• The Korean Journal of Pharmacology
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• v.30 no.1
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• pp.11-18
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• 1994

Cyclic adenosine 3'5'-monophosphate (cyclic AMP) has been frequently accepted as an intracellular messenger for receptor-mediated action of opioids. In this experiment, it was designed to determine the interaction of dopaminergic and opioidergic system in the mouse striatum in normal and chronic haloperidol treated groups. Haloperidol 750ug/kg I.P. for 10 days was performed for dopamine denervation. The morphine, DAGO, DPDPE, and U5O,488H inhibited the increase of haloperidol-induced cyclic AMP content in chronic haloperidol treated mouse striatum. The inhibition of DAGO and DPDPE showed significant increase compared to normal mouse striatum. Naloxone showed antagonistic effect on the morphine and U5O,488H in chronic haloperidol treated group, and showed antagonistic effect on morphine, DAGO, DPDPE, and U5O, 488H in normal mouse striatum. These findings support that there is a functional interrelationship of dopaminergic and opioidergic pathway in the striatum. This result provides an evidence that following destruction of striatal dopaminergic neuron, there are some changes of cAMP content on the ${\mu},\;{\gamma},\;and\;{\kappa}$ opioid receptor, but the ${\kappa}$ opioid receptor still has its function.

• Journal of The Korean Society of Clinical Toxicology
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• v.10 no.1
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• pp.33-36
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• 2012

Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don't always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn't deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it's necessary to consider nalmefene that has a longer duration for opioid intoxication.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.374-379
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• 1996

Background: Recently, improvements in drug administration technology have intensified interest in the treatment of postoperative pain. this has resulted in increased use of continuous intravenous infusion of opioid and epidural opioid as alternative to traditional intramuscular administration of opioid. The goal of this study, therefore, was to document the effects of pain control and side effects following continuous intravenous infusion of morphine or meperidine and intramuscular meperidine following cesarean section. Methods: The vital signs, pain score, oxygen saturation and side effects were compared in 150 patients receiving continuous intravenous infusion of morphine, 30 ${\mu}g/kg/hr$ (n=50, group 1); continuous intravenous infusion of meperidine, 150 ${\mu}g/kg/hr$ (n=50, group 2); or intramuscular meperidine, 50mg/every 6hrs (n=50, group 3). Results: VAS (Visual Analogue Scale) was significantly decreased after 30 minutes of administration in all three groups and was significantly lower at 1 hour, but higher at 6 hours in group 3 than two other groups. Severe desaturation episode, defined as $SpO_2$<90%, occurred in the group 3(0.2%). Moderate desaturation episodes, defined as $SpO_2$ 91~95%, occurred more in group 3 than in group 1 and 2 (17.4% vs. 10.4%, 8.2%). The incidence of side effects were similar among three groups. Conclusion: The continuous infusion of opioid was more effective and safe method of postoperative pain control than traditional intramuscular injection.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1994.04a
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• pp.50-62
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• 1994

Opium, morphine and rotated natural and synthetic opiates have been used since antiquity, and to the present, for the relief of moderate and severe pain. Morphine and pharmacologically related drugs, however, produced an array of undesired or dangerous side effect that limit their use as analgesics. Prominent among the limiting side effects are constipation, respiratory depression, release of prolactin, and liability for the production of drug dependence. It was our aim to develop, if possible, a drug or class of drugs with analgesic activity similar to that of morphine, but without the serious side effects associated with morphine. Our overall strategy was to take advantage of advancing knowledge concerning multiple types of opioid receptors, to develop ligands selective for the delta type receptors, to determine whether delta receptor agonists offer advantages over mu agonists, then to design compounds with pharmacokinetic properties compatible with practical therapeutic application. All but the last of these objectives have been realized.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.218-223
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• 2000

