Special Topic Series on Opioid Therapeutics and Concerns in PediatricsMolecular Biology of Opioid Analgesia and Its Clinical ConsiderationsFinkel, Julia C. MD*; Pukish, Jennifer MD†Author Information *Pain Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Pediatrics and Critical Care Medicine, The George Washington University †Department of Anesthesiology, Pain and Perioperative Medicine, Children’s National Health System, Washington, DC The authors declare no conflict of interest. Reprints: Julia C. Finkel, MD, Pain Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Pediatrics and Critical Care Medicine, The George Washington University, 111 Michigan Ave. NW, Washington DC 20010 (e-mail: [email protected]). The Clinical Journal of Pain: June 2019 - Volume 35 - Issue 6 - p 473-480 doi: 10.1097/AJP.0000000000000705 Buy Metrics Abstract Understanding the molecular biology of opioid analgesia is essential for its proper implementation and mechanistic approach to its modulation in order to maximize analgesia and minimize undesired effects. By appreciating the molecular mechanisms intrinsic to opioid analgesia, one can manipulate a molecular target to augment or diminish a specific effect using adjuvant drugs, select an appropriate opioid for opioid rotation or define a molecular target for new opioid drug development. In this review, we present the cellular and molecular mechanisms of opioid analgesia and that of the associated phenomena of tolerance, dependence, and hyperalgesia. The specific mechanisms highlighted are those that presently can be clinically addressed. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.