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Neuraxial Opioid-Induced Itch and Its Pharmacological Antagonism

  • Chapter
Pharmacology of Itch

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 226))

Abstract

Given its profound analgesic nature, neuraxial opioids are frequently used for pain management. Unfortunately, the high incident rate of itch/pruritus after spinal administration of opioid analgesics reported in postoperative and obstetric patients greatly diminishes patient satisfaction and thus the value of the analgesics. Many endeavors to solve the mystery behind neuraxial opioid-induced itch had not been successful, as the pharmacological antagonism other than the blockade of mu opioid receptors remains elusive. Nevertheless, as the characteristics of all opioid receptor subtypes have become more understood, more studies have shed light on the potential effective treatments. This review discusses the mechanisms underlying neuraxial opioid-induced itch and compares pharmacological evidence in nonhuman primates with clinical findings across diverse drugs. Both nonhuman primate and human studies corroborate that mixed mu/kappa opioid partial agonists seem to be the most effective drugs in ameliorating neuraxial opioid-induced itch while retaining neuraxial opioid-induced analgesia.

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Abbreviations

DOP:

Delta opioid receptor

GRPR:

Gastrin-releasing peptide receptor

KOP:

Kappa opioid receptor

MOP:

Mu opioid receptor

NOP:

Nociceptin/orphanin FQ peptide receptor

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Acknowledgment

Funding from the National Institutes of Health in the United States (DA-013685, AR-059193, and AR-064456) to support the research of neuraxial opioid-induced itch is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Physiology and Pharmacology, Wake Forest University School of Medicine, 205 NRC, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Mei-Chuan Ko

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  1. Mei-Chuan Ko
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Correspondence to Mei-Chuan Ko .

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Editors and Affiliations

  1. Department of Pharmacology Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

    Alan Cowan

  2. Department of Dermatology, Temple University School of Medicine, Philadephia, Pennsylvania, USA

    Gil Yosipovitch

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Ko, MC. (2015). Neuraxial Opioid-Induced Itch and Its Pharmacological Antagonism. In: Cowan, A., Yosipovitch, G. (eds) Pharmacology of Itch. Handbook of Experimental Pharmacology, vol 226. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44605-8_17

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