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Pharmacological Strategies for Suicide Prevention Based on the Social Pain Model: A Scoping Review. PSYCH 2022. [DOI: 10.3390/psych4030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Suicidal behaviour is a public health problem whose magnitude is both substantial and increasing. Since many individuals seek medical treatment following a suicide attempt, strategies aimed at reducing further attempts in this population are a valid and feasible secondary prevention approach. An evaluation of the available evidence suggests that existing treatment approaches have a limited efficacy in this setting, highlighting the need for innovative approaches to suicide prevention. Existing research on the neurobiology of social pain has highlighted the importance of this phenomenon as a risk factor for suicide, and has also yielded several attractive targets for pharmacological strategies that could reduce suicidality in patients with suicidal ideation or a recent attempt. In this paper, the evidence related to these targets is synthesized and critically evaluated. The way in which social pain is related to the “anti-suicidal” properties of recently approved treatments, such as ketamine and psilocybin, is examined. Such strategies may be effective for the short-term reduction in suicidal ideation and behaviour, particularly in cases where social pain is identified as a contributory factor. These pharmacological approaches may be effective regardless of the presence or absence of a specific psychiatric diagnosis, but they require careful evaluation.
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Cameron CM, Nieto S, Bosler L, Wong M, Bishop I, Mooney L, Cahill CM. Mechanisms Underlying the Anti-Suicidal Treatment Potential of Buprenorphine. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2021; 1. [PMID: 35265942 PMCID: PMC8903193 DOI: 10.3389/adar.2021.10009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Death by suicide is a global epidemic with over 800 K suicidal deaths worlwide in 2012. Suicide is the 10th leading cause of death among Americans and more than 44 K people died by suicide in 2019 in the United States. Patients with chronic pain, including, but not limited to, those with substance use disorders, are particularly vulnerable. Chronic pain patients have twice the risk of death by suicide compared to those without pain, and 50% of chronic pain patients report that they have considered suicide at some point due to their pain. The kappa opioid system is implicated in negative mood states including dysphoria, depression, and anxiety, and recent evidence shows that chronic pain increases the function of this system in limbic brain regions important for affect and motivation. Additionally, dynorphin, the endogenous ligand that activates the kappa opioid receptor is increased in the caudate putamen of human suicide victims. A potential treatment for reducing suicidal ideation and suicidal attempts is buprenorphine. Buprenorphine, a partial mu opioid agonist with kappa opioid antagonist properties, reduced suicidal ideation in chronic pain patients with and without an opioid use disorder. This review will highlight the clinical and preclinical evidence to support the use of buprenorphine in mitigating pain-induced negative affective states and suicidal thoughts, where these effects are at least partially mediated via its kappa antagonist properties.
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Affiliation(s)
- Courtney M. Cameron
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Steven Nieto
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucienne Bosler
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Megan Wong
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Isabel Bishop
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Larissa Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Catherine M. Cahill
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Shirley and Stefan Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Correspondence: Catherine M. Cahill,
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Gistelinck L, Heylens G, Schelfout S, Lemmens G. Oral and buccal abuse of transdermal opioids : an underdetected but potentially lethal practice. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives : Transdermal opioid patches (TOPs) are effective and well tolerated in patients with moderate to severe chronic pain syndromes. Their specific pharmacological properties, however, make them prone to abuse. The objective of this article is to describe the practice of oral and buccal abuse of TOPs and to discuss its clinical implications.
Methods : We present the case of a patient admitted to the intensive care unit after oral abuse of transdermal opioid patches. Additionally, a narrative literature review on the topic is conducted, referring to Pubmed and Embase.
Results : Oral or buccal TOP abuse is the most frequent method of TOP abuse, followed by intravenous injection, inhaling, and applying multiple patches. The main reasons for TOP abuse include drug addiction, suicidal behavior and self-medication. Oral ingestion is potentially lethal because of the high doses of fentanyl that are found in a single patch. Buccal abuse results in fast elevations of fentanyl serum concentrations, caused by transmucosal absorption of fentanyl, thus bypassing hepatic metabolism. During emergency management, naloxone should be administered in a continuous infusion, given the high risk of recurrence of symptoms. Evidence suggests that transdermal buprenorphine is safer in terms of abuse potential. This is explained by its ceiling effect for respiratory depression and its lower peak effects in supratherapeutic doses. Risk factors for abuse include history of substance use disorder, prior opioid overdose and mental illness. Patients with suspected opioid abuse should be referred to pain clinics, mental health specialists or drug addiction facilities.
