Sucrose and sweet taste

Abundant published evidence demonstrates the pain-reducing effects of sweet solutions in human infants and animals. Analgesic effects persist up to around 1 year of age in human infants, though there is less research to support analgesic effects in older infants and, for the existing research, effects are more moderate than seen in the neonatal period. Though the exact mechanisms are unclear, analgesic effects are believed to be due to the relationship between sweet taste and the endogenous opiate system. Based on the extensive evidence to support sweet solutions, their use can be recommended prior to commonly performed short-lasting minor painful procedures in newborn and young infants. Despite extensive research, knowledge gaps and controversies remain relating to the mechanisms of analgesia; the effectiveness and safety of sweet solutions when given over prolonged periods to preterm and sick infants; the effectiveness in sick infants receiving concomitant analgesics; and the effectiveness in children older than 12 months of age.

The possibilities of using xenon therapy in patients with severe cancer pain

In accordance with the clinical recommendations of the World Health Organization and the Ministry of Health of the Russian Federation, the main analgesics for the treatment of chronic cancer pain are non-opioid and opioid analgesics, given stepwise in combination with co-analgesics and adjuvant drugs. As a rule, this stepwise scheme of painkilling is effective in most cases. However, 20-30% of patients cannot achieve an acceptable level of pain relief despite the use of these analgesics in combination. Is there another way to help such patients? Interventional methods of analgesia are an option, yet not all patients agree to invasive methods due to the possible side effects and unavailability of these methods. In these cases other mechanisms of analgesia are required, such as NMDA receptor antagonists, which reduce opioid tolerance and hyperalgesia. Still not all the drugs of this group can be applied in our practice. Analgesic properties of nitrous oxide can only be found in high anesthetic doses. Another option is metadon, but it is forbidden and cannot be used in our country. Still one more option is ketamine, which has severe side effects. In our clinical practice we decided to use xenon, which has NMDA inhibition effects. Its analgesic effect and safety have been confirmed in numerous studies. This publication aims to demonstrate a successful clinical case when we used xenon and oxygen inhalations course for the treatment of a severe cancer pain with a patient who had been taking morphine by mouth.

Central Nervous System Targets: Supraspinal Mechanisms of Analgesia

While the acute sensation of pain is protective, signaling the presence of actual or potential bodily harm, its persistence is unpleasant. When pain becomes chronic, it has limited evolutionarily advantage. Despite the differing nature of acute and chronic pain, a common theme is that sufferers seek pain relief. The possibility to medicate pain types as varied as a toothache or postsurgical pain reflects the diverse range of mechanism(s) by which pain-relieving “analgesic” therapies may reduce, eliminate, or prevent pain. Systemic application of an analgesic able to cross the blood–brain barrier can result in pain modulation via interaction with targets at different sites in the central nervous system. A so-called supraspinal mechanism of action indicates manipulation of a brain-defined circuitry. Pre-clinical studies demonstrate that, according to the brain circuitry targeted, varying therapeutic pain-relieving effects may be observed that relate to an impact on, for example, sensory and/or affective qualities of pain. In many cases, this translates to the clinic. Regardless of the brain circuitry manipulated, modulation of brain processing often directly impacts multiple aspects of nociceptive transmission, including spinal neuronal signaling. Consideration of supraspinal mechanisms of analgesia and ensuing pain relief must take into account nonbrain-mediated effects; therefore, in this review, the supraspinally mediated analgesic actions of opioidergic, anti-convulsant, and anti-depressant drugs are discussed. The persistence of poor treatment outcomes and/or side effect profiles of currently used analgesics highlight the need for the development of novel therapeutics or more precise use of available agents. Fully uncovering the complex biology of nociception, as well as currently used analgesic mechanism(s) and site(s) of action, will expedite this process.