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Viñas-Bastart M, Oms-Arias M, Pedraza-Gutiérrez À, Lizano-Díez I, Mariño EL, Modamio P. Tapentadol and Oxycodone/Naloxone Prescribing Patterns in Primary Health Care in Catalonia, Spain: A Cross-Sectional Study. Risk Manag Healthc Policy 2021; 14:4155-4168. [PMID: 34675710 PMCID: PMC8500723 DOI: 10.2147/rmhp.s301724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To characterize the use of tapentadol and the combination oxycodone/naloxone in primary health care. Data on their use and possible misuse will allow the identification of risk factors and to design protocols to reduce and prevent avoidable harm to patients being treated for pain. Design A descriptive, cross-sectional and multicenter study was performed. Setting Fifty-three primary health care teams, which provides healthcare for 1,300,000 inhabitants. Patients A total of 1840 patients had active prescriptions of tapentadol and 985 of oxycodone/naloxone. Methods Demographic (age, sex) and clinical (glomerular filtration rate; active liver disease; dosing and duration of treatment), prescribed daily dose (according to age, sex, length of treatment), concomitant analgesic treatment and diagnosis. Patient information was obtained from medical records. Results Most of the patients were women (>74.0% in both cases), and the average age was 69.3 years (women: 70.1±13.2; men: 66.7±13.9 years) in the case of tapentadol and 70.6 years (women: 64.0±13.6; men: 72.6±14.3 years) in the case of oxycodone/naloxone. Only 12.2% of patients taking tapentadol and 12.1% taking oxycodone/naloxone had a normal renal function. In both cases, 4.1% of patients had active liver disease. The average length of treatment was 246.4 days in oxycodone/naloxone and 199.0 days in tapentadol. It was recorded that 85.1% of patients in the case of tapentadol and 89.0% in the oxycodone/naloxone had at least another drug prescribed for pain. About 42.2% of patients treated with tapentadol and 34.4% of patients treated with oxycodone/naloxone had associated neuralgia as a diagnosis. Conclusion The pattern of use and profile of patients with tapentadol and oxycodone/naloxone had more similarities than differences, and suggested that prescribing practice, and monitoring should be assessed regularly to ensure patient safety and effective management of pain.
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Affiliation(s)
- Montserrat Viñas-Bastart
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Míriam Oms-Arias
- Costa de Ponent Primary Care Directorate, Catalan Institute of Health, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Àfrica Pedraza-Gutiérrez
- Costa de Ponent Primary Care Directorate, Catalan Institute of Health, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Irene Lizano-Díez
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
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Provenzano DA, Sitzman BT, Florentino SA, Buterbaugh GA. Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic. Reg Anesth Pain Med 2020; 45:579-585. [PMID: 32475827 PMCID: PMC7402455 DOI: 10.1136/rapm-2020-101640] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Although the clinical implications are of the utmost importance, the economic consequences have also been serious and resulted in substantial damage to the US healthcare system, including pain practices. Outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed. For the most part, ambulatory surgical centers have had to cease operations. As patient volumes have decreased for non-emergent elective care, the financial indicators have deteriorated. This review article will provide insight into solutions to mitigate the clinical and economic challenges induced by COVID-19. Undoubtedly, the COVID-19 pandemic will have short-term and long-term implications for all medical practices and facilities. In order to survive, medical practices will need dynamic, operational, and creative strategic plans to mitigate the disruption in medical care and pathways for successful reintegration of clinical and surgical practice.
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Shanthanna H, Strand NH, Provenzano DA, Lobo CA, Eldabe S, Bhatia A, Wegener J, Curtis K, Cohen SP, Narouze S. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia 2020; 75:935-944. [PMID: 32259288 PMCID: PMC7262200 DOI: 10.1111/anae.15076] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2020] [Indexed: 12/17/2022]
Abstract
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the COVID-19 situation continues to evolve rapidly, these recommendations are based on the best available evidence and expert opinion at this present time and may need adapting to local workplace policies.
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Affiliation(s)
- H Shanthanna
- Department of Anesthesia, McMaster University, ON, Canada
| | - N H Strand
- Division of Pain Medicine, Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - D A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, PA, USA
| | - C A Lobo
- Department of Anaesthesiology, Hospital das Forças Armadas, Pólo Porto, Portugal
| | - S Eldabe
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
| | - A Bhatia
- Comprehensive Integrated Pain Program-Interventional Pain Service, Department of Anesthesia and Pain Medicine, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - J Wegener
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - K Curtis
- Comprehensive Integrated Pain Program-Interventional Pain Service, Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - S P Cohen
- Department of Anesthesiology and Critical Care Medicine, Neurology and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S Narouze
- Northeast Ohio Medical University and Chairman, Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Bargon CA, Zale EL, Magidson J, Chen N, Ring D, Vranceanu AM. Factors Associated With Patients' Perceived Importance of Opioid Prescribing Policies in an Orthopedic Hand Surgery Practice. J Hand Surg Am 2019; 44:340.e1-340.e8. [PMID: 30122303 DOI: 10.1016/j.jhsa.2018.06.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/18/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to survey the attitudes and beliefs about opioids and opioid prescribing policies among patients presenting to an orthopedic hand surgery practice. METHODS Patients (n = 118; median age, 49 years) who presented to their regularly scheduled appointment at a major urban university medical center completed surveys assessing their sociodemographic and clinical characteristics, beliefs about prescription opioids, beliefs about opioid prescribing policies, and perceived importance of opioid prescribing policies in the department. RESULTS Many patients were aware of potential risks of opioids (eg, 80% are aware of addictive properties) and would support opioid prescribing policies that aim to decrease opioid misuse and diversion. However, a small but important number of patients have concerning beliefs about prescription opioids (eg, 28% believe opioids work well for long-term pain) or believe that doctors should prescribe "as much medication as the patient needs" (7%). The vast majority (98%) indicated that they would like more education on opioids and that information about prescription opioids should be provided to all patients in orthopedic practices. Patients with higher educational attainment reported a greater perceived importance of opioid prescribing policies. CONCLUSIONS The results of this study suggest that opioid prescribing strategies that promote safe and effective alleviation of pain and optimal opioid stewardship will be well received by patients. CLINICAL RELEVANCE Efforts to develop and test the effects of opioid prescribing policies and nonopioid pain relief strategies on opioid prescribing are merited.
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Affiliation(s)
- Claudia Antoinette Bargon
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA; University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Emily L Zale
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jessica Magidson
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Neal Chen
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - David Ring
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Dell Medical School, The University of Texas, Austin, TX
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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Lakkakula BV, Sahoo R, Verma H, Lakkakula S. Pain Management Issues as Part of the Comprehensive Care of Patients with Sickle Cell Disease. Pain Manag Nurs 2018; 19:558-572. [DOI: 10.1016/j.pmn.2018.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/14/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
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Monge-Fuentes V, Arenas C, Galante P, Gonçalves JC, Mortari MR, Schwartz EF. Arthropod toxins and their antinociceptive properties: From venoms to painkillers. Pharmacol Ther 2018; 188:176-185. [PMID: 29605457 DOI: 10.1016/j.pharmthera.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The complex process of pain control commonly involves the use of systemic analgesics; however, in many cases, a more potent and effective polypharmacological approach is needed to promote clinically significant improvement. Additionally, considering side effects caused by current painkillers, drug discovery is once more turning to nature as a source of more efficient therapeutic alternatives. In this context, arthropod venoms contain a vast array of bioactive substances that have evolved to selectively bind to specific pharmacological targets involved in the pain signaling pathway, playing an important role as pain activators or modulators, the latter serving as promising analgesic agents. The current review explores how the pain pathway works and surveys neuroactive compounds obtained from arthropods' toxins, which function as pain modulators through their interaction with specific ion channels and membrane receptors, emerging as promising candidates for drug design and development.
