Articles: opioid.
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Dopaminergic signaling is implicated in nociceptive pathways. These effects are mediated largely through dopamine receptors and modulated in part by dopamine transporters. This study tested the hypothesis that genetic variants in the genes encoding dopamine receptor 2 (DRD2) and the dopamine active transporter (SLC6A3) influence acute pain severity after motor vehicle collision. ⋯ Genetic variants in DRD2 are associated with acute pain after a traumatic stressful event. These results suggest that dopaminergic agents may be useful for the treatment of individuals with acute posttraumatic pain as part of a multimodal opioid-sparing analgesic regimen.
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"Burst ketamine" (BK) is the long-term infusion of subanesthetic ketamine in combination with an opioid. It is used clinically with mixed success to provide long-term pain relief and improve opioid response in patients. BK has not been simulated preclinically, therefore, its effectiveness was investigated in an animal model of neuropathic pain--streptozotocin-induced diabetic neuropathy. ⋯ This is the first preclinical study to use a model of neuropathic pain to demonstrate the utility of the BK procedure for delivering a long-lasting reduction in hyperalgesia and improved antinociceptive responsiveness to opioids.
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A sufficient pain management forms the foundation for a successful operative treatment of orthopedic patients. Clinical guideline standards must be provided to ensure safe and immediate pain therapy. Training in these guidelines should be held for clinical personnel on a regular basis. ⋯ A sufficient pain management includes basic analgesics, analgesics on demand as well as special features, such as regional nerve blocks and patient-controlled anesthesia (PCA). The basic analgesics are primarily the groups of classical non-steroidal anti-inflammatory drugs (NSAID) and cyclooxygenase 2 (COX-2) inhibitors as well as stand by analgesics, such as metamizole. If there is further need for pain therapy, medium strong and strong opioids can be used but adverse events must be taken into consideration.
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Gen Hosp Psychiatry · Sep 2015
Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain.
Borderline personality disorder (BPD) is common in patients with chronic non-cancer pain (CNCP). BPD patients often report worse pain and are more likely to abuse opioid medication. Although the prevalence of suicidality is high in both CNCP patients and those with BPD, no studies have examined the interrelationship of BPD, CNCP and suicidality. This article aims to examine the prevalence and associations of BPD in a large community sample of CNCP patients and the association with medication problems and suicidality. ⋯ BPD symptoms were prevalent among people prescribed opioids for CNCP and are associated with a number of adverse consequences. Further, those screening positive were at elevated risk of suicidal behaviors. Careful opioid prescription monitoring and appropriate referrals by clinicians are warranted in BPD with CNCP.
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There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each. ⋯ In this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems.