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Jeyaraman N, Migliorini F, Ramkumar V, Ramasubramanian S, Patro BP, Maffulli N, Jeyaraman M. Angioembolization in the management of joint pain: current concepts. ORTHOPADIE (HEIDELBERG, GERMANY) 2024:10.1007/s00132-024-04531-5. [PMID: 39060549 DOI: 10.1007/s00132-024-04531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by elaborating on the mechanism, safety, efficacy, comparative analysis of treatment and the road ahead, in addition to summarizing the existing data on this treatment. The inferences from this review further consolidate transcatheter arterial embolization as one of the prime options for managing joint pain when it is refractory to conservative treatment and label it as one of the most exciting prospects. A limitation of this review is that most of the data were from open label case series or case reports.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Bohler 5, 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Varunkumar Ramkumar
- Department of Orthopaedics, Madurai Medical College and Hospital, 625020, Madurai, Tamil Nadu, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, 600002, Chennai, Tamil Nadu, India
| | - Bishnu Prasad Patro
- Department of Orthopaedics, All India Institute of Medical Sciences, 751019, Bhubaneswar, Odisha, India
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Roma, Italy.
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, UK.
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, E1 4DG, London, UK.
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
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Rudolph KE, Williams NT, Diaz I, Forrest S, Hoffman KL, Samples H, Olfson M, Doan L, Cerda M, Ross RK. Pain Management Treatments and Opioid Use Disorder Risk in Medicaid Patients. Am J Prev Med 2024:S0749-3797(24)00248-4. [PMID: 39025248 DOI: 10.1016/j.amepre.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION People with chronic pain are at increased risk of opioid misuse. Less is known about the unique risk conferred by each pain management treatment, as treatments are typically implemented together, confounding their independent effects. This study estimated the extent to which pain management treatments were associated with risk of opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain management treatments at their observed levels. METHODS Data were analyzed in 2024 from 2 chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: those with (1) chronic pain and physical disability (CPPD) (N=6,133) or (2) chronic pain without disability (CP) (N=67,438). Nine pain management treatments were considered: prescription opioid (1) dose and (2) duration; (3) number of opioid prescribers; opioid co-prescription with (4) benzo- diazepines, (5) muscle relaxants, and (6) gabapentinoids; (7) nonopioid pain prescription, (8) physical therapy, and (9) other pain treatment modality. The outcome was OUD risk. RESULTS Having opioids co-prescribed with gabapentin or benzodiazepine was statistically significantly associated with a 37-45% increased OUD risk for the CP subgroup. Opioid dose and duration also were significantly associated with increased OUD risk in this subgroup. Physical therapy was significantly associated with an 18% decreased risk of OUD in the CP subgroup. DISCUSSION Coprescription of opioids with either gabapentin or benzodiazepines may substantially increase OUD risk. More positively, physical therapy may be a relatively accessible and safe pain management strategy.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Nicholas T Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ivan Diaz
- Division of Biostatistics, New York University Grossman School of Medicine, New York, New York
| | - Sarah Forrest
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine L Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Hillary Samples
- Rutgers Institute for Health, Rutgers University, New Brunswick, New Jersey
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lisa Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Grossman School of Medicine, New York, New York
| | - Magdalena Cerda
- Division of Epidemiology, New York University Grossman School of Medicine, New York, New York
| | - Rachael K Ross
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Darcq E, Kieffer BL. Neuroscience and addiction research: current advances and perspectives. J Neural Transm (Vienna) 2024; 131:405-408. [PMID: 38492013 DOI: 10.1007/s00702-024-02763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Emmanuel Darcq
- Strasbourg Translational Neuroscience and Psychiatry, Université de Strasbourg (UNISTRA), INSERM UMR-S 1329, Centre de Recherche en Biomédecine de Strasbourg, Strasbourg, France
| | - Brigitte L Kieffer
- Strasbourg Translational Neuroscience and Psychiatry, Université de Strasbourg (UNISTRA), INSERM UMR-S 1329, Centre de Recherche en Biomédecine de Strasbourg, Strasbourg, France.
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Hoffman KL, Milazzo F, Williams NT, Samples H, Olfson M, Diaz I, Doan L, Cerda M, Crystal S, Rudolph KE. Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients. Psychol Med 2024; 54:1419-1430. [PMID: 37974483 PMCID: PMC10994776 DOI: 10.1017/s003329172300332x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain. METHODS Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019). RESULTS We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk. CONCLUSIONS These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.
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Affiliation(s)
- Katherine L. Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Floriana Milazzo
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Nicholas T. Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | | | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Ivan Diaz
- New York University Grossman School of Medicine
| | - Lisa Doan
- New York University Grossman School of Medicine
| | | | | | - Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University
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Shim M, Gaydos M, Goldstein-Levitas N, Musalo N, Prakash N, Bradt J, Zhang F, Wenger S, Gonzalez A. Development and feasibility of a mindfulness-based dance/movement therapy intervention for chronic low back pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1281085. [PMID: 38689886 PMCID: PMC11057879 DOI: 10.3389/fpain.2024.1281085] [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: 08/21/2023] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Responding to the need for innovative, multi-modal, non-pharmacological strategies in chronic low back pain (cLBP) care, this article presents the development and a mixed methods feasibility trial of a manualized Mindfulness-based Dance/Movement Therapy (M-DMT) program for cLBP. The 12-week program is designed as a group therapy, integrating mindfulness principles, creative/expressive dance and movement, and psychoeducational content focused on cLBP management. This holistic program seeks to cultivate nonjudgmental awareness of pain experiences, challenge maladaptive pain-related beliefs, enhance emotional well-being, foster social support, and promote effective coping strategies for the daily challenges associated with cLBP. Methods The 12-week M-DMT intervention was administered to individuals with non-specific cLBP (N = 18, aged 51.7 ± 13.9 years, 72% female, 55% Black and 39% White). We assessed feasibility and acceptability through monitoring enrollment and retention rates, attendance, and adverse events. Moreover, we measured the intervention's credibility/expectancy, participants' perception of changes, and overall satisfaction. Additionally, we collected qualitative data, capturing participants' perspectives on the intervention's usefulness and perceived benefits. Specific benchmarks were established to gauge the successful feasibility and acceptability of the program. Results The adherence rate stood at 80%, with a perfect retention rate of 100%. The study successfully met the benchmarks for treatment acceptability and satisfaction criteria, with 61% of participants reporting "feeling better" or a "great deal better" after the intervention. No adverse events were observed. Participants found the intervention enjoyable and reported that it provided effective tools for cLBP and related symptoms. Notably, participants reported a decrease in fear-avoidance behaviors, increased motivation for physical activity, and a boost in self-efficacy for pain management. Discussion These encouraging findings establish a strong basis for considering the M-DMT intervention as a promising approach for cLBP management, warranting further investigation in larger-scale studies.
