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Burns JW, Gerhart J, Smith DA, Porter L, Rye B, Keefe F. Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain. Pain 2024; 165:1559-1568. [PMID: 38334493 DOI: 10.1097/j.pain.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/04/2023] [Indexed: 02/10/2024]
Abstract
ABSTRACT People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
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Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - David A Smith
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Laura Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Bonny Rye
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Rivera-Espinosa L, Vicencio-Rosas E, Flores-Pérez C, Flores-Pérez J, Lares-Asseff I, Gándara Mireles JA, Solorio-López E, Chávez-Pacheco JL. Influence of Age, Gender and Body Mass Index on Intravenous Pharmacokinetics of Buprenorphine in Children Undergoing Orthopedic Surgery. Dose Response 2024; 22:15593258241266469. [PMID: 39132282 PMCID: PMC11311171 DOI: 10.1177/15593258241266469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/14/2024] [Indexed: 08/13/2024] Open
Abstract
Background Buprenorphine (BPN) is a widely used analgesic in the pediatric population, although there are few studies on the pharmacokinetics and pharmacodynamics of this drug. Objective The objective was to characterize the pharmacokinetics of BPN after intravenous administration and analyze the effect of age, gender, weight, height, body mass index (BMI), and drug-drug interactions as covariates. Methods Ninety-nine children (2-10 years), who underwent orthopedic surgery under regional, general, or combined anesthesia were included. Patients evaluated according to the American Society of Anesthesiologists Physical Status Classification, who received intravenous BPN 2 μg/kg were enrolled. Blood was collected from 1-240 min. Drug plasma concentrations were determined by LC-MS/MS. Population pharmacokinetic parameters were obtained with Monolix 2021R1 software. Pearson's correlation and/or ANOVA were used for statistical analysis. Results Age was associated with changes in clearance and central compartment volume and the female gender was associated with lower intercompartmental clearance, while BMI modified clearance, central and peripheral compartment volume. Concomitant administration of BPN with fentanyl and dexamethasone produced decreases in clearance. Conclusions The covariates of sex, age, and BMI are directly related to the increase or decrease in BPN pharmacokinetic parameters.
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Affiliation(s)
- Liliana Rivera-Espinosa
- Laboratorio de Farmacología, Instituto Nacional de Pediatría (INP), CP 04530, Ciudad de México, México
| | - Eréndira Vicencio-Rosas
- Coordinación Nacional Programa Institucional de Atención Paliativa (PALIATIVISSSTE), Dirección Médica, ISSSTE, Mexico City, Mexico
| | - Carmen Flores-Pérez
- Laboratorio de Farmacología, Instituto Nacional de Pediatría (INP), CP 04530, Ciudad de México, México
| | - Janett Flores-Pérez
- Laboratorio de Farmacología, Instituto Nacional de Pediatría (INP), CP 04530, Ciudad de México, México
| | | | | | - Edelmira Solorio-López
- Laboratorio de Farmacología, Instituto Nacional de Pediatría (INP), CP 04530, Ciudad de México, México
| | - Juan Luis Chávez-Pacheco
- Laboratorio de Farmacología, Instituto Nacional de Pediatría (INP), CP 04530, Ciudad de México, México
- Departamento de Biología Celular, Facultad de Ciencias UNAM, Ciudad de Mexico, México
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Sex and Age Influence on Association of CYP450 Polymorphism with Midazolam Levels in Critically Ill Children. Diagnostics (Basel) 2022; 12:diagnostics12112797. [PMID: 36428856 PMCID: PMC9689687 DOI: 10.3390/diagnostics12112797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Midazolam is a drug that is metabolized by cytochrome P450 (CYP450) enzymes, particularly CYP3A4 and CYP3A5. The present study aimed to determine the sex and age influence on association of CYP450 polymorphism with midazolam levels in critically ill children. Seventy-two DNA samples were genotyped by real-time PCR. Children ≤ five years of age who carry the rs776746 (T) allele in CYP3A5 gene were associated with lower plasma midazolam levels. The concentration median in patients was 0.0 ng/mL, while in patients with the normal (C) allele, it was 438.17 ng/mL (Q25 135.75-Q75 580.24), p = 0.005. The midazolam plasmatic concentration in female patients with the minor (T) allele was 0.0 ng/mL (Q250.00-Q75204.3), while in patients with the normal (C) allele median it was 459.0 ng/mL (Q25296.9-Q75789.7), p = 0.002. Analysis of the dominant model for the rs2740574 variant in CYP3A4 revealed a median of 0.38 L/kg (Q250.02-Q751.5) for the volume of distribution parameter in female patients with the normal T allele, while female patients with the minor C allele showed a median of 18.1 L/kg (Q257.5-Q7528.7) p = 0.02. Our results suggest an altered midazolam metabolism due to the presence the allelic rs2740574 variants of CYP3A4 and rs776746 of CYP3A5, and also the strong influence of age and sex.
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Li X, Li J, Zhang P, Deng H, Yang M, He H, Wang R. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided caudal block in anorectal surgery. A dose finding study. PLoS One 2021; 16:e0257283. [PMID: 34534232 PMCID: PMC8448308 DOI: 10.1371/journal.pone.0257283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background Caudal epidural block (CEB) provides reliable anesthesia for adults undergoing anorectal surgery. Despite the widely utilization, the minimum effective concentration for 90% patients (MEC90) of ropivacaine for CEB remains unknown. Objective To estimate MEC of ropivacaine for CEB in anorectal surgery. Design A prospective dose-finding study using biased coin design up-and-down sequential method. Setting Operating room and postoperative recovery area of Chengdu Shangjin Nanfu Hospital, from October 2019 to January 2020. Patients 50 males and 51 females scheduled for anorectal surgery. Interventions We conducted two independent biased coin design up-and down trials by genders. The concentration of ropivacaine administered to the first patient of male and female were 0.25% with fixed volume of 14ml for male and 12ml for female patients based on our previous study. In case of failure, the concentration was increased by 0.05% in the next subject. Otherwise, the next subject was randomized to a concentration 0.05% less with a probability of 0.11, or the same concentration with a probability of 0.89. Success was defined as complete sensory blockade of perineal area 15 min after the block evidenced by the presence of a lax anal sphincter and pain-free surgery. Main outcome measures The MEC of ropivacaine to achieve a successful CEB in 90%(MEC90) of the patients. Results The MEC90 of ropivacaine for CEB were estimated to be 0.35% (95% CI 0.29 to 0.4%) for male and 0.353% (95%CI 0.22 to 0.4%) for female. By extrapolation to MEC in 99% of subjects (MEC99) and pooled adjacent violators algorithm (PAVA) adjusted responses, it would be optimal to choose 0.4% ropivacaine with a volume of 14ml for male and 12ml for female. Conclusions A concentration of 0.35% ropivacaine with a volume of 14ml provided a successful CEB in 90% of the male patients, while 0.353% ropivacaine with a volume of 12ml provided a successful CEB in 90% of the female patients. A concentration of 0.4% and a volume of 14ml for male and 12 ml for female would be successful in 99% of the patients. Trial registration Chictr.org.cn identifier: No. ChiCTR 1900024315.
