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1.
Neural Regen Res ; 18(5): 996-1003, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36254980

RESUMO

Nitric oxide (NO)/cyclic guanosine 3',5'-monophosphate (cGMP) signaling has been shown to act as a mediator involved in pain transmission and processing. In this review, we summarize and discuss the mechanisms of the NO/cGMP signaling pathway involved in chronic pain, including neuropathic pain, bone cancer pain, inflammatory pain, and morphine tolerance. The main process in the NO/cGMP signaling pathway in cells involves NO activating soluble guanylate cyclase, which leads to subsequent production of cGMP. cGMP then activates cGMP-dependent protein kinase (PKG), resulting in the activation of multiple targets such as the opening of ATP-sensitive K+ channels. The activation of NO/cGMP signaling in the spinal cord evidently induces upregulation of downstream molecules, as well as reactive astrogliosis and microglial polarization which participate in the process of chronic pain. In dorsal root ganglion neurons, natriuretic peptide binds to particulate guanylyl cyclase, generating and further activating the cGMP/PKG pathway, and it also contributes to the development of chronic pain. Upregulation of multiple receptors is involved in activation of the NO/cGMP signaling pathway in various pain models. Notably the NO/cGMP signaling pathway induces expression of downstream effectors, exerting both algesic and analgesic effects in neuropathic pain and inflammatory pain. These findings suggest that activation of NO/cGMP signaling plays a constituent role in the development of chronic pain, and this signaling pathway with dual effects is an interesting and promising target for chronic pain therapy.

2.
Addict Behav ; 136: 107495, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36156453

RESUMO

The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.


Assuntos
Dor Crônica , Dor Lombar , Transtornos Relacionados ao Uso de Opioides , Uso Indevido de Medicamentos sob Prescrição , Adulto , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Feminino , Humanos , Dor Lombar/tratamento farmacológico , Masculino , Motivação , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor , Uso Indevido de Medicamentos sob Prescrição/psicologia
3.
Int J Clin Health Psychol ; 23(1): 100330, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36199368

RESUMO

Background/objective: Chronic pain due to osteoarthritis (OA) is a prevalent cause of global disability. New biomarkers are needed to improve treatment allocation, and genetic polymorphisms are promising candidates. Method: We aimed to assess the association of OPRM1 (A118G and C17T) and brain-derived neurotrophic factor (BDNF [G196A]) polymorphisms with pain-related outcomes and motor cortex excitability metrics (measured by transcranial magnetic stimulation) in 113 knee OA patients with chronic pain. We performed adjusted multivariate regression analyses to compare carriers versus non-carriers in terms of clinical and neurophysiological characteristics at baseline, and treatment response (pain reduction and increased cortical inhibitory tonus) after rehabilitation. Results: Compared to non-carriers, participants with polymorphisms on both OPRM1 (A118G) and BDNF (G196A) genes were less likely to improve pain after rehabilitation (85 and 72% fewer odds of improvement, respectively). Likewise, both carriers of OPRM1 polymorphisms (A118G and C17T) were also less likely to improve cortical inhibition (short intracortical inhibition [SICI], and intracortical facilitation [ICF], respectively). While pain and cortical inhibition improvement did not correlate in the total sample, the presence of OPRM1 (A118G) and BDNF (G196A) polymorphisms moderated this relationship. Conclusions: These results underscore the promising role of combining genetic and neurophysiological markers to endotype the treatment response in this population.

4.
Vet Clin North Am Exot Anim Pract ; 26(1): 65-81, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402489

RESUMO

The recognition and assessment of pain in avian species are crucial tools in providing adequate supportive care in clinical, laboratory, zoologic, rehabilitation, and companion animal settings. With birds being a highly diverse class of species, there is still much to be determined regarding how to create specific criteria to recognize and assess pain in these animals. This article provides a clinical review on the physiology of pain in birds, observed behavioral and physiologic alterations with pain, how different sources and degrees of pain can alter behaviors observed, and how this information can be applied in a clinical setting.


