Warren A Southerland1, Justin Gillis2, Sumanth Kuppalli2, Alex Fonseca2, Andrew Mendelson3, Storm V Horine3, Nitin Bansal3, Amitabh Gulati4. 1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA. wsouther@bidmc.harvard.edu. 2. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA. 3. Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA. 4. Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE OF REVIEW: Dual enkephalinase inhibitors (DENKIs) are pain medications that indirectly activate opioid receptors and can be used as an alternative to traditional opioids. Understanding the physiology of enkephalins and their inhibitors and the pharmacology of these drugs will allow for proper clinical application for chronic pain patients in the future. RECENT FINDINGS: DENKIs can be used as an alternative mode of analgesia for patients suffering from chronic pain by preventing the degradation of endogenous opioid ligands. By inhibiting the two major enkephalin-degrading enzymes (neprilysin and aminopeptidase N), DENKIs can provide analgesia with less adverse effects than nonendogenous opioids. The purpose of this paper is to review the current literature investigating DENKIs and explore their contribution to chronic pain management.
PURPOSE OF REVIEW: Dual enkephalinase inhibitors (DENKIs) are pain medications that indirectly activate opioid receptors and can be used as an alternative to traditional opioids. Understanding the physiology of enkephalins and their inhibitors and the pharmacology of these drugs will allow for proper clinical application for chronic painpatients in the future. RECENT FINDINGS: DENKIs can be used as an alternative mode of analgesia for patients suffering from chronic pain by preventing the degradation of endogenous opioid ligands. By inhibiting the two major enkephalin-degrading enzymes (neprilysin and aminopeptidase N), DENKIs can provide analgesia with less adverse effects than nonendogenous opioids. The purpose of this paper is to review the current literature investigating DENKIs and explore their contribution to chronic pain management.
Authors: Jason W Busse; Li Wang; Mostafa Kamaleldin; Samantha Craigie; John J Riva; Luis Montoya; Sohail M Mulla; Luciane C Lopes; Nicole Vogel; Eric Chen; Karin Kirmayr; Kyle De Oliveira; Lori Olivieri; Alka Kaushal; Luis E Chaparro; Inna Oyberman; Arnav Agarwal; Rachel Couban; Ludwig Tsoi; Tommy Lam; Per Olav Vandvik; Sandy Hsu; Malgorzata M Bala; Stefan Schandelmaier; Anne Scheidecker; Shanil Ebrahim; Vahid Ashoorion; Yasir Rehman; Patrick J Hong; Stephanie Ross; Bradley C Johnston; Regina Kunz; Xin Sun; Norman Buckley; Daniel I Sessler; Gordon H Guyatt Journal: JAMA Date: 2018-12-18 Impact factor: 56.272