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Affiliation(s)
- Xuehan Li
- Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jun Li
- Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Pei Zhang
- Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huifei Deng
- Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Mingan Yang
- Division of Biostatistics & Epidemiology, School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - Hongbo He
- Benign Coloproctological Diseases Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Rurong Wang
- Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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Leino T, Viitamaa T, Salonen JS, Pesonen U, Haapalinna A. Effects of fadolmidine, an α 2 -adrenoceptor agonist, as an adjuvant to spinal bupivacaine on antinociception and motor function in rats and dogs. Pharmacol Res Perspect 2021; 9:e00830. [PMID: 34302721 PMCID: PMC8308519 DOI: 10.1002/prp2.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022] Open
Abstract
α2 -Adrenoceptor agonists such as clonidine and dexmedetomidine are used as adjuvants to local anesthetics in regional anesthesia. Fadolmidine is an α2 -adrenoceptor agonist developed especially as a spinal analgesic. The current studies investigate the effects of intrathecally administered fadolmidine with a local anesthetic, bupivacaine, on antinociception and motor block in conscious rats and dogs. The antinociceptive effects of intrathecal fadolmidine and bupivacaine alone or in combination were tested in the rat tail-flick and the dog's skin twitch models. The durations of motor block in rats and in dogs were also assessed. In addition, the effects on sedation, mean arterial blood pressure, heart rate, respiratory rate and body temperature were evaluated in telemetrized dogs. Concentrations of fadolmidine in plasma and spinal cord were determined after intrathecal and intravenous administration in rats. Co-administration of intrathecal fadolmidine with bupivacaine increased the magnitude and duration of the antinociceptive effects and prolonged motor block without hypotension. The interaction of the antinociceptive effect was synergistic in its nature in rats. Concentration of fadolmidine in plasma was very low after intrathecal dosing. Taken together, these studies show that fadolmidine as an adjuvant to intrathecal bupivacaine provides enhanced sensory-motor block and enables a reduction of the doses of both drugs. The results indicate that co-administration of fadolmidine with intrathecal bupivacaine was able to achieve an enhanced antinociceptive effect without hypotension and could thus represent a suitable combination for spinal anesthesia.
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Affiliation(s)
- Tiina Leino
- Orion Corporation Orion PharmaR&DTurkuFinland
| | | | | | - Ullamari Pesonen
- Integrative Physiology and Pharmacology Research UnitInstitute of BiomedicineFaculty of MedicineUniversity of TurkuTurkuFinland
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Thrul J, Rabinowitz JA, Reboussin BA, Maher BS, Ialongo NS. Adolescent cannabis and tobacco use are associated with opioid use in young adulthood-12-year longitudinal study in an urban cohort. Addiction 2021; 116:643-650. [PMID: 32692425 PMCID: PMC7855765 DOI: 10.1111/add.15183] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/08/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Cannabis, tobacco and alcohol use are prevalent among youth in the United States and may be risk factors for opioid use. The current study aimed at investigating associations between developmental trajectories of cannabis, tobacco and alcohol use in adolescence and opioid use in young adulthood in an urban cohort over the span of 12 years. DESIGN Cohort study of adolescents originally recruited for a randomized prevention trial with yearly assessments into young adulthood. SETTING Nine urban elementary schools in Baltimore, MD in the United States. PARTICIPANTS Participants (n = 583, 86.8% African American, 54.7% male) were originally recruited as first grade students. MEASUREMENTS Cannabis, tobacco and alcohol use were assessed annually from ages 14-18 years and opioid use from ages 19-26. Socio-demographics were assessed at age 6. Intervention status was also randomly assigned at age 6. Gender, race, free/reduced-priced lunch and intervention status were included as covariates in individual and sequential growth models. FINDINGS There were significant positive associations between the cannabis use intercept at age 14 and the opioid use intercept at age 19 (beta = 1.43; P = 0.028), the tobacco use intercept at age 14 and the opioid use intercept at age 19 (beta = 0.82; P = 0.042). Specifically, more frequent use of cannabis or tobacco at age 14 was associated with more frequent use of opioids at age 19. CONCLUSIONS Cannabis and tobacco use in early adolescence may be risk factors for opioid use in young adulthood among African Americans living in urban areas.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill A. Rabinowitz
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC,, USA
| | - Brion S. Maher
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Ialongo
- Department of Mental Heath, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cascella M, Bimonte S, Di Napoli R. Delayed Emergence from Anesthesia: What We Know and How We Act. Local Reg Anesth 2020; 13:195-206. [PMID: 33177867 PMCID: PMC7652217 DOI: 10.2147/lra.s230728] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
The emergence from anesthesia is the stage of general anesthesia featuring the patient’s progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the “active awakening” are reported.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale, Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale, Naples, Italy
| | - Raffaela Di Napoli
- Department of Anesthesiology, Institut Jules Bordet, Université Libre De Bruxelles, Bruxelles 1000, Belgium
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Street AD, Elia JM, McBroom MM, Hamilton AJ, Grundt JE, Blackwell JMN, Romito BT. The impact of implementation of a hysterectomy enhanced recovery pathway on anesthetic medication costs. J Comp Eff Res 2020; 9:1067-1077. [PMID: 33052053 DOI: 10.2217/cer-2020-0142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: To evaluate the effect of implementation of a hysterectomy Enhanced Recovery After Surgery (ERAS) protocol on perioperative anesthetic medication costs. Patients & methods: Historical cohort study of 84 adult patients who underwent a hysterectomy. Forty-two patients who underwent surgery before protocol implementation comprised the pre-ERAS group. Forty-two patients who underwent surgery after protocol implementation comprised the post-ERAS group. Data on anesthetic medication costs and outcomes were analyzed. Results: Compared with the pre-ERAS group, the post-ERAS group's total medication cost was significantly lower (median: 325.20 USD; interquartile range [IQR]: 256.12-430.65 USD vs median: 273.10 USD; IQR: 220.63-370.59 USD, median difference: -40.76, 95% CI: -130.39, 16.99, p = 0.047). Length of stay was significantly longer in pre-ERAS when compared with post-ERAS groups (median: 5.0 days; IQR: 4.0-7.0 days vs median: 3.0 days; IQR: 3.0-4.0 days, median difference: -2.0 days, 95% CI: -2.5581, -1.4419, p < 0.0001). Conclusion: ERAS protocols may reduce perioperative medication costs.
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Affiliation(s)
- Austin D Street
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jennifer M Elia
- Department of Anesthesiology & Perioperative Care, University of California - Irvine, 333 City Boulevard W #2150, Orange, CA 92868, USA
| | - Mandy M McBroom
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Allan J Hamilton
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jessica E Grundt
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James-Michael N Blackwell
- Department of Population & Data Sciences, Division of Behavioral & Communication Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9066, USA
| | - Bryan T Romito
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Choong ALC, Shadbolt C, Dowsey MM, Choong PFM. Sex-based differences in the outcomes of total hip and knee arthroplasty: a narrative review. ANZ J Surg 2020; 91:553-557. [PMID: 32954641 DOI: 10.1111/ans.16299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, which aims to alleviate pain and improve function and mobility. Despite the remarkable success of TJA, complications can arise, leading to unplanned hospital readmission, implant failure, morbidity and mortality. Recently, there has been a growing interest in analysing sex-based differences in diseases and response to medical interventions. This review summaries evidence pertaining to the widening gap between men and women regarding the utilization and outcome of TJA surgery. Interactions between sex and patient-reported outcome, implant failure and medical complication are complex and often demonstrate conflicting results. Significantly, there is a global consensus that men are at a higher risk of developing prosthetic joint infection following joint arthroplasty. Guided by the literature, there is a clear need for standardized methods of collecting, analysing and reporting sex-specific data to improve outcomes for both men and women who undergo TJA.
