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Opioids have been used for thousands of years for the treatment of pain. Records on papyri in Ancient Egypt reported the use of opium to relieve pain. In 1973, Candace Pert used radioactive morphine to assess its place of action and, surprisingly, found that the drug attaches to specific areas of the brain, namely on receptors called “morphine receptors”. Because animal model studies have debunked that a receptor would not be needed for the alkaloid in the Papaver somniferum plant, this finding sparked a search for the molecule that would endogenously stimulate that receptor, culminating in the discovery of “endogenous opiopeptides” or “endorphins” by John Hughes and Hans Kosterlitz in 1975. Most clinically relevant opioids operate at the level of the “morphine receptor” or “μ receptors”, and are therefore considered “agonists μ”. This paper looks at opioids in an effort to better understand the side effects and drug interactions. [ABSTRACT FROM AUTHOR]

Background/Aims: Repetitive transcranial magnetic stimulation and transcutaneous electrical nerve stimulation have been studied repeatedly to reduce diabetic neuropathic pain. The objective of this study was to compare the effects of aerobic training plus one of the treatment therapies on decreasing pain severity in patients with diabetic peripheral neuropathy. Methods: A total of 30 patients with diabetic peripheral neuropathy were randomly assigned into two equal groups: group A and group B. Both groups received aerobic training exercises. Group A received repetitive transcranial magnetic stimulation, and Group B received transcutaneous electrical nerve stimulation for 5 consecutive days in 1 week. Outcome measures included pain severity assessment using the Visual Analogue Scale and the serum β-endorphin levels. Results: There was a non-significant difference in pre-treatment (P=0.061) and post-treatment (P=0.652) in the Visual Analogue Scale scores between groups. However, β-endorphin levels were significantly different between groups in post- (P=0.015) rather than pre-treatment (P=0.459) levels. A significant moderate correlation between β-endorphin levels and Visual Analogue Scale scores was found in group A (r=−0.6783) at (P=0.008), while it was not significant in group B (r=0.043) at (P=0.883). Conclusions: Adding transcutaneous electrical nerve stimulation or repetitive transcranial magnetic stimulation therapies to aerobic training showed similar effects in reducing pain severity in patients with diabetic peripheral neuropathy. [ABSTRACT FROM AUTHOR]