Buprenorphine: Far Beyond the “Ceiling”

Chronic pain, including neuropathic pain, represents an untreated disease with important repercussions on the quality of life and huge costs on the national health system. It is well known that opioids are the most powerful analgesic drugs, but they represent the second or third line in neuropathic pain, that remain difficult to manage. Moreover, these drugs show several side effects that limit their use. In addition, opioids possess addictive properties that are associated with misuse and drug abuse. Among available opioids compounds, buprenorphine has been suggested advantageous for a series of clinical reasons, including the effectiveness in neuropathic pain. Some properties are partly explained by its unique pharmacological characteristics. However, questions on the dynamic profile remain to be answered. Pharmacokinetics optimization strategies, and additional potentialities, are still to be explored. In this paper, we attempt to conceptualize the potential undiscovered dynamic profile of buprenorphine.

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Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

Pain Research and Management ◽

10.1155/2020/7565962 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yinxia Wang ◽

Ligang Xing

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cancer Pain ◽

Cancer Patients ◽

Pain Control ◽

Analgesic Drugs ◽

Oxycodone Hydrochloride ◽

Radiation Esophagitis

Radiotherapy is commonly used to treat cancer patients. Besides the curable effect, radiotherapy also could relieve the pain of cancer patients. However, cancer pain is gradually alleviated about two weeks after radiotherapy. In addition, cancer patients who receive radiotherapy may also suffer from pain flare or radiotherapy-induced side effects such as radiation esophagitis, enteritis, and mucositis. Pain control is reported to be inadequate during the whole course of radiotherapy (before, during, and after radiotherapy), and quality of life is seriously affected. Hence, radiotherapy is suggested to be combined with analgesic drugs in clinical guidelines. Previous studies have shown that radiotherapy combined with oxycodone hydrochloride can effectively alleviate cancer pain. In this review, we firstly presented the necessity of analgesia during the whole course of radiotherapy. We also sketched the role of oxycodone hydrochloride in radiotherapy of bone metastases and radiotherapy-induced oral mucositis. Finally, we concluded that oxycodone hydrochloride shows good efficacy and tolerance and could be used for pain management before, during, and after radiotherapy.

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Opioid Analgesia: Perspectives on Right Use and Utility

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/479 ◽

2007 ◽

Vol 3;10 (5;3) ◽

pp. 479-491 ◽

Cited By ~ 2

Author(s):

Jane C. Ballantyne

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Side Effects ◽

Clinical Decision Making ◽

Analgesic Efficacy ◽

Clinical Decision ◽

Opioid Analgesia ◽

Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

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Patient perspectives

Neuropathic Pain ◽

10.1093/med/9780199563678.003.0019 ◽

2010 ◽

pp. 181-187

Author(s):

S. Jos Closs

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Suicidal Ideation ◽

Side Effects ◽

Focus Group ◽

Drug Treatment ◽

Sleep Disturbance ◽

Focus Group Research ◽

The Impact

The impact of neuropathic pain on quality of life has been under-researched and poorly understood though survey and focus group research is helping to gain better insights into what patients suffer Neuropathic pain can result in significant sleep disturbance, fatigue, and low mood (that sometimes leads to suicidal ideation), and side-effects from drug treatment are common...

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Chronic Pain After Lung Resection: Risk Factors, Neuropathic Pain, and Quality of Life

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.03.012 ◽

2020 ◽

Vol 60 (2) ◽

pp. 326-335 ◽

Cited By ~ 1

Author(s):

Silvia Fiorelli ◽

Luigi Cioffi ◽

Cecilia Menna ◽

Mohsen Ibrahim ◽

Roberto A. De Blasi ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Chronic Pain ◽

Neuropathic Pain ◽

Lung Resection

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Dorsal Root Ganglion (DRG) and Chronic Pain

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113020 ◽

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.