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Affiliation(s)
- Annabelle L C Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Caterino M, Ruoppolo M, Villani GRD, Marchese E, Costanzo M, Sotgiu G, Dore S, Franconi F, Campesi I. Influence of Sex on Urinary Organic Acids: A Cross-Sectional Study in Children. Int J Mol Sci 2020; 21:ijms21020582. [PMID: 31963255 PMCID: PMC7013514 DOI: 10.3390/ijms21020582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
The characterization of urinary metabolome, which provides a fingerprint for each individual, is an important step to reach personalized medicine. It is influenced by exogenous and endogenous factors; among them, we investigated sex influences on 72 organic acids measured through GC-MS analysis in the urine of 291 children (152 males; 139 females) aging 1–36 months and stratified in four groups of age. Among the 72 urinary metabolites, in all age groups, 4-hydroxy-butirate and homogentisate are found only in males, whereas 3-hydroxy-dodecanoate, methylcitrate, and phenylacetate are found only in females. Sex differences are still present after age stratification being more numerous during the first 6 months of life. The most relevant sex differences involve the mitochondria homeostasis. In females, citrate cycle, glyoxylate and dicarboxylate metabolism, alanine, aspartate, glutamate, and butanoate metabolism had the highest impact. In males, urinary organic acids were involved in phenylalanine metabolism, citrate cycle, alanine, aspartate and glutamate metabolism, butanoate metabolism, and glyoxylate and dicarboxylate metabolism. In addition, age specifically affected metabolic pathways, the phenylalanine metabolism pathway being affected by age only in males. Relevantly, the age-influenced ranking of metabolic pathways varied in the two sexes. In conclusion, sex deeply influences both quantitatively and qualitatively urinary organic acids levels, the effect of sex being age dependent. Importantly, the sex effects depend on the single organic acid; thus, in some cases the urinary organic acid reference values should be stratified according the sex and age.
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Affiliation(s)
- Marianna Caterino
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II’, 80131 Napoli, Italy; (M.C.); (G.R.D.V.); (M.C.)
- CEINGE—Biotecnologie Avanzate Scarl, 80145 Naples, Italy;
| | - Margherita Ruoppolo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II’, 80131 Napoli, Italy; (M.C.); (G.R.D.V.); (M.C.)
- CEINGE—Biotecnologie Avanzate Scarl, 80145 Naples, Italy;
- Correspondence: (M.R.); (I.C.); Tel.: +39-08-1373-7850 (M.R.); +39-0-7922-8518 (I.C.)
| | - Guglielmo Rosario Domenico Villani
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II’, 80131 Napoli, Italy; (M.C.); (G.R.D.V.); (M.C.)
- CEINGE—Biotecnologie Avanzate Scarl, 80145 Naples, Italy;
| | - Emanuela Marchese
- CEINGE—Biotecnologie Avanzate Scarl, 80145 Naples, Italy;
- Department of Mental and Physical Health, Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Michele Costanzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II’, 80131 Napoli, Italy; (M.C.); (G.R.D.V.); (M.C.)
- CEINGE—Biotecnologie Avanzate Scarl, 80145 Naples, Italy;
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (G.S.); (S.D.)
| | - Simone Dore
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (G.S.); (S.D.)
| | - Flavia Franconi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
| | - Ilaria Campesi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy;
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence: (M.R.); (I.C.); Tel.: +39-08-1373-7850 (M.R.); +39-0-7922-8518 (I.C.)
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Pisanu C, Franconi F, Gessa GL, Mameli S, Pisanu GM, Campesi I, Leggio L, Agabio R. Sex differences in the response to opioids for pain relief: A systematic review and meta-analysis. Pharmacol Res 2019; 148:104447. [DOI: 10.1016/j.phrs.2019.104447] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022]
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McGillion MH, Henry S, Busse JW, Ouellette C, Katz J, Choinière M, Lamy A, Whitlock R, Pettit S, Hare J, Gregus K, Brady K, Dvirnik N, Yang SS, Parlow J, Dumerton-Shore D, Gilron I, Buckley DN, Shanthanna H, Carroll SL, Coyte PC, Ebrahim S, Isaranuwatchai W, Guerriere DN, Hoch J, Khan J, MacDermid J, Martorella G, Victor JC, Watt-Watson J, Howard-Quijano K, Mahajan A, Chan MTV, Clarke H, Devereaux PJ. Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study. BMJ Open 2019; 9:e022995. [PMID: 30826789 PMCID: PMC6398732 DOI: 10.1136/bmjopen-2018-022995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. METHODS AND ANALYSES In this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score. ETHICS AND DISSEMINATION This protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals. TRIAL REGISTRATION NUMBER NCT01842568.
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Affiliation(s)
- Michael H McGillion
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shaunattonie Henry
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Carley Ouellette
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Manon Choinière
- Centre de recherche de Centre hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Andre Lamy
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shirley Pettit
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jacqueline Hare
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Krysten Gregus
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Katheryn Brady
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Nazari Dvirnik
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Su Yang
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Sandra L Carroll
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shanil Ebrahim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Denise N Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - James Khan
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Howard-Quijano
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Matthew T V Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hance Clarke
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - P J Devereaux
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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13
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Dussor G, Boyd JT, Akopian AN. Pituitary Hormones and Orofacial Pain. Front Integr Neurosci 2018; 12:42. [PMID: 30356882 PMCID: PMC6190856 DOI: 10.3389/fnint.2018.00042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/06/2018] [Indexed: 12/15/2022] Open
Abstract
Clinical and basic research on regulation of pituitary hormones, extra-pituitary release of these hormones, distribution of their receptors and cell signaling pathways recruited upon receptor binding suggests that pituitary hormones can regulate mechanisms of nociceptive transmission in multiple orofacial pain conditions. Moreover, many pituitary hormones either regulate glands that produce gonadal hormones (GnH) or are regulated by GnH. This implies that pituitary hormones may be involved in sex-dependent mechanisms of orofacial pain and could help explain why certain orofacial pain conditions are more prevalent in women than men. Overall, regulation of nociception by pituitary hormones is a relatively new and emerging area of pain research. The aims of this review article are to: (1) present an overview of clinical conditions leading to orofacial pain that are associated with alterations of serum pituitary hormone levels; (2) discuss proposed mechanisms of how pituitary hormones could regulate nociceptive transmission; and (3) outline how pituitary hormones could regulate nociception in a sex-specific fashion. Pituitary hormones are routinely used for hormonal replacement therapy, while both receptor antagonists and agonists are used to manage certain pathological conditions related to hormonal imbalance. Administration of these hormones may also have a place in the treatment of pain, including orofacial pain. Hence, understanding the involvement of pituitary hormones in orofacial pain, especially sex-dependent aspects of such pain, is essential to both optimize current therapies as well as provide novel and sex-specific pharmacology for a diversity of associated conditions.
