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Archambault L, Bertrand K, Martel MO, Bérubé M, Belhouari S, Perreault M. The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review. J Clin Nurs 2024; 33:3056-3076. [PMID: 38532646 DOI: 10.1111/jocn.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND AIMS Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. DESIGN Scoping review. METHODS The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. RESULTS Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. CONCLUSIONS The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. CLINICAL RELEVANCE Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.
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Affiliation(s)
- Léonie Archambault
- Université de Sherbrooke and Douglas Research Center, Montréal, Quebec, Canada
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Karine Bertrand
- Institut Universitaire Sur les dépendances and Community Health Science Dept., Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marc O Martel
- Faculty of Dentistry & Department of Anesthesiology, McGill University, Montréal, Quebec, Canada
| | - Mélanie Bérubé
- Faculté Des Sciences infimières, Université Laval, Quebec City, Quebec, Canada
| | | | - Michel Perreault
- Douglas Research Center and Dept. of Psychiatry, McGill University, Montréal, Quebec, Canada
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Zhang X, Guan M, Yi W, Li X, Ding X, He Y, Han W, Wang Z, Tang Q, Liao B, Shen J, Han X, Bai D. Smart Response Biomaterials for Pain Management. Adv Healthc Mater 2024:e2401555. [PMID: 39039990 DOI: 10.1002/adhm.202401555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/12/2024] [Indexed: 07/24/2024]
Abstract
The intricate nature of pain classification and mechanism constantly affects the recovery of diseases and the well-being of patients. Key medical challenges persist in devising effective pain management strategies. Therefore, a comprehensive review of relevant methods and research advancements in pain management is conducted. This overview covers the main categorization of pain and its developmental mechanism, followed by a review of pertinent research and techniques for managing pain. These techniques include commonly prescribed medications, invasive procedures, and noninvasive physical therapy methods used in rehabilitation medicine. Additionally, for the first time, a systematic summary of the utilization of responsive biomaterials in pain management is provided, encompassing their response to physical stimuli such as ultrasound, magnetic fields, electric fields, light, and temperature, as well as changes in the physiological environment like reactive oxygen species (ROS) and pH. Even though the application of responsive biomaterials in pain management remains limited and at a fundamental level, recent years have seen the examination and debate of relevant research findings. These profound discussions aim to provide trends and directions for future research in pain management.
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Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Mengtong Guan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Weiwei Yi
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xinhe Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xiaoqian Ding
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Yi He
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Wang Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zijie Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Qiuyu Tang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Bo Liao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jieliang Shen
- Department of Rehabilitation Medicine, Bishan Hospital of Chongqing Medical University, Bishan Hospital of Chongqing, Chongqing, 402760, P. R. China
| | - Xiaoyu Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
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Nwaefuna PN. Assessing Relapse in Patients with Opioid-Use Disorder and Chronic Non-Cancer Pain. Pain Manag Nurs 2024; 25:189-194. [PMID: 38036409 DOI: 10.1016/j.pmn.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/09/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The opioid crisis in the United States is of public health significance, with an estimated 128 opioid overdose-related deaths per day in 2018 and a relapse rate of 90% or higher. This crisis persists despite the adoption of Medication-Assisted Treatment (MAT), therefore, there is a need to prevent relapse. AIMS The purpose of this study was to determine risk factors for relapse in patients admitted with opioid use disorder (OUD) at a local addiction treatment center in Western New York, from 2018-2020. The aims were to compare rates of relapse to illicit substances between patients with OUD and chronic non-cancer pain (CNCP) to those with OUD alone; and to determine factors that predict relapse. METHOD A retrospective chart review design was used. Electronic health records of 75 patients with OUD were reviewed. Descriptive statistics were used to analyze demographic data; and a χ2 test was performed to compare relapse rates in patients with OUD plus CNCP to those with OUP alone. Binary logistic regression was performed to ascertain the effects of psychiatric comorbidities on relapse. RESULTS There was no statistically significant difference between demographic subgroups. No group differences were observed in rates of relapse; however, patients with CNCP were more likely to relapse (p = .06). Psychiatric comorbidities did not predict relapse (p > .05). CONCLUSIONS Additional research is needed to ascertain other factors predicting relapse in patients with OUD in addiction treatment centers.
