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Opioid hyperalgesia

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https://www.readbyqxmd.com/read/29147587/dexmedetomidine-as-part-of-a-multimodal-analgesic-treatment-regimen-for-opioid-induced-hyperalgesia-in-a-patient-with-significant-opioid-tolerance
#1
Richard K Patch Iii, Jason S Eldrige, Susan M Moeschler, Matthew J Pingree
Acute postoperative pain in patients with opioid tolerance creates a significant management challenge for anesthesiologists and pain medicine physicians. A multimodal approach is key; however other factors can complicate management such as opioid induced hyperalgesia. We present the case of a patient on large amounts of intrathecal opioids for chronic pain syndrome with opioid induced hyperalgesia after an exploratory laparotomy. Dexmedetomidine was utilized successfully as part of a controlled multimodal analgesic plan and should be a consideration for opioid tolerant patients experiencing opioid induced hyperalgesia...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29142219/electroacupuncture-attenuates-induction-of-inflammatory-pain-by-regulating-opioid-and-adenosine-pathways-in-mice
#2
Hsien-Yin Liao, Ching-Liang Hsieh, Chun-Ping Huang, Yi-Wen Lin
Although inflammatory pain is a common clinical condition, its mechanisms are still unclear. Electroacupuncture (EA), a well-known method of pain management, may reduce inflammatory pain by regulating neurons, astrocytes, and inflammatory signaling pathways. Injections of complete Freund's adjuvant (CFA), which can initiate cell-mediated inflammatory pain, resulted in significant hyperalgesia, which was subsequently prevented by EA. In CFA-injected mice, a dramatic increase was observed in the expression of the following proteins in the dorsal root ganglion and spinal cord dorsal horn: the astrocytic marker GFAP, S100B, RAGE, pPKCε, COX-2, pERK, and pNFκB...
November 15, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29136763/amorphous-solid-dispersions-of-hecogenin-acetate-using-different-polymers-for-enhancement-of-solubility-and-improvement-of-anti-hyperalgesic-effect-in-neuropathic-pain-model-in-mice
#3
Carlos Demócedes Luís de França Almeida Moreira, Jonas Gabriel de Oliveira Pinheiro, Walter Ferreira da Silva-Júnior, Euzébio Guimarães Barbosa, Zênia Maria Maciel Lavra, Erick Willyame Menezes Pereira, Marília Matos Resende, Eduardo Pereira de Azevedo, Lucindo José Quintans-Júnior, Adriano Antunes de Souza Araújo, Jullyana de Souza Siqueira Quintans, Ádley Antonini Neves de Lima
Hecogenin acetate (HA) is an acetylated sapogenin that has shown potential antihyperalgesic activity, inhibiting descending pain and acting in opioid receptors. However, HA exhibits poor aqueous solubility, which may limit its application. This study aims to develop amorphous solid dispersions (ASD) using five hydrophilic polymers, to characterize them and to evaluate their antihyperalgesic activity. Physicochemical characterization was performed by X-Ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and Fourier Transformed Infrared (FTIR) spectroscopy...