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Affiliation(s)
- Gregory Dussor
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Jacob T Boyd
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Armen N Akopian
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,Department of Pharmcology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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14
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Fujita A, Hayamizu K, Yoshihara T, Zaitsu M, Shiraishi F, Arima H, Matsuo K, Shiokawa K, Setoguchi H, Sasaguri T. Effect of sex and polymorphisms of CYP2B6 and UGT1A9 on the difference between the target-controlled infusion predicted and measured plasma propofol concentration. JA Clin Rep 2018; 4:59. [PMID: 32025958 PMCID: PMC6966915 DOI: 10.1186/s40981-018-0196-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction To examine whether sex and polymorphisms of cytochrome P450 (CYP) 2B6 and UDP-glucuronosyltransferase (UGT) 1A9 affect the difference between predicted and measured plasma propofol concentration during continuous infusion by target-controlled infusion. Results Blood samples of 69 patients (48 men and 21 women) were obtained at 4 h after initial propofol infusion. Percentage performance error (PE) was calculated to assess the difference between measured and predicted propofol concentration. Regression coefficients (β) and 95% confidence intervals (CI) of sex and the polymorphisms of CYP2B6 and UGT1A9 for PE were, separately and mutually, estimated with linear regression. Covariates included age and body mass index in the minimal adjusted model, and additionally included clinical factors (mean blood pressure, heart rate, volume of intravenous fluid, surgical site, surgical position, and pneumoperitoneum) in the full adjusted model. PE was higher in men than in women (28.7% versus 10.5%, p = 0.015). Female sex was inversely associated with PE: the minimal adjusted β = − 8.84 (95% CI, − 16.26 to − 1.43); however, the fully adjusted β with clinical factors became not significant. The average of PE did not differ between polymorphisms of CYP2B6 and UGT1A9, and β of CYP2B6 516G>T polymorphisms mutually adjusted with female sex was not significant. Mean blood pressure, heart rate, and volume of intravenous fluid were independently associated with PE in the full adjusted model. Conclusions Under 4 h anesthesia with propofol target-controlled infusion in our population, sex differences appeared to exist in the propofol concentration, which might be largely mediated by clinical factors, such as hemodynamic status. Trial registration UMIN-CTR UMIN000009015, Registered 1 October 2012 Electronic supplementary material The online version of this article (10.1186/s40981-018-0196-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ai Fujita
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Anesthesiology, Chihaya Hospital, Chihaya 2-30-1, Higashi-ku, Fukuoka, Japan
| | - Kengo Hayamizu
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Anesthesiology and Critical Care Medicine, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuya Yoshihara
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. .,Clinical Research Center, Fukuoka Mirai Hospital, Kashiiteriha 3-5-1, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Masayoshi Zaitsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Fumie Shiraishi
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Nanakuma 8-19-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazumasa Matsuo
- Department of Anesthesiology, Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Yamamoto Memorial Hospital, Hachiyagarami 88-4, Niricho, Imari, Saga, 848-0031, Japan
| | - Kanako Shiokawa
- Department of Anesthesiology, Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hidekazu Setoguchi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Anesthesiology, Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Toshiyuki Sasaguri
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
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15
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McGregor AJ, Beauchamp GA, Wira CR, Perman SM, Safdar B. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review. West J Emerg Med 2017; 18:1079-1090. [PMID: 29085541 PMCID: PMC5654878 DOI: 10.5811/westjem.2017.8.34997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/16/2022] Open
Abstract
The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.
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Affiliation(s)
- Alyson J McGregor
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Division of Sex and Gender in Emergency Medicine, Providence, Rhode Island
| | - Gillian A Beauchamp
- Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon
| | - Charles R Wira
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Sarah M Perman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Basmah Safdar
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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16
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Blennerhassett MG, Lourenssen SR, Parlow LRG, Ghasemlou N, Winterborn AN. Analgesia and mouse strain influence neuromuscular plasticity in inflamed intestine. Neurogastroenterol Motil 2017; 29:1-12. [PMID: 28466581 DOI: 10.1111/nmo.13097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mouse models of inflammatory bowel disease (IBD) identify an impact on the enteric nervous system (ENS) but do not distinguish between Crohn's disease and ulcerative colitis phenotypes. In these models, analgesia is required, but its influence on different strains and disease outcomes is unknown. Therefore, changes to the ENS and intestinal smooth muscle were studied in trinitrobenzene sulfonic acid (TNBS) and dextran sodium sulfate (DSS) induced colitis to identify the effects of analgesia, and compared between two mouse strains. METHODS Colitis was induced in CD1 or BALB/c mice receiving analgesia with either buprenorphine or tramadol. Euthanasia was on Day 8 (DSS) or Day 4 (TNBS). Outcomes were Disease Activity Index and cytokine assay, and quantitative histology and immunocytochemistry were used to evaluate effects of inflammation on neurons and smooth muscle. KEY RESULTS In BALB/c mice, both models of colitis caused >2-fold increase in smooth muscle cell number. DSS caused axon proliferation without neuron loss while TNBS caused significant neuron loss and axonal damage. Buprenorphine (but not tramadol) was generally anti-inflammatory in both strains, but correlated with lethal outcomes to TNBS in BALB/c mice. CONCLUSIONS AND INFERENCES Smooth muscle growth is common to both models of colitis. In contrast, ENS damage in TNBS is correlated with the severe response of a Crohn's disease-like phenotype, while DSS correlates with a milder, ulcerative colitis-like outcome in the deeper tissues. Analgesia with tramadol over buprenorphine is supported for mouse studies of IBD.
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Affiliation(s)
- M G Blennerhassett
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - S R Lourenssen
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - L R G Parlow
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
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Effects of Nei-Guan (P6) Acupressure Wristband: On Nausea, Vomiting, and Retching in Women After Thyroidectomy. Cancer Nurs 2017; 39:61-6. [PMID: 25730589 DOI: 10.1097/ncc.0000000000000243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) after thyroidectomy is a common health problem in the recovery room. OBJECTIVE The aim of this study is to examine the effect of the Nei-Guan (P6) acupressure wristband for PONV among patients undergoing thyroidectomy. METHODS Sixty Korean female participants were assigned to 1 of 3 groups (n = 20 each). The control group received usual care without the wristband. The placebo group received usual nursing care plus a wristband at the non-P6 site. The treatment group received usual care plus a wristband at the P6 acupoint 30 minutes before anesthesia; the wristband was removed before leaving the recovery room. Data were collected at 3 periods: in the recovery room and at 6 and 24 hours after surgery. RESULTS The nausea scores of the treatment group were significantly lower than the scores of the placebo or control groups in the recovery room (F = 6.229, P = .044). There were no significant differences in vomiting or retching among the groups. CONCLUSIONS The P6 stimulation with wristband suppressed nausea right after thyroidectomy in the recovery room but did not suppress subsequent vomiting or retching. IMPLICATION FOR PRACTICE The findings indicate that P6 acupressure has the short-term effect of relieving nausea but not vomiting and retching. Use of P6 wristband holds promise and suggests the need for further testing in a larger randomized clinical trial. Identifying other acupoints is recommended to achieve successful management of PONV.
