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Valades MT, Montero-Torres M, Lara-Abelenda FJ, Carabot F, Ortega MA, Álvarez-Mon M, Alvarez-Mon MA. Understanding public perceptions and discussions on diseases involving chronic pain through social media: cross-sectional infodemiology study. BMC Musculoskelet Disord 2024; 25:569. [PMID: 39034398 PMCID: PMC11265081 DOI: 10.1186/s12891-024-07687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent medical condition that negatively impacts quality of life and is associated with considerable functional disability. Certain diseases, such as fibromyalgia, headache, paraplegia, neuropathy, and multiple sclerosis, manifest with chronic pain. OBJECTIVE The aim of this study is to examine the number and type of tweets (original or retweet) related to chronic pain, as well as to analyze the emotions and compare the societal impact of the diseases under study. METHODS We investigated tweets posted between January 1, 2018, and December 31, 2022, by Twitter users in English and Spanish, as well as the generated retweets. Additionally, emotions were extracted from these tweets and their diffusion was analyzed. Furthermore, the topics most frequently discussed by users were collected. RESULTS A total of 72,874 tweets were analyzed, including 44,467 in English and 28,407 in Spanish. Paraplegia represented 23.3% with 16,461 of the classified tweets, followed by headache and fibromyalgia with 15,337 (21.7%) and 15,179 (21.5%) tweets, respectively. Multiple sclerosis generated 14,781 tweets (21%), and the fewest tweets were related to neuropathy with 8,830 tweets (12.5%). The results showed that the primary emotions extracted were "fear" and "sadness." Additionally, the reach and impact of these tweets were investigated through the generated retweets, with those related to headaches showing the highest interest and interaction among users. CONCLUSION Our results underscore the potential of leveraging social media for a better understanding of patients suffering from chronic pain and its impact on society. Among the most frequently encountered topics are those related to treatment, symptoms, or causes of the disease. Therefore, it is relevant to inform the patient to prevent misconceptions regarding their illness.
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Affiliation(s)
- M T Valades
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain.
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain.
| | - M Montero-Torres
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
| | - F J Lara-Abelenda
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Madrid, Spain
| | - F Carabot
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
| | - M A Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
| | - M Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, Center for Biomedical Research in Hepatic and Digestive Diseases Network, University Hospital Principe de Asturias, Alcala de Henares, Madrid, Spain
| | - M A Alvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
- Department of Psychiatry and Mental Health, University Hospital Infanta Leonor, Madrid, Spain
- CIBERSAM-ISCIII, Biomedical Research Networking Centre in Mental Health, Madrid, Spain
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Khosravi M, Alzahrani AA, Muhammed TM, Hjazi A, Abbas HH, AbdRabou MA, Mohmmed KH, Ghildiyal P, Yumashev A, Elawady A, Sarabandi S. Management of Refractory Functional Gastrointestinal Disorders: What Role Should Psychiatrists Have? PHARMACOPSYCHIATRY 2024. [PMID: 38897220 DOI: 10.1055/a-2331-7684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Currently, it has been stated that psychiatric and psychological problems are equally paramount aspects of the clinical modulation and manifestation of both the central nervous and digestive systems, which could be used to restore balance. The present narrative review aims to provide an elaborate description of the bio-psycho-social facets of refractory functional gastrointestinal disorders, psychiatrists' role, specific psychiatric approach, and the latest psychiatric and psychological perspectives on practical therapeutic management. In this respect, "psyche," "psychiatry," "psychology," "psychiatrist," "psychotropic," and "refractory functional gastrointestinal disorders" (as the keywords) were searched in relevant English publications from January 1, 1950, to March 1, 2024, in the PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, and Google Scholar databases. Eventually, the narrative technique was adopted to reach a compelling story with a high level of cohesion through material synthesis. The current literature recognizes the brain-gut axis modulation as a therapeutic target for refractory functional gastrointestinal disorders and the bio-psycho-social model as an integrated framework to explain disease pathogenesis. The results also reveal some evidence to affirm the benefits of psychotropic medications and psychological therapies in refractory functional gastrointestinal disorders, even when psychiatric symptoms were absent. It seems that psychiatrists are required to pay higher levels of attention to both the assessment and treatment of patients with refractory functional gastrointestinal disorders, accompanied by educating and training practitioners who take care of these patients.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Thikra M Muhammed
