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Chronic AND Opioid AND Treatment

Matthew S Ellis, Zachary A Kasper, Theodore J Cicero
BACKGROUND/AIMS: Recent supply-side efforts enacted to curb the opioid epidemic have had both positive (i.e., prescription opioid abuse is on the decline) and negative outcomes (i.e., shifts to other drugs). Given methamphetamine is notably increasing in use across the United States, we sought to understand whether use of methamphetamine has increased among opioid users and whether there is an association between these two epidemics. METHODS: Patients (N = 13,521) entering drug treatment programs across the United States completed an anonymous survey of drug use patterns from 2011 to 2017...
October 10, 2018: Drug and Alcohol Dependence
Kirin Gada, Leigh D Plant
Chronic pain is a debilitating and increasingly common medical problem with few effective treatments. In addition to the direct and indirect economic burden of pain syndromes, the concomitant increase in prescriptions for narcotics has contributed to a sharp rise in deaths associated with drug misuse-the 'opioid crisis'. Together, these issues highlight the unmet clinical and social need for a new generation of safe, efficacious analgesics. The detection and transmission of pain stimuli is largely mediated by somatosensory afferent fibres of the dorsal root ganglia...
October 16, 2018: British Journal of Pharmacology
Caterina Magnani, Diana Giannarelli, Alice Calvieri, Ana Dardeli, Giovanni Eusepi, Maria Rosa Restuccia, Chiara Mastroianni, Giuseppe Casale
BACKGROUND: Various options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient's ability to take medication. OBJECTIVE: The goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer...
October 13, 2018: Postgraduate Medical Journal
Anne Marie Carew, Catherine Comiskey
BACKGROUND: Literature identifies older people who use opioids as a neglected population. Little is known about temporal changes, or about treatment demand among this population. METHODS: The EU Treatment Demand Indicator (TDI) for Ireland (1996-2014) was analyzed for trends in new opioid treatment admissions, ageing and drug using behaviors. A Joinpoint analysis was conducted. RESULTS: Data from 18,692 individuals entering treatment for the first time showed that while the trend of age-adjusted incidence declined between 1996 and 2014, incidence among older age groups increased, with a rising incidence not previously observed among those aged 50 years and older...
October 6, 2018: Drug and Alcohol Dependence
Hsien-Chang Lin, Zhi Wang, Linda Simoni-Wastila, Carol Boyd, Anne Buu
All fifty states have implemented prescription drug monitoring programs (PDMPs) to reduce misuse and diversion of controlled drugs. Interstate PDMP data sharing has been called for by clinical practitioners, but evidence to support the effectiveness of PDMP data sharing is lacking. This study examined whether PDMP interstate data sharing with bordering states was associated with prescriptions of opioids. This was a cross-sectional study that included patients with non-cancer chronic pain from the 2014 National Ambulatory Medical Care Survey (weighted N = 66,198,751; unweighted N = 2846)...
October 11, 2018: Preventive Medicine
Rahul Raghav, Raka Jain, Anju Dhawan, T S Roy, Punit Kumar
Nalbuphine is an agonist of κ-opioid receptors and a partial agonist of μ-opioid receptors, which can stimulate κ-receptors and antagonize the acute rewarding effects of morphine. It is widely used either as an analgesic or as an adjuvant with morphine. This present study aimed to compare the acute and chronic effects of nalbuphine on the naloxone-precipitated opiate-withdrawal in rats. Male adult Wistar albino rats (150-175 g, n = 160) were made physically dependent by administrating increasing dose of morphine (5-25 mg/kg; i...
October 9, 2018: Pharmacology, Biochemistry, and Behavior
Chih-Peng Lin, Dai-Hua Lu
Opioid analgesics remain the most effective and widely used analgesics for the management of moderate to severe pain, including cancer pain and chronic non-cancer pain. However, the efficacy of long-term opioid analgesics is attenuated by tolerance and/or hyperalgesia after long-term use, preventing adequate pain relief under stable opioid dosages for chronic pain patients. Classical neuron-centered concepts about tolerance, such as internalization of opioid receptors, upregulation of N-methyl-D-aspartate receptor function, or downregulation of glutamate transporter activity, can only partially explain the phenomenon of tolerance...