Assuntos
Aves , Dor , Animais , Medição da Dor/veterinária , Dor/diagnóstico , Dor/veterinária
5.
Dent Clin North Am ; 67(1): 141-155, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404075

RESUMO

This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.


Assuntos
Dor Crônica , Pessoas com Deficiência , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Dor Facial/etiologia , Dor Crônica/complicações , Comorbidade
6.
Dent Clin North Am ; 67(1): 61-70, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404081

RESUMO

This article describes a woman in her forties who spontaneously developed facial pain 19 years after double-jaw orthognathic surgery. The focus of her pain was the left side of the face, including the temporomandibular joint (TMJ). Conservative treatment was initiated, including several occlusal splints, in addition to injections with local anesthesia, botulinum toxin, and corticosteroids, with limited effects. Surgical treatments with arthroscopy and discectomy, and ultimately a TMJ prosthesis, improved the patient's joint function but did not reduce pain. The question is whether the degenerated joint was due to progression of the original disease process or to multiple surgical procedures.


Assuntos
Prótese Articular , Transtornos da Articulação Temporomandibular , Feminino , Humanos , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular , Dor Facial/etiologia , Dor Facial/cirurgia
7.
Dent Clin North Am ; 67(1): 49-60, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404080

RESUMO

Burning mouth syndrome (BMS) is a rare chronic neuropathic pain condition characterized by recurring burning pain or dysesthesia in the absence of any local or systemic causes of symptoms. The exact pathophysiology of BMS is unknown, but recent research suggests a medley of neuropathic, endocrinological, and psychosocial elements. This article presents a case history and reviews the epidemiology, diagnostic criteria, clinical features, diagnostic investigations, pathophysiology, and management of BMS.


Assuntos
Síndrome da Ardência Bucal , Neuralgia , Humanos , Síndrome da Ardência Bucal/diagnóstico , Síndrome da Ardência Bucal/etiologia , Síndrome da Ardência Bucal/terapia , Neuralgia/complicações
8.
Dent Clin North Am ; 67(1): 99-115, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404084

RESUMO

Trigeminal neuralgia (TN) is a rare neuropathic pain disorder characterized by recurrent, paroxysmal episodes of short-lasting severe electric shock-like pain along the sensory distribution of the trigeminal nerve. Recent classification systems group TN into 3 main categories depending on the underlying pathophysiology. This article will present a case history and review the epidemiology, diagnostic criteria, classification, clinical features, diagnostic investigations, pathophysiology, and management of TN.


Assuntos
Neuralgia , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/terapia , Nervo Trigêmeo
9.
J Interpers Violence ; 38(1-2): NP1540-NP1568, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35512192

RESUMO

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.


Assuntos
Dor Crônica , Violência por Parceiro Íntimo , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Depressão/epidemiologia , Depressão/psicologia , Dor Crônica/epidemiologia , Estudos Longitudinais , Canadá/epidemiologia , Violência por Parceiro Íntimo/psicologia
10.
Neuropharmacology ; 222: 109304, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36341807

RESUMO

Chronic pain is a persistent, complex condition that contributes to impaired mood, anxiety and emotional problems. Osteoarthritis (OA) is one of the major causes of chronic pain in adults and elderly people. A substantial body of evidence demonstrate that hippocampal neural circuits, especially monoamine dopamine and serotonin levels, contributes to negative affect and avoidance motivation experienced during pain. Current pharmacological strategies for OA patients are unsatisfying and the endocannabinoid system modulation might represent an alternative for the treatment of OA-related pain. In the present study, we used a rat model of osteoarthritis induced by intra-articular injection of sodium monoiodoacetate to assess, 28 days post-induction, the contribution of endocannabinoid system on the possible alteration in pain perception and affective behavior, in LTP and monoamine levels in the lateral entorhinal cortex-dentate gyrus pathway. The results show that OA-related chronic pain induces working memory impairment and depressive-like behavior appearance, diminishes LTP, decreases dopamine levels and increases serotonin levels in the rat dentate gyrus. URB597 administration (i.p., 1 mg/kg) reduces hyperalgesia and mechanical allodynia, improves recognition memory and depressive-live behavior, restores LTP and normalizes monoamine levels in the hippocampus. The effect was observed 60-120 min post-treatment and was blocked by AM251, which proves the action of URB597 via the CB1 receptor. Therefore, our study confirms the role of anandamide in OA-related chronic pain management at the behavioral and hippocampal levels. This article is part of the Special Issue on 'Advances in mechanisms and therapeutic targets relevant to pain'.