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Affiliation(s)
- Minjung Shim
- Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Monica Gaydos
- Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | | | - Nicole Musalo
- Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Nalini Prakash
- Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Joke Bradt
- Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Fengqing Zhang
- Psychology, Drexel University, Philadelphia, PA, United States
| | - Sarah Wenger
- Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA, United States
| | - Adam Gonzalez
- Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, United States
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Abd-Elsayed A, González DA, Salom CA. Spinal cord stimulation implant (percutaneous leads). NEUROMODULATION TECHNIQUES FOR THE SPINE 2024:67-90. [DOI: 10.1016/b978-0-323-87584-4.00018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Sourty M, Champagnol-Di Liberti C, Nasseef MT, Welsch L, Noblet V, Darcq E, Kieffer BL. Chronic Morphine Leaves a Durable Fingerprint on Whole-Brain Functional Connectivity. Biol Psychiatry 2023:S0006-3223(23)01765-1. [PMID: 38104648 PMCID: PMC11178678 DOI: 10.1016/j.biopsych.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Opioid use disorder is a chronic relapsing disorder. The brain adapts to opioids that are taken for pain treatment or recreational use so that abstinence becomes a true challenge for individuals with opioid use disorder. Studying brain dysfunction at this stage is difficult, and human neuroimaging has provided highly heterogeneous information. METHODS Here, we took advantage of an established mouse model of morphine abstinence together with functional magnetic resonance imaging to investigate whole-brain functional connectivity (FC) first at rest and then in response to an acute morphine challenge during image acquisition. RESULTS Hierarchical clustering of seed pair correlation coefficients showed modified FC in abstinent animals, brainwide and regardless of the condition. Seed-to-voxel analysis and random forest classification, performed on data at rest, indicated that the retrosplenial cortex (a core component of the default mode network) and the amygdala (a major aversion center) are the best markers of abstinence, thus validating the translatability of the study. Seed pair network clustering confirmed disruption of a retrosplenial cortex-centered network, reflecting major reorganization of brain FC. The latter analysis also identified a persistent but unreported morphine signature in abstinent mice at rest, which involves cortical and midbrain components and characterizes the enduring morphine footprint. Finally, dynamic FC analysis revealed that the intrascanner acute morphine challenge modified FC faster and more broadly in abstinent animals, demonstrating brainwide adaptations of FC reactivity to an acute opioid challenge. CONCLUSIONS This study used a unique experimental design to demonstrate that a prior history of chronic opioid exposure leaves a durable pharmacological signature on brain communication, with implications for pain management and recovery from opioid use disorder.
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Affiliation(s)
- Marion Sourty
- University of Strasbourg, French Institute of Health and Medical Research UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, Centre de Recherche en Biomedicine de Strasbourg, Strasbourg, France; iCube, University of Strasbourg, National Centre for Scientific Research, Strasbourg, France
| | - Cédric Champagnol-Di Liberti
- University of Strasbourg, French Institute of Health and Medical Research UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, Centre de Recherche en Biomedicine de Strasbourg, Strasbourg, France
| | - Md Taufiq Nasseef
- Douglas Research Center, Department of Psychiatry, McGill University, Montréal, Quebec, Canada; Department of Mathematics, College of Science and Humanity Studies, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Lola Welsch
- University of Strasbourg, French Institute of Health and Medical Research UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, Centre de Recherche en Biomedicine de Strasbourg, Strasbourg, France; Douglas Research Center, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Vincent Noblet
- iCube, University of Strasbourg, National Centre for Scientific Research, Strasbourg, France
| | - Emmanuel Darcq
- University of Strasbourg, French Institute of Health and Medical Research UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, Centre de Recherche en Biomedicine de Strasbourg, Strasbourg, France; Douglas Research Center, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Brigitte L Kieffer
- University of Strasbourg, French Institute of Health and Medical Research UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, Centre de Recherche en Biomedicine de Strasbourg, Strasbourg, France; Douglas Research Center, Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
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Tabor A, Constant A. Lifeworlds in pain: a principled method for investigation and intervention. Neurosci Conscious 2023; 2023:niad021. [PMID: 37711314 PMCID: PMC10499064 DOI: 10.1093/nc/niad021] [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: 04/06/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
The experience of pain spans biological, psychological and sociocultural realms, both basic and complex, it is by turns necessary and devastating. Despite an extensive knowledge of the constituents of pain, the ability to translate this into effective intervention remains limited. It is suggested that current, multiscale, medical approaches, largely informed by the biopsychosocial (BPS) model, attempt to integrate knowledge but are undermined by an epistemological obligation, one that necessitates a prior isolation of the constituent parts. To overcome this impasse, we propose that an anthropological stance needs to be taken, underpinned by a Bayesian apparatus situated in computational psychiatry. Here, pain is presented within the context of lifeworlds, where attention is shifted away from the constituents of experience (e.g. nociception, reward processing and fear-avoidance), towards the dynamic affiliation that occurs between these processes over time. We argue that one can derive a principled method of investigation and intervention for pain from modelling approaches in computational psychiatry. We suggest that these modelling methods provide the necessary apparatus to navigate multiscale ontology and epistemology of pain. Finally, a unified approach to the experience of pain is presented, where the relational, inter-subjective phenomenology of pain is brought into contact with a principled method of translation; in so doing, revealing the conditions and possibilities of lifeworlds in pain.
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Affiliation(s)
- Abby Tabor
- Faculty of Health and Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Ln, Stoke Gifford, Bristol BS16 1QY, UK
- Centre for Pain Research, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Axel Constant
- Department of Engineering and Informatics, The University of Sussex, Chichester 1 Room 002, Falmer, Brighton BN1 9QJ, UK
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Ramírez-Gonzalez M, Torres-Lugo NJ, Deliz-Jimenez D, Echegaray-Casalduc G, Ramírez N, Colón-Rodriguez E, Carro-Rivera J, De La Cruz A, Claudio-Roman Y, Massanet-Volrath J, Escobar-Medina E, Montañez-Huertas J. Efficacy of an Opioid-Sparing Perioperative Multimodal Analgesia Protocol on Posterior Lumbar Fusion in a Hispanic Population: A Randomized Controlled Trial. J Am Acad Orthop Surg 2023; 31:931-937. [PMID: 37192425 DOI: 10.5435/jaaos-d-22-00878] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative pain control for spine surgery has relied on opioids. However, opioid use is associated with adverse effects such as dependence, respiratory depression, and altered cognition. Our study aimed to determine whether an opioid-sparing multimodal analgesia regimen (ketorolac, orphenadrine, and gabapentin) could be a viable alternative to diminish opioid use compared with a standard opioid-based regimen in Hispanic patients undergoing posterior lumbar spinal fusion. METHODS This was a randomized controlled trial of Hispanic patients scheduled to undergo elective posterior spinal fusion. Inclusion criteria included age 30 to 85 years, Hispanic ethnicity, lumbar stenosis between L1 and S1, elective posterior spinal fusion with instrumentation, American Society of Anesthesiologists Score <2, and consent to participate in the study. Patients were randomized into two groups, an experimental multimodal analgesia and control (opioid-based) treatment groups, and outcomes such as morphine milligram equivalents used, visual analog scale score, and length of hospital stay were compared between the groups. RESULTS The MMA experimental group used significantly lower amounts of opioid (measured with morphine milligram equivalent) than the opioid-based group during the 12-hour and 24-hour postoperative periods ( P -value = 0.023 and P -value = 0.033, respectively). No statistically significant difference was observed in opioid use in the 48-hour postoperative period between both groups ( P -value = 0.066). The MMA group had significantly lower VAS scores reported at the 12-hour, 24-hour, and 48-hour postoperative periods compared with the opioid-based group ( P -values = 0.016, 0.020, and 0.020, respectively). No difference was observed in the length of hospital stay between groups ( P -value = 0.169). DISCUSSION Implementing an MMA protocol in Hispanic patients undergoing posterior lumbar fusion resulted in decreased overall opioid use and decreased pain intensity compared with the opioid-based group. MMA is an effective alternative for pain control in patients who want to avoid opioid use. CLINICAL TRIAL REGISTRATION Identifier: NCT05413902.
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Affiliation(s)
- Manuel Ramírez-Gonzalez
- Twin Cities Spine Center, Minneapolis, MN (Ramirez-Gonzalez), University of Puerto Rico School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR (Claudio-Roman), Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Deliz-Jimenez, Torres-Lugo, and Echegaray-Casalduc, Massanet-Volrath, Carro-Rivera, Escobar-Medina, De La Cruz, and Montañez-Huertas), Department of Pediatric Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, PR (Ramirez), Department of Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Colon-Rodriguez)
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Rockholt MM, Addae G, Chee A, Chin W, Cuff G, Wang J, Umeh UO, Doan LV. Implementing Telemedicine During the COVID-19 Pandemic: Disparities in Utilization in an Urban Pain Medicine Practice. J Pain Res 2023; 16:2763-2775. [PMID: 37577160 PMCID: PMC10422968 DOI: 10.2147/jpr.s415415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/19/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The COVID-19 pandemic led to a drastic expansion in utilizing telemedicine, circumventing some of the geographical barriers to accessing pain care. However, uncertainties around the impact of telemedicine across various sociodemographic groups still exist, prompting further exploration. Therefore, this study aimed to evaluate the impact of sociodemographic factors in telemedicine utilization during and after the COVID-19 pandemic. Patients and methods All outpatient non-procedural visits at the pain medicine division of a large academic institution in the epicenter of the pandemic (New York, USA), between March 2019 and October 2021, were retrospectively included. Sociodemographic data including gender, age, ethnicity/race, postal code, and type of health insurance, across three time periods associated with the COVID-19 pandemic - pre-lockdown (in-office visits only), lockdown (telemedicine visits only) and post-lockdown (offering both in-office and telemedicine visits) - were analyzed and compared. Results In total, 12,615 unique patients - The majority being women (58%) - were seen during the whole study period. In the post-lockdown period, telemedicine was utilized by 42% of all patients. Follow-up visits, younger patients, white patients, patients residing further away from the hospital, and privately insured patients were more likely to utilize telemedicine post-lockdown (p <0.05). Older patients, minorities, Manhattan residents, and Medicare/Medicaid recipients, were more likely to use in-office visits post-lockdown (p <0.05). Conclusion We identified disparities in the utilization of telemedicine in Pain Medicine, which may be due to socioeconomic factors such as lack of access to reliable internet access, cost of devices, and technological know-how. This emphasizes the need for further studies to better understand the reasons for and barriers to telemedicine use. This could help inform policymaking to safeguard equitable access to telemedicine use for pain care.
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Affiliation(s)
- Mika M Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Gifty Addae
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Alexander Chee
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Wanda Chin
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Germaine Cuff
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Uchenna O Umeh
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
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Geller JS, Milner JE, Pandya S, Mohile NV, Massel DH, Eismont FJ, Maaieh MA. The Impact of the Florida Law HB21 on Opioid Prescribing Patterns After Spine Surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2023; 14:100202. [PMID: 36970062 PMCID: PMC10034149 DOI: 10.1016/j.xnsj.2023.100202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
Background The opioid epidemic represents a major public health issue in the United States and has led to significant morbidity and mortality. On July 1 2018, Florida implemented state-law House Bill 21 (HB21), limiting opioid prescriptions to a 3-day supply for acute pain or 7 days if an exception is documented. The purpose of this study is to evaluate the effects of HB21 on opioid prescribing patterns after spine surgery. Methods Patients 18 years and older who underwent spine surgery between January 2017 and January 2021 were eligible for inclusion. Information including demographics, pills, days, and morphine milligram equivalents (MMEs) was obtained via retrospective chart review using the Florida Prescription Drug Monitoring Program and Epic Chart Review. Student's t tests and Fisher's exact tests were used for comparison of continuous variables. Multiple logistic regression was utilized to determine which variables were associated with postoperative opioid prescriptions. p<.05 was considered significant. Results We reviewed 114 patients who underwent spine surgery from January 2017 to July 2018 and 264 patients from July 2018 to January 21. There were no significant differences between the groups in age, sex, ethnicity, body mass index, number of levels fused, or preoperative opioid use. The average number of MMEs, pills prescribed and days in the first postoperative prescription decreased significantly after HB21. Multiple logistic regression revealed that the variable most predictive of MMEs and number of pills in the first postoperative prescription was postlaw status (p=.002, p=.50). Conclusions Florida law HB21 was successful in decreasing postoperative opioid prescriptions after spine surgery, however, the need for additional progress remains. Legislation should be combined with multimodal pain regimens, as well as patient and provider education in order to further decrease postoperative opioid requirements. Future studies should include a larger number of patients treated by multiple spine surgeons across multiple institutions in order to further evaluate the effects of HB21 on postoperative opioid prescriptions.
