Gabapentin reduces postoperative pain and opioid consumption in patients who underwent lumbar laminectomy.

BACKGROUND: Postoperative pain management solely with opioids elevates the risk of opioid-related adverse events during hospitalization and after discharge from the hospital. Clinical trials have demonstrated gabapentinoids as viable adjunctive treatments for spinal surgeries. However, only a few practice-based studies have examined the efficacy of gabapentin as an opioid-sparing agent for patients undergoing lumbar laminectomy in rural hospital settings. OBJECTIVE: To determine the effects of gabapentin on opioid consumption and pain perception in patients who underwent lumbar laminectomy at a rural community hospital. METHODS: Data were collected by retrospective chart reviews of 99 patients who underwent lumbar laminectomy at Yavapai Regional Medical Center from January 1, 2017, to July 1, 2019. The patients were stratified into 2 groups: those who were taking gabapentin as outpatients before surgery and were continued on the same dose postoperatively (n = 50, gabapentin group) and those who were not taking gabapentin preoperatively or postoperatively (n = 49, usual-treatment group). The primary end points were opioid consumption in morphine milligram equivalents (MME) and pain for 24 hours postsurgery. RESULTS: Outcomes from the mixed-model analysis of variance showed significant main effects of group and time for opioid consumption in MME (F1,97 = 4.3, P < 0.05 and F3,291 = 133.9, P < 0.001, respectively) and numerical pain scale scores (F1,99 = 4.0, P < 0.05 and F3,241 = 21.4, P < 0.001, respectively) and group-time interaction for opioid consumption in MME (F3,291 = 2.6, P = 0.05). Post hoc analyses showed that opioid consumption in MME was significantly lower in the gabapentin group than in the usual-treatment group for the first 6 hours postoperatively. The pain scores were significantly lower in the gabapentin group than in the usual-treatment group across all time periods. CONCLUSION: Patients on gabapentin showed reductions in pain perception and postoperative opioid consumption. The results extend the findings from randomized trials to a real-world clinical setting. These data support using gabapentin in conjunction with opioids for pain management of patients undergoing lumbar laminectomy.

An Isoform-Selective PTP1B Inhibitor Derived from Nitrogen-Atom Augmentation of Radicicol.

A library of natural products and their derivatives was screened for inhibition of protein tyrosine phosphatase (PTP) 1B, which is a validated drug target for the treatment of obesity and type II diabetes. Of those active in the preliminary assay, the most promising was compound 2 containing a novel pyrrolopyrazoloisoquinolone scaffold derived by treating radicicol (1) with hydrazine. This nitrogen-atom augmented radicicol derivative was found to be PTP1B selective relative to other highly homologous nonreceptor PTPs. Biochemical evaluation, molecular docking, and mutagenesis revealed 2 to be an allosteric inhibitor of PTP1B with a submicromolar Ki. Cellular analyses using C2C12 myoblasts indicated that 2 restored insulin signaling and increased glucose uptake.

Psychological and Genetic Predictors of Pain Tolerance.

Previous studies have shown associations between genetic polymorphisms and pain tolerance, but psychological evaluations are seldom measured. The objective of this study was to determine the independent effects of demographic, psychological, and genetic predictors of cold noxious pain tolerance. Healthy subjects (n = 89) completed the Pain Catastrophizing Scale (PCS) and Fear of Pain Questionnaire (FPQ-III), underwent genotyping for candidate single nucleotide polymorphisms (SNPs), and completed a cold-pressor test in a 1-2°C water bath for a maximum of 3 minutes. The primary outcome measure was pain tolerance, defined as the maximum duration of time subjects left their nondominant hand in the cold-water bath. Cox proportional hazards regression indicated that female sex, Asian race, and increasing PCS and FPQ-III scores were associated with lower pain tolerance. No candidate SNP was significantly associated with pain tolerance. Future genetic studies should include demographic and psychological variables as confounders in experimental pain models.

Case reports of viral meningitis/encephalitis.

The purpose of this paper is to present three case reports of patients who presented to a local hospital in Northern Louisiana with symptoms of viral meningitis and encephalitis. It also updates physicians on the signs and symptoms of persons infected with West Nile virus (WNV), a new and emerging infection in the Western Hemisphere. Beginning in June 2002, persons in Louisiana, particularly the southern part of the state, started presenting to health facilities with symptoms of infection with the WNV. By August 2002, persons in the northern part of the state were also experiencing symptoms that include neurologic presentations of the disease. After completing recommended diagnostic measures for possible infection with flaviviruses, the three cases presented here were positive for viral meningitis/encephalitis. Beginning in June 2002, the state experienced an outbreak of WNV of epidemic proportions. Consequently, clinicians need to be mindful of the symptoms, diagnostic measures, treatment, prevention, and reporting of meningitis/encephalitis.