November 6, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29123358/chronic-cancer-pain-diagnostic-dilemma-and-management-challenges
#4
Deepti Ahuja, Sachidanand Jee Bharati, Seema Mishra, Sushma Bhatnagar
A 32-year-old female, diagnosed case of neuroendocrine tumor of pancreas, was admitted to the pain and palliative care unit with complaints of diffuse abdominal pain which was severe in intensity with score on numerical rating scale-9/10. Pain was not relieved even after taking tablet morphine immediate release 360 mg every 4 hourly, paracetamol 500 mg 6 hourly, and gabapentin 300 mg 8 hourly. She had undergone distal pancreatectomy with splenectomy and also received multiple lines of chemotherapy. After making a diagnosis of opioid-induced hyperalgesia, opioid rotation from morphine to fentanyl was done...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29121294/low-dose-buprenorphine-infusion-to-prevent-postoperative-hyperalgesia-in-patients-undergoing-major-lung-surgery-and-remifentanil-infusion-a-double-blind-randomized-active-controlled-trial
#5
Marco Mercieri, Stefano Palmisani, Roberto A De Blasi, Antonio D'Andrilli, Alessia Naccarato, Barbara Silvestri, Sara Tigano, Domenico Massullo, Monica Rocco, Roberto Arcioni
Background: Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29091881/phytochemical-profile-and-mechanisms-involved-in-the-anti-nociception-caused-by-the-hydroethanolic-extract-obtained-from-tocoyena-formosa-cham-schltdl-k-schum-jenipapo-bravo-leaves-in-mice
#6
Francisco Rafael Alves Santana Cesário, Thaís Rodrigues de Albuquerque, Giovana Mendes de Lacerda, Maria Rayane Correia de Oliveira, Lindaiane Bezerra Rodrigues, Anita Oliveira Brito Pereira Bezerra Martins, Aline Augusti Boligon, Lucindo José Quintans Júnior, Adriano Antunes de Souza Araújo, Mariana Lima Vale, Henrique Douglas Melo Coutinho, Irwin Rose Alencar de Menezes
Tocoyena formosa, a small ornamental tree growing in the dry regions of central Brazil, is commonly known as 'genipapo do bravo'. This is a medicinal plant traditionally used as an analgesic for rheumatic pain, lower back pain and myalgia, however its use is carried out without scientific evidence, which thus justifies the development of studies to investigate and prove its therapeutic potential. Therefore, the objective of this study was to evaluate the phytochemical profile of Tocoyena formosa (Cham. & Schlecht...
October 26, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29091880/central-and-peripheral-anti-hyperalgesic-effects-of-diosmin-in-a-neuropathic-pain-model-in-rats
#7
Azucena Ibeth Carballo-Villalobos, María Eva González-Trujano, Francisco Pellicer, Noé Alvarado-Vásquez, Francisco Javier López-Muñoz
Flavonoids are natural compounds showing anti-hyperalgesic activity in models of pain. Diosmin is a compound poorly studied in the treatment of neuropathic pain. This study evaluates the anti-hyperalgesic actions of diosmin and possible mechanisms of action involved by using a neuropathic pain model in rats. Experimental neuropathic pain was induced by chronic constriction injury (CCI) in male Wistar rats, then aesthesiometric index and plantar tests were assessed to evaluate mechanical and thermal hyperalgesia, respectively, in order to explore the analgesic effects of acute and sub-chronic treatment with diosmin...
October 26, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29075135/dnmt3a-methylation-in-neuropathic-pain
#8
Cuijie Shao, Yong Gao, Dan Jin, Xin Xu, Shuying Tan, Hui Yu, Qingxiang Zhao, Li Zhao, Wansheng Wang, Deqiang Wang
BACKGROUND: Mu opioid receptor (MOR) plays a crucial role in mediating analgesic effects of opioids and is closely associated with the pathologies of neuropathic pain. Previous studies have reported that peripheral nerve injury downregulates MOR expression, but the epigenetic mechanisms remain unknown. OBJECTIVE: Therefore, we investigated DNA methyltransferase3a (DNMT3a) expression or methylation changes within MOR promoter in the spinal cord in a neuropathic pain induced by a chronic constriction injury (CCI) mouse model and further determined whether these injury-associated changes are reversible by pharmacological interventions...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29049122/case-series-of-successful-postoperative-pain-management-in-buprenorphine-maintenance-therapy-patients
#9
Barbara L Leighton, Lara W Crock
Buprenorphine maintenance therapy patients frequently have severe postoperative pain due to buprenorphine-induced hyperalgesia and provider use of opioids with limited efficacy in the presence of buprenorphine. The authors report good-to-excellent pain management in 4 obstetric patients using nonopioid analgesics, regional anesthesia, continuation of buprenorphine, and use of opioids with high μ receptor affinity.
