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Opioids AND Pain

Sara Post, Henry A Spiller, Thitphalak Chounthirath, Gary A Smith
CONTEXT: Kratom, or Mitragyna speciosa, is a plant indigenous to Southeast Asia that has gained national attention in the United States for its increased use in the self-management of opioid withdrawal and pain, as well as for concerns about its safety. METHODS: This study analyzes exposures to kratom reported to poison control centers (PCCs) in the United States during 2011-2017 from the National Poison Data System (NPDS). DISCUSSION: From 2011 through 2017, 1807 kratom exposures were reported to United States PCCs...
February 20, 2019: Clinical Toxicology
Sergio D Bergese, Timothy I Melson, Keith A Candiotti, Sabry S Ayad, Randall J Mack, Stewart W McCallum, Wei Du, Alexis Gomez, Jorge E Marcet
An intravenous (IV) formulation of meloxicam is being studied for moderate to severe pain management. This phase 3, randomized, multicenter, double-blind, placebo-controlled trial evaluated the safety of once-daily meloxicam IV 30 mg in subjects following major elective surgery. Eligible subjects were randomized (3:1) to receive meloxicam IV 30 mg or placebo administered once daily. Safety was evaluated via adverse events, clinical laboratory tests, vital signs, wound healing, and opioid consumption. The incidence of adverse events was similar between meloxicam IV- and placebo-treated subjects (63...
February 20, 2019: Clinical Pharmacology in Drug Development
Adriane Kênia Moreira Silva, Dayane Carlos Mota da Costa, Adriano Max Moreira Reis
OBJECTIVE: To investigate the use of fall-risk-increasing drugs among patients with falls reported to the Patient Safety Office of a hospital, and to identify the factors associated with high risk for fall. METHODS: A cross-sectional study, carried out in a teaching hospital. The study population was the universe of fall reports received by the Patient Safety Office. The dependent variable was a high risk for falls. The Medication Fall Risk Score was used to measure fall risk...
February 14, 2019: Einstein
Cathy R Fulton, Yong Zang, Zeruesenay Desta, Marc B Rosenman, Ann M Holmes, Brian S Decker, Yifei Zhang, John T Callaghan, Victoria M Pratt, Kenneth D Levy, Brandon T Gufford, Paul R Dexter, Todd C Skaar, Michael T Eadon
BACKGROUND: Tramadol and codeine are metabolized by CYP2D6 and are subject to drug-gene and drug-drug interactions. METHODS: This interim analysis examined prescribing behavior and efficacy in 102 individuals prescribed tramadol or codeine while receiving pharmaco-genotyping as part of the INGENIOUS trial (NCT02297126). RESULT: Within 60 days of receiving tramadol or codeine, clinicians more frequently prescribed an alternative opioid in ultrarapid and poor metabolizers (odds ratio: 19...
February 20, 2019: Pharmacogenomics
Monir Uzzaman, Mohammad Nasir Uddin
BACKGROUND: Ketorolac (KTR) is used as an analgesic drug with an efficacy close to that of the opioid family. It is mainly used for the short term treatment of post-operative pain. It can inhibit the prostaglandin synthesis by blocking cyclooxygenase (COX). METHODS: In this investigation, the inherent stability and biochemical interaction of Ketorolac (KTR) and its degradation products have been studiedon the basis of quantum mechanical approaches. Density functional theory (DFT) with B3LYP/ 6-31G (d) has been employed to optimize the structures...
February 19, 2019: Daru: Journal of Faculty of Pharmacy, Tehran University of Medical Sciences
F V Estévez, Mª D L Alarcón, V Mayoral, M de Madariaga, C Margarit, J A Duran, J M T Martín-Arroyo, A Carregal
PURPOSE: Current evidence suggests the need to improve the management of breakthrough cancer pain (BTcP). For this reason, we aimed to assess the opinion of a panel of experts composed exclusively of physicians from pain units, who play a major role in BTcP diagnosis and treatment, regarding the key aspects of BTcP management. METHODS: An ad hoc questionnaire was developed to collect real-world data on the management of BTcP. The questionnaire had 5 parts: (a) organizational aspects of pain units (n = 12), (b) definition and diagnosis (n = 3), (c) screening (n = 3), (d) treatment (n = 8), and (e) follow-up (n = 7)...
February 19, 2019: Clinical & Translational Oncology
Faezeh Basiri, Abolfazl Rad, Davood Mahdian, Mehdi Molavi, Bahareh Amin
BACKGROUND: The most important limitations of morphine in pain therapy are its tolerance and dependence. In this study, we evaluated the protective effect of glucosamine against morphine-induced tolerance and dependence in mice. METHODS: Mice received twice daily morphine (20 mg/kg, s.c.) alone, or along with orally administered glucosamine (500, 1000 and 2000 mg/kg), for 9 continuous days. To assess antinociceptive effect of morphine, percentage of maximal possible effect (%MPE) of animals exposed to thermal stimulus was measured in the hot plate test, 30 min after morphine administration...
February 19, 2019: Journal of Biomedical Science
Ernst Yorke, Folaju O Oyebola, Samuel Anaja Otene, Axel Klein
OBJECTIVE: Pain management is unsatisfactory worldwide, particularly in developing countries where access to opioids is restricted and cost is an issue. It is a major concern in West Africa and we therefore undertook a survey of pain experts to obtain a better understanding of the problems in the region. METHODS: Medical practitioners involved in pain management, identified via professional networks, were interviewed to share their experience in treating moderate-to-severe pain in West Africa...
February 20, 2019: Current Medical Research and Opinion
Kelvin A Wong, Kanu S Goyal
BACKGROUND: Patients with prior opioid use are often difficult to manage postoperatively. We examined potential strategies for managing these patients: (1) prescribing a different opioid; and (2) encouraging the use of nonopioid analgesics over opioids. METHODS: A pain control program was implemented at an outpatient hand and upper-extremity center. Patients were recruited before (n = 305) and after (n = 225) implementation. Seventy of them were taking opioids prior to surgery...
February 19, 2019: Hand: Official Journal of the American Association for Hand Surgery
Marco Rossi, Giuseppe Casale, Danilo Badiali, Federica Aielli, Maria Antonietta Aloe Spiriti, Roberto Arcioni, Francesca Bordin, Maurizio Ferrara, Gloria Morelli Sbarra, Antonio Corcione, Franco Marinangeli, Paolo Marchetti
Constipation, one of the adverse effects of opioid therapy with a major impact on quality of life, is still an unmet need for cancer patients, particularly those with an advanced and progressive disease, and for non-cancer patients chronically treated with opioids. The awareness of this condition is poor among healthcare providers, despite the recent publication of guidelines and consensus conferences. An early multidisciplinary approach of opioid-induced bowel dysfunction (OIBD), based on available therapies of proven effectiveness, could support clinicians in managing this condition, thus increasing patients' adherence to pain therapy...
February 18, 2019: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Jeffrey Eric Rollman, James Heyward, Lily Olson, Peter Lurie, Joshua Sharfstein, G Caleb Alexander
Importance: Transmucosal immediate-release fentanyls (TIRFs), indicated solely for breakthrough cancer pain in opioid-tolerant patients, are subject to a US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) to prevent them from being prescribed inappropriately. Objectives: To evaluate knowledge assessments of pharmacists, prescribers, and patients regarding appropriate TIRF use; to describe sponsor assessments, based on claims data, of whether the REMS program was meeting its goals; and to characterize how the FDA responded to REMS assessments...
February 19, 2019: JAMA: the Journal of the American Medical Association
Alfred C Kuo, Karthik Raghunathan, Alain M Lartigue, William E Bryan, Marc J Pepin, Steven Takemoto, Arthur W Wallace
BACKGROUND: In the United States, opioids are commonly prescribed to treat knee pain after total knee arthroplasty (TKA). While surgery leads to decreased pain in most patients, a sizable minority continue to experience severe pain and consume opioids chronically after TKA. We sought to determine the population-level effect of TKA on opioid consumption by detailing the pattern of opioid prescriptions before and after surgery. METHODS: We retrospectively identified US Veterans Health Administration TKA patients from 2010 to 2015...
January 29, 2019: Journal of Arthroplasty
Fábio Farias de Aragão, Pedro Wanderley de Aragão, Carlos Alberto Martins, Karlla Fernanda Custódia Silva Leal, Alexandro Ferraz Tobias
The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic...
February 15, 2019: Revista Brasileira de Anestesiologia
Qiang Zhu, Li Li, Zhaoyun Yang, Jinmei Shen, Rong Zhu, Yu Wen, Wenwu Cai, Lei Liu
BACKGROUND: Quadratus lumborum (QL) block is increasingly being used as a new abdominal nerve block technique. In some studies of mid and lower abdominal and hip analgesia, continuous QL block achieved favorable outcomes as an alternative to continuous intravenous analgesia with opioids. However, the use of continuous QL block for upper abdominal pain is less well characterized. This study aimed to investigate the effects of continuous anterior QL block (CQLB) on postoperative pain and recovery in patients undergoing open liver resection...
