Acute Morphine Administration Reduces Cell-Mediated Immunity and Induces Reactivation of Latent Herpes Simplex Virus Type 1 in BALB/c Mice

Mojadadi, Mohammad-Shafi; Jamali, Abbas; Khansarinejad, Behzad; Soleimanjahi, Hoorieh; Bamdad, Taravat

doi:10.1038/cmi.2009.15

Cited by 31 publications

(16 citation statements)

References 33 publications

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“…18–23 Opioids are associated with immunosuppression and opioid-induced endocrinopathy (sexual dysfunction, depression, decreased energy). 24–30 Opioids are implicated in opioid-induced hyperalgesia or increased pain sensitivity despite increasing doses of opioids. This hyperalgesia has been demonstrated with exposure to both short- and long-term opioids.…”

Section: Risks Associated With Opioid Use After Surgerymentioning

confidence: 99%

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Hah

Bateman

Ratliff³

et al. 2017

Anesthesia &Amp; Analgesia

505

221

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Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance two competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use following the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that post-surgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use following surgery, and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery, and proceed with an analysis of the extent to which opioid sparing perioperative interventions (e.g., nerve blockade) have been shown to reduce the risk of chronic opioid use following surgery. We then conclude with a discussion of future research directions.

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Section: Risks Associated With Opioid Use After Surgerymentioning

confidence: 99%

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Hah

Bateman

Ratliff³

et al. 2017

Anesthesia &Amp; Analgesia

505

221

View full text Add to dashboard Cite

show abstract

“…The adverse effects of prescription opioids are well documented including the presence of tolerance and physical dependence [8][9][10][11][12][13][14][15][16][17][18][19][20]. Opioids are also implicated in opioidinduced hyperalgesia or increased pain sensitivity despite increasing doses of opioids [21][22][23].…”

mentioning

confidence: 99%

Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate

Hah

Mackey

Barelka³

et al. 2014

Pain Med

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Objective We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%–64%) reduction in the rate of opioid cessation following surgery. (1) We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs. somatic) associated with a decreased rate of opioid cessation after surgery. Methods We conducted a secondary analysis of the data from a previously reported (1) prospective, longitudinal, observational study of opioid use after 5 distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. Results The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75–0.99, p-value 0.037). Conclusions Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

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“…Morphine acts primarily as a μ-opioid receptor agonist with lesser affinity for the δ-opioid and κ-opioid receptors [12]. These G-protein coupled receptors are expressed in multiple regions, including the central nervous system [13,14], the gastrointestinal tract [15], and immune system [16], and can induce effects ranging from analgesia and addiction to peripheral immunosuppression [17–20]. …”

Section: Introductionmentioning

confidence: 99%

Long-term morphine delivery via slow release morphine pellets or osmotic pumps: Plasma concentration, analgesia, and naloxone-precipitated withdrawal

et al. 2017

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Aims Slow-release morphine sulfate pellets and osmotic pumps are common routes of chronic morphine delivery in mouse models, but direct comparisons of these drug delivery systems are lacking. In this study, we assessed the efficacy of slow-release pellets versus osmotic pumps in delivering morphine to adult mice. Main methods Male C57BL/6NCr mice (8 weeks old) were implanted subcutaneously with slow-release pellets (25 mg morphine sulfate) or osmotic pumps (64 mg/mL, 1.0 μL/hour). Plasma morphine concentrations were quantified via LC-MS/MS, analgesic efficacy was determined by tail flick assay, and dependence was assessed with naloxone-precipitated withdrawal behaviors (jumping) and physiological effects (excretion, weight loss). Key findings Morphine pellets delivered significantly higher plasma drug concentrations compared to osmotic pumps, which were limited by the solubility of the morphine sulfate and pump volume/flow rate. Within 96 hours post-implantation, plasma morphine concentrations were indistinguishable in pellet vs. pump-treated samples. While osmotic pump did not have an antinociceptive effect in the tail flick assay, pumps and pellets induced comparable dependence symptoms (naloxone-precipitated jumping behavior) from 24–72 hours post-implantation. Significance In this study, we compared slow-release morphine pellets to osmotic minipumps for morphine delivery in mice. We found that osmotic pumps and subcutaneous morphine sulfate pellets yielded significantly different pharmacokinetics over a 7-day period, and as a result significantly different antinociceptive efficacy. Nonetheless, both delivery methods induced dependence as measured by naloxone-precipitated withdrawal.

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Acute Morphine Administration Reduces Cell-Mediated Immunity and Induces Reactivation of Latent Herpes Simplex Virus Type 1 in BALB/c Mice

Cited by 31 publications

References 33 publications

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate

Long-term morphine delivery via slow release morphine pellets or osmotic pumps: Plasma concentration, analgesia, and naloxone-precipitated withdrawal

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