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Opioids AND Pain

Nora D Volkow, Emily B Jones, Emily B Einstein, Eric M Wargo
Importance: More than 42 000 Americans died of opioid overdoses in 2016, and the fatalities continue to increase. This review analyzes the factors that triggered the opioid crisis and its further evolution, along with the interventions to manage and prevent opioid use disorder (OUD), which are fundamental for curtailing the opioid crisis. Observations: Opioid drugs are among the most powerful analgesics but also among the most addictive. The current opioid crisis, initially triggered by overprescription of opioid analgesics, which facilitated their diversion and misuse, has now expanded to heroin and illicit synthetic opioids (fentanyl and its analogues), the potency of which further increases their addictiveness and lethality...
December 5, 2018: JAMA Psychiatry
Krish C Dewan, Karan S Dewan, Jay J Idrees, Suparna M Navale, Brad F Rosinski, Lars G Svensson, A Marc Gillinov, Douglas R Johnston, Faisal Bakaeen, Edward G Soltesz
Importance: Persistent opioid use is currently a major health care crisis. There is a lack of knowledge regarding its prevalence and effect among patients undergoing cardiac surgery. Objective: To characterize the national population of cardiac surgery patients with opioid use disorder (OUD) and compare outcomes with the cardiac surgery population without OUD. Design, Setting, and Participants: In this retrospective population-based cohort study, more than 5...
December 5, 2018: JAMA Surgery
H Kramar, H Stepaniuk, N Voloshchuk, I Taran, S Kovalenko
An in-depth study of the pharmacological properties of 4-[4-oxo-(4h)-quinazolin-3-yl]-benzoic acid as an analgesic agent established that it had a sufficiently high analgesic effect on models of somatic and neuropathic pain syndromes. Study objective was to study the mechanisms of analgesic action of PK-66 compound in rats using the pharmacological analysis. We evaluated the mechanisms of analgesic effect of PK-66 (1 mg/kg, intraperitoneal) compound on the thermal irritation model on Hours 1, 2, 4 and 6 after administration of study compounds...
October 2018: Georgian Medical News
M Apkhazava, I Kvachadze, M Tsagareli, D Mzhavanadze, M Chakhnashvili
Large number of studies consider gonadal hormones as factors influencing pain perception by changing the activity of nociceptive and antinociceptive systems. Recent studies indicate that testosterone, along with some other gonadal hormones, plays a key role in the regulation of TRPV1 and MOR expression. In addition, some works focus on the relationship between pain sensation and hostility indices, as well as their interaction with gonadal hormones. The purpose of this study is to elucidate the relationship of thermal sensation and pain threshold with free testosterone, transient receptor potential cation channel subfamily V member 1(TRPV1) and µ-opioid receptor (MOR) protein levels as well as various degrees of hostility in young healthy males...
October 2018: Georgian Medical News
Alessia Gallucci, Pedro H Lucena, Géraldine Martens, Aurore Thibaut, Felipe Fregni
Opioid misuse leading to dependence is a major health issue. Recent studies explored valid alternatives to treat pain in postsurgical settings. This systematic review aims to discuss the role of transcranial direct current stimulation (tDCS) in preventing and treating postoperative pain and opioid dependence. PubMed and Embase databases were screened, considering studies testing tDCS effects on pain and opioid consumption in surgical settings and opioid addiction. Eight studies met our inclusion criteria...
December 5, 2018: Pain Management
Qiang Wu, Guihua Wei, Fengtao Ji, Shushan Jia, Shaogen Wu, Xinying Guo, Long He, Zhiqiang Pan, Xuerong Miao, Qingxiang Mao, Yong Yang, Minghui Cao, Yuan-Xiang Tao
Peripheral nerve injury downregulates the expression of the μ-opioid receptor (MOR) and voltage-gated potassium channel subunit Kv1.2 by increasing their DNA methylation in the dorsal root ganglion (DRG). Ten-eleven translocation methylcytosine dioxygenase 1 (TET1) causes DNA demethylation. Given that DRG MOR and Kv1.2 downregulation contribute to neuropathic pain genesis, this study investigated the effect of DRG TET1 overexpression on neuropathic pain. Overexpression of TET1 in the DRG through microinjection of herpes simplex virus expressing full-length TET1 mRNA into the injured rat DRG significantly alleviated the fifth lumbar spinal nerve ligation (SNL)-induced pain hypersensitivities during the development and maintenance periods, without altering acute pain or locomotor function...
December 4, 2018: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Mairi Mascarenhas, Michelle Beattie, Michelle Roxburgh, John MacKintosh, Noreen Clarke, Devjit Srivastava
Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments...
2018: BMJ Open Quality
Senay Dagilgan, Seref Erdogan, Fazilet Aksu
Objective: Neuropathic pain (NP) is an inescapable stressor that significantly affects both the nervous and endocrine system functions. In this study, we investigated the effect of NP on female reproductive function using the number of oocytes as an index as well as the copulation rates of female mice, with and without males. We also examined whether NP symptoms stopped after injecting tramadol, an opioid analgesic. Materials and Methods: The partial sciatic nerve was tightly ligated to produce neuropathy, and allodynia was assessed using the cold-plate test...
