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Opioid-induced hyperalgesia (OIH) or opioid-induced abnormal pain sensitivity, also called paradoxical hyperalgesia, is an uncommon condition of generalized pain caused by the long-term use of high dosages of opioids [1] such as morphine, [2] oxycodone, [3] and methadone. [4] [5] OIH is not necessarily confined to the original affected site. [6]
About 70% of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. [22] [23] [24] It is a Schedule II drug in the United States, [23] Class A in the United Kingdom, [5] and Schedule I in Canada. [25] It is on the World Health Organization's List of Essential Medicines. [26]
Hydrocodone is a highly selective full agonist of the μ-opioid receptor (MOR). [28] [54] [49] This is the main biological target of the endogenous opioid neuropeptide β-endorphin. [55] Hydrocodone has low affinity for the δ-opioid receptor (DOR) and the κ-opioid receptor (KOR), where it is an agonist similarly. [49]
Opioids act upon opioid receptors that are coupled to inhibitor G protein coupled receptors (GPCR). These receptors fall into 3 classes: μ (mu), δ (delta), and κ (kappa) receptors. [36] More than 70% of opioid receptors are μ receptors, predominantly located on the central terminals of nociceptors in the dorsal horn of the spinal cord.
Tramadol also acts as an opioid agonist and thus can increase the risk for side effects when used with other opioid and opioid-containing analgesics (such as morphine, pethidine, tapentadol, oxycodone, fentanyl, and Tylenol 3). [61] Tramadol increases the risk for seizures by lowering the seizure threshold.
Now opioid deaths are occurring in the suburbs and rural communities, where methadone clinics are few and far between, making the need for a new medical model that much more apparent. “You got all these people with this disease who need treatment,” he said.
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