Scleroderma is an inflammatory autoimmune disease affecting connective tissue, the fibrous tissue that surrounds and supports organs and other tissues. It is characterized by the immune system mistakenly attacking healthy connective tissue, leading to scarring that causes connective tissue to harden and thicken.
Scleroderma that affects only the skin is referred to as localized scleroderma. The disease form that damages both the skin and internal organs is called systemic scleroderma, and often results in chronic pain in muscles, tendons, and joints. In cases where over-the-counter pain medications such as Tylenol (acetaminophen) are insufficient, narcotic analgesics may be prescribed to alleviate severe pain.
How narcotic analgesics work
Narcotic analgesics work by modulating signaling in the brain. They bind to protein receptors called opioid receptors within the central nervous system. These receptors work in tandem with another type of receptor, called G-protein receptors. When narcotic analgesics bind to protein receptors, they block an enzyme called adenylate cyclase from working. Adenylate cyclase produces cyclic AMP (cAMP), an important signaling molecule in the nervous system.
By inhibiting adenylate cyclase, narcotic analgesics lower the amount of cAMP available, which reduces the excitability of neurons. The combination of these effects results in a decrease in pain signaling in the nervous system.
However, the body responds to inhibiting, or blocking, its opioid receptors by increasing the number of opioid receptors present on the neurons, as well as increasing the sensitivity of downstream signaling. This means that, over time, more narcotic analgesics are needed to experience a similar reduction in pain. This process is thought to be a contributing factor to people developing a chemical dependence on narcotic analgesics.
Narcotic analgesics and scleroderma
Narcotic analgesics prescribed for scleroderma include Vicodin (acetaminophen/hydrocodone), Percocet (acetaminophen/oxycodone), and OxyContin (oxycodone). Both oxycodone and hydrocodone work by activating opioid receptors in the nervous system. These treatments may be taken by mouth, via a patch on the skin, by injection, or as a suppository.
Narcotic analgesics are highly addictive and should not be used long term.
Side effects may include dizziness, faintness, nausea, and vomiting. Less common side effects include difficulty urinating, headaches, nervousness, and difficulty sleeping.
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