Pharmacologic and Technological Innovations in Pain Medicine

2016 ◽  
Author(s):  
Anita Gupta ◽  
Hawa Abubakar
Keyword(s):  
Pain Management ◽  
Disease Process ◽  
Multimodal Analgesia ◽  
Underlying Disease ◽  
Antiinflammatory Drug ◽  
Treatment Modalities ◽  
Technological Innovations ◽  
Duration Of Action ◽  
Key Words Pain ◽  
Opioid Receptor Antagonists

The experience of pain is subjective, and treatment modalities should aim at providing the greatest amount of pain relief while minimizing adverse effects. Pharmacologic and technological innovations are making this possible. By taking advantage of new manufacturing processes, the pharmaceutical industry is retooling old and effective drugs. SoluMatrix diclofenac uses nanotechnology to address the need for an effective nonsteroidal antiinflammatory drug at the lowest possible dose to minimize risks associated with cardiac, renal, and gastrointestinal side effects. Intravenous acetaminophen provides an additional alternative in multimodal analgesia in instances when the oral or rectal route of delivery is not desirable. Liposomal bupivacaine uses liposomal encapsulated, resulting in a local anesthetic with a prolonged duration of action that can be used effectively in the management of postoperative pain. With the recognition that opioid therapy still remains a mainstay in pain management, advances in science have allowed for the development of peripherally acting mu opioid receptor antagonists such as naloxegol, which minimize the bothersome side effect of opioid-induced constipation. In terms of interventional pain management, advances in radiofrequency ablation (RFA) technology have resulted in cooled RFA, which allows for the creation of larger spherical lesions, thereby alleviating pain by interfering with neurotransmission. Advances in stem cell research have led to the application of multipotent cells with the aim of treating the underlying disease process and thereby eliminating pain. Finally, pharmacogenetics testing and smart drugs provide an avenue via which issues surrounding how medication is consumed, determination of effectiveness, and ensuring compliance and adherence can be optimized. Key words: Pain, Pharmacology, Medications, Technology, Innovation, Smart Pills, Personalized Medicine, Biotechnology, Device, Surgery, Multimodal

scholarly journals Perception and Attitudes of Medical Students Regarding Postoperative Pain Management

2021 ◽  
Author(s):  
Fatema Johora ◽  
Asma Akter Abbasy ◽  
Fatiha Tasmin Jeenia ◽  
Ferdaush Ahmed Sojib ◽  
Mohsena Aktar ◽  
...  
Keyword(s):  
Pain Management ◽  
Medical Students ◽  
Postoperative Pain ◽  
Essential Element ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Treatment Modalities ◽  
Early Recovery ◽  
Medical College ◽  
Medical Colleges

Background: Postoperative pain remains a challenging problem, which requires a dynamic approach using a variety of treatment modalities to obtain an optimal outcome with respect to enhancing patient comfort and facilitating the recovery process. Multimodal analgesia signifies an increasingly popular approach to prevent postoperative pain. The approach includes administering a combination of opioid and nonopioid analgesics that act at different sites within the central and peripheral nervous systems in an effort to improve pain control while eliminating opioid-related adverse effects. Materials and Methods: To understand the perception and attitude of 4th year medical students, a structured questionnaire survey was done among six different medical colleges including government (Armed Forces Medical College, Cumilla Medical College and Colonel Malek Medical College, Manikganj) and non-government medical colleges (Army Medical College Bogura, Brahmanbaria Medical College and Chattogram International Medical College) of Bangladesh in October 2019. Total 340 students participated in the study. Result: Among the 340 students, almost 336 (98.2%) students were agreed that postoperative pain management is an essential element of patient care. Only 4 (1.18%) respondents disagreed. On the other hand, regarding its influence on early recovery and reduction of hospital staying, 311 (91.47%) respondents agreed and 29 (8.53%) respondents were found as disagreed. Regarding the issue of opioid commonly induced respiratory depression, 257 (75.59%) respondents thought it is a common adverse event and 81 (23.82%) respondents disagreed. 206 (60.59%) respondents did not agree that opioid always produce addiction or tolerance and 134 (39.71%) respondents disagreed with the same issue. 294 (86) respondents agreed that multimodal analgesia increases patients cost and 46 (14%) disagreed. 249 (74%) students agreed that regional techniques are useful for postoperative pain management and 89 (26%) respondents disagreed. Conclusion: Adequate post-operative pain management knowledge is necessary to reduce post-operative complications.

