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Chronic AND Opioid AND Treatment

M M Wertli, J Steurer
Low back pain is common. In the acute (duration <6 weeks) and subacute pain phases (6-12 weeks) the main goal of pharmacological pain treatment is to enable patients to move and to stay as active as possible. In the chronic phase, pain medications can support non-pharmacological measures and improve physical function. Although almost every person will experience low back pain at least once in a lifetime, for many pain medications no clinical studies on their efficacy exist. Most data are available on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in acute and chronic low back pain; however, potential adverse effects and contraindications for NSAIDs need to be taken into account when the medication is prescribed...
August 16, 2018: Der Internist
Mehdi Borjkhani, Fariba Bahrami, Mahyar Janahmadi
There are several experimental studies which suggest opioids consumption forms pathological memories in different brain regions. For example it has been empirically demonstrated that the theta rhythm which appears during chronic opioid consumption is correlated with the addiction memory formation. In this paper, we present a minimal computational model that shows how opioids can change firing patterns of the neurons during acute and chronic opioid consumption and also during withdrawal periods. The model consists of a pre- and post-synaptic neuronal circuits and the astrocyte that monitors the synapses...
2018: Frontiers in Computational Neuroscience
Annarita Tagliaferri, Massimo Franchini, Gianna F Rivolta, Stefania Farace, Gabriele Quintavalle, Antonio Coppola
INTRODUCTION: Persons with haemophilia (PWH) experience recurrent joint bleeding which leads from early synovitis to irreversible joint damage. Pain strongly affects patients' quality of life, as PWH suffer from acute pain associated with haemarthroses and chronic pain due to arthritic and degenerative complications. AIM: To investigate pain issues among PWH and their treaters in Italy. METHODS: Persons with haemophilia and specialist physicians responded to a survey focused on pain characteristics, assessment, and management by phone call and online, respectively...
August 16, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Dalila R Veiga, Liliane Mendonça, Rute Sampaio, José C Lopes, Luís F Azevedo
Background: High rates of opioid use for chronic noncancer pain (CNCP) have been reported worldwide, despite its association with adverse events, inappropriate use, and limited analgesic effect. Opioid-induced constipation (OIC) is the most prevalent and disabling adverse effect associated with opioid therapy. Our aim was to assess the incidence, health related quality of life (HRQOL), and disability in OIC patients. Methods: A prospective cohort study was performed, with 6 months of follow-up, of adult CNCP patients consecutively admitted in 4 multidisciplinary pain clinics (MPC)...
2018: Pain Research and Treatment
Eyup Akgűn, Mary M Lunzer, Philip Portoghese
Commonly prescribed opioid analgesics produce tolerance upon chronic use due in part to induction of hyperalgesia. Given that two reported bivalent ligands (MMG22 and MCC22) produce potent antinociception without tolerance only in inflamed mice, we have investigated the possible cellular and receptor targets of these ligands. The selective microglia inhibitors, minocycline and SB290157, antagonized intrathecal (i.t.) MCC22 antinociception orders of magnitude more potently than MMG22, suggesting that MCC22 selectively targets activated microglia...
August 15, 2018: ACS Chemical Neuroscience
Hanna Grol-Prokopczyk
Objectives: This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined. Method: Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n=3,721)...
August 13, 2018: Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
Koustav Roy, Garima Chauhan, Punita Kumari, Meetu Wadhwa, Shahnawaz Alam, Koushik Ray, Usha Panjwani, Krishna Kishore
AIMS: Sleep loss at high altitude (HA) play major role in worsening of neuropsychological functions, such as attention, memory and decision making. This study investigates the role of phosphorylated delta sleep inducing peptide (p-DSIP) in improving sleep architecture during chronic hypobaric hypoxia (HH) exposure and restoration of spatial navigational memory. METHODS: Morris water maze (MWM) trained rats were exposed to HH at 7620 m. p-DSIP was injected intra-peritoneally (10 μg/Kg bw) during HH exposure as an intervention against sleep alteration...
