Innovative Opioid Peptides and Biased Agonism: Novel Avenues for More Effective and Safer Analgesics to Treat Chronic Pain

2018 ◽  
Vol 25 (32) ◽  
pp. 3895-3916 ◽  
Author(s):  
Andrea Bedini ◽  
Santi Spampinato
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Opioid Peptides ◽  
Pain Treatment ◽  
Treatment Options ◽  
Opioid Analgesics ◽  
Research Literature ◽  
Bibliographic Databases ◽  
Innovative Strategy ◽  
Biased Agonism

Background: Chronic pain states are clinically relevant and yet unsolved conditions impacting on quality of life and representing an important social and economic burden; these diseases are poorly treated with the currently available drugs, being urgent the need of innovative analgesics. In this frame, novel analogues of endomorphin-1 and dermorphin emerge as promising starting points to develop innovative, more effective analgesics to treat neuropathic pain. Methods: An extensive and structured search of bibliographic databases for peer-reviewed research literature was undertaken using focused review questions; all the retrieved papers were published on prestigious international journals by the experts of the field and were carefully analyzed to collect all the information and data necessary to the conceptual framework of this review. Results: One hundred papers were included in this review; forty-one defined the up-to-date findings on neuropathic pain etiopathogenesis and its currently available treatment options. Thirty-five papers described all the advantages and drawbacks of using endomorphin-1 (23) or dermorphin (12) in the frame of neuropathic pain and outlined the most relevant advances in developing endomorphin-1 and dermorphin analogs useful as potential, innovative analgesics. Twenty-four papers provided the latest insights into exploiting biased agonism at opioid receptor as an innovative strategy to develop more effective and safer analgesics. Conclusion: This review reports that innovative opioid peptides will be of great help in better understanding the multifaceted scenario of neuropathic pain treatment, providing very interesting opportunities for the identification of novel and more effective opioid analgesics to be employed as medications.

scholarly journals Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 268
Author(s):  
Robert Blake Windsor ◽  
Michael Sierra ◽  
Megan Zappitelli ◽  
Maria McDaniel
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Treatment Options ◽  
Narrative Review ◽  
Mood Stabilizers ◽  
Complex Nature ◽  
Multidisciplinary Teams ◽  
Complex Population ◽  
Heterogenous Population ◽  
Psychiatric Conditions

Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.

The role of oxycodone/naloxone in pain management

Ból ◽  
2017 ◽  
Vol 17 (4) ◽  
pp. 26-40
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Anna Przeklasa-Muszyńska ◽  
Jan Dobrogowski
Keyword(s):  
Side Effects ◽  
Pain Treatment ◽  
Treatment Options ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Bowel Dysfunction ◽  
Prolonged Release ◽  
Gastrointestinal Side Effects ◽  
Strong Opioids ◽  
Pain Patients

ABSTRACT: Strong opioid analgesics are essential for pain treatment of moderate to severe intensity, regardless of its etiology. An important factor limiting safety and efficacy of opioids are side effects, particularly gastrointestinal. Constipation as part of opioid induced bowel dysfunction is one of the most common reason for discontinuation of strong opioids. Introduction of novel oxycodone/naloxone formulation is an attempt to resolve the problem of opioid induced gastrointestinal side effects. On the basis of clinical trials from 2008-2016 the authors discuss the applicability of oxycodone/naloxone prolonged release in management of different pain syndromes in humans, in cancer patients, in neuropathic pain patients, in the elderly, in acute post-operative pain and other clinical indications for example restless leg syndrome. Presented data indicate comparable or in some cases even better analgesic efficacy of oxycodone with naloxone and lower risk of gastrointestinal side effects, especially constipation, when compared to other strong opioids. The introduction of oxycodone with naloxone significantly expands treatment options for chronic pain patients, likewise improving safety and thus the effectiveness of treatment with strong opioids.

scholarly journals Dorsal Root Ganglion (DRG) and Chronic Pain

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Amnon A. Berger ◽  
Yao Liu ◽  
HarLee Possoit ◽  
Anna C. Rogers ◽  
Warner Moore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dorsal Root ◽  
Randomized Trials ◽  
Pain Treatment ◽  
Common Condition ◽  
Significant Morbidity ◽  
Chronic Neuropathic Pain

