How Morphine Controls Acute Pain

Marisa R. Adelman, M.D. as Assistant Professor, with a specisl interest in Minimally invasive gynecology. Dr. Adelman received a B.A. from Johns Hopkins University, and her M.D. from the University of Virginia. She completed her Obstetrics

Understanding medications and relating them to a patient’s care is a legal requirement for the RN. Morphine an opioid analgesic is for moderate to severe pain which has respiratory suppression as the main side effect, naloxone and resuscitation equipment should be close by to reverse this effect. (Tiziani, 2013). Glyceryl trinitrate (GTN) used for chest pain, works by causing vasodilation to the blood vessels therefore increasing blood flow to the heart, the risk of repeated doses may lead to hypotension (Tiziani, 2013). Aspirin is used as an antiplatelet for Mr Jones and given for a suspected myocardial infarction (MI) due to plaque that may have broken away within a coronary artery and formed a blood clot that leads to a blockage (Tiziani,

In the alleviation of pain in chronic conditions such as cancer and rheumatoid arthritis, opioids are used. The codeine that falls under opioids is ten times less efficient compared to morphine. Some opioid analgesics such as hydromorphone are more potent compared to morphine, reports Rxlist. The opioid drugs act by binding to opioid receptors in the central nervous system. Unlike other analgesics that inhibits cyclooxygenase enzymes involved in mediating the

Philippe Lucas’s article “Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain” recommends using cannabis instead of opiates to relieve chronic pain. He also proposes cannabis may be used to treat prescription opiate abuse by patients suffering from chronic pain and depicts cannabis as a medicine and not a gateway drug. Lucas suggests national governments abandon misinformation emphasizing drug prohibition and start supporting the claim that cannabis effectively treats a variety of illnesses including chronic pain, and is a possible “drug exit” for problematic substance abuse. Appeals to logos, ethos, and pathos are frequently present, creating the ideal balance of evidence and theory regarding medicinal cannabis and opiates.

Narcotic analgesics, especially morphine are underused for pain control with in the medical field. This underuse is because medical professionals, including doctors, fear patient addiction, side effects and possible lose of their licenses. These fears deny adequate healing and a better quality of life to those who would benefit from a more effective use of these drugs, as done in hospice care.

This hinders the production of the neurotransmitter ACh, resulting in fewer action potentials being transmitted down the neurones and hence a numbing effect is experienced. It is thought that morphine and other narcotics may exploit this natural mechanism that has evolved for the similarly-shaped enkephalins. Heroin is a far more powerful drug than morphine, possibly because the drugpasses the blood-brain barrier far more readily. The heroin is then hydrolysed to morphine once inside the body and so the pain-killing mechanism is likely to be very similar to the way in which morphine works. However, it is common to develop tolerance and desensitization towards opioids as the opioid receptors are continually used. This has been termed “the cascade of cellular adaptation” (Strelzer J, 2001; Borgland SL, 2001). Furthermore, animal studies have suggested that, in the case of morphine taken during chronic pain, not only tolerance is acquired towards its analgesic effects, but also an increased sensitivity towards pain actually develops (Ibuki T, et al, 1997; Celerier E et al, 2001).

The most commonly available exogenous opioids primarily work by “high jacking” μ receptor functionality. μ receptors can be found throughout our brain and spinal cord and control reward, euphoria, analgesia, breathing, and nausea. These receptors are designed to be activated by our endogenous opioids. Exogenous opioids, however, are far better at attaching themselves and activating these same receptors. The result is an overactivation of these receptors throughout the body.

This operation requires 3 to 5 small incisions be made in your lower stomach. A medical laparoscope is an instrument with a slender tube and an attached camera that the surgeon puts into one of the incisions in order to see where the damaged area is located. Your stomach is filled with gas so that the surgeon has a good view of the area where he will be working. One larger cut may be required if the surgeon needs to put a hand inside of the stomach to help remove the colon. It is not unusual to remove some lymph nodes while removing the damaged areas. The incisions will be closed with stitches or staples.

Opioid receptors can be separated into two different categories: classic and non-classic. Classic consists of the Mu (), Kappa (), Delta () receptors[15]. While the Non-classic includes only ORL1[15]. As shown in Figure 9, presynaptic neutrons contain opioid receptors are G-protein coupled receptors with seven transmembrane helical twist alongside three extracellular and intracellular loops[15]. Further, G-proteins are typically made of three subunits which include , , and . These receptors can be activated by either an endogenous peptide or an exogenous drug that acts as an agonist[16]. In this case, morphine is an exogenous drug that can mimic the response of an endogenous peptide such as endorphins[16]. If opioid receptors is inactive, the Ca2+ ion channels are open which permits the flow of Ca2+ ions into the presynaptic neuron. Simultaneously, the K+ ion channel is closed that prevents any release of K+ ions to the extracellular space.

There is a growing concern for the use of opiates in pain management and other medical treatments. Due to illegal use and abuse of the opiates, there has been an increase in overdose and dependency throughout the nation and even the world. The use of opiate substances can include pain management and even cough suppression in severe cases; however, the side affects make the drugs appealing to those with substance abuse problems. President Donald Trump has declared the opioid epidemic a national public health emergency, which has led to the discussions of how to control the abuse of these substances (Merica). Despite the growing concern about opioid use, there are some benefits in the use of opioid substances in pain management. Many argue,

Next, there is an extensive history of opioid use for pain management, and other symptom management as well. Morphine can be traced back to Civil War veterans trying to manage pain and, consequently, being addicted. “‘Drugs were already on the scene and being consumed at alarming rates long before the start of the war,’ said Mark A Quinoes, a scholar who studied drug abuse during the Civil War.” It was not until 1898 that heroin was on the market for commercial sale, considered a “wonder drug,” it began to spread in use along with users that found out injecting it would increase its effects. There was little known about these new opioids, they were even used as cough suppressants. Heroin worked for what is was being used as, a pain suppressant, and there were few other options. In 1914 the Harrison Narcotics Tax Act imposed a tax on importing and selling opium or coca leaves. In 1924 doctors were avoiding using opioids after being aware of their addictive nature which lead heroin becoming illegal. Without this opioid, doctors had to get creative when treating World War II soldiers, this sparked research into nerve blockers. These nerve blockers managed pain without the use of surgery. This was, unfortunately, not the end of the opioid. While these results were shocking the pharmaceutical industry still faces much leniency from the federal

The opioids produce analgesic effects no matter is endogenous or synthetic, including morphine, codeine and methadone. (3)Endogenous opioid peptides such as endorphins, enkephalins and dynorphins activate opioid receptors including mu-receptors (mainly), delta-receptors, kappa-receptors and ORL1 receptors to produce different effects. One of the non-analgesic effects is the disruption of sleep-wake behaviour by the opioids’ actions on the ventrolateral preoptic nucleus (VLPO). The differences of the pharmacokinetic properties between the 3 opioids mentioned and the possible mechanisms of sleep-wake regulations will be discussed below.

This is complicated by the observation that estradiol can attenuate the analgesic effects of morphine and that females often require higher doses than males to achieve similar levels of analgesia (Kest, Sarton, & Dahan, 2000). However, most studies manipulated circulating estrogen instead of examining its local effects on morphine (Craft, Mogil, & Aloisi, 2004). There is evidence that estrogen may have different effects on MORs, depending on if they are located peripherally, spinally, or supraspinally (Ji, Murphy, & Traub, 2003). Further complicating this, estrogen appears to increase morphine potency at low and high doses but attenuate it at intermediate doses, suggesting that its effect on MORs is bidirectional (Craft et al., 2008). The majority of studies also exclusively used morphine which binds much more strongly to MORs than to either DORs or KORs. This is important because DORs and KORs have slightly different roles in nociception than MORs do. For example, DORs are only mildly antinociceptive during acute pain but have a significantly greater effect in chronic pain (Hurley & Hammond, 2000).

Opioids are drugs taken for relieving pain. This drug has its effect on the human body through the reduction of the intensity of neuro-pain signals which are relayed to the brain (Opioids, 2009). Classic examples are the painkillers that include morphine, methadone, and hydrocodone among others. Pain is a physical suffering caused by illness or injury and may vary from steady to constant and throbbing to pulsating. It is not reasonable for anyone of us to except no pain except for those who suffer from anhydrases. This is an unusual genetic disorder that makes one unable to feel pain. Opioids play a significant role in the health system but they can be hazardous if used for pleasure or in a case of addiction. It is therefore important that

A laparoscopic approach appears to be associated with a reduction in surgical trauma and blood loss. In addition, it is presumable that some of the benefits of minimally invasive surgery such as reduced analgesic requirements, a shorter recovery period and reduced hospital stay (Kuhry, 2005). It has become a forerunner in the quest of improving surgical results by dropping postoperative pain and lessening recovery time. Yet, the use of laparoscopic instruments can be awkward and cumbersome, thus escalating operative time and dropping dexterity, which can