Journal of pain & palliative care pharmacotherapy
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Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question about medication overuse headache, its presentation, causes, treatment, and prevention will be discussed.
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J Pain Palliat Care Pharmacother · Jan 2016
Clinical TrialMinocycline Does Not Decrease Intensity of Neuropathic Pain Intensity, But Does Improve Its Affective Dimension.
Recent understanding of the neuron-glia communication shed light on an important role of microglia to develop neuropathic pain The analgesic effect of minocycline on neuropathic pain is promising but it remains unclear in clinical settings. This study included 20 patients with neuropathic pain of varied etiologies. We administered 100 mg/day of minocycline for 1 week and then 200 mg/day for 3 weeks, as an open-label adjunct to conventional analgesics. ⋯ There was no significant improvement in the scoring of NRS (5.6 ± 1.2 at baseline vs. 5.3 ± 1.9 at 4 weeks; P =.60). The total score of the SF-MPQ decreased significantly (17.2 ± 7.4 vs. 13.9 ± 9.6; P =.02), particularly in the affective subscale (4.4 ± 2.7 vs. 3.3 ± 3.6; P =.007) but not so in the sensory subscale (12.8 ± 5.2 vs. 10.6 ± 6.2; P =.06). We conclude that minocycline failed to decrease pain intensity but succeeded in reducing the affective dimension associated with neuropathic pain.
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J Pain Palliat Care Pharmacother · Jan 2016
Ritonavir Use in Human Immunodeficiency Virus-Positive Surgical Patients Is Not Associated with an Increase in Postoperative Critical Respiratory Events.
This study evaluated whether highly active antiretroviral therapy for human immunodeficiency virus (HIV) including ritonavir is independently associated with increased critical respiratory events after general anesthesia with opioid analgesia. The impact of ritonavir on hepatic microsomal enzymes was considered due to the effect of these enzymes on opioid metabolism. Medical records of over 1900 patients were reviewed, and those of 941 patients met inclusion criteria and were analyzed. Chronic treatment with ritonavir was not associated with critical respiratory events in HIV-positive patients.
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J Pain Palliat Care Pharmacother · Jan 2016
Negative outcomes of unbalanced opioid policy supported by clinicians, politicians, and the media.
Harmful and nonmedical use of prescription opioids has increased precipitously in the United States and some other countries in recent years, but not everywhere around the world. Addressing this problem requires attention to scientific data and to objective and balanced consideration of factors driving the problems. Unfortunately, the situation has been blurred by some politicians, health professionals, and the media by their using inadequate concepts, misrepresenting and exaggerating facts, and demonizing pain patients. ⋯ We advocate comprehensive drug control policies implemented in a way to reduce harmful use and diversion problems balancing the public health benefits and risks of opioid medications. We make recommendations for responsible prescribing, including implementing the World Health Organization (WHO) policy guidelines and similar United Nations Office of Drug Control (UNODC), which we believe can contribute measurably to the prevention of diversion of prescription opioids while ensuring patient access to the most appropriate medicines. Measures to reduce the risks of nonmedical use of opioid medicines should be based to the greatest extent possible on accurate evaluation of the mechanisms leading to such use, including diversion activities.
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J Pain Palliat Care Pharmacother · Jan 2016
Relationship Between Buprenorphine Dosing and Triglyceride Lowering and creatine kinase [corrected] Elevation in Felines: Possible Human Implications.
Recently published feline data suggest that high doses of buprenorphine can elevate creatine kinase (CK) [corrected] and profoundly influence triglyceride levels in an inverted dose versus effect relationship. This intriguing observation in felines, hitherto not documented for buprenorphine, should be considered in human situations for any trends of translatability. The report evaluates the observed effects in domestic cats and what is known about buprenorphine in human subjects. Based on the objective assessment, the following are deduced: (a) although elevated CK levels is a nonissue in humans, one needs to pay attention especially when buprenorphine is used at the high end of therapeutic dose range in the presence of drugs that can impair the hepatic metabolism of buprenorphine; and (b) the potential for triglyceride lowering can be easily confirmed in human trials, and since it may occur at the relevant therapeutic doses of buprenorphine, it may be beneficial in such patients who may have added cardiovascular risk factors.