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Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids

British Journal of Pain ◽

10.1177/2049463720974053 ◽

2020 ◽

pp. 204946372097405

Author(s):

Jane Quinlan ◽

Heather Willson ◽

Katheryn Grange

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Side Effects ◽

Phenomenological Approach ◽

Free Text ◽

Significant Depression ◽

Opioid Tapering ◽

The Uk

Background: It is clear that the risks of opioids in chronic pain outweigh the benefits, creating a drive for clinicians to support patients taper and stop long-term opioids. However, it is not known how patients who have been taking these medicines for months or years feel about reducing them. Using quantitative and qualitative data, this study describes the psychological complexity of these patients and examines their hopes and fears before opioid reduction. Methods: Sixty patients attending the opioid clinic completed psychological and pain questionnaires, providing quantitative data, just before they commenced opioid tapering. They scored the severity of opioid side effects and completed a free text framework to express their beliefs about stopping or continuing opioids. A phenomenological approach was used to identify common qualitative themes. Results: Most patients were taking opioid doses above the UK recommended maximum dose and reported severe pain with high pain interference. Over 80% of patients described significant depression and 60% significant anxiety. Negative themes around stopping opioids were more common than positive ones, with 63% patients fearing increased pain. A quarter of patients referred to addiction and 16% feared withdrawal. Five patients hoped for a better quality of life; seven feared a worse one. Opioid side effects were common and severe. Conclusion: Patients with chronic pain taking long-term opioids demonstrate high psychological distress and low self-efficacy. Their concerns around opioid tapering relate to pain, quality of life and withdrawal. Identifying and addressing patients’ individual concerns should increase the likelihood of successful opioid tapering.

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Failure of long-term nerve root stimulation to improve neuropathic pain

Journal of Neurosurgery ◽

10.3171/jns/2008/108/5/0921 ◽

2008 ◽

Vol 108 (5) ◽

pp. 921-925 ◽

Cited By ~ 13

Author(s):

Ralf Weigel ◽

Hans-Holger Capelle ◽

Joachim K. Krauss

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Side Effects ◽

Nerve Root ◽

Daily Living ◽

Short Term ◽

Test Stimulation ◽

Root Stimulation

Object Stimulation of dorsal nerve roots or dorsal root ganglia was reported to alleviate neuropathic pain in selected patients during the early postoperative period. A prospective study was initiated to investigate long-term outcome in patients with neuropathic pain of the lower extremities or groin who were treated with selective nerve root stimulation. Methods The study included patients with dermatomally distributed neuropathic pain who were > 18 years of age and in whom the pain was refractory to medical treatment. The patients were prospectively evaluated using a visual analog scale (VAS) for pain and ratings for quality of life, activities of daily living, and depression preoperatively, and after defined intervals postoperatively. Implantation of electrodes was performed via foraminotomy or interlaminar fenestration in an awake procedure. An implantable pulse generator (IPG) was implanted in a second operation after successful test stimulation performed over several days. Results Three patients were included in the study before it was stopped. The mean maximum pain score preoperatively was 9.3. All patients had successful test stimulation with > 50% pain relief prior to implantation of the IPG (mean maximum VAS Score 3.6). The beneficial effect, however, was lost within the next few months despite adjustment of stimulation settings. With higher amplitudes, side effects such as pain attacks or motor phenomena occurred. They disappeared after stopping stimulation, but neuropathic pain recurred to its full extent. The study was stopped 18 months after the first implantation, when the third and last IPG of this series was explanted. Due to the overall short-term effect of stimulation, no relevant changes in ratings for quality of life, activities of daily living, or depression were detected. Conclusions Spinal nerve root stimulation proved to be effective on short-term follow-up in 3 patients with neuropathic pain in a dermatomal distribution. Long-term stimulation, however, was disappointing because of the loss of effectiveness and the occurrence of side effects.

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Delayed-Onset Neuropathic Pain after Septoplasty

Case Reports in Otolaryngology ◽

10.1155/2021/9966318 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Foteini-Stefania Koumpa ◽