Assuntos
Dor Crônica , Osteoartrite , Ratos , Animais , Endocanabinoides , Serotonina , Dopamina , Osteoartrite/tratamento farmacológico , Hipocampo , Aminas , Hiperalgesia
11.
J Affect Disord ; 320: 42-47, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36179777

RESUMO

BACKGROUND: Sleep problems are common among older adults worldwide. The present study aims to determine the prevalence of poor sleep quality and its independent factors among retired people in health check-ups population in China. METHOD: In this multicenter, cross-sectional survey in 2017, a group of retired people was invited to participate in an online survey of health status, and their data, including socio-demographic information, lifestyle, and medical characteristics, were recorded. Binary logistic regression was used to analyze the independent factors responsible for poor sleep quality. RESULTS: Data from 17,408 responders who met the inclusion criteria were analyzed; among them, 53.04 % (95 % CI = 52 %-54 %) reported poor sleep quality. Binary logistic regression showed that poor sleep quality was associated with a number of factors, including being female (OR = 1.42, 95 % CI = 1.32-1.53), being single (OR = 1.35, 95 % CI = 1.18-1.54), non-smoker (OR = 1.12, 95 % CI = 1.03-1.22), physical inactivity (OR = 1.14, 95 % CI = 1.05-1.23), poor self-rated health status (OR = 1.69, 95 % CI = 1.43-2.00), long-term medication use (OR = 1.05, 95 % CI = 1.07-1.23), chronic pain (OR = 1.33, 95 % CI = 1.22-1.45), comorbidity (OR = 1.16, 95 % CI = 1.07-1.25), and depressive symptoms (mild depression: OR = 2.14, 95 % CI = 1.96-2.34; moderate depression: OR = 4.00, 95 % CI = 3.49-4.58, moderately severe depression: OR = 4.15, 95 % CI = 3.47-4.97, severe depression: OR = 4.27, 95 % CI = 2.93-6.22); while age (OR = 0.99, 95 % CI = 0.99-1.00) was negatively related to poor sleep quality. CONCLUSION: The prevalence of poor sleep quality in the studied population is relatively high (53.04 %). Sleep problems are common among Chinese retirees, especially older females, and have a great impact on their quality of life. People living with depression, chronic diseases, and chronic pain were at a higher risk of developing sleep disorders. Therefore, it is critical to formulate effective management strategies for Chinese retirees with poor sleep quality in the context of healthy aging.


Assuntos
Dor Crônica , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Humanos , Feminino , Idoso , Masculino , Estudos Transversais , Prevalência , Qualidade de Vida , Qualidade do Sono , Transtornos do Sono-Vigília/epidemiologia , China/epidemiologia , Depressão/epidemiologia , Sono
13.
Reg Anesth Pain Med ; 48(1): 37-43, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36202619

RESUMO

IMPORTANCE: The COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts. OBJECTIVE: To summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada. EVIDENCE REVIEW: We searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results. FINDINGS: Among 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each. INTERPRETATION: Significant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves. PROSPERO REGISTRATION NUMBER: CRD42021236464.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos/epidemiologia , Analgésicos Opioides/efeitos adversos , Antagonistas de Entorpecentes/uso terapêutico , Overdose de Opiáceos/diagnóstico , Overdose de Opiáceos/epidemiologia , Pandemias , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle
14.
Rev. esp. anestesiol. reanim ; 69(10): 640-648, dic. 2022. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-VR-17

