scholarly journals The Circadian Hormone Melatonin Inhibits Morphine-Induced Tolerance and Inflammation via the Activation of Antioxidative Enzymes

Antioxidants ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 780
Author(s):  
Ing-Jung Chen ◽  
Chih-Ping Yang ◽  
Sheng-Hsiung Lin ◽  
Chang-Mei Lai ◽  
Chih-Shung Wong
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Antioxidative Enzymes ◽  
Light Exposure ◽  
Morphine Tolerance ◽  
Melatonin Receptors ◽  
Constant Light ◽  
Clinical Pain ◽  
The Impact

Opioids are commonly prescribed for clinical pain management; however, dose-escalation, tolerance, dependence, and addiction limit their usability for long-term chronic pain. The associated poor sleep pattern alters the circadian neurobiology, and further compromises the pain management. Here, we aim to determine the correlation between constant light exposure and morphine tolerance and explore the potential of melatonin as an adjuvant of morphine for neuropathic pain treatment. Methods: Wistar rats were preconditioned under constant light (LL) or a regular light/dark (LD) cycle before neuropathic pain induction by chronic constriction injury. An intrathecal (i.t.) osmotic pump was used for continued drug delivery to induce morphine tolerance. Pain assessments, including the plantar test, static weight-bearing symmetry, and tail-flick latency, were used to determine the impact of the light disruption or exogenous melatonin on the morphine tolerance progression. Results: constant light exposure significantly aggravates morphine tolerance in neuropathic rats. Continued infusion of low-dose melatonin (3 μg/h) attenuated morphine tolerance in both neuropathic and naïve rats. This protective effect was independent of melatonin receptors, as shown by the neutral effect of melatonin receptors inhibitors. The transcriptional profiling demonstrated a significant enhancement of proinflammatory and pain-related receptor genes in morphine-tolerant rats. In contrast, this transcriptional pattern was abolished by melatonin coinfusion along with the upregulation of the Kcnip3 gene. Moreover, melatonin increased the antioxidative enzymes SOD2, HO-1, and GPx1 in the spinal cord of morphine-tolerant rats. Conclusion: Dysregulated circadian light exposure significantly compromises the efficacy of morphine’s antinociceptive effect, while the cotreatment with melatonin attenuates morphine tolerance/hyperalgesia development. Our results suggest the potential of melatonin as an adjuvant of morphine in clinical pain management, particularly in patients who need long-term opioid treatment.

scholarly journals Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i48-i49
Author(s):  
S Visram ◽  
J Saini ◽  
R Mandvia
Keyword(s):  
Data Analysis ◽  
Pain Management ◽  
Cancer Pain ◽  
Educational Intervention ◽  
Opioid Analgesics ◽  
Educational Outreach ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

scholarly journals THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S709-S709
Author(s):  
Rachael Hemmert ◽  
Gabriella E Dull ◽  
Linda S Edelman
Keyword(s):  
Pain Management ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Well Being ◽  
Educational Needs ◽  
Opioid Use ◽  
Term Care ◽  
Opioid Prescription ◽  
The Impact

Abstract Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.

scholarly journals Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

2020 ◽  
Vol 14 (6) ◽  
Author(s):  
Ali Dergham ◽  
Greg Hosier ◽  
Melanie Jaeger ◽  
J. Curtis Nickel ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Pain Management ◽  
Response Rate ◽  
Formal Training ◽  
Knowledge Gaps ◽  
Opioid Prescribing ◽  
Review Course ◽  
Student’S T ◽  
The Impact ◽  
Student’S T Test

Introduction: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. Methods: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student’s t-test were performed. Results: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least. Conclusions: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.

