Influence of opioids on immune function in patients with cancer pain: from bench to bedside

Boland, J.W. and Pockley, A.G. ORCID: 0000-0001-9593-6431, 2017. Influence of opioids on immune function in patients with cancer pain: from bench to bedside. British Journal of Pharmacology. ISSN 0007-1188

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In patients with cancer, opioids are principally used for the management of acute surgical and chronic cancer-related pain. However, opioids have many non-analgesic effects, including direct and indirect effects on cancer cells and on anti-tumour immunity (NK cells, macrophages and T-cells). Direct effects on immune cells are manifested via opioid and non-opioid toll-like receptors, whereas indirect effects are manifested via the sympathetic nervous system and hypothalamic–pituitary–adrenal axis. Opioids can also decrease/alter immune cell infiltration into the tumour micro-environment. Animal models have shown that this is not a class effect, in that morphine and fentanyl suppress NK cell cytotoxicity; buprenorphine does not affect NK cell cytotoxicity, whereas tramadol increases NK cell cytotoxicity, reducing metastasis. In healthy individuals, morphine suppresses and fentanyl enhances NK cell cytotoxicity. In patients undergoing surgery, fentanyl decreased and tramadol increased NK cell cytotoxicity; clinical outcomes were not determined. Meta-analyses of opioid-sparing surgical studies report an association between improved recurrence-free and/or overall survival with regional/neuraxial anaesthesia compared with systemic opioids. In patients receiving opioids for non-surgical cancer-related pain, morphine has variable effects on immunity; clinical outcomes were not assessed. Although there is a potential association between systemic opioid administration and shorter survival in cancer patients with a prognosis of months to years, studies have not been designed to primarily assess survival, as a consequence of which causality cannot be apportioned. Pain is immunosuppressive, so analgesia is important. Opioids for cancer-related pain will continue to be recommended until definitive data on the effects of opioids on clinical outcomes in specific patient groups becomes available.

Item Type: Journal article
Publication Title: British Journal of Pharmacology
Creators: Boland, J.W. and Pockley, A.G.
Publisher: John Wiley
Date: 9 July 2017
ISSN: 0007-1188
Divisions: Schools > School of Science and Technology
Depositing User: Jonathan Gallacher
Date Added: 25 Jul 2017 08:11
Last Modified: 25 Jul 2017 08:11

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