RESUMO

El dolor neuropático es un problema clínico importante e incapacitante, su manejo constituye un reto para los profesionales sanitarios. Vortioxetina es un nuevo fármaco antidepresivo con acción multimodal, lo que le confiere un perfil único. Los antidepresivos tricíclicos, en particular amitriptilina, y los inhibidores de la recaptación de serotonina y noradrenalina venlafaxina y duloxetina constituyen fármacos de primera línea en el tratamiento del dolor neuropático. La interacción entre el binomio dolor y depresión es muy frecuente, siendo la complicación psicológica más frecuente en los pacientes con dolor crónico. Esta revisión exhaustiva y descriptiva resume los datos farmacológicos más relevantes de vortioxetina, así como la bibliografía específica de vortioxetina en dolor neuropático y dolor crónico.(AU)


Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.(AU)


Assuntos
Humanos , Vortioxetina , Dor Crônica , Antidepressivos , Cognição , Receptores de Serotonina , Anestesiologia , Espanha
15.
Br J Pain ; 16(6): 619-631, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36452124

RESUMO

Although several studies and reports have shown the potential analgesic use of serotonergic psychedelics in cancer pain, phantom limb pain and cluster headache, evidence supporting their use for chronic pain is still limited. The past years have seen a considerable renewal of interest toward the therapeutic use of these compounds for mood disorders, resulting in a marked increase in the number of people turning to psychedelics in an attempt to self-medicate a health condition or improve their wellbeing. In western countries particularly, this population of users overlaps substantially with chronic pain sufferers, representing a unique opportunity to evaluate the effects these compounds have on pain and wellbeing. Here, we report results from an online survey conducted between August 2020 and July 2021 in a population of 250 chronic pain sufferers who had experience with psychedelics, either in microdoses (small sub-hallucinogenic doses), macrodoses (hallucinogenic doses), or both. Macrodoses, while less often used for analgesic purposes than microdoses, were reported to induce a higher level of pain relief than both microdoses and conventional pain medications (including opioids and cannabis). Although the effects were weaker and potentially more prone to expectation bias than with macrodoses, our results also suggested some benefits of psychedelics in microdoses for pain management. The reported analgesic effect appeared unrelated to mood improvements associated with psychedelic use, or the advocacy of psychedelic use. Taken together, our findings indicate interesting potential analgesic applications for psychedelics that warrant further clinical research.

16.
Br J Pain ; 16(6): 641-650, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36452129

RESUMO

Background: Pain education initiatives are typically targeted at health professionals, with less attention being placed on the education of other target audiences. Recent curriculum changes across undergraduate liberal studies degree programs at The University of Sydney presented an opportunity to develop an online course entitled Health Challenges: Pain and Society, which was aimed at a non-traditional target audience. To promote student engagement about the problem of pain for society, the course was designed using the Community of Inquiry framework. Research Design: This paper reports on an Educational Design Research study, investigating the effectiveness of the course in engaging students across two cohorts, in 2019 and 2020. Data Collection: Learning analytics were collected from the Learning Management System each year. The level of student engagement in non-assessable tasks was measured using multiple linear regression. Students' degree type and majors were recorded. In 2020, the quality of student workbook responses was recorded. Results: In both cohorts, engagement with the workbooks was a predictor of academic achievement. In 2020, a significant interaction effect between quantity and quality of engagement was observed. Conclusions: Our findings highlight the importance of designing online learning to facilitate successful engagement for non-traditional target audiences about the issue of chronic pain for society.

17.
Br J Pain ; 16(6): 581-592, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36452127

RESUMO

Introduction: Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients' acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain. Methods: Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis. Results: Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care. Conclusions: There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future.