February 18, 2019: BMC Anesthesiology
Brandon Kandarian, Pier F Indelli, Sanjay Sinha, Oluwatobi O Hunter, Rachel R Wang, T Edward Kim, Alex Kou, Edward R Mariano
Background: The IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block is a new anesthesiologist-administered analgesic technique for controlling posterior knee pain in total knee arthroplasty (TKA) patients that has not yet been well studied. We compared pain outcomes in TKA patients before and after implementation of IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 compared to non-IPACK patients...
February 19, 2019: Korean Journal of Anesthesiology
Shu-Yu Lin, Yu-Hsien Kuo, Ya-Wen Tien, Yi-Yu Ke, Wan-Ting Chang, Hsiao-Fu Chang, Li-Chin Ou, Ping-Yee Law, Jing-Hua Xi, Pao-Luh Tao, Horace H Loh, Yu-Sheng Chao, Chuan Shih, Chiung-Tong Chen, Shiu-Hwa Yeh, Shau-Hua Ueng
Morphine is widely used for the treatment of severe pain. This analgesic effect is mediated principally by the activation of μ-opioid receptors (MOR). However, prolonged activation of MOR also results in tolerance, dependence, addiction, constipation, nausea, sedation, and respiratory depression. To address this problem, we sought alternative ways to activate MOR - either by use of novel ligands, or via a novel activation mechanism. To this end, a series of compounds were screened using a sensitive CHO-K1/MOR/Gα15 cell-based FLIPR® calcium high-throughput screening (HTS) assay, and the bithiazole compound 5a was identified as being able activate MOR in combination with naloxone...
February 2, 2019: European Journal of Medicinal Chemistry
Aleksandra Kotlinska-Lemieszek, Pål Klepstad, Dagny Faksvåg Haugen
CONTEXT: Most patients with advanced malignant disease need to take several drugs to control symptoms. This treatment raises risks of serious adverse effects and drug-drug interactions (DDIs). OBJECTIVES: To identify studies reporting clinically significant DDIs involving medications used for symptom control, other than opioids used for pain management, in adult patients with advanced malignant disease. METHODS: Systematic review with searches in Embase, MEDLINE and the Cochrane Central Register of Controlled Trials, from the start of the databases (Embase from 1980) through 21st June 2018...
February 15, 2019: Journal of Pain and Symptom Management
Oscar Corli, Claudia Santucci, Nicole Corsi, Silvia Radrezza, Francesca Galli, Cristina Bosetti
CONTEXT: Opioids are frequently used for the treatment of moderate to severe pain and their use may produce a number of unwanted adverse events (AEs). OBJECTIVES: To understand the burden of opioid-induced AEs in cancer patients with pain after the introduction of strong opioids (WHO step III). METHODS: This is a cohort study derived from a randomized controlled trial involving 498 cancer patients with pain who received strong opioids. During 28-day follow-up, we analyzed frequency, intensity, and changes over time of the main opioid-induced AEs, the influence of previous pain therapy on AEs, and the relationships between the presence of AEs and analgesic response...
February 15, 2019: Journal of Pain and Symptom Management
Blaine A Jacobs, Miryam M Pando, Elaine M Jennings, Raehannah J Jamshidi, Joshua C Zamora, Teresa S Chavera, William P Clarke, Kelly A Berg
Receptor heteromers often display distinct pharmacological and functional properties compared to the individual receptor constituents. In this study, we compared the properties of the DOP-KOP heteromer agonist, 6'-guanidinonaltrindole (6'-GNTI), with agonists for DOP ([D-Pen2,5]-enkephalin [DPDPE]) and KOP (U50488) in peripheral sensory neurons in culture and in vivo. In primary cultures, all three agonists inhibited PGE2 -stimulated cAMP accumulation as well as activated extracellular signal-regulated kinase 1/2 (ERK) with similar efficacy...
February 15, 2019: Neuropharmacology
Raj Desai, Young Rock Hong, Jinhai Huo
Purpose: Pain medications are widely prescribed to treat chronic back pain (CBP). However, the effect of using pain medications on individuals with CBP has received very little attention. Objective: The aim of this study was to determine the patterns of pharmacological treatment in the population with CBP and assess its impact on quality of life, health care utilization and associated costs in USA. Patients and methods: Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Survey (MEPS), from 2011 to 2015, were utilized for this study...
2019: Journal of Pain Research
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