February 28, 2019

Personalized pain management

Understanding how natural brain chemicals with pain-relieving properties interact with administered opioids may guide personalized approaches for pain management.

by Niyati Vachharajani

There is an urgent need to identify reliable predictors of opioid responses to develop personalized opioid therapy for chronic pain management. A goal is to target opioid therapy to patients most likely to benefit from treatment with few side effects and low risk of opioid misuse.

Stephen Bruehl, PhD,and colleagues previously established an inverse correlation between levels of endogenous opioids (EOs), natural brain chemicals with pain-relieving properties, and analgesic responses to morphine.

Their latest study, published in the March issue of the journal Pain, tested whether circulating endocannabinoids, which stimulate the same brain receptors turned on by the active ingredient in marijuana, directly influence opioid analgesic responses or interact with EO function.

While they did not find that endocannabinoids directly affect morphine responses, they did find that the inverse association between EO activity and the analgesic and subjective effects of morphine was strongest in those with low endocannabinoid levels.

These findings may assist in developing approaches in personalized pain medicine to predict opioid analgesic responses in patients.

This research was supported by grants from the National Institutes of Health (DA037891, AA026186, GM108554, TR002243).