Dexmedetomidine for cancer pain: mechanisms and opioid-sparing effects

作者：Wei Liao, Shuzhai Li, Qisheng Chen, Li Wan, Shixuan Peng, Huidan Ouyang, Xiaoling Zhu, Lingli Tan, Zhiming Zhang · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002536 · 被引用次数：9 · 研究领域：Cancer, Stress, Anesthesia, and Immune Response、Pain Management and Opioid Use、Pain Mechanisms and Treatments

BACKGROUND AND OBJECTIVE: Cancer pain treatment faces challenges such as ineffective pain management, high-dose opioid use, and insufficient analgesia. Dexmedetomidine (DEX), a novel α2 receptor agonist, is a potential adjuvant analgesic. Its analgesic mechanism involves central coeruleus cell hyperpolarization, activation of peripheral, spinal cord, and spinal α2 receptors, and regulation of cellular signaling pathways and inflammatory factors. DEX reduces harmful neurotransmitter production and pain signal transmission and enhances opioid analgesia while decreasing opioid use and tolerance. This review introduces the main mechanisms of DEX and its potential for treating complex and refractory cancer pain. METHODS: We conducted literature searches using the terms "dexmedetomidine," "cancer pain," "opioid sparing," "analgesic mechanism," and their combinations in PubMed, Embase, Cochrane Library, and Web of Science. We systematically retrieved research articles, reviews, and editorials published in English up to mid-December 2024. All identified publications were reviewed, and their key references were cross-checked to ensure a comprehensive and high-quality review. KEY CONTENT AND FINDINGS: Preclinical and clinical studies have demonstrated the advantages and potential of DEX in cancer pain management. DEX has intrinsic analgesic properties and can significantly relieve cancer pain by interacting with opioids, thereby delaying the development of opioid tolerance. It is parti...