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https://www.readbyqxmd.com/read/28221178/non-neuraxial-labor-analgesia-options
#1
John C Markley, Mark D Rollins
Although it is the most effective method to treat labor pain, neuraxial analgesia may be undesired, contraindicated, unsuccessful, or unavailable. Providing safe choices for labor pain relief is a central goal of health care providers alike. Consequently, knowledge of the efficacy, clinical implementation, and side effects of various non-neuraxial strategies is needed to provide appropriate options for laboring patients. In addition to nonpharmacologic alternatives, inhaled nitrous oxide and systemic opioids represent two broad classes of non-neuraxial pharmacologic labor analgesia most commonly available...
February 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28216001/loperamide-inhibits-sodium-channels-to-alleviate-inflammatory-hyperalgesia
#2
Ying Wu, Beiyan Zou, Lingli Liang, Min Li, Yuan-Xiang Tao, Haibo Yu, Xiaoliang Wang, Min Li
Previous studies demonstrated that Loperamide, originally known as an anti-diarrheal drug, is a promising analgesic agent primarily targeting mu-opioid receptors. However some evidences suggested that non-opioid mechanisms may be contributing to its analgesic effect. In the present study, Loperamide was identified as a Nav1.7 blocker in a pilot screen. In HEK293 cells expressing Nav1.7 sodium channels, Loperamide blocked the resting state of Nav1.7 channels (IC50 = 1.86 ± 0.11 μM) dose-dependently and reversibly...
February 16, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28213891/opioids-and-the-immune-system-friend-or-foe
#3
REVIEW
Lisanne Mirja Plein, Heike L Rittner
Systemically administered opioids are among the most powerful analgesics for treating severe pain. Several negative side-effects (respiratory depression, addiction, nausea, confusion) and the risk of opioid-induced hyperalgesia accompany opioid administration. One other side effect is the potential of opioids to suppress the immune response and thereby to increase the vulnerability for infections. Several studies have investigated the link between opioids and immunosuppression in vitro, in vivo as well as in patients with divergent results: Exogenous opioids such as morphine and fentanyl can impair macrophage and natural killer cell as well as T cell function and weaken the gut barrier in vitro and in animal studies...
February 18, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28211895/electroacupuncture-attenuates-cfa-induced-inflammatory-pain-by-suppressing-nav1-8-through-s100b-trpv1-opioid-and-adenosine-pathways-in-mice
#4
Hsien-Yin Liao, Ching-Liang Hsieh, Chun-Ping Huang, Yi-Wen Lin
Pain is associated with several conditions, such as inflammation, that result from altered peripheral nerve properties. Electroacupuncture (EA) is a common Chinese clinical medical technology used for pain management. Using an inflammatory pain mouse model, we investigated the effects of EA on the regulation of neurons, microglia, and related molecules. Complete Freund's adjuvant (CFA) injections produced a significant mechanical and thermal hyperalgesia that was reversed by EA or a transient receptor potential V1 (TRPV1) gene deletion...
February 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28210861/the-effects-of-alcoholism-and-smoking-on-advanced-cancer-patients-admitted-to-an-acute-supportive-palliative-care-unit
#5
Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Alessandra Casuccio
AIM: The aim of this prospective study was to determine the characteristics and symptom burden of advanced cancer patients with alcoholism problems and smoking, who were referred to an acute palliative/supportive care unit (ASPCU) of a comprehensive cancer center. METHODS: Patients' characteristics, indications for admission, kind of admission, awareness of prognosis, and anticancer treatments were recorded. The Edmonton Symptom Assessment Scale (ESAS) was used to assess physical and psychological symptoms, and the CAGE questionnaire for the diagnosis of alcoholism...