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Affiliation(s)
| | - Jacob E. Milner
- Corresponding author. 801 South Miami Ave, Unit 1901, Miami, FL 33130, USA. Tel.: (203) 927-7339.
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Kishore S, Sheira D, Malin ML, Trost DW, Mandl LA. Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic Review of Indications, Safety, and Efficacy. ACR Open Rheumatol 2022; 4:209-217. [PMID: 34842365 PMCID: PMC8916547 DOI: 10.1002/acr2.11383] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study objective was to evaluate the safety and efficacy of transcatheter arterial "embolization" (TAE) in the treatment of chronic "musculoskeletal pain" refractory to standard therapy. METHODS PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for original research articles evaluating TAE in patients with musculoskeletal conditions from database inception to January 21, 2020. Search terms employed were as follows: "embolization", "pain", "knee osteoarthritis", joint replacement, epicondylitis, tenderness, inflammation, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), microspheres, Embozene, geniculate artery, neovascularity, transcatheter, embolic, imipenem/cilastatin sodium, angiogenesis, and "musculoskeletal". Studies involving particle "embolization" for painful musculoskeletal conditions were included. Studies of TAE for hemarthrosis or malignancy-related "musculoskeletal pain" were excluded. RESULTS The primary search yielded 1,099 sources; 7 articles and 4 abstracts were included for data extraction. All were cohorts or case series, with low risk of bias and moderate to poor level of evidence. Heterogeneity between studies was high, precluding meta-analysis. The reviewed studies reported the safety and efficacy of TAE for the treatment of "knee osteoarthritis"; adhesive capsulitis of the shoulder; tendinopathy/enthesopathy of the knee, shoulder, elbow, and ankle; and cervical myalgia. All TAEs were reported as technically successful without major complications or subsequent serious adverse events, including no reported osteonecrosis, cutaneous ulceration, limb ischemia, cartilage degeneration, or myotendinous injury. TAE significantly reduced pain and improved function for all of the treated conditions, with durable response up to 24 months post procedure. CONCLUSION TAE appears to be a safe and effective treatment for some types of chronic refractory "musculoskeletal pain". Randomized placebo-controlled studies are necessary to confirm these findings.
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Affiliation(s)
- SirishA. Kishore
- Palo Alto Veterans Affairs Healthcare SystemPalo AltoCalifornia
- Department of RadiologyStanford UniversityPalo AltoCalifornia
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Dina Sheira
- Division of RheumatologyHospital for Special SurgeryNew YorkNew YorkUSA
| | | | - David W. Trost
- Department of RadiologyWeill Cornell MedicineNew YorkUSA
| | - Lisa A. Mandl
- Division of RheumatologyHospital for Special SurgeryNew YorkNew YorkUSA
- Department of MedicineWeill Cornell Medicine, New YorkNew YorkUSA
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13
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Wender CLA. Immersive virtual reality to relieve exercise-induced pain caused by aerobic cycling. Pain Manag 2022; 12:665-674. [PMID: 35174723 DOI: 10.2217/pmt-2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic pain affects 20% of the global population and is incredibly complex to treat. The burden of chronic pain is physical, emotional and financial, and prevalence rates continue to rise. Current treatments are ineffective long-term against pain and common comorbidities, including anxiety and depression, mood and sleep disorders, and social isolation. While a large body of evidence supports regular physical exercise as an effective long-term treatment for chronic pain and its comorbidities, exercise-induced pain and kinesiophobia are significant barriers to participation and adherence. Immersive virtual reality is a powerful short-term pain reliever, that, when combined with exercise, can help overcome these barriers. This perspective argues for the use of combined exercise and virtual reality treatment techniques to mitigate chronic pain.
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Affiliation(s)
- Carly LA Wender
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ 07936, USA.,Department of Physical Medicine & Rehabilitation, Rutgers-NJ Medical School, Newark, NJ 07102, USA
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14
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Quirk K, Stevenson M. Buprenorphine Microdosing for the Pain and Palliative Care Clinician. J Palliat Med 2022; 25:145-154. [PMID: 34978915 DOI: 10.1089/jpm.2021.0378] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Buprenorphine (BUP) can be a safe and effective alternative to traditional opioids for many patients with chronic pain. For patients on higher doses of opioids, rotation to BUP is complicated by the requirement of an opioid-free interval or withdrawal during the transition. Microdosing inductions, in which BUP is gradually titrated, while full agonist opioids are continued, are a viable alternative to traditional inductions. The objective of this article is to review the current literature on BUP microdosing induction, with a focus on patients using opioids for pain. A literature review of the PubMed database was performed in the United States on articles published from inception to May 2021. A total of 34 publications were included. The most commonly utilized microdosing strategy involved administering divided doses of sublingual (SL) products marketed for opioid use disorder treatment, with 25 (73.5%) articles reporting use of partial SL tablets or films (ranging from 1/8 to 1/2 of a 2 mg product) at some point during the induction. Transdermal patches, low-dose SL BUP available in Europe, intravenous BUP, and buccal BUP have also been used. Beyond the products used, the speed of the microinduction, setting, final BUP dosing, and management of concomitant full agonists vary widely in the literature. Microdosing regimens should be individualized based on local guidelines and patient-specific factors. Further studies comparing the safety and efficacy of different protocols are warranted.
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Affiliation(s)
- Kyle Quirk
- Department of Palliative Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maximillian Stevenson
- Department of Palliative Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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15
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Lea M, Hofmann BM. Dediagnosing - a novel framework for making people less ill. Eur J Intern Med 2022; 95:17-23. [PMID: 34417089 DOI: 10.1016/j.ejim.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023]
Abstract
Diagnosing constitutes a substantial part of healthcare work and triggers a wide range of actions including the prescription of medicines. Dediagnosing is proposed as a novel framework for removing diagnoses that do not contribute to the reduction of persons' suffering and should be introduced to make people less ill. Dediagnosing comes together with other efforts to reduce overuse, such as deimplementation, deprescribing, decommissioning, and disinvestment. Because diagnoses may influence identity construction and social rights, dediagnosing must be conducted in close collaboration with the patient.
