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AANA Journal Feb 2021Opioids are a mainstay in the modern practice of anesthesia and perioperative pain management. However, due to the crisis surrounding opioid use and abuse, as well as... (Review)
Review
Opioids are a mainstay in the modern practice of anesthesia and perioperative pain management. However, due to the crisis surrounding opioid use and abuse, as well as the undesirable side effects that occur with normal use, anesthesia providers are searching for ways to curtail perioperative opioid use. The advent of various analgesic adjuncts such as dexmedetomidine has opened new avenues for multimodal analgesic approaches to perioperative pain management. A review of current research focused on these analgesic adjuncts and the drawbacks of opioid use reveals increased understanding and complexity of the physiology of pain, its treatment, and our understanding of pharmacologic mechanisms of action of analgesics. This course will examine the current limitations of opioids, provide a brief overview of the physiology of pain, and discuss the pharmacologic mechanism of action of dexmedetomidine and patient populations in which its use might be advantageous.
Topics: Analgesics; Analgesics, Opioid; Dexmedetomidine; Humans; Opioid-Related Disorders; Pain, Postoperative
PubMed: 33501912
DOI: No ID Found -
The evidence of neuraxial administration of analgesics for cancer-related pain: a systematic review.Acta Anaesthesiologica Scandinavica Oct 2015The present systematic review analysed the existing evidence of analgesic efficacy and side effects of opioids without and with adjuvant analgesics delivered by... (Review)
Review
BACKGROUND
The present systematic review analysed the existing evidence of analgesic efficacy and side effects of opioids without and with adjuvant analgesics delivered by neuraxial route (epidural and subarachnoid) in adult patients with cancer.
METHODS
Search strategy was elaborated with words related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation.
RESULTS
The number of abstracts retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant analgesic compared with neuraxial administration of opioid alone (n = 4); single neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neuraxial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences in favour of the tested interventions.
CONCLUSION
Heterogeneous characteristics and several methodological limitations of the studies resulted in evidence of low quality and a weak recommendation for neuraxial administration of opioids with or without adjuvant analgesics in adult patients with cancer.
Topics: Analgesia, Epidural; Analgesics; Analgesics, Opioid; Humans; Neoplasms; Pain; Pain Management; Treatment Outcome
PubMed: 25684104
DOI: 10.1111/aas.12485 -
Advances in Pharmacology (San Diego,... 2017The endocannabinoid system, consisting of the cannabinoid receptor (CBR) and cannabinoid receptor (CBR), endogenous cannabinoid ligands (endocannabinoids), and... (Review)
Review
The endocannabinoid system, consisting of the cannabinoid receptor (CBR) and cannabinoid receptor (CBR), endogenous cannabinoid ligands (endocannabinoids), and metabolizing enzymes, is present throughout the pain pathways. Endocannabinoids, phytocannabinoids, and synthetic cannabinoid receptor agonists have antinociceptive effects in animal models of acute, inflammatory, and neuropathic pain. CBR and CBR located at peripheral, spinal, or supraspinal sites are important targets mediating these antinociceptive effects. The mechanisms underlying the analgesic effects of cannabinoids likely include inhibition of presynaptic neurotransmitter and neuropeptide release, modulation of postsynaptic neuronal excitability, activation of the descending inhibitory pain pathway, and reductions in neuroinflammatory signaling. Strategies to dissociate the psychoactive effects of cannabinoids from their analgesic effects have focused on peripherally restricted CBR agonists, CBR agonists, inhibitors of endocannabinoid catabolism or uptake, and modulation of other non-CBR/non-CBR targets of cannabinoids including TRPV1, GPR55, and PPARs. The large body of preclinical evidence in support of cannabinoids as potential analgesic agents is supported by clinical studies demonstrating their efficacy across a variety of pain disorders.
Topics: Analgesics; Animals; Cannabinoids; Disease Models, Animal; Humans; Models, Biological; Pain; Receptors, Cannabinoid
PubMed: 28826543
DOI: 10.1016/bs.apha.2017.05.003 -
The Veterinary Clinics of North... Sep 2017The importance of appropriate recognition, assessment, and treatment of pain in all veterinary species, including exotic animals, cannot be overstated. Although the... (Review)
Review
The importance of appropriate recognition, assessment, and treatment of pain in all veterinary species, including exotic animals, cannot be overstated. Although the assessment of pain perception in nondomestic species is still in its infancy, this does not preclude appropriate analgesic management in these species. Although analgesic drug selection is often based on data extrapolated from similar species, as the pharmacokinetics and pharmacodynamics of many drugs can vary greatly between species, an evidence-based approach to analgesic therapy should be used whenever possible. This article provides an overview of recent advances in evidence-based analgesic management in companion exotic animals.
