Pain practice : the official journal of World Institute of Pain
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Patients taking more than one drug metabolized through the cytochrome P450 (CYP450) enzyme system experience a drug-drug exposure (DDE), which puts them at risk for a potential pharmacokinetic drug-drug interaction (DDI), defined as two or more drugs interacting in such a way that the effectiveness and/or toxicity of one or all drugs are changed. Any patient subjected to a DDE is at risk for a potentially serious DDI, the epidemiology of which has not been thoroughly studied. Many drugs are metabolized primarily via the CYP450 enzyme system, including certain opioids used to manage moderate to severe chronic pain. ⋯ The risk of DDE during the study period was threefold greater for patients with one medication in the 90-day period before index date compared with similar patients with no prescriptions in that same period before the index date. DDEs are more common than may be generally believed in patients with osteoarthritis, regardless of age, and can occur even in patients taking few medications. When selecting an opioid analgesic to treat osteoarthritis, physicians should consider the potential for exposure of these patients to drugs that could interact unfavorably.
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Herpes zoster pain and postherpetic neuralgia (PHN) particularly affect older persons. This literature review presents how quality of life is evaluated and the consequences of shingles and PHN on the quality of life of older persons. Although more than 150 articles have been published on herpes zoster and its consequences, specific studies focusing on the older population are needed, in several domains like epidemiology, preventive medicine, neuropsychology, and pharmacology.
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With few exceptions, anesthesiologists have not received training in the use of immune modulating drugs (IMDs); but recent evidence suggests that such drugs may be effective in reducing chronic pain. We therefore wished to learn how anesthesiologists working in pain medicine might envisage the treatment of their patients with IMDs in the future. We expected that anesthesiologists would want to refer patients for treatment with IMDs to medical colleagues, such as oncologists or rheumatologists, with prior experience in using these drugs, rather than treat these patients within their own practice. ⋯ Contrary to what we had expected, we found that a majority of the respondents would administer IMDs within their own practice, after appropriate training. The overall response rates were 30% and 23%, respectively; therefore, no firm conclusions can be drawn as to the views of the majority of practicing pain specialists. Our findings may have implications for the planning of both health service delivery and training in pain medicine.
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One indirect line of evidence for opioid-induced hyperalgesia (OIH) in humans is decreased pain thresholds (PTREs) and tolerances (PTOLs) in opioid addicts on opioids. There are a number of such studies in opioid maintained addicts, but no such studies in chronic pain patients (CPPs) with current opioid addiction. The objective of this study was to determine if this group demonstrates hyperalgesia. ⋯ This study contributes to the human OIH literature. However, because of the potential confounders in this study, the issue of OIH in humans remains unresolved.