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BJA Advance Access originally published online on April 8, 2008
British Journal of Anaesthesia 2008 101(1):40-44; doi:10.1093/bja/aen078
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pain and the immune system

H. L. Rittner*, A. Brack and C. Stein

Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30 D-12200, Berlin, Germany

* Corresponding author. E-mail: heike.rittner{at}charite.de

In inflammation, leucocytes containing opioid peptides migrate into the tissue. Opioid peptides can be released and bind to opioid receptors on peripheral nerve terminals, which counteracts inflammatory pain. Migration of opioid peptide-containing leucocytes is controlled by chemokines and adhesion molecules. Neurokinins, such as, substance P also contribute to the recruitment of these cells. Opioid peptide release from granulocytes can be stimulated by chemokines, such as, CXCR2 ligands. The release is dependent on intracellular calcium and activation of phosphoinositol-3 kinase and p38 mitogen activated kinase. Endogenous opioid peptides produced by leucocytes not only confer analgesia but recent evidence supports the concept that they also prevent the development of tolerance at peripheral opioid receptors. This review presents the discoveries that led to the concept of analgesia produced by immune-derived opioids.

Keywords: immune response; pain, experimental; polypeptides, endorphins; polypeptides, enkephalins; receptors, opioid


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 Br J AnaesthHome page
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