February 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28188737/genetic-variation-in-the-behavioral-effects-of-buprenorphine-in-female-mice-derived-from-a-murine-model-of-the-oprm1-a118g-polymorphism
#6
Caroline A Browne, Rebecca L Erickson, Julie A Blendy, Irwin Lucki
Pharmacogenetic studies have identified the non-synonymous single nucleotide polymorphism (A118G) in the human mu opioid receptor (MOR) gene (OPRM1) as a critical genetic variant capable of altering the efficacy of opioid therapeutics. To date few studies have explored the potential impact of the OPRM1 A118G polymorphism on the pharmacological effects of buprenorphine (BPN), a potent MOR partial agonist and kappa opioid receptor antagonist, which is approved by the FDA for the treatment of opioid addiction and chronic pain...
February 7, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28178769/improving-post-caesarean-analgesia-where-to-next
#7
Alexander Butwick
The provision of effective pain relief to mothers after caesarean section (CS) is a priority for both obstetric and anaesthesia providers. To meet this goal, multimodal analgesic regimens have been endorsed to manage pain and reduce opioid requirements after CS. Post-CS, typical oral analgesic regimens may comprise paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and an oral opioid. The inclusion of paracetamol and NSAIDs is important as each drug has an opioid sparing effect, thereby reducing the incidence of opioid related side-effects...
February 8, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28163558/effect-of-intravenous-acetaminophen-on-post-anesthesia-care-unit-length-of-stay-opioid-consumption-pain-and-analgesic-drug-costs-after-ambulatory-surgery
#8
Moteb A Khobrani, James M Camamo, Asad E Patanwala
OBJECTIVES: The primary objective was to assess whether the use of intravenous acetaminophen (APAP) in the ambulatory surgery setting is associated with a decreased length of stay in the post-anesthesia care unit (PACU). The secondary outcomes evaluated were pain scores, opioid consumption, and total cost of analgesics used in the PACU. METHODS: This was a retrospective cohort study conducted in adult patients (18 years of age or older) who received an eye, ear, nose, or throat (EENT) procedure at an outpatient surgery center between January 2014 and January 2015...
February 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28162663/-421-a-novel-non-opioid-conesnail-peptide-based-analgesic-as-a-therapeutic-alternative-for-the-treatment-of-chronic-pain
#9
J Mercado, M Xu, K Norton, D Peckham, J Posakony, E Tarcha, J Bartron, M Brown, K Lustig, L Manelli, C Ghelardini, B Cheppudira, M Fowler, S Christensen, J McIntosh, S Iadonato
No abstract text is available yet for this article.
April 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28160235/characteristics-of-patients-with-an-unplanned-admission-to-an-acute-palliative-care-unit
#10
Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Alessandra Casuccio
The aim of this cohort study is to compare the symptom burden of patients who have an unplanned admission to an acute palliative care unit (APCU) with patients who have a regular planned admission. A consecutive sample of advanced cancer patients who were admitted to an APCU was prospectively assessed. The reasons and the kind of admission were recorded (unplanned, UP, or planned, P). Anticancer treatments, whether patients were on/off treatment or uncertain, previous care setting, and who referred the patient to the unit were also recorded...
February 3, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28156637/complications-of-intrathecal-pump-therapy-in-malignancy-related-pain
#11
Egidio Del Fabbro
: 102 Background: Intrathecal pumps (ITP) are used to manage severe malignancy related pain by delivering analgesics directly into the cerebrospinal fluid, in theory allowing for a reduced opioid dose and fewer complications. Although there is literature to support efficacy in patients with cancer, including improved survival, this mode of drug delivery also carries a risk of serious complications. Reports of complications in non-malignant pain suggest the risks and mortality related to ITP may be under-appreciated and that injury and liability occur with both ITP placement and ITP maintenance...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156584/survivor-pain-experience-at-an-oncology-palliative-care-clinic
#12
Lisa Emond, Ann Wojtaszczyk
: 260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28154162/outcomes-of-physician-staffed-versus-non-physician-staffed-helicopter-transport-for-st-elevation-myocardial-infarction
#13
Sverrir I Gunnarsson, Joseph Mitchell, Mary S Busch, Brenda Larson, S Michael Gharacholou, Zhanhai Li, Amish N Raval
BACKGROUND: The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physician-staffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. METHODS AND RESULTS: We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014...
