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Screening and Pharmacological Management of Neuropathic Pain
Published in Suvardhan Kanchi, Rajasekhar Chokkareddy, Mashallah Rezakazemi, Smart Nanodevices for Point-of-Care Applications, 2022
Manu Sharma, Ranju Soni, Kakarla Raghava Reddy, Veera Sadhu, Raghavendra V. Kulkarni
During intense or persistent pain, neurons in the dorsal horn liberate endogenous opioid peptides (beta-endorphin, enkephalins, dynorphins) to diminish the perception of pain. These endogenous opioids modulate pain-related signals by inhibiting the transmission of signals at synapses. Opioid receptors (µ, κ, and δ) are present in different areas of the brain, brain stem, spinal cord, and peripheral nervous system. Opioids exhibit mood-elevating properties because of specific affinity towards µ receptors in the brain whereas they enhance the performance of cells in the brain stem involved in inhibition of descending pain. Opioids also inhibit the transmission of nociceptive pain signals at the spinal cord and peripheral nervous system. Agonistic binding of opioids to all receptors elicits the closure of Ca+2 channels which diminishes neurotransmitter release and inhibits postsynaptic neurons [35–37].
Payers, purchasers, and promotions
Published in Rachel Kim, Economics and Management in the Biopharmaceutical Industry in the USA, 2018
Most recently, the FDA has reached a point where it may be time to go back to its conservative focus: safety of new drug candidates. Certainly, the agency should have tightened regulations on painkillers when the new drugs were entering the market years ago. The so-called prescription painkillers, drugs classified as opioid analgesics, are at the center of the prescription drug abuse problem. These medications relieve pain by reducing the intensity of pain signals that reach the brain. Opioid analgesics include the following common drugs: Hydrocodone (Vicodin®, Lortab®, Lorcet®); Oxycodone (OxyContin®); Oxymorphone (Opana®); Propoxyphene (Darvon®); Hydromorphone (Dilaudid®); Meperidine (Demerol®); Diphenoxylate (Lomotil®); Morphine (Kadian®, Avinza®, MS Contin®); Codeine; Fentanyl (Duragesic®); and Methadone (see Shepherd, 2014). Opioid painkillers have reignited the debates on tightening FDA policy to prevent this type of prescription drug addiction epidemic from happening in the future.
Homo Sapiens (“Us”): Strengths and Weaknesses
Published in Michael Hehenberger, Zhi Xia, Our Animal Connection, 2019
Another important category of pain medicines are the opioids. They are limited to the natural alkaloids found in the resin of the opium poppy although some include semi-synthetic derivatives. An important semi-synthetic opioid that is synthesized from codeine, one of the opioid alkaloids found in the opium poppy, is hydrocodone. It is a narcotic analgesic used orally for relief of moderate to severe pain, but also commonly taken in liquid form as an antitussive/cough suppressant. Opioids act by binding to opioid receptors. They are found principally in the central and peripheral nervous system and the gastrointestinal tract. Opioid receptors mediate both the psychoactive and the somatic (associated with voluntary movements of the body) effects of opioids. Medically, they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, suppressing cough, and suppressing opioid induced constipation. However, opioids are also frequently used nonmedically for their euphoric effects or to prevent withdrawal. Side effects of opioids may include itchiness, sedation, nausea, respiratory depression, constipation, and euphoria. Tolerance and dependence will develop with continuous use, requiring increasing doses and leading to a withdrawal syndrome upon abrupt discontinuation. The euphoria attracts recreational use, and frequent, escalating recreational use of opioids typically results in addiction. Fatal consequences can be caused by an overdose or by concurrent use of opioids with other depressant drugs, resulting frequently in death from respiratory depression. This risk for addiction and fatal overdoses dictates that opioids are mostly controlled substances.
Transcranial direct current stimulation combined with peripheral stimulation in chronic pain: a systematic review and meta-analysis
Published in Expert Review of Medical Devices, 2023
Rayssa Maria Do Nascimento, Rafael Limeira Cavalcanti, Clécio Gabriel Souza, Gabriela Chaves, Liane Brito Macedo
The combination of peripheral stimulation and transcranial stimulation could act priming the brain, that is, one therapy would increase the brain’s receptiveness to receive the other therapy. This occurs due to the capacity of these techniques to neuromodulate the cortex, increasing or decreasing its excitability [46]. Besides that, their top-down and bottom-up approaches could act together by bombarding the pain system and inducing a summative effect [45,47]. It is worth to remember that tDCS acts on motor cortex and its mechanisms for pain are related to neurophysiological changes, such as decrease in thalamic hyperactivity and neurochemical mediation of neurotransmitters and central receptors involved with the inhibitory control of descending pain pathways [48,49]. On the other hand, the most used forms of peripheral electrical stimulation for pain treatment, in theory, act through two main mechanisms: 1) selective stimulation of large-diameter non-nociceptive neural fibers at the level of spinal dorsal horn, activating inhibitory neurons of pain and suppressing nociceptive fibers (gait control theory of pain) [50,51] and 2) release of endogenous opioids and inhibition of nociceptive markers through activation of specific receptors in areas of pain control, such as rostral ventromedial medulla and periaqueductal gray [52,53].
Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving
Published in Traffic Injury Prevention, 2021
Arianna Unger, Flaura K. Winston, Dominique G. Ruggieri, Joshua Remba
Of perhaps greatest concern are the effects of medications such as opioids and skeletal muscle relaxants on patients’ ability to drive safely. Opioids frequently produce side effects such as fatigue, lightheadedness, and miosis, which can affect attentiveness and the ability to effectively navigate traffic (Hetland and Carr 2014). Similarly, skeletal muscle relaxants can cause patients to experience drowsiness, ataxia, reduced coordination, and blurred vision which may also affect driving ability (Hetland and Carr 2014). Opioids and several classes of skeletal muscle relaxants, along with an array of other medications prescribed for neurological conditions, have repeatedly been shown to increase the risk of crash involvement (Bramness et al. 2007; Hetland and Carr 2014; Li and Chihuri 2019).
An integrated opioid prescription optimization framework for total joint replacement surgery patients
Published in IISE Transactions on Healthcare Systems Engineering, 2021
Sujee Lee, Philip A. Bain, Albert J. Musa, Christine Baker, Jingshan Li
Opioids are a class of drugs used to reduce pain. Among them, prescription opioids, such as oxycodone, hydrocodone, codeine, and morphine, are typically prescribed by physicians to treat chronic or acute pain, or manage pain-related serious health conditions, for instance, cancer (Centers for Disease Control and Prevention, 2020; National Institute on Drug Abuse, 2020). However, serious risks and side effects have been associated with the prescription opioids. A substantial number of patients using prescription opioids for chronic pain may develop opioid use disorder (Voon et al., 2017). It is reported that 55% of opioid deaths are related to prescription opioids (Centers for Disease Control and Prevention, 2018; Hedegaard et al., 2018; Scholl et al., 2019). Since one of the major sources of opioid overdose is hospital over-prescription (Carey et al., 2018), to fight against the opioid crisis, reducing over-prescription at hospitals is of significant importance.