Diet and companionship modulate pain via a serotonergic mechanism

AbstractTreatment of severe chronic and acute pain in sickle cell disease (SCD) remains challenging due to the interdependence of pain and psychosocial modulation. We examined whether modulation of the descending pain pathway through an enriched diet and companionship could alleviate pain in transgenic sickle mice. Mechanical and thermal hyperalgesia were reduced significantly with enriched diet and/or companionship. Upon withdrawal of both conditions, analgesic effects observed prior to withdrawal were diminished. Serotonin (5-hydroxytryptamine, 5-HT) was found to be increased in the spinal cords of mice provided both treatments. Additionally, 5-HT production improved at the rostral ventromedial medulla and 5-HT accumulated at the dorsal horn of the spinal cord of sickle mice, suggesting the involvement of the descending pain pathway in the analgesic response. Modulation of 5-HT and its effect on hyperalgesia was also investigated through pharmaceutical approaches. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, showed a similar anti-nociceptive effect as the combination of diet and companionship. Depletion of 5-HT through p-chlorophenylalanine attenuated the anti-hyperalgesic effect of enriched diet and companionship. More significantly, improved diet and companionship enhanced the efficacy of a sub-optimal dose of morphine for analgesia in sickle mice. These findings offer the potential to reduce opioid use without pharmacological interventions to develop effective pain management strategies.

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Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

Journal of Clinical Medicine ◽

10.3390/jcm10020308 ◽

2021 ◽

Vol 10 (2) ◽

pp. 308

Author(s):

Angel L. Montejo ◽

Rubén de Alarcón ◽

Nieves Prieto ◽

José Mª Acosta ◽

Bárbara Buch ◽

...

Keyword(s):

Sexual Dysfunction ◽

Management Strategies ◽

Drop Out ◽

Adjunctive Treatment ◽

Psychotic Symptoms ◽

Clinical Approach ◽

Clinical Perspective ◽

Pharmacological Interventions ◽

Dopaminergic Agonist ◽

Low Rate

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results.

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Perioperative Management of Buprenorphine: Solving the Conundrum

Pain Medicine ◽

10.1093/pm/pny217 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1395-1408 ◽

Cited By ~ 7

Author(s):

Aurora Naa-Afoley Quaye ◽

Yi Zhang

Keyword(s):

Perioperative Management ◽

Case Reports ◽

Management Strategies ◽

Case Series ◽

Analgesic Efficacy ◽

Published Data ◽

Opioid Use ◽

Mu Opioid ◽

Periprocedural Management ◽

Opioid Agonists

Abstract Objective There is no consensus on the optimal perioperative management of patients on buprenorphine (BUP) for opioid use disorder (OUD). This article will review the available literature on BUP and the analgesic efficacy of BUP combined with full mu-opioid agonists and discuss the conflicting management strategies in the context of acute pain and our institution’s protocol for the periprocedural management of BUP. Methods We searched published data on BUP periprocedural management from inception through March 2018 without language restrictions. Study selection included publications reporting outcomes on perioperative pain management in OUD patients maintained on BUP. Results Our search resulted in four case reports supporting periprocedural discontinuation of BUP and two case series, one secondary observational study, one prospective matched cohort study, and four retrospective cohort studies supporting periprocedural continuation of BUP. No clinical trials were identified. Conclusions Maintaining BUP perioperatively does not lead to worsened clinical outcomes. Patients can receive adequate pain control from mu-opioid agonists while maintained on BUP. Based upon available evidence, we recommend continuing BUP at a reduced dose when indicated to avoid withdrawal symptoms and to facilitate the analgesic efficacy of mu-opioid agonists administered in combination for acute postoperative pain.