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Affiliation(s)
- Marianne Lea
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway; Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Norway.
| | - Bjørn Morten Hofmann
- Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway; Centre of Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
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16
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Dalrymple AN, Ting JE, Bose R, Trevathan JK, Nieuwoudt S, Lempka SF, Franke M, Ludwig KA, Shoffstall AJ, Fisher LE, Weber DJ. Stimulation of the dorsal root ganglion using an Injectrode ®. J Neural Eng 2021; 18. [PMID: 34650008 DOI: 10.1088/1741-2552/ac2ffb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 01/15/2023]
Abstract
Objective. The goal of this work was to compare afferent fiber recruitment by dorsal root ganglion (DRG) stimulation using an injectable polymer electrode (Injectrode®) and a more traditional cylindrical metal electrode.Approach. We exposed the L6 and L7 DRG in four cats via a partial laminectomy or burr hole. We stimulated the DRG using an Injectrode or a stainless steel (SS) electrode using biphasic pulses at three different pulse widths (80, 150, 300μs) and pulse amplitudes spanning the range used for clinical DRG stimulation. We recorded antidromic evoked compound action potentials (ECAPs) in the sciatic, tibial, and common peroneal nerves using nerve cuffs. We calculated the conduction velocity of the ECAPs and determined the charge-thresholds and recruitment rates for ECAPs from Aα, Aβ, and Aδfibers. We also performed electrochemical impedance spectroscopy measurements for both electrode types.Main results. The ECAP thresholds for the Injectrode did not differ from the SS electrode across all primary afferents (Aα, Aβ, Aδ) and pulse widths; charge-thresholds increased with wider pulse widths. Thresholds for generating ECAPs from Aβfibers were 100.0 ± 32.3 nC using the SS electrode, and 90.9 ± 42.9 nC using the Injectrode. The ECAP thresholds from the Injectrode were consistent over several hours of stimulation. The rate of recruitment was similar between the Injectrodes and SS electrode and decreased with wider pulse widths.Significance. The Injectrode can effectively excite primary afferents when used for DRG stimulation within the range of parameters used for clinical DRG stimulation. The Injectrode can be implanted through minimally invasive techniques while achieving similar neural activation to conventional electrodes, making it an excellent candidate for future DRG stimulation and neuroprosthetic applications.
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Affiliation(s)
- Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America
| | - Jordyn E Ting
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America
| | - James K Trevathan
- Departments of Biomedical Engineering and Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | | | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Kip A Ludwig
- Departments of Biomedical Engineering and Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America.,Neuronoff Inc., Cleveland, OH, United States of America.,Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Andrew J Shoffstall
- Neuronoff Inc., Cleveland, OH, United States of America.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, 15217, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, 15217, United States of America.,Neuroscience Institute, Carnegie Mellon University, 5000 Forbes Ave, Wean 1323, Pittsburgh, PA 15217, United States of America
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17
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Atlas LY. A social affective neuroscience lens on placebo analgesia. Trends Cogn Sci 2021; 25:992-1005. [PMID: 34538720 PMCID: PMC8516707 DOI: 10.1016/j.tics.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
Pain is a fundamental experience that promotes survival. In humans, pain stands at the intersection of multiple health crises: chronic pain, the opioid epidemic, and health disparities. The study of placebo analgesia highlights how social, cognitive, and affective processes can directly shape pain, and identifies potential paths for mitigating these crises. This review examines recent progress in the study of placebo analgesia through affective science. It focuses on how placebo effects are shaped by expectations, affect, and the social context surrounding treatment, and discusses neurobiological mechanisms of placebo, highlighting unanswered questions and implications for health. Collaborations between clinicians and social and affective scientists can address outstanding questions and leverage placebo to reduce pain and improve human health.
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Affiliation(s)
- Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA; National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
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18
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Dalrymple AN, Ting JE, Bose R, Nieuwoudt S, Franke M, Ludwig KA, Shoffstall AJ, Fisher LE, Weber DJ. Recruitment of Primary Afferents by Dorsal Root Ganglion Stimulation using the Injectrode. INTERNATIONAL IEEE/EMBS CONFERENCE ON NEURAL ENGINEERING : [PROCEEDINGS]. INTERNATIONAL IEEE EMBS CONFERENCE ON NEURAL ENGINEERING 2021; 2021:609-612. [PMID: 34630868 DOI: 10.1109/ner49283.2021.9441420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic pain affects millions of people in the United States and pharmacological treatments have been ineffective. Dorsal root ganglion (DRG) stimulation is a neuromodulation method that delivers electrical stimulation to the DRG to relieve pain. DRG electrodes are rigid and cylindrical. The implantation of DRG electrodes requires a technically-challenging surgery that involves steering electrodes laterally towards the DRG. The Injectrode is an injectable conductive polymer that cures in place and is capable of delivering electrical current to stimulate neural tissue. We used the Injectrode to stimulate the L6 and L7 DRG in cats, measuring neural responses evoked in the sciatic, tibial, and common peroneal nerves to measure the thresholds for activating fibers. A cylindrical stainless-steel electrode was used for comparison. Thresholds were 38% higher with the Injectrode versus stainless-steel, likely owing to its larger contact surface area with the DRG. Both Aα and Aβ sensory fibers were activated using DRG stimulation. The Injectrode has the potential to offer a new and simple method for DRG stimulation that can potentially offer more complete coverage of the DRG.
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Affiliation(s)
- Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jordyn E Ting
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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19
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Wu B, Hand W, Alexov E. Opioid Addiction and Opioid Receptor Dimerization: Structural Modeling of the OPRD1 and OPRM1 Heterodimer and Its Signaling Pathways. Int J Mol Sci 2021; 22:ijms221910290. [PMID: 34638633 PMCID: PMC8509015 DOI: 10.3390/ijms221910290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022] Open
Abstract
Opioid addiction is a complex phenomenon with genetic, social, and other components. Due to such complexity, it is difficult to interpret the outcome of clinical studies, and thus, mutations found in individuals with these addictions are still not indisputably classified as opioid addiction-causing variants. Here, we computationally investigated two such mutations, A6V and N40D, found in the mu opioid receptor gene OPRM1. The mutations are located in the extracellular domain of the corresponding protein, which is important to the hetero-dimerization of OPRM1 with the delta opioid receptor protein (OPRD1). The hetero-dimerization of OPRD1-OPRM1 affects the signaling pathways activated by opioids and natural peptides and, thus, could be considered a factor contributing to addiction. In this study, we built four 3D structures of molecular pathways, including the G-protein signaling pathway and the β-arrestin signaling pathway of the heterodimer of OPRD1-OPRM1. We also analyzed the effect of mutations of A6V and N40D on the stability of individual OPRM1/OPRD1 molecules and the OPRD1-OPRM1 heterodimer with the goal of inferring their plausible linkage with opioid addiction. It was found that both mutations slightly destabilize OPRM1/OPRD1 monomers and weaken their association. Since hetero-dimerization is a key step for signaling processes, it is anticipated that both mutations may be causing increased addiction risk.