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Affiliation(s)
- Patricia N Nwaefuna
- State University at Buffalo, Buffalo, New York; Opioid Workforce Expansion Program (OWEP) Fellow.
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Secrest S, Miller-Matero LR, Chrusciel T, Salas J, Sullivan MD, Zabel C, Lustman P, Ahmedani B, Carpenter RW, Scherrer JF. Baseline Characteristics From a New Longitudinal Cohort of Patients With Noncancer Pain and Chronic Opioid Use in the United States. THE JOURNAL OF PAIN 2024; 25:984-999. [PMID: 37907114 PMCID: PMC10960712 DOI: 10.1016/j.jpain.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Retrospective cohort studies have consistently observed that long-term prescription opioid use is a risk factor for new major depressive episodes. However, prospective studies are needed to confirm these findings and establish evidence for causation. The Prescription Opioids and Depression Pathways cohort study is designed for this purpose. The present report describes the baseline sample and associations between participant characteristics and odds of daily versus nondaily opioid use. Second, we report associations between participant characteristics and odds of depression, dysthymia, anhedonia, and vital exhaustion. Patients with noncancer pain were eligible if they started a new period of prescription opioid use lasting 30 to 90 days. Participants were 54.8 (standard deviation ± 11.3) years of age, 57.3% female and 73% White race. Less than college education was more common among daily versus nondaily opioid users (32.4% vs 27.3%; P = .0008), as was back pain (64.2% vs 51.3%; P < .0001), any nonopioid substance use disorder (12.8% vs 4.8%; P < .0001), and current smoking (30.7% vs 18.4% P < .0001). High pain interference (50.9% vs 28.4%; P < .0001) was significantly associated with depression, as was having more pain sites (6.9 ± 3.6 vs 5.7 ± 3.6; P < .0001), and benzodiazepine comedication (38.2% vs 23.4%; P < .0001). High pain interference was significantly more common among those with anhedonia (46.8% vs 27.4%; P < .0001), and more pain sites (7.0 ± 3.7 vs 5.6 ± 3.6; P < .0001) were associated with anhedonia. Having more pain sites (7.9 ± 3.6 vs 5.5 ± 3.50; P < .0001) was associated with vital exhaustion, as was back pain (71.9% vs 56.8%; P = .0001) and benzodiazepine comedication (42.8% vs 22.8%; P < .0001). Patients using prescription opioids for noncancer pain have complex pain, psychiatric, and substance use disorder comorbidities. Longitudinal data will reveal whether long-term opioid therapy leads to depression or other mood disturbances such as anhedonia and vital exhaustion. PERSPECTIVE: This study reports baseline characteristics of a new prospective, noncancer pain cohort study. Risk factors for adverse opioid outcomes were most common in those with depression and vital exhaustion and less common in dysthymia and anhedonia. Baseline data highlight the complexity of patients receiving long-term opioid therapy for noncancer pain.
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Affiliation(s)
- Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
| | - Lisa R. Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO. 63104 U.S.A
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle WA. 98195
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Patrick Lustman
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Blvd, Suite 301, St. Louis, MO. 63108
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Ryan W. Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., Saint Louis, MO. 63121
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd. St. Louis, MO 63104 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
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Maremmani I, Dematteis M, Gorzelanczyk EJ, Mugelli A, Walcher S, Torrens M. Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. J Clin Med 2023; 12:5575. [PMID: 37685642 PMCID: PMC10488107 DOI: 10.3390/jcm12175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
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Affiliation(s)
- Icro Maremmani
- VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy;
- UniCamillus, International Medical University in Rome, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Maurice Dematteis
- Department of Pharmacology and Addiction Medicine, Grenoble-Alpes University Hospital, Grenoble Alpes University, Rue de la Chantourne, 38043 Grenoble, France;
| | - Edward J. Gorzelanczyk
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Faculty of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction ”Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NeuroFarBa), University of Florence, Via della Pergola, 50121 Firenze, Italy;
| | - Stephan Walcher
- CONCEPT Center for Addiction Medicine, Kaiserstrasse 1, D-80801 Munich, Germany;
| | - Marta Torrens
- Addiction Research Group, Hospital del Mar Research Institute Barcelona, 08003 Barcelona, Spain
