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Salabasidou E, Binder T, Volkmann J, Kuzkina A, Üçeyler N. Pain in Parkinson disease: a deep phenotyping study. Pain 2024; 165:1642-1654. [PMID: 38314763 DOI: 10.1097/j.pain.0000000000003173] [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: 04/06/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
ABSTRACT In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)-related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease-related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice.
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Affiliation(s)
- Elena Salabasidou
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Kuzkina is now with the Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Farid AR, Liimakka AP, Parker EB, Smith JT, Melnic CM, Chen AF, Lange JK. Association of Pharmacologic Treatment of Depression/Anxiety With Initial Patient-Reported Outcome Measures in Patients With Hip and Knee Osteoarthritis. J Am Acad Orthop Surg 2024; 32:516-524. [PMID: 38595309 DOI: 10.5435/jaaos-d-23-00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/27/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Depression and anxiety are common comorbidities that may exacerbate osteoarthritis (OA)-related pain. We aim to evaluate the effect of pharmacologic treatment of depression/anxiety on hip and knee patient-reported outcome measures (PROMs). METHODS A multi-institutional PROMs database was queried for patients with depression or anxiety and hip or knee OA who completed a PROMs questionnaire at an initial orthopaedic visit between January 2015 and March 2023. Data on demographics, comorbidities, and duration of pharmacologic treatment of depression/anxiety were obtained. Patients were stratified into three cohorts based on treatment duration. PROMs were compared across cohorts. RESULTS Two thousand nine hundred sixty patients who completed PROMs at their initial orthopaedic visit had both OA and depression/anxiety. One hundred thirty-four (4.5%) received pharmacologic treatment of depression/anxiety for < 1 year, versus 196 (6.6%) for more than 1 year. In unadjusted analyses, patients with pharmacologic treatment had significantly lower Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical (39.8 [IQR 34.9, 44.9] vs 42.3 [37.4, 47.7], P < 0.001) and PROMIS-Mental (43.5 [36.3, 50.8] vs 48.3 [41.1, 53.3], P < 0.001) scores than those without treatment. After adjusting for demographics and comorbidities, only differences in PROMIS-Mental scores remained statistically significant, with pharmacologic treatment associated with lower scores (β = -2.26, 95% CI, [-3.29, -1.24], P < 0.001). On secondary analysis including duration of pharmacologic treatment, < 1 year of treatment was associated with significantly lower PROMIS-Mental scores than those not treated (β = -4.20, 95% CI [-5.77, -2.62], P < 0.001) while scores of patients with more than 1 year of treatment did not differ significantly from those without treatment. CONCLUSION :Our results indicate that pharmacologic treatment of depression/anxiety is associated with improved psychological health but not with improved physical symptoms related to OA. We observed a nonsignificant trend that patients with depression/anxiety who warrant pharmacologic treatment tend to have worse physical symptoms than those who do not; however, unadjusted analyses suggest this is a complex relationship beyond the isolated effect of pharmacologic treatment.
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Affiliation(s)
- Alexander R Farid
- From the Harvard Medical School, Boston, MA (Farid, Liimakka, and Parker), the Department of Orthopaedic Surgery, Division of Adult Reconstruction and Total Joint Arthroplasty, Brigham and Women's Hospital, Boston, MA (Liimakka, Chen, and Lange), the Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Boston, MA (Parker and Smith), and the Department of Orthopaedic Surgery, Hip & Knee Replacement Service, Massachusetts General Hospital, Boston, MA (Melnic)
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Buchanan WW, Rainsford KD, Kean CA, Kean WF. Narcotic analgesics. Inflammopharmacology 2024; 32:23-28. [PMID: 37515654 DOI: 10.1007/s10787-023-01304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
There is documentation of the use of opium derived products in the ancient history of the Assyrians: the Egyptians; in the sixth century AD by the Roman Dioscorides; and by Avicenna (980-1037). Reference to opium like products is made by Paracelsus and by Shakespeare. Charles Louis Derosne and Fredrich Wilhelm Adam Serturner isolated morphine from raw opium in 1802 and 1806 respectively, and it was Sertürner who named the substance morphine, after Morpheus, the Greek God of dreams. By the middle 1800s, Opium and related opioid derived products were the source of a major addiction in USA, and to some extent in the United Kingdom. Opioid products are of major therapeutic value in the treatment of pain from injury, post surgery, intractable pain conditions, and some forms of terminal cancer.
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Affiliation(s)
- W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | | | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | - Walter F Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Maihöfner C, de Haas A, Sethi V, Shanga G, Wilcox TK, Csoke E, Fabrikant K. Patients' experience and utilization patterns of diclofenac gel in Germany: a real-world study with a prospective longitudinal survey and a retrospective analysis of pharmacy data. Curr Med Res Opin 2023; 39:1649-1661. [PMID: 37545357 DOI: 10.1080/03007995.2023.2243804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Describe and characterize treatment patterns, satisfaction, improvement in pain and functional impairment (health-related quality of life [HRQoL]) in users of over the counter (OTC) Voltaren gel diclofenac (VGD) 2.32% and 1.16% in a real-world setting. METHODS This observational real-world German study had prospective and retrospective components. The prospective data were collected from electronic surveys completed by adults who purchased VGD to treat their musculoskeletal pain at baseline and 4 and 12 weeks after baseline. Retrospective data were from a 12-month (March 2019 to February 2020) abstraction from dispensing software platforms used in select German pharmacies. RESULTS Surveys from 467 participants (mean age 60.8 years) were analyzed. Average pain severity at baseline was 6.0 on an 11-point Numeric Rating Scale (0 = no pain, 10 = worst possible pain), improving by 0.8 and 1.2 points at Weeks 4 and 12, respectively. Performance of functional activities (daily/physical/social activities and errands/chores) improved and the proportion of participants with at least moderate interference decreased at both follow-up timepoints. Retrospective analyses indicated that majority of patients receiving VGD (n = 95,085) were ≥65 years old (67.9%), had one dispensed tube (70.8%) and did not switch to another topical treatment (including other NSAIDs) (77.3%), and were co-prescribed at least one cardiovascular medication (74.3%). CONCLUSIONS This study provides the first real-world insights into OTC VGD use in Germany. The participants using VGD reported a decrease in pain severity and an improvement of HRQoL while under treatment, as well as resulting satisfaction with treatment. Patients infrequently switched to alternate topical therapies/NSAIDs.
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Affiliation(s)
- Christian Maihöfner
- Department of Neurology, General Fürth Hospital, University of Erlangen, Germany
| | - Anke de Haas
- Medical Affairs, Haleon (Formerly GSK Consumer Healthcare), Munich, Germany
| | - Vidhu Sethi
- Medical Affairs, Haleon, Singapore, Singapore
| | | | - Teresa K Wilcox
- Epidemiology and Scientific Affairs, Formerly of PPD, Part of Thermo Fisher Scientific, Bethesda, Maryland, USA
| | - Emese Csoke
- Medical Affairs, Formerly of GSK Consumer Healthcare, Basel, Switzerland
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Li J, Zhang X, Guo D, Shi Y, Zhang S, Yang R, Cheng J. The mechanism of action of paeoniae radix rubra–angelicae sinensis radix drug pair in the treatment of rheumatoid arthritis through PI3K/AKT/NF-κB signaling pathway. Front Pharmacol 2023; 14:1113810. [PMID: 36992829 PMCID: PMC10040578 DOI: 10.3389/fphar.2023.1113810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Objective: To investigate the effects and mechanisms of Paeoniae radix rubra–Angelicae sinensis radix (P-A) drug pair in the treatment of rheumatoid arthritis (RA).Methods: Mass spectrometry was employed to accurately characterize the main components of the P-A drug pair. Network pharmacology was used to analyze the main components and pathways of the P-A drug pair in the treatment of RA, and Discovery Studio software was used to molecularly dock the key proteins on the pathway with their corresponding compounds. The levels of serum TNF-a, IL-1β, and IL-6 were measured by enzyme linked immunosorbent assay (ELISA). The histopathology of the ankle joint was observed by hematoxylin-eosin (HE) staining, and the positive expression of p-PI3K, p-IKK, p-NF-κB, and p-AKT in the synovial tissue of the ankle joint was detected by immunohistochemical analysis. Finally, the expression of PI3K, IKK, and AKT and their phosphorylation levels were determined by western blot in each group of rats.Results: Network pharmacology combined with molecular docking analysis revealed that the pharmacodynamic mechanism of the P-A drug pair for the treatment of RA may be related to the contents of caffeic acid, quercetin, paeoniflorin, and baicalein in the regulation of the expression of the PI3K/AKT/NF-κB signaling pathway and the targets of PIK3CA, PIK3R1, AKT1, HSP90AA1 and IKBKB in the pathway. Compared with the model group, the P-A drug pair significantly improved the pathological changes of the synovial tissue and reduced feet swelling in RA model rats. Moreover, it regulated the levels of TNF-α, IL-1β, and IL-6 in serum (p < 0.05). The results of the immunohistochemical analysis and western blot showed that the expression of PI3K, IKK, NF-κB, and AKT decreased after phosphorylation in the synovial tissue (p < 0.05).Conclusion: The P-A drug pair exhibited an inhibitory effect on the hyperactivation of the PI3K/AKT/NF-κB signaling pathway in the synovial membrane of RA rats. The mechanism may be related to the downregulation of the phosphorylation levels PI3K, IKK, NF-κB, and AKT, which in turn decreased inflammatory cell infiltration and synovial membrane proliferation.