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Affiliation(s)
- Bohua Wu
- Department of Physics, College of Science, Clemson University, Clemson, SC 29634, USA;
| | - William Hand
- Department of Anesthesiology and Perioperative Medicine, Prisma Health, Greenville, SC 29605, USA;
| | - Emil Alexov
- Department of Physics, College of Science, Clemson University, Clemson, SC 29634, USA;
- Correspondence:
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20
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The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization. THE JOURNAL OF PAIN 2021; 22:1396-1407. [PMID: 34004347 DOI: 10.1016/j.jpain.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 03/03/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) intervention (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes. PERSPECTIVE: This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changes in pain conceptualization and pain-related functioning argues for its potential clinical relevance.
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21
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Chen L, Wang Q, Li D, Chen C, Li Q, Kang P. Meta-analysis of retrospective studies suggests that the pre-operative opioid use is associated with an increased risk of adverse outcomes in total hip and or knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:1923-1932. [PMID: 33594465 DOI: 10.1007/s00264-021-04968-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Opioid use is prevalent in the general population. This systematic review and meta-analysis sought to evaluate whether it affects patient-reported outcomes (PROs) following total hip or knee arthroplasty. METHODS The following databases were systematically searched on February 5, 2020: Medline, Embase (Ovid), Cochrane Library, and Web of Science. Studies were included if they compared patients who received opioids or not before total hip or knee arthroplasty. Outcomes of interest were rates of post-operative revision, peri-prosthetic infection, and readmission. RESULTS Ten retrospective studies were included for review. Pre-operative opioid use was identified as a risk factor for post-operative revision [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.15-1.73, p<0.01], peri-prosthetic infection (OR 1.36, 95% CI 1.08-1.71, p=0.01), and readmission (OR 1.41, 95% CI 1.20-1.75, p<0.01). CONCLUSION The available evidence indicates that pre-operative opioid use increases the risk of adverse outcomes following total hip or knee arthroplasty. Orthopedic physicians should consider these risks when treating their patients.
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Affiliation(s)
- Liyile Chen
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Qiuru Wang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Changjun Chen
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Qianhao Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China.
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22
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Creed SM, Gutridge AM, Argade MD, Hennessy MR, Friesen JB, Pauli GF, van Rijn RM, Riley AP. Isolation and Pharmacological Characterization of Six Opioidergic Picralima nitida Alkaloids. JOURNAL OF NATURAL PRODUCTS 2021; 84:71-80. [PMID: 33326237 PMCID: PMC7932029 DOI: 10.1021/acs.jnatprod.0c01036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The seeds of the akuamma tree (Picralima nitida) have been used as a traditional treatment for pain and fever. Previous studies have attributed these effects to a series of indole alkaloids found within the seed extracts; however, these pharmacological studies were significantly limited in scope. Herein, an isolation protocol employing pH-zone-refining countercurrent chromatography was developed to provide six of the akuamma alkaloids in high purity and quantities sufficient for more extensive biological evaluation. Five of these alkaloids, akuammine (1), pseudo-akuammigine (3), akuammicine (4), akuammiline (5), and picraline (6), were evaluated against a panel of >40 central nervous system receptors to identify that their primary targets are the opioid receptors. Detailed in vitro investigations revealed 4 to be a potent kappa opioid receptor agonist, and three alkaloids (1-3) were shown to have micromolar activity at the mu opioid receptor. The mu opioid receptor agonists were further evaluated for analgesic properties but demonstrated limited efficacy in assays of thermal nociception. These findings contradict previous reports of the antinociceptive properties of the P. nitida alkaloids and the traditional use of akuamma seeds as analgesics. Nevertheless, their opioid-preferring activity does suggest the akuamma alkaloids provide distinct scaffolds from which novel opioids with unique pharmacologic properties and therapeutic utility can be developed.
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Affiliation(s)
- Simone M Creed
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Anna M Gutridge
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, Purdue University, West Lafayette, Indiana 47907, United States
| | - Malaika D Argade
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Madeline R Hennessy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - J Brent Friesen
- Department of Pharmaceutical Sciences and Pharmacognosy Institute, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Guido F Pauli
- Department of Pharmaceutical Sciences and Pharmacognosy Institute, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Richard M van Rijn
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, Purdue Institute for Drug Discovery, Purdue Institute for Integrative Neuroscience, Purdue Interdisciplinary Life Sciences Graduate Program, Purdue University, West Lafayette, Indiana 47907, United States
| | - Andrew P Riley
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
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23
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Chai PR, Gale JY, Patton ME, Schwartz E, Jambaulikar GD, Wade Taylor S, Edwards RR, Boyer EW, Schreiber KL. The Impact of Music on Nociceptive Processing. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:3047-3054. [PMID: 32337605 PMCID: PMC7685689 DOI: 10.1093/pm/pnaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Music has been shown to modulate pain, although the impact of music on specific aspects of nociceptive processing is less well understood. Using quantitative sensory testing (QST), we assessed the impact of a novel music app on specific aspects of nociceptive processing. DESIGN Within-subjects paired comparison of pain processing in control vs music condition. SETTING Human psychophysical laboratory. SUBJECTS Sixty healthy adult volunteers. METHODS Subjects were assessed for baseline anxiety, depression, and catastrophizing using validated questionnaires. QSTs measured included 1) pain threshold and tolerance to deep muscle pressure, 2) pain with mechanical pinprick, 3) temporal summation of pain (TSP) with a repeated pain stimulus, and 4) conditioned pain modulation (CPM) with a second painful stimulus. QSTs were performed in the absence and presence of music delivered through a music app. RESULTS We found an increase in pressure pain thresholds in both the forearm (P = 0.007) and trapezius (P = 0.002) with music, as well as a decrease in the amount of pinprick pain (P < 0.001) and TSP (P = 0.01) with music. Interestingly, CPM was also significantly diminished (P < 0.001) in the music condition. No significant difference in cold pain, anxiety, or situational catastrophizing was observed with music. Higher baseline pain catastrophizing scores were associated with less music-induced pressure pain reduction. CONCLUSIONS Several measures of mechanical pain sensitivity were reduced with music. TSP, a measure of central sensitization, also decreased with music, but CPM, a measure of descending modulation of pain, was not further augmented by music.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