- Department of Biotechnology, College of Applied Sciences, University of Fallujah, Al-anbar, Iraq
| | - Ahmed Hjazi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Huda H Abbas
- National University of Science and Technology, Dhi Qar, Iraq
| | - Mervat A AbdRabou
- Department of Biology, College of Science, Jouf University, Sakaka, Saudi Arabia
| | | | - Pallavi Ghildiyal
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
| | - Alexey Yumashev
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ahmed Elawady
- College of technical engineering, the Islamic University, Najaf, Iraq
- College of technical engineering, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- College of technical engineering, the Islamic University of Babylon, Babylon, Iraq
| | - Sahel Sarabandi
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Alansary AM, Elbeialy MAK. Impact of Preoperative Aripiprazole on Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Double-blind Placebo-controlled Trial. Clin J Pain 2024; 40:341-348. [PMID: 38450551 DOI: 10.1097/ajp.0000000000001210] [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: 07/25/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Aripiprazole is a second-generation atypical antipsychotic with worldwide clinical approval. Nevertheless, its perioperative antinociceptive application has not been studied. As a result, the purpose of this study was to investigate the analgesic effects of perioperative aripiprazole on reducing postoperative pain, as well as the possible adverse effects. PATIENTS AND METHODS This randomized controlled study enrolled 80 female patients scheduled for laparoscopic hysterectomy who were assigned randomly into 2 equal groups in 1:1; aripiprazole group (n = 40), patients received an aripiprazole 30 mg tablet orally 3 hours before surgery and placebo group (n = 40), patients received a placebo tablet 3 hours before surgery. The 24-hour morphine consumption postoperatively was the primary outcome, and the time to the first analgesic request, sedation scores, and the incidence of perioperative adverse events were the secondary outcomes. RESULTS The mean 24-hour morphine consumption was significantly lower with aripiprazole (2.5 ± 0.5 mg) than with placebo (23.7 ± 1.6 mg; mean ± SE -21.2 ± 0.3, 95% CI: -21.7 to -20.6, P < 0.001). In addition, the mean time to the first analgesic request was significantly longer with aripiprazole (212.2 ± 14.7 min) than with placebo (27.0 ± 2.0 min; mean ± SE 185.2 ± 2.3, 95% CI: 180.5 to 189.8, P < 0.001). Furthermore, the aripiprazole group reported higher sedation scores ( P < 0.001). Bradycardia and hypotension were reported more frequently among patients in the aripiprazole group ( P < 0.05). CONCLUSION Aripiprazole was effective in reducing pain after laparoscopic hysterectomy. Although self-limited, side effects should be taken into consideration when using the medication perioperatively.
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Affiliation(s)
- Amin Mohamed Alansary
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Drabczyk AK, Kułaga D, Zaręba P, Tylińska W, Bachowski W, Archała A, Wnorowski A, Tzani A, Detsi A, Jaśkowska J. Eco-friendly synthesis of new olanzapine derivatives and evaluation of their anticancer potential. RSC Adv 2023; 13:20467-20476. [PMID: 37435368 PMCID: PMC10331126 DOI: 10.1039/d3ra03926a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
New derivatives of the known antipsychotic drug olanzapine have been obtained as potential compounds with anticancer activity in two metabolically different breast cancer cell lines: MCF-7 and triple negative MDA-MB-231. The compounds were obtained under phase transfer catalysis (PTC) in the presence of microwave irradiation (MW) or ultrasound (")))"), evaluating the effect of solvents such as dimethylformamide, water, or choline chloride/urea (natural deep eutectic solvent, NaDES). In the best option, the compounds were obtained within 2 minutes with a yield of 57-86% in MW. Two of the obtained compounds which have a naphthalimide moiety and a pentyl (7) or hexyl chain (8) show pronounced cytotoxicity. Interestingly, neither olanzapine nor desmethylolanzapine (DOLA), which was one of the substrates for the synthesis reaction, showed any significant activity in the study.
