Pharmacology of opiate analgesics for chronic pain management - La gestione del dolore cronico: Farmacologia degli analgesici oppiacei

The opiate analgesic drugs currently represent the most powerful instrument in pain therapy and elicit their therapeutic action mimicking endogenous substances, the opioid peptides, natural ligands of the opioid receptors. They interact with specific receptors, physiologically present in the CNS and in periphery, where they modulate different functions. Beside the well known function related to nociceptive transmission modulation, this system is also involved in the regulation of gastrointestinal, endocrine and autonomic functions, as well as in the mechanisms underlying reward, addiction and in memory and learning processes. Opiates are more and more diffusing in pain therapy and physicians should be able to control pain before this becomes intractable. The recent discovery of new opioid endogenous systems, like the nociceptin one, the development of alternative administration routes and of new drugs with less abuse liability, will allow better scientific understanding, better targeted therapy and a safer use of opiate drugs for the pharmacological control of pain. The goals in this field of research are important and future knowledges will be able to help physicians to use therapeutic tools in the control of pain, before it becomes intractable.