Conclusion : Oral or buccal abuse is the most reported non-dermal form of TOP abuse. When ingested or chewed, TOPs pose considerable health risks. It is critical to screen patients with chronic opioid therapy regularly for opioid use disorder. When confronted with patients at risk of abuse, close monitoring and referral to specialist care is advised.
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Pfeifer P, Nigg-Trawally N, Bartsch C, Reisch T. Characteristics of Suicides and Toxicology in a Cohort of Individuals With Opioid Use Disorder. Arch Suicide Res 2021; 25:287-296. [PMID: 32281522 DOI: 10.1080/13811118.2020.1746941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Suicide in patients with opioid use disorder (OUD) is a complex issue. In addition to accidental intoxications, a higher prevalence of fatal suicides in patients with OUD can be found compared to the general population. In this study, suicides with a diagnosis of OUD documented in the project "Suicides, A National Survey" were extracted from our data bank. Individuals with a diagnosis of OUD in their medical history were compared to other suicides. The analyses included clinical and demographic factors as well as an investigation of suicide methods and toxicology of psychotropic drugs. For the statistical analyses, we applied chi-square tests and calculated odds ratios. Out of 6,495 suicide cases in Switzerland between 2000 and 2010, 215 individuals with a medical history of OUD could be identified. Persons in OUD cases were significantly younger than in other suicide cases (p < .001) and had more frequently a positive history for suicide attempts (p = .02). In addition, persons in OUD cases were more often female (p = .076). Intentional self-poisoning with medication was applied more often in individuals with OUD compared to other suicide methods (p < .001). When self-poisoning with drugs was compared to violent suicide methods, a combination of benzodiazepines with antidepressants was predominantly found. Our study yielded significant characteristics and risk factors for suicides in individuals with OUD. The predominant method of suicide in individuals with OUD was intended self-poisoning by medication. This knowledge is of clinical importance for the monitoring of at-risk individuals with OUD as well as for suicide prevention in this patient group.
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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Xu X, Xie L, Liu H, Hu Y. Transdermal buprenorphine patch versus oral celecoxib for pain management after total knee arthroplasty: An open- label, randomized controlled trial. Orthop Traumatol Surg Res 2020; 106:915-919. [PMID: 32624377 DOI: 10.1016/j.otsr.2020.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for post-operative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects. PATIENTS AND METHODS A total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided the TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events post-operatively. RESULTS The total morphine given during the first 72h post-operatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h post-operatively, and during activity at 12, 24 and 48h and 3 days post-operatively. The mean range of motion on post-operative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group. DISCUSSION Use of the TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Xinxian Xu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Linghui Xie
- The Radiology Department of Wenzhou Seventh Hospital, Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haixiao Liu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuezheng Hu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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Webster L, Gudin J, Raffa RB, Kuchera J, Rauck R, Fudin J, Adler J, Mallick-Searle T. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:714-723. [PMID: 31917418 PMCID: PMC7139205 DOI: 10.1093/pm/pnz356] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE An expert panel convened to reach a consensus on common misconceptions surrounding buprenorphine, a Schedule III partial µ-opioid receptor agonist indicated for chronic pain. The panel also provided clinical recommendations on the appropriate use of buprenorphine and conversion strategies for switching to buprenorphine from a full µ-opioid receptor agonist for chronic pain management. METHODS The consensus panel met on March 25, 2019, to discuss relevant literature and provide recommendations on interpreting buprenorphine as a partial µ-opioid receptor agonist, prescribing buprenorphine before some Schedule II, III, or IV options, perioperative/trauma management of patients taking buprenorphine, and converting patients from a full µ-opioid receptor agonist to buprenorphine. RESULTS The panel recommended that buprenorphine's classification as a partial µ-opioid receptor agonist not be clinically translated to mean partial analgesic efficacy. The panel also recommended that buprenorphine be considered before some Schedule II, III, or IV opioids in patients with a favorable risk/benefit profile on the basis of metabolic factors, abuse potential, and tolerability and that buprenorphine be continued during the perioperative/trauma period. In addition, switching patients from a full µ-opioid receptor agonist to buprenorphine should be considered with no weaning period at starting doses that are based on the previous opioid dose. CONCLUSIONS These recommendations provide a framework for clinicians to address most clinical scenarios regarding buprenorphine use. The overall consensus of the panel was that buprenorphine is a unique Schedule III opioid with favorable pharmacologic properties and a safety profile that may be desirable for chronic pain management.
