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Chodnekar SY, Jain N, Lansiaux E, Panag DS, Gibietis V. Beyond Traditional Pain Relief: A Review of Alternative Analgesics in Myocardial Infarction Patient Management. J Pain Palliat Care Pharmacother 2024; 38:157-169. [PMID: 38329476 DOI: 10.1080/15360288.2024.2304008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
While morphine is the recommended first-line treatment for pain management in patients with acute coronary syndrome, recent studies have raised concerns about its association with adverse outcomes. Morphine has been found to cause delayed antiplatelet effects, decreased ticagrelor absorption, increased platelet reactivity, and compromised efficacy of dual antiplatelet therapy (DAPT). Alternative analgesics, such as lidocaine, fentanyl, and acetaminophen, have begun to emerge as viable alternatives, each with unique mechanisms and potential benefits. Lidocaine is demonstrated to have superior effects in reducing microvascular obstruction and fewer adverse events compared to fentanyl, despite being less effective in pain reduction. Fentanyl, which shows rapid onset and powerful analgesic properties, may interfere with ticagrelor absorption, potentially affecting platelet inhibition. Acetaminophen, a centrally acting analgesic, emerges as a safer alternative with comparable pain relief efficacy and minimal side effects. The results of multiple clinical trials emphasize the significance of customizing pain management approaches to match individual patient profiles and achieving the optimal balance between pain relief and potential adverse outcomes.
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Affiliation(s)
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
| | - Edouard Lansiaux
- Faculty of Medicine, Lille University School of Medicine, Lille, France
| | | | - Valdis Gibietis
- Department of Internal Diseases, Riga Stradinš University, Riga, Latvia
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Wang Z, Wang F, Jiang X, Wang W, Xing Y, Qiu X, Sun L, Li C, Tang L. Perspectives and Practice in Eastern and Western Medicine for Pain Management in Rehabilitation Training after Orthopedic Trauma Surgery: A Qualitative Study. Pain Manag Nurs 2024; 25:e201-e208. [PMID: 38278749 DOI: 10.1016/j.pmn.2023.12.015] [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: 07/14/2023] [Revised: 12/30/2023] [Accepted: 12/31/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Despite the increasing emphasis on rehabilitation training after orthopedic surgery, little is known about the pain caused by the procedure itself. Clinical practice is driven by beliefs in pain management. AIMS This study aimed to explore the perspective of pain management during rehabilitation training after orthopedic trauma in China and its influencing factors from different perspectives in traditional Chinese medicine and Western medicine, respectively. DESIGN A phenomenological qualitative study involving semi-structured interviews. SETTINGS METHODS: A qualitative study was conducted with 16 medical workers working in the Rehabilitation Medicine Department in eastern China from July 2022-February 2023. A directed method to thematic analysis was used to code the transcribed data and identify themes. RESULTS Four main themes emerged. (1) Inconsistent perspectives and practice: Chinese doctors majoring in Western medicine felt sympathy, helpless, and had a lack of knowledge and misconception about pain. Traditional Chinese medicine deemed that pain is a protective mechanism and attached importance to holism and unique means. (2) Consistent outcome: Insufficient pain management will have a series of negative consequences for patients' recovery, forming a vicious cycle. (3) Expectations: Though they are not optimistic about traditional analgesics, enhancement, cooperation and ideal analgesic methods still be expressed, and (4) Concept transformation: Conducting nitrous oxide is a process not only to promote analgesic technology but also to promote the awareness and concept of pain management. CONCLUSIONS Our study emphasized that medical workers should be aware of the importance of pain management at the same time while treating the disability. The study provides insight into pain management experiences within different educational backgrounds. The findings enable professionals to recognize the importance of pain management and its influencing factors to provide feasible and effective pain management strategies.
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; School of Nursing, Weifang Medical University, Weifang, China
| | - Fei Wang
- Department of Anesthesiology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China
| | - Xiaochen Jiang
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; School of Nursing, Weifang Medical University, Weifang, China
| | - Weifeng Wang
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; School of Nursing, Weifang Medical University, Weifang, China
| | - Yihui Xing
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; Qingdao Stomatological Hospital, Qingdao, China
| | - Xueling Qiu
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; School of Nursing, Shandong First Medical University, Taian, China
| | - Lukun Sun
- Department of rehabilitation medicine, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China
| | - Cui Li
- Department of rehabilitation medicine, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China
| | - Lu Tang
- Department of Stomatology, the 960th Hospital of People' s Liberation Army of China (PLA), Jinan, China; School of Nursing, Weifang Medical University, Weifang, China.