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Affiliation(s)
- Victoria Monge-Fuentes
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil.
| | - Claudia Arenas
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil
| | - Priscilla Galante
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil
| | - Jacqueline Coimbra Gonçalves
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil
| | - Márcia Renata Mortari
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil
| | - Elisabeth Ferroni Schwartz
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília 70910-900, Brazil
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Evidence Gaps in the Use of Spinal Cord Stimulation for Treating Chronic Spine Conditions. Spine (Phila Pa 1976) 2017; 42 Suppl 14:S80-S92. [PMID: 28368981 DOI: 10.1097/brs.0000000000002184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A review of literature. OBJECTIVE The aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions. SUMMARY OF BACKGROUND DATA Although over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist. METHODS A literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored. RESULTS The efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine. CONCLUSION Evidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions. LEVEL OF EVIDENCE N/A.
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Wang Y, Li X, Yang M, Wu C, Zou Z, Tang J, Yang X. Centipede venom peptide SsmTX-I with two intramolecular disulfide bonds shows analgesic activities in animal models. J Pept Sci 2017; 23:384-391. [PMID: 28247497 DOI: 10.1002/psc.2988] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 12/19/2022]
Abstract
Pain is a major symptom of many diseases and results in enormous pressures on human body or society. Currently, clinically used analgesic drugs, including opioids and nonsteroidal anti-inflammatory drugs, have adverse reactions, and thus, the development of new types of analgesic drug candidates is urgently needed. Animal venom peptides have proven to have potential as new types of analgesic medicine. In this research, we describe the isolation and characterization of an analgesic peptide from the crude venom of centipede, Scolopendra subspinipes mutilans. The amino acid sequence of this peptide was identical with SsmTX-I that was previously reported as a specific Kv2.1 ion channel blocker. Our results revealed that SsmTX-I was produced by posttranslational processing of a 73-residue prepropeptide. The intramolecular disulfide bridge motifs of SsmTX-I was Cys1-Cys3 and Cys2-Cys4. Functional assay revealed that SsmTX-I showed potential analgesic activities in formalin-induced paw licking, thermal pain, and acetic acid-induced abdominal writhing mice models. Our research provides the first report of cDNA sequences, disulfide motif, successful synthesis, and analgesic potential of SsmTX-I for the development of pain-killing drugs. It indicates that centipede peptide toxins could be a treasure trove for the search of novel analgesic drug candidates. Copyright © 2017 European Peptide Society and John Wiley & Sons, Ltd.
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Affiliation(s)
- Ying Wang
- Ethic Drug Screening and Pharmacology Center, Key Laboratory of Chemistry in Ethnic Medicine Resource, State Ethnic Affairs Commission and Ministry of Education, Yunnan University of Nationalities, Kunming, 650500, China
| | - Xiaojie Li
- Department of Biochemistry and Molecular Biology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
| | - Meifeng Yang
- Department of Biochemistry and Molecular Biology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
| | - Chunyun Wu
- Department of Anatomy and Histology and Embryology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
| | - Zhirong Zou
- Department of Anatomy and Histology and Embryology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
| | - Jing Tang
- Department of Biochemistry and Molecular Biology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
| | - Xinwang Yang
- Department of Anatomy and Histology and Embryology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, 650500, China
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White R, Hayes C, White S, Hodson FJ. Using social media to challenge unwarranted clinical variation in the treatment of chronic noncancer pain: the "Brainman" story. J Pain Res 2016; 9:701-709. [PMID: 27703395 PMCID: PMC5036613 DOI: 10.2147/jpr.s115814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is a substantial clinical variation in the contemporary treatment of chronic noncancer pain reflecting different explanatory models and treatment emphasis. Hunter Integrated Pain Service and collaborators developed three key messaging videos outlining the foundations of chronic pain treatment, thus challenging unwarranted clinical variation and calling for greater therapeutic consistency. The videos were released on YouTube as a low-cost public health intervention. Each video used an evidenced informed script appropriate for low literacy and a cartoonist to provide matching images. The whole-person approach emphasized the role of the nervous system and active self-management approaches over passively received medical treatments. The first video was launched on YouTube in August 2011 and made freely available through a Creative Commons license. Multisource feedback led to refinement of key messages using a broader advisory group. Two further videos were launched on a dedicated YouTube channel in October 2014 and circulated through varied professional and consumer networks. All videos were widely viewed on YouTube, utilized by diverse health care organizations, and independently translated into multiple languages. They were embedded in multiple health-related websites. The first video "Understanding pain in less than 5 minutes" is known to have been translated into 15 languages by other health care organizations. The subsequent two videos (Brainman stops his opioids, and Brainman chooses) were translated into German and subtitled in French and Japanese. When the organization hosting the first video ceased operation in 2015 due to changes in primary health care funding, the video had received >700,000 views. Each of the three videos continues to receive ~1,500 views per month on YouTube. Release of evidence-informed key messages via YouTube is a simple method of challenging clinical variation and providing education about chronic pain across the health care system and community.