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Affiliation(s)
- Anna K Drabczyk
- Faculty of Chemical Engineering and Technology, Department of Chemical Technology and Environmental Analytics, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
| | - Damian Kułaga
- Faculty of Chemical Engineering and Technology, Department of Chemical Technology and Environmental Analytics, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
| | - Przemysław Zaręba
- Faculty of Chemical Engineering and Technology, Department of Organic Chemistry and Technology, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
| | - Wiktoria Tylińska
- Faculty of Chemical Engineering and Technology, Department of Chemical Technology and Environmental Analytics, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
| | - Wojciech Bachowski
- Faculty of Chemical Engineering and Technology, Department of Chemical Technology and Environmental Analytics, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
| | - Aneta Archała
- Department of Biopharmacy, Medical University of Lublin 4a Chodzki Street 20-059 Lublin Poland
| | - Artur Wnorowski
- Department of Biopharmacy, Medical University of Lublin 4a Chodzki Street 20-059 Lublin Poland
| | - Andromachi Tzani
- Laboratory of Organic Chemistry, Department of Chemical Sciences, School of Chemical Engineering, National Technical University of Athens 15780 Zografou Athens Greece
| | - Anastasia Detsi
- Laboratory of Organic Chemistry, Department of Chemical Sciences, School of Chemical Engineering, National Technical University of Athens 15780 Zografou Athens Greece
| | - Jolanta Jaśkowska
- Faculty of Chemical Engineering and Technology, Department of Chemical Technology and Environmental Analytics, Cracow University of Technology 24 Warszawska Street 31-155 Cracow Poland
- Laboratory of Organic Chemistry, Department of Chemical Sciences, School of Chemical Engineering, National Technical University of Athens 15780 Zografou Athens Greece
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Hershkovich O, Hayun Y, Oscar N, Shtein A, Lotan R. The role of cannabis in treatment-resistant fibromyalgia women. Pain Pract 2023; 23:180-184. [PMID: 36333278 PMCID: PMC10100523 DOI: 10.1111/papr.13179] [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: 06/14/2022] [Revised: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fibromyalgia is a complex pain-focused syndrome. Previous studies showed that Cannabis is efficacious in promoting sleep, deepening and lengthening the sleep cycle, and good pain relief (compared with the SSRIs and SNRIs). PURPOSE This study aimed to use the World Health Organization Quality of Life Bref questionnaire (WhoQoL-bref) to characterize the impact of Cannabis Treatment initiation on the quality of life in women suffering from treatment-resistant fibromyalgia. METHODS A prospective cohort study involving 30 women aged 18-70 years old diagnosed with fibromyalgia, exhausted pharmacological fibromyalgia treatment, and started Cannabis treatment. Pregnant women were excluded. WhoQoL-bref was filled before Cannabis treatment initiation and 1 month following treatment. RESULTS Women's average age was 46 years (±5), with a poor general quality of life (1.47 ± 0.63), poor general health (1.47 ± 0.78), pain and discomfort, and dependence on medication (3.77 ± 1.3 and 3.07 ± 1.74, respectively) prior to Cannabis intervention. Cannabis treatment for 30 days showed a marked improvement in general quality of life (1.97 scores, p < 0.01), general health (1.83, p < 0.01), physical health (1.5, p < 0.01), and psychological domain (1.3, p < 0.01). Financial resources and home environment were not influenced by cannabis treatment (p = 0.07, p = 0.31, respectively). CONCLUSION Results suggest a potentially significant role of Cannabis in treatment-resistant Fibromyalgia women. Early Cannabis treatment may result in a beneficial short-term effect on the quality of life through its influence on pain, sleep, and physical and psychological domains. Further studies are still indicated to understand this potential and its long-term beneficial impact.
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Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv, Israel), Holon, Israel
| | - Yemima Hayun
- Pain Service Unit, Wolfson Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv, Israel), Holon, Israel
| | - Nataly Oscar
- Pain Service Unit, Wolfson Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv, Israel), Holon, Israel
| | - Arnold Shtein
- Pain Service Unit, Wolfson Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv, Israel), Holon, Israel
| | - Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv, Israel), Holon, Israel
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Serrano A, Gálvez R, Paremés E, Navarro A, Ochoa D, Pérez C. Off-label pharmacological treatment for neuropathic pain: A Delphi study by the Spanish Pain Society Neuropathic Pain Task Force. Pain Pract 2023; 23:167-179. [PMID: 36308490 DOI: 10.1111/papr.13176] [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: 05/03/2022] [Revised: 08/23/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The use of off-label pharmacotherapies for neuropathic pain (NP) is growing relating to the many unmet needs of patients. However, clinical guidelines fail to address it, and the available evidence is sparse and fragmented. We arranged a formal expert consensus to address this controversial issue and provide some guidance on judicious use. METHODS A two-round standard Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 40-item questionnaire prepared by the authors. Consensus on each statement was defined as at least either 80% endorsement or rejection after the second round. RESULTS Forty-three and thirty-seven panelists participated in the first and second round, respectively. Consensus was reached in 34 out of 40 statements. Endorsed alternatives for unresponsive patients include non-gabapentinoid antiepileptics (oxcarbazepine and eslicarbazepine), venlafaxine, intravenous lidocaine (when doses can be optimized), and some vaporized cannabinoids (under appropriate surveillance). In addition, lacosamide, low-dose naltrexone, propofol, or ketamine could prove beneficial if subjected to more research. Other options were rejected, and there was controversy about the usefulness of topical preparations. DISCUSSION For patients who do not respond to standard NP treatments, some other viable pharmacological options can be attempted before advancing to other therapeutic stages. This may help patients who are reluctant to or have some contraindication for interventional therapies.