Mark Ferguson ◽

Hesham Saleh

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Postoperative Pain ◽

Facial Pain ◽

Substantial Effect ◽

Maxillary Nerve ◽

Delayed Onset ◽

Neuralgic Pain

Postoperative pain following a septoplasty is expected to be mild and limited to a few days after the operation. Chronic pain following the procedure is rare. No cases of delayed-onset neuropathic pain or allodynia have been described in the literature. This paper presents a case of delayed-onset neuropathic pain after septoplasty in a previously pain-free asthmatic patient that was successfully managed by administration of intranasal local anaesthesia. Physical examination and imaging excluded any other cause of neuralgia. A literature review revealed reports of chronic pain in patients following septoplasty if there were nasal contact or compression points or nasal tumours. Separately, acute postseptoplasty allodynia is documented in iatrogenic maxillary nerve damage. However, delayed-onset neuralgic pain, exacerbated by certain environmental triggers, has not been previously described. Facial pain can be debilitating; successfully managing this neuralgic pain with administration of intranasal local anaesthetic had a substantial effect on the patient’s quality of life.

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The Effect of Repeated Electroacupuncture Analgesia on Neurotrophic and Cytokine Factors in Neuropathic Pain Rats

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/8403064 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Junying Wang ◽

Yonghui Gao ◽

Shuping Chen ◽

Chenlin Duanmu ◽

Jianliang Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Neurotrophic Factors ◽

Quantitative Real Time Pcr ◽

Chronic Neuropathic Pain ◽

Elevated Expression ◽

Chronic Constrictive Injury ◽

The Relationship

Chronic pain is a common disability influencing quality of life. Results of previous studies showed that acupuncture has a cumulative analgesic effect, but the relationship with spinal cytokines neurotrophic factors released by astrocytes remains unknown. The present study was designed to observe the effect of electroacupuncture (EA) treatment on spinal cytokines neurotrophic factors in chronic neuropathic pain rats. The chronic neuropathic pain was established by chronic constrictive injury (CCI). EA treatment was applied at Zusanli (ST36) and Yanglingquan (GB34) (both bilateral) once a day, for 30 min. IL-1βmRNA, TNF-αmRNA, and IL-1 mRNA were detected by quantitative real-time PCR, and the proteins of BDNF, NGF, and NT3/4 were detected by Western blot. The expression levels of cytokines such as IL-1βmRNA, TNF-αmRNA, IL-6 mRNA, and neurotrophic factors such as BDNF, NGF, and NT3/4 in the spinal cord were increased significantly after CCI. The astrocytes released more IL-1βand BDNF after CCI. Repeated EA treatment could suppress the elevated expression of IL-1βmRNA, TNFαmRNA, and BDNF, NGF, and NT3/4 but had no effect on IL-6 mRNA. It is suggested that cytokines and neurotrophic factors which may be closely associated with astrocytes participated in the process of EA relieving chronic pain.

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Neuropathic pain in rheumatoid arthritis

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2020-5-60-65 ◽

2020 ◽

Vol 12 (5) ◽

pp. 60-65

Author(s):

E. S. Filatova ◽

A. M. Lila ◽

V. A. Parfenov

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Chronic Pain ◽

Nervous System ◽

Neuropathic Pain ◽

Pain Syndrome ◽

Chronic Pain Syndrome ◽

Paindetect Questionnaire ◽

Somatosensory Nervous System

Objective: to identify the signs of neuropathic pain (NP) in patients with rheumatoid arthritis (RA) on the basis of the PainDETECT questionnaire and neurological examination.Patients and methods. A total of 208 RA patients (39 men and 169 women; mean age, 47.7 years) with chronic pain syndrome were examined. The patients underwent rheumatological and neurological examinations; NP was diagnosed using the PainDETECT questionnaire; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.Results and discussion. 172 (82.7%) patients had moderate and high disease activity according to the DAS28. The signs of possible and highly probable NP according to the PainDETECT questionnaire were detected in 29.8 and 26.9% of patients, respectively; they were significantly more likely to be detected in patients with more severe pain syndrome, clinically significant anxiety, and worse quality of life, but were unassociated with RA activity according to the DAS28. Somatosensory nervous system injury (polyneuropathy, tunnel syndromes, and cervical myelopathy) was found in 77.6% of patients with possible NP and in 80.4% with highly probable NP. In other patients, NP might be caused by central sensitization. Conclusion. In patients with a RA exacerbation, chronic pain syndrome is caused not only by an active inflammatory process in the joint area and adjacent tissues, but also by somatosensory nervous system injury and central sensitization.

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