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Affiliation(s)
- Ruth White
- Hunter Integrated Pain Service, Hunter New England Local Health District, Newcastle, NSW
| | - Chris Hayes
- Hunter Integrated Pain Service, Hunter New England Local Health District, Newcastle, NSW
| | - Scott White
- Hunter New England Central Coast Primary Health Network, Newcastle, NSW, Australia
| | - Fiona J Hodson
- Hunter Integrated Pain Service, Hunter New England Local Health District, Newcastle, NSW
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10
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Antinociceptive properties of the mastoparan peptide Agelaia-MPI isolated from social wasps. Toxicon 2016; 120:15-21. [DOI: 10.1016/j.toxicon.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/28/2016] [Accepted: 07/10/2016] [Indexed: 01/13/2023]
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Argoff C, McCarberg B, Gudin J, Nalamachu S, Young C. SoluMatrix® Diclofenac: Sustained Opioid-Sparing Effects in a Phase 3 Study in Patients with Postoperative Pain. PAIN MEDICINE 2016; 17:1933-1941. [PMID: 26995799 DOI: 10.1093/pm/pnw012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate opioid rescue medication usage and the opioid-sparing effect of low-dose SoluMatrix® diclofenac developed using SoluMatrix Fine Particle Technology™ in a phase 3 study in patients experiencing pain following bunionectomy surgery. DESIGN Multicenter, randomized, double-blind, parallel-group study (NCT01462435). SETTING Four clinical research centers in the United States. SUBJECTS Four hundred twenty-eight patients aged 18 to 65 years who experienced moderate-to-severe pain following bunionectomy surgery. METHODS Patients were randomized to receive low-dose SoluMatrix diclofenac 35 mg or 18 mg capsules three times daily (35-mg group or 18-mg group), celecoxib 400 mg loading dose followed by 200-mg capsules twice daily (celecoxib 200-mg group), or placebo capsules postsurgery. Patients were permitted to receive opioid-containing rescue medication as needed. RESULTS Significantly fewer patients who received SoluMatrix diclofenac 35 mg or 18 mg or celecoxib required rescue medication during 0-24 h and >24-48 h postsurgery compared with placebo. Patients in the SoluMatrix diclofenac 35 mg or 18 mg groups or in the celecoxib group used fewer mean rescue medication tablets over 0-24 h and >24-48 h compared with placebo-treated patients. Patients in the SoluMatrix diclofenac 35 mg and 18 mg groups and in the celecoxib group also required rescue medication at later times and at slower rates compared with placebo-treated patients. No serious adverse effects occurred in patients receiving SoluMatrix diclofenac. CONCLUSIONS SoluMatrix diclofenac at two dosage strengths demonstrated an opioid-sparing effect postoperatively in this phase 3 study. SUMMARY The opioid-sparing effect following low-dose SoluMatrix diclofenac (35 mg or 18 mg three times daily) administration was evaluated in patients experiencing pain following bunionectomy. Significantly fewer patients receiving SoluMatrix diclofenac or celecoxib (400 mg loading, 200 mg twice daily) required rescue medication during 0-24 h and >24-48 h following bunionectomy compared with placebo. No serious adverse events were reported among patients who received SoluMatrix diclofenac. SoluMatrix diclofenac may reduce opioid usage in the postoperative setting in patients with acute pain.