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18
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Wang H, Sherwood GD, Gong Z, Ren L, Liu H. Reliability and Validity of the Chinese Version of the Revised American Pain Society Patient Outcome Questionnaire in Postoperative Patients. Pain Manag Nurs 2017; 18:110-120. [PMID: 28259638 DOI: 10.1016/j.pmn.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
Abstract
The American Pain Society Patient Outcome Questionnaire and the subsequent revised version are the most frequently reported measures of the quality of pain management. However, the reliability and validity of the revised questionnaire have not been reported in Chinese patients. This study sought to evaluate the psychometric properties of the Chinese version of the revised questionnaire in postoperative patients in China. The study was a descriptive, cross-sectional psychometric study. The revised questionnaire was translated into Chinese according to international guidelines and then administered to participants. The patients' present, average, and worst pain intensity were evaluated in face-to-face interviews. The Pain Management Index was calculated according to the worst pain intensity and the classification of analgesic drugs used by the patients. The continuous items in the revised questionnaire demonstrated excellent construct validity and acceptable internal consistency reliability (0.732). Cronbach's alpha coefficients for the following subscales were acceptable: pain severity and sleep interference (0.773), activity interference (0.812), affective (0.824), and adverse effects (0.636); the exception was for the perception of pain care subscale (0.492). Patients with different anticipated pain management outcomes were differentiated as expected. Satisfaction could be predicted (31.3% of the variance) using subscales and items in the questionnaire. Although our evidence supports the psychometric properties of the Chinese version of the revised questionnaire when tested with postoperative patients, further study is needed, especially on the subscale perception of pain care.
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Affiliation(s)
- Hui Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gwen D Sherwood
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zhiyi Gong
- Department of Anesthesia, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liying Ren
- Operation Room, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Huaping Liu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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19
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Hansen MS, Wetterslev J, Pipper CB, Asghar MS, Dahl JB. Heat pain detection threshold is associated with the area of secondary hyperalgesia following brief thermal sensitization: a study of healthy male volunteers. J Pain Res 2017; 10:265-274. [PMID: 28184167 PMCID: PMC5291329 DOI: 10.2147/jpr.s121189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction The area of secondary hyperalgesia following brief thermal sensitization (BTS) of the skin and heat pain detection thresholds (HPDT) may both have predictive abilities in regards to pain sensitivity and clinical pain states. The association between HPDT and secondary hyperalgesia, however, remains unsettled, and the dissimilarities in physiologic properties suggest that they may represent 2 distinctively different pain entities. The aim of this study was to investigate the association between HPDT and BTS-induced secondary hyperalgesia. Methods A sample of 121 healthy male participants was included and tested on 2 separate study days with BTS (45°C, 3 minutes), HPDT, and pain during thermal stimulation (45°C, 1 minute). Areas of secondary hyperalgesia were quantified after monofilament pinprick stimulation. The pain catastrophizing scale (PCS) and hospital anxiety and depression scale (HADS) were also applied. Results A significant association between HPDT and the size of the area of secondary hyperalgesia (p<0.0001) was found. The expected change in area of secondary hyperalgesia due to a 1-degree increase in HPDT was estimated to be −27.38 cm2, 95% confidence interval (CI) of −37.77 to −16.98 cm2, with an R2 of 0.19. Likewise, a significant association between HADS-depression subscore and area of secondary hyperalgesia (p=0.046) was found, with an estimated expected change in secondary hyperalgesia to a 1-point increase in HADS-depression subscore of 11 cm2, 95% CI (0.19–21.82), and with R2 of 0.03. We found no significant associations between secondary hyperalgesia area and PCS score or pain during thermal stimulation. Conclusion HPDT and the area of secondary hyperalgesia after BTS are significantly associated; however, with an R2 of only 19%, HPDT only offers a modest explanation of the inter-participant variation in the size of the secondary hyperalgesia area elicited by BTS.
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Affiliation(s)
- Morten Sejer Hansen
- Department of Anesthesiology, 4231, Centre of Head and Orthopedics, Rigshospitalet
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812
| | | | | | - Jørgen Berg Dahl
- Department of Anesthesiology, Department Z, Bispebjerg Hospital, Copenhagen, Denmark
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Sex-dependent effects of cannabis-induced analgesia. Drug Alcohol Depend 2016; 167:112-20. [PMID: 27522535 PMCID: PMC5037015 DOI: 10.1016/j.drugalcdep.2016.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preclinical studies demonstrate that cannabinoid-mediated antinociceptive effects vary according to sex; it is unknown if these findings extend to humans. METHODS This retrospective analysis compared the analgesic, subjective and physiological effects of active cannabis (3.56-5.60% THC) and inactive cannabis (0.00% THC) in male (N=21) and female (N=21) cannabis smokers under double-blind, placebo-controlled conditions. Pain response was measured using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4°C); times to report pain (pain sensitivity) and withdraw the hand (pain tolerance) were recorded. Subjective drug ratings were also measured. RESULTS Among men, active cannabis significantly decreased pain sensitivity relative to inactive cannabis (p<0.01). In women, active cannabis failed to decrease pain sensitivity relative to inactive. Active cannabis increased pain tolerance in both men women immediately after smoking (p<0.001); a trend was observed for differences between men and women (p<0.10). Active cannabis also increased subjective ratings of cannabis associated with abuse liability ('Take again,' 'Liking,' 'Good drug effect'), drug strength, and 'High' relative to inactive in both men and women (p<0.01). CONCLUSIONS These results indicate that in cannabis smokers, men exhibit greater cannabis-induced analgesia relative to women. These sex-dependent differences are independent of cannabis-elicited subjective effects associated with abuse-liability, which were consistent between men and women. As such, sex-dependent differences in cannabis's analgesic effects are an important consideration that warrants further investigation when considering the potential therapeutic effects of cannabinoids for pain relief.
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21
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Lindberg MF, Miaskowski C, Rustøen T, Rosseland LA, Paul SM, Lerdal A. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty. PLoS One 2016; 11:e0161681. [PMID: 27583551 PMCID: PMC5008744 DOI: 10.1371/journal.pone.0161681] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 08/10/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. METHODS Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. RESULTS Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. DISCUSSION Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.