Context: Chronic neuropathic pain is a common condition, and up to 11.9% of the population have been reported to suffer from uncontrolled neuropathic pain. Chronic pain leads to significant morbidity, lowered quality of life, and loss of workdays, and thus carries a significant price tag in healthcare costs and lost productivity. dorsal root ganglia (DRG) stimulation has been recently increasingly reported and shows promising results in the alleviation of chronic pain. This paper reviews the background of DRG stimulation, anatomical, and clinical consideration and reviews the clinical evidence to support its use. Evidence Acquisition: The DRG span the length of the spinal cord and house the neurons responsible for sensation from the periphery. They may become irritated by direct compression or local inflammation. Glial cells in the DRG respond to nerve injury, producing inflammatory markers and contribute to the development of chronic pain, even after the resolution of the original insult. While the underlying mechanism is still being explored, recent studies explored the efficacy of DRG stimulation and neuromodulation for chronic pain treatment. Results: Several reported cases and a small number of randomized trials were published in recent years, describing different methods of DRG stimulation and neuromodulation with promising results. Though evidence quality is mostly low, these results provide evidence to support the utilization of this technique. Conclusions: Chronic neuropathic pain is a common condition and carries significant morbidity and impact on the quality of life. Recent evidence supports the use of DRG neuromodulation as an effective technique to control chronic pain. Though studies are still emerging, the evidence appears to support this technique. Further studies, including large randomized trials evaluating DRG modulation versus other interventional and non-interventional techniques, are needed to further elucidate the efficacy of this method. These studies are also likely to inform the patient selection and the course of treatment.

scholarly journals Opioids in the Management of HIV-Related Pain

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES157-ES168 ◽  
Author(s):  
Daniel Krashin
Keyword(s):  
Chronic Pain ◽  
Human Immunodeficiency Virus ◽  
Opioid Dependence ◽  
Scientific Literature ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Hiv Patients ◽  
Comprehensive Review ◽  
Opioid Treatment ◽  
Immunodeficiency Virus

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment. Objectives: The objective of this comprehensive review is to assess and summarize the complicating factors involved in treating HIV patients’ pain with opioid analgesics. Study Design: This is a narrative review without a systematic quality assessment of the literature discussion. Methods: A comprehensive review of the literature relating to pain and pain treatment in HIV patients. The literature was collected from electronic databases, textbooks, and other sources. The scientific literature reviewed includes randomized trials, observational studies, systematic reviews, guidelines, and government reports. Results: This patient population is heterogeneous and diverse in their medical issues and comorbidities, but a systematic, stepwise approach to assessing and managing pain in HIV patients is described. Chronic opioid treatment has proven to be problematic and considerations and alternatives to this treatment are described. Management of pain in patients with opioid addiction, a frequent comorbidity of HIV infection, requires special awareness and different prescribing practices. Screening and identifying patients who are at special risk for developing medical or behavior complications of pain treatment is essential, and approaches to this, and common forms of aberrant behavior, are described. Limitations: The scientific literature on opioid treatment in this population is limited. The population of HIV patients is heterogeneous and differs in significant ways based on ethnicity, national origin, and mode of transmission, making it difficult to generalize about pain treatment in such a diverse group. Conclusions: Pain management in HIV patients must take these factors into account and use all available modalities for treatment, including nonopioid analgesics, adjuvant medications, and psychosocial therapies. Opioid analgesics should be prescribed with caution in accordance with current guidelines and after careful risk assessment. Key words: HIV, Human Immunodeficiency Virus, acute pain, chronic pain, psychiatric comorbidity, opioid dependence, opioids, chronic opioid therapy, substance abuse.

scholarly journals Drug-Induced Peripheral Neuropathy: A Narrative Review

2020 ◽  
Vol 15 (1) ◽  
pp. 38-48 ◽  
Author(s):  
Mark R. Jones ◽  
Ivan Urits ◽  
John Wolf ◽  
Devin Corrigan ◽  
Luc Colburn ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Treatment Options ◽  
Chemotherapeutic Agents ◽  
Research Literature ◽  
Cardiovascular Drugs ◽  
Bibliographic Databases ◽  
Drug Induced ◽  
Painful Condition ◽  
Review Question ◽  
New Onset