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Affiliation(s)
- Ancor Serrano
- Pain Clinic, Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, L'Hospital et de Llobregat, Spain
| | - Rafael Gálvez
- Pain Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Elena Paremés
- Pain Clinic, Department of Anesthesia and Reanimation, Hospital Povisa, Vigo, Spain
| | - Ana Navarro
- Centro de Salud Puerta del Ángel, Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology, Hospital de la Princesa, Madrid, Spain
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lidocaine infusion for the treatment of burn pain: A review of Recent updates. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lurati AR. Management of Obsessive Compulsive Symptoms in a Patient Diagnosed With Bipolar 1 Disorder and a History of Migraines. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bastaki K, El Anbari M, Ghuloum S, Jithesh PV. Prescription Pattern and Off-Label Use of Antipsychotics in a Middle Eastern Population. Front Pharmacol 2021; 12:753845. [PMID: 34790126 PMCID: PMC8591163 DOI: 10.3389/fphar.2021.753845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Understanding the prescription pattern of medications in a population can help reveal the potential usage scenarios, including off-label prescriptions, and the need for precision medicine implementation. Therefore, the aim of this study was to assess the prescription pattern and off-label use of antipsychotics in the Qatari population. Methods: We performed a cross-sectional study of Qatari patients who received antipsychotic prescriptions from the major healthcare providers in the country during the 2-year period between June 2018 and May 2020. The number of patients, prescriptions dispensed, and clinical indications were collected and statistical analysis using chi-square test was conducted. Results: Among the 9,349 Qatari patients prescribed with antipsychotics during the study period, the majority were female (57%; p < 0.001) and were in the age categories 20–39 and 30–39 years (both 22%; p < 0.001). Among the 35,938 antipsychotic prescriptions dispensed, second-generation antipsychotics were the most highly prescribed (59%), specifically, quetiapine (16%) and olanzapine (12%), but the first-generation antipsychotic prochlorperazine (13%) was also highly prescribed. Most of the indications of antipsychotics (69%) were for off-label use such as for controlling chronic diseases, sleeping disorders, benign paroxysmal positional vertigo and irritable bowel syndrome. Conclusion: Non-mental health and off-label prescriptions of several antipsychotics were observed. Integration of this data with pharmacogenomic and clinical outcome data will help in determining the course of action for implementing personalized and precision medicine in the country and beyond.
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Affiliation(s)
- Kholoud Bastaki
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar.,Hamad Medical Corporation, Doha, Qatar
| | | | - Suhaila Ghuloum
- Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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Lazebnik LB, Golovanova EV, Volel BA, Korochanskaya NV, Lyalyukova EA, Mokshina MV, Mekhtiev SN, Mekhtieva OA, Metsaeva ZV, Petelin DS, Simanenkov VI, Sitkin SI, Cheremushkin SV, Chernogorova MV, Khavkin АI. Functional gastrointestinal disorders. Overlap syndrome Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine and Gastroenterological Scientific Society of Russia. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:5-117. [DOI: 10.31146/1682-8658-ecg-192-8-5-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- L. B. Lazebnik
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - E. V. Golovanova
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - B. A. Volel
- I. M. Sechenov First Moscow Medical State University
| | - N. V. Korochanskaya
- Federal State Budgetary Educational Institution of Higher Education “Kuban State Medical University” Health Ministry of Russian Federation; State Budgetary Institution of Health Care “Region Clinic Hospital Nr 2” Health Ministry of Krasnodar Region
| | - E. A. Lyalyukova
- FSBEI VO “Omsk State Medical University” of the Ministry of Health
| | - M. V. Mokshina
- Institute of therapy a. instrumental diagnostics of FSBEI VO “Pacifi c State Medical Unuversity”
| | | | | | - Z. V. Metsaeva
- Republican clinical hospital of Health Care Ministry of Northen Ossetia- Alania Republic
| | - D. S. Petelin
- I. M. Sechenov First Moscow Medical State University
| | - V. I. Simanenkov
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - S. I. Sitkin
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - S. V. Cheremushkin
- Federal State Budgetary Educational Institution of Higher Education “A. I. Yevdokimov Moscow State University of Medicine and Dentistry” of the Ministry of Healthcare of the Russion Federation
| | - M. V. Chernogorova
- Moscow regional research and clinical Institute of M. F. Vladimirsky; GBUZ MO “Podolsk City Clinical Hospital No. 3”
| | - А. I. Khavkin
- FSBAI HPE “N. I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
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Törnblom H, Drossman DA. Psychopharmacologic Therapies for Irritable Bowel Syndrome. Gastroenterol Clin North Am 2021; 50:655-669. [PMID: 34304793 DOI: 10.1016/j.gtc.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychopharmacologic therapies are beneficial in reducing symptoms when treating irritable bowel syndrome (IBS) and other disorders of gut-brain interaction (DGBI). Noradrenaline, serotonin, and dopamine are neurotransmitters of key importance in psychopharmacology and pain-reduction mechanisms. The first-line (tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors) and second-line (atypical antipsychotics, delta-ligand agents, low-dose naltrexone) neuromodulator treatment options are recommended when IBS-associated abdominal pain is of moderate or severe intensity and is persistent. To understand the implementation strategy, the multidimensional clinical profile as a template is used for presenting 3 case scenarios involving painful IBS and DGBI of varying complexity.