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Affiliation(s)
- Charles Argoff
- *Neurology Group, Albany Medical College, Albany, New York
| | - Bill McCarberg
- School of Medicine, University of California San Diego, San Diego, California
| | - Jeff Gudin
- Pain and Palliative Care, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - Srinivas Nalamachu
- Department of Physical Medicine & Rehabilitation, International Clinical Research Institute, Overland Park, Kansas
| | - Clarence Young
- Iroko Pharmaceuticals, LLC, Philadelphia, Pennsylvania USA
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12
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Wong Lit Wan D, Wang Y, Xue CCL, Wang LP, Liang FR, Zheng Z. Local and distant acupuncture points stimulation for chronic musculoskeletal pain: A systematic review on the comparative effects. Eur J Pain 2015; 19:1232-47. [PMID: 25690699 DOI: 10.1002/ejp.671] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 01/11/2023]
Abstract
One in four people suffers from chronic musculoskeletal pain (CMP). Acupuncture points stimulation is increasingly used for pain relief for CMP. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is unknown. This systematic review aimed to determine if there was a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. English and Chinese electronic databases were searched to identify randomized controlled trials, where local or distant points were stimulated in adults with CMP. Pain intensity was the primary outcome measure. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.
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Affiliation(s)
- D Wong Lit Wan
- School of Health Sciences, and Health Innovations Research Institute, RMIT University, Bundoora, Vic., Australia
| | - Y Wang
- School of Health Sciences, and Health Innovations Research Institute, RMIT University, Bundoora, Vic., Australia
| | - C C L Xue
- School of Health Sciences, and Health Innovations Research Institute, RMIT University, Bundoora, Vic., Australia
| | - L P Wang
- Department of Acupuncture, Beijing Hospital of Traditional Chinese Medicine, Affiliated to Capital Medical University, Beijing, China
| | - F R Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Z Zheng
- School of Health Sciences, and Health Innovations Research Institute, RMIT University, Bundoora, Vic., Australia
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Chartier SR, Thompson ML, Longo G, Fealk MN, Majuta LA, Mantyh PW. Exuberant sprouting of sensory and sympathetic nerve fibers in nonhealed bone fractures and the generation and maintenance of chronic skeletal pain. Pain 2014; 155:2323-36. [PMID: 25196264 PMCID: PMC4254205 DOI: 10.1016/j.pain.2014.08.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/17/2014] [Accepted: 08/12/2014] [Indexed: 01/14/2023]
Abstract
Skeletal injury is a leading cause of chronic pain and long-term disability worldwide. While most acute skeletal pain can be effectively managed with nonsteroidal anti-inflammatory drugs and opiates, chronic skeletal pain is more difficult to control using these same therapy regimens. One possibility as to why chronic skeletal pain is more difficult to manage over time is that there may be nerve sprouting in nonhealed areas of the skeleton that normally receive little (mineralized bone) to no (articular cartilage) innervation. If such ectopic sprouting did occur, it could result in normally nonnoxious loading of the skeleton being perceived as noxious and/or the generation of a neuropathic pain state. To explore this possibility, a mouse model of skeletal pain was generated by inducing a closed fracture of the femur. Examined animals had comminuted fractures and did not fully heal even at 90+days post fracture. In all mice with nonhealed fractures, exuberant sensory and sympathetic nerve sprouting, an increase in the density of nerve fibers, and the formation of neuroma-like structures near the fracture site were observed. Additionally, all of these animals exhibited significant pain behaviors upon palpation of the nonhealed fracture site. In contrast, sprouting of sensory and sympathetic nerve fibers or significant palpation-induced pain behaviors was never observed in naïve animals. Understanding what drives this ectopic nerve sprouting and the role it plays in skeletal pain may allow a better understanding and treatment of this currently difficult-to-control pain state.
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Affiliation(s)
| | | | - Geraldine Longo
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Michelle N Fealk
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Lisa A Majuta
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Patrick W Mantyh
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA; Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
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