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Gavril W. Pasternak, MD, PhD

JAMA. 1988;259(9):1362-1367.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

AFTER thousands of years, opiates remain the drugs of choice for severe pain. Their potency and ability to relieve the "hurt" associated with nociceptive stimuli without significantly altering such basic sensations as touch, temperature, and proprioception separate them from all other analgesics. Despite these advantages, side effects such as tolerance, physical dependence, respiratory depression, and constipation greatly limit their usefulness. In addition to these physiological actions of the opiates, their abuse is also a concern, but this remains uncommon in the treatment of acute pain and cancer pain. Opiates mimic the actions of a series of brain peptides and activate endogenous pain-modulating systems by binding to a number of different types of opioid receptors, each mediating distinct actions. Recent work indicates that the receptors responsible for many opiate side effects differ from those producing analgesia, implying that analgesics lacking these unwanted actions may be possible. This article reviews some physiological . . . [Full Text PDF of this Article]

Author Affiliations
From the Cotzias Laboratory of Neuro-Oncology, Memorial Sloan-Kettering Cancer Center; and the Departments of Neurology and Pharmacology, Cornell University Medical College, New York.

Footnotes
Reprint requests to Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Dr Pasternak).

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