August 11, 2018: Life Sciences
Domenico D'Amico, Emanuela Sansone, Licia Grazzi, Ambra M Giovannetti, Matilde Leonardi, Silvia Schiavolin, Alberto Raggi
OBJECTIVES: Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, i.e. the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim is to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS: In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH...
August 14, 2018: Acta Neurologica Scandinavica
Xian Wang, Xiaofeng Shen, Yingli Xu, Shiqin Xu, Fan Xia, Bei Zhu, Yusheng Liu, Wei Wang, Haibo Wu, Fuzhou Wang
Neuropathic pain is a common chronic pain condition with mechanisms far clearly been elucidated. Mounting preclinical and clinical studies have shown neuropathic pain is highly associated with histone acetylation modification, which follows expression regulation of various pain-related molecules such as mGluR1/5, glutamate aspartate transporter, glutamate transporter-1, GAD65, Nav1.8, Kv4.3, μ-opioid receptor, brain-derived neurotrophic factor, and certain chemokines. As two types of pivotal enzymes involved in histone acetylation, histone deacetylases (HDACs) induce histone deacetylation to silence gene expression; in contrast, histone acetyl transferases (HATs) facilitate histone acetylation to potentiate gene transcription...
August 14, 2018: Molecular Pain
Peter Przekop, Allison Przekop, Mark G Haviland, Keiji Oda
Patients with chronic pain (CP) and substance use disorder (SUD) are complex, not yet adequately described, and in need of comprehensive treatments that address both diseases concurrently. Our objectives were to (a) describe a cohort of CP patients who failed traditional treatment (mainly opioids) - then developed opioid use disorder (OUD) and other SUDs and (b) evaluate a comprehensive inpatient treatment program for these patients. Patients were enrolled in an inpatient CP program. Treatment consisted of medical detoxification, group process/education, external and internal qigong, osteopathic manual medicine, and qigong-based mindfulness...
July 2018: Journal of Bodywork and Movement Therapies
A Coloma-Carmona, J L Carballo, J Rodríguez-Marín, C J van-der Hofstadt
BACKGROUND: Withdrawal symptoms have been widely shown to be a useful indicator of the severity of opioid dependence. One of the most used instruments to assess them is the Adjective Rating Scale for Withdrawal (ARSW). However, there is a lack of adaptations and validations for its use with prescription opioids, even less for chronic pain patients under treatment with these analgesics. Thus, the aims of this study were to analyze the psychometric properties and invariance across gender of the ARSW in a sample of chronic non-cancer pain patients...
August 10, 2018: European Journal of Pain: EJP
M Carmen Blanco-Gandía, Marta Rodríguez-Arias
Addiction pharmacotherapy aims to prevent drug abstinence symptoms, reduce drug craving and relapse, and normalize physiologic functions disrupted by chronic use of the drug. During the last 50 years, there has been an enormous revolution in pharmacotherapy for drug addiction. From abstinence as practically the only treatment option available, there are now multiple drugs on the market that have proved their efficacy in treating opiate and alcohol disorders. The present review will focus on the pharmacological treatments of the drugs whose consumption most affects individuals and society: alcohol and opiates...
August 7, 2018: European Journal of Pharmacology
Marco Zucconi, Andrea Galbiati, Fabrizio Rinaldi, Francesca Casoni, Luigi Ferini-Strambi
Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a sleep disorder characterized by an urge to move the legs, frequently associated or triggered by unpleasant sensations in the lower limbs that affects approximately 2.5% of adults. Therapy and management of RLS/WED require long term interventions, since the typical manifestation of this disorder is chronic. Areas covered: In this review, we provide an update regarding the treatment of RLS/WED with particular attention to future challenges for its management...