18.
Cell Rep Methods ; 2(11): 100341, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36452863

RESUMO

Despite development of protocols to differentiate human pluripotent stem cells (hPSCs), those used to produce sensory neurons remain difficult to replicate and result in heterogenous populations. There is a growing clinical burden of chronic pain conditions, highlighting the need for relevant human cellular models. This study presents a hybrid differentiation method to produce nociceptive sensory neurons from hPSCs. Lines harboring an inducible NEUROG2 construct were patterned toward precursors with small molecules followed by NEUROG2 overexpression. Neurons expressed key markers, including BRN3A and ISL1, with single-cell RNA sequencing, revealing populations of nociceptors expressing SCN9A and TRP channels. Physiological profiling with multi-electrode arrays revealed that neurons responded to noxious stimuli, including capsaicin. Finally, we modeled pain-like states to identify genes and pathways involved in pain transduction. This study presents an optimized method to efficiently produce nociceptive sensory neurons and provides a tool to aid development of chronic pain research.

19.
Pain Med ; 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36458906

RESUMO

INTRODUCTION: Opioids are used for acute and chronic pain in patients with sickle cell disease. How outpatient opioid regimens relate to acute care visits is of interest given risks of high opioid doses and high hospital utilization. A prior study by our group suggested outpatient opioid treatment for chronic pain could contribute to a vicious cycle of treatment-refractory acute pain, greater acute care utilization, and escalating opioid doses. This larger naturalistic observational study was undertaken to determine if the results were reliable across multiple acute care settings. METHODS: One year of clinical data on patients (n = 291) followed in the Sickle Cell Center for Adults (August 2018 to July 2019) were extracted, including visits to the emergency department, infusion center, and inpatient admissions. Outpatient opioid dosage was used to predict acute care treatment in generalized linear models controlling for patient, disease, and treatment characteristics. RESULTS: Outpatient opioid dosage predicted dosage during visits, but not visit length or pain relief. Higher outpatient opioid dosage was associated with greater number of visits. However, in post hoc analyses this relationship was nonlinear; with clear positive association only for those prescribed the lowest 50% of dosages. DISCUSSION: Higher outpatient opioid dosage predicted higher dosages during acute care visits to achieve the same pain score improvement, more consistent with opioid tolerance than treatment-refractory pain. The relationship of outpatient opioid dosage with number of acute care visits was more complex, suggesting opioid consumption at lower levels is driven by intermittent acute pain, and at higher levels by chronic pain.

20.
Curr Neuropharmacol ; 2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36453497

RESUMO

As a global health problem, chronic pain is one of the leading causes of disability, and it imposes a huge economic and public health burden on families and society. Opioids represent the cornerstone of analgesic drugs. However, opioid tolerance caused by long-term application of opioids is a major factor leading to drug withdrawal, serious side effects caused by dose increases, and even the death of patients, placing an increasing burden on individuals, medicine, and society. Despite efforts to develop methods to prevent and treat opioid tolerance, no effective treatment has yet been found. Therefore, understanding the mechanism underlying opioid tolerance is crucial for finding new prevention and treatment strategies. Noncoding RNAs (ncRNAs) are important parts of mammalian gene transcriptomes, and there are thousands of unique noncoding RNA sequences in cells. With the rapid development of high-throughput genome technology, research on ncRNAs has become a hot topic in biomedical research. In recent years, studies have shown that ncRNAs mediate physiological and pathological processes, including chromatin remodeling, transcription, posttranscriptional modification and signal transduction, which are key regulators of physiological processes in developmental and disease environments and have become biomarkers and potential therapeutic targets for various diseases. An increasing number of studies have found that ncRNAs are closely related to the development of opioid tolerance. In this review, we have summarized the evidence that ncRNAs play an important role in opioid tolerance and that ncRNAs may be novel targets for opioid tolerance.

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