Influence of opioids on immune function in patients with cancer pain: from bench to bedside

Abstract

This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc.

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

“…The catecholamines excreted from the adrenal glands showed depression of NK cell activity, as well as decreased proliferation and differentiation of peripheral blood lymphocytes. The effects associated with glucocorticosteroids are associated with the modulation of transcription of genes related to both innate and adaptive immune defense (13)(14)(15)(16)(17).…”

“…It seems that in the perioperative period, many pharmacological substances used during general anesthesia cause immunosuppression through modulation of the oxidative balance and activation of HPA and the sympathomimetic system. These mechanisms have been reported to increase ROS concentration and release catecholamines and prostaglandins, which in turn induce the secretion of chemokines, immunosuppressive cytokines and proinflammatory cytokines that promote angiogenesis in tumor tissues and metastases (12,14,16).…”

“…The functions and significance of MORs have been well understood and described. The most important aspect related to NOR activation is analgesic effects at the spinal cord level, and unlike other opioid receptors, NORs do not contribute to the development of respiratory depression and have minimal risk of tolerance or addiction (11)(12)(13)(14).…”

Opioide supprimieren das Immunsystem

“…der damit verbundene Stress, Schmerz und mögliche chirurgische Interventioneneinen negativen Einfluss auf die natürliche Killerzell-Aktivität hat [5]. Werden in diesem situativen Kontext Opiodie gegeben, so führen sie über eine Reduktion von Stress und Schmerz zu einer verbesserten natürlichen Killerzell-Aktivität [6]. In den meisten bisherigen klinischen Studien lag der Fokus auf einem bestimmten Immunparameter (wie die natürliche Killerzell-Aktivität)und das, wo es doch noch zahlreiche andere Immunparameter gibtwährend klinische Outcome Parameter nicht erhoben wurden.…”

Emerging areas of opioid pharmacology

“…However, further studies at the clinical and epidemiological level are required to determine the importance of such interactions to the patient. Opioid drugs are often prescribed to manage pain in cancer, but as described by Boland and Pockley (), opioids can also affect the entry of immune cells into the tumour micro‐environment. Some of these effects vary with the exact opioid drug being employed while some of the effects of opioid drugs on immune cells may be mediated by non‐opioid receptor mechanisms.…”