Retrospectieve praktijkanalyse van tapentadol met vertraagde afgifte bij patiënten met chronische pijn refractair aan sterke opioïden

2021 ◽  
Author(s):  
L. Brullot ◽  
G. Hans ◽  
P.J. Germonpré ◽  
D. Mesotten ◽  
T. Vanneste ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Daily Practice ◽  
Prolonged Release ◽  
Refractory Pain ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Secondary Endpoints ◽  
Strong Opioids ◽  
Numeric Scale

Retrospective practice analysis of tapentadol prolonged release in patients with chronic pain refractory to strong opioids Tapentadol is a strong opioid with mixed antinociceptive analgesia and inhibition of the descending pain pathway, tested for the management of different types of chronic refractory pain. In daily practice, tapentadol prolonged release (tapentadol PR) is reserved for patients who already received strong opioids with unsatisfactory pain control or severe side effects, or patients who experienced opioid-induced hyperalgesia. The data of patients treated with tapentadol PR in 3 pain centers in Flanders (Belgium) were analyzed. The primary endpoint was the number of patients who continued the tapentadol PR treatment 6 weeks after it started. The secondary endpoints were pain reduction, global perceived effect (GPE) and side effects. Six weeks after the start of the treatment, 83% of the patients continued the therapy. The median reduction in pain score was 2 points on a numeric scale from 0-10. The GPE showed an improvement of 25% to 30% in 52% of the patients. The mean duration of the tapentadol PR treatment was 6.5 months. Only 24% of the patients stopped the treatment because of side effects and 34% due to an unsatisfactory result. Tapentadol PR is a possible addition in the therapeutic arsenal for the treatment of patients with severe chronic pain.

scholarly journals Opioid Induced Hyperalgesia, a Research Phenomenon or a Clinical Reality? Results of a Canadian Survey

2020 ◽  
Vol 10 (2) ◽  
pp. 27
Author(s):  
Grisell Vargas-Schaffer ◽  
Suzie Paquet ◽  
Andrée Neron ◽  
Jennifer Cogan
Keyword(s):  
Chronic Pain ◽  
Nmda Antagonist ◽  
Treatment Modalities ◽  
Clinical Test ◽  
Physician Practice ◽  
Clinical Tests ◽  
Opioid Rotation ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Age Range

Background: Very little is known regarding the prevalence of opioid induced hyperalgesia (OIH) in day to day medical practice. The aim of this study was to evaluate the physician’s perception of the prevalence of OIH within their practice, and to assess the level of physician’s knowledge with respect to the identification and treatment of this problem. Methods: An electronic questionnaire was distributed to physicians who work in anesthesiology, chronic pain, and/or palliative care in Canada. Results: Of the 462 responses received, most were from male (69%) anesthesiologists (89.6%), in the age range of 36 to 64 years old (79.8%). In this study, the suspected prevalence of OIH using the average number of patients treated per year with opioids was 0.002% per patient per physician practice year for acute pain, and 0.01% per patient per physician practice year for chronic pain. Most physicians (70.2%) did not use clinical tests to help make a diagnosis of OIH. The treatment modalities most frequently used were the addition of an NMDA antagonist, combined with lowering the opioid doses and using opioid rotation. Conclusions: The perceived prevalence of OIH in clinical practice is a relatively rare phenomenon. Furthermore, more than half of physicians did not use a clinical test to confirm the diagnosis of OIH. The two main treatment modalities used were NMDA antagonists and opioid rotation. The criteria for the diagnosis of OIH still need to be accurately defined.

Arzneimittelinteraktionen, die man kennen muss!

2019 ◽  
Vol 144 (04) ◽  
pp. 264-275
Author(s):  
Niels Voigt ◽  
Katharina Ort ◽  
Samuel Sossalla
Keyword(s):  
Cytochrome P450 ◽  
Plasma Concentration ◽  
Side Effects ◽  
Daily Practice ◽  
Modern Medicine ◽  
Ageing Society ◽  
Mortality And Morbidity ◽  
Exponential Increase ◽  
Number Of Patients ◽  
Multiple Drugs

AbstractDrug-drug interactions (DDI) represent a significant problem in modern medicine. The number of patients with multi-morbidity, who take multiple drugs, is constantly increasing (polypharmacy). The related exponential increase in potential DDI is almost incomprehensible. In this article, we review pharmacodynamic DDI and provide clinically relevant examples. In addition, we extensively review pharmakokinetic DDI (e. g. through the cytochrome P450-system or p-glycoproteins) that can modify the plasma concentration of many compounds, thereby also increasing the likelihood of unwanted side effects. Finally we provide tools, which may help clinicians in their daily practice to identify and avoid potential DDI. In the context of an ageing society receiving polypharmacy, a better awareness of DDI and of strategies to prevent them is expected to reduce mortality and morbidity.