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Affiliation(s)
- Jia Li
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xiaofei Zhang
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
- Department of Pharmaceutics, The Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Dongyan Guo
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yajun Shi
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Shihao Zhang
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ruiying Yang
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiangxue Cheng
- Department of Pharmaceutics, The Key Laboratory of Basic and New Drug Research of Traditional Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
- *Correspondence: Jiangxue Cheng,
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Paul AK, Lim CL, Apu MAI, Dolma KG, Gupta M, de Lourdes Pereira M, Wilairatana P, Rahmatullah M, Wiart C, Nissapatorn V. Are Fermented Foods Effective against Inflammatory Diseases? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2481. [PMID: 36767847 PMCID: PMC9915096 DOI: 10.3390/ijerph20032481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
Fermented foods have been used over the centuries in various parts of the world. These foods are rich in nutrients and are produced naturally using various biological tools like bacteria and fungi. Fermentation of edible foods has been rooted in ancient cultures to keep food for preservation and storage for a long period of time with desired or enhanced nutritional values. Inflammatory diseases like rheumatoid arthritis, osteoarthritis, and chronic inflammatory pain are chronic disorders that are difficult to treat, and current treatments for these disorders fail due to various adverse effects of prescribed medications over a long period of time. Fermented foods containing probiotic bacteria and fungi can enhance the immune system, improve gastrointestinal health, and lower the risk of developing various inflammatory diseases. Foods prepared from vegetables by fermentation, like kimchi, sauerkraut, soy-based foods, or turmeric, lack proper clinical and translational experimental studies. The current review has focused on the effectiveness of various fermented foods or drinks used over centuries against inflammation, arthritis, and oxidative stress. We also described potential limitations on the efficacies or usages of these fermented products to provide an overarching picture of the research field.
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Affiliation(s)
- Alok K. Paul
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia
| | - Chooi Ling Lim
- Division of Applied Biomedical Science and Biotechnology, School of Health Sciences, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Md. Aminul Islam Apu
- Department of Nutrition and Hospitality Management, The University of Mississippi, Oxford, MS 38677, USA
| | - Karma G. Dolma
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok 737102, India
| | - Madhu Gupta
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Re-search University, New Delhi 110017, India
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Mohammed Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh
| | - Christophe Wiart
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD), and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand
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Zeng L, Yang T, Yang K, Yu G, Li J, Xiang W, Chen H. Efficacy and Safety of Curcumin and Curcuma longa Extract in the Treatment of Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Front Immunol 2022; 13:891822. [PMID: 35935936 PMCID: PMC9353077 DOI: 10.3389/fimmu.2022.891822] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
BackgroundModern pharmacological research found that the chemical components of Curcuma longa L. are mainly curcumin and turmeric volatile oil. Several recent randomized controlled trials (RCT) have shown that curcumin improves symptoms and inflammation in patients with arthritis.MethodsPubmed, Cochran Library, CNKI, and other databases were searched to collect the randomized controlled trials (RCTs). Then, the risk of bias of RCTs were assessed and data of RCTs were extracted. Finally, RevMan 5.3 was utilized for meta-analysis.ResultsTwenty-nine (29) RCTs involving 2396 participants and 5 types of arthritis were included. The arthritis included Ankylosing Spondylitis (AS), Rheumatoid Arthritis (RA), Osteoarthritis (OA), Juvenile idiopathic arthritis (JIA) and gout/hyperuricemia. Curcumin and Curcuma longa Extract were administered in doses ranging from 120 mg to 1500 mg for a duration of 4-36 weeks. In general, Curcumin and Curcuma longa Extract showed safety in all studies and improved the severity of inflammation and pain levels in these arthritis patients. However, more RCTs are needed in the future to elucidate the effect of Curcumin and Curcuma longa Extract supplementation in patients with arthritis, including RA, OA, AS and JIA.ConclusionCurcumin and Curcuma longa Extract may improve symptoms and inflammation levels in people with arthritis. However, due to the low quality and small quantity of RCTs, the conclusions need to be interpreted carefully.
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Affiliation(s)
- Liuting Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- *Correspondence: Hua Chen, ; Liuting Zeng, ; Tiejun Yang, ; Kailin Yang,
| | - Tiejun Yang
- Department of Orthopedics, People’s Hospital of Ningxiang City, Ningxiang City, China
- *Correspondence: Hua Chen, ; Liuting Zeng, ; Tiejun Yang, ; Kailin Yang,
| | - Kailin Yang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha City, China
- *Correspondence: Hua Chen, ; Liuting Zeng, ; Tiejun Yang, ; Kailin Yang,
| | - Ganpeng Yu
- Department of Orthopedics, People’s Hospital of Ningxiang City, Ningxiang City, China
| | - Jun Li
- Department of Orthopedics, People’s Hospital of Ningxiang City, Ningxiang City, China
| | - Wang Xiang
- Department of Rheumatology, The First People's Hospital Changde City, Changde City, China
| | - Hua Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- *Correspondence: Hua Chen, ; Liuting Zeng, ; Tiejun Yang, ; Kailin Yang,
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Whale K, Gooberman‐Hill R. The importance of sleep for people with chronic pain: current insights and evidence. JBMR Plus 2022; 6:e10658. [PMID: 35866153 PMCID: PMC9289983 DOI: 10.1002/jbm4.10658] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Katie Whale
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
| | - Rachael Gooberman‐Hill
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
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Hayashi K, Miki K, Kajiyama H, Ikemoto T, Yukioka M. Impact of Non-steroidal Anti-inflammatory Drug Administration for 12 Months on Renal Function. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:644391. [PMID: 35295466 PMCID: PMC8915618 DOI: 10.3389/fpain.2021.644391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022]
Abstract
Background: The use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of renal complications. Resolution of renal adverse effects after NSAID administration has been observed after short-term use. Thus, the present study aimed to investigate a series of patients with chronic musculoskeletal pain who underwent long-term NSAID administration followed by switching to tramadol hydrochloride/acetaminophen (TA) combination tablets to study the impact of NSAID-induced renal adverse effects. Methods: This was a longitudinal retrospective study of 99 patients with chronic musculoskeletal pain. The patients were administrated with NSAIDs daily during the first 12 months, followed by daily TA combination tablets for 12 months. Estimated glomerular filtration rate (eGFR) and serum levels of aspartate aminotransferase and alanine transaminase were measured at baseline, after NSAID administration and after TA administration. Results: eGFR was significantly reduced after 12-month NSAID administration (median, from 84.0 to 72.8 ml/min/1.73 m2), and the reduction was not shown after the subsequent 12-month TA administration (median, 71.5 ml/min/1.73 m2). Reduction in eGFR was less in patients who received celecoxib (median, -1.8 ml/min/1.73 m2) during the first 12 months. There was no significant difference in aspartate aminotransferase and alanine transaminase in each period. Conclusions: Thus, patients receiving NSAIDs for 12 months displayed both reversible and irreversible reduction of eGFR upon cessation of NSAIDs and switching to TA. Our data highlight the potential safety benefit of utilizing multimodal analgesic therapies to minimize the chronic administration of NSAIDs.
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Affiliation(s)
- Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Kenji Miki
- Center for Pain Management, Hayaishi Hospital, Osaka, Japan.,Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Saitama Medical University, Saitama, Japan
| | - Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Masao Yukioka
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
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Mahmoud AM, Sayed AM, Ahmed OS, Abdel-Daim MM, Hassanein EHM. The role of flavonoids in inhibiting IL-6 and inflammatory arthritis. Curr Top Med Chem 2022; 22:746-768. [PMID: 34994311 DOI: 10.2174/1568026622666220107105233] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the synovial joints. RA has well-known clinical manifestations and can cause progressive disability and premature death along with socioeconomic burdens. Interleukin-6 (IL-6) has been implicated in the pathology of RA where it can stimulate pannus formation, osteoclastogenesis, and oxidative stress. Flavonoids are plant metabolites with beneficial pharmacological effects, including anti-inflammatory, antioxidant, antidiabetic, anticancer, and others. Flavonoids are polyphenolic compounds found in a variety of plants, vegetables, and fruits. Many flavonoids have demonstrated anti-arthritic activity mediated mainly through the suppression of pro-inflammatory cytokines. This review thoroughly discusses the accumulate data on the role of flavonoids on IL-6 in RA.
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Affiliation(s)
- Ayman M Mahmoud
- Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Egypt
| | - Ahmed M Sayed
- Biochemistry Laboratory, Chemistry Department, Faculty of Science, Assiut University, Egypt
| | - Osama S Ahmed
- Faculty of Pharmacy, Al-Azhar University-Assiut Branch, Egypt
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Egypt
| | - Emad H M Hassanein
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Al-Azhar University-Assiut Branch, Egypt
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Hallowell BD, Chambers LC, Barre L, Diao N, Onyejekwe C, Banks A, Bratberg J, Weidele H, Viner-Brown S, McDonald J. Association between initial opioid prescription diagnosis type and subsequent chronic prescription opioid use in Rhode Island: a population-based cohort study. BMJ Open 2022; 12:e050540. [PMID: 34992104 PMCID: PMC8739418 DOI: 10.1136/bmjopen-2021-050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify initial diagnoses associated with elevated risk of chronic prescription opioid use. DESIGN Population-based, retrospective cohort study. SETTING State of Rhode Island. PARTICIPANTS Rhode Island residents with an initial opioid prescription dispensed between 1 April 2019 and 31 March 2020. PRIMARY OUTCOME MEASURE Subsequent chronic prescription opioid use, defined as receiving 60 or more days' supply of opioids in the 90 days following an initial opioid prescription. RESULTS Among the 87 055 patients with an initial opioid prescription, 3199 (3.7%) subsequently became chronic users. Patients who become chronic users tended to receive a longer days' supply, greater quantity dispensed, but a lower morphine milligram equivalents on the initial opioid prescription. Patients prescribed an initial opioid prescription for diseases of the musculoskeletal system and connective tissue (adjusted OR (aOR): 5.9, 95% CI: 4.7 to 7.6), diseases of the nervous system (aOR: 6.3, 95% CI: 4.9 to 8.0) and neoplasms (aOR: 5.6, 95% CI: 4.2 to 7.5) had higher odds of subsequent chronic prescription opioid use, compared with a referent group that included all diagnosis types with fewer than 15 chronic opioid users, after adjusting for confounders. CONCLUSIONS By focusing interventions and prescribing guidelines on specific types of diagnoses that carry a high risk of chronic prescription opioid use and diagnoses that would benefit equally or more from alternative management approaches, states and healthcare organisations may more efficiently decrease inappropriate opioid prescribing while improving the quality of patient care.