Drug-Induced Movement Disorders

2015 ◽  
Vol 25 (2) ◽  
pp. 70-77
Author(s):  
Amy Lustig ◽  
Cesar Ruiz
Keyword(s):  
Movement Disorders ◽  
Medical Management ◽  
Disease Process ◽  
Underlying Disease ◽  
Extrapyramidal Symptoms ◽  
Drug Induced ◽  
General Overview ◽  
Management Approaches ◽  
Broad Understanding ◽  
Underlying Disease Process

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

scholarly journals AB0267 HOW EFFECTIVE IS PAIN MANAGEMENT IN THE PATIENTS’ OPINION? DATA FROM THE COMPAS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1160.1-1160
Author(s):  
E. Pogozheva ◽  
A. Karateev ◽  
V. Amirdzhanova
Keyword(s):  
Pain Management ◽  
Pain Therapy ◽  
Significant Proportion ◽  
Connective Tissue Diseases ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Results Of Treatment ◽  
Analgesic Therapy ◽  
Folk Remedies ◽  
Personalized Approach

Objectives:to evaluate the effectiveness and satisfaction of pain management in patients with rheumatic diseases (RD) according to a survey in the COMPAS (Quality of Pain Management according to Patients with Arthritis and Back pain) study.Methods:the survey involved 1040 patients with RD (rheumatoid arthritis-40.6%, osteoarthritis -32.1%, spondyloarthritis-10.6%, connective tissue diseases-8.6% of patients). 76.8% were women, the mean age was 55.8±14.0 years. 35.7% of patients continued to work in their specialty, 31.6% had various degrees of disability. The effectiveness of pain therapy was evaluated by the patient in the last month preceding the survey on a 5-point scale, where 1 - no effect and 5-excellent effect. Patients ‘ satisfaction with treatment, possible reasons for the lack of effectiveness of pain therapy and the use of additional treatment tools were also evaluated.Results:as therapy for the underlying disease, 40% of patients received conventional disease modifying antirheumatic drugs, 33.1% - glucocorticoids, 7.2% - biological agents and 15.2% - symptomatic slow-acting drugs in osteoarthritis. At the same time, 68% of patients needed additional analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Slightly less than half of the surveyed patients (46.9%) noted a moderate effect of analgesic therapy, 22.7% - a low effect and 5% - no effect, 23.7% rated the effectiveness of therapy as good and only 1.7% - as excellent. At the same time, only 15.6% of patients were completely satisfied with the result of NSAIDs, 64% were partially satisfied with the treatment and 20.4% were completely dissatisfied. As the reason of insufficient effectiveness of NSAIDs, most often (34.3%) patients named fear of adverse events associated with taking drugs, 19.4% - weak drugs, 15.3% - insufficient attention of doctors to complaints, 6.6% - poor diagnosis of the causes of pain. Others found it difficult to answer or were completely satisfied with the treatment. 40% of patients used additional methods, most often chiropractic (12.3%), acupuncture (4.8%), physiotherapy (12.7%) and folk remedies (7.4%).Conclusion:A significant proportion of patients with RD don’t have adequate pain control. Only 25.4% of patients rate the result of treatment as good and excellent, and even fewer patients (15.6%) are completely satisfied with the results of therapy. Thus, a personalized approach to analgesic therapy is necessary, taking into account the expectations of patients regarding the results of treatment.Disclosure of Interests:None declared