2018: Advances in Experimental Medicine and Biology
Sarah Kim, Yun Kyung Hahn, Elizabeth M Podhaizer, Virginia D McLane, Shiping Zou, Kurt F Hauser, Pamela E Knapp
BACKGROUND: The collective cognitive and motor deficits known as HIV-associated neurocognitive disorders (HAND) remain high even among HIV+ individuals whose antiretroviral therapy is optimized. HAND is worsened in the context of opiate abuse. The mechanism of exacerbation remains unclear but likely involves chronic immune activation of glial cells resulting from persistent, low-level exposure to the virus and viral proteins. We tested whether signaling through C-C chemokine receptor type 5 (CCR5) contributes to neurotoxic interactions between HIV-1 transactivator of transcription (Tat) and opiates and explored potential mechanisms...
October 10, 2018: Journal of Neuroinflammation
Darlene A Pena, Mariana Lemos Duarte, Dimitrius T Pramio, Lakshmi A Devi, Deborah Schechtman
It is well accepted that treatment of chronic pain with morphine leads to μ opioid receptor (MOR) desensitization and the development of morphine tolerance. MOR activation by the selective peptide agonist, D-Ala2, N-MePhe4, Gly-ol]-enkephalin(DAMGO), leads to robust G protein receptor kinase activation, β-arrestin recruitment, and subsequent receptor endocytosis, which does not occur in an activation by morphine. However, MOR activation by morphine induces receptor desensitization, in a Protein kinase C (PKC) dependent manner...
October 6, 2018: Proteomes
Athanasios Fountas, Shu Teng Chai, Chrysoula Kourkouti, Niki Karavitaki
The use of opioids has grown substantially over the past two decades reaching the dimensions of a global epidemic. These drugs have effects on multiple levels of the endocrine system through mechanisms which are still not fully elucidated, and awareness of their endocrine sequelae is vital for all specialists prescribing or managing patients on them. Hypogonadism is the most well-recognised consequence of opioid use (prevalence 21–86%) which, however, may remain undiagnosed with potential adverse outcomes for the patients...
October 1, 2018: European Journal of Endocrinology
Michael A Fishman, Phillip S Kim
PURPOSE OF REVIEW: The purpose of this review is to evaluate and explain our current understanding of the clinical use of buprenorphine in the treatment of chronic pain. RECENT FINDINGS: There has been few high-quality, unbiased studies performed on the use of buprenorphine in the treatment of chronic pain. Buprenorphine is an effective and safe analgesic that is tolerated at least as well, if not better, than other opioids. Given its safety and mechanistic advantages, the authors believe there is an important role for buprenorphine in the treatment of chronic pain severe enough to warrant the use of an opioid analgesic...
October 5, 2018: Current Pain and Headache Reports
Eugene R Viscusi
OBJECTIVES: Opioid analgesics may be associated with chronic adverse effects, such as opioid-induced constipation (OIC). Available and emerging prescription medications for OIC in patients with chronic noncancer pain are described, including concerns and challenges associated with OIC management. METHODS: Narrative review. RESULTS: Opioid-induced constipation is characterized by a change in bowel habits and defecation patterns that occurs when initiating opioid therapy and is associated with reduced bowel frequency, straining, sensation of incomplete evacuation, and/or patient distress related to bowel habits...
October 4, 2018: Clinical Journal of Pain
Jasper Pannemans, Tim Vanuytsel, Jan Tack
Chronic pain affects a large part of the global population, leading to an increase of opioid use. Opioid-induced constipation (OIC), a highly prevalent adverse effect of opioid use, has a major impact on patients' quality of life. Thanks to the introduction of new drugs for chronic constipation, which can also be used in OIC, and the development of peripherally acting mu-opioid receptor blockers, specifically for use in OIC, therapeutic options have seen major development. This review summarises current and emerging treatment options for OIC based on an extensive bibliographical search...
October 2018: United European Gastroenterology Journal
Donna M Urquhart, Anita E Wluka, Maurits van Tulder, Stephane Heritier, Andrew Forbes, Chris Fong, Yuanyuan Wang, Malcolm R Sim, Stephen J Gibson, Carolyn Arnold, Flavia M Cicuttini
Importance: Antidepressants at low dose are commonly prescribed for the management of chronic low back pain and their use is recommended in international clinical guidelines. However, there is no evidence for their efficacy. Objective: To examine the efficacy of a low-dose antidepressant compared with an active comparator in reducing pain, disability, and work absence and hindrance in individuals with chronic low back pain. Design, Setting, and Participants: A double-blind, randomized clinical trial with a 6-month follow-up of adults with chronic, nonspecific, low back pain who were recruited through hospital/medical clinics and advertising was carried out...
