{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:44:45Z","timestamp":1788435885980,"version":"build-2803163510"},"reference-count":29,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["KAKENHI\/JP21K09006"],"award-info":[{"award-number":["KAKENHI\/JP21K09006"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,6,9]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Tramadol, a weak opioid anesthetic, is used for pain management in patients with cancer, but the effects of tramadol on cancer via \u00b5-opioid receptor are still unknown. We assessed the effects of tramadol on pancreatic ductal adenocarcinoma using transgenic mice (<jats:italic>LSL-Kras<jats:sup>G12D\/+<\/jats:sup>; Trp53<jats:sup>flox\/flox<\/jats:sup>; Pdx-1<jats:sup>cre\/+<\/jats:sup>\n                     <\/jats:italic>).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Six-week-old transgenic mice were orally administered 10\u2009mg\/kg\/day tramadol (n=12), 10\u2009mg\/kg\/day tramadol and 1\u2009mg\/kg\/day naltrexone (n=9), or vehicle water (n=14) until the humane endpoint. Cancer-related pain and plasma cytokine levels were assessed by the mouse grimace scale and cytokine array, respectively. Tumor status was determined histopathologically. Tramadol\u2019s effects on proliferation and invasion in pancreatic ductal adenocarcinoma cell lines were studied in vitro.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Tramadol with\/without naltrexone improved mouse grimace scale scores while decreasing inflammatory cytokines such as tumor necrosis factor-\u03b1 and interleukin-6. Proliferative Ki-67 and cyclins decreased by tramadol, while local M1-like tumor-associated macrophages increased by tramadol, which was blocked by naltrexone. Meanwhile, tramadol with\/without naltrexone reduced juxta-tumoral cancer-associated fibroblasts and M2-like tumor-associated macrophages. Tumor-associated neutrophils, natural killers, and cytotoxic T cells were not altered. Tramadol decreased the proliferative and invasive potentials of pancreatic ductal adenocarcinoma cell lines via decreasing cyclins\/cyclin-dependent kinases, which was partially reversed by naltrexone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These findings imply that tramadol might be a useful anesthetic for pancreatic ductal adenocarcinoma: inhibiting the proliferation and invasion along with increasing antitumor M1-like tumor-associated macrophages via the \u00b5-opioid receptor, while improving cancer-associated pain possibly through the antitumor effects with the decrease of inflammatory cytokines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104511","type":"journal-article","created":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T22:31:49Z","timestamp":1687559509000},"page":"200-208","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of tramadol via a \u00b5-opioid receptor on pancreatic ductal adenocarcinoma in vitro and in vivo"],"prefix":"10.1136","volume":"49","author":[{"given":"Tomoya","family":"Kuramochi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6718-2353","authenticated-orcid":false,"given":"Makoto","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichie","family":"Kajiwara","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukino","family":"Oshima","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Itaya","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinsuk","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshimi","family":"Ichimaru","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Shonan University of Medical Sciences, Yokohama, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Kitajima","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Masamune","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Ijichi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan"},{"name":"Clinical Nutrition Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,23]]},"reference":[{"key":"2025101109145743000_49.3.200.1","unstructured":"Fitzgibbon DR , Loese JD . Cancer pain: assessment, diagnosis, and management 1st Edn. Philadelphia, PA: Lippincott Williams & Wilkins\/Wolters Kluwer Health, Inc, 2010."},{"key":"2025101109145743000_49.3.200.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21708"},{"key":"2025101109145743000_49.3.200.3","doi-asserted-by":"crossref","first-page":"e971","DOI":"10.1002\/onco.13796","article-title":"Consortium PP: Pancreas cancer-associated pain management","volume":"26","author":"Coveler","year":"2021","journal-title":"Oncologist"},{"key":"2025101109145743000_49.3.200.4","first-page":"2573","article-title":"Tramadol regulates proliferation, migration and invasion via PTEN\/Pi3K\/AKT signaling in lung adenocarcinoma cells","volume":"20","author":"Xia","year":"2016","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025101109145743000_49.3.200.5","first-page":"157","article-title":"Tramadol inhibits proliferation, migration and invasion via \u03912-adrenoceptor signaling in breast cancer cells","volume":"20","author":"Xia","year":"2016","journal-title":"Eur Rev Med 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