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Delta opioids

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    Delta opioids

    Many thanks to Aquitaine for giving the URL for Melzack's article cited by Wise. You notice Melzack divides pain tracts into what he calls:
    1) the medial(GABA suppressed, "spinothalamic tradt" involving small, slow fibers for "tonic" or lasting pain) and
    2) the lateral(dopamine supressed-periaqueductal gray with large, rapid fibers for fast pain) systems. (An oversimplification)

    Melzack points out that morphine reaches BOTH pain systems by its action at the dorsal entry area of the cord.

    In a prior post, I attempted to highlight how scientists are attempting to circumvent the supposed evils of opioids by finding opioids which have mainly peripheral action but no central action (the idea being any brain effect might tend toward addiction).

    Melzack would say this distinction is not particularly important in people without psychopathology, who are not going to be addicted (citing burn patients who are on morphine for months without addiction ie, using proper decreases they get off and stay off)

    Are we not burn patients also? The morphine has no impact on their tissue damage but is directed solely at the action potentials flowing through their pain nerves. Are our action potentials any less significant because they are not accompanied by tissue damage? The same ions flow, through increased ion channels, and the same signal pours into the thalamus--on what basis would any rational person deny us pain relief. (This is not really my battle, since like Alan opiates have no effect on my Central Pain, except to add nausea and constipation to it, neither of which seemed worth acquiring).

    But, the powers that be appear fixed in their aversion to long term morphine for chronic pain.

    I pointed out that Mu and Kappa opioids with peripheral activity are being fashioned which may be acceptable to regulatory agencies.

    I have been interested in the posts by many of you on your "spasms", "movements", "terrible cramps" etc. Some of these seem violent movement and others may be only the sensation of cramping without actual cramping. Would opioids have any role?

    Work has now shown that people with Tourettes lack delta opioids in the globus pallidus, a relay area next to the thalamus.

    Some scientists believe delta opioids are involved in movement(movement is routed from the cortex THROUGH the anterior nucleus of the thalamus to the globus pallidus). Study of delta opioids may therefore lead to medications which calm abnormal movements and muscle tone, voluntary or otherwise. Here again is a strong reason for NIH to support research into pain medications.

    Stigmatizing opioid users taints opioid research. Stringent regulation of those who do this research may discourage scientists from getting involved.

    Pain people are the lowest caste. They are weak, drug seeking, pathetic, hurting, needful human beings. We are fighting a war for public opinion. Publicity has made the public hate those who use legal drugs as much as users of illegal drugs.

    A woman who said God wanted her to bash her children's heads in was found by the jury and all experts, defense as well as prosecution, to be insane since God would never will this. Yet, how many of those same people think central pain is God's will? Who is sane and who is insane?

    We have to get away from any witch-hunt mentality and trust responsible researchers and in fact reward them. If we spent half the money researching pain meds that we do regulating them, we could solve the problem another way, by developing newer medicines. Opium was used at least as early as 2500 BC (Edwin Smith papyrus) and most likely long before that. It is time now to block the chemical cascade of pain more effectively.

    Every hospital ward on every shift must have a nurse to chart all narcotics, and then inventory and recheck with the next shift every day, all day. The cost of this is phenomenal. It also takes nurses away from the bedside.

    So those with abnormal movements or cramps (which are very common among CP people) have an incentive to encourage research on opioids, especially delta opioids, and blockers of neurotransmission. NIH, help us out. Please.

    Write to:

    Dr. Elias Zerhouni, Chairman
    National Institutes of Health
    Bethesda Maryland

    P.S. The above information is for educational purposes only. This allows us to speculate and consider. It is not medical information or advice. Do not rely on the internet for care. See a good doctor, in person.

    [This message was edited by dejerine on 04-04-04 at 09:28 PM.]

    Better put that link in this thread now:

    The more I read about this, the more I'm realizing how lucky I am that I have a doctor willing to give me long term morphine treatments. He seems to feel that the extended release type is much safer, but he also said that people in pain are very unlikely to become addicted to morphine in any case. If I didn't have this I'd have lost it long ago, although I'm just as happy that the neurontin is allowing me to cut back on it. Morphine needs a careful, slow reduction to avoid withdrawal symptoms, and I've been there before, physical addiction is inevitable after long term usage of morphine. It should say something about this CP, that even after dealing with withdrawal in the past, I was still willing to deal with morphine, in order to give some relief from it. The bottom line... if it helps, if it relieves any of the terrible symptoms of CP, it should be used.
    Never underestimate an individual, Never overestimate a bureaucracy.


      Dear Aquitaine,

      Yes, I think you are fortunate to be in the bay area where good pain specialists exist who would go to bat for your doctor if he needed it. Most areas are not so fortunate. UCSF is one of the few schools with pain in the curriculum. They have a pain braintrust going out there which is something to behold--even their internists know about pain.

      [This message was edited by dejerine on 04-04-04 at 10:23 PM.]