A Systematic Review of The Professional Medical Conversation Regarding Conflict Related Chronic Post Amputation & Neuropathic Pain 1914-1985

2020 ◽  
Author(s):  
Sarah Dixon Smith
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
First World War ◽  
Phantom Limb ◽  
Long Term Effects ◽  
World War ◽  
The Uk ◽  
The Impact ◽  
First World

The First World War resulted in the largest amputee cohort in history, with over 41,000 amputees in the UK alone. Limb wounds were (and still are) the most common site of survivable injury in conflict and accounted for 70% of all British casualties from 1914 to 1918. Of these casualties, 59% were caused by artillery or high velocity munitions, wounds that today, in some cases, could be termed ‘blast injury’.To date, there appears to have been no detailed analysis of the impact of this type of injury or pain on veterans’ long-term health and quality of life, or into the evolution of the professional, political and lay concepts, attitudes or clinical assessment and management for these types of chronic pain and the inherent years lost to disability [YLD] it caused.Although amputation rates have been reduced in recent conflicts, chronic residual stump, phantom limb and peripheral neuropathic pain are still significant issues in the rehabilitation of conflict wounds, and it is estimated that up to 85% of amputees suffer from chronic pain as a result of amputation. Given the similarities between the injury patterns caused by First World War weaponry and those from the improvised explosive devices [IEDs] of 21st century conflicts, this project has the potential to inform contemporary medical researchers, clinicians and disability policy as the long-term effects of blast injuries sustained by UK military personnel in Iraq and Afghanistan (329 blast-related amputations in total) become more evident.

scholarly journals Physicians’ Attitudes to Clinical Pain Management and Education: Survey from a Middle Eastern Country

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Soumana C. Nasser ◽  
Jeanette G. Nassif ◽  
Aline Hanna Saad
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Middle Eastern ◽  
Continuing Professional Development ◽  
Developed Countries ◽  
Management Skills ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Pain ◽  
The Impact

Despite promising initiatives to advance the practice of pain management in Middle Eastern countries, their pain care lags behind developed countries. The objectives of this study are to evaluate physicians’ assessment of their own competency in pain management, to assess physicians’ practice related to pain management, and to identify physician-related barriers to effective pain control. A cross-sectional survey was conducted in 3 teaching medical centers in Lebanon targeting the above-mentioned outcomes and assessing the impact of physicians’ years in practice on the studied end-points. A total of 69 physicians were surveyed. Fifty-seven percent reported “very good to excellent” pain management skills; only 25% of them described the need for continuing professional development. When treating patients with pain, 52% of physicians refer to updated international guidelines, whereas 43% rely on their own judgment. Physicians were more likely to consult with another physician (65%) rather than a pharmacist (12%) when treating patients with pain. Fear of adverse effects of analgesics was the most commonly reported barrier (45%) to pain control among physicians from different career stages. Based on these survey findings, national pain management and practice policies are needed to optimize this area of deficiency in patient care.

Light, lighting and human health

2021 ◽  
pp. 147715352110102
Author(s):  
PR Boyce
Keyword(s):  
Human Health ◽  
Optical Radiation ◽  
Light Exposure ◽  
Health Impacts ◽  
Lighting Conditions ◽  
Visual Systems ◽  
Medical Status ◽  
Risk Of Falls ◽  
The Impact

Light can impact human health via the visual and non-visual systems originating in the retina of the eye or as optical radiation falling on eye or skin. This paper provides a summary of what is known about these impacts. Topics covered include aspects of lighting likely to cause eyestrain and headaches; increase the risk of falls; induce circadian disruption; enhance sleep; mitigate Alzheimer’s disease and depression; produce tissue damage; alleviate diseases through phototherapy and inactivate viruses through germicidal irradiation. It is concluded that human health is undoubtedly influenced by lighting, but there are four conditions that should be attached to such a simple assertion. First, the impact of lighting on human health can be either positive or negative. Second, human health is affected by many factors other than lighting. Third, the severity of the effects of light exposure can vary widely from the short-lived and trivial to the long-term and fatal. Fourth, the same lighting conditions can have very different health impacts for different individuals depending on their age and medical status. Taken together, these conditions imply that care is required when judging the veracity and relevance of broad assertions about the benefits of lighting for human health.

scholarly journals Expert review and recommendations for the management of acute, chronic, and neuropathic pain in Qatar

