Epidural haloperidol enhances epidural morphine analgesia: Three case reports

Epidural opioids provide significant postoperative analgesia; however, their use is often limited by side effects such as nausea and pruritus, or they require the addition of epidural local anesthetics with possible side effects of motor block and hypotension. Adjuncts to epidural opioid analgesia would benefit pain management. There is evidence that epidural butyrophenones may enhance opioid analgesics and reduce side effects. The authors present the first reported use of epidural haloperidol to enhance epidural morphine analgesia in three individuals. Pharmacodynamic interactions of haloperidol, which may explain its analgesic efficacy, are summarized.

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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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The role of oxycodone/naloxone in pain management

Ból ◽

10.5604/01.3001.0009.7381 ◽

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.

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(271) Epidural haloperidol enhances epidural morphine analgesia: Three case reports

Journal of Pain ◽

10.1016/j.jpain.2008.01.192 ◽

2008 ◽

Vol 9 (4) ◽

pp. 43

Author(s):

G. Colclough ◽

T. McLarney ◽

P. Sloan

Keyword(s):

Epidural Morphine ◽

Case Reports ◽

Morphine Analgesia

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COMPLAINTS OF SIDE EFFECTS FROM POSTCESAREAN EPIDURAL OPIOID ANALGESIA

Anesthesiology ◽

10.1097/00000542-199209001-00859 ◽

1992 ◽

Vol 77 (Supplement) ◽

pp. A859

Author(s):

Paul Youngstrom ◽

David Boyd AA ◽

Frances Rhoton

Keyword(s):

Side Effects ◽

Opioid Analgesia ◽

Epidural Opioid

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Opioid Drug-Drug Interactions: A Review

Journal of Pharmacy Practice ◽

10.1177/089719009801100504 ◽

1998 ◽

Vol 11 (5) ◽

pp. 325-341 ◽

Cited By ~ 3

Author(s):

Heidi L. Liston ◽

John S. Markowitz

Keyword(s):

Drug Interactions ◽

Selective Serotonin Reuptake Inhibitors ◽

Case Reports ◽

Analgesic Efficacy ◽

Opioid Analgesics ◽

Toxic Metabolite ◽

Metabolite Formation ◽

Pharmacokinetic Interactions ◽

Cyp 2D6 ◽

Enzyme Inducers

Opioid analgesics are among the most commonly prescribed medications. Frequently, they are combined with other therapeutic agents and pharmacodynamic or pharmacokinetic interactions may ensue. This review summarizes published case reports and studies of potential opioid drug interactions. A MED-LINE computer literature search (1966-1998) was undertaken to retrieve all pertinent case reports and studies of opioid drug interactions published in the English language. The results of the search indicate that numerous compounds from various therapeutic classes may participate in clinically significant pharmacodynamic and pharmacokinetic drug-drug interactions. Pharmacodynamic interactions usually involved additive central nervous system depression. Additionally, propoxyphene and tramadol can potentiate a hyperserotonergic state when coadministered with the SSRIs and MAOIs. Pharmacokinetic interactions typically involved inhibition or induction by specific hepatic cytochrome P-450 isoenzymes. Agents with enzyme inhibiting ability such as erythromycin, cimetidine, and selective serotonin reuptake inhibitors have been shown to potentiate the effects of certain opioid analgesics while codeine, which requires metabolic conversion via CYP 2D6 for pharmacological effectiveness, has reduced analgesic efficacy in the presence of inhibitors. The enzyme inducers rifampin and several anticonvulsants have been involved in the emergence of methadone withdrawal when added to existing methadone treatment. Additionally, enzyme inducers can increase the formation of the toxic metabolite of meperidine. Genetic polymorphism also potentially impacts the effectiveness of agents such as codeine since reduced active metabolite formation and analgesic efficacy has been demonstrated in individuals who lack CYP 2D6 activity.

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Sending out Biased Signals: an Appropriate Proposition for Pain?

Douleur et Analgésie ◽

10.3166/dea-2019-0065 ◽

2019 ◽

Vol 32 (2) ◽

pp. 108-110 ◽

Cited By ~ 1

Author(s):

E. Besserer-Offroy ◽

P. Sarret

Keyword(s):

Side Effects ◽

Acute Pain ◽

Gold Standard ◽

Pain Treatment ◽

Opioid Analgesics ◽

Mu Opioid Receptor ◽

Clinical Development ◽

Mu Opioid ◽

Development Stages ◽

The Past

In the past few years, several biased ligands acting at the mu-opioid receptor were reported in the literature. These agonists are aimed at reducing pain while having fewer side effects than morphine, the gold standard of opioid analgesics. In this mini-review, we describe and discuss the recent advances in mu-biased ligands actually in preclinical and clinical development stages, including the latest U.S. Food and Drug Administration review of oliceridine, a biased mu-agonist for moderate to severe acute pain treatment developed by the company Trevena.

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