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29047208/expression-of-aromatase-in-the-rostral-ventromedial-medulla-and-its-role-in-the-regulation-of-visceral-pain
#10
Po Gao, Xiao-Wei Ding, Li Dong, Ping Luo, Guo-Hua Zhang, Wei-Fang Rong
AIMS: Estrogens are known to exert a wide spectrum of actions on brain functions including modulation of pain. Besides the circulating estrogens produced mainly by the ovaries, many brain regions are also capable of de novo synthesizing estrogens, which may exert important modulatory effects on neuronal functions. This study was aimed to test the hypothesis that aromatase, the enzyme that catalyzes the conversion of testosterone to estradiols, may be distributed in the rostral ventromedial medulla (RVM), where it may impact on visceral pain...
October 18, 2017: CNS Neuroscience & Therapeutics
https://www.readbyqxmd.com/read/29045243/use-of-ketamine-in-a-multimodal-analgesia-setting-for-rapid-opioid-tapering-in-a-profoundly-opioid-tolerant-patient-a-case-report
#11
Elise M Strickler, Eric S Schwenk, Mitchell J Cohen, Eugene R Viscusi
Opioids are frequently used for the treatment of chronic pain, and patients taking high doses are at increased risk of complications and adverse opioid-related events. Ketamine is appealing as an opioid adjunct because of its lack of respiratory depression and potential prevention of hyperalgesia and central sensitization. We present a case in which a ketamine infusion was utilized over a 7-day period to provide rapid taper of a daily dose of 400 mg of morphine equivalents to less than one-third of that dose on discharge with unchanged pain levels and no symptoms of opioid withdrawal...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29030938/opioid-use-disorder-and-misuse-a-review-of-the-epidemiology-and-medical-implications-for-pediatric-anesthesiologists
#12
REVIEW
Emily Knipper, Caleb J Banta-Green, Nathalia Jimenez
This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29029049/intraoperative-naloxone-reduces-remifentanil-induced-postoperative-hyperalgesia-but-not-pain-a-randomized-controlled-trial
#13
C-H Koo, S Yoon, B-R Kim, Y J Cho, T K Kim, Y Jeon, J-H Seo, Paul Myles
Background: Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone. Methods: Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29024786/neurobiological-correlates-of-pain-avoidance-like-behavior-in-morphine-dependent-and-non-dependent-rats
#14
Amanda R Pahng, Rod I Paulsen, M Adrienne McGinn, Kimberly N Edwards, Scott Edwards
Repeated use of opioids can lead to the development of analgesic tolerance and dependence. Additionally, chronic opioid exposure can cause a paradoxical emergence of heightened pain sensitivity to noxious stimuli, termed hyperalgesia, which may drive continued or escalated use of opioids to manage worsening pain symptoms. Opioid-induced hyperalgesia has traditionally been measured in rodents via reflex-based assays, including the von Frey method. To better model the cognitive/motivational dimension of pain in a state of opioid dependence and withdrawal, we employed a recently developed non-reflex-based method for measuring pain avoidance-like behavior in animals (mechanical conflict avoidance test)...
October 9, 2017: Neuroscience
https://www.readbyqxmd.com/read/28988976/role-of-endogenous-melatoninergic-system-in-development-of-hyperalgesia-and-tolerance-induced-by-chronic-morphine-administration-in-rats
#15
Yuchao Fan, Xiao Liang, Rurong Wang, Li Song
Morphine is a widely used analgesic for various types of pain. However, its efficacy is impeded by development of hyperalgesia and tolerance. Melatonin has antinociceptive effect and is involved in morphine-induced hyperalgesia and tolerance but the mechanism of its involvement remains to be defined. In this study, we established a rat model of morphine-induced hyperalgesia and tolerance. We determined the serum level of melatonin and expression of μ-opioid receptor (MOR), melatonin receptor (MT1, MT2) and protein kinase C γ(PKCγ) in the spinal dorsal horn of the rats with morphine-induced hyperalgesia and tolerance...
