Journal of opioid management
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In addition to producing analgesia, opioids can increase sensitivity to pain (opioid-induced hyperalgesia [OIH]) in humans and rodents. Tolerance/OIH is likely mediated by similar mechanisms that lead to development of hyperalgesia after nerve injury (neuropathic pain). OIH may be a reason for loss of opioid efficacy and/or a worsening of pain. Ultra-low-dose (ULD) opioid evokes hyperalgesia independently of analgesia. Tolerance to ULD-OIH develops with repeated dosing in rats. ⋯ Although the translational aspect of this preclinical study has limitations, the present data may suggest a new strategy for the pre-emptive use of ULD opioids to prevent the development of neuropathic pain with certain procedures or disease states.
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Review Meta Analysis
Analgesic efficacy of intravenous naloxone for the treatment of postoperative pruritus: a meta-analysis.
Pruritus may be a significant problem for patients in the postoperative period. There are many options for the treatment of pruritus including intravenous (IV) naloxone. However, it is not clear whether the use of IV naloxone may also affect analgesia or other opioid-related side effects. The authors have performed a systematic review to further examine this issue. ⋯ Our pooled analysis examining the analgesic efficacy of IV naloxone (either as a continuous infusion or IV PCA) revealed that naloxone was associated with a decrease in pruritus and nausea without any increase in pain scores. When compared with controls, the use of IV naloxone was not associated with any significant changes in opioid consumption or with the risk of sedation or emesis.
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The OPRM1 gene was studied for DNA methylation in opioid dependence and possible paternal contribution to epigenetic inheritance of altered methylation profiles. ⋯ Increased DNA methylation in the OPRM1 gene is associated with opioid dependence. Hypermethylated CpG sites located in OPRM1 promoter may potentially block the binding of Sp1 and other transcription activators, thus leading to OPRM1 silencing. The increased DNA methylation in sperm may suggest a way of epigenetic heritability of opioid abuse or dependence phenotypes.
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Comparative Study
Economic evaluation of OROS hydromorphone for chronic pain: a Pan-European perspective.
OROS hydromorphone (osmotic extended-release oral delivery system [OROS] hydromorphone) is a long-acting opioid analgesic, which is approved in Europe for the management of severe pain. The authors aimed to estimate the economic value of this product relative to other widely used oral opioids, including sustained-release morphine, extended-release (ER) oxycodone, and twice-daily (bid) hydromorphone. ⋯ This model demonstrates the cost effectiveness of OROS hydromorphone relative to other strong oral opioids in the treatment of chronic severe malignant and nonmalignant pain.
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Multicenter Study
Depressive symptoms in community-dwelling older adults receiving opioid therapy for chronic pain.
The purpose of the study was to identify factors associated with depressive symptoms in community-dwelling older adults receiving prescription opioids for chronic pain. ⋯ Depression is an underdiagnosed, treatable pain comorbidity that should be evaluated in older patients receiving opioid therapy. Undertreated depression in chronic pain patients receiving opioid medications may explain suboptimal improvement in pain and functional status despite increasing opioid dosage.