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Amr Elmoheen ◽  
Abdullah F. Nazal ◽  
Osman Zubaidi ◽  
Urooj A. Siddiqui ◽  
Mohammed Alhatou
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Expert Panel ◽  
Pain Treatment ◽  
Treatment Protocols ◽  
Face To Face ◽  
Expert Review ◽  
Pain Specialist

Background: Pain management is an evolving area of expertise in Qatar. Gaps in knowledge, inadequate training for physicians and nurses, and the absence of policies/guidelines are the main barriers to effective pain management in Qatar. In addition, the use of certain pain medication, especially opioids, is highly regulated, limiting their availability in outpatient pain management. These factors are responsible for the undertreatment of pain in Qatar. This study aimed to standardize evidence-based local recommendations for pharmacological treatment of pain in Qatar. Methods: An expert panel of physicians from different disciplines, with experience in diagnosis and treatment of the three pain types (i.e., acute, chronic, and neuropathic), was convened for two face-to-face meetings in Doha, Qatar, on November 29, 2019, and on February 22, 2020, with subsequent virtual meetings. A literature search was performed on Medline and Google Scholar databases from inception till December 2019, and all relevant articles were selected. Based on these articles and repeated feedback from the authors, the final pain treatment protocols were developed.Results: Recommendations for the treatment of acute pain, based on pain severity, followed three approaches: acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for mild pain and moderate pain and referral to a pain specialist for severe pain. Acetaminophen/paracetamol or NSAIDs is recommended for chronic pain, and the use of opioids was strongly discouraged because of its long-term side effects. For neuropathic pain, tricyclic antidepressants or gabapentin or pregabalin or serotonin-norepinephrine reuptake inhibitors were recommended first-line agents. Non-responders must be referred to neurologists or a pain specialist. Conclusion: The expert panel provides recommendations for the management of acute, chronic, and neuropathic pain based on international guidelines adapted to local practice and treatment availability in Qatar. More importantly, the panel has recommended taking extreme caution in the use of opioids for long-term management of chronic pain and to refer the patient to a pain specialist clinician as required.

scholarly journals Activity-dependent circuitry plasticity via the regulation of the histamine receptor level in the Drosophila visual system

2021 ◽  
Author(s):  
Yiming Bai ◽  
Takashi Suzuki
Keyword(s):  
Visual System ◽  
Light Exposure ◽  
Continuous Light ◽  
Histamine Receptor ◽  
Constant Light ◽  
Enhanced Activity ◽  
Photoreceptor Neurons ◽  
Activity Dependent

Activity-dependent synaptic plasticity is crucial for responses to the environment. Although the plasticity mechanisms of presynaptic photoreceptor neurons in the Drosophila visual system have been well studied, postsynaptic modifications remain elusive. In addition, further studies on the adaption of the visual system to different light experiences at a circuitry scale are required. Using the modified transcriptional reporter of intracellular Ca2+ method, we describe a way to visualize circuitry changes according to different light experiences. We found enhanced postsynaptic neuronal activity responses in lamina monopolar neuron L2 after prolonged light treatment. Although L1 also has connections with photoreceptors, there were no enhanced activity responses in L1. We also report in this study that activity-dependent transcriptional downregulation of inhibitory histamine receptors (HRs) occurs in postsynaptic neuron L2, but not in L1, during continuous light conditions. We expressed exogenous HR proteins in L2 neurons and found that it attenuated the enhanced activity response caused by constant light exposure. These findings, together with the fact that histamine is the main inhibitory neurotransmitter released by photoreceptors in the Drosophila visual system, confirmed our hypothesis that the activity-dependent transcriptional downregulation of HRs is responsible for the constant light exposure-induced circuitry response changes in L2. The results successfully demonstrated the selective circuit change after synaptic remodeling evoked by long-term activation and provided in vivo evidence of circuitry plasticity upon long-term environmental stimulation.

