Journal of pain & palliative care pharmacotherapy
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The neurobiology of pain and analgesia exhibits plasticity in different pain states. Animal models allow the study of the pathways, neuronal plasticity, and pharmacology that reflect the pains many patients have. Inherited pain disorders may also indicate the pain-related roles of gene products. ⋯ Pain remains a subjective experience, and the search for objective measures or biomarkers of pain has so far not yielded definitive results. However, rational, mechanistic explanations for pain states are emerging, and a number of potential treatment targets that have recently been revealed by animal models of clinical pain conditions are beginning to be translated to the patient. This article outlines some of the major recent developments in preclinical and clinical pain science that have the potential to shape the development of new treatments for pain.
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J Pain Palliat Care Pharmacother · Mar 2015
Chronic opioid pain management for chronic kidney disease.
Questions from patients about pain conditions, pain treatment, and responses from authors are presented to help educate patients and make them effective self-advocates. The topics addressed in this issue are renal or kidney failure and chronic pain management with opioids, morphine, and oxycodone effect in the body over a period of time. This includes process of absorption, distribution, localization in tissues, biotransformation and excretion in chronic kidney disease, expected side effects and recommendations.
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J Pain Palliat Care Pharmacother · Mar 2015
Case ReportsPatient-tailored combinations of systemic and topical preparations for localized peripheral neuropathic pain: a two-case report.
This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both patients for a long time. ⋯ The second patient achieved optimal pain control with dipyrone (500 mg three times per day), pregabalin (150 mg twice a day), dextromethorphan (60 mg three times per day), plus topical compounds (10% ketamine, 0.3% clonidine, 5% diclofenac) in a penetrating enhancing gel. Notably, the individualized approach described herein was made possible through collaboration between a public health pain specialist and a private sector compounding pharmacist, highlighting the importance of such infrequent but, highly desirable collaborations.
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J Pain Palliat Care Pharmacother · Mar 2015
CYP2D6 phenotype-specific codeine population pharmacokinetics.
Codeine's metabolic fate in the body is complex, and detailed quantitative knowledge of it, and that of its metabolites is lacking among prescribers. We aimed to develop a codeine pharmacokinetic pathway model for codeine and its metabolites that incorporates the effects of genetic polymorphisms. We studied the phenotype-specific time courses of plasma codeine, codeine-6-glucoronide, morphine, morphine-3-glucoronide, and morphine-6-glucoronide. ⋯ The model also showed that about 39% of the MO formed from codeine was converted to morphine-6-glucoronide in extensive-metabolizer phenotypes, and about 58% was converted in ultrarapid-metabolizers. We conclude, a population pharmacokinetic codeine pathway model can be useful because beyond helping to achieve a quantitative understanding the codeine and MO pathways, the model can be used for simulation to answer questions about codeine's pharmacogenetic-based disposition in the body. Our study suggests that pharmacogenetics for personalized dosing might be most effectively advanced by studying the interplay between pharmacogenetics, population pharmacokinetics, and clinical pharmacokinetics.
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J Pain Palliat Care Pharmacother · Mar 2015
Case ReportsTreat the whole patient and be aware of drug interactions.
The case of an elderly male with bilateral shoulder pain is presented. The pain had been successfully treated years earlier with surgery, but a repeat rotator cuff procedure when the pain recurred was not effective. ⋯ Cardiovascular and renal risks of NSAOIDs are discussed as are potential toxicities of tramadol and too rapid withdrawal from it. Drug interactions of medications used are described.