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Affiliation(s)
| | - Laura C Chambers
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Luke Barre
- Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Nancy Diao
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | | | - Alexandra Banks
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jeffery Bratberg
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Heidi Weidele
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | | | - James McDonald
- Rhode Island Department of Health, Providence, Rhode Island, USA
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Neelamegam M, Zgibor J, Chen H, O’rourke K, Bakour C, Rajaram L, Anstey KJ. The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study. Age Ageing 2021; 50:1699-1708. [PMID: 33755047 PMCID: PMC8437064 DOI: 10.1093/ageing/afab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. OBJECTIVE we examined the association between opioid use, and changes in cognitive function of older adults. DESIGN prospective study. SETTING community dwelling older adults. SUBJECTS study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia. METHODS medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. RESULTS cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. CONCLUSION prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
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Affiliation(s)
- Malinee Neelamegam
- Yale School of Public Health, Yale University, New Haven, CT, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Janice Zgibor
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Henian Chen
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kathleen O’rourke
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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Singhal S, Hasan N, Nirmal K, Chawla R, Chawla S, Kalra BS, Dhal A. Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol. Trials 2021; 22:105. [PMID: 33516238 PMCID: PMC7847013 DOI: 10.1186/s13063-021-05053-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To compare the efficacy and safety of bioavailable turmeric extract versus paracetamol in patients with knee osteoarthritis (OA). METHODS In this randomized, non-inferiority, controlled clinical study, patients of knee OA were randomized to receive bioavailable turmeric extract (BCM-95®) 500 mg capsule two times daily or paracetamol 650 mg tablet three times daily for 6 weeks. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. The secondary outcome measures were WOMAC total, WOMAC stiffness, and WOMAC physical function scores. Responder analysis of individual patients at different levels (≥ 20%, ≥ 50%, and ≥ 70%) for WOMAC score was calculated. TNF alpha and CRP levels were evaluated and adverse events (AE) were also recorded. RESULTS Seventy-one and seventy-three knee OA patients, respectively in bioavailable turmeric extract and paracetamol groups, completed the study. Non-inferiority (equivalence) test showed that WOMAC scores were equivalent in both the groups (p value < 0.05) in all the domains within the equivalence limit defined by effect size (Cohen's d) of 0.5 whereas CRP and TNF-α were better reduced with turmeric extract than paracetamol. After 6 weeks of treatment, WOMAC total score, pain, stiffness, and function scores got a significant improvement of 23.59, 32.09, 28.5, and 20.25% respectively with turmeric extract. In the turmeric extract group, 18% of patients got more than 50% improvement and 3% of patients got more than 70% improvement in WOMAC pain and function/stiffness score and none of the patients in the paracetamol group met the criteria. CRP and TNF-α got significantly reduced (37.21 and 74.81% respectively) in the turmeric extract group. Adverse events reported were mild and comparatively less in the turmeric extract group (5.48%) than in the paracetamol group (12.68%). CONCLUSION The results of the study suggest that bioavailable turmeric extract is as effective as paracetamol in reducing pain and other symptoms of knee osteoarthritis and found to be safe and more effective in reducing CRP and TNF-α. TRIAL REGISTRATION Clinical Trials Registry - India CTRI/2017/02/007962 . Registered on 27 February 2017.
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Affiliation(s)
- Shubha Singhal
- Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
| | - Nazer Hasan
- Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
| | - Kirti Nirmal
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Rohit Chawla
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Shalini Chawla
- Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
| | | | - Anil Dhal
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, Delhi, India
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AlRuthia Y, Alhazzani H, Alhindi G, Alarfaj M, Almutairi L, Alanazi M, Alokili K, Alanazi N, Alodaibi F, Alwhaibi M, Bashatah AS, Asiri Y, Alsanawi H. Predictors of Opioid Prescription Among a Sample of Patients with Acute Musculoskeletal Pain at a Tertiary Care Hospital in Saudi Arabia. J Pain Res 2020; 13:2929-2936. [PMID: 33235491 PMCID: PMC7678505 DOI: 10.2147/jpr.s276630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Musculoskeletal pain is one of the most complex and debilitating types of pain. Although different pharmacologic treatments are available, very few studies have explored the predictors for opioid analgesics prescription to manage this type of pain. Objective The aim of this study was to explore the predictors for opioid prescription in patients with acute musculoskeletal pain in Saudi Arabia. Methods This was a single-center, retrospective chart review of adult patients (≥18 yrs.) with an acute nociceptive musculoskeletal pain at a university-affiliated medical center in Riyadh, Saudi Arabia. Cancer patients and those with chronic neuropathic pain were excluded. Patients’ age, gender, number of comorbidities, duration of pain management, number of clinic visits for pain, and Numeric Pain Rating Scale (NPRS) scores at rest and with normal activities were collected. Multiple logistic regression was conducted to examine the relationship between the type of musculoskeletal pain and the prescription of opioid analgesics controlling for NPRS score on activity, age, gender, number of comorbidities, duration of pain treatment, and number of clinic visits for pain. Results The mean age of the 227 patients, who met the inclusion criteria, was 39 years and 68% of them were male. Sixty-three percent of the patients were prescribed opioid analgesics, and 61% of them had shoulder pain, 29% had back pain, and 10% had lower extremity pain (eg, hip, thigh, lower leg, knee, ankle, and foot pain). Tramadol was the most commonly prescribed opioid analgesic (82%), followed by codeine (13%). Ninety-seven percent of patients who were prescribed non-opioid analgesics had shoulder pain. Patients with shoulder pain had lower odds of receiving opioid analgesics (OR=0.019, P<0.0001, 95% CI=0.004–0.081) in comparison to their counterparts who had lower extremity or back pains. Moreover, the higher the pain score on activity was, the higher odds of receiving opioid analgesics (OR=1.317, P<0.0001, 95% CI=1.029–1.685). Conclusion Future studies should explore the impact of different opioid prescribing policies to improve the quality of patient care and reduce the unnecessary prescribing of opioids for patients with non-cancer musculoskeletal pain.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hawazin Alhazzani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghaida Alhindi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Maryam Alarfaj
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama Almutairi
- Department of Pharmacy, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Miteb Alanazi
- Department of Pharmacy, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Khaulah Alokili
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faris Alodaibi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Adel S Bashatah
- Department of Nursing Education and Administration, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hisham Alsanawi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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15
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Borodulina IV, Badalov NG, Mukhina AA, Gushcha AO, Marfina TV, Volovets SA. [General hydro galvanic baths in the treatment of patients with lumbosacral radiculopathy]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:35-42. [PMID: 32592568 DOI: 10.17116/kurort20209703135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hydrogalvanic baths are a hydrotherapy method based on the combined effect of electric current and fresh water on the body. AIM OF STUDY Scientific evidence and evaluation of the effectiveness of use of general hydrogalvanic baths in the treatment of patients with lumbosacral radiculopathy with the background of degenerative spinal disorder. MATERIALS AND METHODS A randomized comparative clinical trial included 84 patients. The 1st (active) group included 43 patients, the 2nd (control) had 41 patients. Patients of the 1st group received general hydrogalvanic baths. Patients in the control group - drug treatment, including NSAIDs, muscle relaxants, anticonvulsants. The assessment was carried out before treatment, at the end of the course (on the 14th day) and 3 months after the end of treatment according to the results of neurological examination, VAS questionnaires, Pain DETECT, Beck scale, Oswestry scale, SF-36 scales, electroneuromyography (nerve conduction study). RESULTS In patients receiving general hydrogalvanic baths, in comparison with the control group, there was an improvement in sensitivity (the incidence of hypesthesia decreased from 77 to 11%, p=0.008) and conductivity in peripheral sensory fibers. A decrease in pain was observed in both groups, however, a decrease in neuropathic pain was recorded only in patients receiving drug treatment. In the 1st group during therapy, an improvement in the emotional state in patients and a decrease in the level of depression were revealed. An analysis of long-term results showed that the delayed effect of non-drug treatment significantly increased in patients of the 1st group in comparison with the control group (p<0.05). CONCLUSIONS Exposure to general hydrogalvanic baths is an effective way to treat lumbosacral radiculopathy, the main registered effects are: improvement of sensitivity, reduction of pain and stabilization of the emotional background. However, the studied method does not affect neuropathic pain.
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Affiliation(s)
- I V Borodulina
- Medical scientific educational center, Moscow state university named after M.V. Lomonosov, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - N G Badalov
- Scientific practical center of medical and social rehabilitation named after L.I. Shvetsova, Moscow, Russia.,First Moscow state medical university named after I.M. Sechenov, Moscow, Russia
| | - A A Mukhina
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A O Gushcha
- Scientific center of neurology, Moscow, Russia
| | - T V Marfina
- Medical scientific educational center, Moscow state university named after M.V. Lomonosov, Moscow, Russia
| | - S A Volovets
- Scientific practical center of medical and social rehabilitation named after L.I. Shvetsova, Moscow, Russia
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16
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Bell JE, Sequeira SB, Chen DQ, Haug EC, Werner BC, Browne JA. Preoperative Pain Management: Is Tramadol a Safe Alternative to Traditional Opioids Before Total Hip Arthroplasty? J Arthroplasty 2020; 35:2886-2891.e1. [PMID: 32466997 DOI: 10.1016/j.arth.2020.04.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preoperative opioid use has been associated with worse clinical outcomes and higher rates of prolonged opioid use following lower extremity arthroplasty. Tramadol has been recommended for management of osteoarthritis-related pain; however, outcomes following total hip arthroplasty (THA) in patients taking tramadol in the preoperative period have not been well described. The aim of this study is to examine the effect of preoperative tramadol use on postoperative outcomes in patients undergoing elective THA. METHODS A total of 5304 patients who underwent primary THA for degenerative hip pathology from 2008 to 2014 were identified using the Humana Claims Database. Patients were grouped by preoperative pain management modality into 3 mutually exclusive populations including tramadol, traditional opioid, or nonopioid only. A multivariate logistic regression was used to evaluate all postsurgical outcomes of interest. RESULTS Tramadol users had an increased risk of developing prolonged narcotic use (odds ratio [OR], 2.17; confidence interval [CI], 1.89-2.49; P < .001) following surgery compared to nonopioid-only users. When compared to traditional opioid use, tramadol use was associated with decreased risk of subsequent 90-day minor medical complications (OR, 0.75; CI, 0.62-0.90; P = .002), emergency department visits (OR, 0.70; CI, 0.57-0.85; P < .001), and prolonged narcotic use (OR, 0.43; CI, 0.37-0.49; P < .001). Traditional opioid use significantly increased length of stay by 0.20 days (P = .001) when compared to tramadol use. CONCLUSION Preoperative tramadol use is associated with prolonged opioid use following THA but is not associated with other postoperative complications. Patients taking tramadol preoperatively appear to have a lower risk of postoperative complications compared to patients taking traditional opioids preoperatively.