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Affiliation(s)
- Maren Falch Lindberg
- Department of Surgery, Lovisenberg Diakonale Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Anners Lerdal
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway
- * E-mail:
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22
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Hansen MS, Wetterslev J, Pipper CB, Asghar MS, Dahl JB. Is heat pain detection threshold associated with the area of secondary hyperalgesia following brief thermal sensitization? A study of healthy volunteers - design and detailed plan of analysis. BMC Anesthesiol 2016; 16:28. [PMID: 27246322 PMCID: PMC4888470 DOI: 10.1186/s12871-016-0193-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 05/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background Several factors are believed to influence the development and experience of pain. Human clinical pain models are central tools, in the investigation of basic physiologic pain responses, and can be applied in patients as well as in healthy volunteers. Each clinical pain model investigates different aspects of the human pain response. Brief thermal sensitization induces a mild burn injury, resulting in development of primary hyperalgesia at the site of stimulation, and secondary hyperalgesia surrounding the site of stimulation. Central sensitization is believed to play an important role in the development of secondary hyperalgesia; however, a possible association of secondary hyperalgesia following brief thermal sensitization and other heat pain models remains unknown. Our aim with this study is to investigate how close the heat pain detection threshold is associated with the size of the area of secondary hyperalgesia induced by the clinical heat pain model: Brief thermal sensitization. Methods and design We aim to include 120 healthy participants. The participants will be tested on two separate study days with the following procedures: i) Brief thermal sensitization, ii) heat pain detection threshold and iii) pain during thermal stimulation. Additionally, the participants will be tested with the Pain Catastrophizing Scale and Hospital Anxiety and Depression Scale questionnaires. We conducted statistical simulations based on data from our previous study, to estimate an empirical power of 99.9 % with α of 0.05. We define that an R2 < 0.25 and predictive intervals larger than +/−150 cm2 are indications of a weak association. Discussion The area of secondary hyperalgesia may serve as a quantitative measure of the central sensitization induced by cutaneous heat stimulation, and thus may be a biomarker of an individual’s pain sensitivity. The number of studies investigating secondary hyperalgesia is growing; however basic knowledge of the physiologic aspects of secondary hyperalgesia in humans is still incomplete. We therefore find it interesting to investigate if HPDT, a known quantitative sensory test, is associated with areas of secondary hyperalgesia following brief thermal sensitization Trial registration Clinicaltrials.gov (Identifier: NCT02527395). Danish Research Ethics Committee (Identifier: H-8-2014-012). Danish Data Protection Agency (Identifier: 30-1436). Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0193-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Morten Sejer Hansen
- Department of Anaesthesiology, 4231, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, dep. 7812, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Christian Bressen Pipper
- Section of Biostatistics, Faculty of Health, Copenhagen University, Øster Farigmagsgade 5, Copenhagen, 1014, Denmark
| | - Mohammad Sohail Asghar
- Department of Anaesthesiology, 4231, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Jørgen Berg Dahl
- Department of Anaesthesiology, dep. Z, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
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Green DP, Patil MJ, Akopian AN. Influence of hypophysectomy, ovariectomy and gonadectomy on postoperative hypersensitivity in rats. ACTA ACUST UNITED AC 2016; 2:171-175. [PMID: 29399371 PMCID: PMC5791901 DOI: 10.15761/gapm.1000145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical procedures lead to profound and sustained (up to 1–2 weeks) activation of the pituitary gland, resulting in changes in endocrine function. Questions remain on whether activation of the pituitary influences the threshold and development time-course of postoperative pain. To address these questions, we evaluated postoperative hypersensitivity in female and male rats with ablated pituitary and gonadal hormone productions via hypophysectomy, ovariectomy and gonadectomy, respectively. Plantar incision, a model of acute postoperative pain, or sham operation was performed on rat hind paws. Hypophysectomy, ovariectomy and gonadectomy were achieved by surgical disconnection of pituitary, ovaries and testicles, respectively. Postoperative thermal and mechanical hypersensitivity were monitored for 7 days post incision. Hypophysectomy on female and male rats produced statistically similar thermal and mechanical postoperative hypersensitivity thresholds and time-courses as compared to intact estrous female and male rats. Moreover, ovariectomy and gonadectomy did not significantly change postoperative hypersensitivity observed in control female and male animals. Our experiments demonstrate that hypophysectomy, ovariectomy and gonadectomy do not significantly impact postoperative hypersensitivity observed in normal female and male animals. These data suggest that surgery-induced changes in the endocrine system via activation of pituitary and subsequently gonadal tissues have little impact on the threshold and development of postoperative pain in female and male rats.
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Affiliation(s)
- Dustin P Green
- Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Mayur J Patil
- Department of Pharmacology, UT Health Science Center, San Antonio, TX, USA
| | - Armen N Akopian
- Department of Pharmacology, UT Health Science Center, San Antonio, TX, USA.,Department of Endodontics, UT Health Science Center, San Antonio, TX, USA
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Hansen MS, Wetterslev J, Pipper CB, Østervig R, Asghar MS, Dahl JB. The Area of Secondary Hyperalgesia following Heat Stimulation in Healthy Male Volunteers: Inter- and Intra-Individual Variance and Reproducibility. PLoS One 2016; 11:e0155284. [PMID: 27167119 PMCID: PMC4864410 DOI: 10.1371/journal.pone.0155284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Clinical pain models can be applied when investigating basic physiologic pain responses in healthy volunteers. Several pain models exist; however, only few have been adequately validated. Our primary aim with this prospective study was to investigate the intra- and inter-individual variation in secondary hyperalgesia elicited by brief thermal sensitization (45°C for 3 min) in healthy volunteers. MATERIAL AND METHODS Fifty healthy volunteers were included. Areas of secondary hyperalgesia following brief thermal sensitization were investigated by 2 observers on 4 experimental days, with a minimum interval of 7 days. Additionally, heat pain detection threshold and pain during thermal stimulation (45°C for 1 min.), and the psychological tests Pain Catastrophizing Scale and Hospital Anxiety and Depression Score were applied. RESULTS For areas of secondary hyperalgesia, an intra-observer intra-person correlation of 0.85, 95% CI [0.78, 0.90], an intra-observer inter-person correlation of 0.03, 95% CI [0.00, 0.16], and a coefficient of variation of 0.17, 95% CI [0.14, 0.21] was demonstrated. Four percent of the study population had areas of secondary hyperalgesia both below the 1st and above the 3rd quartile considering all included participants. Heat pain detection threshold predicted area of secondary hyperalgesia with an adjusted R2 of 0.20 (P = 0.0006). CONCLUSIONS We have demonstrated a low intra-individual, and a high inter-individual variation in thermally induced secondary hyperalgesia. We conclude that brief thermal sensitization produce secondary hyperalgesia with a high level of reproducibility, which can be applied to investigate different phenotypes related to secondary hyperalgesia in healthy volunteers. TRIAL REGISTRATION clinicaltrials.gov NCT02166164.
