Supplemental Reading

Darland T et al. Orphanin FQ/nociceptin: A role in pain and analgesia, but so much more.

Trends Neurosci 1998;21:215-221.

Devi LA. Heterodimerization of G-protein-coupled receptors: Pharmacology, signaling and trafficking. Trends Pharmacol Sci 2001;22:532-537.

Julius D and Basbaum AI. Molecular mechanisms of nociception. Nature 2001;413:203-210.

Marnett LJ and Kalgutkar M. Cyclooxygenase 2 inhibitors: Discovery, selectivity and the future. Trends Pharmacol Sci 1999;20:465-469.

Moran TD et al. Cellular neurophysiological actions of nociceptin/orphanin FQ. Peptides 2000;21:969-976.

Tseng, L. Evidence for e-opioid receptor-mediated ß-endorphin-induced analgesia. Trends Pharmacol Sci 2001;22:623-630.

Wallace JL. Selective COX-2 inhibitors: Is the water becoming muddy? Trends Pharmacol Sci. 1999;20: 4-6.

Zadina JE et al. Endomorphins: novel endogenous mu-opiate receptor agonists in regions of high mu-receptor density. Ann NY Acad Sci 1999;897: 136-144.

^ Case Study Opioids and Head Trauma

A 45-year-old woman is found outside her car after hitting a tree. The car appears severely damaged. There is no evidence as to how the woman escaped from the car. It is thought that she was able to open her door and then fell from the car. When she is discovered, she is conscious but disoriented and complaining of severe pain of multiple origins. While in route to the emergency department, her pain increases in intensity. Which opi-oid might be used to ease her pain immediately upon her arrival at the hospital?

Answer: No opioid should be used immediately. The use of an opioid at this stage will block the pupillary responses in her eyes due to miosis, which will detract from immediate diagnosis of a concussion. In addition, opioids will induce hypercapnia due to respiratory depression, vasodilation, bradycardia, and hypotension and make a patient in shock less stable. Such effects will be intensified if the woman was drinking prior to the accident. In addition, opi-oids increase intracranial pressure via hypercapnia and vasodilation, possibly increasing any damage to the brain. In general a patient in severe pain may be given a general anesthetic agent.

Local Anesthetics

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