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Affiliation(s)
- Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-41345, Sweden.
| | - Douglas A Drossman
- Drossman Center for the Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; The Rome Foundation, Raleigh, NC, USA, and Drossman Gastroenterology, Durham NC, USA
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Silvestro M, Tessitore A, Scotto di Clemente F, Battista G, Tedeschi G, Russo A. Refractory migraine profile in CGRP-monoclonal antibodies scenario. Acta Neurol Scand 2021; 144:325-333. [PMID: 34019304 PMCID: PMC8453754 DOI: 10.1111/ane.13472] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 12/23/2022]
Abstract
Objective Refractory migraine (Ref‐M) represents a conundrum that headache experts have to face with. We aim to investigate whether a peculiar profile may characterize patients with Ref‐M according to 2020 European Headache Federation criteria. Furthermore, to substantiate a dysfunctional dopaminergic pathway involvement in these patients, we explored the effectiveness of olanzapine. Materials & Methods Eighty‐four patients (fitting previous Ref‐M criteria of the 2014) were treated with erenumab for six months. Differences between clinical and demographic features of responder (Ref‐M according to 2014 criteria) and not‐responder (Ref‐M according to 2020 criteria) patients to CGRP‐mAbs were investigated and their predictive values assessed. In fifteen patients with Ref‐M not responders to CGRP‐mAbs, olanzapine was administered (5 mg/die) for 3 months and frequency and pain intensity of migraine attacks were estimated. Results Patients with Ref‐M not responsive to CGRP‐mAbs (29/84) when compared with Ref‐M responsive to CGRP‐mAbs showed higher baseline frequency of migraine attacks, medication overuse and pain catastrophizing scale (PCS) scores. Logistic regression analyses showed that frequency of attacks, medication overuse and PCS score represent independent negative predictors of CGRP‐mAbs response. A ≥50% reduction of headache days/month was observed after olanzapine treatment in 67% of patients with Ref‐M not responsive to CGRP‐mAbs. Conclusions We outline that higher frequency of migraine attacks, medication overuse and pain catastrophizing characterize patients with Ref‐M not responsive to CGRP‐mAbs. In this frame, olanzapine effectiveness on frequency and pain intensity of migraine attacks supports the hypothesis that migraine refractoriness may be subtended by a prominent involvement of the dopaminergic pathway.
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Affiliation(s)
- Marcello Silvestro
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Alessandro Tessitore
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Fabrizio Scotto di Clemente
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Giorgia Battista
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Gioacchino Tedeschi
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Antonio Russo
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
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Vaalto S, Nyman AL, Shulga A. Analgesic effect of paired associative stimulation in a tetraplegic patient with severe drug-resistant neuropathic pain: a case report. Scand J Pain 2021; 21:831-838. [PMID: 34019752 DOI: 10.1515/sjpain-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is no effective evidence-based non-pharmacological treatment for severe neuropathic pain after spinal cord injury (SCI). Paired associative stimulation (PAS) has been used in motor rehabilitation of patients after SCI. In the SCI-PAS protocol for tetraplegic patients, peripheral and central nerve tracts are activated with subject-specific timing, such that ascending and descending signals appear simultaneously at the cervical level. The effect on motor rehabilitation is thought to arise via strengthening of cervical upper and lower motoneuron synapses. We have observed an analgesic effect of PAS on mild-to-moderate neuropathic pain in tetraplegic patients receiving PAS for motor rehabilitation. Here, we applied PAS to a patient with severe drug-resistant neuropathic pain. METHODS The patient is a 50-year-old man who had a traumatic cervical SCI three years earlier. He has partial paresis in the upper limbs and completely plegic lower limbs. The most severe pain is located in the right upper limb and shoulder region. The pain has not responded to either pharmacological therapy or repetitive-TMS therapy targeted to either primary motor cortex or secondary somatosensory cortex. PAS was targeted to relieve pain in the right upper arm. Peripheral nerve stimulation targeted the median, ulnar, and radial nerves and was accompanied by TMS pulses to the motor representation area of abductor pollicis brevis, abductor digiti minimi, and extensor digitorum communis muscles, respectively. RESULTS Hand motor function, especially finger abduction and extension, was already enhanced during the first therapy week. Pain decreased at the end of the second therapy week. Pain was milder especially in the evenings. Numerical rating scale scores (evening) decreased 44% and patient estimation of global impression of change was 1, subjectively indicating great benefit when compared to before therapy. Quality of sleep also improved. CONCLUSIONS The SCI-PAS protocol reduced neuropathic pain in our subject. The mechanism behind the analgesic effect may involve the modulation of nociceptive and sensory neuronal circuits at the spinal cord level. The possibility to use PAS as an adjunct treatment in drug-resistant post-SCI neuropathic pain warrants further investigation and sham-controlled studies. Patients with neuropathic pain due to SCI may benefit from PAS therapy in addition to PAS therapy-induced improvement in motor function.
