Articles: chronic-pain
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Buprenorphine is an effective treatment for chronic pain and may reduce opioid-induced hyperalgesia. However, its pharmacological properties make its induction challenging, time-consuming, and can precipitate opioid withdrawal. We present the case of a 66-year-old woman with inadequately controlled postoperative pain despite escalating doses of oxycodone and methadone, who was successfully transitioned to buprenorphine/naloxone using a rapid microinduction technique without precipitating opioid withdrawal. Rapid induction provides an alternative method for transitioning patients from other opioids to buprenorphine/naloxone and facilitates transition of patients with chronic pain to buprenorphine therapy within a shorter window compared to currently existing protocols.
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An expert panel convened to reach a consensus on common misconceptions surrounding buprenorphine, a Schedule III partial µ-opioid receptor agonist indicated for chronic pain. The panel also provided clinical recommendations on the appropriate use of buprenorphine and conversion strategies for switching to buprenorphine from a full µ-opioid receptor agonist for chronic pain management. ⋯ These recommendations provide a framework for clinicians to address most clinical scenarios regarding buprenorphine use. The overall consensus of the panel was that buprenorphine is a unique Schedule III opioid with favorable pharmacologic properties and a safety profile that may be desirable for chronic pain management.
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Racial and ethnic disparities in pain management are widely documented in the United States. The 2016 Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing have generated new imperatives for using complementary and alternative medicine approaches (CAM) to manage chronic pain, including cancer pain. This review's purpose was to explore the prevalence of CAM use for cancer-related pain among racial and ethnic minorities and to organize these findings according to the CAM modalities proposed by the National Center for Complementary and Integrative Health (NCCIH). ⋯ Overall, CAM use for any modality ranged from 51% to 83%. Mind-body therapies were reported most, and energy therapies the least. Differences in CAM use were most often attributable to socioeconomic status (SES), with those of higher SES associated with greater use of practitioner-assisted CAM therapies and those of lower SES with greater use of free therapies. This difference has implications for achieving adequate and consistent pain relief among subgroups of patients with cancer. This review also identifies a literature gap regarding racial/ethnic disparities in access to CAM for cancer pain, and a need for validated measures to assess CAM use.
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Alleviating chronic pain is challenging, due to lack of drugs that effectively inhibit nociceptors without off target effects on motor or central neurons. Dorsal root ganglia (DRG) contain nociceptive and non-nociceptive neurons. Drug screening on cultured DRG neurons, rather than cell lines, allows the identification of drugs most potent on nociceptors with no effects on non-nociceptors (as a proxy for unwanted side effects on CNS and motor neurons). ⋯ We confirmed the link between the oscillatory profile and nociceptors; and the slow-decay profile and non-nociceptors using three transgenic mouse lines of known pain phenotypes. We used the assay to show that blockers for Nav1.7 and Nav1.8 channels, which are validated targets for analgesics, affect non-nociceptors at concentrations needed to effectively inhibit nociceptors. However, a combination of low doses of both blockers had an additive effect on nociceptors without a significant effect on non-nociceptors, indicating that the assay can also be used to screen for combinations of existing or novel drugs for the greatest selective inhibition of nociceptors.