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Affiliation(s)
- Joshua E Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Sean B Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Dennis Q Chen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Emanuel C Haug
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Franz S, Schulz B, Wang H, Gottschalk S, Grüter F, Friedrich J, Glaesener JJ, Bock F, Schott C, Müller R, Schultes K, Landmann G, Gerner HJ, Dietz V, Treede RD, Weidner N. Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2019; 17:Doc05. [PMID: 31354397 PMCID: PMC6637293 DOI: 10.3205/000271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Indexed: 12/19/2022]
Abstract
Introduction: Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain. Methods: The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie – DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the “German instrument for methodological guideline appraisal”. Results: This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain. Discussion: Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Barbara Schulz
- BG Klinikum Bergmannstrost, Abteilung Medizinische Psychologie, Spezielle Traumatherapie (DeGPT), Hypnotherapie und Hypnose (DGH), Halle, Germany
| | - Haili Wang
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Gottschalk
- Zentralklinik Bad Berka GmbH, Querschnittgelähmten-Zentrum/Klinik für Paraplegiologie und Neuro-Urologie, Bad Berka, Germany
| | - Florian Grüter
- Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Beelitz-Heilstätten, Germany
| | | | | | | | - Cordelia Schott
- Orthopädische Privatpraxis Schott (OPS), Im Medizinischen Zentrum Essen, Germany
| | | | - Kevin Schultes
- Fördergemeinschaft der Querschnittgelähmten in Deutschland e.V., Lobbach, Germany
| | - Gunther Landmann
- Center for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Hans Jürgen Gerner
- Fördergemeinschaft der Querschnittgelähmten in Deutschland e.V., Lobbach, Germany
| | - Volker Dietz
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Rolf-Detlef Treede
- Chair of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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Campbell P, Lewis M, Chen Y, Lacey RJ, Rowlands G, Protheroe J. Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis. BMC FAMILY PRACTICE 2019; 20:101. [PMID: 31319792 PMCID: PMC6637599 DOI: 10.1186/s12875-019-0994-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
Background People with low health literacy (HL) are at increased risk of poor health outcomes, and receive less benefit from healthcare services. However, healthcare practitioners can effectively adapt healthcare information if they are aware of their patients’ HL. Measurements are available to assess HL levels but may not be practical for use within primary care settings. New alternative methods based on demographic indicators have been successfully developed, and we aim to test if such methodology can be applied to routinely collected consultation records. Methods Secondary analysis was carried out from a recently completed prospective cohort study that investigated a primary care population who had consulted about a musculoskeletal pain problem. Participants completed questionnaires (assessing general health, HL, pain, and demographic information) at baseline and 6 months, with linked data from the participants’ consultation records. The Single Item Literacy Screener was used as a benchmark for HL. We tested the performance of an existing demographic assessment of HL, whether this could be refined/improved further (using questionnaire data), and then test the application in primary care consultation data. Tests included accuracy, sensitivity, specificity, and area under the curve (AUC). Finally, the completed model was tested prospectively using logistic regression producing odds ratios (OR) in the prediction of poor health outcomes (physical health and pain intensity). Results In total 1501 participants were included within the analysis and 16.1% were categorised as having low HL. Tests for the existing demographic assessment showed poor performance (AUC 0.52), refinement using additional components derived from the questionnaire improved the model (AUC 0.69), and the final model using data only from consultation data remained improved (AUC 0.64). Tests of this final consultation model in the prediction of outcomes showed those with low HL were 5 times more likely to report poor health (OR 5.1) and almost 4 times more likely to report higher pain intensity (OR 3.9). Conclusions This study has shown the feasibility of the assessment of HL using primary care consultation data, and that people indicated as having low HL have poorer health outcomes. Further refinement is now required to increase the accuracy of this method.
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Affiliation(s)
- Paul Campbell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. .,Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, ST16 3AG, UK.
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Ying Chen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Rosie J Lacey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Gillian Rowlands
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
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Esakkimuthu S, Mutheeswaran S, Elankani P, Pandikumar P, Ignacimuthu S. Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India. J Ayurveda Integr Med 2019; 12:58-64. [PMID: 31003860 PMCID: PMC8039335 DOI: 10.1016/j.jaim.2018.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022] Open
Abstract
Background Siddha is one of the traditional medical systems of India; previous ethnobotanical survey in Virudhunagar district indicated a high consensus for treating musculoskeletal ailments. Objectives This study was aimed to quantitatively document the medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India. Materials and methods This work was the outcome of free-list interviews conducted among 45 informants between April 2016 and January 2017. Sampling sufficiency was assessed by plotting Shannon–Wiener's index and cumulative number of UR. Informant consensus was assessed using Informant Consensus Factor (Fic) and Informant Agreement Ratio (IAR). Results This study recorded the data regarding 116 plant species which were used to prepare 129 formulations; analysis of the data yielded 490 UR. Among these, 65.3% of UR dealt with internal applications and 34.6% dealt with external applications. In the case of internally used formulations, pain and general musculoskeletal ailments had high Fic values. In the case of externally used formulations, headache and pain had high Fic values. Conclusion Important species prescribed by the informants to treat various musculoskeletal ailments were: Azima tetracantha, Ricinus communis, Sesamum indicum, Moringa oleifera, Cardiospermum halicacabum (internal application), Calophyllum inophyllum, Justicia adhatoda, Curcuma longa, Calotropis gigantea, Zingiber officinale, Withania somnifera, Strychnos nux-vomica, Dodonaea viscosa (external application), Azadirachta indica, Clerodendrum phlomidis,Delonix elata, Pergularia daemia and Vitex negundo (internal and external applications). Robust studies on these local claims will help to improve the community healthcare and will yield some novel agents to treat musculoskeletal ailments. Siddha is one of major traditional medicinal systems of India. Non-institutional training is still major in siddha system of medicine. This survey documented the plants used to treat various musculoskeletal ailments. Though there were some scientific evidences; many local claims lack rigorous studies. Further studies will yield some useful clues for the management of various MSDs.
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Affiliation(s)
- S Esakkimuthu
- Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai, Tamil Nadu, 600 034, India
| | - S Mutheeswaran
- Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai, Tamil Nadu, 600 034, India
| | - P Elankani
- Siddha Clinical Research Unit, Government Siddha Medical College Campus, Palayamkottai, Tirunelveli, 627 002, India
| | - P Pandikumar
- Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai, Tamil Nadu, 600 034, India.
| | - S Ignacimuthu
- Division of Ethnopharmacology, Entomology Research Institute, Loyola College, Nungambakkam, Chennai, Tamil Nadu, 600 034, India
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20
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Chen HY, Liu NY. Analgesic Effect of Sinew Acupuncture for Patients with Soft-Tissue Injuries: A Pilot Trial. Chin J Integr Med 2019; 25:613-616. [DOI: 10.1007/s11655-019-3061-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Indexed: 10/27/2022]
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21
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Zella MAS, May C, Müller T, Ahrens M, Tönges L, Gold R, Marcus K, Woitalla D. Landscape of pain in Parkinson’s disease: impact of gender differences. Neurol Res 2018; 41:87-97. [DOI: 10.1080/01616412.2018.1531208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Maria Angela Samis Zella
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
| | - Caroline May
- Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Müller
- Department of Neurology, St. Joseph Krankenhaus Berlin-Weißensee, Berlin, Germany
| | - Maike Ahrens
- Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katrin Marcus
- Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
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22
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Faria J, Barbosa J, Moreira R, Queirós O, Carvalho F, Dinis-Oliveira RJ. Comparative pharmacology and toxicology of tramadol and tapentadol. Eur J Pain 2018; 22:827-844. [PMID: 29369473 DOI: 10.1002/ejp.1196] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2018] [Indexed: 12/18/2022]
Abstract
Moderate-to-severe pain represents a heavy burden in patients' quality of life, and ultimately in the society and in healthcare costs. The aim of this review was to summarize data on tramadol and tapentadol adverse effects, toxicity, potential advantages and limitations according to the context of clinical use. We compared data on the pharmacological and toxicological profiles of tramadol and tapentadol, after an extensive literature search in the US National Library of Medicine (PubMed). Tramadol is a prodrug that acts through noradrenaline and serotonin reuptake inhibition, with a weak opioid component added by its metabolite O-desmethyltramadol. Tapentadol does not require metabolic activation and acts mainly through noradrenaline reuptake inhibition and has a strong opioid activity. Such features confer tapentadol potential advantages, namely lower serotonergic, dependence and abuse potential, more linear pharmacokinetics, greater gastrointestinal tolerability and applicability in the treatment of chronic and neuropathic pain. Although more studies are needed to provide clear guidance on the opioid of choice, tapentadol shows some advantages, as it does not require CYP450 system activation and has minimal serotonergic effects. In addition, it leads to less side effects and lower abuse liability. However, in vivo and in vitro studies have shown that tramadol and tapentadol cause similar toxicological damage. In this context, it is important to underline that the choice of opioid should be individually balanced and a tailored decision, based on previous experience and on the patient's profile, type of pain and context of treatment. SIGNIFICANCE This review underlines the need for a careful prescription of tramadol and tapentadol. Although both are widely prescribed synthetic opioid analgesics, their toxic effects and potential dependence are not completely understood yet. In particular, concerning tapentadol, further research is needed to better assess its toxic effects.
