Background Pruritus is a common side-effect of intrathecal opiate analgesia and the pathogenesis of neuraxial opioid-induced pruritus is still unclear, which may be opioid receptor-induced or non-opioid receptor-induced, the central μ-opioid receptor may play the key role. The traditional antihistamines are ineffective for neuraxial opioid-induced pruritus. Opioid antagonists seem to be the most potent antipruritus drugs, but for reserving analgesia, they have limitation for wide use. Other drugs for itch such as κ-opioid receptor agonist, serotonin (5-HT3) receptor antagonist, dopamine (D2) receptor antagonist, propofol and nonsteroidal anti-inflammatory drugs have been tried, but none is completely satisfactory. Further studies are required to develop more effective treatments. Objective To investigate the pathogenesis of neuraxial opioid-induced pruritus and to seek new treatments. Content This article reviewed home and abroad literatures relating the mechanism and treatment of neuraxial opioid-induced pruritus. Trend Now the μ-opioid receptor isoform MOR1D has been reported to be essential for morphine-induced itching, which offers the possibility to develop a novel therapeutic strategy to specifically attenuate itch without affecting the analgesic efficacy of opioids.