February 2, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28151795/effect-of-preoperative-opioid-exposure-on-healthcare-utilization-and-expenditures-following-elective-abdominal-surgery
#14
Jennifer F Waljee, David C Cron, Rena M Steiger, Lin Zhong, Michael J Englesbe, Chad M Brummett
OBJECTIVE: To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. SUMMARY BACKGROUND DATA: Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood. METHODS: Truven Health Marketscan Databases were used to identify adult patients who underwent elective abdominal surgery between June 2009 and December 2012 (n = 200,005)...
February 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28146271/liposomal-bupivacaine-infiltration-at-the-surgical-site-for-the-management-of-postoperative-pain
#15
REVIEW
Thomas W Hamilton, Vassilis Athanassoglou, Stephen Mellon, Louise H Strickland, Marialena Trivella, David Murray, Hemant G Pandit
BACKGROUND: Despite multi-modal analgesic techniques, acute postoperative pain remains an unmet health need, with up to three quarters of people undergoing surgery reporting significant pain. Liposomal bupivacaine is an analgesic consisting of bupivacaine hydrochloride encapsulated within multiple, non-concentric lipid bi-layers offering a novel method of sustained-release analgesia. OBJECTIVES: To assess the analgesic efficacy and adverse effects of liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain...
February 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28144710/selective-venous-vasodilator-properties-of-the-analgesic-metamizole-dipyrone-in-a-human-ex-vivo-model-implications-for-postoperative-pain-management
#16
Markus Hoenicka, Hagen Gorki, Karl Traeger, Andreas Liebold
Metamizole (dipyrone) is a first-line, non-opioid analgesic used for postoperative pain management. Clinical data and animal experiments indicate a possible vasodilator action of this drug. We investigated the effects of metamizole on human artery and vein tone in an ex vivo model to assess potential contributions to venous pooling. Excess segments of bypass grafts were harvested during coronary artery bypass grafting procedures. Tensions were measured in an organ bath for 120 min after adding metamizole to the preconstricted vessels...
January 31, 2017: Naunyn-Schmiedeberg's Archives of Pharmacology
https://www.readbyqxmd.com/read/28132576/what-are-the-advantages-of-non-opioid-analgesic-techniques-in-the-management-of-acute-and-chronic-pain
#17
Paul F White
No abstract text is available yet for this article.
January 30, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28125964/effect-of-admission-fascia-iliaca-compartment-blocks-on-post-operative-abbreviated-mental-test-scores-in-elderly-fractured-neck-of-femur-patients-a-retrospective-cohort-study
#18
Peter M Odor, Irina Chis Ster, Iain Wilkinson, Frederic Sage
BACKGROUND: Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block...
January 5, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28125215/molecular-docking-molecular-dynamics-and-structure-activity-relationship-explorations-of-14-oxygenated-n-methylmorphinan-6-ones-as-potent-%C3%AE-opioid-receptor-agonists
#19
Stefan M Noha, Helmut Schmidhammer, Mariana Spetea
Among opioids, morphinans are of major importance as the most effective analgesic drugs acting primarily via μ-opioid receptor (μ-OR) activation. Our long-standing efforts in the field of opioid analgesics from the class of morphinans led to N-methylmorphinan-6-ones differently substituted at positions 5 and 14 as μ-OR agonists inducing potent analgesia and fewer undesirable effects. Herein we present the first thorough molecular modeling study and structure-activity relationship (SAR) explorations aided by docking and molecular dynamics (MD) simulations of 14-oxygenated N-methylmorphinan-6-ones to gain insights into their mode of binding to the μ-OR and interaction mechanisms...
February 9, 2017: ACS Chemical Neuroscience
https://www.readbyqxmd.com/read/28118835/pilot-evaluation-of-a-novel-unilateral-onychectomy-model-and-efficacy-of-an-extended-release-buprenorphine-product
#20
RANDOMIZED CONTROLLED TRIAL
Masataka Enomoto, Patricia D Kigin, David Bledsoe, Robyn Slone, Jonathan Hash, Charles E Smith, B Duncan X Lascelles
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods...
January 24, 2017: BMC Veterinary Research
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