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Chronic AND Opioid AND Treatment

Bertram Richter, Jeff Bergman, James Pierre, Nestor D Tomycz
Loin Pain Hematuria Syndrome (LPHS) is a rare condition characterized by cryptogenic debilitating flank pain and microscopic or macroscopic hematuria. The pathophysiology of LPHS remains poorly understood and diagnosis is made largely by exclusion of alternate pathology. Management strategies can vary widely and include chronic opioid medication and a variety of invasive procedures including regional nerve blocks, transcutaneous electrical nerve stimulation, local capsaicin infusion, and surgical renal denervation...
December 16, 2018: Pain Practice: the Official Journal of World Institute of Pain
Laura S Moye, Alycia F Tipton, Isaac Dripps, Zoie Sheets, Aimee Crombie, Jonathan D Violin, Amynah A Pradhan
Headaches are highly disabling and are among the most common neurological disorders worldwide. Despite the high prevalence of headache, therapeutic options are limited. We recently identified the delta opioid receptor (DOR) as an emerging therapeutic target for migraine. In this study, we examined the effectiveness of a hallmark DOR agonist, SNC80, in disease models reflecting diverse headache disorders including: chronic migraine, post-traumatic headache (PTH), medication overuse headache by triptans (MOH), and opioid-induced hyperalgesia (OIH)...
December 13, 2018: Neuropharmacology
Sade C Iriah, Malav Trivedi, William Kenkel, Simone E Grant, Kelsey Moore, Jason R Yee, Dan Madularu, Praveen Kulkarni, Craig F Ferris
The present study was designed to use blood-oxygen-level dependent (BOLD) imaging to "fingerprint" the change in activity in response to oxycodone (OXY) in drug naïve rats before and after repeated exposure to OXY. It was hypothesized that repeated exposure to OXY would initiate adaptive changes in brain organization that would be reflected in an altered response to opioid exposure. Male rats exposed to OXY repeatedly showed conditioned place preference, evidence of drug seeking behavior and putative neuroadaptation...
December 11, 2018: Neuroscience
Paul Trowbridge, Alexander Y Walley
: Tianeptine is an atypical antidepressant which exerts an opioid-like effect on the μ-opioid receptor. There is well documented intentional misuse and addiction to tianeptine in Europe, and this is increasingly being seen in the United States. We presented a case of buprenorphine/naloxone successfully being used to aid in cessation and subsequent abstinence from tianeptine after years of use. An additional consideration with tianeptine use is the potential for the development or re-emergence of depression and anxiety on cessation...
December 13, 2018: Journal of Addiction Medicine
Javier Muriel, César Margarit, Jordi Barrachina, Pura Ballester, Andrea Flor, Domingo Morales, José F Horga, Eduardo Fernández, Ana M Peiró
The threats involved in the long-term opioid treatment of chronic non-cancer pain (CNCP) have increased notably. Strategies to identify at-risk patients are important because there is no clear evidence showing which screening or deprescription programmes are appropriate. Our aim was to evaluate the evidence provided by pharmacogenetics applied to predict an analgesic toxicity profile in prescription opioid use disorder (POUD) patients participating in an opioid deprescription programme. Pharmacogenetic markers were analysed in an observational, prospective deprescription programme for POUD patients (n = 88) treated for CNCP...
October 29, 2018: Basic & Clinical Pharmacology & Toxicology
Bryan J Black, Rahul Atmaramani, Sarah Plagens, Zachary T Campbell, Gregory Dussor, Theodore J Price, Joseph J Pancrazio
The tolerance, abuse, and potential exacerbation associated with classical chronic pain medications such as opioids creates a need for alternative therapeutics. Phenotypic screening provides a complementary approach to traditional target-based drug discovery. Profiling cellular phenotypes enables quantification of physiologically relevant traits central to a disease pathology without prior identification of a specific drug target. For complex disorders such as chronic pain, which likely involves many molecular targets, this approach may identify novel treatments...
November 13, 2018: Biosensors & Bioelectronics
Laurie-Anne Roeckel, Dominique Massotte, Mary C Olmstead, Katia Befort
Opioids are powerful analgesics but the clinical utility of these compounds is reduced by aversive outcomes, including the development of affective and substance use disorders. Opioid systems do not function in isolation so understanding how these interact with other neuropharmacological systems could lead to novel therapeutics that minimize withdrawal, tolerance, and emotional dysregulation. The cannabinoid system is an obvious candidate as anatomical, pharmacological, and behavioral studies point to opioid-cannabinoid interactions in the mediation of these processes...
2018: Frontiers in Psychiatry
Pablo Ferreira-Chamorro, Alejandro Redondo, Gabriela Riego, Sergi Leánez, Olga Pol
Chronic neuropathic pain is associated with anxiety- and depressive-like disorders. Its treatment remains a serious clinical problem due to the lack of efficacy of the available therapeutic modalities. We investigated if the activation of the transcription factor Nrf2 could modulate the nociceptive and emotional disorders associated with persistent neuropathic pain and potentiated the analgesic activity of morphine. The possible mechanisms implicated in these effects have been also evaluated. Therefore, in C57BL/6 mice with neuropathic pain induced by the chronic constriction of the sciatic nerve (CCI), we assessed the antinociceptive, anxiolytic, and anti-depressant effects of the repeated intraperitoneal administration of a Nrf2 inducer, sulforaphane (SFN), and the effects of this treatment on the local antinociceptive actions of morphine...