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Affiliation(s)
| | - Jeffrey Gudin
- Department of Anesthesiology and Pain Management, Englewood Hospital and Medical Center, Englewood, New Jersey; Rutgers New Jersey Medical School, Newark, New Jersey
| | - Robert B Raffa
- College of Pharmacy, The University of Arizona Health Sciences, Tucson, Arizona
- Temple University School of Pharmacy, Philadelphia, Pennsylvania; Neumentum Inc, Palo Alto, California
| | - Jay Kuchera
- Resolute Pain Solutions, Okeechobee, Florida
| | - Richard Rauck
- Carolinas Pain Institute, Winston-Salem, North Carolina
| | - Jeffrey Fudin
- Remitigate LLC, Delmar, New York; Western New England University College of Pharmacy, Springfield, Massachusetts
- Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Jeremy Adler
- Pacific Pain Medicine Consultants, Encinitas, California
| | - Theresa Mallick-Searle
- Division of Pain Medicine, Stanford Medicine Outpatient Center, Redwood City, California, USA
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Johnson MJ, Sbizzera I, Fairhurst C, Fazekas B, Agar M, Ekstrom M, Currow DC. No excess harms from sustained-release morphine: a randomised placebo-controlled trial in chronic breathlessness. BMJ Support Palliat Care 2019; 10:421-428. [DOI: 10.1136/bmjspcare-2019-002009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/03/2022]
Abstract
ObjectivesWe aimed to identify and evaluate: (1) treatment-emergent adverse events (TEAE (worse or new since baseline)) and the subgroup of severe TEAEs in a placebo-controlled 7-day randomised trial of regular, low-dose, sustained-release oral morphine for chronic breathlessness and (2) clinical characteristics associated with TEAE.MethodsSafety analysis of trial data. Adults with chronic breathlessness (modified Medical Research Council breathlessness score ≥2) due to heart or lung disease, or cancer, not on regular opioids were eligible. Symptoms associated with opioids (TEAE of special interest) were systematically sought using Common Terminology Criteria for Adverse Events (CTCAE) grading. Other harms could be reported at any time. The relationship between characteristics and presence of ≥1 TEAE of special interest was explored using univariable logistic regression analyses.Results1449/5624 (26%) Adverse Events from 279 participants were TEAE of which 150/1449 (10%) were severe (CTCAE grades 3–5). 1086/5624 (75%) were events of special interest of which 41/1086 (4%) were severe. Compared with placebo, morphine was not associated with more TEAE or severe TEAE of special interest (TEAE: OR 0.53, 95% CI 0.21 to 1.38, p=0.20; severe TEAE: OR 0.96, 95% CI 0.27 to 3.41, p=0.95) nor with CTCAE severity grade (χ2=4.39, p=0.50). Among the 26/150 (17%) with severe TEAEs, study withdrawal was more common in the morphine arm (18/26 (69%) morphine arm; 8/26 (30%) placebo arm). None of the severe TEAEs was a respiratory harm.ConclusionsSevere morphine-associated toxicity was uncommon and not associated with study arm. Clinical consequences were minor and self-limiting.Trial registration numberACTRN126000806268.
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Pitman A, Tham SG, Hunt IM, Webb RT, Appleby L, Kapur N. Access to means of lethal overdose among psychiatric patients with co-morbid physical health problems: Analysis of national suicide case series data from the United Kingdom. J Affect Disord 2019; 257:173-179. [PMID: 31301620 DOI: 10.1016/j.jad.2019.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many physical health problems are associated with elevated suicide risk whilst also providing access to means of overdose. We aimed to investigate whether psychiatric patients with physical co-morbidities who die by suicide were more likely than those without co-morbidities to self-poison with non-psychotropic medications. METHODS We analysed data on 14,648 psychiatric patients who died by suicide in England & Wales during 2004-2015, as recorded by the National Confidential Inquiry into Suicide and Safety in Mental Health. Using logistic regression models adjusted for age, gender, ethnicity, and primary drug dependence/misuse we compared patients diagnosed with physical co-morbidities versus those without to assess whether a greater proportion of the former had died by overdose, and medication prescribed to treat such disorders (e.g. opioids, insulin). RESULTS 24% (n = 3525) were recorded as having physical co-morbidity. A greater proportion of these individuals died by self-poisoning than those without physical co-morbidity (37% vs. 20%, p < .001; adjusted OR 2.47; 95% CI 2.26-2.70), and they were more likely to have used medications for a physical health disorder in overdose (50% vs. 34%; adjusted OR 2.10; 95% CI 1.80-2.46), particularly opioids (30% vs. 22%; p < .001), paracetamol/opioid compounds (11% vs. 7%, p < .001) and insulin (4% vs. 1%, p < .001). LIMITATIONS Use of survey data may have resulted in under-reporting of physical health problems and/or overdose medications. CONCLUSIONS Overdose, rather than hanging, is the leading cause of suicide among psychiatric patients with physical co-morbidities, particularly using non-psychotropic medications. There is potential for means restriction in preventing suicide among these patients.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK.
