Year 2019 / Volume 26 / Number 6

Special Article

Key factors governing spinal cord opioid bioavailability in the management of acute pain

Rev. Soc. Esp. Dolor. 2019; 26(6): 359-367 / DOI: 10.20986/resed.2019.3737/2019

Borja Mugabure Bujedo


ABSTRACT

Although there is no either ideal analgesic or route of neuraxial administration, clinicians alike continue to search for compounds with qualities which may approach this idea. However, it´s a demonstrated fact that spinal administration of an opioid drug does not always guarantee segmental and selective analgesia into the spinal cord. This point is valid due to partial reuptake of the drug to systemic blood circulation reaching specific brain opioid receptors, rather than the differences are explained by variations in the clearance rate from the cerebrospinal fluid. Published evidence from either human or animal experimental studies indicates that bioavailability in the spinal cord biophase is negatively correlated with liposolubility. Therefore, opioid spinal cord bioavailability is higher for hydrophilic opioids like morphine, than for lipophilic ones such as fentanyl, sufentanil or alfentanil.



RESUMEN

Aunque no existe un analgésico ni una vía de administración neuroaxial ideal, los clínicos continúan buscando compuestos con cualidades que puedan acercarse a esta idea. Sin embargo, se ha demostrado que la administración espinal de un medicamento opioide no siempre garantiza una analgesia segmentaria y selectiva en la médula espinal. Este punto es cierto debido a la recaptación parcial del fármaco a la circulación sistémica sanguínea que alcanza receptores opioides cerebrales específicos, además de las diferencias que se explican por las variaciones en la tasa de eliminación del líquido cefalorraquídeo. La evidencia publicada de estudios experimentales en humanos o animales indica que la biodisponibilidad en la biofase medular está
correlacionada negativamente con la liposolubilidad. Por lo tanto, la analgesia espinal es mayor para los opioides hidrófilos como la morfina, que para los lipófilos como el fentanilo, el sufentanilo o el alfentanilo.





Complete Article

Nuevo comentario

Security code:
CAPTCHA code image
Speak the codeChange the code
 

Comentarios

No comments in this article

Tablas y Figuras

Table I

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Artículos relacionados

Superior hypogastric plexus block for the management of non-oncological chronic pelvic pain: effectiveness and safety

Rev. Soc. Esp. Dolor. 2023; 30(2): 109-114 / DOI: 10.20986/resed.2023.4038/2022

Review of the remission and management of a cancer related pain population to a pain unit. What can we improve?

Rev. Soc. Esp. Dolor. 2023; 30(1): 7-14 / DOI: 10.20986/resed.2023.4010/2022

How to prevent the abuse of opioids without hindering access to them for those patients who need them?

Rev. Soc. Esp. Dolor. 2023; 30(1): 1-2 / DOI: 10.20986/resed.2023.4078/2023

Cross-sectional study on factors related to chronic pain and its care, according to sex

Rev. Soc. Esp. Dolor. 2022; 29(2): 61-70 / DOI: 10.20986/resed.2022.3968/2022

Attitudes and current knowledge of the spanish pain treatment specialist regarding medical cannabis

Rev. Soc. Esp. Dolor. 2022; 29(13): 52-57 / DOI: 10.20986/resed.2022.4032/2022

Cannabinoids in neuropathic pain: lights and shadows

Rev. Soc. Esp. Dolor. 2022; 29(13): 20-26 / DOI: 10.20986/resed.2022.4027/2022

Bone pain management with opioid medication in a patient with Camurati-Engelmann disease: a case report

Rev. Soc. Esp. Dolor. 2022; 29(1): 51-55 / DOI: 10.20986/resed.2021.3930/2021

OFA in major surgery. Experience at a secondary level hospital

Rev. Soc. Esp. Dolor. 2022; 29(1): 8-14 / DOI: 10.20986/resed.2022.3991/2022

Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

Rev. Soc. Esp. Dolor. 2021; 28(6): 350-353 / DOI: 10.20986/resed.2022.3920/2021

Recommendations for the safe prescription of opioids in patients with a history or risk of abuse

Rev. Soc. Esp. Dolor. 2021; 28(6): 343-349 / DOI: 10.20986/resed.2022.3935/2021

New opioids with different intracellular mechanism of action; is a new therapeutic window opening up?