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Affiliation(s)
- Morten Sejer Hansen
- Department of Anesthesiology 4231, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Jørn Wetterslev
- Department 7812, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
| | | | - Rebecca Østervig
- Department of Anesthesiology 4231, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
| | - Mohammad Sohail Asghar
- Department of Anesthesiology 4231, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Berg Dahl
- Department of Anesthesiology, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
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Lanza M, Ferrari F, Menghetti I, Tremolada D, Caselli G. Modulation of imidazoline I2 binding sites by CR4056 relieves postoperative hyperalgesia in male and female rats. Br J Pharmacol 2016; 171:3693-701. [PMID: 24758515 PMCID: PMC4128066 DOI: 10.1111/bph.12728] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/27/2014] [Accepted: 04/09/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE CR4056 is a novel imidazoline-2 (I2 ) ligand exhibiting potent analgesic activity in animal models of pain. In this study, we investigated the effects of CR4056 in a well-established model of postoperative pain where rats develop hyperalgesia in the injured hind paw. EXPERIMENTAL APPROACH By measuring paw withdrawal threshold to mechanical pressure, we studied the pharmacology of CR4056, potential sex differences in pain perception and response to treatment, and the pharmacodynamic interaction of CR4056 with morphine. KEY RESULTS Oral CR4056 and subcutaneous morphine dose-dependently reversed the hyperalgesic response. Analgesic effects of CR4056 were completely suppressed by the non-selective imidazoline I2 /α2 -adrenoceptor antagonist idazoxan, were partially reduced (~30%; P < 0.05) by the selective α2 -adrenoceptor antagonist yohimbine, but were not influenced by the non-selective I1 /α2 -adrenoceptor antagonist efaroxan or by the μ opioid receptor antagonist naloxone. We found no differences in responses to CR4056 or morphine between male and female rats. However, females had a lower pain threshold than males, and needed lower doses of drugs to reach a significant analgesia. When CR4056 and morphine were combined, their median effective doses were lower than expected for additive effects, both in males and in females. Isobolographic analysis confirmed a synergism between CR4056 and morphine. CONCLUSIONS AND IMPLICATIONS CR4056 is a novel pharmacological agent under development for postoperative pain both as stand-alone treatment and in association with morphine. CR4056 has successfully completed Phase I studies for tolerability and pharmacokinetics in healthy volunteers, and is currently entering the first proof-of-concept study in patients.
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Affiliation(s)
- Marco Lanza
- Department of Pharmacology & Toxicology, Rottapharm Biotech S.r.l., Monza, MB, Italy
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26
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Graziani M, Nisticò R. Gender difference in prescription opioid abuse: A focus on oxycodone and hydrocodone. Pharmacol Res 2016; 108:31-38. [PMID: 27107788 DOI: 10.1016/j.phrs.2016.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/18/2022]
Abstract
Several data gathered in the last decade indicate an increase of abuse of prescription opioid drugs oxycodone (OXY) and hydrocodone (HYDRO) in women. However, to date there are no conclusive evidences investigating the gender-dependent abuse liability of prescription opioids. This study aims to supply a specific focus on women's data through a selective summary of the literature analyzing gender differences in the pharmacokinetic and pharmacodynamic dimension of OXY and HYDRO. Findings from this study suggest that the majority of OXY and HYDRO pharmacokinetic and pharmacodynamic effects do not differ according to gender, though confirming a significant difference in the incidence of adverse effects as demonstrated by the increased gastrointestinal adverse reactions in female subjects. Although the majority of recent clinical studies include an equal number of female and male subjects, the main outcome parameters do not relate specifically to gender differences. Due to the gender influence in activity of CYP3A4 and its crucial role in metabolism of both OXY than HYDRO, we suggest that assessing pharmacokinetic and pharmacodynamic interactions in clinical studies may be useful to clarify the effect of the higher CYP3A4 activity in female in relation to CYP2D6 genotype. Overall, considering the paucity of data regarding gender differences in European Union, this work highlights that impact of new abuse deterrent formulations should be assessed with a special focus on data concerning female subjects.
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Affiliation(s)
- Manuela Graziani
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy; Drug Addiction and Clinical Pharmacology Unit, University Hospital Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Robert Nisticò
- Department of Biology, University of Rome 'Tor Vergata', Rome, Italy
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27
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Devarakonda K, Kostenbader K, Giuliani MJ, Young JL. Single-dose pharmacokinetics of 2 or 3 tablets of biphasic immediate-release/extended-release hydrocodone bitartrate/acetaminophen (MNK-155) under fed and fasted conditions: two randomized open-label trials. BMC Pharmacol Toxicol 2015; 16:31. [PMID: 26614499 PMCID: PMC4662814 DOI: 10.1186/s40360-015-0032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/12/2015] [Indexed: 11/11/2022] Open
Abstract
Background Biphasic immediate-release (IR)/extended-release (ER) hydrocodone bitartrate (HB)/acetaminophen (APAP) 7.5/325-mg tablets are formulated with gastroretentive ER drug delivery technology that has been associated with clinically meaningful food effects in other approved products. Two phase 1 studies evaluated potential effects of food on single-dose pharmacokinetics of IR/ER HB/APAP tablets. Methods These were single-center, open-label, randomized, single-dose, 3-period crossover studies in healthy volunteers (aged 18–55 years). IR/ER HB/APAP was administered as a single 2-tablet dose (study 1) or 3-tablet dose (study 2) under fed (high- and low-fat) and fasted conditions. Area under the plasma concentration-time curve from 0 h to time t (AUC0–t) and from time 0 extrapolated to infinity (AUC0–inf) and maximum observed plasma concentration (Cmax) of hydrocodone and APAP under fed versus fasted conditions were compared using analysis of variance. A 90 % confidence interval of the geometric least squares mean ratio fully contained within 80 to 125 % indicated no treatment difference. Safety and tolerability were assessed. Results Forty of 48 participants in study 1 and 21 of 30 in study 2 completed all treatments. In both studies, under fed (high- or low-fat meal) versus fasted conditions, 90 % CIs for AUC0–t and AUC0–inf for both hydrocodone and APAP were entirely contained within the bioequivalent range (80–125 %), indicating that high- and low-fat meals did not affect the extent of exposure. In both studies, a high-fat meal did not affect the Cmax for hydrocodone. Hydrocodone Cmax was not affected by a low-fat meal in study 1 but increased by approximately 19 % in study 2. A high-fat meal decreased APAP Cmax by approximately 20 % (study 1) and 13 % (study 2); a low-fat meal decreased APAP Cmax by 22 % (study 1) and 21 % (study 2). Approximately 50 % of participants in both studies reported ≥1 treatment-emergent adverse event (TEAE), with no notable difference based on food intake. There were no serious or severe AEs. The most common TEAEs were nausea, vomiting, and dizziness. Conclusions Pharmacokinetic and safety findings were similar regardless of food intake. TEAEs were consistent with those reported with low-dose combination opioids. IR/ER HB/APAP can be administered without regard to food. Trial registration ClinicalTrials.gov NCT02561650 and NCT02561741. Electronic supplementary material The online version of this article (doi:10.1186/s40360-015-0032-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krishna Devarakonda
- Department of Clinical Pharmacology, Mallinckrodt Pharmaceuticals, Hazelwood, MO, USA. .,Department of Clinical Pharmacology, Mallinckrodt Inc., 675 James S. McDonnell Blvd, Hazelwood, MO, 63042, USA.
| | - Kenneth Kostenbader
- Independent Pharmaceuticals Professional, Mallinckrodt Pharmaceuticals, Hazelwood, MO, USA.
| | - Michael J Giuliani
- Research and Development, Mallinckrodt Pharmaceuticals, Hazelwood, MO, USA.
| | - Jim L Young
- Clinical Affairs and Program Management, Mallinckrodt Pharmaceuticals, Hazelwood, MO, USA.
