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spinal opioids

Chang Ju Hwang, Sung Soo Chung, Kyu-Yeol Lee, Jae Hyup Lee, Seong-Hwan Moon, Jin-Hyok Kim, Kyu-Jung Cho, Jae-Sung Ahn, Dong-Soo Kim, Ye-Soo Park, Hye-Jeong Park
Background: A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. Methods: In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks...
March 2018: Clinics in Orthopedic Surgery
Jun-Bin Yin, Ya-Cheng Lu, Ban Feng, Zhen-Yu Wu, Ying-Biao Chen, Ting Zhang, Zhen-Zhen Kou, Ming-Ming Zhang, Han Zhang, Jin-Lian Li, Hui Li, Tao Chen, Yu-Lin Dong, Yun-Qing Li
BACKGROUND/AIMS: Spinal dorsal horn (SDH) is one of the most important regions for analgesia produced by endomorphin-2 (EM2), which has a higher affinity and specificity for the µ-opioid receptor (MOR) than morphine. Many studies have focused on substantia gelatinosa (SG, lamina II) neurons to elucidate the cellular basis for its antinociceptive effects. However, the complicated types and local circuits of interneurons in the SG make it difficult to understand the real effects of EM2...
March 15, 2018: Neuro-Signals
Lucy Gee, Heather C Smith, Zohal Ghulam-Jelani, Hirah Khan, Julia Prusik, Paul J Feustel, Sarah E McCallum, Julie G Pilitsis
BACKGROUND: Chronic pain causes a significant burden to the US health care system, is difficult to treat, and remains a significant contributor to increased opioid use in the United States. Spinal cord stimulation (SCS) has been FDA approved for the treatment of chronic pain. OBJECTIVE: To evaluate the hypothesis that SCS reduces opioid use, and alone maintains clinical outcome measures of pain and psychosocial determinants of health. METHODS: In this prospective cohort study, we evaluated 86 patients undergoing SCS surgery for the treatment of chronic pain between September 2012 and August 2015...
March 12, 2018: Neurosurgery
Andrei D Sdrulla, Yun Guan, Srinivasa N Raja
The field of spinal cord stimulation (SCS) owes its inception to the concept of gate control theory (GCT), put forth by Wall and Melzack in their landmark 1965 paper, which proposed that "control of pain may be achieved by selectively activating the large, rapidly conducting fibers". The first reported clinical application of dorsal column stimulation came 2 years later, and the field has gradually expanded ever since. Today, an estimated 50,000 spinal cord neurostimulators are implanted annually...
March 11, 2018: Pain Practice: the Official Journal of World Institute of Pain
Kris Rutten, Wolfgang Schröder, Thomas Christoph, Thomas Koch, Thomas M Tzschentke
Agonists selectively acting at NOP, MOP, DOP and KOP receptors as well as mixed opioid receptor agonists are known to exert anti-hypersensitive efficacy in the rat spinal nerve ligation (SNL) model of neuropathic pain. To investigate the relative contribution of individual opioid receptor activation to the overall efficacy of mixed opioid receptor agonists, selective doses of respective opioid receptor antagonists have to be employed. In order to identify such selective antagonist doses, doses of the selective NOP, MOP, DOP and KOP receptor agonists Ro65-6570, morphine, SNC-80 and U50488H, that produced maximum efficacy without apparent side effects, were challenged by each of the receptor antagonists J-113397 (NOP receptor), naloxone (MOP receptor), naltrindole (DOP receptor) and nor-binaltorphimine (KOP receptor)...
March 7, 2018: European Journal of Pharmacology
Lin Zhou, Yahui Hu, Chengyuan Li, Yunyi Yan, Luyao Ao, Boyang Yu, Weirong Fang, Jihua Liu, Yunman Li
Vincristine is a commonly used chemotherapeutic drug that can produce painful peripheral neuropathy. The chemokine (C-X-C motif) ligand 1 (CXCL1) and its receptor chemokine (C-X-C motif) receptor 2 (CXCR2) may mediate the resolution of this inflammation. In this study, we investigated whether and how CXCL1 contributes to vincristine-induced pain and the underlying mechanisms of levo-corydalmine (l-CDL, a tetrahydroprotoberberine). Oxycodone hydrochloride (a semisynthetic opioid analgesic) was used as positive control in vivo experiments...
