Ketamine in Chronic Pain - McMaster University
Ketamine in Chronic Pain - McMaster University
Ketamine in Chronic Pain - McMaster University
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Opioids, Tolerance and Hyperalgesia<br />
A grow<strong>in</strong>g body of evidence now po<strong>in</strong>ts to a general <strong>in</strong>teraction between the<br />
NMDA and opioid receptor systems <strong>in</strong> many aspects of pa<strong>in</strong> and pa<strong>in</strong><br />
modulation.<br />
The cl<strong>in</strong>ical Interactions between NMDA and opioid receptors could occur <strong>in</strong> 2<br />
directions. Thus, any condition which would result <strong>in</strong> activation of NMDA<br />
receptors with<strong>in</strong> the CNS could modulate opioid receptors caus<strong>in</strong>g reduced<br />
efficacy of opioid analgesia; conversely, repeated treatment with opioids<br />
could set up a condition mimick<strong>in</strong>g ongo<strong>in</strong>g nociceptive <strong>in</strong>put through<br />
<strong>in</strong>teractions between opioid and NMDA receptors.<br />
Apparently, a common factor <strong>in</strong> both directions is the activation of NMDA<br />
receptors.<br />
Most likely kappa receptors are responsible for these effects.
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