Opioids in the immune system: from experimental studies to clinical practice

Abstract

SUMMARY INTRODUCTION: Opioids interact with both innate and adaptive immune systems and have direct effects on opioid receptors located on immune cells. Research on this topic has provided evidence of the opioid influence on the immune response associated with surgical stress. The immunological effects of opioids are currently being investigated, particularly whether they influence the outcome of surgery or the underlying disease regarding important aspects like infection or cancer progression. This review addresses background research related to the influence of the opioid receptor on the immune system, the immunosuppressive effect associated with major opioids during the perioperative period, and their clinical relevance. The objective of the study was to review the effects of opioids on the immune system. Methods: A search strategy was conducted in PubMed, Embase, and the Cochrane databases using the terms “immunosuppression,” “immune system,” “surgical procedures,” “analgesics,” “opioids” and “perioperative care.” Results: The immunosuppressive effect of opioids was identified over 30 years ago. They include signaling and acting directly through immune cells, including B and T lymphocytes, NK cells, monocytes, and macrophages, as well as activating the downstream pathways of the hypothalamic-pituitary-adrenal (HPA) axis leading to the production of immunosuppressive glucocorticoids in the peripheral and sympathetic nervous system.

Preoperative chronic opioid use and its impact on early complications in bariatric surgery: a Swedish nationwide cohort study of 56,183 patients

“…An intact immune system has a central role in tissue healing after surgery and an impaired immune system might therefore led to an increased risk of severe complications and need of reoperation. Based on these findings, it seems likely that chronic opioid users, particularly those with high dosages, may be more susceptible to complications related to poorer tissue healing and infections (30) .…”

Frequency of Candida species in the oral cavity of narcotics and stimulants smokers in Isfahan, using polymerase chain reaction-restriction fragment length polymorphism method

“…[ 19 46 47 48 49 ] The HIV and drug use both significantly affect cellular immunity and especially T lymphocytes so that they interfere with the ratio of CD4+/CD8+ cells while decreasing CD4+ cells. [ 21 50 51 ] It seems that geographical climate, time, underlying factors, population and type of the sample under study as well as the method used can probably contribute to the presence of various species of Candida in communities and the reason for the differences between the results of the present study and the findings of the inconsistent studies.…”

“…[ 18 19 ] Concerning the current claims, with weakening the immune system, addiction provides conditions for the development of chronic infections such as oral thrush or candidiasis. [ 20 21 ] A plethora of previous studies indicates that oral candidiasis is one of the most common oral infections, particularly in individuals with weakened immune systems, including addicts, and in some cases, as it becomes resistant to treatment, it creates certain problems. [ 20 22 ] The application of certain substances lead to changes such as Candidiasis, frictional hyperkeratosis, gingivostomatitis, aphthous stomatitis, and herpes simplex, which are normally found in the oral mucosa.…”

Immunomodulation by ketamine as an adjunct to total intravenous anesthesia in patients undergoing minimally invasive radical prostatectomy: A randomized pilot trial

“…Propofol has been shown to preserve or suppress NKCC to a lesser degree than any other anesthetics (4,7). In contrast, the specific effects of remifentanil on NKCC are unclear due to the limited current literature related to remifentanil (19)(20)(21). A significant reduction of NKCC due to remifentanil infusion in a rat model was reported (21), whereas no alteration in the number or the cytotoxic function of NK cells was observed in healthy volunteers given low-dose remifentanil (19).…”