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De Rosa F, Giannatiempo B, Charlier B, Coglianese A, Mensitieri F, Gaudino G, Cozzolino A, Filippelli A, Piazza O, Dal Piaz F, Izzo V. Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain. Pharmaceutics 2023; 15:2088. [PMID: 37631302 PMCID: PMC10457775 DOI: 10.3390/pharmaceutics15082088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports.
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Affiliation(s)
- Federica De Rosa
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
| | - Bruno Giannatiempo
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
| | - Bruno Charlier
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
| | - Albino Coglianese
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pathology and Clinical Biochemistry, University of Salerno, 84084 Fisciano, Italy
| | - Francesca Mensitieri
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Giulia Gaudino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Armando Cozzolino
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Ornella Piazza
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Fabrizio Dal Piaz
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Viviana Izzo
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
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Assessment of Neurotoxic Effects of Oxycodone and Naloxone in SH-SY5Y Cell Line. Int J Mol Sci 2023; 24:ijms24021424. [PMID: 36674961 PMCID: PMC9861468 DOI: 10.3390/ijms24021424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023] Open
Abstract
Opioid drugs have analgesic properties used to treat chronic and post-surgical pain due to descending pain modulation. The use of opioids is often associated with adverse effects or clinical issues. This study aimed to evaluate the toxicity of opioids by exposing the neuroblastoma cell line (SH-SY5Y) to 0, 1, 10, and 100 µM oxycodone and naloxone for 24 h. Analyses were carried out to evaluate cell cytotoxicity, identification of cell death, DNA damage, superoxide dismutase (SOD), glutathione S-transferase (GST), and acetylcholinesterase (AChE) activities, in addition to molecular docking. Oxycodone and naloxone exposure did not alter the SH-SY5Y cell viability. The exposure to 100 µM oxycodone and naloxone significantly increased the cells' DNA damage score compared to the control group. Naloxone exposure significantly inhibited AChE, GST, and SOD activities, while oxycodone did not alter these enzymes' activities. Molecular docking showed that naloxone and oxycodone interact with different amino acids in the studied enzymes, which may explain the differences in enzymatic inhibition. Naloxone altered the antioxidant defenses of SH-SY5Y cells, which may have caused DNA damage 24 h after the exposure. On the other hand, more studies are necessary to explain how oxycodone causes DNA damage.
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Tyan P, Klebanoff JS, Smith S, Amdur R, North A, Maassen MS, Moawad GN. Perioperative Narcotic Trends in Women Undergoing Minimally Invasive Myomectomy. J Minim Invasive Gynecol 2020; 27:1383-1388.e1. [DOI: 10.1016/j.jmig.2019.09.787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/27/2023]
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