Pain medicine : the official journal of the American Academy of Pain Medicine
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Millions of patients continue to require opioid analgesics for control of moderate to severe chronic pain, which is a disease that affects more Americans than cancer, heart disease, and diabetes combined. Common opioid adverse effects include constipation, sedation, and nausea. A lesser-known sequelae is opioid induced androgen deficiency (OPIAD). The objective of this review was to better characterize the effects of opioids on the endocrine system. ⋯ OPIAD is a recognized consequence of long-term opioid therapy. Patients initiated or maintained on opioids should be queried about symptoms that might suggest hypogonadism including irregular menses, reduced libido, depression, fatigue, and hot flashes or night sweats. Some clinicians recommend assessment of baseline testosterone levels prior to initiating therapy. Additional data appear necessary to formulate guidelines regarding the diagnosis and management of OPIAD. Options include, rotating, reducing the dose or type, or cessation of opioid therapy or adding hormonal supplementation in the form of androgen replacement therapy. There are multiple formulations of testosterone available for replacement therapy, which is usually guided by laboratory measurements.
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Opioid-induced constipation (OIC) is common in people treated with opioids and poses risks for physical sequelae, analgesic discontinuation, and decreased quality of life. ⋯ Physicians need a better understanding of the negative impacts of OIC for patients and better OIC-specific methods to assess, treat, and monitor it.
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Randomized Controlled Trial
Placebo Responses to Original vs Generic ASA Brands During Exposure to Noxious Heat: A Pilot fMRI Study of Neurofunctional Correlates.
We studied the expectation effects associated with brands by labeling placebo interventions (original and generic analgesic) and investigating the potential differences in efficacy between the two placebos in dealing with noxious heat pain, as well as exploring the neurometabolic correlates of the placebo response. ⋯ Our data indicate a behavioral placebo response for the original brand only. Expectations by subjects appear to be triggered not only by the placebo treatment itself but also by the trusted brand, which thus serves as an enhanced placebo. Both processes appear to be based on fronto-cortical neural networks, as these areas showed significantly stronger activations with the original brand.
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To investigate the role of CYP2D6 phenotype in the outcome of postoperative (PO) pain (POP) treatment. ⋯ In respect to the normal CYP2D6 phenotype, our results suggested that slowly metabolizers (IMs and PMs) might have a major sedation, whereas more rapid metabolizers (UM) a minor sedation, in the early time after surgery. A minor role of CYP2D6 phenotype in PO analgesia may be suggested.
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Comparative Study
AN APP for the Assessment of Pain Intensity: Validity Properties and Agreement of Pain Reports When Used with Young People.
Painometer is a mobile application that includes four pain intensity scales: the Numerical Rating Scale, the Faces Pain Scale-Revised, the mechanical visual analogue scale and the Colored Analogue Scale. The aim of this study was to analyze the validity and agreement of the intensity reports provided by these scales and their traditional counterparts. ⋯ Our results demonstrate that pain intensity scores reported with the scales in Painometer are valid, and concordant with their traditional counterparts.