Topics: Analgesia; Analgesics; Animals; Animals, Exotic; Evidence-Based Practice; Pain; Pain Management
PubMed: 28781040
DOI: 10.1016/j.cvex.2017.04.013 -
Current Opinion in Pharmacology Jun 2024Ligand bias offers a novel means to improve the therapeutic profile of drugs. With regard to G protein-coupled receptors involved in analgesia, it could be advantageous... (Review)
Review
Ligand bias offers a novel means to improve the therapeutic profile of drugs. With regard to G protein-coupled receptors involved in analgesia, it could be advantageous to develop such drugs if the analgesic effect is mediated by a different cellular signalling pathway than the adverse effects associated with the drug. Whilst this has been explored over a number of years for the μ receptor, it remains unclear whether this approach offers significant benefit for the treatment of pain. Nevertheless, the development of biased ligands at other G protein-coupled receptors in the CNS does offer some promise for the development of novel analgesic drugs in the future. Here we summarise and discuss the recent evidence to support this.
Topics: Humans; Animals; Signal Transduction; Analgesics; Drug Development; Pain; Receptors, G-Protein-Coupled; Ligands
PubMed: 38830321
DOI: 10.1016/j.coph.2024.102465 -
Behavioural Pharmacology Aug 2020The transient receptor potential (TRP) channel superfamily is comprised of a large group of cation-permeable channels, which display an extraordinary diversity of roles... (Review)
Review
The transient receptor potential (TRP) channel superfamily is comprised of a large group of cation-permeable channels, which display an extraordinary diversity of roles in sensory signaling and are involved in plethora of animal behaviors. These channels are activated through a wide variety of mechanisms and participate in virtually every sensory modality. Modulating TRP channel activity provides an important way to regulate membrane excitability and intracellular calcium levels. This is reflected by the fact that small molecule compounds modulating different TRPs have all entered clinical trials for a variety of diseases. The role of TRPs will be further elucidated in complex diseases of the nervous, intestinal, renal, urogenital, respiratory, and cardiovascular systems in diverse therapeutic areas including pain and itch, headache, pulmonary function, oncology, neurology, visceral organs, and genetic diseases. This review focuses on recent developments in the TRP ion channel-related area and highlights evidence supporting TRP channels as promising targets for new analgesic drugs for therapeutic intervention. This review presents a variety of: (1) phylogeny aspects of TRP channels; (2) some structural and functional characteristics of TRPs; (3) a general view and short characteristics of main seven subfamilies of TRP channels; (4) the evidence for consider TRP channels as therapeutic and analgesic targets; and finally (5) further perspectives of TRP channels research.
Topics: Analgesics; Animals; Behavior, Animal; Humans; Molecular Targeted Therapy; Phylogeny; Transient Receptor Potential Channels
PubMed: 31833970
DOI: 10.1097/FBP.0000000000000524 -
Journal of Pharmacy & Pharmaceutical... 2018Many clinical diseases are accompanied by the symptoms of pain, and the degree of pain is closely related to the patients' suffering. Therefore, effectively relieving... (Review)
Review
Many clinical diseases are accompanied by the symptoms of pain, and the degree of pain is closely related to the patients' suffering. Therefore, effectively relieving pain has become one of the vital concerns of clinical treatment and analgesic drug research. Non-opioid drugs are mainly used for the clinical treatment of mild to moderate pain, whereas opioid drugs are mainly used for treating moderate to severe pain. However, opioid drugs easily elicit adverse reactions, such as gastrointestinal discomfort, addiction, dependence, and so on. Traditional Chinese medicine and its active ingredients have unique advantages in the treatment of pain for quite a long time, and many analgesic drugs directly or indirectly were isolatiedfrom Chinese medicine or natural products, such as Liu Suan Yan Hu Suo Yi Su Pian and aspirin. With the development and modernization of research on herbal medicine more and more studies have been conducted on the active ingredients and mechanisms of traditional Chinese medicine analgesics. However, no review has been done on analgesic active components and their mechanisms. In this paper, 81 active components with clear chemical structure and definite analgesic effects in vivo and in vitro of traditional Chinese medicine and mechanisms of action reported in recent literatures are reviewed and summarized to provide reference for clinical analgesia and analgesics research.