Background: This study was conducted to evaluate the efficacy of a parenteral nonsteroidal anti-inflammatory agent for management of post-surgical pain and its effect on hospital stay and long-term surgical outcome. Methods: Total of 40 patients undergoing lumbar discectomy were randomly assigned to two groups, receiving either 1) 30 mg intravenous ketorolac upon surgical closure, every 6 hours for 36 hours, and morphine IV PCA (intravenous patient controlled analgesia), or 2) only morphine PCA. A blinded investigator recorded; the visual analog pain scores, total postoperative narcotic consumption, complications by morphine PCA, length of hospitalization (from surgery to discharge), and long-term outcome at 6 weeks. Results: The patients who received IV ketorolac and morphine PCA reported significantly lower visual analog pain scores than patients receiving only morphine PCA. Cumulative morphine doses were significantly lower in the ketorolac group (P<0.001). There was no significant difference between groups in the frequency of side effects related to morphine PCA. Mean length of hospitalization was longer for patients receiving only morphine PCA, but there was no statistical significance. Six weeks after surgery, four (20.0%) patients who received only morphine PCA suffered persistent back pain. In contrary, all those patients who received ketorolac were free of back pain at follow-up (P<0.05). Conclusions: These results suggest that intermittent IV bolus ketorolac, when used with opioid IV PCA is more effective than opioid IV PCA alone for postoperative pain following lumbar disc surgery. However, this strategy did not contribute to early discharge from hospital after lumbar disc surgery. The effect to long-term surgical outcome was not conclusive.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.12
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• pp.4983-4988
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• 2014

Background: In Muslim majority countries (MMC) opioid use for pain management is extremely low. The underlying factors contributing to this are not well defined. Aim: The aim of this study was to survey the attitudes of cancer patients towards morphine use for pain management in a MMC and identify the factors that influence patient decisions to accept or refuse morphine as treatment for cancer pain. Settings/participants: Patients were questioned whether they had pain or not, the severity and the medications for pain management. Questions included what type of medication they thought morphine was, whether or not they would be willing to take morphine if recommended for pain management and the basis for their decision if they were against morphine use. Results: Four hundred and eighty-eight patients participated in the study. Some 50% of the patients who refused morphine use and 36.8% of the patients who would prefer another drug, if possible, identified fear of addiction as the basis for their decision. Reservation of morphine for later in their disease was the case for 22.4% of the patients who refused morphine use. Only 13.7 % of the patients refusing morphine and 9.7% of the patients who preferred another drug, if possible, cited religious reasons as the basis for this decision. Conclusions: Identifying the underlying factors contributing to low opioid use for pain management in MMC is important. Once the underlying factors were identified, all efforts should be taken to overcome them as they are barriers to improving patient pain management.

• The Korean Journal of Pharmacology
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• v.28 no.2
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• pp.181-190
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• 1992

The present study was conducted to investigate the effect of opioids on catecholamine (CA) secretion evoked by a selective cholinergic nicotinic agonist, 1,1-dimethyl-4-phenyl piperazinium (DMPP) and acetylcholine from the retrogradely perfused rat adrenal glands. Methionine-enkephalin $(9.68{\times}10^{-6}\;M)$ caused a significant inhibition of CA secretion evoked by DMPP (100 uM) and $ACh\;(50\;{\mu}g)$, but had no effect on the spontaneous (basal) CA release. Morphine $(1.73{\times}10^{-5}\;M)$ attenuated considerablely the increase in CA release induced by DMPP and ACh. Morphine itself also did not affect the basal CA output. A 20 to 65% reduction of the DMPP- and ACh-evoked increase in CA release was observed after the pretreatment with methionine-enkephalin or morphine. The increase in CA release evoked by DMPP and ACh was reduced markedly by preloading with an opiate antagonist naloxone $(1.22{\times}10^{-7}\;M)$ while basal CA output was not affected by naloxone. These present experimental results suggest that the nicotinic stimulation-evoked CA release from the perfused rat adrenal gland is inhibited by endogenously released opioid peptides through activation of opiate receptors located in the adrenal gland.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.49-54
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• 2000