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Affiliation(s)
- J Faria
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J Barbosa
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Moreira
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - O Queirós
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - F Carvalho
- Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal
| | - R J Dinis-Oliveira
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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23
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Zhao B, Yu Y, Liu W, Du J. Efficacy of arthroscopic loose body removal for knee osteoarthritis. Exp Ther Med 2018; 15:1666-1671. [PMID: 29399135 DOI: 10.3892/etm.2017.5564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/28/2017] [Indexed: 11/05/2022] Open
Abstract
The purpose of the present study was to explore the efficacy of arthroscopic loose body removal for knee osteoarthritis (KOA). A total of 23 patients with KOA were enrolled and randomly received conservative treatment (conservative group; n=10) or loose body removal surgery (surgery group; n=13). The serum levels of disease activity indices, including hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and synovial inflammatory factors [interleukin (IL)-1 and IL-6] were detected prior to surgery, and at 4 days, 2 or 4 weeks after surgery. All patients were followed up for 2 years and the cure rate was estimated. No significant difference was identified in pre-operative plasma levels of hs-CRP and ESR as well as the synovial concentration of IL-1 and IL-6 between the two groups (all P>0.05). At 2 and 4 weeks after treatment, the levels of these parameters in the surgery group were significantly lower than those in the conservative group (all P<0.05), although the maximum value of these parameters was higher in the surgery group than in the conservative group at 4 days after surgery. The cure rate for KOA in the surgery group was significantly higher than that in the conservative group. In conclusion, the results demonstrated that arthroscopic loose body removal is a more effective treatment than conservative therapy for KOA.
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Affiliation(s)
- Baoxiang Zhao
- Department of Orthopaedics, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Yibo Yu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Orthopaedics, Chinese Medicine Hospital in Linyi City, Linyi, Shandong 276002, P.R. China
| | - Wenquan Liu
- Department of Orthopaedics, Chinese Medicine Hospital in Linyi City, Linyi, Shandong 276002, P.R. China
| | - Jian Du
- Department of Orthopaedics, Lanshan District People's Hospital, Linyi, Shandong 276000, P.R. China
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24
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Lin XH, Young SH, Luo JC, Peng YL, Chen PH, Lin CC, Chen WM, Hou MC, Lee FY. Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide Population-Based Cohort Study. PAIN MEDICINE 2018; 19:225-231. [DOI: 10.1093/pm/pnx097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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25
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GPs' views and experiences of prescribing non-steroidal anti-inflammatory drugs: a qualitative study. BJGP Open 2017; 1:bjgpopen17X100869. [PMID: 30564663 PMCID: PMC6169948 DOI: 10.3399/bjgpopen17x100869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in primary care despite being a high-risk drug group causing significant adverse events, yet little is known about GPs’ perceptions of NSAID risks and benefits. Aim To explore GPs’ experiences with NSAID prescribing and views about the risks and benefits of this group of medicines. Design & setting A qualitative, inductive study in general practice. Method Individual interviews with 15 GPs using a semi-structured interview guide. Interviews were audiorecorded and transcribed. An inductive, thematic approach was used for analysis. Sampling continued until data saturation was achieved. Results Three main themes illustrate GPs’ key concerns with managing NSAID risks. The first theme was perceptions of risks and benefits of NSAIDs: GPs expressed differing attitudes towards prescribing medication generally. GPs were aware of the general risks of NSAIDs but weighed these up against specific risk factors and potential benefits for particular patients. They were most concerned about long-term use, risks for children, older people, and patients with comorbidities. The second theme was assessing and mitigating risks when prescribing NSAIDs: GPs considered gastric, cardiac, and renal risks of patients as well as drug interactions. Mitigation strategies included alternative treatment, choice and dose of NSAID, and use of gastroprotective agents. The final theme was other factors impacting on NSAID risks: particularly patient expectations and over-the-counter (OTC) availability. Conclusion NSAID prescribing is a complex balance between pragmatism and potential adverse events. Given the costs of morbidity, hospitalisation, and patient demand there is an urgent need to secure a more detailed evidence base and develop practical pathways to support safer prescribing.
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Schlaeger JM, Roach K, Golas M, Takayama M, Wilkie DJ. Treatment-Seeking Behaviors of Persons With Rheumatoid Arthritis. J Holist Nurs 2017; 36:179-191. [PMID: 28506103 DOI: 10.1177/0898010117693539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Describe perceptions of patients with rheumatoid arthritis (RA) regarding disease-related pain, tendency to tell others about their pain, and treatments used since diagnosis. DESIGN Cross sectional, exploratory. METHOD A total of 63 participants responded to telephone interview about their treatments and tendency to tell others about their RA pain. They also responded to McGill Pain Questionnaire and Health Assessment Questionnaire (HAQ) items. Participants marked pain location on mailed body outlines. FINDINGS RA diagnosis occurred an average of 11 years prior. Mean HAQ Standard Disability Index score was 1.26. Previous week symptoms were joint pain (97%), joint swelling (83%), decreased movement/function (83%), fatigue (70%), muscle weakness (65%). Mean morning stiffness duration was 120 ± 137 minutes. Mean pain intensity was 1.15 ± 0.6 at its least and 3.8 ± 1.1 at its worst. 65% were not satisfied with pain levels. 57% stated a tendency not to tell others about their pain; 43% tended to tell. 78% used medications and alternative therapies, none solely used alternative therapies, and 22% only used medications. CONCLUSIONS RA patients reported high rates of alternative therapy use. Dissatisfaction with pain levels indicates need for improved pain management. Not talking about pain lends insights into the importance of teaching patients to communicate their pain to others.
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Affiliation(s)
| | | | - Mary Golas
- University of Illinois at Chicago, Chicago.,Jesse Brown VA Medical Center Chicago, Chicago
| | - Miho Takayama
- Tokyo Ariake University of Medical and Health Sciences, Japan
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27
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Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food 2017; 19:717-29. [PMID: 27533649 PMCID: PMC5003001 DOI: 10.1089/jmf.2016.3705] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although turmeric and its curcumin-enriched extracts have been used for treating arthritis, no systematic review and meta-analysis of randomized clinical trials (RCTs) have been conducted to evaluate the strength of the research. We systemically evaluated all RCTs of turmeric extracts and curcumin for treating arthritis symptoms to elucidate the efficacy of curcuma for alleviating the symptoms of arthritis. Literature searches were conducted using 12 electronic databases, including PubMed, Embase, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were “turmeric,” “curcuma,” “curcumin,” “arthritis,” and “osteoarthritis.” A pain visual analogue score (PVAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used for the major outcomes of arthritis. Initial searches yielded 29 articles, of which 8 met specific selection criteria. Three among the included RCTs reported reduction of PVAS (mean difference: −2.04 [−2.85, −1.24]) with turmeric/curcumin in comparison with placebo (P < .00001), whereas meta-analysis of four studies showed a decrease of WOMAC with turmeric/curcumin treatment (mean difference: −15.36 [−26.9, −3.77]; P = .009). Furthermore, there was no significant mean difference in PVAS between turmeric/curcumin and pain medicine in meta-analysis of five studies. Eight RCTs included in the review exhibited low to moderate risk of bias. There was no publication bias in the meta-analysis. In conclusion, these RCTs provide scientific evidence that supports the efficacy of turmeric extract (about 1000 mg/day of curcumin) in the treatment of arthritis. However, the total number of RCTs included in the analysis, the total sample size, and the methodological quality of the primary studies were not sufficient to draw definitive conclusions. Thus, more rigorous and larger studies are needed to confirm the therapeutic efficacy of turmeric for arthritis.
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Affiliation(s)
- James W Daily
- 1 Department of R&D Daily Manufacturing, Inc. , Rockwell, North Carolina, USA
| | - Mini Yang
- 2 Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University , Asan, South Korea
| | - Sunmin Park
- 2 Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University , Asan, South Korea
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28
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Ernstzen DV, Louw QA, Hillier SL. Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review. Implement Sci 2017; 12:1. [PMID: 28057027 PMCID: PMC5217556 DOI: 10.1186/s13012-016-0533-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/07/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. METHODS A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II. RESULTS Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription. CONCLUSION Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations. TRIAL REGISTRATION PROSPERO CRD42015022098 .
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Affiliation(s)
- Dawn V. Ernstzen
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Quinette A. Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Susan L. Hillier
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
- Sansom Institute for Health Research, University of South Australia, Adelaide, 5000 Australia
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29
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Shinde VA, Kalikar M, Jagtap S, Dakhale GN, Bankar M, Bajait CS, Motghare VM, Pashilkar AA, Raghute LB, Khamkar AD. Efficacy and Safety of Oral Diclofenac Sustained release Versus Transdermal Diclofenac Patch in Chronic Musculoskeletal Pain: A Randomized, Open Label Trial. J Pharmacol Pharmacother 2017; 8:166-171. [PMID: 29472748 PMCID: PMC5820746 DOI: 10.4103/jpp.jpp_35_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: To compare the efficacy, safety, and tolerability of transdermal patches of diclofenac sodium with oral diclofenac sustained release (SR) in patients of chronic musculoskeletal MSK pain conditions. Materials and Methods: The eligible patients were given either transdermal diclofenac patch or tablet diclofenac SR. Pain was assessed at 2 and 4 weeks using a visual analog scale. Adverse events were recorded. Patients with 18–65 years old of either gender with score of ≥4 on a 11-item numeric rating scale-numeric version of visual analog scale for pain with diagnosis of primary osteoarthritis (OA) of the knee or hand of at least 3 months duration, with independent radiological confirmation of OA or having pain associated with other MSK conditions such as soft-tissue rheumatism, cervical and lumbar back pain, and fibromyalgia, of at least 3 months duration were included in this study. Results: Transdermal diclofenac diethylamine patch and tablet diclofenac sodium sustained release (SR) do not significantly differ in the reduction of numerical rating scores at the end of 4 weeks (P = 0.8393). Conclusion: Transdermal diclofenac was equi-efficacious as tablet diclofenac sodium SR in reducing pain due to chronic MSK pain conditions.