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Affiliation(s)
- Selja Vaalto
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Anna-Lena Nyman
- BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anastasia Shulga
- BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physical and Rehabilitation Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Pain Sensitivity in Schizophrenia Spectrum Disorders: A Narrative Review of Recent Work. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Many patients with schizophrenia seem relatively immune to physical pain while others complain of constant pain. This may result from disturbances or alterations of the sensory threshold for pain in populations with psychosis, a possibility for which there is some preliminary evidence. The inconsistency in pain perception may, in part, be explained by the treatments patients receive, but treatment-naïve patients also exhibit differences in response to pain. This suggests that decreased pain sensitivity may represent a specific psychosis endophenotype. Thus far, few experimental studies have investigated sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in psychosis. A digital search for information on this topic was conducted in PubMed and Google Scholar. The result is a non-systematic, narrative review focusing on recent clinical and experimental findings of pain sensitivity in patients with psychosis. Importantly, physical and mental pain are closely connected constructs that may be difficult to differentiate. Our hope is that the review provides some clarity to the field in the specific context of schizophrenia.
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15
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Herrero Babiloni A, Beetz G, Bruneau A, Martel MO, Cistulli PA, Nixdorf DR, Conway JM, Lavigne GJ. Multitargeting the sleep-pain interaction with pharmacological approaches: A narrative review with suggestions on new avenues of investigation. Sleep Med Rev 2021; 59:101459. [PMID: 33601274 DOI: 10.1016/j.smrv.2021.101459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022]
Abstract
The multimorbidity formed by sleep disturbances and pain conditions is highly prevalent and has a significant impact in global health and in the socioeconomic system. Although different approaches have been directed toward its management, evidence regarding an optimal treatment is lacking, and pharmacological options are often preferred. Health professionals (e.g., pain and sleep clinicians) tend to focus on their respective expertise, targeting a single symptom with a single drug. This may increase polypharmacy and the risk of drug interactions, adverse events, and mortality. Hence, the use of medications that can directly or indirectly improve sleep, pain, and other possible accompanying conditions without exacerbating them becomes especially relevant. The objectives of this comprehensive review are to: a) describe the beneficial or deleterious effects that some commonly used medications to manage pain have on sleep and sleep disorders; and b) describe the beneficial or deleterious effects that frequently prescribed medications for sleep may have on pain. Moreover, medications targeting some specific sleep-pain interactions will be suggested and future directions for improving sleep and alleviating pain of these patients will be provided with clinical and research perspectives.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada.
| | - Gabrielle Beetz
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada
| | - Alice Bruneau
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Faculty of Dentistry & Department of Anesthesia, McGill University, Canada
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA; HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | | | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada
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16
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Windsor RB, Sierra M, Zappitelli M, McDaniel M. Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders. CHILDREN-BASEL 2020; 7:children7120268. [PMID: 33276542 PMCID: PMC7761583 DOI: 10.3390/children7120268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.
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Affiliation(s)
- Robert Blake Windsor
- Division of Pediatric Pain Medicine, Department of Pediatrics, Prisma Health, Greenville, SC 29607, USA;
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Correspondence:
| | - Michael Sierra
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29607, USA
| | - Megan Zappitelli
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29607, USA
| | - Maria McDaniel
- Division of Pediatric Pain Medicine, Department of Pediatrics, Prisma Health, Greenville, SC 29607, USA;
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
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17
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Abstract
OPINION STATEMENT Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the list of drugs to use for patients who do complain of insomnia. There is no good evidence that it potentiates the respiratory depression of opioids unlike benzodiazepines. The evidence is weak that olanzapine in as an adjuvant analgesic. Hopefully, future trials will explore this in greater depth. The benefits of adding olanzapine to potent opioids are that it may reduce craving, drug cues, and opioid misuse. Other symptoms like anxiety and depression may be addressed by the addition of olanzapine to standard antidepressants.
