University of Arizona Health Sciences researchers have found that chronic morphine use may contribute to bone loss and heightened pain, according to a study published in PAIN.
While opioids like morphine are commonly used to manage cancer-induced bone pain, the findings shed light on the potential drawbacks of long-term morphine use in treating bone metastases.
“These findings suggest that chronic morphine for the treatment of things like metastatic cancer may not be the best since it may be actually decreasing bone density,” said senior author Todd Vanderah, Ph.D., director of the Arizona Health Sciences Comprehensive Pain and Addiction Center.
Alternative Therapies To Mitigate Opioid Side Effects
Metastatic cancer, wherein cancer spreads from its primary site to the bone, affects a significant number of patients. The National Institutes of Health reports that around 70% of prostate and breast cancer patients, and 30-40% of lung cancer patients, develop bone metastases with pain being a prominent symptom.
Although opioids should not be eliminated from treatment plans, “it does highlight a need to develop alternative therapies that can lower the risk of side effects from opioids,” according to Dr. Vanderah.
A recent Israeli study published in Frontiers in Pain Research revealed that medical marijuana has the potential to alleviate cancer-associated pain, with nearly half of the patients discontinuing other pain medications after six months of medical cannabis treatment.
About The Study
Previous research, both in preclinical models and humans, indicated a link between chronic morphine use and reduced bone density, as well as an increased risk of hip fracture.
However, this study is the first to identify a specific mechanism through which morphine contributes to bone loss and pain.
Specifically, researchers investigated how morphine interacts with mu-opioid receptors and toll-like receptor 4 (TLR4). Mu opioid receptors are the primary targets for opioids and play a crucial role in pain control and the occurrence of side effects. TLR4, on the other hand, recognizes foreign molecules and is commonly found in immune cells, per the study.
“We believe that morphine is acting through toll-like receptor 4 to increase the number of osteoclasts that are produced and the activity of those osteoclasts,” Dr. Vanderah said, explaining that as osteoclasts chew away more bone, pain levels rise. “In the bigger picture, chronic opiates may start enhancing bone loss in any inflammatory condition – if somebody has an activated immune system because of cancer or arthritis, for example.”
See Also: Breast Cancer Survivor Enjoys Remission After Doctors Supported Using Cannabis With Chemotherapy
It is important to note that this study emerged as an extension of Dr. Vanderah's research on cannabinoids as potential non-opioid treatments for cancer-induced bone pain, which is an ongoing project.
The study was authored by Dr. Tally Largent-Milnes, Dr. Jennifer Uhrlab, Austen Thompson, MD, Ph.D., Haley Ciccone, Dieter Mohty, and other researchers associated with the University of Arizona College of Medicine - Tucson and supported in part by the National Institutes of Health, the National Cancer Institute and the National Institute on Drug Abuse.
As more research is conducted in this area, it is hoped that these findings will inform medical practices and lead to better treatment options for patients suffering from cancer-induced bone pain, researchers concluded.
Read More: Cannabis For Cancer Symptoms, But How Are Patients Supposed To Know About Potency And Dosing?
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