Measuring Disease Modification in Alzheimer's Disease

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S1) ◽  
pp. 11-14
Author(s):  
Jeffrey L. Cummings
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Immunoglobulin A ◽  
Disease Process ◽  
Underlying Disease ◽  
Therapeutic Interventions ◽  
Disease Modification ◽  
Amyloid Disease ◽  
Therapeutic Modalities ◽  
Disease Modifying

AbstractWe appear to be on the brink of a new epoch of treatment for Alzheimer's disease. Compelling evidence suggests that Aβ42 secretion is the triggering event in the pathogenesis of Alzheimer's disease, and that tau aggregation may be an important secondary event linked to neurodegeneration. Prophylactic administration of anti-amyloid agents designed to prevent Aβ accumulation in persons with subclinical disease is likely to be more effective than therapeutic interventions in established Alzheimer's disease. Drug development programs in Alzheimer's disease focus primarily on agents with anti-amyloid disease-modifying properties, and many different pharmacologic approaches to reducing amyloid pathology and tauopathy are being studied. Classes of therapeutic modalities currently in advanced-stage clinical trial testing include forms of immunotherapy (active β -amyloid immunoconjugate and human intravenous immunoglobulin), a γ-secretase inhibitor, the selective Aβ42-lowering agent R-flurbiprofen, and the anti-aggregation agent tramiprosate. Non-traditional dementia therapies such as the HMG-CoA reductase inhibitors (statins), valproate, and lithium are now being assessed for clinical benefit as anti-amyloid disease-modifying treatments. Positive findings of efficacy and safety from clinical studies are necessary but not sufficient to demonstrate that a drug has disease-modifying properties. Definitive proof of disease-modification requires evidence from validated animal models of Alzheimer's disease; rigorously controlled clinical trials showing a significantly improved, stabilized, or slowed rate of decline in cognitive and global function compared to placebo; and prospectively obtained evidence from surrogate biomarkers that the treatment resulted in measurable biological changes associated with the underlying disease process.

scholarly journals Clinical Features and Outcomes of a Racially Diverse Population with Fibrillary Glomerulonephritis

2017 ◽  
Vol 45 (3) ◽  
pp. 248-256 ◽  
Author(s):  
Fernanda Payan Schober ◽  
Meghan A. Jobson ◽  
Caroline J. Poulton ◽  
Harsharan K. Singh ◽  
Volker Nickeleit ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Disease Process ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Fibrillary Glomerulonephritis ◽  
Black Patients ◽  
End Stage ◽  
20 Nm ◽  
The University

Background: Fibrillary glomerulonephritis is characterized by randomly arranged fibrils, approximately 20 nm in diameter by electron microscopy. Patients present with proteinuria, hematuria and kidney insufficiency, and about half of the reported patients progress to end-stage kidney disease within 4 years. The dependence of patient characteristics and outcomes on race has not been explored. In this study, we describe a cohort of patients with fibrillary glomerulonephritis and compare their clinical characteristics and outcomes with those of patients previously described. Methods: The University of North Carolina (UNC) Nephropathology Database was used to retrospectively identify patients diagnosed with fibrillary glomerulonephritis between 1985 and 2015. Of these patients, those treated at UNC were selected. Their demographic and clinical characteristics - including signs and symptoms, comorbidities, laboratory values, treatments and outcomes - were compared with those of patients described earlier. Results: Among the 287 patients identified, 42 were treated at the UNC Kidney Center. When compared to earlier cohorts, a higher frequency of black race, hepatitis C virus (HCV) infection and use of hemodialysis were noted in both black and HCV-positive patients. Autoimmune diseases, infections and malignancies were frequently observed, present in over half of all cases. Conclusion: According to this study, fibrillary glomerulonephritis represents a secondary glomerular disease process (associated with autoimmune disease, infection or malignancy) in many cases and hence screening is essential. As the screening for comorbidities increased over time, more underlying causes were identified. We noted a high frequency of HCV among black patients, suggesting a possible causative association. Treatment of underlying disease is essential for patients for the best outcome.