| | - Su-Gwan Tham
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Isabelle M Hunt
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Dhawan A, Modak T, Sarkar S. Transdermal buprenorphine patch: Potential for role in management of opioid dependence. Asian J Psychiatr 2019; 40:88-91. [PMID: 30772733 DOI: 10.1016/j.ajp.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 11/16/2022]
Abstract
Despite proven clinical utility, use of sublinugual buprenorphine is fraught with issues of potential diversion among patients with opioid dependence. Transdermal buprenorphine patches provide an alternative delivery model that can be utilized to reduce such diversion. This narrative review discusses the transdermal buprenorphine formulations, and its pharmacology, drug interaction and tolerability profile. The studies utilizing buprenorphine transdermal patches in the treatment of opioid dependence are examined, while the potential of using such patches for maintenance treatment of opioid dependence is examined.
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Affiliation(s)
- Anju Dhawan
- Professor, Department of Psychiatry and National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi
| | - Tamonud Modak
- Senior Resident, Department of Psychiatry and National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi.
| | - Siddharth Sarkar
- Assistant Professor, Department of Psychiatry and National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi
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Johnson MJ, Fallon M. Chronic breathlessness: time for Cinderella to go to the ball! Eur Respir J 2018; 52:52/3/1801452. [DOI: 10.1183/13993003.01452-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
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12
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Xu C, Li M, Wang C, Li H, Liu H. Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study. J Pain Res 2018; 11:867-873. [PMID: 29731664 PMCID: PMC5927186 DOI: 10.2147/jpr.s153456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery. Patients and methods A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F), oral celecoxib (Group C), and buprenorphine transdermal delivery system (BTDS) (Group BTDS). The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3. Results The BTDS could effectively control perioperative pain for patients undergoing hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS) scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05) than that of the other two groups. Conclusion The BTDS (a preemptive analgesia regimen) could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation.
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Affiliation(s)
- Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Mingqing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
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13
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Pergolizzi JV, Coluzzi F, Taylor R. Transdermal buprenorphine for moderate chronic noncancer pain syndromes. Expert Rev Neurother 2018; 18:359-369. [PMID: 29667437 DOI: 10.1080/14737175.2018.1462701] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Chronic noncancer pain has remained a challenging clinical problem. Opioid analgesics are effective, but they are known to be associated with opioid use disorder and potentially treatment-limiting side effects. Buprenorphine is a Schedule III synthetic opioid in the USA with a chemical structure similar to that of morphine but with a longer duration of action, greater potency, and other unique pharmacological attributes. Its role in treatment of chronic noncancer pain may be broader than currently thought.Areas covered: The pharmacokinetics, pharmacodynamics, clinical efficacy, and safety profile of transdermal buprenorphine in moderate chronic noncancer pain syndromes patients will be discussed.Expert commentary: Buprenorphine offers effective analgesia in the form of a Schedule III drug (rather than Schedule II such as oxycodone or morphine) and transdermal buprenorphine is a convenient, accepted, around-the-clock pain reliever. Its lower potential for abuse should make it a more desirable pain reliever but many payers do not reimburse buprenorphine, driving prescribers and their patients to generic versions of the riskier Schedule II oral opioids such as oxycodone and morphine.
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Affiliation(s)
| | - Flaminia Coluzzi
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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Macintyre PE, Huxtable CA. Buprenorphine for the management of acute pain. Anaesth Intensive Care 2017; 45:143-146. [PMID: 28267934 DOI: 10.1177/0310057x1704500202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P E Macintyre
- Director, Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Clinical Professor, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - C A Huxtable
- Consultant Anaesthetist, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
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