellular mechanisms; clinical variability;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
188
Recensione:
Indirizzi per estratti:
Indirizzo: Muller, A Hop Univ Strasbourg, Hop Civil, Clin de la Douleur, 1 Pl Hop,BP 426, F-67091 Strasbourg, France Hop Univ Strasbourg 1 Pl Hop,BP 426 Strasbourg France F-67091 e
Citazione:
A. Muller et al., "Mechanisms of opioid tolerance and dependence", ANN FR A R, 18(8), 1999, pp. 866-895

Abstract

Objective: Prescription of opiates to non cancer chronic pain patients is controversial, partly because of the risk of tolerance and dependence development. The two objectives of that review were: a) to identify the factors which may explain the variability of tolerance and dependence in clinical practice; b) to analyse the cellular mechanisms of occurrence of those phenomenons. Data sources and extraction: To our own file, we added articles retrieved in the Medline(R) database, using, alone or in combination, following key-words (opiate, tolerance, dependence, opiate receptor, pain treatment, cAMP,cGMP, NO, NMDA, protein kinase, gene). Out of nearly 450 articles, we selected less than 200. Data synthesis: Tolerance, defined as loss of opioid efficacy with time, is extremely variable and depends on pain mechanisms, intrinsic efficacy andadministration modality of the opioid, as well as co-administration of other agents. Physical dependence is a consequence of the intrinsic and extrinsic adaptations concerning structures as locus coeruleus, paragigantocellular nucleus, spinal cord. Acute and chronic application of opiates and withdrawal give rise to cellular adaptations which depend on the nature and efficacy of the opiate, the type of receptor and second messengers, as well as the type of cell line under study. These cellular mechanisms have consequences on neuronal excitability and gene expression. They constitute a model of cellular tolerance and dependence, but cannot explain the subtelties encountered in clinical practice. (C) 1999 Editions scientifiques et medicales Elsevier SAS.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 03:53:07