October 6, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28975565/inhibition-of-%C3%AE-ark1-ameliorates-morphine-induced-tolerance-and-hyperalgesia-via-modulating-the-activity-of-spinal-nmda-receptors
#16
Xue Zhang, Shaorui Chen, Hong Chen, Huilin Pan, Yilin Zhao
Our previous study has proposed that increased presynaptic NMDARs activities play pivotal roles in the development of opioid tolerance and hyperalgesia, and blocking spinal NMDARs attenuates chronic morphine-induced synaptic plasticity and behavior. However, the cellular signaling mechanisms remain to be investigated. The aim of this research was to address the role of β-ARK1 in opioid analgesia. Opioid tolerance and hyperalgesia was induced by daily systemic morphine injections in rats for eight consecutive days...
October 3, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28969521/the-role-of-glutamate-and-its-receptors-in-central-nervous-system-in-stress-induced-hyperalgesia
#17
Yan-Na Lian, Qi Lu, Jin-Long Chang, Ying Zhang
Substantial evidence has shown that stress can induce hyperalgesia (stress-induced hyperalgesia, SIH). SIH is characterized by enhancement and extension response to noxious stimuli. According to previous studies, we have known that the occurrence of SIH involves various neurotransmitters including opioid, glutamate and gamma-aminobutyric acid and so on. Glutamate acts as the main excitatory neurotransmitter in the central nervous system and plays a key role in the modulation of nociceptive processing. However, the mechanisms of effects of glutamate and its receptors on SIH are still not very clear...
October 2, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28947488/treatment-with-sulforaphane-produces-antinociception-and-improves-morphine-effects-during-inflammatory-pain-in-mice
#18
Alejandro Redondo, Pablo Aníbal Ferreira Chamorro, Gabriela Riego, Sergi Leánez, Olga Pol
The activation of nuclear factor erythroid 2-related factor 2 (Nrf2) exerts potent antioxidative and anti-inflammatory effects; however, its participation in the modulation of chronic inflammatory pain and on the antinociceptive effects of μ-opioid receptor (MOR) agonists has not been evaluated. We investigated whether the induction of Nrf2 could alleviate chronic inflammatory pain and augment the analgesic effects of morphine and mechanisms implicated. In male C57BL/6 mice with inflammatory pain induced by complete Freund's adjuvant (CFA) subplantarly administered, we assessed: 1) antinociceptive actions of the administration of 5 and 10 mg/kg of a Nrf2 activator, sulforaphane (SFN); and 2) effects of SFN on the antinociceptive actions of morphine and on protein levels of Nrf2, heme oxygenase 1 (HO-1), and NAD(P)H: quinone oxidoreductase 1 (NQO1) enzymes, microglial activation and inducible nitric oxide synthase (NOS2) overexpression, as well as on mitogen-activated protein kinase (MAPK) and MOR expression in the spinal cord and paw of animals with inflammatory pain...
December 2017: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/28939014/novel-endomorphin-analogs-are-more-potent-and-longer-lasting-analgesics-in-neuropathic-postoperative-inflammatory-and-visceral-pain-relative-to-morphine
#19
Amy K Feehan, Jenny Morgenweck, Xing Zhang, Ariel Amgott-Kwan, James E Zadina
Activation of the mu-opioid receptor provides the gold standard for pain relief, but a majority of opioids used clinically have adverse effects that have contributed to an epidemic of overdose deaths. We recently characterized mu-opioid receptor selective endomorphin (EM) analogs that provide potent antinociception with reduction or absence of a number of side effects of traditionally prescribed opioids including abuse liability, respiratory depression, motor impairment, tolerance, and inflammation [91]. The current study explores the effectiveness of these EM analogs relative to morphine in four major pain models by both intrathecal and intravenous administration in male, Sprague-Dawley rats and male CD-1 mice...
September 19, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28922338/does-the-%C3%AE-receptor-antagonist-esmolol-have-analgesic-effects-a-randomised-placebo-controlled-cross-over-study-on-healthy-volunteers-undergoing-the-cold-pressor-test
#20
Fredrik Ander, Anders Magnuson, Alex de Leon, Rebecca Ahlstrand
BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se. OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo...
September 15, 2017: European Journal of Anaesthesiology
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