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Regenerative Medicine in Pain Management
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Sharon McQuillan, Rafael Gonzalez
Two of the most troublesome side effects of opioid use/abuse are the occurrence of opioid tolerance and opioid-induced hyperalgesia. Opioid tolerance occurs when an individual requires greater amounts of opioids over time to obtain the original degree of therapeutic effect. This does not necessarily involve addiction. Increased dosages however, can lead to overdose and death. Opioid-induced hyperalgesia describes a situation in which individuals taking opioids to treat pain paradoxically develop an increased sensitivity to noxious stimuli.93 Currently, there are very few options in treating opioid tolerance or opioid-induced hyperalgesia other than medication rotation.
Safer Prescribing: The Threat and Challenge of Caring for People with Chronic Pain
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Clarissa Hemmingsen, James Matheson
Research indicates direct correlation of opioid-related harm with dose and continued use. The most at-risk user group are those already suffering the greatest distress and most in need of pain relief. They are most likely to experience significant adverse effects through drug-drug and drug-disease interaction [1,2,8]. The adverse consequences of high dose and prolonged opioid use (equivalent to 120mg morphine daily) include tolerance, dependence, addiction, abuse, cognitive impairment, immune suppression, hormonal disruption, gastrointestinal disturbance, nausea, headaches, somnolence, increased fracture risk, acute myocardial infarction, respiratory depression, increased pain and reduced quality of life through opioid-induced hyperalgesia and generally increased mortality [5,7–10].
Pharmacological Treatment Approaches
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
Catherine G. Derington, David K. Choi, Katy E. Trinkley
Finally, animal and human studies have shown that opioid use results in hyperalgesia by disrupting the body’s normal biologic responses to pain sensation, transmission, perception, and response (Lee, Silverman, Hansen, Patel, & Manchikanti, 2011). In effect, while administering an opioid results in short-term pain relief, it can be harmful to the patient to continue and escalate therapy. The only way to relieve a patient of opioid-induced hyperalgesia is to reduce the dose of the opioid or to discontinue it altogether.
Predictive factors of daily opioid use and quality of life in adults with sickle cell disease
Published in Hematology, 2018
Matthew S. Karafin, Arun Singavi, Jawad Hussain, Nancy Wandersee, Thomas Heinrich, Robert W. Hurley, Liyun Zhang, Pippa Simpson, Joshua J. Field
Few studies have examined how opioids affect the life of an adult with SCD in areas besides pain. The only large, prospective study to do so was the Pain in Sickle Cell Epidemiology Study (PiSCES), in which 230 adults with SCD were administered measures of physical function, mental health and health-related quality of life (HRQOL) [7,8]. Not surprisingly, adults with SCD demonstrated a higher somatic symptom burden compared to primary care patients, even when common pain sites were excluded in the SCD subjects [7]. High somatic symptom burden in adults with SCD was also associated with increased rates of depression, anxiety, and lower HRQOL [7,8]. A major reason for the low HRQOL scores was pain [7]. When the association between opioid use and HRQOL was examined, those adults with SCD who used opioids scored higher on measures of somatic symptom burden, stress, physical and mental HRQOL than non-opioid users [9]. Although this study showed that opioid use was associated with worse HRQOL, a limitation was that opioid dose was not examined. In the general population, high-dose opioids are known to be associated with more side effects, an increased risk of overdose and death, and the development of opioid-induced hyperalgesia. Although these risks have not been demonstrated in SCD patients, the impact of opioid dose on HRQOL in these patients is still a knowledge gap that needs to be addressed [10–13].
Heavy prescription over time leading to opioid dependence
Published in Journal of Substance Use, 2018
Pol Bruguera, Pablo Barrio, Lluïsa Ortega, Ana Isabel Lopez-Lazcano, Adela Fauli, Anna Lligoña
Patients affected by depressive and anxiety disorders benefit less from opioid treatment due to more sensibility to pain and reduced response to opioids (Goldner, Lusted, Roerecke, Rehm, & Fischer, 2014; Wasan et al., 2015). In this sense, these patients tend to receive opioids doses three times higher than patients without psychiatric symptoms (Edlund et al., 2010). Clinicians should take into account this point when prescribing high doses of opioids, and considering opioid misuse and psychiatric comorbidities as a factor for this lack of efficacy. For all this, it seems convenient to reconsider the treatment strategy when exceeding opioid doses recommended by clinical guidelines. In addition, high doses of opioid without adequate pain control have been related to opioid-induced hyperalgesia, an unclear condition that could explain loss of opioid efficacy. It is defined as a state of nociceptive sensitization and a paradoxical response opioids (Yi & Pryzbylkowski, 2015).
State of the art opioid-sparing strategies for post-operative pain in adult surgical patients
Published in Expert Opinion on Pharmacotherapy, 2019
Rodney A. Gabriel, Matthew W. Swisher, Jacklynn F. Sztain, Timothy J. Furnish, Brian M. Ilfeld, Engy T. Said
Intraoperatively, opioid administration should be limited to reduce opioid-induced hyperalgesia and side effects. Pre-incision ketamine, dexamethasone, and dexmedetomidine boluses should be considered. Continuous ketamine (0.1–0.6 mg/kg/h) and dexmedetomidine infusions should be part of the anesthetic plan if appropriate, especially in patients with pre-existing chronic pain. If a TEA is present and no concerns for hemodynamic instability, this should be started intraoperatively to reduce the total required anesthetic for surgery and initiate postoperative analgesia. When no local anesthetic infusion through an epidural/perineural catheter is available, providers should consider administering an intravenous lidocaine infusion (1–3 mg/kg/h) intraoperatively.