Pain medicine : the official journal of the American Academy of Pain Medicine
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Endogenous morphine-like compounds have been identified in humans and are released in response to stress. Human monocytes and granulocytes express the micro opiate receptor, micro3, which is morphine selective but opiate peptide insensitive. Recent studies have shown that CYP2D6 acts at critical steps for endogenous morphine biosynthesis. We theorized that ultrarapid (UM) CYP2D6 metabolizers may have an enhancement of their endogenous pain modulating mechanisms. ⋯ Our current results suggest that CYP2D6 UM appear to require less morphine in the acute postoperative period compared with other CYP2D6 metabolizer groups. One possible mechanism for this observation is that CYP2D6 UM may have higher efficiency in synthesizing endogenous morphine compared with other metabolizers, thus increasing endogenous pain modulation and reducing the need for exogenous morphine.
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Review
Current risk assessment and management paradigms: snapshots in the life of the pain specialist.
Opioid analgesics can be a safe and effective treatment option for patients with chronic pain, but issues surrounding their use-including side effects, tolerance, and the potential for misuse and diversion-prompt some clinicians to avoid using these agents, and can lead to the continued undertreatment of pain. This article offers practical advice to clinicians who choose to prescribe opioid analgesics. Through a series of case presentations, it illustrates the steps health care providers can take to prepare their practice for opioid prescribing, assess and select patients for opioid treatment, initiate and manage therapy, and address concerns about aberrant behaviors.
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Bodily pain and psychiatric distress are common symptoms in patients with dialysis. However, the temporal relationships have not yet been investigated. Objective. To evaluate the longitudinal association between depressive symptoms and subsequent risk of developing severe bodily pain in dialysis patients. Design. Prospective cohort study. ⋯ Results of this study suggest that depressive symptoms measured by CES-D predict the future risk of developing severe bodily pain in dialysis patients.