scholarly journals Long-term Consequences of Acute Pain for Patients under Methadone or Buprenorphine Maintenance Treatment

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. E739-E747 ◽  
Author(s):  
Maryse Lapeyre-Mestre
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Maintenance Treatment ◽  
Rating Scales ◽  
Rating Scale ◽  
Negative Impact ◽  
Opioid Maintenance Treatment ◽  
The Impact

Background: Acute and chronic pains are reported to be highly prevalent in patients under opioid maintenance treatment (OMT). Lack of knowledge concerning the complex relationship between pain, opioid use, and their impact on OMT efficacy can account for the barriers encountered for pain management. Objectives: To assess the impact of acute pain exposure on long-term OMT retention in a cohort of patients under buprenorphine or methadone followed up during 12 months. Study Design: Prospective, multi-center observational cohort clinical study. Setting: Emergency departments, surgery departments, and specialized addiction care centers in an outpatient setting in south-western France (Midi-Pyrénées area), from April 2008 to January 2010. Methods: Patients aged 18 or more under OMT for at least 3 months, and followed up by a physician were recruited. Acute pain was assessed using the Visual Analog Scale (VAS) or the Verbal Rating Scale (VRS). Exposed patients were those with a pain score greater than 0 at the time of admission on any of the rating scales. The OMT rate after 12 months was compared among exposed and unexposed patients. OMT retention was also investigated after 3 and 6 months follow-up. Results: A total of 151 patients, 81 exposed and 70 unexposed, were recruited; among them, respectively, 26 (32%) and 34 (49%) completed 12-months follow-up. Acute pain exposure appeared to be significantly and negatively associated with retention in treatment (crude OR: 0.44; 95% CI [0.22 – 0.87]; adjusted OR: 0.46; 95% CI [0.23 – 0.93]). Compared to methadone users, patients under buprenorphine were less likely to have their OMT maintained after 12 months (OR 0.37; 95% CI [0.18 – 0.75]; adjusted OR 0.38; 95% CI [0.18 – 0.80]). Limitations: Follow-up rate was 40 % (60/151). Conclusion: This study demonstrates the strong negative impact of acute pain on OMT in a population mainly composed of patients under buprenorphine, as well as differential response depending on the OMT medication. The findings highlight the need to consider the characteristics of pain in the population under OMT and to develop evidence-based guidelines for pain management. Trial registration: The study was registered at www.clinical.trials.gov with the study identifier: NCT00738036. Ethics Committee approval was received on February 11, 2008. Participants’ written consent was not required. Key words: Analgesic drug, methadone, buprenorphine, opioid, opioid maintenance treatment, acute pain, long-term retention, pharmacodependence, pharmacoepidemiology

Suppressed, but Not Forgotten

2011 ◽  
Vol 70 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Beat Meier ◽  
Anja König ◽  
Samuel Parak ◽  
Katharina Henke
Keyword(s):  
Memory Trace ◽  
Thought Suppression ◽  
Test Phase ◽  
Indirect Test ◽  
Final Test ◽  
Test Experiment ◽  
And Control ◽  
Cue Words ◽  
The Impact

This study investigates the impact of thought suppression over a 1-week interval. In two experiments with 80 university students each, we used the think/no-think paradigm in which participants initially learn a list of word pairs (cue-target associations). Then they were presented with some of the cue words again and should either respond with the target word or avoid thinking about it. In the final test phase, their memory for the initially learned cue-target pairs was tested. In Experiment 1, type of memory test was manipulated (i.e., direct vs. indirect). In Experiment 2, type of no-think instructions was manipulated (i.e., suppress vs. substitute). Overall, our results showed poorer memory for no-think and control items compared to think items across all experiments and conditions. Critically, however, more no-think than control items were remembered after the 1-week interval in the direct, but not in the indirect test (Experiment 1) and with thought suppression, but not thought substitution instructions (Experiment 2). We suggest that during thought suppression a brief reactivation of the learned association may lead to reconsolidation of the memory trace and hence to better retrieval of suppressed than control items in the long term.

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