Victoria Huynh, Kristin Rojas, Gretchen Ahrendt, Colleen Murphy, Kshama Jaiswal, Ethan Cumbler, Nicole Christian, Sarah Tevis
BACKGROUND: This study aims to assess multimodal pain management and opioid prescribing practices in patients undergoing breast surgery. METHODS: A retrospective review of patients undergoing breast surgery at an academic medical center between April 1, 2018 and September 30, 2019, was performed. Patients with a history of recent opioid use or conditions precluding use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (APAP) were excluded. Opioid-sparing pain regimens were assessed...
May 28, 2020: Journal of Surgical Research
María Isabel Torres-González, Francisco Javier Manzano-Moreno, Manuel Francisco Vallecillo-Capilla, Maria Victoria Olmedo-Gaya
OBJECTIVE: The objective of this systematic review was to determine the effectiveness of preoperative oral pregabalin for anxiety control, the most effective dosage regimen, its impact on postoperative pain, and its adverse effects. MATERIALS AND METHODS: A search was conducted of PubMed/Medline and (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases for studies published between January 2009 and November 2018, with no language restriction...
July 2020: Clinical Oral Investigations
Xueya Cai, Jennifer S Gewandter, Hua He, Dennis C Turk, Robert H Dworkin, Michael P McDermott
In clinical trials of treatments for chronic pain, the percentage of participants who withdraw early can be as high as 50%. Major reasons for early withdrawal in these studies include perceived lack of efficacy and adverse events. Commonly employed strategies for accommodating missing data include last observation carried forward, baseline observation carried forward, and more principled methods such as mixed model repeated measures and multiple imputation. All of these methods require strong and untestable assumptions concerning the conditional distribution of outcomes after dropout given the observed data...
May 22, 2020: Pain
Katherine Z Isoardi, Gregory Polkinghorne, Keith Harris, Geoffrey K Isbister
AIMS: With rising use worldwide, pregabalin is increasingly implicated in poisoning deaths. We aimed to investigate the clinical effects and complications of pregabalin poisoning. METHODS: This is a retrospective review of patients presenting with pregabalin poisoning to two tertiary toxicology units from 1 July 2014 to 30 June 2019. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records...
May 6, 2020: British Journal of Clinical Pharmacology
Sascha R A Alles, Stuart M Cain, Terrance P Snutch
Initially developed to generate new treatments for epilepsy, gabapentin, and pregabalin ("gabapentinoids") were engineered to mimic the action of GABA and to modulate GABA metabolism. Rather than their intended pharmacological action on GABA neurotransmission, instead, they exhibit a high affinity for the α2δ-1 and α2δ-2 subunits of voltage-activated calcium channels, wherein binding of gabapentinoids inhibits cellular calcium influx and attenuates neurotransmission. Despite a lack of activity on GABA levels, gabapentin and pregabalin are effective at suppressing seizures and subsequently approved as a new class of antiepileptic therapy for partial-onset epilepsy...
2020: Frontiers in Cellular Neuroscience
Wei Jiang, Baishan Fang
The chiral feature is a critical factor for the efficacy and safety of many therapeutic agents. At present, about 57% of marketed drugs are chiral drugs and about 99% of purified natural products are chiral compounds. There has been a tremendous potential of functional microorganisms and biocatalysts derived from them for the bioconversion of synthetic chemicals into drugs with high enantio-, chemo-, and regio-selectivities. Biocatalysis is becoming a key subassembly in the medicinal chemist's toolbox. In fact, the intermediates of many important therapeutic agents such as sitagliptin, pregabalin, ragaglitazar, paclitaxel, epothilone, abacavir, atorvastatin, rosuvastatin, and omapatrilat have been successfully synthesized via biocatalysis...
April 22, 2020: Applied Biochemistry and Biotechnology
Manuel E Machado-Duque, Andres Gaviria-Mendoza, Jorge E Machado-Alba, Natalia Castaño
Background: Neuropathic pain has a prevalence of 2-17% in the general population. Diagnosis and treatment of neuropathic pain are not fully described in different populations. The aim was to determine the treatment patterns and direct costs of care associated with the management of neuropathic pain from the onset of the first symptom to up to two years after diagnosis. Methods: From a drug-claim database, a cohort of randomly selected outpatients diagnosed with neuropathic pain was obtained from an insurer in Colombia and followed up for two years after diagnosis...
2020: Pain Research & Management: the Journal of the Canadian Pain Society
X Moisset, D Bouhassira, J Avez Couturier, H Alchaar, S Conradi, M H Delmotte, M Lanteri-Minet, J P Lefaucheur, G Mick, V Piano, G Pickering, E Piquet, C Regis, E Salvat, N Attal
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018...
April 7, 2020: Revue Neurologique
Tessa Lefebvre, Laura Tack, Michelle Lycke, Fréderic Duprez, Laurence Goethals, Sylvie Rottey, Lieselot Cool, Koen Van Eygen, Brendon Stubbs, Patricia Schofield, Hans Pottel, Tom Boterberg, Philip Debruyne
OBJECTIVE: Our aim was to give an overview of the effectiveness of adjunctive analgesics in head and neck cancer (HNC) patients receiving (chemo-) radiotherapy. DESIGN: Systematic review. INTERVENTIONS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Web of Science, the Cochrane Library, and were searched for studies concerning "head neck cancer," "adjunctive analgesics," "pain," and "radiotherapy...
