International Association for the Study of Pain®    IASP Press®

Progress in Pain Research and Management, Vol. 14
Editors: Eija Kalso, Henry J. McQuay, and Zsuzsanna Wiesenfeld-Hallin

1999 · hardbound · 406 pages · ISBN 0-931092-28-0.  Special Price: US$42.00

Table of Contents (click or see below)            Order Form                 Reviews                    IASP

This book provides fresh perspectives on opioid sensitivity of chronic noncancer pain and covers new aspects of the mechanisms of action, therapeutic evaluation, and clinical use of opioids. Particular attention is devoted to neuropathic pain. Although neuropathic pain has been viewed in the past as insensitive to morphine, many clinical research groups today have found evidence for efficacy of opioids on this type of pain. Models of neuropathic, inflammatory, ischemic, visceral, and musculoskeletal pain provide valuable data fundamental to a better understanding of the mechanisms underlying chronic pain. This book emphasizes the need for controlled clinical studies that will improve pharmacological treatment of these types of pain.

The use of opioids in treating chronic cancer pain has long been accepted. During the past decade, discussions about opioids have also addressed their efficacy in treating chronic noncancer pain. Legal aspects, adverse effects in long-term use, and cultural attitudes relating to their use remain major issues. Above all, clinicians and researchers are investigating whether all types of pain can be relieved by opioid treatment. Within this context the opioid responsiveness of neuropathic pain remains a focus for debate.

This volume also examines the issues of opioid responsiveness of ischemic and musculoskeletal pain as well as the differential efficacy of several drug classes for different pain syndromes. It covers the medical and political importance of opioid use and the scientific approach to illuminating the underlying biology of chronic pain mechanisms.

Opioid Sensitivity of Chronic Noncancer Pain is based on proceedings of the first IASP Research Symposium, held in Helsinki, Finland, in November–December 1998.

Table of Contents

Function and Dysfunction of Opioid Receptors

Targeting of Opioid Receptors to Presynaptic Sites. M. Riedl, S. Shuster, and R. Elde

Function and Dysfunction of Opioid Receptors in the Spinal Cord.
A.H. Dickenson and R. Suzuki

Opioid Receptors in the Periphery.
H. Machelska, W. Binder, and C. Stein

Relevance of Proposed Mechanisms of G-Protein-Coupled Receptor Desensitization to Opioid Receptors. 
V. Beaumont and G. Henderson

Modulation of Opioid Analgesia: Tolerance and Beyond.
G.W. Pasternak

Clinical Pharmacology of Opioids—Relevant Aspects

Different Opioids—Same Actions? G.K. Gourlay

Route of Administration— Does It Make a Difference?
E. Kalso

Clinical Status of Opioid Tolerance in Long-Term Therapy of Chronic Noncancer Pain. 
R. Dertwinkel, M. Zenz, M. Strumpf, and B. Donner

Understanding and Improving Opioid Sensitivity—New Perspectives

Phenotypic Changes Induced in Dorsal Root Ganglion Neurons by Nerve Injury. T. Hökfelt, T.-J.S. Shi, J.-G. Cui, B. Meyerson, B. Linderoth, Y.-G. Tong, H.F. Wang, Z.Q.D. Xu, G. Ju, G. Grant, and X. Zhang

Opioid Analgesic Activity in Neuropathic Pain States. M.H. Ossipov, J. Lai, T.P. Malan, Jr., and F. Porreca

Opioid Sensitivity in Experimental Central Pain after Spinal Cord Injury in Rats.
X.-J. Xu, W. Yu, J.-X. Hao, T. Hökfelt, and Z. Wiesenfeld-Hallin

Antinociceptive Effect of Opioid Substances in Different Models of Inflammatory Pain
. G. Guilbaud, V. Kayser,  S. Perrot, and H. Keita

Opioid Modulation of Visceral Pain. G.F. Gebhart, X. Su, S. Joshi, N. Ozaki, and J.N. Sengupta

Opioid Sensitivity in Antinociception: Role of Anti-Opioid Systems with Emphasis on Cholecystokinin and NMDA Receptors. Z. Wiesenfeld-Hallin, P. Alster, S. Grass, O. Hoffman, G. de Araújo Lucas, A. Plesan, and X.-J. Xu

Alpha, Omega, and In Between.
S. R. Chaplan

Alternatives to Mu-Receptor-Selective Opioid Analgesics.
A. Dray

Opioid Gene Knockouts: New Answers to Old Questions?
I. Kitchen

Opioid Sensitivity of Different Chronic Pain States—Answers and Questions from the Clinic