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Affiliation(s)
- Viraj Ashok Shinde
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Mrunalini Kalikar
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Satyajeet Jagtap
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Ganesh N Dakhale
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Mangesh Bankar
- Department of Pharmacology, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar, India
| | - Chaitali S Bajait
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Vijay M Motghare
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Ashlesha A Pashilkar
- Department of Pharmaceutics, Dadasaheb Balpande College of Pharmacy, Nagpur, Maharashtra, India
| | - Latesh B Raghute
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Ajita D Khamkar
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
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30
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Chun K, Kim SO, Lee SH. Analgesic effects of 1,2,3,4,6-penta-O-galloyl-β-D-glucose in an animal model of lipopolysaccharide-induced pain. Int J Mol Med 2016; 38:1264-70. [PMID: 27600119 DOI: 10.3892/ijmm.2016.2726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 08/24/2016] [Indexed: 11/05/2022] Open
Abstract
We examined the analgesic effects of 1,2,3, 4,6-penta-O-galloyl-β-D-glucose (β-PGG), a prototypical gallotannin, in an animal model of lipopolysaccharide (LPS)‑induced pain. To evaluate the analgesic activity of β-PGG, we assessed the potential of β-PGG to inhibit the generation of nitric oxide (NO) in LPS-stressed RAW 264.7 cells, and found that β-PGG inhibits NO generation in a dose-dependent manner. Furthermore, the effects of β-PGG on the voluntary movements of LPS-exposed animals were evaluated. The results showed that the voluntary movements of animals were markedly recovered after β-PGG treatment. The mRNA expression of interleukin (IL)-1β (1.33±0.38-fold) and IL-6 (0.64±0.40-fold) in the brain tissue of β-PGG-treated animals markedly decreased compared with that observed in the control groups (3.86±0.91 and 2.45±1.12-fold, respectively) and in the other LPS-administered groups. The results showed that β-PGG has potential to alleviate pain, not only by decreasing cellular NO generation in RAW 264.7 cells but also by the recovery of voluntary movement lost owing to inflammatory pain. This suggests that β-PGG is comparable to ibuprofen, which was used as a positive control in this study. Collectively, these findings suggest that β-PGG is a valuable natural compound which possesses analgesic activity.
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Affiliation(s)
- Kun Chun
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Si-Oh Kim
- Department of Anesthesiology, Kyungpook National University School of Medicine, Daegu 41944, Republic of Korea
| | - Sang-Han Lee
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Republic of Korea
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Abstract
In elderly patients, persistent pain negatively impacts quality of life. An interdisciplinary approach to pain management and emphasis on quality improvement will help to achieve better therapeutic outcomes. Managing pain in the geriatric population is challenging because of age-related changes in pain perception, cognition, pharmacokinetics, and drug effects. Improvement and maintenance of physical and emotional function is the goal. Pharmacotherapy should be initiated conservatively and titrated to effective doses with minimal adverse effects. Milder pain should be treated with non-opioid analgesics with a progression toward opioids and/or adjuvant medications as the pain intensifies. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications represent most of the analgesic agents used in pain management. Knowing the underlying mechanism of pain will help guide pharmacologic therapy. The patient should be monitored initially, with every dose change, and periodically to assess efficacy and severity of adverse effects.
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Affiliation(s)
- Meri D. Hix
- Midwestern University Chicago College of Pharmacy and Clinical Pharmacist-Internal Medicine at Loyola University Medical Center,
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32
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Prescribing patterns of non-steroidal anti-inflammatory drugs in chronic kidney disease patients in the South African private sector. Int J Clin Pharm 2016; 38:863-9. [DOI: 10.1007/s11096-016-0298-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/29/2016] [Indexed: 01/10/2023]
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33
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Dresner D, Gergen Barnett K, Resnick K, Laird LD, Gardiner P. Listening to Their Words: A Qualitative Analysis of Integrative Medicine Group Visits in an Urban Underserved Medical Setting. PAIN MEDICINE 2016; 17:1183-1191. [PMID: 27040666 DOI: 10.1093/pm/pnw030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Integrative Medicine Group Visits (IMGVs) are an 8-week outpatient medical group visit program for chronic pain patients combining mindfulness-based stress reduction (MBSR), integrative medicine, and patient education. The authors conducted a qualitative study with IMGV participants to better understand the effects of IMGVs on patients' health. DESIGN This qualitative study enrolled a convenience sample of 19 participants from the parent prospective observational cohort study of IMGVs (n = 65). All participants in the parent study were invited to participate. SETTING Boston Medical Center (BMC) is a private, not-for-profit, 496-bed, academic medical center and the largest safety net hospital in New England. SUBJECTS Individuals in this study had a diagnosis of chronic pain and/or one or more chronic conditions (e.g., diabetes, depression, or metabolic syndrome), had attended ≥1 group visit, and their 8-week session had ended before completing the interview. METHODS The authors conducted individual semi-structured interviews. Interviews were audio-taped, transcribed, and analyzed. RESULTS Participants cite gains from IMGVs including improved self-monitoring, self-regulation, and increased mindfulness. The group setting leads patients to feel "not alone" in their health conditions, gain a sense of perspective on their health, and share coping strategies in a supportive network. These improvements in physical and mental health improved clinical outcomes for participants including reductions in pain. CONCLUSIONS Group visits and integrative medicine both offer some potential solutions in the treatment of chronic pain. Models such as IMGVs can help individuals living with chronic conditions, addressing their emotional and physical health needs.
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Affiliation(s)
- Danielle Dresner
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Kirsten Resnick
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lance D Laird
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Paula Gardiner
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Park S, Lee LR, Seo JH, Kang S. Curcumin and tetrahydrocurcumin both prevent osteoarthritis symptoms and decrease the expressions of pro-inflammatory cytokines in estrogen-deficient rats. GENES AND NUTRITION 2016; 11:2. [PMID: 27482294 PMCID: PMC4959551 DOI: 10.1186/s12263-016-0520-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022]
Abstract
Background Menopausal symptoms are associated with inflammation. Curcumin is a well-known anti-inflammatory bioactive compound from turmeric whereas tetrahydrocurcumin (THC) is a major metabolite of curcumin that may have different efficacies. However, they have not been studied for anti-menopausal symptoms and anti-osteoarthritis effects. We compared the efficacies of curcumin and THC for preventing postmenopausal and osteoarthritis symptoms in ovariectomized (OVX) obese rats with monoiodoacetate (MIA) injections into the right knee to generate a similar pathology as osteoarthritis. Methods OVX rats were provided a 45 % fat diet containing either (1) 0.4 % curcumin (curcumin), (2) 0.4 % THC, (3) 30 μg/kg body weight 17β-estradiol + 0.4 % dextrin (positive control), (4) 0.4 % dextrin (placebo; control), or (5) 0.4 % dextrin with no MIA injection (normal control) for 4 weeks. At the beginning of the fifth week, OVX rats were given articular injections of MIA or normal-control saline into the right knee and the assigned diets were provided for an additional 3 weeks. Results Curcumin and THC had similar efficacies for skin tail temperature in OVX rats whereas THC, but not curcumin, prevented glucose intolerance, which might be involved in exacerbating osteoarthritis. Both protected against osteoarthritis symptoms and pain-related behaviors better than 17β-estradiol treatment in estrogen-deficient rats. Curcumin and THC prevented the deterioration of articular cartilage compared to control. They also maintained lean body mass and lowered fat mass as much as 17β-estradiol treatment. The improvement in osteoarthritis symptoms was associated with decreased gene expressions of matrix metalloproteinase (MMP)3 and MMP13 and tumor necrosis factor-α, interleukin (IL)1β, and IL6 in the articular cartilage. Conclusions THC and curcumin are effective for treating postmenopausal and osteoarthritis symptoms in OVX rats with MIA-induced osteoarthritis-like symptoms and may have potential as interventions for menopausal and osteoarthritic symptoms in humans.
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Affiliation(s)
- Sunmin Park
- Department of Food and Nutrition, College of Natural Sciences, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do 336-795 South Korea
| | - La Ra Lee
- Department of Food and Nutrition, College of Natural Sciences, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do 336-795 South Korea
| | - Ji Hyun Seo
- Department of Food and Nutrition, College of Natural Sciences, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do 336-795 South Korea
| | - Suna Kang
- Department of Food and Nutrition, College of Natural Sciences, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do 336-795 South Korea
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35
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Pergolizzi JV, Raffa RB, Nalamachu S, Taylor R. Evolution to low-dose NSAID therapy. Pain Manag 2016; 6:175-89. [PMID: 26980438 DOI: 10.2217/pmt.15.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
All NSAIDs are to varying degrees associated with gastrointestinal, cardiovascular and renal adverse effects (AEs). Differences in selectivity for inhibition of the COX isozymes (COX-1/COX-2) have been used as an indicator of the likelihood of experiencing an AE, but the measure of 'selectivity' commonly used is less than desirable, and selectivity has not yielded unequivocal superior safety. Recent guidelines recommend that NSAIDs be used at the lowest effective dose and for the shortest period of time. In response, 'low-dose' NSAID formulations have been developed. Such formulations may help by reducing overall systemic exposure, thereby reducing the frequency or severity of AEs. It seems timely to review the need, rationale and application of such an approach.