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Pooperacinis skausmo malšinimas deksametazonu po laparoskopinių gaubtinės žarnos operacijų

Lietuvos chirurgija ◽

10.15388/lietchirur.2012.1.2071 ◽

2012 ◽

Vol 10 (1-2) ◽

pp. 0-0

Author(s):

Povilas Miliauskas ◽

Renatas Tikuišis ◽

Narimantas Evaldas Samalavičius ◽

Aleksas Žurauskas

Keyword(s):

Visual Analog Scale Score ◽

Colon Surgery ◽

Anesthetic Technique ◽

Anesthesia Induction ◽

Opioid Use ◽

Analgesic Requirement ◽

Analgesic Effects ◽

Medicine Clinic ◽

Laparoscopic Colon Surgery ◽

Laparoscopic Colon

Povilas Miliauskas1, Renatas Tikuišis1, Narimantas Evaldas Samalavičius2, Aleksas Žurauskas1 1Vilniaus universiteto Onkologijos instituto Chirurgijos klinika, Santariškių g. 1, LT-08660 Vilnius2Vilniaus universiteto Medicinos fakulteto Anesteziologijos ir Reanimatologijos klinika, Šiltnamių g. 29, LT-04130 Vilnus3Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika, Santariškių g. 2, LT-08661 Vilnius El. paštas: [email protected] Įvadas / tikslas Deksametazonas pasižymi pykinimą slopinančiomis ir skausmą malšinančiomis savybėmis atliekant įvairias operacijas. Optimali deksametazono dozė, malšinant skausmą po laparoskopinių operacijų, tiksliai nežinoma. Šio darbo tikslas – nustatyti skausmą malšinančią deksametazono dozę po laparoskopinių gaubtinės žarnos operacijų. Ligoniai ir metodai Į tyrimą buvo įtraukta 60 ligonių, kuriems atliktos laparoskopinės gaubtinės žarnos operacijos. Atsitiktinės atrankos būdu jie suskirstyti į keturias grupes, atsižvelgiant į deksametazono dozę: D0 grupę sudarė kontrolinės grupės pacientai, kuriems nebuvo skirto deksametazono, D4, D8, ir D12 – tiriamųjų grupių pacientai, kuriems buvo sušvirkšta atitinkamai 4 mg, 8 mg, ir 12 mg deksametazono tirpalo į veną anestezijos indukcijos metu. Visų grupių pacientams buvo taikyta tokia pati bendroji nejautra. Pirmas 24 val. po operacijos skausmo intensyvumą vertinome pagal vizualinę analoginę skalę ir suvartotų analgetikų kiekį. Rezultatai Pirmą parą po operacijos suvartota ketolgano, paracetamolio ir tramadolio dozė buvo mažesnė D8 ir D12 grupių pacientų, palyginti su D0 ir D4 grupių pacientais. Analgetikų suvartojimas D0 ir D4 grupių pacientų buvo vienodas. Pavartojus didesnę deksametazono dozę D12 grupės pacientams negu D8 grupės pacientams, didesnio skausmo malšinamojo poveikio nenustatyta. Išvada Deksametazono 8 mg dozė anestezijos indukcijos metu malšina pooperacinį skausmą ir sumažina analgetikų poreikį pirmą parą po laparoskopinių gaubtinės žarnos operacijų. Reikšminiai žodžiai: pooperacinis skausmo malšinimas, deksametazonas, laparoskopinės operacijos Postoperative reduction pain with dexamethasone after laparoscopic colon surgery Povilas Miliauskas1, Renatas Tikuišis1, Narimantas Evaldas Samalavičius2,Renatas Tikuišis1,2, Povilas Miliauskas1, Narimantas Evaldas Samalavičius1,3, Aleksas Žurauskas11Vilnius University, Institute of Oncology, Santariškių Str. 1, LT-08660 Vilnius, Lithuania2Vilnius University, Faculty of Medicine, Clinic of Anesthesiology and Intensive Care, Šiltnamių Str. 29, LT-04130 Vilnius, Lithuania3Vilnius Uuniversity, Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Santariškių Str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / Objective Dexamethasone has antiemetic and analgesic effects in various types of surgery. The optimal doses of dexamethasone in the management of pain after laparoscopic surgery are not well defined. The purpose of this study was to evaluate the dose-dependent analgesic effects of dexamethasone after laparoscopic colon surgery. Patients and methods Sixty patients after laparoscopic colon surgery were included in the study. The patients were randomized to receive saline (group D0), dexamethasone 4 mg (group D4), 8 mg (group D8) and 12 mg (group D12) intravenously during the induction of anesthesia. The same anesthetic technique was used to all these patients. The visual analog scale score for pain and the amounts of the analgesics were recoded 24 h after surgery. Results The total doses of ketolgan, paracetamol and tramadol in the first 24 hours postoperatively were smaller in the D8 and D12 groups than in the D0 and D4 groups (p < 0.05). No difference in analgesic requirement was found between the D0 and D4 groups. No increase in the analgesic effectiveness or reduction of opioid use could be demonstrated in the D8 and D12 groups. Conclusion Intravenous dexamethasone (8 mg) during anesthesia induction is effective in reducing analgesic requirement during the first postoperative day after laparoscopic colon surgery. Key words: postoperative analgesia, dexamethasone, laparoscopic colectomy

