Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance
Abstract
:Simple Summary
Abstract
1. Introduction
2. Search Methodology
3. Mechanisms of Pain and Its Important Role in Animal Welfare
3.1. Concepts of Type Pain, Physiopathology, and Management Approach
3.2. Pathophysiology of Pain in the Oncologic Patient
4. Main Opioids Used for Pain Control in Oncological Patients
4.1. The Mechanisms of Action of Opioids Rely on the Body’s Receptors
4.2. Morphine, Methadone and Fentanyl as Pure Opioids Agonist
4.3. Buprenorphine, a Partial Opioid Agonist
4.4. Butorphanol, an Opioid Agonist-Antagonist
4.5. Tramadol, an Atypical Opioid
5. The “Conflicting Relationship” between Opioids and the Immune System
6. The Opioid Agents as Influencers of Tumor Survival
7. Limitations of Opioid Use for Cancer Pain Management in Dogs and Cats and Further Research
8. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Opioid Analgesic | Dogs | Cats | Route of Administration 2 | Main Indications for Use? | ||
---|---|---|---|---|---|---|
Dose 2 | Frequency 2 | Dose 2 | Frequency 2 | |||
Morphine | 0.3 to 0.5 mg/kg | every 2 to 4 h | 0.2 to 0.3 mg/kg | every 4 to 6 h | IM, IV * | Moderate-to-severe pain ‡ |
Methadone | 0.3 to 0.5 mg/kg | every 3 to 4 h | 0.2 to 0.3 mg/kg | every 4 h | IM, IV, oral transmucosal † | Moderate-to-severe pain |
Fentanyl | 2 to 5 μg/kg 3 to 6 μg/kg/h | Bolus CRI | 1 to 3 μg/kg 2 to 3 μg/kg/h | Bolus CRI | IV | Severe pain |
Remifentanil | 6 to 12 μg/kg/h | CRI | 4 to 6 μg/kg/h | CRI | IV | Severe pain |
Buprenorphine | 0.01 to 0.02 mg/kg | every 4 to 8 h | 0.02 to 0.04 mg/kg | every 4 to 8 h | IM, IV, oral transmucosal † | Moderate pain |
Butorphanol | 0.2 to 0.4 mg/kg | every 1 to 2 h | 0.2 to 0.4 mg/kg | every 1 to 2 h | IM, IV | Mild pain |
Tramadol | NR ¥ | NR ¥ | 2 to 4 mg/kg | every 8 to 12 h | Orally, IM, IV | Chronic pain |
Drug | Dose | Effect on Immune System | Study Model | References |
---|---|---|---|---|
Fentanyl | Low (1–5 μg/kg) and High (75–100 μg/kg) | Suppression of NK cell activity | Human (perioperative) | [134] |
Chronic administration | Suppression of NK activity, lymphocyte proliferation, and cytokine production | Rodent | [129] | |
Butorphanol | Low | Enhanced macrophage phagocytic activity; balanced cytokine production | Rodent | [135] |
Moderate | Reduced IL-6 and TNF-α | Rodent | [132] | |
High | Increased immunosuppressive effects; potential for reduced inflammatory responses | Rodent | [132] | |
Buprenorphine | Low to Moderate | Modulation of T cell function; reduced proinflammatory cytokine production | Rodent | [120] |
Chronic administration | Development of tolerance to immunosuppressive effects | Rodent | [129] | |
Methadone | Low to Moderate | Suppresses lymphocyte proliferation; reduces cytokine production | Rodent | [136] |
Tramadol | Low to Moderate | Minimal immunosuppressive effects; can enhance certain immune functions | Rodent | [125] |
Morphine | Low | Suppresses NK cell activity and cytokine production; increases susceptibility to infections | Rodent | [136] |
High | Significant immunosuppression; decreased macrophage function and cytokine production | Rodent | [136] | |
Chronic administration | Development of tolerance to immunosuppressive effects; persistent analgesic effects | Rodent | [136] |
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Pinheiro, A.V.; Petrucci, G.N.; Dourado, A.; Silva, F.; Pires, I. Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance. Cancers 2024, 16, 3015. https://doi.org/10.3390/cancers16173015
Pinheiro AV, Petrucci GN, Dourado A, Silva F, Pires I. Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance. Cancers. 2024; 16(17):3015. https://doi.org/10.3390/cancers16173015
Chicago/Turabian StylePinheiro, Ana Vidal, Gonçalo N. Petrucci, Amândio Dourado, Filipe Silva, and Isabel Pires. 2024. "Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance" Cancers 16, no. 17: 3015. https://doi.org/10.3390/cancers16173015