March 5, 2018: Neuropharmacology
Gerardo Cortese, Gabriele Sales, Giorgia Maiolo, Mario Morino, Martina Scanu, Luca Brazzi
BACKGROUND: The feasibility and safety of transanal endoscopic microsurgery (TEM) performed under spinal anaesthesia (SA) has been recently demonstrated. This retrospective study compared the differences in opioid consumption and postoperative recovery in patients undergoing TEM under GA and SA. METHODS: All consecutive patients who underwent TEM at 'Città della Salute e della Scienza' hospital of Turin (Italy) between January 2012 and December 2015 were enrolled...
March 7, 2018: Minerva Anestesiologica
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Dimitra Tziona, Marianna Papaioannou, Argyro Mela, Styliani Potamianou, Alexandros Makris
PURPOSE: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. This study evaluates the technique of local infiltration analgesia (LIA), by comparing it to saline injections in addition to a standardized multimodal regimen including an adductor canal block. METHODS: Between September 2015 and March 2016, forty patients aged 18 years and older, ASA I-III, undergoing primary unilateral cemented TKA under spinal anesthesia were randomized to receive either LIA (LIA group) or normal saline (sham LIA group)...
March 5, 2018: Journal of Anesthesia
Marko Tomov, Kevin Tou, Rose Winkel, Ross Puffer, Mohamad Bydon, Ahmad Nassr, Paul Huddleston, Michael Yaszemski, Bradford Currier, Brett Freedman
Study Design: Retrospective case-control study using prospectively collected data. Purpose: Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF). Overview of Literature: Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain...
February 2018: Asian Spine Journal
Sascha R A Alles, Peter A Smith
Injury to or disease of the nervous system can invoke chronic and sometimes intractable neuropathic pain. Many parallel, interdependent, and time-dependent processes, including neuroimmune interactions at the peripheral, supraspinal, and spinal levels, contribute to the etiology of this "disease of pain." Recent work emphasizes the roles of colony-stimulating factor 1, ATP, and brain-derived neurotrophic factor. Excitatory processes are enhanced, and inhibitory processes are attenuated in the spinal dorsal horn and throughout the somatosensory system...
April 2018: Pharmacological Reviews
Felix Greimel, Guenther Maderbacher, Clemens Baier, Armin Keshmiri, Timo Schwarz, Florian Zeman, Winfried Meissner, Joachim Grifka, Achim Benditz
Numbers of knee replacement surgeries have been rising over the past years. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. All 15326 patients included had undergone primary knee arthroplasty within this multicenter cohort-study, conducted in 46 orthopedic departments. Parameters were evaluated on first postoperative day. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction). Pain medication necessity was analyzed...
February 27, 2018: Scientific Reports
M R Hoyt, U Shah, J Cooley, M Temple
OBJECTIVES: Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. METHODS: We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1...
January 31, 2018: International Journal of Obstetric Anesthesia
Martin Kaczocha, Syed Azim, James Nicholson, Mario J Rebecchi, Yong Lu, Tian Feng, Jamie L Romeiser, Ruth Reinsel, Sabeen Rizwan, Shivam Shodhan, Nora D Volkow, Helene Benveniste
BACKGROUND: The primary goal of this study was to determine whether administration of intrathecal morphine reduces postoperative pain. The secondary goal was to determine the effect of intrathecal morphine upon circulating levels of the weakly analgesic endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and the related lipids palmitoylethanolamide (PEA) and oleoylethanolamide (OEA). METHODS: Forty two total knee arthroplasty (TKA) patients were enrolled in a prospective, double-blinded, randomized study...
