Affiliation:
1. Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
Abstract
Multimodal, non-opioid based analgesia has become the cornerstone of ERAS protocols for effective
analgesia after spinal surgery. Opioid side effects, dependence and legislation restricting long term opioid use has
led to a resurgence in interest in opioid sparing techniques. The increasing array of multimodal opioid sparing
analgesics available for spinal surgery targeting novel receptors, transmitters, and altering epigenetics can help
provide an optimal perioperative experience with less opioid side effects and long-term dependence. Epigenetic
mechanisms of pain may enhance or suppress gene expression, without altering the genome itself. Such mechanisms
are complex, dynamic and responsive to environment. Alterations that occur can affect the pathophysiology
of pain management at a DNA level, modifying perceived pain relief. In this review, we provide a brief overview
of epigenetics of pain, systemic local anesthetics and neuraxial techniques that continue to remain useful for
spinal surgery, neuropathic agents, as well as other common and less common target receptors for a truly multimodal
approach to perioperative pain management.
Publisher
Bentham Science Publishers Ltd.
Subject
Drug Discovery,Pharmacology
Cited by
6 articles.
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