Opioid-induced immunosuppression and carcinogenesis promotion theories create the newest trend in acute and chronic pain pharmacotherapy

Kościuczuk, Urszula; Knapp, Paweł; Lotowska-Cwiklewska, Anna Maria

doi:10.6061/clinics/2020/e1554

Cited by 17 publications

(12 citation statements)

References 46 publications

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“…Post-viral syndrome can result in organ damage that can lead to exacerbation of chronic pain [ 10 ]. Furthermore, chronic pain can increase the subspecialty to viral infection to due compromised immunity as a result of stress, sleep deficit, and the use of opioid [ 11 ]. COVID19 is often presented with myalgia, arthralgia, musculoskeletal dysfunction, decreased bone mineral density, and joint disorder [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Does COVID19 activates previous chronic pain? A case series

Alizadeh

Aghsaeifard

2021

Annals of Medicine and Surgery

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Introduction With the outbreak of coronavirus, the number of patients who referred to the pain clinic for follow-up was much higher than before, which coincided with the onset of the coronavirus pandemic. However, due to incomplete knowledge regarding the virus and its effects, patients did not follow up to the pain. Methods We present case of 8 patients who were treated previously for chronic pain (complete remission). Results During the pandemic, these patients were presented to our center presenting identical pain, that did not respond to the conservative therapy. Owing to the symptoms, these patients were screened and tested positive for COVID19. Two of the patients died whereas, symptoms were improved in other patients. Conclusion Patients with the history of chronic pain may present relapse as a result of the infection or infection can trigger previous chronic pain among patients with risk factors.

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Section: Discussionmentioning

confidence: 99%

Does COVID19 activates previous chronic pain? A case series

Alizadeh

Aghsaeifard

2021

Annals of Medicine and Surgery

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“…However, the effects of overanalgesia are not only of an apparent manner, such as hypotension, bradycardia, respiratory depression, and intestinal paralysis due to excessive use of opioids. Opioids can potentially cause negative immunomodulatory effects, which should be considered, especially in the critically ill patient (31)(32)(33)(34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

Measurement of the nociceptive flexion reflex threshold in critically ill patients - a monocentric prospective observational study

Schick

Mayer

Walter

et al. 2021

Preprint

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Background Pain detection and treatment is a major challenge in the care of critically ill patients. However, in addition to the risk of analgesic undersupply, there is also the risk of overanalgesia. In the perioperative context, the measurement of the nociceptive flexion reflex threshold has become established for measuring the level of analgesia. To date, however, it is unclear whether measurement of NFRT can be usefully applied to noncommunicating, ventilated, and analgosedated ICU patients. Therefore, the aim of the present study was to investigate whether NFRT measurement correlates with the Behavioral Pain Scale (BPS) in critically ill, analgosedated, and mechanically ventilated patients and whether it can also detect possible overanalgesia.Methods In this prospective, observational, single-center study, 114 patients were included. All patients were admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany. First measurements of the NFRT and the Behavioral Pain Scale (BPS) were conducted within 12 hours after admission. In the further observation period, a structured pain assessment was performed at least twice daily until extubation (Group A: BPS + NFRT, Group B: BPS). Univariate analysis was performed to evaluate possible associations between NFRT measurement and baseline characteristics. Furthermore, mixed linear regression modeling was used to evaluate possible effects of administered analgesics or sedatives on NFRT. Results NFRT correlates negatively with the Behavioral Pain Scale. NFRT was almost twice as high in patients with a RASS of -5 compared with patients with a RASS ≥ -4 (RASS -5 - NFRT: 59.40 vs. RASS -4 - NFRT: 29.00, p < 0.001). By means of NFRT measurement, potential overanalgesia could not be detected.Conclusion The NFRT measurement reliably correlates negatively with the Behavioral Pain Scale in critically ill patients. In patients with RASS scores ≤ -4, in whom analgesia level is often difficult to assess, NFRT measurement provides guidance in the assessment of nociceptive processes. However, in order to detect possible overanalgesia and to derive therapeutic consequences, a defined stimulus threshold must be determined for the critically ill patient, above which the absence of pain can be safely assumed.Trial Registration Retrospectively registered at German Clinical Trials Register, registration number DRKS00021149, date of registration: March 26, 2020. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021149

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“…Initial concern regarding the immunosuppressive effects of chronic opioid administration dates back to the 1890s 19,20 . The use of opioids affects both innate and adaptive immunity 21,22 . Opioid receptors (OP) include the mu (MOP), delta (DOP), kappa, (KOP), and non‐classic nociceptin/orphanin FQ (FOP) receptors, and all of them have analgesic effects 23 .…”

Section: Opioid Use In Patients With Chronic Pain and Immunologymentioning

confidence: 99%

“…Importantly, T lymphocytes express the 3 ordinary opioid receptor types (MOP, KOP, and DOP). Continued opioid use induces T lymphocyte differentiation toward the Th2 subset while promoting Th1 apoptosis, thereby decreasing the Th1/Th2 ratio 21,22 . This is relevant because the cytokine release syndrome that occurs during COVID‐19 infection can be attributed to Th1 cell activation.…”

Section: Opioid Use In Patients With Chronic Pain and Immunologymentioning

confidence: 99%

“…B‐lymphocytes are largely involved with humoral immunity, primarily via antibody and memory cell production. Opioid effects on these cells are not well understood; however, they have been reported to include decreased antibody production, increased anti‐inflammatory cytokines, such as growth factor β, and secretion of nuclear factor κB, which causes Th1 apoptosis 22 …”

Section: Opioid Use In Patients With Chronic Pain and Immunologymentioning

confidence: 99%

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How to Restart the Interventional Activity in the COVID‐19 Era: The Experience of a Private Pain Unit in Spain

et al. 2020

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Introduction: The situation generated in the health system by the COVID-19 pandemic has provoked a crisis involving the necessity to cancel non-urgent and oncologic activity in the operating room and in day-today practice. As the situation continues, the need to reinstate attention for patients with chronic pain grows. The restoration of this activity has to begin with on-site appointments and possible surgical procedures. On-site clinical activity has to guarantee the safety of patients and health workers.

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Opioid-induced immunosuppression and carcinogenesis promotion theories create the newest trend in acute and chronic pain pharmacotherapy

Cited by 17 publications

References 46 publications

Does COVID19 activates previous chronic pain? A case series

Does COVID19 activates previous chronic pain? A case series

Measurement of the nociceptive flexion reflex threshold in critically ill patients - a monocentric prospective observational study

How to Restart the Interventional Activity in the COVID‐19 Era: The Experience of a Private Pain Unit in Spain

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