Topics: Analgesics; Animals; Drugs, Chinese Herbal; Humans; Medicine, Chinese Traditional; Molecular Structure; Pain
PubMed: 30465707
DOI: 10.18433/jpps30212 -
International Journal of Molecular... Dec 2017The constituents of essential oils are widely found in foods and aromatic plants giving characteristic odor and flavor. However, pharmacological studies evidence its... (Review)
Review
The constituents of essential oils are widely found in foods and aromatic plants giving characteristic odor and flavor. However, pharmacological studies evidence its therapeutic potential for the treatment of several diseases and promising use as compounds with analgesic-like action. Considering that pain affects a significant part of the world population and the need for the development of new analgesics, this review reports on the current studies of essential oils' chemical constituents with analgesic-like activity, including a description of their mechanisms of action and chemical aspects.
Topics: Analgesics; Animals; Burseraceae; Food; Humans; Lamiaceae; Molecular Structure; Oils, Volatile; Pain
PubMed: 29232831
DOI: 10.3390/ijms18122392 -
Current Protocols Feb 2024Anesthesia and analgesia play pivotal roles in ethically and humanely using animal models in research, especially concerning mice and rats. These rodent species,...
Anesthesia and analgesia play pivotal roles in ethically and humanely using animal models in research, especially concerning mice and rats. These rodent species, extensively utilized in scientific investigations due to their genetic resemblance to humans, serve as invaluable tools for studying diseases and testing treatments. Proper anesthesia and analgesia not only prioritize animal welfare but also heighten experimental validity by minimizing stress-induced physiological responses. Recent years have seen remarkable advancements in anesthesia for mice and rats. The focus has shifted away from the 'one size fits all' toward tailoring anesthesia protocols, considering factors like age, strain, and the nature of the experimental procedure. The use of inhalation agents such as isoflurane and sevoflurane is often preferred due to their rapid induction and recovery characteristics, allowing precise control over anesthesia depth. However, refinements in injectable anesthetic agents also provide researchers the flexibility to select suitable agents based on study requirements. Additionally, progress in analgesic techniques has led to effective pain management strategies for these rodents. Common analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and local anesthetics are administered to alleviate pain and discomfort. However, standard practice also involves continuous monitoring of animals' behavior and physiological parameters, ensuring timely adjustments in analgesic regimens for optimal pain relief without compromising experimental outcomes. By integrating tailored anesthesia and analgesia protocols into the experimental design, researchers uphold high animal welfare standards while obtaining reliable scientific data. This contributes significantly to advancing medical knowledge and therapeutic interventions with reproducible results. Published 2024. This article is a U.S. Government work and is in the public domain in the USA. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Injectable anesthesia for mouse and rat Basic Protocol 2: Inhalant anesthesia using isoflurane for mouse and rat Basic Protocol 3: Analgesia for mice and rats.
Topics: Humans; Rats; Mice; Animals; Pain Management; Isoflurane; Anesthesia; Pain; Analgesia; Analgesics; Anesthetics, Local
PubMed: 38406895
DOI: 10.1002/cpz1.995 -
British Journal of Clinical Pharmacology Oct 2016Palmitoylethanolamide (PEA) has been suggested to have useful analgesic properties and to be devoid of unwanted effects. Here, we have examined critically this... (Review)
Review
Palmitoylethanolamide (PEA) has been suggested to have useful analgesic properties and to be devoid of unwanted effects. Here, we have examined critically this contention, and discussed available data concerning the pharmacokinetics of PEA and its formulation. Sixteen clinical trials, six case reports/pilot studies and a meta-analysis of PEA as an analgesic have been published in the literature. For treatment times up to 49 days, the current clinical data argue against serious adverse drug reactions (ADRs) at an incidence of 1/200 or greater. For treatment lasting more than 60 days, the number of patients is insufficient to rule out a frequency of ADRs of less than 1/100. The six published randomized clinical trials are of variable quality. Presentation of data without information on data spread and nonreporting of data at times other than the final measurement were among issues that were identified. Further, there are no head-to-head clinical comparisons of unmicronized vs. micronized formulations of PEA, and so evidence for superiority of one formulation over the other is currently lacking. Nevertheless, the available clinical data support the contention that PEA has analgesic actions and motivate further study of this compound, particularly with respect to head-to-head comparisons of unmicronized vs. micronized formulations of PEA and comparisons with currently recommended treatments.
Topics: Amides; Analgesics; Ethanolamines; Humans; Pain; Palmitic Acids
PubMed: 27220803
DOI: 10.1111/bcp.13020