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Pryce KD, Serafini RA, Ramakrishnan A, Nicolais A, Giosan IM, Polizu C, Torres-Berrío A, Vuppala S, Kronman H, Ruiz A, Gaspari S, Peña CJ, Sakloth F, Mitsi V, van Duzer J, Mazitschek R, Jarpe M, Shen L, Nestler EJ, Zachariou V. Oxycodone withdrawal induces HDAC1/HDAC2-dependent transcriptional maladaptations in the reward pathway in a mouse model of peripheral nerve injury. Nat Neurosci 2023; 26:1229-1244. [PMID: 37291337 PMCID: PMC10752505 DOI: 10.1038/s41593-023-01350-3] [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: 09/27/2021] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
The development of physical dependence and addiction disorders due to misuse of opioid analgesics is a major concern with pain therapeutics. We developed a mouse model of oxycodone exposure and subsequent withdrawal in the presence or absence of chronic neuropathic pain. Oxycodone withdrawal alone triggered robust gene expression adaptations in the nucleus accumbens, medial prefrontal cortex and ventral tegmental area, with numerous genes and pathways selectively affected by oxycodone withdrawal in mice with peripheral nerve injury. Pathway analysis predicted that histone deacetylase (HDAC) 1 is a top upstream regulator in opioid withdrawal in nucleus accumbens and medial prefrontal cortex. The novel HDAC1/HDAC2 inhibitor, Regenacy Brain Class I HDAC Inhibitor (RBC1HI), attenuated behavioral manifestations of oxycodone withdrawal, especially in mice with neuropathic pain. These findings suggest that inhibition of HDAC1/HDAC2 may provide an avenue for patients with chronic pain who are dependent on opioids to transition to non-opioid analgesics.
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Affiliation(s)
- Kerri D Pryce
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Randal A Serafini
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aarthi Ramakrishnan
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Nicolais
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilinca M Giosan
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Claire Polizu
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angélica Torres-Berrío
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sreeya Vuppala
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hope Kronman
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne Ruiz
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sevasti Gaspari
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Farhana Sakloth
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vasiliki Mitsi
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ralph Mazitschek
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Li Shen
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric J Nestler
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Venetia Zachariou
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 PMCID: PMC10341731 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; (R.T.); (V.C.)
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Delorme J, Kerckhove N, Authier N, Pereira B, Bertin C, Chenaf C. Systematic Review and Meta-Analysis of the Prevalence of Chronic Pain Among Patients With Opioid Use Disorder and Receiving Opioid Substitution Therapy. THE JOURNAL OF PAIN 2023; 24:192-203. [PMID: 36220483 DOI: 10.1016/j.jpain.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022]
Abstract
To assess studies examining the prevalence of chronic pain (CP) in patients treated with Opioid Substitution Treatment (OST - buprenorphine or methadone) for Opioid Used Disorder (OUD), we conducted a systematic review and meta-analysis of the literature between the years 2000 and 2020. We searched EMBASE, PsycINFO, Cochrane, and MEDLINE databases and included studies assessing the prevalence of CP in OUD adults treated with OST. The studies were assessed for risk of bias and overall quality and the results were pooled using a random-effects model. Subgroup analyses and meta-regressions were used to identify possible factors associated with CP. Twenty-three studies reported data on the prevalence of CP in patients treated with OST were evaluated. The prevalence obtained was 45.3% (CI95% [38.7; 52.1]). Overall, 78.3% of the studies had a low risk of bias. Subgroup analysis estimates did not vary according to gender, OST, and CP duration. However, it appeared that the clinical settings was associated with a lower CP prevalence when assessed in primary care sites. Our study provided an estimate regarding the prevalence of CP among OST patients. These patients deserve specific attention from health professionals and health authorities. Thus, the real challenge in OST patients is the implementation of a multidisciplinary approach to manage CP. PERSPECTIVE: Our meta-analysis provided an estimate of CP prevalence, reaching almost 50% of OUD patients with OST. Thus, the urgent challenge in OST patients is to pay systematic attention to chronic pain diagnosis, along with the implementation of a multidisciplinary patient-focused approach for an appropriate management of CP. REGISTRATION: PROSPERO (CRD42021284790).