October 1, 2018: JAMA Internal Medicine
Salman Nusrat, Taseen Syed, Rabia Saleem, Shari Clifton, Klaus Bielefeldt
BACKGROUND: Widespread opioid use has led to increase in opioid-related adverse effects like constipation. We examined the impact of study endpoints on reported treatment benefits. METHODS: Using MEDLINE, EMBASE, and, we searched for randomized control trials targeting chronic opioid-induced constipation (OIC) and subjected them to meta-analysis. Data are given with 95% confidence intervals. RESULTS: Thirty trials met our inclusion criteria...
October 3, 2018: Digestive Diseases and Sciences
Meritxell Llorca-Torralba, Fuencisla Pilar-Cuéllar, Lidia Bravo, Cristina Bruzos-Cidon, María Torrecilla, Juan A Mico, Luisa Ugedo, Emilio Garro-Martínez, Esther Berrocoso
Pain affects both sensory and emotional aversive responses, often provoking depression and anxiety-related conditions when it becomes chronic. As the opioid receptors in the locus coeruleus (LC) have been implicated in pain, stress responses, and opioid drug effects, we explored the modifications to LC opioid neurotransmission in a chronic constriction injury (CCI) model of short- and long-term neuropathic pain (7 and 30 days after nerve injury). No significant changes were found after short-term CCI, yet after 30 days, CCI provoked an up-regulation of cAMP (cyclic 5'-adenosine monophosphate), pCREB (phosphorylated cAMP response element binding protein), protein kinase A, tyrosine hydroxylase, and electrical activity in the LC, as well as enhanced c-Fos expression...
October 3, 2018: Molecular Neurobiology
John C Licciardone, Robert J Gatchel, Subhash Aryal
Measuring treatments used by 202 patients with chronic low back pain in the PRECISION Pain Research Registry, this study determined the associations of opioid and nonsteroidal anti-inflammatory drug (NSAID) therapy with clinical status. More than one-fourth of patients did not use nonpharmacologic treatments for low back pain. Patients age 50-59 and 60-79 years old were more likely to use opioids than younger patients. Patients using opioids reported greater pain and back-related disability than did patients using NSAIDs...
October 1, 2018: Texas Medicine
Suzanne Nielsen, Nicholas Lintzeris, Bridin Murnion, Louisa Degenhardt, Raimondo Bruno, Paul Haber, Jennifer Johnson, Mark Hardy, Stephen Ling, Craig Saddler, Adrian Dunlop, Apo Demirkol, Catherine Silsbury, Nghi Phung, Jennie Houseman, Briony Larance
INTRODUCTION AND AIMS: Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics. DESIGN AND METHODS: People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia...
October 2, 2018: Drug and Alcohol Review
Alan K Davis, Joseph P Barsuglia, Austin-Marley Windham-Herman, Marta Lynch, Martin Polanco
Background and aims: Very few studies have reported the effectiveness of ibogaine as a treatment for chronic opioid use. Therefore, this study evaluated the acute subjective effects of ibogaine, outcomes on problematic opioid consumption, and the long-term associations with psychological functioning. Methods: Using online data collection, 88 patients who received ibogaine treatment in Mexico between 2012 and 2015 completed our survey. Results: Most participants (72%) had used opioids for at least 4 years and 69% reported daily use...
November 2017: Journal of psychedelic studies
Ulderico Freo, Maurizio Furnari, Carlo Ori
Background: Pain is a common and undertreated non-motor symptom in patients with Parkinson's disease (PD). Opioids have been seldom used in PD because they could worsen cognitive and motor functions. Objective: We aimed to assess efficacy and tolerability of tapentadol in PD patients. Methods: We retrospectively reviewed 21 PD patients treated with tapentadol extended release (ER) for chronic pain. Patients were evaluated before treatment and at 3 and 6 months during treatment for pain intensity (current, 24-hour average, and minimum and worst) with a 0-10 Numerical Rating Scale and the painDETECT questionnaire; for motor symptom severity with the Unified PD Rating Scale part III and the Hoehn and Yahr scale; for cognitive functions with Mini-Mental Status Examination, Corsi's Block-Tapping test, Digit Span test, Digit-Symbol Substitution test, FAS test, Rey's Auditory Verbal Learning test, Trail-Making test A and B and the 9-Hole Peg test; for anxiety and depression with the Hospital Anxiety and Depression Scale; and for the quality of life with the Short Form-12...
2018: Journal of Pain Research
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