Psychological Factors Affecting Pain Response in Critically Ill Patients

2021 ◽  
Vol 1 (2) ◽  
pp. 32-34
Author(s):  
Rani Iswara
Keyword(s):  
Pain Management ◽  
Sleep Deprivation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Psychological Factors ◽  
Multimodal Analgesia ◽  
Traumatic Experience ◽  
Factors Affecting ◽  
Control Pain ◽  
Harmful Effects

Pain is a traumatic experience and discomfort for all patients, especially critically ill patients; if not treated properly, it can have harmful effects. Critical illnesses are usually painful, both because of the underlying source of the disease and the necessary procedures performed to monitor and care for these patients. Pain induces anxiety, sleep deprivation, disorientation, agitation, delirium, and often become chronic depression. Psychological factors (sleep deprivation, anxiety, and delirium) can also increase the perception of pain. Pain assessment is required for proper pain management. Opioids are commonly used in pain management, but acetaminophen, dexmedetomidine, and gabapentin have more advantages. The recent trend is multimodal analgesia, which uses a combination of analgesic drugs with different mechanisms of action. Another trend is the increasing use of pain relievers, which can control pain and relieve anxiety.

scholarly journals Multimodal Analgesia in Perioperative Settings: Improvement Perspectives / Multimodāla Analgēzija Perioperatīvajā Periodā: Uzlabošanas Iespējas

2014 ◽  
Vol 68 (5-6) ◽  
pp. 222-227
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miščuks ◽  
Ēriks Rudzītis
Keyword(s):  
Pain Management ◽  
Lower Extremity ◽  
Pain Intensity ◽  
Severe Pain ◽  
Rating Scale ◽  
Multimodal Analgesia ◽  
Numeric Rating Scale ◽  
Plexus Brachialis ◽  
Single Shot ◽  
Maximum Pain

Abstract The aim of this study was to evaluate the intensity of pain in orthopaedic hospital patients and to identify unsatisfactory pain management and possibilities for improvements in the future. Data collection included Numeric Rating Scale (NRS) scores, which characterised the intensity of pain. Maximum pain on the day of surgery, mean pain on the day of surgery (D0), and mean pain on first (D1) and second (D2) postoperative days were documented. The pain of an intensity from 0 to 3 was defined as mild pain, 4 to 6 as moderate pain, and 6 to 10 as severe pain. Maximum severe pain intensity on the day of surgery was experienced by 20.5% of patients, moderate by 45.8%, and mild by 33.6%. The reported mean pain intensity according to type of surgery was as follows: hip replacement- 2.79 ± 1.6 (D0), 2.09 ± 1.4 (D1), and 1.35 ± 1.2 (D2); knee replacement - 3.39 ± 1.7 (D0), 2.98 ± (D1), 1.82 ± 1.36, and (D2); upper extremity surgery - 3.59 ± 1.9 (D0), 3.4 ± 1.7 (D1), and 2.1 ± 1.5 (D2); lower extremity surgery - 4.1 ± 2.1 (D0), 3.49 ± 1.42 (D1), and 2.58 ± 1.4 (D2); spine surgery - 3.31 ± 1.58 (D0), 2.88 ± 1.96 (D1), and 1.83 ± 1.74 (D2). Patients in the lower extremity group experienced unacceptable mean pain. The maximum pain intensity on day of surgery was experienced by patients after single-shot plexus brachialis block anaesthesia (5.24 ± 2.4). Well-designed multimodal analgesia with special attention to single shot techniques may improve pain management and functional outcomes after orthopaedic surgery.

scholarly journals Median nerve stimulation induces analgesia via orexin-initiated endocannabinoid disinhibition in the periaqueductal gray