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Affiliation(s)
- Mellar P Davis
- Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
| | - Gareth J Sanger
- Blizard Institute and National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
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18
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Fugger G, Dold M, Bartova L, Mitschek MMM, Souery D, Mendlewicz J, Serretti A, Zohar J, Montgomery S, Fabbri C, Frey R, Kasper S. Clinical Correlates and Outcome of Major Depressive Disorder and Comorbid Migraine: A Report of the European Group for the Study of Resistant Depression. Int J Neuropsychopharmacol 2020; 23:571-577. [PMID: 32885810 PMCID: PMC7710912 DOI: 10.1093/ijnp/pyaa035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/22/2020] [Accepted: 05/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The present multicenter study aimed at defining the clinical profile of patients with major depressive disorder (MDD) and comorbid migraine. METHODS Demographic and clinical information for 1410 MDD patients with vs without concurrent migraine were compared by descriptive statistics, analyses of covariance, and binary logistic regression analyses. RESULTS The point prevalence rate for comorbid migraine was 13.5% for female and 6.2% for male patients. MDD + migraine patients were significantly younger, heavier, more likely female, of non-Caucasian origin, outpatient, and suffering from asthma. The presence of MDD + migraine resulted in a significantly higher functional disability. First-line antidepressant treatment strategy revealed a trend towards agomelatine. Second-generation antipsychotics were significantly less often administered for augmentation treatment in migraineurs. Overall, MDD + migraine patients tended to respond worse to their pharmacotherapy. CONCLUSION Treatment guidelines for comorbid depression and migraine are warranted to ensure optimal efficacy and avoid possible pitfalls in psychopharmacotherapy, including serotonin syndrome.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marleen M M Mitschek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles, Bruxelles, Belgium,Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria,Correspondence: Siegfried Kasper, MD, Medical University of Vienna, Center for Brain Research, Spitalgasse 4, A-1090 Vienna, Austria ()
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19
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Khan SR, Heller DA, Latty LL, Cadieux RJ, LaSure M, Brown TV. Association between psychotropic drug use and prescription opioid use among older adults. Geriatr Nurs 2020; 41:776-781. [PMID: 32522424 DOI: 10.1016/j.gerinurse.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/25/2023]
Abstract
This study investigated the association between psychotropic drug use and prescription opioid use/high dosage opioid use among older adults. A sample of 203,750 older adults enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) program during 2017 was evaluated for prescription opioid and psychotropic drug usage. High dosage opioid use was defined as using >90 morphine milligram equivalents (MME)/day for ≥90 consecutive days. Overall, 20.7% of enrollees filled opioid prescriptions, of which 1.4% used them at high dosages. Multivariate logistic regression indicated that the odds of prescription opioid use increased with anxiolytic/sedative/hypnotic use and antidepressant use. Moreover, high dosage opioid use was significantly associated with anxiolytic/sedative/hypnotic use, antidepressant use and other factors including being younger, male, white, and married but living separately, and having multiple opioid prescribers. Clinicians should carefully evaluate opioid use among older patients using anxiolytics or antidepressants to minimize risks for adverse consequences of opioids.
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Affiliation(s)
- Shivani R Khan
- Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA.
| | - Debra A Heller
- Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA
| | - Leroy L Latty
- Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA
| | - Roger J Cadieux
- Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA
| | - Michelle LaSure
- Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA
| | - Theresa V Brown
- Pennsylvania Department of Aging, 555 Walnut Street, Forum Place 5th Floor, Harrisburg, PA 17101, USA
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20
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Ikkos G, Ramanuj PP. Brain and pain: old assumptions and new science about chronic pain. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThe authors summarise the evolving understanding of the neuropsychophysiology of chronic pain, including the relevance of adverse childhood experiences in facilitating it and similarities between the central physiology of chronic pain and opioid addiction. Emerging understanding highlights the importance of dopamine-expressing GABAergic neurons in the nucleus accumbens and suggests that D1 expression is associated with a sense of pleasure and approach behaviour and D2 with a sense of punishment and behavioural inhibition. Regulation of D1 and D2 expression may be mediated by nigrostriatal and medial frontal striatal pathways within the increasingly understood brain as a ‘predictive’ organ. The distinction between the predictive brain and personal ‘expectations’ and the importance of the latter for clinical outcomes are emphasised. The relevance of findings for possible future psychopharmacological treatment avenues is also presented.