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.

Opioid induced hyperalgesia: A focus on opioid use in chronic pain

2013 ◽  
Vol 2 (12) ◽  
pp. 395-397
Author(s):  
Julie L. Cunningham
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Treatment Option ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Patients ◽  
Established Treatment

Opioids are a well-established treatment option for chronic pain. However, opioid therapy is associated with many side effects, including opioid induced hyperalgesia (OIH). This article reviews studies which have evaluated OIH in chronic pain patients on opioids.

RESEARCH EPIDURAL ANALGESIA TO PAIN RELIEF ON LABOR PROGRESS

2012 ◽  
pp. 31-41
Author(s):  
Quang Thuy Phung ◽  
Ngoc Thanh Cao ◽  
Quang Vinh Truong
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Pain Relief ◽  
Epidural Anesthesia ◽  
Good Condition ◽  
Cervical Dilation ◽  
Normal Birth ◽  
Normal Limits ◽  
Constant Pain ◽  
Background Pain

Background: Pain during labor as pain in the fracture is not treated, chronic pain, so pain is very essential issues to be studied. Epidural anesthesia (NMC) has many advantages over spinal anesthesia in constant pain. Study objectives: 1. Assessing the effects analgesia by epidural anesthesia during labor. 2. Assessing progress and final results of labor for pregnant women and fetuses. Materials and Methods: The study described 37 pregnant from 38 to less than 42 weeks had a positive phase of labor to pain relief by continuous epidural anesthesia method, with cervical dilation between 3 cm and 4 cm. Results: Women feel very satisfied (67.5%) on methods of natural pain relief during labor. Most women deliver normally (73%). Evolution of the cervix takes place smoothly. Duration of labor within the normal birth. Breast sucking good condition accounted for 86.5% rate, the reflecting normal 94.6%. Conclusions: This is the effective method of pain relief during labor birth. Duration of labor in normal limits. Side effects occur less and can be well controlled. Keywords: epidural anesthesia; relief pain on labor.

Mesenchymal Stem Cells and their Exosomes: Promising Therapeutics for Chronic Pain

2019 ◽  
Vol 14 (8) ◽  
pp. 644-653 ◽  
Author(s):  
Jinxuan Ren ◽  
Na Liu ◽  
Na Sun ◽  
Kehan Zhang ◽  
Lina Yu
Keyword(s):  
Stem Cells ◽  
Chronic Pain ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Side Effects ◽  
Human Life ◽  
Analgesic Effects ◽  
Pain Models ◽  
Inflammatory Drugs ◽  
Anxiety Depression

Chronic pain is a common condition that seriously affects the quality of human life with variable etiology and complicated symptoms; people who suffer from chronic pain may experience anxiety, depression, insomnia, and other harmful emotions. Currently, chronic pain treatments are nonsteroidal anti-inflammatory drugs and opioids; these drugs are demonstrated to be insufficient and cause severe side effects. Therefore, research into new therapeutic strategies for chronic pain is a top priority. In recent years, stem cell transplantation has been demonstrated to be a potent alternative for the treatment of chronic pain. Mesenchymal stem cells (MSCs), a type of pluripotent stem cell, exhibit multi-directional differentiation, promotion of stem cell implantation, and immune regulation; they have also been shown to exert analgesic effects in several chronic pain models. Exosomes produced by MSCs have been demonstrated to relieve painful symptoms with fewer side effects. In this review, we summarize the therapeutic use of MSCs in various chronic pain studies. We also discuss ways to enhance the treatment effect of MSCs. We predict in the future, cell-free therapies for chronic pain will develop from exosomes secreted by MSCs.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

scholarly journals Buprenorphine: Far Beyond the “Ceiling”

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 816
Author(s):  
Rosmara Infantino ◽  
Consalvo Mattia ◽  
Pamela Locarini ◽  
Antonio Luigi Pastore ◽  
Sabatino Maione ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Drug Abuse ◽  
Side Effects ◽  
National Health System ◽  
Analgesic Drugs ◽  
Third Line ◽  
Dynamic Profile

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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