Pain clinic and drugs of abuse

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  • SUZUKI Tsutomu
    Department of Toxicology, Hoshi University School of Pharmacy and Pharmaceutical Sciences
  • YAJIMA Yoshinori
    Department of Toxicology, Hoshi University School of Pharmacy and Pharmaceutical Sciences
  • NARITA Minoru
    Department of Toxicology, Hoshi University School of Pharmacy and Pharmaceutical Sciences

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Other Title
  • ペインクリニックと依存性薬物
  • ペインクリニック ト イゾンセイ ヤクブツ

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Abstract

Opioid analgesics are usually prescribed for patients being treated in the pain clinic. However, opioids have undesirable effects such as physical and psychological dependence. To avoid causing drug dependence, we should understand the strategies for use and the risks of these drugs. Although the mechanism of psychological dependence on drugs of abuse is very complex, it is well established that the mesolimbic dopaminergic system, projecting from the ventral tegmental area of the midbrain to the nucleus accumbens, is the critical substrate for psychological dependence on drugs of abuse. However, various studies provide evidence that noradrenergic transmission originating from the locus coeruleus is most likely to play the primary causal role in the expression of physical dependence on morphine. In addition, there is considerable evidence suggesting that GABAergic and glutamatergic systems may also contribute to the development of physical dependence on drugs of abuse. This review attempts to summarize some of the mechanisms underlying the development of dependence on drugs of abuse in the pain clinic and the prevention of psychological dependence on opioids under the condition of chronic pain.

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