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By Jianren Mao

- similar to opioid rotation and tapering, offer clinicians with replacement tools for treating OIH's tricky, power, and sundry difficulties

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There are three major means of painful chemical stimulation, the first of which includes intradermal injection or topical application of capsaicin, which evokes cutaneous pain and subsequent hyperalgesia. This model has been used to test analgesic effects in the context of neuropathic pain. In particular, some studies have quantified the extent of secondary hyperalgesia following standardized topical capsaicin application, and have utilized the resultant data as an index of spinal processing of nociceptive input, as in studies of putative neuropathic pain-relieving medications (43–45).

INRC, Charleston, SC, 2008:46. 50. Matsushita Y, Ueda H. Curcumin blocks chronic morphine analgesic tolerance and brain-derived neurotrophic factor upregulation. Neuroreport 2009; 20(1):63–68. 51. Akbarian S, Rios M, Liu RJ, et al. Brain-derived neurotrophic factor is essential for opiate-induced plasticity of noradrenergic neurons. J Neurosci 2002; 22(10): 4153–4162. 52. Deng X, Yellaturu C, Cagen L, et al. Expression of the rat sterol regulatory elementbinding protein-1c gene in response to insulin is mediated by increased transactivating capacity of specificity protein 1 (Sp1).

40. Bijur PE, Schechter C, Esses D, et al. Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients. J Pain 2006; 7(2):75–81. 41. Yeh YC, Lin TF, Wang CH, et al. Effect of combining ultralow-dose naloxone with morphine in intravenous patient-controlled analgesia: the cut-off ratio of naloxone to morphine for antiemesis after gynecologic surgery. J Formos Med Assoc 2008; 107(6): 478–484. 42. Webster LR, Butera PG, Moran LV, et al.

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