August 10, 2018: Expert Review of Neurotherapeutics
Yuhui Zhu, Elizabeth A Evans, Larissa J Mooney, Andrew J Saxon, Annamarie Kelleghan, Caroline Yoo, Yih-Ing Hser
Opioid use disorder (OUD) is a chronic, relapsing condition with severe negative health consequences. Previous studies have reported that 5-year opioid abstinence is a good predictor of reduced likelihoods of relapse, but factors that shape long-term opioid abstinence are poorly understood. The present study is based on data from a prospective study of 699 adults with OUD who had been randomized to either methadone or buprenorphine/naloxone and who were followed for at least 5 years. During the 5 years prior to the participants' last follow-up interview, 232 (33...
August 9, 2018: Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology
Carlos G Musso, Alejandrina Castañeda, María Giordani, Cesar Mombelli, Silvia Groppa, Nora Imperiali, Guillermo Rosa Diez
Kidney transplant patients (KTPs), and particularly those with advanced chronic kidney rejection, may be affected by opportunistic infections, metabolic alterations and vascular and oncologic diseases that promote clinical conditions that require a variety of treatments, the combinations of which may predispose them to hyponatremia. Salt and water imbalance can induce abnormalities in volemia and/or serum sodium depending on the nature of this alteration (increase or decrease), its absolute magnitude (mild or severe) and its relative magnitude (body sodium:water ratio)...
August 2018: Clinical Kidney Journal
Muhammad Hassan Majeed, Ali Ahsan Ali, Donna M Sudak
Background Long-term use of opioids to treat chronic pain incurs serious risks for the individual-including misuse, abuse, addiction, overdose and death-as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients...
August 9, 2018: International Journal of Psychiatry in Medicine
Lusine Gomtsian, Kirsty Bannister, Nathan Eyde, Dagoberto Robles, Anthony H Dickenson, Frank Porreca, Edita Navratilova
Modulation of pain may result from engagement of opioid receptors in multiple brain regions. Whether sensory and affective qualities of pain are differentially affected by brain opioid receptor circuits remains unclear. We previously reported that opioid actions within the rostral anterior cingulate cortex (rACC) produces selective modulation of affective qualities of neuropathic pain in rodents but whether such effects may occur in other areas of the anterior cingulate cortex (ACC) is not known. Here, morphine was microinjected in three regions of the ACC or in the rostral ventromedial medulla (RVM) and pain behaviors in naïve, sham or spinal nerve ligated (SNL) rats were evaluated...
August 2, 2018: Pain
Thomas N Bryce
Most people with spinal cord injury (SCI) have chronic pain and effective treatments have not been identified. Within the first two decades of the 21st century, opioids have been commonly prescribed in an attempt to manage pain after SCI, however, the risks and absence of benefit of opioids have become more apparent as opioid crises have developed around the world. This perspective is an argument for why opioids should no longer be prescribed to treat chronic pain after SCI.
2018: Spinal Cord Series and Cases
Peter Wayne New
The controversial issue of prescribing opioids to people with spinal cord damage who have severe pain is discussed in this paper. The reasons for concern regarding the increase in opioid prescription over recent years are outlined, along with a summary of the major potential adverse outcomes associated with opioids, such as falls, respiratory suppression, adverse endocrine effects, cognitive impairment, and the potential for opioid abuse, addiction and death. Situations when opioids are more appropriate are considered to be in the immediate post-trauma or post-operative periods...
2018: Spinal Cord Series and Cases
Stefan G Kertesz, Ajay Manhapra
The high prevalence of pain in patients with spinal cord injury, coupled with a national recalibration of opioid prescribing, presents a challenge. Prescribers may attempt to taper opioids, where observable harms from the prescribed opioid appear to outweigh benefits, a stance endorsed by the 2016 Guideline for Prescribing Opioids for Chronic Pain, issued by the Centers for Disease Control and Prevention. Different considerations apply when clinicians wish to reduce doses in adherent and stable patients, absent their consent...
2018: Spinal Cord Series and Cases
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