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The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain

Dental Update ◽

10.12968/denu.2021.48.10.859 ◽

2021 ◽

Vol 48 (10) ◽

pp. 859-864

Author(s):

Daniel Merrick ◽

Michael O'Sullivan ◽

Mary Clarke

Keyword(s):

Management Strategies ◽

Opioid Analgesics ◽

Dental Pain ◽

Opioid Analgesia ◽

Dental Practice ◽

Opioid Use ◽

Safety And Efficacy ◽

Post Operative Pain ◽

The Us ◽

The Uk

The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects. CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.

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Delirium and Acute Anxiety

A Field Manual for Palliative Care in Humanitarian Crises ◽

10.1093/med/9780190066529.003.0007 ◽

2019 ◽

pp. 46-52

Author(s):

Kevin Bezanson ◽

Stephanie Rogers

Keyword(s):

Management Strategies ◽

Psychosocial Care ◽

Health Conditions ◽

Pharmacological Interventions ◽

Humanitarian Crises ◽

Acute Confusion ◽

Relationship Of ◽

Personal Trauma ◽

Distinguishing Features ◽

Acute Anxiety

This chapter reviews the assessment and management of patients presenting with acute confusion and agitation in humanitarian crises. The first section focuses on delirium, its distinguishing characteristics, and its diagnosis. The chapter then describes a contextually appropriate process for identifying and treating potentially reversible causes. Finally, it recommends management strategies for associated distressing symptoms with a priority on behavioral over pharmacological interventions. The second section addresses acute anxiety in the context of collective and personal trauma. Distinguishing features and manifestations are described. Approaches to management emphasizing behavioral and psychosocial care, with a limited role for pharmacological support, are outlined. The potential relationship of acute anxiety to other mental health conditions is also referenced.

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Analgesic effects of optogenetic inhibition of basolateral amygdala inputs into the prefrontal cortex in nerve injured female mice

Molecular Brain ◽

10.1186/s13041-019-0529-1 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Vinicius M. Gadotti ◽

Zizhen Zhang ◽

Junting Huang ◽

Gerald W. Zamponi

Keyword(s):

Prefrontal Cortex ◽

Nerve Injury ◽

Basolateral Amygdala ◽

Thermal Hyperalgesia ◽

Pyramidal Cells ◽

Male Mice ◽

Female Mice ◽

Analgesic Effects ◽

Induced Changes ◽

Thermal Stimuli

AbstractPeripheral nerve injury can lead to remodeling of brain circuits, and this can cause chronification of pain. We have recently reported that male mice subjected to spared injury of the sciatic nerve undergo changes in the function of the medial prefrontal cortex (mPFC) that culminate in reduced output of layer 5 pyramidal cells. More recently, we have shown that this is mediated by alterations in synaptic inputs from the basolateral amygdala (BLA) into GABAergic interneurons in the mPFC. Optogenetic inhibition of these inputs reversed mechanical allodynia and thermal hyperalgesia in male mice. It is known that the processing of pain signals can exhibit marked sex differences. We therefore tested whether the dysregulation of BLA to mPFC signaling is equally altered in female mice. Injection of AAV-Arch3.0 constructs into the BLA followed by implantation of a fiberoptic cannula into the mPFC in sham and SNI operated female mice was carried out, and pain behavioral responses were measured in response to yellow light mediated activation of this inhibitory opsin. Our data reveal that Arch3.0 activation leads to a marked increase in paw withdrawal thresholds and latencies in response to mechanical and thermal stimuli, respectively. However, we did not observe nerve injury-induced changes in mPFC layer 5 pyramidal cell output in female mice. Hence, the observed light-induced analgesic effects may be due to compensation for dysregulated neuronal circuits downstream of the mPFC.

