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Publications

Journal Article Ahead of print

PubMed: 42864794 DOI: 10.2174/0113892010424007260928171201

Dopamine Homeostasis, Cognitive Testing, and Precision Pain Management: A Narrative Review of Reward Circuitry, Opioid Risk, and Personalized Recovery Metrics.

Curr Pharm Biotechnol

Authors: Kai-Uwe Lewandrowski, Sergio Schmidt, Rossano Kepler Alvim Fiorelli, Kavya Mohankumar, Albert Pinhasov, Morgan P Lorio, Panayotis K Thanos, Mark S Gold, Eliot L Gardner, Igor Elman, Alireza Sharafshah, Catherine A Dennen, Debasis Bagchi, Alexander P L Lewandrowski, Edward J Modestino, David Baron, Rajendra D Badgaiyan, Abdalla Bowirrat, Keerthy Sunder, Milan Makale, Kenneth Blum

Affiliations

  • Division of Personalized Pain Therapy and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA.
  • Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia.
  • Programa de Pós-Graduação em Neurologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20270-004, Brazil.
  • Department of Orthopaedic Surgery, University of Arizona School of Medicine, Tucson, AZ, USA.
  • Division of Nutrigenomics, The Kenneth Blum Behavioral Neurogenetic Institute, Austin, TX, USA.
  • Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel, Israel.
  • Advanced Orthopedics, Altamonte Springs, FL 32701, USA.
  • Research Institute on Addictions, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
  • Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
  • Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
  • Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
  • Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA.
  • Department of Biology, College of Arts and Sciences, Adelphi University, Garden City, NY, USA and Department of Psychology, Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA.
  • Department of Biological Sciences, Dornsife College of Letters, Arts & Sciences, University of Southern California, Los Angeles, CA, USA.
  • Brain & Behavior Laboratory, Department of Psychology, Curry College, Milton, MA, USA.
  • Division of Addiction Research & Education, Center for Sports, Exercise & Mental Health, Western University of Health Sciences, Pomona, CA, USA.
  • Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
  • Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA 92093-0819, USA.
  • Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA.

Abstract

INTRODUCTION/OBJECTIVE

Chronic pain and opioid-related harm intersect through overlapping biological, behavioral, and clinical pathways. This narrative review presents a framework linking dopamine homeostasis, opioid-risk reduction, and objective cognitive testing in precision pain and addiction medicine.

METHODS

Literature on chronic pain, opioid exposure, mesocorticolimbic dopamine signaling, reward-circuit vulnerability, pharmacogenomics, dopamine precursor and pro-dopaminergic adjuncts, and Continuous Visual Attention Test (CVAT) metrics was synthesized narratively; this is not a systematic review or clinical guideline.

RESULTS

Pain relief, reinforcement, withdrawal, mood, attention, and recovery motivation involve overlapping regulatory systems. Dopamine biology is relevant to these intersections but does not provide a single-cause explanation for pain or addiction. Genetic risk stratification and pharmacogenomic testing may enrich research models and selected counseling but require external validation, ancestry-aware calibration, and ethical safeguards. CVAT reaction time, variability, omissions, and commissions may complement pain and disability scales during treatment.

DISCUSSION

The framework distinguishes established opioid-sparing care from investigational dopamine precursor strategies and emphasizes repeated measurement of function, medication exposure, and cognition.

CONCLUSION

Precision pain care should integrate biological risk, opioid stewardship, multimodal analgesia, dopamine-homeostasis hypotheses, and objective cognitive monitoring.

MeSH

Research Design, Chronic Pain, Pain, Homeostasis, Pain Management, Reward, Dopamine, Recycling, Precision Medicine