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Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Robert B Raffa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
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Bassani AS, Banov D, Phan H. Characterization of the Percutaneous Absorption of Ketoprofen Using the Franz Skin Finite Dose Model. Postgrad Med 2016; 128:262-7. [PMID: 26788899 DOI: 10.1080/00325481.2016.1144448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Ketoprofen is an analgesic, anti-inflammatory agent commonly used in the management of chronic musculoskeletal pain. The aim of this study is to characterize the percutaneous absorption of 2 ketoprofen formulations (ketoprofen 10% in Pluronic Lecithin Organogel (PLO) and ketoprofen 10% in Lipoderm, referred to as phospholipid base), when applied to the human cadaver trunk skin, in vitro, using the Franz skin finite dose model. PLO and phospholipid base are vehicles used to facilitate the delivery of drugs into and through the skin following topical applications. METHODS The percutaneous absorption of ketoprofen was evaluated using human cadaver trunk skin from 3 donors. The skin was cut into small sections and cultured within Franz diffusion cells. A variable finite dose of each formulation was then applied to 3 replicate skin sections per donor and receptor solutions were collected at predetermined time points (0, 4, 8, 12, 24, 32, and 48 hr). After the last receptor sample was collected, skin surfaces were washed and split into epidermis and dermis. Collected samples were analyzed using HPLC. RESULTS Both PLO and phospholipid base were capable of facilitating the absorption of ketoprofen across human cadaver trunk skin. However, ketoprofen, when in phospholipid base, showed higher mean total absorption (p = 0.022) and faster rate of absorption (p < 0.05 at 2, 6, 10, and 18 hr) than when in PLO. CONCLUSION Chronic musculoskeletal pain can be a major burden for most patients, affecting their lifestyle and reducing overall quality of life. When compared to PLO, phospholipid base has the ability to potentially deliver higher concentrations of ketoprofen to underlying soft tissues and at a more rapid rate. With more ketoprofen at the site of injury, the analgesic and anti-inflammatory effects will likely be enhanced, potentially reducing pain and improving quality of life.
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Affiliation(s)
- August S Bassani
- a Research and Development, Professional Compounding Centers of America (PCCA) , Houston , TC , USA
| | - Daniel Banov
- a Research and Development, Professional Compounding Centers of America (PCCA) , Houston , TC , USA
| | - Ha Phan
- a Research and Development, Professional Compounding Centers of America (PCCA) , Houston , TC , USA
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Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus 2015; 24:483-9. [PMID: 25801891 DOI: 10.1177/0961203314558676] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The current mode of therapy for many patients with musculoskeletal pain is unsatisfactory. PURPOSE We aimed to assess the impact of adding 4000 IU of vitamin D on pain and serological parameters in patients with musculoskeletal pain. MATERIALS AND METHODS This was a randomized, double-blinded and placebo-controlled study assessing the effect of 4000 IU of orally given vitamin D3 (cholecalciferol) (four gel capsules of 1000 IU, (SupHerb, Israel) vs. placebo on different parameters of pain. Eighty patients were enrolled and therapy was given for 3 months. Parameters were scored at three time points: prior to intervention, at week 6 and week 12. Visual analogue scale (VAS) scores of pain perception were recorded following 6 and 12 weeks. We also measured serum levels of leukotriene B4 (LTB4), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and prostaglandin E2 (PGE2) by ELISA. RESULTS The group receiving vitamin D achieved a statistically significant larger decline of their VAS measurement throughout the study compared with the placebo group. The need for analgesic 'rescue therapy' was significantly lower among the vitamin D-treated group. TNFα levels decreased by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group. PGE2 decreased by39.2% in the group treated with vitamin D and increased by 16% in the placebo group. LTB4 levels decreased in both groups by 24% (p < 0.05). CONCLUSION Adding 4000 IU of vitamin D for patients with musculoskeletal pain may lead to a faster decline of consecutive VAS scores and to a decrease in the levels of inflammatory and pain-related cytokines.
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Affiliation(s)
- O Gendelman
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Itzhaki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Central Laboratory of Clalit Health Services, Tel-Aviv, Israel
| | - S Makarov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - M Bennun
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - H Amital
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Orrock PJ. The patient experience of osteopathic healthcare. ACTA ACUST UNITED AC 2015; 22:131-7. [PMID: 26718053 DOI: 10.1016/j.math.2015.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 08/10/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Osteopathy in Australia is a primary care limited scope practice. Practitioner surveys suggest that patients present with chronic pain and receive manual therapies, exercise and lifestyle advice. Further research is required to deepen the understanding of this intervention from the perspective of patients. OBJECTIVE To explore the experience of patients receiving osteopathic healthcare. DESIGN Mixed methodology. METHOD A quantitative survey of a convenience sample of patients was followed by qualitative semi-structured interviews in a purposive sample of respondents with chronic non-specific low back pain. The transcripts were analysed using a phenomenological approach. RESULTS The survey results suggested directions of enquiry for the interviews. Eleven subjects were interviewed and reported commonalities in their clinical histories with multisystem co-morbidities. Four themes became apparent: patient decision-making, patient shared experiences of the osteopathic healthcare consultation, tailored patient-centred care, and therapeutic relationship in healthcare. CONCLUSION This data suggests that patients experience osteopathic healthcare after trying other disciplines; that there are shared aspects of the consultations, with a thorough assessment, education about their condition, multiple manual therapies and lifestyle advice; that the experience is patient-centred and tailored to their context; and that the therapeutic relationship is a key aspect of the experience. These results reflect a number of aspects of osteopathic healthcare from workplace surveys.
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Affiliation(s)
- Paul J Orrock
- Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.
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Sousa CM, Coimbra D, Machado J, Greten HJ. Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: a randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2015; 13:314-8. [PMID: 26343102 DOI: 10.1016/s2095-4964(15)60194-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. OBJECTIVE To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n=39) and the control (n=30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. MAIN OUTCOME MEASURES Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. RESULTS In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. CONCLUSION The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.
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Affiliation(s)
- Cláudia Maria Sousa
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-030 Porto, Portugal; E-mail:
| | - Daniela Coimbra
- Porto Polytechnic Institute, Superior School of Music and PerformingArts, 4000-035 Porto, Portugal
| | - Jorge Machado
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-030 Porto, Portugal
| | - Henry J Greten
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-030 Porto, Portugal.,German Society of Traditional Chinese Medicine, 69126 Heidelberg, Germany.,Heidelberg School of Chinese Medicine, 69126 Heidelberg, Germany
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Sousa CM, Moreira L, Coimbra D, Machado J, Greten HJ. Immediate effects of Tuina techniques on working-related musculoskeletal disorder of professional orchestra musicians. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2015; 13:257-61. [PMID: 26165370 DOI: 10.1016/s2095-4964(15)60181-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Musicians are a prone group to suffer from working-related musculoskeletal disorder (WRMD). Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their efficiency is sometimes disappointing. OBJECTIVE The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS We performed a prospective, controlled, single-blinded, randomized study. Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group (n=39) and the control group (n=30). During an individual interview, Chinese diagnosis took place and treatment points were chosen. Real acupoints were treated by Tuina techniques into the experimental group and non-specific skin points were treated into the control group. Pain was measured by verbal numerical scale before and immediately after intervention. RESULTS After one treatment session, pain was reduced in 91.8% of the cases for the experimental group and 7.9% for the control group. CONCLUSION Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal, further investigations with stronger measurements, double-blinding designs and bigger simple sizes are needed.
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Affiliation(s)
- Cláudia Maria Sousa
- University of Porto, Institute of Biomedical Sciences Abel Salazar, 4099-030 Porto, Portugal
| | - Luis Moreira
- Jean Piaget Health Superior School, 4405-708 Gaia, Portugal
- Research in Education and Community Intervention - RECI, 3515-776 Viseu, Portugal
| | - Daniela Coimbra
- Porto Polytechnic Institute, Superior School of Music and PerformingArts, i2ads, 4000-035 Porto, Portugal
| | - Jorge Machado
- University of Porto, Institute of Biomedical Sciences Abel Salazar, 4099-030 Porto, Portugal
| | - Henry J Greten
- University of Porto, Institute of Biomedical Sciences Abel Salazar, 4099-030 Porto, Portugal
- German Society of Traditional Chinese Medicine, 69126 Heidelberg, Germany
- Heidelberg School of Chinese Medicine, 69126 Heidelberg, Germany
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Biondi DM, Xiang J, Etropolski M, Moskovitz B. Evaluation of blood pressure and heart rate in patients with hypertension who received tapentadol extended release for chronic pain: a post hoc, pooled data analysis. Clin Drug Investig 2015; 34:565-76. [PMID: 24916058 PMCID: PMC4102827 DOI: 10.1007/s40261-014-0209-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background and Objectives Hypertension is one of the most common co-existing conditions in patients with chronic pain, and the potential effects of an analgesic on heart rate and blood pressure are of particular concern for patients with hypertension. The purpose of this analysis was to evaluate changes in blood pressure and heart rate with tapentadol extended release (ER) treatment in patients with hypertension. Methods We performed a post hoc analysis of data pooled from three randomized, placebo- and active-controlled, phase III studies of tapentadol ER for managing chronic osteoarthritis knee (NCT00421928, NCT00486811) or low back (NCT00449176) pain (15-week, double-blind treatment period). Data were independently analyzed for patients with a listed medical history of hypertension at baseline and patients with at least one listed concomitant antihypertensive medication at baseline. Heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at each visit. Results In patients with a listed medical history of hypertension (n = 1,464), least-squares mean (LSM [standard error (SE)]) changes from baseline to endpoint with placebo, tapentadol ER, and oxycodone HCl controlled release (CR), respectively, were −0.7 (0.44), 0.2 (0.43), and −0.9 (0.45) beats per minute (bpm) for heart rate; −2.4 (0.64), −2.7 (0.64), and −3.7 (0.67) mmHg for SBP; and −1.0 (0.39), −1.3 (0.39), and −2.3 (0.41) mmHg for DBP; in patients with at least one listed concomitant antihypertensive medication (n = 1,376), the LSM (SE) changes from baseline to endpoint were −0.6 (0.45), 0.1 (0.44), and −0.7 (0.47) bpm for heart rate; −1.8 (0.66), −3.3 (0.65), and −3.7 (0.69) mmHg for SBP; and −0.7 (0.40), −1.4 (0.40), and −2.3 (0.42) mmHg for DBP. Conclusion No clinically meaningful mean changes in heart rate or blood pressure were observed for the evaluated cohorts of patients with hypertension who were treated with tapentadol ER (100–250 mg twice daily).
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Affiliation(s)
- David M Biondi
- US Medical Affairs, Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA,
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Danno K, Joubert C, Duru G, Vetel JM. Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort. Clin Epidemiol 2014; 6:333-41. [PMID: 25298739 PMCID: PMC4186571 DOI: 10.2147/clep.s64049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD) and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho) group, conventional medicine (CM) group, or mixed prescription (MX) group. Methods The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index) within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews. Results 146 patients (mean age ± standard deviation: 75.8±4.8 years) were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD). Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12–12.30; OR =2.52, 95% CI: 1.05–6.05; respectively) to have used non-steroidal anti-inflammatory drugs (NSAIDs) than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09–12.11; OR =0.34 [MX versus Ho], 95% CI: 0.07–1.57). Overall functional score evolution was similar in the three groups over time (P=0.16). Conclusion NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs.
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Suokas AK, Sagar DR, Mapp PI, Chapman V, Walsh DA. Design, study quality and evidence of analgesic efficacy in studies of drugs in models of OA pain: a systematic review and a meta-analysis. Osteoarthritis Cartilage 2014; 22:1207-23. [PMID: 25008207 DOI: 10.1016/j.joca.2014.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/28/2014] [Accepted: 06/12/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies using animal models are important in drug development, but often poorly predict treatment results in man. We investigated factors that may impact on the magnitude of the analgesic treatment effect in animal models of osteoarthritis (OA) pain. DESIGN Systematic review of studies that measured behavioural pain outcomes in small animal models of OA, and tested drugs which reduce OA pain in man. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects meta-analysis for selected models and drugs. RESULTS Most studies used rat models (42/50) and chemical methods of OA induction (39/50). Analgesic treatment effect (SMD) was most commonly measured between drug- and vehicle treated rats with knee OA. Meta-analysis was carried out for 102 such comparisons from 26 studies. The pooled SMD was 1.36 (95% CI = 1.15-1.57). Non-steroidal anti-inflammatory drugs (NSAIDs) were associated with smaller SMDs than opioids (z = -3.25, P = 0.001). Grip strength gave larger SMDs than assessment of static weight bearing (z = -4.60, P < 0.001), mechanically-evoked pain (z = -3.83, P = 0.001) and movement-evoked pain (z = -5.23, P < 0.001), and SMDs for mechanically-evoked pain were larger than for movement-evoked pain (z = -2.78, P = 0.006). Studies that reported structural evaluation of OA phenotype were associated with smaller SMDs (z = -2.45, P = 0.014). Publication was significantly biased towards positive findings. CONCLUSION Attention to study-level moderators and publication bias may improve the ability of research using animal models to predict whether analgesic agents will reduce arthritis pain in man.
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Affiliation(s)
- A K Suokas
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK.
| | - D R Sagar
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham, UK
| | - P I Mapp
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK
| | - V Chapman
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK
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Taylor R, V Pergolizzi J, Puenpatom RA, Summers KH. Economic implications of potential drug-drug interactions in chronic pain patients. Expert Rev Pharmacoecon Outcomes Res 2014; 13:725-34. [PMID: 24219048 DOI: 10.1586/14737167.2013.851006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic pain patients may be subject to polypharmacy because of long-term pharmacological pain treatment and additional comorbidities. Many chronic pain patients expose themselves to potential drug-drug interactions (DDIs) and these interactions can have unintended and severe consequences. Prevalence and costs associated with DDIs are inconsistent and has led to an inadequate level of awareness among the medical community; therefore, it has become necessary to re-evaluate the rates of DDIs in chronic pain patients. Utilizing medical and prescription claims databases, five studies were conducted to assess the health care utilization of and associated financial payments for patients >18 years with chronic noncancer pain. The studies evaluated drug-drug exposures with the potential to cause DDIs specifically occurring through the CYP450 enzyme system. The studies reported that drug-drug exposures are prevalent, costly and can occur in any age group and that physicians should consider ways to limit their patients' exposure to potential DDIs.
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Affiliation(s)
- Robert Taylor
- NEMA Research, 840 111th Avenue North, Suite 9, Naples 34108-1877, FL, USA
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Dickie AC, Torsney C. The chemerin receptor 23 agonist, chemerin, attenuates monosynaptic C-fibre input to lamina I neurokinin 1 receptor expressing rat spinal cord neurons in inflammatory pain. Mol Pain 2014; 10:24. [PMID: 24716552 PMCID: PMC4023702 DOI: 10.1186/1744-8069-10-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recent evidence has shown that the chemerin receptor 23 (ChemR23) represents a novel inflammatory pain target, whereby the ChemR23 agonists, resolvin E1 and chemerin, can inhibit inflammatory pain hypersensitivity, by a mechanism that involves normalisation of potentiated spinal cord responses. This study has examined the ability of the ChemR23 agonist, chemerin, to modulate synaptic input to lamina I neurokinin 1 receptor expressing (NK1R+) dorsal horn neurons, which are known to be crucial for the manifestation of inflammatory pain. Results Whole-cell patch-clamp recordings from pre-identified lamina I NK1R+ neurons, in rat spinal cord slices, revealed that chemerin significantly attenuates capsaicin potentiation of miniature excitatory postsynaptic current (mEPSC) frequency, but is without effect in non-potentiated conditions. In tissue isolated from complete Freund’s adjuvant (CFA) treated rats, chemerin significantly reduced the peak amplitude of monosynaptic C-fibre evoked excitatory postsynaptic currents (eEPSCs) in a subset of lamina I NK1R+ neurons, termed chemerin responders. However, chemerin did not alter the peak amplitude of monosynaptic C-fibre eEPSCs in control tissue. Furthermore, paired-pulse recordings in CFA tissue demonstrated that chemerin significantly reduced paired-pulse depression in the subset of neurons classified as chemerin responders, but was without effect in non-responders, indicating that chemerin acts presynaptically to attenuate monosynaptic C-fibre input to a subset of lamina I NK1R+ neurons. Conclusions These results suggest that the reported ability of ChemR23 agonists to attenuate inflammatory pain hypersensitivity may in part be due to a presynaptic inhibition of monosynaptic C-fibre input to lamina I NK1R+ neurons and provides further evidence that ChemR23 represents a promising inflammatory pain target.
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Affiliation(s)
| | - Carole Torsney
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, UK.
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Recomendaciones para una prescripción segura de antiinflamatorios no esteroideos: documento de consenso elaborado por expertos nominados por 3 sociedades científicas (SER-SEC-AEG). GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:107-27. [DOI: 10.1016/j.gastrohep.2013.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/12/2013] [Indexed: 12/17/2022]
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Lanas A, Benito P, Alonso J, Hernández-Cruz B, Barón-Esquivias G, Perez-Aísa Á, Calvet X, García-Llorente JF, Gobbo M, Gonzalez-Juanatey JR. Safe prescription recommendations for non steroidal anti-inflammatory drugs: consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG). ACTA ACUST UNITED AC 2014; 10:68-84. [PMID: 24462644 DOI: 10.1016/j.reuma.2013.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 02/06/2023]
Abstract
This article outlines key recommendations for the appropriate prescription of non steroidal anti-inflammatory drugs to patients with different musculoskeletal problems. These recommendations are based on current scientific evidence, and takes into consideration gastrointestinal and cardiovascular safety issues. The recommendations have been agreed on by experts from three scientific societies (Spanish Society of Rheumatology [SER], Spanish Association of Gastroenterology [AEG] and Spanish Society of Cardiology [SEC]), following a two-round Delphi methodology. Areas that have been taken into account encompass: efficiency, cardiovascular risk, gastrointestinal risk, liver risk, renal risk, inflammatory bowel disease, anemia, post-operative pain, and prevention strategies. We propose a patient management algorithm that summarizes the main aspects of the recommendations.
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Affiliation(s)
- Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Lozano Blesa, Universidad de Zaragoza, IIS Aragón, CIBERehd, Zaragoza, España.
| | - Pere Benito
- Servicio de Reumatología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Joaquín Alonso
- Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - Blanca Hernández-Cruz
- i+D+I, Unidad de Gestión Clínica de Reumatología, Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Gonzalo Barón-Esquivias
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - Ángeles Perez-Aísa
- Unidad de Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Xavier Calvet
- Servei de Digestiu, Hospital de Sabadell, Universidad Autónoma de Barcelona, CIBERehd, Sabadell, Barcelona, España
| | | | - Milena Gobbo
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | - José R Gonzalez-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, España
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Mongin G. Tramadol extended-release formulations in the management of pain due to osteoarthritis. Expert Rev Neurother 2014; 7:1775-84. [DOI: 10.1586/14737175.7.12.1775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gadzhanova S, Ilomäki J, Roughead EE. COX-2 inhibitor and non-selective NSAID use in those at increased risk of NSAID-related adverse events: a retrospective database study. Drugs Aging 2014. [PMID: 23179898 DOI: 10.1007/s40266-012-0037-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Adverse events related to analgesic use represent a challenge for optimizing treatment of pain in older people. OBJECTIVE The aim of this study was to determine whether non-selective non-steroidal anti-inflammatory drug (NS-NSAID) and cyclo-oxygenase (COX)-2 inhibitor use is appropriately targeted in those with a prior history of gastrointestinal (GI) events, myocardial infarction (MI) or stroke. METHODS A retrospective study of pharmacy claims data from the Australian Government Department of Veterans' Affairs was conducted, involving 288,912 veterans aged 55 years and over. Analgesic utilization from 2007 to 2009 was assessed. Three risk cohorts (veterans with prior hospitalization for GI bleed, MI or stroke) and a low-risk cohort were identified. Poisson regression was applied to test for a linear trend over the study period. RESULTS The prevalence of analgesics dispensed in the overall study population was approximately 34 % between 2007 and 2009. COX-2 inhibitors were more widely dispensed than NS-NSAIDs in all those at risk of NSAID-related adverse events. At the end of 2009, the ratio was 5.1 % to 2.5 % in the GI cohort, 3.6 % to 3.2 % in the MI cohort and 3.6 % to 2.6 % in the stroke cohort. CONCLUSIONS Although COX-2 inhibitors appeared to be preferred over NS-NSAIDs in those with a prior history of GI events, 2.5 % of patients were still using an NS-NSAID at the end of the study period. Consistent with treatment guidelines, in most of these cases, these drugs were co-dispensed with proton pump inhibitors. COX-2 inhibitors were used at slightly higher rates than NS-NSAIDs in those with a prior history of MI or stroke, which is not consistent with guidelines recommending NS-NSAID use.
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Affiliation(s)
- Svetla Gadzhanova
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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