| | - Jasmine Y Gale
- Department of Emergency Medicine, Brigham and Women’s Hospital
- Tufts University School of Medicine
| | - Megan E Patton
- Department of Anesthesiology, Brigham and Women’s Hospital
| | - Emily Schwartz
- Department of Anesthesiology, Brigham and Women’s Hospital
| | | | - S Wade Taylor
- The Fenway Institute
- Boston University, Boston, Massachusetts, USA
| | | | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
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24
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Brockway DF, Crowley NA. Turning the 'Tides on Neuropsychiatric Diseases: The Role of Peptides in the Prefrontal Cortex. Front Behav Neurosci 2020; 14:588400. [PMID: 33192369 PMCID: PMC7606924 DOI: 10.3389/fnbeh.2020.588400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Recent advancements in technology have enabled researchers to probe the brain with the greater region, cell, and receptor specificity. These developments have allowed for a more thorough understanding of how regulation of the neurophysiology within a region is essential for maintaining healthy brain function. Stress has been shown to alter the prefrontal cortex (PFC) functioning, and evidence links functional impairments in PFC brain activity with neuropsychiatric disorders. Moreover, a growing body of literature highlights the importance of neuropeptides in the PFC to modulate neural signaling and to influence behavior. The converging evidence outlined in this review indicates that neuropeptides in the PFC are specifically impacted by stress, and are found to be dysregulated in numerous stress-related neuropsychiatric disorders including substance use disorder, major depressive disorder (MDD), posttraumatic stress disorder, and schizophrenia. This review explores how neuropeptides in the PFC function to regulate the neural activity, and how genetic and environmental factors, such as stress, lead to dysregulation in neuropeptide systems, which may ultimately contribute to the pathology of neuropsychiatric diseases.
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Affiliation(s)
- Dakota F Brockway
- Neuroscience Curriculum, Pennsylvania State University, University Park, PA, United States
| | - Nicole A Crowley
- Neuroscience Curriculum, Pennsylvania State University, University Park, PA, United States.,The Department of Biology, Pennsylvania State University, University Park, PA, United States
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Craft WH, Tegge AN, Bickel WK. Episodic future thinking reduces chronic pain severity: A proof of concept study. Drug Alcohol Depend 2020; 215:108250. [PMID: 32889451 DOI: 10.1016/j.drugalcdep.2020.108250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic pain is a major public health challenge in the United States and around the world. Current treatments including opioid analgesics and cognitive behavioral therapy possess harmful side effects or limited efficacy, respectively. Chronic pain is associated with a variety of unhealthy behaviors including opioid misuse. Moreover, individuals who suffer from chronic pain exhibit excessive discounting of delayed rewards, suggesting a constricted temporal window of valuation. Reductions in the excessive discounting of delayed rewards has been achieved with Episodic Future Thinking (EFT; vividly imagining realistic future events). EFT has also been associated with reductions in a variety of unhealthy behaviors. In this study, the effects of EFT on delay discounting and levels of pain were investigated in individuals reporting chronic pain. METHODS Individuals reporting chronic pain (N = 250; 42.4 % female) were recruited through the Amazon Mechanical Turk platform. Measures of delay discounting and pain were collected at baseline and again after randomization to EFT (N = 128) or Control Episodic Thinking (CET) (N = 122). RESULTS EFT significantly reduced delay discounting relative to baseline (p < 0.001) and EFT reduced pain scores in a baseline dependent manner (p = 0.001) when compared to CET; that is, those with the greatest reports of pain experienced the greatest reduction. Furthermore the reduction in delay discounting fully mediated the reduction in pain. CONCLUSIONS These findings suggest that Episodic Future Thinking, by widening the temporal window, may reduce pain in those reporting chronic pain and therefore represents a potential novel therapeutic.
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Affiliation(s)
- William H Craft
- Center for Transformative Research on Health Behaviors, 1 Riverside Circle, Roanoke, VA 24016, United States; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, 1 Riverside Circle, Roanoke, VA 24016, United States; Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Allison N Tegge
- Center for Transformative Research on Health Behaviors, 1 Riverside Circle, Roanoke, VA 24016, United States; Department of Statistics, Virginia Tech, Blacksburg, VA 24061, United States
| | - Warren K Bickel
- Center for Transformative Research on Health Behaviors, 1 Riverside Circle, Roanoke, VA 24016, United States; Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA 24016, United States.
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Mattson A, Friend K, Brown CS, Cabrera D. Reintegrating droperidol into emergency medicine practice. Am J Health Syst Pharm 2020; 77:1838-1845. [DOI: 10.1093/ajhp/zxaa271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Purpose
After a long period of low utilization, droperidol has become easier to obtain in the US market. This comprehensive review discusses the safety, indications, clinical efficacy, and dosing of droperidol for use in the emergency department (ED) setting.
Summary
In 2001 the US Food and Drug Administration (FDA) mandated a boxed warning in the labeling of droperidol after reports of QT interval prolongation associated with droperidol use. Since that time, it has been difficult to access droperidol in the United States; as a result, many practicing clinicians lack experience in its clinical use. Multiple studies have been conducted to assess the clinical efficacy and safety of droperidol use in ED patients. Results consistently show the safety of droperidol and its clinical efficacy when used as an analgesic, antiemetic, and sedative. Now that droperidol is more widely available for use in the US market, pharmacists and prescribers need to reliably translate safety and efficacy data compiled since 2001 to help ensure appropriate and effective use of the medication.
Conclusion
Droperidol is an effective and safe option for the treatment of acute agitation, migraine, nausea, and pain for patients in the ED setting. Healthcare professionals can adopt droperidol for use in clinical practice, and they should become familiar with how to dose and monitor droperidol for safe and effective use.