Background: Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. Bupivacaine has a potent analgesic effect with early peak onset in the postoperative period. The combination of intrapelvic bupivacaine and morphine has been suggested as an ideal analgesic after endoscopic pelvic surgery. Methods: Sixty patients scheduled for endoscopic pelvic surgery under general anesthesia were allocated randomly to three groups. Group 1 received normal saline 20 ml, group 2 received morphine 5 mg in normal saline 20 ml, and group 3 received morphine 5 mg in 0.25% bupivacaine 20 ml into the pelvic cavity. Postoperative pain was assessed using the visual analogue scale at 1, 2, 4, 8, and 24 hours after the intrapelvic instillation. Supplemental analgesic requirements, vital signs, and side effects were recorded for 24 hours. Results: Intrapelvic morphine and bupivacaine produced significant analgesia after endoscopic pelvic surgery. The patients in group 3 had lower pain scores than those in the group 1 and 2 at 1, 2 and 4th hours. There were no significant differences in the pain scores at 8 hours and 24 hours postoperatively between group 2 and 3. Supplemental analgesic requirements were significantly greater in the groups 1 and 2 than the group 3 for 24 hours. No significant side effects occurred. Conclusion: The intrapelvic instillation of morphine and bupivacaine is effective for the postoperative pain control in patients undergoing endoscopic pelvic surgery.

• Journal of Ginseng Research
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• v.13 no.2
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• pp.239-241
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• 1989

Naloxone partially antagonized the analgesic effect of a large dose of morphine and inhibited the development of an acute type tolerance. Ginseng total saponins did not antagonize the analgesia of a large dose of morphine but inhibited the delrelopment of acute and delayed types tolerance. The morphine analgesia and the development of acute type tolerance were affected by the opioid receptor antagonist, naloxone, but the development of acute type tolerance was not. Ginseng total saponins partially inhibited the development of the delayed type tolerance that was not inhibited by naloxone, but also partially suppressed the development of the acute type tolerance that was completely inhibited by naloxone. These results imply that the partial inhibition of the development of the acute and delayed types tolerance by ginseng total saponins is not mediated by the opioid receptors.

• Proceedings of the Ginseng society Conference
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• 2005.11a
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• pp.41-63
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• 2005

Ginseng has been useful for the treatment of diverse disease in oriental countries for thousands of years. In addition, a folk medicine prescribed by seven herbal drugs including Panax ginseng has been antinarcotics in the treatment of morphine-dependent patients. Many articles have been reported on these works. Therefore, we review the protective effects of Panax ginseng on the neurotoxicity induced by abuse drugs. Ginseng total saponins (GTS) extracted and isolated by Panax ginseng antagonized morphine-induced analgesia, and inhibited the development of analgesic tolerance to and physical dependence on morphine. CTS inhibited morphine-6 dehydrogenase, which catalyzes production of mophinone from morphine, and increased hepatic glutathione level responsible to toxicity. Therefore, wehypothesized that these dual actions of ginseng can be associated with the detoxication of morphine. In addition, the inhibitory or facilitated effects of GTS on electrically evoked contraction in guinea pig ileum (${\mu}$-receptors) and mouse vas deferens(${\delta}$-receptors) were not mediated through opioid receptors, suggesting non-opioid mechanisms. On the hand, antagonism of U-50,488H (${\kappa}$-agonist)-induced antinociception is mediated by serotonergic mechanisms. GTS also inhibited hyperactivity, reverse tolerance (sensitization) and conditioned place preference-induced by psychostimulants such as methamphetamine, cocaine and morphine. On the other hand, GTS reduced the dopamine levels induced by methamphetamine. Moreover, GTS blocked the development of dopamine receptor activation, showing antidopaminergic effect. We suggest that GTS prevent the methamphetamine-induced striatal dopaminergic neurotoxicity. In addition, Ginsenoside also attenuates morphine-induced CAMP signaling pathway. These results suggested that GTS might be useful for the therapy of the adverse actions of drugs with abuse liability.