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Opioid conversion

Priya Gopalan, Eydie Moses-Kolko, Robin Valpey, Neeta Shenai, Erin Smith
BACKGROUND: As more patients are admitted for medical complications related to opioid use disorders, physicians are called upon to manage withdrawal from co-occurring substance use disorders. We present an observational study of pregnant women with comorbid opioid and sedative-hypnotic use disorders hospitalized for benzodiazepine withdrawal. OBJECTIVES: Our primary aims were to assess current practices in withdrawal management in the perinatal period in patients admitted to an antepartum unit at a tertiary care setting with comorbid opioid and sedative-hypnotic use disorders; specifically, to identify patterns of withdrawal management, including the type of withdrawal protocol utilized, the total dosage of benzodiazepine used during that protocol, to assess patient variables associated with higher dosing, and to analyze neonatal outcomes...
December 11, 2018: General Hospital Psychiatry
Vishal Uppal, Susanne Retter, Margaret Casey, Sushil Sancheti, Kara Matheson, Dolores M McKeen
BACKGROUND: Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery...
January 8, 2019: Anesthesia and Analgesia
Aziz A Ansari, Daniel H Pomerantz, Robert L Jayes, Eric A Aguirre, Rachel D Havyer
Chronic obstructive pulmonary disease (COPD) poses challenges not only in symptom management but also in prognostication. Managing COPD requires clinicians to be proficient in the primary palliative care skills of symptom management and communication focused on eliciting goals and preferences. Dyspnea should initially be managed with the combination of long-acting muscarinic antagonists and long-acting β-agonist inhalers, adding inhaled corticosteroids if symptoms persist. Opioids for the relief of dyspnea are safe when used at appropriate doses...
December 26, 2018: Journal of Palliative Care
Jennifer I Etcheson, Chukwuweike U Gwam, Nicole E George, Naval Walia, Christophe Jerjian, Ga-Ram Han, Sana Virani, Seth J Miller, Ronald E Delanois
Purpose  The purpose of the present study was to assess perception of pain and pain management in smokers versus nonsmokers who received a total hip arthroplasty (THA). Methods  Patients who underwent THA from 2010 to 2016 were propensity score matched 1:1 based on race, body mass index, age, and sex. This yielded 124 smokers and 124 nonsmokers. Pain intensity was quantified using area under the curve for visual analog scale pain scores. Opioid consumption was determined using a morphine milliequivalent (mEq) conversion algorithm...
September 2018: Joints
Richard Rawson, Sarah J Cousins, Michael McCann, Regina Pearce, Anne Van Donsel
Opioid overdose deaths in the United States have risen dramatically in the past decade. In response to this public health crisis, Vermont created an innovative system called the "hub-and-spoke" (H & S) system, initiated in January 2013. The H & S system has 7 regional "hubs" that offer methadone and buprenorphine, as well as intensive support, and 77 local "spokes" (primary care settings) that offer buprenorphine (and naltrexone to a much lesser extent). Questionnaires were administered to 80 participants in the H & S system (stratified by geographic region, treatment site, and gender) and 20 participants with opioid use disorder not currently in treatment...
February 2019: Journal of Substance Abuse Treatment
Mark W Goodman, Thomas P Guck, Robyn M Teply
In this study, significant opioid tapering was achieved following frank discussions and the use of a tapering protocol. And patient-physician relationships weren't jeopardized.
December 2018: Journal of Family Practice
Rachel I Anderson, Marcelo F Lopez, William C Griffin, Harold L Haun, Daniel W Bloodgood, Dipanwita Pati, Kristen M Boyt, Thomas L Kash, Howard C Becker
Although previous research has demonstrated a role for kappa opioid receptor-mediated signaling in escalated alcohol consumption associated with dependence and stress exposure, involvement of the dynorphin/kappa opioid receptor (DYN/KOR) system in binge-like drinking has not been fully explored. Here we used pharmacological and chemogenetic approaches to examine the influence of DYN/KOR signaling on alcohol consumption in the drinking-in-the-dark (DID) model of binge-like drinking. Systemic administration of the KOR agonist U50,488 increased binge-like drinking (Experiment 1) while, conversely, systemic administration of the KOR antagonist nor-BNI reduced drinking in the DID model (Experiment 2)...