October 2018: Eurasian Journal of Medicine
Joseph Arthur, Eduardo Bruera
The current opioid crisis has brought renewed attention and scrutiny to opioid prescriptions. When patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, untoward consequences can occur. New evidence suggests that patients with cancer might be at a higher risk of NMOU than was previously thought, but clinical evidence still supports the use of opioid analgesics as the gold standard to treat cancer-related pain, creating a dilemma in patient management. Clinicians are encouraged to adopt a universal precautions approach to patients with cancer receiving opioids, which includes screening all patients; discussing the risks, benefits, adverse effects and alternatives of opioid therapy; and providing education on safe use, storage and disposal...
December 4, 2018: Nature Reviews. Clinical Oncology
Tucker C Callanan, Antonio T Brecevich, Craig D Steiner, Fred Xavier, Justin A Iorio, Celeste Abjornson, Frank P Cammisa
PURPOSE: To evaluate the radiographic and clinical outcomes of the combination of platelet-rich fibrin matrix (PRFM) with beta-tricalcium phosphate (β-TCP) and bone marrow aspirate (BMA) as a graft alternative in posterolateral lumbar fusion procedures. METHODS: Researchers evaluated 50 consecutive patients undergoing one-level to three-level posterolateral lumbar fusion procedures, resulting in a total of 66 operated levels. The primary outcome was evidence of radiographic fusion at 1-year follow-up, assessed by three independent evaluators using the Lenke scoring system...
December 3, 2018: European Spine Journal
Mustafa Karahan
Pain management is crucial for a successful result after various knee surgeries. Opioids may be included in the postoperative pain management protocol but may be abused if not controlled. Following knee arthroscopy and related surgery, adolescent and young adult patients are commonly overprescribed opioids. The driving force behind opioid prescription should be explored in addition to reviewing and emphasizing perioperative interventions that can reduce postoperative opioid consumption, including wound injections and peripheral nerve blocks...
December 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Sriram Yennuralingam, Srikanth Reddy Barla, Joseph Arthur, Gary B Chisholm, Eduardo Bruera
IntroductionCancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS). METHOD: We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale...
December 4, 2018: Palliative & Supportive Care
David W Lee, Christopher Huston
BACKGROUND: There is a paucity of literature studying therapeutic intraarticular zygapophyseal (commonly referred to as facet) joint injections in the atraumatic patient population. As a result of this, intraarticular injections have been dismissed as a possible treatment for cervical zygapophyseal joint-mediated pain. Radiofrequency neurotomy (RFN) is currently the accepted treatment for facet joint neck pain. OBJECTIVE: This prospective observational study investigated injection response in an atraumatic population to determine treatment viability and whether injections reduce the need for RFN in neck pain patients...
November 2018: Pain Physician
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
Gualberto Ruano, Jonathan A Kost
BACKGROUND: A major challenge for effective pharmacotherapy in pain management is to provide the drug best suited to the patient's innate characteristics. OBJECTIVE: The article illustrates pharmacogenetic principles to optimize treatments for patients and increase the likelihood of pain relief without dependence. Genetic variances are particularly relevant to opioid drugs used in pain control, and can now be harvested for predictive clinical decision support. STUDY DESIGN: Clinically actionable polymorphisms in CYP2D6 (cytochrome p450 2D6) and OPRM1 (mu 1 opioid receptor), the most important gene coding, respectively, for a metabolizing enzyme and receptor for opioids are reviewed, and functional effects described...
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
Zhen Tan, Pengde Kang, FuXing Pei, Bin Shen, ZongKe Zhou, Jing Yang
BACKGROUND: The aim of this study was to compare the analgesic effect on the lateral and overall knee and early rehabilitation between adductor canal block (ACB) and femoral nerve block (FNB) after total-knee arthroplasty. METHOD: Two hundred patients randomly participated in the study and were divided into the ACB group and FNB group in a randomized manner. All patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included visual analog scale (VAS) scores at rest and during activity, quadriceps strength, range of motion (ROM), total opioid consumption and complication occurrence, sleep interruptions caused by pain, postoperative nausea and vomiting (PONV), and postoperative length of stay (PLOS) before discharge in all groups...
November 2018: Medicine (Baltimore)
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
Hanaa M Mohamed, Ayman M Mahmoud
Tramadol is an opioid used as analgesic for treating moderate or sever pain. The long-term use of tramadol can induce several deleterious effects. We investigated the impact of chronic tramadol administration on the cerebrum of rats, focusing on oxidative damage, inflammation, apoptosis and changes in monoamine neurotransmitters. Rats received 30 or 60 mg/kg body weight tramadol dissolved in physiological saline daily for 8 weeks via oral gavage. Tramadol-induced rats showed significantly increased cerebral lipid peroxidation and nitric oxide, and deceased GSH content and activity and expression of the antioxidant enzymes...
November 30, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
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