Targeting peripheral opioid receptors to promote analgesic and anti-inflammatory actions

Abstract

Mechanisms of endogenous pain control are significant. Increasing studies have clearly produced evidence for the clinical usefulness of opioids in peripheral analgesia. The immune system uses mechanisms of cell migration not only to fight pathogens but also to control pain and inflammation within injured tissue. It has been demonstrated that peripheral inflammatory pain can be effectively controlled by an interaction of immune cell-derived opioid peptides with opioid receptors on peripheral sensory nerve terminals. Experimental and clinical studies have clearly shown that activation of peripheral opioid receptors with exogenous opioid agonists and endogenous opioid peptides are able to produce significant analgesic and anti-inflammatory effects, without central opioid mediated side effects (e.g., respiratory depression, sedation, tolerance, dependence). This article will focus on the role of opioids in peripheral inflammatory conditions and the clinical implications of targeting peripheral opioid receptors.

Keywords: analgesia; anti-inflammatory; immune cells; inflammation; opioids; pain; peripheral opioid receptors.

FIGURE 1

Migration of opioid-containing immune cells and opioid release within inflamed tissue. Adhesion molecules interact with their respective ligands to facilitate endothelial transmigration of immune cells. In response to stress or releasing agents (e.g., CRF, IL-1, CXCL8), the immune cells secrete opioid peptides. Opioid peptides or exogenous opioids bind to opioid receptors on primary afferent neurons, leading to analgesia. Direct adhesion between opioid-containing immune cells and peripheral sensory neurons (via ICAM-1 and/or NCAM) may be necessary to release opioid peptides within the effective range of peripheral opioid receptors. The immune cells, depleted of opioids, then migrate to regional lymph nodes. The arrows denote an increased expression within inflamed tissue of cell adhesion molecules, opioid receptors, endogenous opioid peptides, and receptors for ligands that trigger opioid release on the surface of immune cells (e.g., CXCR2, IL-1 receptors, CRF receptors). This all enhances the analgesic and anti-inflammatory activity of the peripheral opioid pathway in inflammatory conditions.