Department of Anesthesiology and Critical Care Medicine, Freie Universität Berlin, Charité Campus Benjamin Franklin, 12200 Berlin, Germany; email:
Helmholtz Virtual Institute, Multifunctional Biomaterials for Medicine, 14513 Teltow, Germany.
Annu Rev Med. 2016;67:433-51. doi: 10.1146/annurev-med-062613-093100. Epub 2015 Aug 26.
Opioids are the oldest and most potent drugs for the treatment of severe pain. Their clinical application is undisputed in acute (e.g., postoperative) and cancer pain, but their long-term use in chronic pain has met increasing scrutiny. This article reviews mechanisms underlying opioid analgesia and other opioid actions. It discusses the structure, function, and plasticity of opioid receptors; the central and peripheral sites of analgesic actions and side effects; endogenous and exogenous opioid receptor ligands; and conventional and novel opioid compounds. Challenging clinical situations, such as the tension between chronic pain and addiction, are also illustrated.
阿片类药物是治疗重度疼痛最古老、最有效的药物。它们在急性（例如术后）和癌症疼痛中的临床应用是无可争议的，但在慢性疼痛中的长期使用受到了越来越多的关注。本文综述了阿片类药物镇痛和其他阿片类药物作用的机制。讨论了阿片受体的结构、功能和可塑性；镇痛作用和副作用的中枢和外周部位；内源性和外源性阿片受体配体；以及传统和新型阿片类化合物。还举例说明了一些具有挑战性的临床情况，如慢性疼痛和成瘾之间的紧张关系。