The Debate over Opioids and Neuropathic Pain. M.C. Rowbotham
Opioids and Painful Peripheral Neuropathy. G.J. Bennett
Efficacy of Peripheral Opioid Analgesia in Inflammatory Pain: Evidence from Clinical Studies. M. Schäfer
Opioids in Ischemic Pain. J. Persson
Opioids for Chronic Musculoskeletal Pain. P.J.D. Evans
Opioids in Headache. F.W. Bach
How Should We Measure the Outcome? H.J. McQuay

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Overall, this is an interesting textbook, with detailed and timely information regarding basic research of opioid receptors and clinical experience learned from patient treatment. This text is particularly of interest to practitioners with specific interest in pain control in patients with chronic pain syndromes due to nonmalignant origins. It is by no means a "how to" guide for those looking to initiate patient care, but a reference of the current state of affairs and where we might be directed for future interventions. The Annals of Pharmacotherapy

The aim of both the symposium and the book is to promote further more systematic clinical studies that will lead to better therapeutic approaches to the control of chronic noncancer pain. Thus, while the use of morphine in cancer pain is well accepted and there are clear guidelines on opioid prescribing practices, the use of opioids in chronic noncancer pain is much more variable and, even when it occurs, is not necessarily based on well validated clinical data ... This book has examined opioid responsiveness in different states, with the hope that this focused attention might reveal approaches likely to benefit patients.
Is this "just another book on opioids" or did the volume indeed attain the goal of the conference organizers and editors in bringing together basic and clinical sciences to provide a focused, critical and useful view of the use of opioids in chronic noncancer pain? Very clearly, it is the latter ... A particular strength of the book is the very successful integration between basic and clinical issues, and for this reason, it should be of considerable value to scientists and clinicians alike both in understanding the current state of knowledge and in deciding where further initiatives need to be directed. Pain Research and Management

Neurological clinicians should know that significant advances, such as the use of opioids, are occurring in the management of non-cancer pain, particularly the neuropathic pains, about which they should be aware if they are to help their patients with these difficult problems. This book, like all volumes of IASP Press, is a compilation of mainstream expert opinions and is a very good value for the price.
[It] is divided into four sections but is worthwhile for clinicians for Part IV alone, which is a state of the art summary of the clinical use of opioids in non-malignant pain ... This [part] commences with an excellent review of the evidence for the effect of opioids in neuropathic pain and, further, the practical issue of whether they are useful and for how many patients and for which patients. The issue of the anti-inflammatory effect of opioids is raised [as well as their] possible role in arthritis, both as analgesics and anti-inflammatory agents, which causes a radical shift in our thinking.
Canadian Journal of Neurological Sciences

This is a very timely book in several ways. First, it addresses a pertinent topic that is badly in need of solid basic scientific research and decent clinical trials. Second, the debate on the use of opioids for patients with chronic noncancer pain is currently raging. Third, it was published within 6 months of the IASP-sponsored First International Research Symposium, held in Helsinki, Finland. [It is] attractively published [and] contains a useful index.
Almost all of the individual papers in this volume are superb reviews of research on specific, well-defined topics. The critical papers are referenced and the authors do a good job presenting both what is known and what is not known.
I strongly recommend this book as a source of up-to-date information about opioid mechanisms and their utility for chronic noncancer pain. The chapters are concise and packed with information, and the editing is superb.  APS Bulletin (American Pain Society)

This book covers extensively the known and proposed mechanisms of action of opioids, whilst the therapeutic evaluation and clinical use of opioids is covered in lesser detail. A special emphasis of the book is to explore the issue of opioids and neuropathic pain.
This book provides an excellent review of the current status of basic research of the opioids. The issues of opioid responsiveness and the influence of duration or severity of chronic pain on opioid sensitivity in different types of pain are addressed in detail along with the concept that long-lasting pain may induce phenotypic changes in expression of many neuroactive substances and receptors.
A key objective of the symposium, and thus this book, was to establish the evidence of opioid efficacy in chronic non-cancer pain. This book accomplishes this objective admirably and is worthy of review by both clinicians and researchers.  Canadian Journal of Anesthesia

This book is another in the excellent series from IASP Press ... Like all IASP publications, it is reasonably priced. It would be a valuable addition to the library of any palliative care unit and a good buy for the interested individual.
There is a particularly good chapter by Pasternak on tolerance and issues relating to opioid rotation ... Gourlay’s contribution [in the section concerning clinical pharmacology] is excellent and easy to follow ... An excellent review of anti-opioids is also included. The [] chapter on gene knockouts by Kitchen is clear and current.
[The final section] covers clinical aspects of opioid use in chronic nonmalignant pain. This section is fascinating; it would be worth buying the book for this alone. Neuropathic pain, peripheral neuropathy, inflammation, ischaemic pain, musculoskeletal pain and headache are covered. The final part of the book contains a good solid section from McQuay on measuring outcome. 
Palliative Medicine


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