Background: Peripheral neuropathy is a painful condition deriving from many and varied etiologies. Certain medications have been implicated in the iatrogenic development of Drug Induced Peripheral Neuropathy (DIPN) and include chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, anticonvulsants, among others. This review synthesizes current clinical concepts regarding the mechanism, common inciting medications, and treatment options for drug-induced peripheral neuropathy. Methods: The authors undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The most relevant and up to date research was included. Results: Drug-induced peripheral neuropathy is a common and painful condition caused by many different and frequently prescribed medications. Most often, DIPN is seen in chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, and anticonvulsant drugs. Certain drugs exhibit more consistent neuropathic side effects, such as the chemotherapeutic compounds, but others are more commonly prescribed by a larger proportion of providers, such as the statins. DIPN is more likely to occur in patients with concomitant risk factors such as preexisting neuropathy, diabetes, and associated genetically predisposing diseases. DIPN is often difficult to treat, however medications including duloxetine, and gabapentin are shown to reduce neuropathic pain. Advanced techniques of neuromodulation offer promise though further randomized and controlled studies are needed to confirm efficacy. Conclusion: Awareness of the drugs covered in this review and their potential for adverse neuropathic effect is important for providers caring for patients who report new onset symptoms of pain, paresthesia, or weakness. Prevention of DIPN is especially important because treatment often proves challenging. While many pharmacologic therapies have demonstrated analgesic potential in the pain caused by DIPN, many patients remain refractive to treatment. More studies are needed to elucidate the effectiveness of interventional, neuromodulating therapies.

scholarly journals Neurostimulation for Intractable Chronic Pain

2019 ◽  
Vol 9 (2) ◽  
pp. 23 ◽  
Author(s):  
Timothy Deer ◽  
Sameer Jain ◽  
Corey Hunter ◽  
Krishnan Chakravarthy
Keyword(s):  
Chronic Pain ◽  
Dorsal Root ◽  
Pain Treatment ◽  
Treatment Options ◽  
Mechanisms Of Action ◽  
Treatment Paradigm ◽  
Chronic Pain Treatment ◽  
Interventional Therapies ◽  
Interesting Area ◽  
Viable Treatment

The field of neuromodulation has seen unprecedented growth over the course of the last decade with novel waveforms, hardware advancements, and novel chronic pain indications. We present here an updated review on spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation. We focus on mechanisms of action, clinical indications, and future areas of research. We also present current drawbacks with current stimulation technology and suggest areas of future advancements. Given the current shortage of viable treatment options using a pharmacological based approach and conservative interventional therapies, neuromodulation presents an interesting area of growth and development for the interventional pain field and provides current and future practitioners a fresh outlook with regards to its place in the chronic pain treatment paradigm.

INTRATHECAL OPIOIDS IN THE INTRA - AND POSTOPERATIVE PAIN MANAGEMENT

2013 ◽  
pp. 89-94
Author(s):  
Van Minh Nguyen
Keyword(s):  
Chronic Pain ◽  
Regional Anesthesia ◽  
Historical Development ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Perioperative Period ◽  
Postoperative Pain Management ◽  
Clinical Use ◽  
Chronic Pain Treatment ◽  
Intrathecal Analgesia

Opioid analgesics have long been considered as among the most effective treatments for pain, but these medications was used without a fully known mechanism of action until finding its receptor. The discovery of opioid receptors in the dorsal horn has opened a new pain treatment. Intrathecal opioids are widely used as useful adjuncts to anesthesia during regional anesthesia, in the treatment of postoperative acute pain and chronic pain treatment. This article summarizes the historical development and examines the current use of intrathecal opioids in the perioperative period. Pharmacology and clinical use were also reviewed in detail, including dosage in different surgeries, side effects and the treatment. Key words: opioid, intrathecal analgesia, regional anesthesia

Teenager With Disabling Leg Pain

2021 ◽  
pp. 179-186
Author(s):  
Daniel M. Doleys ◽  
Nicholas D. Doleys
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dietary Supplements ◽  
Dietary Habits ◽  
Food Selection ◽  
Treatment Options ◽  
Age Groups ◽  
Leg Pain ◽  
Younger Age

The incidence and prevalence of chronic pain among children and adolescents appears to be increasing. The treatment options are limited. Understandably, one would want to minimize, if not avoid, long-term use of opioids. There are a number of modality and nonopioid therapies available. One approach often overlooked and underutilized, with all age groups, in the use of nutritional and dietary supplements. Many painful conditions, especially neuropathic pain, can be initialed and maintained by neuroinflammatory substances. Certain nutritional and dietary supplements can alter the effect of these substances and the abnormal neuronal functioning associated with pain. Unfortunately, the increased incidence of obesity, even among the younger age groups, reflects a continued trend toward poor dietary habits and food selection. This, along with other lifestyle issues, results in a population that is more vulnerable to developing painful disorders. For this reason, nutritional pain management should be given serious consideration.

Sign in / Sign up

Export Citation Format

Share Document