Articles: hyperalgesia.
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Journal of pain research · Jan 2015
ReviewBuprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain.
Despite proven clinical utility, buprenorphine has not been used widely for the treatment of chronic pain. Questions about "ceiling effect" or bell-shaped curve observed for analgesia in preclinical studies and potential withdrawal issues on combining with marketed μ-agonists continue to hinder progress in expanding full potential of buprenorphine in the treatment of cancer and noncancer pain. Mounting evidence from clinical studies and conclusions drawn by a panel of experts strongly support superior safety and efficacy profile of buprenorphine vs marketed opioids. ⋯ The receptor pharmacology and pharmacokinetics profile of buprenorphine is complex but unique and contributes to its distinct safety and efficacy. The buprenorphine pharmacology also allows it to be combined with other μ-receptor opioids for additivity in efficacy. Transdermal delivery products of buprenorphine have been preferred choices for the management of pain but new delivery options are under investigation for the treatment of both opioid dependence and chronic pain.
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Evid Based Compl Alt · Jan 2015
Dezocine Prevents Postoperative Hyperalgesia in Patients Undergoing Open Abdominal Surgery.
Objective. Postoperative hyperalgesia is very frequent and hard to treat. Dezocine is widely used and has a modulatory effect for thermal hyperalgesia in animal models. ⋯ Rescue analgesic use, cumulative PCIA consumption, and pain scores were statistically significantly decreased in the true treatment group compared to the sham treatment group. Conclusions. Dezocine offers a significant antihyperalgesic and analgesic effect in patients undergoing elective open gastrectomy for up to 48 hours postoperatively.
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The activation of alpha-7 nicotinic acetylcholine receptors (α7-nAchRs) are currently being considered as novel therapeutic approaches for managing hyperalgesia in inflammation and chronic neuropathic pain, but the role of a7-nAChRs on opioids induced hyperalgesia remain unknown. The present study investigated the effects of α7-nAChRs selective agonists PHA-543613 and type II positive allosteric modulators (PAMs) PNU-120596 in remifentanil induced postoperative hyperalgesia. As the results shown, intrathecal treatment with both α7-nAChRs agonists and type II PAMs could attenuate remifentanil induced hyperalgesia by increasing paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL). ⋯ Our data indicated that activation of α7-nAchRs decreased the proinflammatory cytokines (TNF-α, IL-6) and p-NR2B protein level in the spinal cord. The depression of the increased levels of proinflammatory cytokines and p-NR2B after remifentanil treatment may contribute to the anti-hyperalgesia effects of PHA-543613and PNU-120596 via α7-nAChRs. Therefore, our findings demonstrated that α7-nAChRs may be potential candidates for treating opioids induced hyperalgesia.
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J Pain Palliat Care Pharmacother · Jan 2015
Case ReportsOpioid-Induced Hyperalgesia: A Diagnostic Dilemma.
Opioids are utilized frequently for the treatment of moderate to severe acute pain in the perioperative setting, as well as in the treatment of cancer-related pain. When prescribing chronic opioid therapy to patients with chronic pain, it is crucial for the practitioner to be aware not only of the issues of tolerance and withdrawal, but also to have knowledge of the possibility for opioid-induced hyperalgesia (OIH). ⋯ In this case, high-dose opioid therapy did not improve chronic pain and contributed to a hyperalgesic state in which a young man experienced severe intractable pain postoperatively after two routine thoracotomies, despite aggressive pharmacologic measures to manage his perioperative pain. Furthermore, it illustrates the potential advantages of opioid rotation to methadone when OIH is suspected.
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J Pain Palliat Care Pharmacother · Jan 2015
Case ReportsFentanyl-Induced Neurotoxicity in Children.
Fentanyl-induced neurotoxicity is an uncommon adverse effect of fentanyl and is seldom seen in pediatric palliative care practice. It presents as myriad of nonspecific symptoms such as severe pain, allodynia, insomnia, agitation, hallucinations, behavioral changes, and headache. ⋯ This is a case report of an 11-year-old girl; a case of locally advanced neuroblastoma, progressed on disease-modifying treatment, and referred to pediatric palliative care for best supportive care. She developed features of fentanyl-induced neurotoxicity during upward titration of transdermal fentanyl that was promptly identified and managed in a pediatric palliative care setting.