March 27, 2020: Pain Medicine
Pavel Klein, Alon Friedman, Mustafa Q Hameed, Rafal M Kaminski, Guy Bar-Klein, Henrik Klitgaard, Mathias Koepp, Sergiusz Jozwiak, David A Prince, Alexander Rotenberg, Roy Twyman, Annamaria Vezzani, Michael Wong, Wolfgang Löscher
Prevention of epilepsy is a great unmet need. Acute central nervous system (CNS) insults such as traumatic brain injury (TBI), cerebrovascular accidents (CVA), and CNS infections account for 15%-20% of all epilepsy. Following TBI and CVA, there is a latency of days to years before epilepsy develops. This allows treatment to prevent or modify postinjury epilepsy. No such treatment exists. In animal models of acquired epilepsy, a number of medications in clinical use for diverse indications have been shown to have antiepileptogenic or disease-modifying effects, including medications with excellent side effect profiles...
March 2020: Epilepsia
Roie Tzadok, Jacob N Ablin
Introduction . Fibromyalgia syndrome (FMS) is a pain disorder with an estimated prevalence of 1-5%. It is associated with a variety of somatic and psychological disorders. Its exact pathogenesis is still unclear but is involved with neural oversensitization and decreased conditioned pain modulation (CPM), combined with cognitive dysfunction, memory impairment, and altered information processing. Connectivity between brain areas involved in pain processing, alertness, and cognition is increased in the syndrome, making its pharmacologic therapy complex...
2020: Pain Research & Management
N Siddique, R Durcan, S Smyth, T Kyaw Tun, S Sreenan, J H McDermott
Summary: We present three cases of acute diabetic neuropathy and highlight a potentially underappreciated link between tightening of glycaemic control and acute neuropathies in patients with diabetes. Case 1: A 56-year-old male with poorly controlled type 2 diabetes (T2DM) was commenced on basal-bolus insulin. He presented 6 weeks later with a diffuse painful sensory neuropathy and postural hypotension. He was diagnosed with treatment-induced neuropathy (TIN, insulin neuritis) and obtained symptomatic relief from pregabalin...
February 26, 2020: Endocrinology, Diabetes & Metabolism Case Reports
Alberto Verrotti, Simona Lattanzi, Francesco Brigo, Gaetano Zaccara
BACKGROUND: Approximately 50% of patients do not achieve seizure control with antiepileptic drug (AED) monotherapy, and polytherapy, with more than one AED, is often required. To date, no evidence-based criteria on how to combine AEDs exist. OBJECTIVE: This narrative review aimed to provide critical findings of the available literature about the role of pharmacodynamic AEDs' interactions in patients whose epilepsies were treated with polytherapy. METHODS: Electronic databases, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE), were systematically searched to identify relevant studies on pharmacodynamic AEDs' interactions in patients with epilepsy...
March 2020: Epilepsy & Behavior: E&B
Uazman Alam, Gordon Sloan, Solomon Tesfaye
There is a high prevalence of painful diabetic polyneuropathy (pDPN) with around one-third of all patients with diabetes suffering from pDPN. pDPN has debilitating consequences, with a major impact on morbidity and quality of life. Unfortunately, there is no globally licenced pharmacotherapy that modulates the underlying disease mechanisms to prevent or halt the progression of diabetic neuropathy. The cornerstone of treatment therefore remains optimising glycaemic control and cardiovascular risk factors, and symptom control...
March 2020: Drugs
Taryn Williams, Michael McCaul, Guido Schwarzer, Andrea Cipriani, Dan J Stein, Jonathan Ipser
OBJECTIVE: The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence. METHODS: The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD...
February 10, 2020: Acta Neuropsychiatrica
Borwin Bandelow
Anxiety disorders, including panic disorder/agoraphobia (PDA), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and others, are the most prevalent mental disorders. In this paper, recommendations are given for the psychopharmacological treatment of these disorders which are based on comprehensive treatment guidelines, meta-analyses, and systematic reviews of available randomized controlled studies. Anxiety disorders can effectively be treated with psychotherapy, pharmacotherapy, or a combination of both...
2020: Advances in Experimental Medicine and Biology
Carole A Federico, Jeffrey S Mogil, Tim Ramsay, Dean A Fergusson, Jonathan Kimmelman
Despite large efforts to test analgesics in animal models, only a handful of new pain drugs have shown efficacy in patients. Here, we report a systematic review and meta-analysis of preclinical studies of the commercially successful drug pregabalin. Our primary objective was to describe design characteristics and outcomes of studies testing the efficacy of pregabalin in behavioral models of pain. Secondarily, we examined the relationship between design characteristics and effect sizes. We queried MEDLINE, Embase, and BIOSIS to identify all animal studies testing the efficacy of pregabalin published before January 2018 and recorded experimental design elements addressing threats to validity and all necessary data for calculating effect sizes, expressed as the percentage of maximum possible effect...
April 2020: Pain
Valeriu Ardeleanu, Alexandra Toma, Kalliopi Pafili, Nikolaos Papanas, Ion Motofei, Camelia Cristina Diaconu, Manfredi Rizzo, Anca Pantea Stoian
Background and Objectives : Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN...
January 9, 2020: Medicina
Aubrey J Husak, Matthew J Bair
OBJECTIVE: The objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions? METHODS: Ovid Medline and PubMed were searched...
June 1, 2020: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Eder de Andrade Gambeta, Juliana G Chichorro, Gerald W Zamponi
The trigeminal nerve (V) is the fifth and largest of all cranial nerves and it is responsible for detecting sensory stimuli that arise from the craniofacial area. The nerve is divided into three branches: ophthalmic (V1), maxillary (V2) and mandibular (V3); their cell bodies are located in the trigeminal ganglia (TG) and they make connections with second order neurons in the trigeminal brainstem sensory nuclear complex (VBSNC). Ascending projections via the trigeminothalamic tract transmit information to the thalamus and other brain regions responsible for interpreting sensory information...
January 7, 2020: Molecular Pain
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