“…IL-6 elevation after morphine (Johnston et al, 2004;Dave and Khalili, 2010) is dependent on sphingosine kinase (Muscoli et al, 2010), p38, CGRP , and TLR2 and could also be blocked by etanercept (Shen et al, 2011), naltrexone (Bokhari et al, 2009), amitriptyline (Tai et al, 2006;Tai et al, 2009), and propentofylline (Raghavendra et al, 2004a). Finally, morphine elevation of TNF-␣ (Johnston et al, 2004) is dependent on TLR2 , ceramide synthase ), p38, and CGRP ) and is sensitive to amitriptyline (Tai et al, 2006;Tai et al, 2009), naltrexone (Bokhari et al, 2009), naloxone, and -funaltrexamine (Sawaya et al, 2009). Other nonclassic opioid ligands such as (ϩ)-morphine, (ϩ)-methadone and morphine-3-glucuronide are also capable of inducing upregulation of IL-1, IL-6, and TNF-␣ (Hutchinson et al, 2010a;Lewis et al, 2010), suggesting a possible role for nonclassic opioid pathways in inducing opioid proinflammatory responses.…”