Medical Pharmacology Chapter 13:  Pain Management:  Opioids

• Chronic Pain and the Brain

  • "Pain and the Brain"

    Attribution: Basbaum, A, Ph.D.  "Pain and the Brain"  https://www.youtube.com/watch?v=gQS0tdIbJ0w University of California Television (UCTV) YouTube Channel:  https://www.youtube.com/channel/UCh6KFtW4a4Ozr81GI1cxaBQ

• Opioid Receptor Distribution

  • Spinal cord: dorsal horn

    • Spinal Cord Dorsal Horn and Pain Pathways

      C Fibers are small, unmyelinated nerves with slow conduction velocities that carry dull, aching burning pain impulses. Thinly myelinated A afferent fibers carry fast, sharp, shooting pain sensations and are most integral to the propagation of mechanical pressure stimuli from muscles, joints, and bone. Compared with these fibers, C afferent fibers have a higher threshold for mechanical stimuli and a smaller field of reception. Both these classes of nociceptive fibers ultimately synapse with neurons in the dorsal horn of the spinal cord. The dorsal horn contains several types of neurons that become hyperexcited by distinct types of stimuli from primary afferent nociceptors. Class I cells respond to low-threshold mechanical and thermal impulses and class III respond only to stimuli resulting from tissue damage (ie, they are nociceptive-specific) class II neurons have a wide dynamic range. Nociceptive stimuli that activate these neurons are transmitted to the brain via the spinothalamic, spinoreticular, or spinomesencephalic tracts (STT, SRT, SMT, respectively). courtesy of Roxane Pain Institute used with permission

  • Primary afferents to pain transmission neurons

    • Opioid agonists:

      • Inhibit excitatory transmitters release from these primary afferents

      • Inhibit dorsal horn pain transmission neurons

      • Clinical application: directed administration of opioid agonists allow regional analgesia which minimizes CNS side effects.

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