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Garin D, Degrauwe S, Carbone F, Musayeb Y, Lauriers N, Valgimigli M, Iglesias JF. Differential impact of fentanyl and morphine doses on ticagrelor-induced platelet inhibition in ST-segment elevation myocardial infarction: a subgroup analysis from the PERSEUS randomized trial. Front Cardiovasc Med 2024; 11:1324641. [PMID: 38628315 PMCID: PMC11018886 DOI: 10.3389/fcvm.2024.1324641] [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: 10/19/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), intravenous fentanyl does not enhance ticagrelor-induced platelet inhibition within 2 h compared to morphine. The impact of the total dose of fentanyl and morphine received on ticagrelor pharmacodynamic and pharmacokinetic responses in patients with STEMI remains however undetermined. Materials and methods We performed a post-hoc subanalysis of the prospective, open-label, single-center, randomized PERSEUS trial (NCT02531165) that compared treatment with intravenous fentanyl vs. morphine among symptomatic patients with STEMI treated with primary PCI after ticagrelor pretreatment. Patients from the same population as PERSEUS were further stratified according to the total dose of intravenous opioids received. The primary outcome was platelet reactivity using P2Y12 reaction units (PRU) at 2 h following administration of a loading dose (LD) of ticagrelor. Secondary outcomes were platelet reactivity and peak plasma levels of ticagrelor and AR-C124910XX, its active metabolite, at up to 12 h after ticagrelor LD administration. Generalized linear models for repeated measures were built to determine the relationship between raw and weight-weighted doses of fentanyl and morphine. Results 38 patients with STEMI were included between December 18, 2015, and June 22, 2017. Baseline clinical and procedural characteristics were similar between low- and high-dose opioid subgroups. At 2 h, there was a significant correlation between PRU and both raw [regression coefficient (B), 0.51; 95% confidence interval (CI), 0.02-0.99; p = 0.043] and weight-weighted (B, 0.54; 95% CI, 0.49-0.59; p < 0.001) doses of fentanyl, but not morphine. Median PRU at 2 h was significantly lower in patients receiving low, as compared to high, doses of fentanyl [147; interquartile range (IQR), 63-202; vs. 255; IQR, 183-274; p = 0.028], whereas no significant difference was found in those receiving morphine (217; IQR, 165-266; vs. 237; IQR, 165-269; p = 0.09). At 2 h, weight-weighted doses of fentanyl and morphine were significantly correlated to plasma levels of ticagrelor and AR-C124910XX. Conclusion In symptomatic patients with STEMI who underwent primary PCI after ticagrelor pretreatment and who received intravenous opioids, we found a dose-dependent relationship between the administration of intravenous fentanyl, but not morphine, and ticagrelor-induced platelet inhibition.
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Affiliation(s)
- Dorian Garin
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Yazan Musayeb
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Lauriers
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Valgimigli
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Juan F. Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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5
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 566] [Impact Index Per Article: 566.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Custodio-Sánchez P, Miranda-Noé D, López-Rojas LM, Paredes Paucar CP, Yábar Galindo WG, Rojas De La Cuba P, Martos Salcedo JO, Chacón-Diaz M. [Proposal for initial management of uncomplicated ST elevation myocardial infarction in centers without percutaneous coronary intervention capacity in Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:164-183. [PMID: 38298415 PMCID: PMC10824752 DOI: 10.47487/apcyccv.v4i4.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.
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Affiliation(s)
- Piero Custodio-Sánchez
- Unidad de Cardiología Intervencionista, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú.Unidad de Cardiología IntervencionistaHospital Nacional Almanzor Aguinaga AsenjoChiclayoPerú
| | - David Miranda-Noé
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR, Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - L. Marco López-Rojas
- Hospital Nacional Hipólito Unanue, Lima, Perú.Hospital Nacional Hipólito UnanueLimaPerú
| | - Cynthia Paola Paredes Paucar
- Unidad de insuficiencia cardiaca, Hospital Germans Trias i Pujol, Barcelona, España.Unidad de insuficiencia cardiacaHospital Germans Trias i PujolBarcelonaEspaña
| | - W. Germán Yábar Galindo
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.Hospital Nacional Guillermo Almenara IrigoyenLimaPerú
| | - Paol Rojas De La Cuba
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.Hospital Nacional Guillermo Almenara IrigoyenLimaPerú
| | - Jorge Orlando Martos Salcedo
- Servicio de Cardiología. Hospital Regional Docente de Cajamarca, Cajamarca, Perú.Servicio de CardiologíaHospital Regional Docente de CajamarcaCajamarcaPerú
| | - Manuel Chacón-Diaz
- Unidad Cardiovascular. Clínica Delgado AUNA, Lima, Perú.Unidad CardiovascularClínica Delgado AUNALimaPerú
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Xing Y, Zhou L, Yu J, Wang Z, Ding Z, Xie C, Li Y, Wang F, Tang L. Analgesic efficacy of nitrous oxide in adults in the emergency department: A meta-analysis of randomized controlled trials. Am J Emerg Med 2022; 56:92-99. [DOI: 10.1016/j.ajem.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022] Open
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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9
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Moore CH, Lukas JG, Cave BE, Khouzam RN. Challenges of Combining Opioids and P2Y 12 Inhibitors in Acute Coronary Syndrome: Should the Future Be Opioid Free? Curr Probl Cardiol 2020; 46:100781. [PMID: 33453543 DOI: 10.1016/j.cpcardiol.2020.100781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
Morphine has been long recognized as standard of care in the treatment of acute coronary syndrome (ACS) patients; however, its safety has recently been called into question due to a drug interaction with P2Y12 inhibitors. Opioids, given in combination with P2Y12 inhibitors, can reduce antiplatelet effects by slowing gastrointestinal motility and ultimately reducing drug absorption. While there are proposed benefits of opioids in ACS patients, conflicting data regarding clinical outcomes exist. The majority of clinical data slightly favors opioid use in ST-elevation myocardial infarction over non-ST-elevation myocardial infarction, although trends for increased myocardial infarction are present in both settings. Current practice should be aimed at discerning the need for routine opioid use in ACS. Alternative strategies may be needed to overcome these interactions; however, no robust data are currently available to support these treatment options. Future research should be aimed at non-opioid treatment options in ACS, as opioid use remains controversial in this population.
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Affiliation(s)
- Catherine H Moore
- Department of Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical and Translational Science, University of Tennessee Health Sciences Center, Memphis, TN.
| | - Jack G Lukas
- Department of Pharmacy, Methodist University Hospital, Memphis, TN
| | - Brandon E Cave
- Department of Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical and Translational Science, University of Tennessee Health Sciences Center, Memphis, TN
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Sciences Center, Methodist Le Bonheur Healthcare System, Memphis, TN
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