Rev. Soc. Esp. Dolor. 2021; 28(5): 292-297 / DOI: 10.20986/resed.2021.3891/2021

Efficacy and complications of analgesic techniques for the treatment of moderate to severe postoperative acute pain

Rev. Soc. Esp. Dolor. 2021; 28(5): 264-265 / DOI: 10.20986/resed.2021.3942/2021

The unsolved problem of postoperative pain: critical analysis and prospects for improvement

Rev. Soc. Esp. Dolor. 2021; 28(4): 232-238 / DOI: 10.20986/resed.2021.3917/2021

Postoperative ketamine efficacy in patients receiving chronic opioids undergoing spinal surgery

Rev. Soc. Esp. Dolor. 2021; 28(2): 92-99 / DOI: 10.20986/resed.2021.3825/2020

Evolution of low back pain in cancer patients treated with interventional pain management

Rev. Soc. Esp. Dolor. 2021; 28(2): 76-81 / DOI: 10.20986/resed.2021.3901/2021

Analgesic effectiveness of tapentadol in neuropathic pain secondary to post-laminectomy syndrome

Rev. Soc. Esp. Dolor. 2021; 28(2): 71-75 / DOI: 10.20986/resed.2021.3822/2020

Parsonage-turner after rabies vaccination due to bat bite: case report

Rev. Soc. Esp. Dolor. 2021; 28(1): 57-61 / DOI: 10.20986/resed.2021.3832/2020

Management and perception of therapeutic adherence of breakthrough cancer pain by oncologists in Spain

Rev. Soc. Esp. Dolor. 2021; 28(1): 19-26 / DOI: 10.20986/resed.2021.3824/2020

Platelet rich plasma and intra-articular mesenchymal stem cells in osteoarthritis

Rev. Soc. Esp. Dolor. 2021; 28(13): 80-84 / DOI: 10.20986/resed.2021.3858/2020

Opioids in osteoarthritis

Rev. Soc. Esp. Dolor. 2021; 28(13): 49-56 / DOI: 10.20986/resed.2021.3855/2020

Transitional pain clinic

Rev. Soc. Esp. Dolor. 2020; 27(6): 369-374 / DOI: 10.20986/resed.2020.3840/2020

Study of pain in rehabilitation treatments

Rev. Soc. Esp. Dolor. 2020; 27(6): 361-368 / DOI: 10.20986/resed.2020.3809/2020

School of non-oncologic chronic pain patients and opioid treatment

Rev. Soc. Esp. Dolor. 2020; 27(5): 324-328 / DOI: 10.20986/resed.2020.3804/2020

Opioid misuse in patients with cancer pain: an integrative systematic review of the literature

Rev. Soc. Esp. Dolor. 2020; 27(5): 306-315 / DOI: 10.20986/resed.2020.3801/2020

Back to the future in the treatment of postoperative acute pain

Rev. Soc. Esp. Dolor. 2020; 27(5): 285-286 / DOI: 10.20986/resed.2020.3850/2020

Splanchnic nerve block for the treatment of benign chronic abdominal pain. a case report and literature review

Rev. Soc. Esp. Dolor. 2020; 27(4): 273-277 / DOI: 10.20986/resed.2020.3818/2020

Clinical pathophysiology in patients with sickle cell disease: the transition from acute to chronic pain

Rev. Soc. Esp. Dolor. 2020; 27(4): 257-268 / DOI: 10.20986/resed.2020.3814/2020

Symptomatic treatment for migraña. Drugs used and related variables. Results of the european survey on work and migraine

Rev. Soc. Esp. Dolor. 2020; 27(3): 178-191 / DOI: 10.20986/resed.2020.3744/2019

Drug consumption used for musculoskeletal pain treatment in a cohort of blue-collar workers in Zaragoza (Spain)

Rev. Soc. Esp. Dolor. 2020; 27(3): 150-159 / DOI: 10.20986/resed.2020.3749/2019

Management of breakthrough pain associated with the cure of skin ulcers

Rev. Soc. Esp. Dolor. 2020; 27(2): 113-126 / DOI: 10.20986/resed.2020.3755/2019

Peripheral acting Mu opioid receptor antagonists in the treatment of the opioid-induced constipation: review

Rev. Soc. Esp. Dolor. 2020; 27(1): 37-49 / DOI: 10.20986/resed.2020.3717/2018

Effectiveness of patient-controlled analgesia in acute and chronic pain after cardiac surgery: a prospective study

Rev. Soc. Esp. Dolor. 2020; 27(1): 24-36 / DOI: 10.20986/resed.2020.3747/2019

New strategies for postoperative pain control in tonsillectomy surgery. Is all that glitters gold?