December 11, 2018: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Sriram Sriperumbuduri, Swapnil Hiremath
PURPOSE OF REVIEW: Strong epidemiological and pathologic evidence associates NSAIDs with kidney disease, both acute and chronic. Hence, the usage of NSAIDs has decreased in patients with, or at risk for, chronic kidney disease (CKD). Coupled with this has been a rise in use of opioids and other non-NSAID alternatives, which do come with significant, and underrecognized, risk of nonrenal adverse events. We review the literature to understand if this shift is appropriate or deleterious...
March 2019: Current Opinion in Nephrology and Hypertension
Xue-Ying Cheng, Chen Chen, Shu-Fang He, Chun-Xia Huang, Li Zhang, Zhi-Wu Chen, Ye Zhang
Evidences from previous studies confirmed that intrathecal morphine preconditioning (ITMP) reduces the cardiac injury of ischemia-reperfusion (IR) via the central nervous system. However, the molecular mechanism is not fully understood. The breath of central nerve growth factor (NGF) during nociceptive transmission has been well documented, and little is known about the significance of NGF in myocardial injury of IR and intrathecal morphine-induced cardioprotection. To address these questions, we over-expressed or silenced NGF in the spinal cord by using intrathecal injection of lentivirus-NGF or shRNA respectively, accompanied by ITMP in the IR rat model...
December 6, 2018: European Journal of Pharmacology
Magdalena Sikora, Urszula Skupio, Kamila Jastrzebska, Jan Rodriguez Parkitna, Ryszard Przewlocki
Novelty- and sensation-seeking behaviors induce activity of the brain reward system and are associated with increased susceptibility to drug abuse. Endogenous opioids have been implicated in reward-related behavior; however, the involvement of specific opioid receptors in the mechanism of sensation seeking is unknown. Here, we show that selective inhibition of opioid receptors reduce operant sensation seeking in mice. Administration of naltrexone (a nonselective opioid antagonist) reduced instrumental responding for sensory stimuli at one of the tested doses (2 mg/kg)...
February 1, 2019: Behavioural Brain Research
Erwan Treillet, Sophie Laurent, Yacine Hadjiat
Purpose: To review the recent literature on opioid rotation (ie, switching from one opioid drug to another or changing an opioid's administration route) in cancer patients experiencing severe pain and to develop a novel equianalgesia table for use in routine clinical practice. Methods: The MEDLINE database was searched with terms "cancer pain," "opioid rotation," "opioid switching," "opioid ratio," "opioid conversion ratio," and "opioid equianalgesia" for the major opioids (morphine, oxycodone, fentanyl, and hydromorphone) and the intravenous, subcutaneous, oral, and transdermal administration routes...
2018: Journal of Pain Research
Ana Canseco-Alba, Gabriela Rodríguez-Manzo
The endocannabinoid anandamide (AEA) transforms half of the population of previously non-copulating (NC) rats into sexually active animals in a long-lasting manner. The aim of this work was to explore the nature of this transformation. We identified the dose range in which AEA induces mating behavior in previously NC rats, which evidenced a dose-based, biphasic profile for AEA to induce the transformation of NC rats. We demonstrate that the sexual interaction with a receptive female, involving at least an intromission, is essential for AEA to induce the transformation of NC rats...
February 1, 2019: Behavioural Brain Research
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Lidija Gović-Golčić
Introduction: Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. However, studies have shown a controversial relationship of opioids to survival and a rise in deaths associated with the use of transdermal opioids. Although applying precise doses is paramount, we have no clear recommendations for the exact equianalgesic ratio for buprenorphine patch and no recommendation for the type of transdermal opioid to use in hospice...
2018: Pain Research and Treatment
Alberto A Uribe, Fernando L Arbona, David C Flanigan, Christopher C Kaeding, Marilly Palettas, Sergio D Bergese
Introduction: Acute postoperative pain following knee arthroscopy is common in orthopedic surgeries. Managing pain postoperatively combines usage of opioids and non-steroidal anti-inflammatory drugs. The aim of this clinical study was to assess the efficacy of two different analgesic treatment regimens: intravenous (IV) ibuprofen and IV ketorolac for the treatment of postoperative pain pertaining to arthroscopic knee surgery. Methods: This was a single center, randomized, double-blind, parallel, active comparator clinical pilot study...
2018: Frontiers in Surgery
Sarah F Rosen, Boram Ham, Michael Haichin, Ilana C Walters, Sarasa Tohyama, Susana G Sotocinal, Jeffrey S Mogil
The processing of pain in the central nervous system is now known to have an important immune component, including T cells of the adaptive immune system. T cells have been shown to release endogenous opioids, and although it is well known that opioids have effects on T cell populations, very little attention has been given to the converse: how T cells may affect opioid regulation. We find here that in addition to displaying significantly increased baseline pain sensitivity across various pain modalities, T cell deficient mice (CD-1 nude, Rag1 null mutant and Cd4 null mutant) exhibit pronounced deficiencies in morphine inhibition of thermal or inflammatory pain...
October 16, 2018: Pain
Victor Hugo Azocar, Gladys Sepúlveda, Catalina Ruiz, Consuelo Aguilera, Maria Estela Andrés, José Antonio Fuentealba
Kappa-opioid receptors (KOR) control dopamine (DA) levels in the striatum and contribute significantly to the progression of drug addiction. Repeated exposure to psychostimulants has been associated with up-regulated KOR activity and increased DA levels in dorsal striatum. However, it has not been tested if both processes are linked. In this work, we studied if a mechanism mediated by KOR is contributing to the increase in DA levels in the dorsolateral striatum (DLS) after amphetamine (AMPH) sensitization. The AMPH sensitization was assessed after single or repeated once-a-day AMPH injections (1 mg/kg)...
October 13, 2018: Journal of Neurochemistry
Mary Beth Miller, Wai Sze Chan, Ashley F Curtis, Jeff Boissoneault, Michael Robinson, Roland Staud, Richard B Berry, Christina S McCrae
OBJECTIVE: Research documenting the impact of opioid use on sleep among individuals with chronic pain has been mixed. This study aimed to determine if pain intensity moderates the association between opioid use and insomnia symptoms among adults with comorbid symptoms of insomnia and chronic widespread pain. METHODS: Participants (N = 144; 95% female; mean age = 51.6, SD = 11.4) completed assessments of insomnia symptoms, pain and use of sleep/pain medication...
December 2018: Sleep Medicine
Nathalie Michenot, Sylvie Rostaing, Laurent Baron, Sébastien Faure, Nicolas Jovenin, Philippe Hubault, Thierry Delorme, Elisabeth Collin, Marilène Filbet, Gisèle Chvetzoff, Claire Delorme, Christian Minello, Marc Magnet, Didier Ammar, Ivan Krakowski, Philippe Poulain
This paper reviewed the 2002 guidelines established by the National Federation of Cancer Centres. A group of experts nominated by the 3 French Societies involved in the treatment of cancer pain (AFSOS, SFAP, SFETD), established new guidelines ratios for morphine switching and/or changing of route of administration, in patients for whom either pain was not adequatly managed or adverse effects were unbearable. After a rapid reminder of the pharmacokinetics and metabolism properties of morphine, experts explained why the theory of opioid rotation (oxycodone, hydromorphone, fentanyl, methadone, tapentadol) using fixed equianalgesic ratios is not any more appropriate for a secure clinical practice...
November 2018: Bulletin du Cancer
Allen C Dickie, Andrew M Bell, Noboru Iwagaki, Erika Polgár, Maria Gutierrez-Mecinas, Rosalind Kelly, Heather Lyon, Kirsten Turnbull, Steven J West, Alexander Etlin, Joao Braz, Masahiko Watanabe, David L H Bennett, Allan I Basbaum, John S Riddell, Andrew J Todd
Excitatory interneurons account for the majority of neurons in the superficial dorsal horn, but despite their presumed contribution to pain and itch, there is still limited information about their organisation and function. We recently identified 2 populations of excitatory interneuron defined by expression of gastrin-releasing peptide (GRP) or substance P (SP). Here, we demonstrate that these cells show major differences in their morphological, electrophysiological, and pharmacological properties. Based on their somatodendritic morphology and firing patterns, we propose that the SP cells correspond to radial cells, which generally show delayed firing...
September 20, 2018: Pain
Hironobu Yamashita, Lauren Shuman, Joshua I Warrick, Jay D Raman, David J Degraff
Opioid receptors are G protein-coupled receptors that bind opioid ligands including endorphins and enkephalins. The existence of a number of opioid receptors, including the mu-opioid receptor (OPRM1), delta-opioid receptor (OPRD1), kappa-opioid receptor (OPRK1) and zeta-opioid receptor (OGFR) have been reported. However, the potential expression and role of these receptors on human prostate carcinogenesis is unknown. In the present study, we examined opioid receptor expression in human prostate cancer cell lines and in prostate cancer tissue...
2018: American Journal of Clinical and Experimental Urology
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