Medical hypotheses
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Involuntary medication is one of the coercive measures used in psychiatry. We argue that direct extrapolation of placebo and nocebo effects of psychiatric medication in the voluntary setting to the situation of coercive treatment is probably not justified. ⋯ As a consequence, placebo effects are likely to be diminished in coercive treatment, while nocebo effects are probably increased. This may result in an overall decreased effectiveness of medication in coercive settings.
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Deep brain stimulation of the pedunculopontine tegmental nucleus (PPTg) had usually been reported to improve the symptoms of advanced Parkinson's disease. Previous studies showed that neurons in the PPTg involved in the control of the sympathetic outflow to the kidneys. ⋯ We propose a hypothesis that deep brain stimulation of the PPTg may influence renal function by serotonergic and catecholaminergic pathways. Because PRV-614/tryptophan hydroxylase and PRV-614/tyrosine hydroxylase double-labeled neurons in the compact parts of PPTg (cpPPTg) were not detected, deep brain stimulation of the cpPPTg might not influence renal function.
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Evidence indicates that smokers have hyperalgesia perioperatively as characterized by a higher postoperative pain score as well as increased requirements of opioids during surgery and postoperative patient-controlled analgesia compared with non-smokers. The possible mechanism of hyperalgesia for smokers is related to nicotinic acetylcholine receptor (nAChR) desensitization as well as competitive occupancy for binding sites. For smokers, high doses of opioids are needed perioperatively whereas small doses of nicotine do not reduce postoperative opioid requirements. ⋯ The serotonergic system plays an important part in modulating anti-nociception, and decreasing the concentration of serotonin in vesicles in neurons of the brain and spinal cord is an effective method. Intraoperative application of tramadol could result in an analgesic effect via enhancement of descending inhibitory pain pathways. Therefore, increasing the amount of tramadol given intraoperatively and postoperatively may reduce overall opioid requirements, and decrease the pain score as well as morphine consumption postoperatively.