2018 ◽  
Vol 115 (45) ◽  
pp. E10720-E10729 ◽  
Author(s):  
Yi-Hung Chen ◽  
Hsin-Jung Lee ◽  
Ming Tatt Lee ◽  
Ya-Ting Wu ◽  
Yen-Hsien Lee ◽  
...  
Keyword(s):  
Pain Management ◽  
Median Nerve ◽  
Nerve Stimulation ◽  
Antinociceptive Effect ◽  
Low Frequency ◽  
Periaqueductal Gray ◽  
Orexin A ◽  
Median Nerve Stimulation ◽  
Opioid Receptor Antagonists ◽  
Nociceptive Responses

Adequate pain management remains an unmet medical need. We previously revealed an opioid-independent analgesic mechanism mediated by orexin 1 receptor (OX1R)-initiated 2-arachidonoylglycerol (2-AG) signaling in the ventrolateral periaqueductal gray (vlPAG). Here, we found that low-frequency median nerve stimulation (MNS) through acupuncture needles at the PC6 (Neiguan) acupoint (MNS-PC6) induced an antinociceptive effect that engaged this mechanism. In mice, MNS-PC6 reduced acute thermal nociceptive responses and neuropathy-induced mechanical allodynia, increased the number of c-Fos–immunoreactive hypothalamic orexin neurons, and led to higher orexin A and lower GABA levels in the vlPAG. Such responses were not seen in mice with PC6 needle insertion only or electrical stimulation of the lateral deltoid, a nonmedian nerve-innervated location. Directly stimulating the surgically exposed median nerve also increased vlPAG orexin A levels. MNS-PC6–induced antinociception (MNS-PC6-IA) was prevented by proximal block of the median nerve with lidocaine as well as by systemic or intravlPAG injection of an antagonist of OX1Rs or cannabinoid 1 receptors (CB1Rs) but not by opioid receptor antagonists. Systemic blockade of OX1Rs or CB1Rs also restored vlPAG GABA levels after MNS-PC6. A cannabinoid (2-AG)-dependent mechanism was also implicated by the observations that MNS-PC6-IA was prevented by intravlPAG inhibition of 2-AG synthesis and was attenuated inCnr1−/−mice. These findings suggest that PC6-targeting low-frequency MNS activates hypothalamic orexin neurons, releasing orexins to induce analgesia through a CB1R-dependent cascade mediated by OX1R-initiated 2-AG retrograde disinhibition in the vlPAG. The opioid-independent characteristic of MNS-PC6–induced analgesia may provide a strategy for pain management in opioid-tolerant patients.

Human Immunodeficiency Virus-Associated Thrombocytopenia

DICP ◽  
1989 ◽  
Vol 23 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Dennis M. Hoffman ◽  
Rocco F. Caruso ◽  
Timothy Mirando
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Globulin ◽  
Disease Process ◽  
Underlying Disease ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
A New Technique ◽  
Immunodeficiency Syndrome

Thrombocytopenia has emerged as a major hematological manifestation associated with AIDS (acquired immunodeficiency syndrome) and human immunodeficiency virus (HIV)-positive patients. A study of homosexual patients with thrombocytopenia indicates 93 percent had serological evidence of HIV exposure whereas only 33 percent of homosexuals without thrombocytopenia exhibited this finding. Thrombocytopenia in patients with hemophilia has been identified as an increased risk factor for AIDS development and has been observed in about one-third of children with AIDS. The management of thrombocytopenia in HIV-infected patients poses a therapeutic dilemma for clinicians since many of the traditional modalities for treating immune thrombocytopenia may adversely affect the underlying disease process or further compromise the immune system. Splenectomy, corticosteroids, danazol, intravenous immune globulin, vincristine, and RHo(D) immune globulin have all been used with variable results. A new technique that physically removes antibodies and immune complexes associated with thrombocytopenia is under investigation. Due to either toxicity or the high incidence of transient response, asymptomatic patients may not be candidates for treatment.

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