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Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes

The Journal of Knee Surgery ◽

10.1055/s-0039-1678538 ◽

2019 ◽

Vol 33 (03) ◽

pp. 306-313 ◽

Cited By ~ 1

Author(s):

Kelvin Kim ◽

Kevin Chen ◽

Afshin A. Anoushiravani ◽

Mackenzie Roof ◽

William J. Long ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Postoperative Period ◽

Management Strategies ◽

Opioid Use ◽

Use Patterns ◽

Usage Patterns ◽

Total Knee ◽

Chronic Opioid Use ◽

Opioid Users

AbstractUnsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study—preoperative chronic opioid users and nonchronic opioid users. Opioid usage patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period. Fifty-four (16.0%) preoperative chronic opioid users were identified out of the total 338 patients included in the study. Preoperative chronic opioid users experienced significantly longer LOS (2.9 vs 2.6 days; p = 0.026). Patients who remained persistent chronic users throughout the preoperative and postoperative stages demonstrated a significantly longer LOS (3.4 days vs 2.5 days; p = 0.017) compared with those who were no longer chronically using opioids by the 6 months postoperative period. By the 6 months postoperative time point, preoperative chronic users were consuming eight times the morphine-equivalents (mg/day) compared with nonchronic users (p < 0.001). Preoperative chronic opioid use was associated with substantially higher usage patterns throughout the postoperative stages. Such opioid use patterns were associated with longer LOS. Given that perioperative chronic opioid use has shown to negatively impact TKA outcomes, future studies refining current perioperative management strategies are warranted. This is a Level II, prognostic study.

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Multimodal Analgesia and Decreased Opioid Use in Adult Trauma Patients

The American Surgeon ◽

10.1177/0003134820942177 ◽

2020 ◽

Vol 86 (8) ◽

pp. 950-954

Author(s):

Andrew L. Drahos ◽

Anthony M. Scott ◽

Tracy J. Johns ◽

Dennis W. Ashley

Keyword(s):

Acute Kidney Injury ◽

Management Strategies ◽

Kidney Injury ◽

Multimodal Analgesia ◽

The United States ◽

Control Group ◽

Trauma Patients ◽

Opioid Use ◽

Trauma Service ◽

The Impact

Background There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. Methods In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. Results A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease ( P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). Discussion Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.

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Comparison of Different Histone Deacetylase Inhibitors in Attenuating Inflammatory Pain in Rats

Pain Research and Management ◽

10.1155/2019/1648919 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Yu Mao ◽

Jing Zhou ◽

Xuesheng Liu ◽

Erwei Gu ◽

Zhi Zhang ◽

...

Keyword(s):

Histone Deacetylase ◽

Inflammatory Pain ◽

Histone Deacetylase Inhibitors ◽

Trichostatin A ◽

Thermal Hyperalgesia ◽

Pain Medicine ◽

Once Daily ◽

Analgesic Effects ◽

Phenylbutyric Acid ◽

Selection Of

Histone deacetylase inhibitors (HDACIs), which interfere with the epigenetic process of histone acetylation, have shown analgesic effects in animal models of persistent pain. The HDAC family comprises 18 genes; however, the different effects of distinct classes of HDACIs on pain relief remain unclear. The aim of this study was to determine the efficacy of these HDACIs on attenuating thermal hyperalgesia in persistent inflammatory pain. Persistent inflammatory pain was induced by injecting Complete Freund’s Adjuvant (CFA) into the left hind paw of rats. Then, HDACIs targeting class I (entinostat (MS-275)) and class IIa (sodium butyrate, valproic acid (VPA), and 4-phenylbutyric acid (4-PBA)), or class II (suberoylanilide hydoxamic acid (SAHA), trichostatin A (TSA), and dacinostat (LAQ824)) were administered intraperitoneally once daily for 3 or 4 days. We found that the injection of SAHA once a day for 3 days significantly attenuated CFA-induced thermal hyperalgesia from day 4 and lasted 7 days. In comparison with SAHA, suppression of hyperalgesia by 4-PBA peaked on day 2, whereas that by MS-275 occurred on days 5 and 6. Fatigue was a serious side effect seen with MS-275. These findings will be beneficial for optimizing the selection of specific HDACIs in medical fields such as pain medicine and neuropsychiatry.

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