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Chronic AND Opioid AND Treatment

Stephanie Parent, Seonaid Nolan, Nadia Fairbairn, Monica Ye, Anthony Wu, Julio Montaner, Rolando Barrios, Lianping Ti
BACKGROUND: Co-prescribing benzodiazepines and opioids is relatively contraindicated due to the possible overdose risk. However, people living with HIV (PLWH) may have concurrent psychiatric and/or chronic pain diagnoses that may lead to the use of opioids and/or benzodiazepines for symptomatic treatment. Consequently, some PLWH may be at-risk for the health harms associated with the co-prescribing of these medications. Given this, the objectives of this study were to first examine the prevalence of opioids and benzodiazepines co-prescribing, and second, to characterize patient factors associated with the co-prescribing of opioids and benzodiazepines among PLWH in British Columbia (BC), Canada...
March 18, 2019: International Journal on Drug Policy
Andrew H Rogers, Brooke Y Kauffman, Jafar Bakhshaie, R Kathryn McHugh, Joseph W Ditre, Michael J Zvolensky
BACKGROUND: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions...
March 21, 2019: American Journal of Drug and Alcohol Abuse
Samarth P Shah, Jennifer D Twilla, Leonette Kemp, Gregory L Phelps, Anne Reaves
Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. The main objective of this study is to evaluate whether outcomes differ in patients with VOC based on pain management treatment modality. A retrospective review of admissions with a primary diagnosis of VOC admitted to our facility was conducted...
March 21, 2019: Journal of Pain & Palliative Care Pharmacotherapy
Anupam Aich, Michael K Jones, Kalpna Gupta
PURPOSE OF REVIEW: Pain is a major comorbidity of sickle cell disease (SCD). Opioids are the mainstay for pain treatment but remain suboptimal. We discuss mechanism-based treatable targets devoid of opioids to prevent and/or treat SCD pain. RECENT FINDINGS: Understanding the pathogenesis of pain is critical to develop targeted therapies. Nevertheless, acute and chronic pain can have independent and/or overlapping mechanisms. The origin of pain involves neurovascular and neuroimmune interactions from the periphery and/or central nervous system...
March 18, 2019: Current Opinion in Hematology
Lori N Eidson, Anne Z Murphy
Each year, over 50 million Americans suffer from persistent pain, including debilitating headaches, joint pain, and severe back pain. Although morphine is amongst the most effective analgesics available for the management of severe pain, prolonged morphine treatment results in decreased analgesic efficacy (i.e., tolerance). Despite significant headway in the field, the mechanisms underlying the development of morphine tolerance are not well understood. The midbrain ventrolateral periaqueductal gray (vlPAG) is a primary neural substrate for the analgesic effects of morphine, as well as for the development of morphine tolerance...
March 16, 2019: Peptides
Bumsup Lee, Nipun Sodhi, Hiba K Anis, Joseph O Ehiorobo, Michael A Mont
INTRODUCTION: There has been a rapid increase in opioid-related morbidity and mortality worldwide, and the dangers of excessive opioid use have been observed in patients with chronic musculoskeletal pain, including those diagnosed with knee osteoarthritis. Pain management is an important component of nonoperative treatment in knee osteoarthritis and frequently entails the use of opioids. However, this management technique is not without risks, such as addiction, morbidity, and mortality...
March 19, 2019: Surgical Technology International
Mariusz Sikora, Adriana Rakowska, Małgorzata Olszewska, Lidia Rudnicka
Naltrexone is a competitive opioid receptor antagonist approved as supportive treatment in alcohol dependence and opioid addiction. In a dose 50-100 mg daily, naltrexone is used off-label in dermatology for the treatment of trichotillomania and different types of pruritus. At a dose as low as 1-5 mg of drug per day, naltrexone demonstrates immunomodulatory action i.e. modulates Toll-like receptors signaling, decreases release of proinflammatory cytokines (tumor necrosis factor, interleukin-6, interleukin-12), inhibits T lymphocyte proliferation, down-regulates the expression of chemokine receptors and adhesion molecules...
March 18, 2019: Current Drug Targets
Richard Fagan, Syed Sabeeh Najam Bokhari, Faisal Inayat
Carcinoid tumours have the ability to secrete various peptides and bioamines that lead to carcinoid syndrome manifested as cutaneous flushing, diarrhoea, bronchial constriction and cardiac involvement. The deficiencies of vitamins D and B12 have previously been reported in patients with carcinoid tumours presumably due to chronic diarrhoea associated with the carcinoid syndrome. Herein, we chronicle the case of a patient with opioid use disorder who presented with small bowel obstruction that was found to be caused by a midgut carcinoid tumour...
March 16, 2019: BMJ Case Reports
Jonathan Mercado-Reyes, Angélica Almanza, Pedro Segura-Chama, Francisco Pellicer, Francisco Mercado
Opioids are potent analgesic drugs, but their use has been limited due to their side effects. Antinociceptive effects of D2-like receptor agonists such as quinpirole have been shown at the spinal cord level; however, their efficacy is not as high as that of opioids. Dopaminergic agonists are long-prescribed and well-tolerated drugs that have been useful to treat clinically and experimentally painful conditions. Because current pain treatments are not completely effective, the aim of this work was to determine if a D2-like receptor agonist improves the antinociceptive effects of a μ-opioid receptor agonist...
March 12, 2019: European Journal of Pharmacology
Mona Prasad, Megan Jones
Women with opioid use disorder are at increased risk of other medical complications of pregnancy. Providing care for such complex patients requires the ability to 1) acknowledge addiction as a chronic disease, 2) incorporate the altered physiology of pregnancy, and 3) devise a treatment plan that can effectively manage acute conditions. A basic tenet of care is rooted in experience, rather than evidence, but includes stabilization of opiate use disorder (OUD) as a primary goal of management of other medical complications of pregnancy...
January 14, 2019: Seminars in Perinatology
Caroline E Phelps, Edita Navratilova, Anthony H Dickenson, Frank Porreca, Kirsty Bannister
Diffuse noxious inhibitory controls (DNIC) is a pain inhibits pain phenomenon demonstrated in humans and animals. DNIC is diminished in many chronic pain states, including neuropathic pain. The efficiency of DNIC has been suggested to prospectively predict both the likelihood of pain chronification and treatment response. Little is known as to why DNIC is dysfunctional in neuropathic pain. Here, we evaluated DNIC in the rat L5/L6 spinal nerve ligation (SNL) model of chronic pain using both behavioral and electrophysiological outcomes...
March 8, 2019: Pain
Diane Donegan
PURPOSE OF REVIEW: Despite the declaration of an opioid epidemic, opioid use remains prevalent. Side-effects of chronic opioid use continue to be problematic. Opioid-induced endocrinopathies have been well documented, yet opioid-induced adrenal insufficiency (OIAI) remains underappreciated. This review summarizes what is currently known regarding the prevalence, predictive factors for the development and effect of treatment of OIAI. RECENT FINDINGS: Although several case reports have highlighted the development of adrenal crisis among those receiving chronic opioids, only a few studies have systematically assessed patients for OIAI...
March 11, 2019: Current Opinion in Endocrinology, Diabetes, and Obesity
Emily Hurstak, Maria T Chao, Kristina Leonoudakis-Watts, Joseph Pace, Blue Walcer, Barbara Wismer
OBJECTIVE: To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. DESIGN: We used a quality improvement "Plan Do Study Act" (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. SETTING: An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose...
March 2019: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Julie Worley
Opioids are commonly prescribed in orthopaedics for acute or chronic pain for a variety of conditions, including injury, trauma, degenerative processes, and postsurgical. Patients who are taking opioids because of a substance use disorder (SUD) are also seen in orthopaedics. Patients who are prescribed opioids are at risk of developing an opioid use disorder (OUD). Ten percent of Americans will develop an SUD, which is considered a chronic medical condition that develops due to an imbalance in brain chemistry...
March 8, 2019: Orthopaedic Nursing
Emily L Zale, Lisa R LaRowe, Jeff Boissoneault, Stephen A Maisto, Joseph W Ditre
BACKGROUND: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i...
March 13, 2019: American Journal of Drug and Alcohol Abuse
Shiwei Steve Liu, Sarah Pickens, Nicole E Burma, Ines Ibarra-Lecue, Hongyan Yang, Lihua Xue, Chris Cook, Joshua K Hakimian, Amie L Severino, Lindsay Lueptow, Kristina Komarek, Anna M W Taylor, Mary C Olmstead, F Ivy Carroll, Caroline E Bass, Anne M Andrews, Wendy Walwyn, Tuan Trang, Christopher J Evans, Frances Leslie, Catherine M Cahill
Pain is a multidimensional experience and negative affect, or how much the pain is "bothersome", significantly impacts the sufferers' quality of life. It is well established that the kappa opioid system contributes to depressive and dysphoric states, but whether this system contributes to the negative affect precipitated by the occurrence of chronic pain remains tenuous. Using a model of persistent pain, we show by quantitative RT-PCR, florescence in situ hybridization, western blotting and GTPgS autoradiography an upregulation of expression and the function of kappa opioid receptors (KORs) and its endogenous ligand dynorphin in the mesolimbic circuitry in animals with chronic pain compared to surgical controls...
March 12, 2019: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Christopher W Cunningham, Waleed M Elballa, Stephanie U Vold
Prolonged treatment of chronic severe pain with opioid analgesics is frought with problematic adverse effects including tolerance, dependence, and life-threatening respiratory depression. Though these effects are mediated predominately through preferential activation of μ opioid peptide (μOP) receptors, there is an emerging appreciation that actions at κOP and δOP receptors contribute to the observed pharmacologic and behavioral profile of μOP receptor agonists and may be targeted simultaneously to afford improved analgesic effects...
March 8, 2019: Neuropharmacology
Dokyoung Sophia You, Jennifer M Hah, Sophie Collins, Maisa S Ziadni, Ben W Domingue, Karon F Cook, Sean C Mackey
OBJECTIVE: The National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS)® includes an item bank for measuring misuse of prescription pain medication (PROMIS-Rx Misuse). The bank was developed and its validity evaluated in samples of community-dwelling adults and patients in addiction treatment programs. The goal of the current study was to investigate the validity of the item bank among patients with mixed-etiology chronic pain conditions. METHOD: A consecutive sample of 288 patients who presented for initial medical evaluations at a tertiary pain clinic completed questionnaires using the open-source Collaborative Health Outcomes Information Registry...
March 11, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Ignacio Velázquez Rivera, Lourdes Velázquez Clavarana, Pilar García Velasco, Carmen Melero Ramos
BACKGROUND: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC. METHODS AND PATIENTS: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (>1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine...
January 2019: Journal of Opioid Management
Catherine J Datto, Yiqun Hu, Eric Wittbrodt, Perry G Fine
OBJECTIVE: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations. DESIGN: Retrospective analysis of administrative claims data. SETTING: HealthCore Integrated Research Environment database...
January 2019: Journal of Opioid Management
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