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21
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Schmiedl S, Peters D, Schmalz O, Mielke A, Rossmanith T, Diop S, Piefke M, Thürmann P, Schmidtko A. Loxapine for Treatment of Patients With Refractory, Chemotherapy-Induced Neuropathic Pain: A Prematurely Terminated Pilot Study Showing Efficacy But Limited Tolerability. Front Pharmacol 2019; 10:838. [PMID: 31402867 PMCID: PMC6669235 DOI: 10.3389/fphar.2019.00838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022] Open
Abstract
Neuropathic pain is a debilitating and commonly treatment-refractory condition requiring novel therapeutic options. Accumulating preclinical studies indicate that the potassium channel Slack (KNa1.1) contributes to the processing of neuropathic pain, and that Slack activators, when injected into mice, ameliorate pain-related hypersensitivity. However, whether Slack activation might reduce neuropathic pain in humans remains elusive. Here, we evaluated the tolerability and analgesic efficacy of loxapine, a first-generation antipsychotic drug and Slack activator, in neuropathic pain patients. We aimed to treat 12 patients with chronic chemotherapy-induced, treatment-refractory neuropathic pain (pain severity ≥ 4 units on an 11-point numerical rating scale) in a monocentric, open label, proof-of-principle study. Patients received loxapine orally as add-on analgesic in a dose-escalating manner (four treatment episodes for 14 days, daily dose: 20, 30, 40, or 60 mg loxapine) depending on tolerability and analgesic efficacy. Patient-reported outcomes of pain intensity and/or relief were recorded daily. After enrolling four patients, this study was prematurely terminated due to adverse events typically occurring with first-generation antipsychotic drugs that were reported by all patients. In two patients receiving loxapine for at least two treatment episodes, a clinically relevant analgesic effect was found at a daily dose of 20-30 mg of loxapine. Another two patients tolerated loxapine only for a few days. Together, our data further support the hypothesis that Slack activation might be a novel strategy for neuropathic pain therapy. However, loxapine is no valid treatment option for painful polyneuropathy due to profound dopamine and histamine receptor-related side effects. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02820519.
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Affiliation(s)
- Sven Schmiedl
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany.,Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - David Peters
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany.,Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Oliver Schmalz
- Clinic of Internal Medicine I, Division of Oncology and Palliative Care, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Anke Mielke
- Clinic for Anesthesiology, Pain Management Unit, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), branch for Translational Medicine and Pharmacology of the Fraunhofer IME, Frankfurt, Germany
| | - Shirin Diop
- Neurobiology and Genetics of Behavior, Department of Psychology and Psychotherapy, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Martina Piefke
- Neurobiology and Genetics of Behavior, Department of Psychology and Psychotherapy, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Petra Thürmann
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany.,Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Achim Schmidtko
- Institute of Pharmacology and Toxicology, Centre for Biomedical Education and Research (ZBAF), School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Institute of Pharmacology and Clinical Pharmacy, College of Pharmacy, Goethe University, Frankfurt, Germany
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22
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Tu TTH, Takenoshita M, Matsuoka H, Watanabe T, Suga T, Aota Y, Abiko Y, Toyofuku A. Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review. Biopsychosoc Med 2019; 13:1. [PMID: 30733824 PMCID: PMC6357406 DOI: 10.1186/s13030-019-0142-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.
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Affiliation(s)
- Trang T H Tu
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Miho Takenoshita
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Hirofumi Matsuoka
- 2Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Takeshi Watanabe
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Takayuki Suga
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yuma Aota
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yoshihiro Abiko
- 3Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Akira Toyofuku
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
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23
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Abstract
Purpose of Review The functional gastrointestinal disorders, or disorders of gut-brain interaction as defined by the Rome IV criteria, are the most common diagnostic entities in gastroenterology. Treatments that address the dysregulation of gut-brain interaction with these disorders are increasingly gaining interest as a better option than for example traditional analgesics, particularly opioids. Antidepressants, antianxiety and antipsychotic medications, and visceral analgesics, now termed neuromodulators, are included in this update addressing the evidence of treatment benefit in disorders of brain-gut interaction. Recent Findings By a careful selection based on a multidimensional clinical profile, a decreased symptom burden, particularly regarding abdominal pain, nausea, and vomiting, as well as improved social function and quality of life, can be obtained by use of neuromodulators. There is good evidence for the peripheral neuromodulators from studies in bowel disorders, and the central neuromodulators both from indirect evidence in chronic pain disorders as well as selected disorders of brain-gut interaction. Summary Basic knowledge about the pharmacologic properties and clinical use of neuromodulators in disorders of brain-gut interaction improves the treatment outcome and avoids use of traditional analgesics.
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