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Pei Q, Yang Y, Liu Q, Peng Z, Feng Z. Lack of Sex Difference in Minimum Local Analgesic Concentration of Ropivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block. Med Sci Monit 2015; 21:3459-66. [PMID: 26556653 PMCID: PMC4648125 DOI: 10.12659/msm.894570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Sex differences, which may be an important variable for determining anesthetic requirements, have not been well investigated in the aspect of local anesthetic. This investigation aimed to compare the minimum local analgesic concentration (MLAC) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block (US-SCB) between men and women. Material/Method Patients aged 18–45 years undergoing elective forearm, wrist, or hand surgeries under US-SCB were divided into 2 groups according to sex. The initial concentration was 0.375% ropivacaine 20 mL and the concentration for the next patient was determined by the up-down technique at 0.025% intervals. Success was defined as the absence of any pain in response to a pinprick in the region of all 4 terminal nerves and the skin incision within 45 min. The primary outcome was the MLAC of ropivacaine, which was estimated by the Dixon and Massey method. The analgesia duration, which was defined as the time from the end of the US-SCB injection to the time of feeling discomfort and need for additional analgesics, was observed for each patient. Results The MLAC of ropivacaine 20 mL for US-SCB was 0.2675% (95% confidence interval [CI], 0.2512–0.2838%) in men and 0.2675% (95% CI, 0.2524–0.2826%) in women. There was no significant difference in MLAC or the analgesia duration between the 2 groups (P>0.05). Conclusions We found no significant sex-related differences in MLAC or analgesia duration of ropivacaine for US-SCB.
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Affiliation(s)
- Qingqing Pei
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Yanqing Yang
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Qin Liu
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhiyou Peng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhiying Feng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
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Sadhasivam S, Chidambaran V, Olbrecht VA, Costandi A, Clay S, Prows CA, Zhang X, Martin LJ. Opioid-Related Adverse Effects in Children Undergoing Surgery: Unequal Burden on Younger Girls with Higher Doses of Opioids. PAIN MEDICINE 2015; 16:985-97. [DOI: 10.1111/pme.12660] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Franconi F, Rosano G, Campesi I. Need for gender-specific pre-analytical testing: the dark side of the moon in laboratory testing. Int J Cardiol 2014; 179:514-35. [PMID: 25465806 DOI: 10.1016/j.ijcard.2014.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 01/16/2023]
Abstract
Many international organisations encourage studies in a sex-gender perspective. However, research with a gender perspective presents a high degree of complexity, and the inclusion of sex-gender variable in experiments presents many methodological questions, the majority of which are still neglected. Overcoming these issues is fundamental to avoid erroneous results. Here, pre-analytical aspects of the research, such as study design, choice of utilised specimens, sample collection and processing, animal models of diseases, and the observer's role, are discussed. Artefacts in this stage of research could affect the predictive value of all analyses. Furthermore, the standardisation of research subjects according to their lifestyles and, if female, to their life phase and menses or oestrous cycle, is urgent to harmonise research worldwide. A sex-gender-specific attention to pre-analytical aspects could produce a decrease in the time for translation from the bench to bedside. Furthermore, sex-gender-specific pre-clinical pharmacological testing will enable adequate assessment of pharmacokinetic and pharmacodynamic actions of drugs and will enable, where appropriate, an adequate gender-specific clinical development plan. Therefore, sex-gender-specific pre-clinical research will increase the gender equity of care and will produce more evidence-based medicine.
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Affiliation(s)
- Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy; Vicepresident of Basilicata Region.
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Ilaria Campesi
- Department of Biomedical Sciences, University of Sassari, National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy
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Roth T, Steinberg F, Singh NN, Moline M. Gender influences on efficacy and safety of sublingual zolpidem tartrate for middle-of-the-night awakening in insomnia. Hum Psychopharmacol 2014; 29:25-30. [PMID: 24424704 DOI: 10.1002/hup.2364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/23/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Evaluate potential gender effects on efficacy and safety of a buffered zolpidem sublingual tablet (ZST) formulation. METHODS Post hoc analysis of the pivotal sleep laboratory and outpatient studies, per gender. RESULTS In the sleep laboratory study, polysomnography-derived latency to persistent sleep after middle-of-the-night was significantly improved for both genders at both 1.75 mg and 3.5 mg ZST (females: 15.7 and 8.6 min, respectively, vs. 27.7 min [placebo]; males: 19.0 and 12.7 min vs. 29.0 min [placebo]) with no significant gender differences. In the outpatient study, subjective sleep onset latency after middle-of-the-night was significantly shorter for both genders treated with ZST 3.5 mg versus placebo over the 4-week average (females: 37.3 vs. 59.4 min, p < 0.0001; males: 38.6 vs. 55.1 min, p ≤ 0.01). There were no gender differences in subjective sleep onset latency after middle-of-the-night awakening. In the outpatient study, weekly usage of ZST and placebo by both genders declined throughout the study. Morning alertness following dosing nights improved in both genders, although significant only in females. In both studies, there were no gender differences in adverse events. CONCLUSION(S) Time to return to sleep after middle-of-the-night dosing with ZST improved in both genders, with no gender differences in efficacy and safety.
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Affiliation(s)
- Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Minnesota, USA
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Patil MJ, Green DP, Henry MA, Akopian AN. Sex-dependent roles of prolactin and prolactin receptor in postoperative pain and hyperalgesia in mice. Neuroscience 2013; 253:132-41. [PMID: 23994182 DOI: 10.1016/j.neuroscience.2013.08.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/06/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
Abstract
Although surgical trauma activates the anterior pituitary gland and elicits an increase in prolactin (PRL) serum levels that can modulate nociceptive responses, the role of PRL and the PRL-receptor (PRL-R) in thermal and mechanical hyperalgesia in postoperative pain is unknown. Acute postoperative pain condition was generated with the use of the hindpaw plantar incision model. Results showed endogenous PRL levels were significantly increased in serum, operated hindpaw and spinal cords of male and female rats 24h after incision. These alterations were especially pronounced in females. We then examined the role of the PRL system in thermal and mechanical hyperalgesia in male and female mice 3-168 h after plantar incision with the use of knock-out (KO) mice with PRL or PRL-R gene ablations and in wild-type (WT) mice. WT mice showed postoperative cold hyperalgesia in a sex-dependent manner (only in females), but with no effect on heat hyperalgesia or mechanical allodynia in either sex. Studies in KO mice showed no effect of PRL and PRL-R gene ablation on heat and cold hyperalgesia in male mice, while heat hyperlgesia were reduced 3-72 h post-surgery in female PRL and PRL-R KO mice. In contrast, PRL and PRL-R ablations significantly attenuated mechanical allodynia 3-72 h post-surgery in both male and female mice. Overall, we found elevated PRL levels in serum, hindpaws and spinal cords after incision, and identify a contributory role for the PRL system in postoperative pain responses to thermal stimuli in females and to mechanical stimuli in both males and females.
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Affiliation(s)
- M J Patil
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, TX 78229, USA
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