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Affiliation(s)
| | | | | | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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Johal H, Vannabouathong C, Chang Y, Zhu M, Bhandari M. Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use? Ther Adv Musculoskelet Dis 2020; 12:1759720X20937968. [PMID: 32655704 PMCID: PMC7333482 DOI: 10.1177/1759720x20937968] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022] Open
Abstract
The treatment of chronic, non-cancer musculoskeletal pain has become a topic growing interest as it is believed to be one of the reasons for the current opioid epidemic. The medicinal use of cannabis has a long history as a number of active compounds in cannabis have been shown to interact with the body's endocannabinoid system to reduce pain. This position paper provides a history on the evolution of cannabis, the science behind its therapeutic effects, and review of the evidence and current guideline recommendations on its use as a treatment for patients with chronic, non-cancer musculoskeletal pain. Results from systematic reviews have demonstrated a statistically significant reduction in chronic pain conditions with cannabinoids, compared with placebo, although the effects might be considered small and did not reach the minimally important difference. More adverse events were reported in the cannabinoid group than in the placebo group with longer than 2 weeks of treatment. There is a lack of evidence on dependence. With changes to policies, patients' perception has changed to be more positive toward the use of medical cannabis. Current recommendations from North America, Latin America, Europe, Australia and Iran support the use of medical cannabis for chronic, non-cancer pain. Based on the current evidence, it is our position that cannabinoids may be considered as an adjunctive therapy after recommended first- and second-line therapies have failed to provide sufficient efficacy or tolerability. Patients should consider the balance between the desirable and undesirable effects of taking cannabis for chronic pain, and comprehensively consider their own values and preferences, as well as cost-effectiveness factors, based on the information provided by their physician.
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Affiliation(s)
- Herman Johal
- Department of Surgery, McMaster University, 237 Barton Street East, Floor 5N, Hamilton, ON L8L 2X2, Canada
| | | | - Yaping Chang
- OrthoEvidence Inc., 3228 South Service Road, Suite 206, Burlington, ON L7N 3J6, Canada
| | - Meng Zhu
- OrthoEvidence Inc., Burlington, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- OrthoEvidence Inc., Burlington, ON, Canada
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Urits I, Gress K, Charipova K, Habib K, Lee D, Lee C, Jung JW, Kassem H, Cornett E, Paladini A, Varrassi G, Kaye AD, Viswanath O. Use of cannabidiol (CBD) for the treatment of chronic pain. Best Pract Res Clin Anaesthesiol 2020; 34:463-477. [PMID: 33004159 DOI: 10.1016/j.bpa.2020.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
Chronic pain can be recurrent or constant pain that lasts for longer than 3 months and can result in disability, suffering, and a physical disturbance. Related to the complex nature of chronic pain, treatments have a pharmacological and non-pharmacological approach. Due to the opioid epidemic, alternative therapies have been introduced, and components of the plant Cannabis Sativa, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have gained recent interest as a choice of treatment. The exact mechanism for CBD is currently unknown, but unlike the CBD's psychoactive counterpart, THC, the side effects of CBD itself have been shown to be overall much more benign. The current pharmaceutical products for the treatment of chronic pain are known as nabiximols, and they contain a ratio of THC combined with CBD, which has been promising. This review focuses on the treatment efficacy of CBD, THC: CBD-based treatments for chronic pain and adverse events with each.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Kelly Habib
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - David Lee
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Christopher Lee
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Hisham Kassem
- Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL, USA
| | - Elyse Cornett
- LSUHSC, Department of Anesthesiology, Shreveport, LA, USA
| | | | | | - Alan D Kaye
- LSUHSC, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; LSUHSC, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
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Rajha E, Pillow MT, Brock PA, Jenks S. Oncologic emergencies in the emergency medicine residency curriculum: A national survey. Am J Emerg Med 2020; 38:2477-2481. [PMID: 32178896 DOI: 10.1016/j.ajem.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- E Rajha
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - M T Pillow
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - P A Brock
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Jenks
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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Welsch L, Bailly J, Darcq E, Kieffer BL. The Negative Affect of Protracted Opioid Abstinence: Progress and Perspectives From Rodent Models. Biol Psychiatry 2020; 87:54-63. [PMID: 31521334 PMCID: PMC6898775 DOI: 10.1016/j.biopsych.2019.07.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022]
Abstract
Opioid use disorder (OUD) is characterized by the development of a negative emotional state that develops after a history of long-term exposure to opioids. OUD represents a true challenge for treatment and relapse prevention. Human research has amply documented emotional disruption in individuals with an opioid substance use disorder, at both behavioral and brain activity levels; however, brain mechanisms underlying this particular facet of OUD are only partially understood. Animal research has been instrumental in elucidating genes and circuits that adapt to long-term opioid use or are modified by acute withdrawal, but research on long-term consequences of opioid exposure and their relevance to the negative affect of OUD remains scarce. In this article, we review the literature with a focus on two questions: 1) Do we have behavioral models in rodents, and what do they tell us? and 2) What do we know about the neuronal populations involved? Behavioral rodent models have successfully recapitulated behavioral signs of the OUD-related negative affect, and several neurotransmitter systems were identified (i.e., serotonin, dynorphin, corticotropin-releasing factor, oxytocin). Circuit mechanisms driving the negative mood of prolonged abstinence likely involve the 5 main reward-aversion brain centers (i.e., nucleus accumbens, bed nucleus of the stria terminalis, amygdala, habenula, and raphe nucleus), all of which express mu opioid receptors and directly respond to opioids. Future work will identify the nature of these mu opioid receptor-expressing neurons throughout reward-aversion networks, characterize their adapted phenotype in opioid abstinent animals, and hopefully position these primary events in the broader picture of mu opioid receptor-associated brain aversion networks.
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Affiliation(s)
- Lola Welsch
- Douglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Julie Bailly
- Douglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Emmanuel Darcq
- Douglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Brigitte Lina Kieffer
- Douglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Abstract
The reasons for development of chronic pain are poorly understood. Chronic postoperative pain is linked to severe acute postoperative pain. Head and neck pain is often a complex phenomenon that requires meticulous diagnosis and treatment. Institution of early multimodal analgesic regimens by multidisciplinary teams may attenuate chronic pain formation and propagation in the otolaryngologic patient.
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Affiliation(s)
- Anuj Malhotra
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA
| | - Mourad Shehebar
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, KCC 8th Floor, Box 1010, New York, NY 10029, USA.
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Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, Yip SC, Yap KX. Medical cannabis for chronic pain: can it make a difference in pain management? J Anesth 2019; 34:95-103. [DOI: 10.1007/s00540-019-02680-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
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Natoli S. Opioid use in addiction: swinging between pain under-treatment and opioids harms. Minerva Anestesiol 2019; 85:819-821. [DOI: 10.23736/s0375-9393.19.13767-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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