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France.
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Secteur Biométrie et Médico-économie, Clermont-Ferrand, France
| | - Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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Kerckhove N, Delage N, Bertin C, Kuhn E, Cantagrel N, Vigneau C, Delorme J, Lambert C, Pereira B, Chenaf C, Authier N. Cross-sectional study of the prevalence of prescription opioids misuse in French patients with chronic non-cancer pain: An update with the French version of the POMI scale. Front Pharmacol 2022; 13:947006. [PMID: 36133827 PMCID: PMC9484362 DOI: 10.3389/fphar.2022.947006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Public health issues related to chronic pain management and the risks of opioid misuse and abuse remain a challenge for practitioners. Data on the prevalence of disorders related to the use of prescribed opioids in patients suffering from chronic pain remains rather patchy, in particular because of the absence of a gold standard for their clinical assessment. We estimated the prevalence of prescription opioid misuse (POM), using a specific and validated opioid misuse scale (POMI-5F scale), in adults with chronic non-cancer pain. Nine-hundred-fifty-one (951) patients with opioids prescription and followed-up in pain clinics and addictology centers for chronic non-cancer pain (CNCP) completed the survey interview. The results suggest that 44.4% of participants have POM, accompanied by overuse (42.5%), use of opioids for effects other than analgesia (30.9%), withdrawal syndrome (65.7%), and craving (6.9%). The motivations cited for POM, apart from pain relief, were to calm down, relax and improve mood. POM was shown to be related to male sex (OR 1.52), young age (OR 2.21) and the presence of nociplastic pain (OR 1.62) of severe intensity (OR 2.31), codeine use (OR 1.72) and co-prescription of benzodiazepines (OR 1.59). Finally, despite the presence of three subgroups of misusers, no factor was associated with the intensity of misuse, reinforcing the view that distinguishing between strong and weak opioids is not appropriate in the context of use disorder. Almost half of patients with CNCP misuse their prescribed opioid. Practitioners should be attentive of profiles of patients at risk of POM, such as young, male patients suffering from severe nociplastic pain, receiving prescription for codeine and a co-prescription for benzodiazepine. We encourage French-speaking practitioners to use the POMI-5F scale to assess the presence of POM in their patients receiving opioid-based therapy. Clinical Trial Registrationclinicaltrials.gov, identifier NCT03195374
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- *Correspondence: Nicolas Kerckhove,
| | - Noémie Delage
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuelle Kuhn
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Nathalie Cantagrel
- Centre d’Evaluation et de Traitement de la Douleur, CHU Toulouse, Toulouse, France
| | - Caroline Vigneau
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Jessica Delorme
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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3D-QSAR, ADME-Tox In Silico Prediction and Molecular Docking Studies for Modeling the Analgesic Activity against Neuropathic Pain of Novel NR2B-Selective NMDA Receptor Antagonists. Processes (Basel) 2022. [DOI: 10.3390/pr10081462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A new class of selective antagonists of the N-Methyl-D-Aspartate (NMDA) receptor subunit 2B have been developed using molecular modeling techniques. The three-dimensional quantitative structure–activity relationship (3D-QSAR) study, based on comparative molecular field analysis (CoMFA) and comparative molecular similarity index analysis (CoMSIA) models, indicate that steric, electrostatic and hydrogen bond acceptor fields have a key function in the analgesic activity against neuropathic pain. The predictive accuracy of the developed CoMFA model (Q2 = 0.540, R2 = 0.980, R2 pred = 0.613) and the best CoMSIA model (Q2 = 0.665, R2 = 0.916, R2 pred = 0.701) has been successfully examined through external and internal validation. Based on ADMET in silico properties, L1, L2 and L3 ligands are non-toxic inhibitors of 1A2, 2C19 and 2C9 cytochromes, predicted to passively cross the blood–brain barrier (BBB) and have the highest probability to penetrate the central nervous system (CNS). Molecular docking results indicate that the active ligands (L1, L2 and L3) interact specifically with Phe176, Glu235, Glu236, Gln110, Asp136 and Glu178 amino acids of the transport protein encoded as 3QEL. Therefore, they could be used as analgesic drugs for the treatment of neuropathic pain.
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