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Discovery of endogenous opioid systems: what it has meant for the clinician's understanding of pain and its treatment

Ballantyne, Jane C.a,*; Sullivan, Mark D.b

doi: 10.1097/j.pain.0000000000001043
Pain Classics
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Before the discovery of the endogenous opioid system in the 1970s, opioids were understood only through the lens of opioid drug effects. Opium produced sleep, pain relief, and addiction. Once a variety of opioids had been extracted from opium, and still others synthesized chemically, it became clear that there must be endogenous receptors to explain differential drug effects. So, the search was on to identify the receptors, and subsequently their endogenous ligands. Even then, the consequential ways in which the endogenous opioid system influences the way we respond to the environment and survive took time to unravel. Today's understanding extends far beyond simply accepting pain relief and addiction as separate processes, to the realization that the endogenous opioid system achieves constant adjustments between punishment (pain) and reward in communicating areas of the brain previously thought to subserve separate functions. The system also plays a crucial role in socialization. Taken together, these 2 lines of research have led to new insights into why the endogenous opioid system is so important in terms of evolution, individual survival and day-to-day function, and how important it is to consider opioid medications within the context of these critical natural functions.

Departments of aAnesthesiology and Pain Medicine and

bPsychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

Corresponding author. Address: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Box 356540, Seattle, WA 98195-6560, USA. Tel.: +(206) 543 2568; fax: (206) 543 2958. E-mail address: jcb12@uw.edu (J.C. Ballantyne).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received June 26, 2017

Received in revised form July 28, 2017

Accepted August 11, 2017

© 2017 International Association for the Study of Pain
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