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Neuraxial opioid action site

According to Miller, “the analgesic effects of opioids arise from their ability to directly inhibit ascending transmission of nociceptive information from the spinal cord dorsal horn and to activate pain control circuits that descend from the midbrain, via the rostral ventromedial medulla (RVM), to the spinal cord dorsal horn…In the spinal cord, opioids act at synapses either presynaptically or postsynaptically.Opioid receptors are abundantly expressed in the substantia gelatinosa, where release of substance P from the primary sensory neuron is inhibited by opioids.”