2018: Frontiers in Pharmacology
Ian S Zagon, Patricia J McLaughlin
This mini-review presents information on the intermittent blockade of the opioid growth factor (OGF)-OGF receptor (OGFr) axis by low-dose naltrexone (LDN), and the role of enkephalin (i.e. OGF) in autoimmune disorders, specifically multiple sclerosis, Crohn's, and fibromyalgia. Clinical reports on subjects taking LDN have documented reduced fatigue, few side-effects, and improved overall health. Preclinical studies on mice with experimental autoimmune encephalomyelitis (EAE), the animal model of multiple sclerosis, revealed that immunization for EAE reduces serum OGF...
December 12, 2018: Experimental Biology and Medicine
Wuilker Knoner Campos, Marcelo Neves Linhares, Jamir Sarda, Adair Roberto Soares Santos, Júlio Licinio, João Quevedo, Kátia Lin, Roger Walz
OBJECTIVES: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. MATERIALS AND METHODS: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean)...
December 10, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions...
2018: Local and Regional Anesthesia
Olav Magnus Fredheim, Svetlana Skurtveit, Marte Handal, Vidar Hjellvik
Chronic pain due to either surgery, radiotherapy or chemotherapy is prevalent in long-term cancer survivors. Chronic pain due to successful cancer treatment should be treated as chronic non-malignant pain, primarily with non-pharmacological strategies. Based on complete national data from the Cancer registry of Norway and the Norwegian prescription database the aim of this study was to compare the use of non-opioid analgesics, opioids and benzodiazepines ten years after cancer diagnosis in long-term cancer survivors and the age and gender adjusted general population...
December 7, 2018: Pain
Craig V Towers, Branson W Hyatt, Kevin C Visconti, Lindsey Chernicky, Katie Chattin, Kimberly B Fortner
OBJECTIVES: To compare head circumference (HC) in neonates treated for neonatal abstinence syndrome (NAS) with control neonates without antenatal opioid exposure. METHODS: Our prospective cohort study ran from April 1, 2014, through December 31, 2016. Newborns treated for NAS delivered from well-dated pregnancies ≥34 weeks' gestation were compared with newborns who were nonopioid exposed and matched for race, parity, mode of delivery, and gestational age. All mothers underwent serial antenatal urine drug testing...
December 10, 2018: Pediatrics
Manuel Pedro Pereira, Asit Mittal, Sonja Ständer
Chronic pruritus is a highly prevalent, debilitating disease, which is often refractory to conventional therapies. A step-wise, guideline-driven approach should be adopted in the management of these patients. Emollients as well as topical corticosteroids if appropriate should be initiated whilst looking for the cause underlying the pruritus. If these measures fail, and the origin of the pruritus remains unknown, cannot be treated or does not respond to therapy, systemic therapies as for example gabapentinoids, antidepressants, mu-opioid-receptor antagonists or, in case of inflammatory conditions, immunosuppressive drugs should be recommended...
December 6, 2018: Current Opinion in Pharmacology
Pedro Bichaff, Karina T Setani, Emiliana H G Motta, Artur F Delgado, Werther B Carvalho, Michele Luglio
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly...
October 2018: Revista da Associação Médica Brasileira
Nitika Sanger, Meha Bhatt, Ieta Shams, Hamnah Shahid, Candice Luo, Sabrina Lue Tam, M Constantine Samaan, Russell de Souza, Lehana Thabane, Zainab Samaan
BACKGROUND: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada's opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. OBJECTIVES: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes...
November 2018: Pain Physician
Amol Patwardhan, Ryan Matika, Janalee Gordon, Brian Singer, Michelle Salloum, Mohab Ibrahim
BACKGROUND: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented...
November 2018: Pain Physician
David A Provenzano, Khalid M Kamal, Vincent Giannetti
BACKGROUND: The management of chronic pain is complex and often involves the integration of multiple clinical, humanistic, and economic factors. Primary care physicians (PCPs) are often at the forefront of managing chronic pain and often initiate pharmacological pain management therapy. To date little is known surrounding the pain management practices of PCPs. OBJECTIVE: The purpose of this study is to assess the knowledge and practice of PCPs in management of chronic pain...
November 2018: Pain Physician
Declan T Barry, Mark Beitel, Christopher J Cutter, David A Fiellin, Robert D Kerns, Brent A Moore, Lindsay Oberleitner, Lynn M Madden, Christopher Liong, Joel Ginn, Richard S Schottenfeld
AIMS: The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. METHODS: In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19). RESULTS: Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study...
November 13, 2018: Drug and Alcohol Dependence
W Ling, V Nadipelli, N Ronquest, V Albright, A Aldridge, S Learned, V Mehra, C Heidbreder
Few opioid use disorder (OUD) treatment studies measure meaningful life changes during long-term recovery, focusing instead on retention and abstinence. Here, we report on the design and participant characteristics of the RECOVER Study, a study exploring life changes in persons with OUD for up to 24 months following participation in a Phase III trial evaluating buprenorphine extended-release monthly injection for subcutaneous use (known as RBP-6000 during development). This multisite, observational, cohort study tracks clinical, environmental, and socio-economic changes using self-administered assessments, urine drug screens (UDS), and public databases...
November 30, 2018: Contemporary Clinical Trials
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