February 27, 2018: BMC Anesthesiology
Kyle W Mahoney, Meghan Romba, Philippe Gailloud, Izlem Izbudak, Deanna Saylor
As the opioid epidemic continues, understanding manifestations of abuse, including heroin-associated myelopathy remains essential. Here we describe a young man with a past medical history significant for polysubstance abuse who developed acute-onset, rapidly progressive myelopathy after resumption of intravenous heroin use. He had significant spinal cord involvement with findings suggestive of heroin-associated myelopathy. The salient features of this case include diffusion imaging of the spine and spinal angiography supporting a possible vasculopathy as the pathophysiologic mechanism underlying heroin-associated myelopathy...
February 23, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Xinran Hou, Yingqi Weng, Tongxuan Wang, Bihan Ouyang, Yalin Li, Zongbin Song, Yundan Pan, Zhong Zhang, Wangyuan Zou, Changsheng Huang, Qulian Guo
Epigenetic modulation participates in the mechanism of multiple types of pathological pain, so targeting the involved regulators may be a promising strategy for pain treatment. Our previous research identified the analgesic effect of the histone deacetylase (HDAC) inhibitor trichostatin A (TSA) on mechanical hyperalgesia in a rat model of bone cancer pain (BCP) via restoration of μ-opioid receptor (MOR) expression. However, the specific types of HDACs contributing to BCP have not been explored. The present study investigated the expression pattern of some common HDACs and found that HDAC2 was up-regulated in a time-dependent manner in the lumbar spinal cord of BCP rats...
February 23, 2018: Neuroscience
Patrick Grenier, David Wiercigroch, Mary C Olmstead, Catherine M Cahill
Long-term use of opioid analgesics is limited by tolerance development and undesirable adverse effects. Paradoxically, spinal administration of ultra-low-dose (ULD) G-protein-coupled receptor antagonists attenuates analgesic tolerance. Here, we determined whether systemic ULD α2-adrenergic receptor (AR) antagonists attenuate the development of morphine tolerance, whether these effects extend to the cannabinoid (CB1) receptor system, and if behavioral effects are reflected in changes in opioid-induced spinal gliosis...
February 23, 2018: Behavioural Pharmacology
Rafael Salas, Karla Ramirez, Victor Tortorici, Horacio Vanegas, Enrique Vazquez
The so-called on- and off-cells of the rostral ventromedial medulla (RVM) send their axons to the spinal dorsal horn. Activation of on-cells precedes and coincides with a facilitation, and activation of off-cells coincides with an inhibition, of withdrawal reflexes elicited by noxious agents. Considerable evidence supports the notion that on- and off-cells modulate nocifensive reflexes during opioid and non-opioid action and also during normal circumstances and during peripheral neuropathy and inflammation...
February 21, 2018: Brain Research
Nynke J van den Hoogen, Roel Ri van Reij, Jacob Patijn, Dick Tibboel, Elbert Aj Joosten
Clinical and experimental data suggests that noxious stimulation at critical stages of development results in long-term changes on nociceptive processing in later life. Here, we use an established, well-documented rat model of repetitive noxious procedures closely mimicking the clinical situation in the NICU. In order to understand molecular changes underlying the long-term consequences of repetitive stimulation of the developing nociceptive system the present study aims to analyse the presence of the µ-opioid-receptor-1 (OPRM1)...
February 22, 2018: Developmental Neurobiology
Kornél Király, Márk Kozsurek, Erika Lukácsi, Benjamin Barta, Alán Alpár, Tamás Balázsa, Csaba Fekete, Judit Szabon, Zsuzsanna Helyes, Kata Bölcskei, Valéria Tékus, Zsuzsanna E Tóth, Károly Pap, Gábor Gerber, Zita Puskár
Altered pain sensations such as hyperalgesia and allodynia are characteristic features of various pain states, and remain difficult to treat. We have shown previously that spinal application of dipeptidyl peptidase 4 (DPP4) inhibitors induces strong antihyperalgesic effect during inflammatory pain. In this study we observed low level of DPP4 mRNA in the rat spinal dorsal horn in physiological conditions, which did not change significantly either in carrageenan-induced inflammatory or partial nerve ligation-generated neuropathic states...
February 22, 2018: Scientific Reports
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