Rev. Soc. Esp. Dolor. 2019; 26(5): 270-275 / DOI: 10.20986/resed.2019.3742/2019

Comparative analysis of vital signs in acutely hospitalized patients according to the pain intensity

Rev. Soc. Esp. Dolor. 2019; 26(4): 215-220 / DOI: 10.20986/resed.2019.3707/2018

Optimization of postoperative pain management based on a new technological tool. Pain map

Rev. Soc. Esp. Dolor. 2019; 26(3): 154-165 / DOI: 10.20986/resed.2019.3696/2018

Commonly used analgesics may increase the risk of hearing loss

Rev. Soc. Esp. Dolor. 2019; 26(2): 133-134 / DOI: 10.20986/resed.2017.3560/2017

Myofascial pain syndrome as a cause of postoperative acute pain in hip surgery

Rev. Soc. Esp. Dolor. 2019; 26(2): 117-119 / DOI: 10.20986/resed.2019.3655/2018

Dexmedetomidine as peripheral nerve block adjuvant

Rev. Soc. Esp. Dolor. 2019; 26(2): 103-115 / DOI: 10.20986/resed.2018.3695/2018

Fast opioid detoxification

Rev. Soc. Esp. Dolor. 2019; 26(2): 95-102 / DOI: 10.20986/resed.2019.3681/2018

Opioids and addiction in chronic pain: is it a problem?, how to address it?

Rev. Soc. Esp. Dolor. 2019; 26(2): 65-67 / DOI: 10.20986/resed.2019.3736/2019

Do our patients need opioids and benzodiazepines concurrently?

Rev. Soc. Esp. Dolor. 2019; 26(1): 59-60 / DOI: 10.20986/resed.2017.3552/2016

Project adapta: adequacy of treatment in breakthrough cancer pain

Rev. Soc. Esp. Dolor. 2019; 26(1): 31-43 / DOI: 10.20986/resed.2018.3661/2018

The use of opioids in older adults

Rev. Soc. Esp. Dolor. 2019; 26(1): 4-5 / DOI: 10.20986/resed.2019.3731/2019

Opinaudit study: clinical uses in breakthrough pain, is scientific evidence being followed up?

Rev. Soc. Esp. Dolor. 2018; 25(6): 325-334 / DOI: 10.20986/resed.2018.3634/2017

Use of major opioids for control of pain in hospitalized patients

Rev. Soc. Esp. Dolor. 2018; 25(6): 318-324 / DOI: 10.20986/resed.2018.3629/2017

Farmacologic adyuvants with saving effect of opioids in the perioperative period

Rev. Soc. Esp. Dolor. 2018; 25(5): 278-290 / DOI: 10.20986/resed.2018.3663/2018

Experience in two hospitals about the observation of pain responses in hospitalized preterm infants

Rev. Soc. Esp. Dolor. 2018; 25(5): 271-277 / DOI: 10.20986/resed.2018.3633/2017

Expenditure, prescription and consumption of analgesic drugs before and during the economic crisis

Rev Soc Esp Dolor 2018; 25(3): 155-162 / DOI: 10.20986/resed.2017.3609/2017

Analgesic efficacy of topical sevoflurane on wounds

Rev Soc Esp Dolor 2018; 25(2): 106-111 / DOI: 10.20986/resed.2017.3617/2017

Epidural analgesia vs. surgical wound analgesia to control acute post-operative pain in open colon surgery

Rev Soc Esp Dolor 2017; 24(5): 234-240 / DOI: 10.20986/resed.2017.3559/2016

Control of symptoms in terminally ill patients: effectiveness of opioid treatment for breakthrough dyspnea

Rev Soc Esp Dolor 2017; 24(4): 161-168 / DOI: 10.20986/resed.2017.3582/2017

Prevalence of breakthrough pain associated with chronic low back pain in Andalusia (COLUMBUS study)

Rev Soc Esp Dolor 2017; 24(3):116-124 / DOI: 10.20986/resed.2017.3548/2016

Instrucciones para citar

Mugabure Bujedo B. Key factors governing spinal cord opioid bioavailability in the management of acute pain. Rev Soc Esp Dolor 2019; 26(6): 359-367 / DOI: 1020986/resed20193737/2019


Descargar a un gestores de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica

Este artículo ha sido visitado 51348 veces.
Este artículo ha sido descargado 64 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 08/04/2019

Aceptado: 31/05/2019

Prepublicado: 09/10/2019

Publicado: 11/12/2019

Tiempo de revisión del artículo: 32 días

Tiempo de prepublicación: 184 días

Tiempo de edición del artículo: 247 días


Compartir

Este artículo ha sido valorado por 4 lectores .
Reader rating:
Rate this article:
© 2024 Revista de la Sociedad Española del Dolor
ISSN: 1134-8046   e-ISSN: 2254-6189

      Indexada en: