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British Journal of Pharmacology Jan 2015Opioids are regularly administered in acute and cancer pain. In chronic non-cancer pain (CNCP), however, their use is controversial. Previous meta-analyses and... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Opioids are regularly administered in acute and cancer pain. In chronic non-cancer pain (CNCP), however, their use is controversial. Previous meta-analyses and randomized controlled trials (RCTs) lack methodological homogeneity and comparable data. Here we analysed the maximum analgesic efficacies of opioids and non-opioids compared with placebo, and of physiotherapy and psychotherapy compared with active or waiting-list controls. We screened 3647 citations and included RCTs if treatment duration was at least 3 weeks, data were sufficient for meta-analysis, and criteria for high quality were met. Only 46 studies (10 742 patients) met the criteria. Weighted and standardized mean differences (WMD, SMD) between pain intensities were pooled to conduct separate meta-analyses for each treatment category. At the end of treatment the WMD for pain reduction (100-point scale) was 12.0 for 'strong' opioids, 10.6 for 'weak' opioids, 8.4 for non-opioids (each vs. placebo), 5.5 for psychotherapy and 4.5 for physiotherapy (each vs. active controls). Dropout rates were high in pharmacological studies. The 95% confidence intervals using the outcomes of control groups did not indicate statistical differences between efficacies of the five interventions. Because not enough eligible head-to-head trials were available, our analysis is limited to adjusted indirect comparisons. The heterogeneity of pre-post pain differences in control groups did not allow the definition of a common comparator. In conclusion, although there were statistically significant differences between maximum treatment efficacies, no intervention per se produced clinically important improvements in average pain intensity. Thus, opioids alone are inappropriate and multimodal treatment programmes may be required for CNCP.
LINKED ARTICLES
This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2.
Topics: Analgesics; Chronic Pain; Humans; Quality of Life; Selection Bias; Treatment Outcome
PubMed: 24640991
DOI: 10.1111/bph.12634 -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... Nov 2022The Chinese herbal medicine for Kaiqiao, such as borneol, musk, grassleaf sweetflag rhizome, storax and camphor, have been prescribed in traditional Chinese medicine for... (Review)
Review
The Chinese herbal medicine for Kaiqiao, such as borneol, musk, grassleaf sweetflag rhizome, storax and camphor, have been prescribed in traditional Chinese medicine for thousands of years and now are widely used for neuropathic pain, the main components of which are annular compounds. Studies have shown that their analgesic mechanisms include regulating the expression of γ-aminobutyric acid, -methyl- -aspartic acid and other receptors; regulating ion channel function; inhibiting inflammatory response, oxidative stress and apoptosis; regulating neurotransmission and neuronal excitability; and participating in neuroprotection and neurological repair. It is suggested that the mechanisms of action of Kaiqiao herbs in central nervous system analgesia should be further explored; high-quality rapid screening of drug targets may be used, and the targeted agents using the characteristics of Kaiqiao herbs would be developed. This article reviews the research progress on the effect mechanism of traditional Kaiqiao herbs in the treatment of neuropathic pain to provide further research directions.
Topics: Humans; Neuralgia; Analgesics; Medicine, Chinese Traditional; Antineoplastic Agents; Apoptosis; Drugs, Chinese Herbal
PubMed: 36581573
DOI: 10.3724/zdxbyxb-2022-0351 -
International Journal of Molecular... Oct 2021Biphalin, one of the opioid agonists, is a dimeric analog of enkephalin with a high affinity for opioid receptors. Opioid receptors are widespread in the central nervous... (Review)
Review
Biphalin, one of the opioid agonists, is a dimeric analog of enkephalin with a high affinity for opioid receptors. Opioid receptors are widespread in the central nervous system and in peripheral neuronal and non-neuronal tissues. Hence, these receptors and their agonists, which play an important role in pain blocking, may also be involved in the regulation of other physiological functions. Biphalin was designed and synthesized in 1982 by Lipkowski as an analgesic peptide. Extensive further research in various laboratories on the antinociceptive effects of biphalin has shown its excellent properties. It has been demonstrated that biphalin exhibits an analgesic effect in acute, neuropathic, and chronic animal pain models, and is 1000 times more potent than morphine when administered intrathecally. In the course of the broad conducted research devoted primarily to the antinociceptive effect of this compound, it has been found that biphalin may also potentially participate in the regulation of other opioid system-dependent functions. Nearly 40 years of research on the properties of biphalin have shown that it may play a beneficial role as an antiviral, antiproliferative, anti-inflammatory, and neuroprotective agent, and may also affect many physiological functions. This integral review analyzes the literature on the multidirectional biological effects of biphalin and its potential in the treatment of many opioid system-dependent pathophysiological diseases.
Topics: Analgesics; Analgesics, Opioid; Enkephalins; Morphine; Opioid-Related Disorders; Pain; Receptors, Opioid
PubMed: 34768778
DOI: 10.3390/ijms222111347 -
Medicine Dec 2022Pain is common after heart valve surgery and can stimulate the sympathetic nervous system, causing hemodynamic instability and respiratory complications. Current...
Pain is common after heart valve surgery and can stimulate the sympathetic nervous system, causing hemodynamic instability and respiratory complications. Current treatments for postoperative pain are insufficient, and postoperative pain is difficult to control effectively with a single analgesic. Therefore, we investigated the analgesic efficacy of butorphanol with sufentanil after heart valve surgery and its hemodynamic effects. The records of 221 patients admitted to the intensive care unit after cardiac valve replacement between January 1, 2018, and May 31, 2021, were retrospectively analyzed. Patients were allocated to 2 groups based on the postoperative pain treatment they received: treatment group (administered butorphanol combined with sufentanil), and control group (administered conventional sufentanil analgesia). After propensity score matching for sex, age, Acute Physiology and Chronic Health Evaluation II score, type of valve surgery, and operation duration, 76 patients were included in the study, and analgesic efficacy, hemodynamic changes, and adverse drug reactions were compared between the 2 groups. After propensity score matching, the baseline characteristics were not significantly different between the groups. The histogram and jitter plot of the propensity score distribution indicated good matching. No significant differences were observed in the duration of mechanical ventilation, duration of stay in the intensive care unit, duration of total hospital stay, and hospitalization expenditure between the groups (P > .05). The treatment group had notably higher minimum systolic blood pressure (P = .024) and lower heart rate variability (P = .049) than those in the control group. Moreover, the treatment group exhibited better analgesic efficacy and had lower critical-care pain observation tool scores and consumption of sufentanil 24 hours after surgery than the control group (P < .05). The incidence of vomiting was notably lower in the treatment than in the control group (P = .028). Butorphanol combined with sufentanil can be used in patients after heart valve replacement. This combined treatment has good analgesic efficacy and is associated with reduced adverse drug reactions and, potentially, steady hemodynamics.
Topics: Humans; Sufentanil; Butorphanol; Propensity Score; Retrospective Studies; Analgesics, Opioid; Pain, Postoperative; Analgesics; Heart Valves
PubMed: 36550898
DOI: 10.1097/MD.0000000000032307 -
Journal of the American Association For... Nov 2021Published data are sparse regarding the recognition of clinically relevant pain and appropriate analgesia in amphibians. The amphibian analgesia literature has primarily...
Published data are sparse regarding the recognition of clinically relevant pain and appropriate analgesia in amphibians. The amphibian analgesia literature has primarily focused on nociceptive pathways in a single species, the northern leopard frog (). The objective of the current study was to assess the analgesic efficacy and safety of oral tramadol and subcutaneous morphine in a commonly maintained zoo and pet species, White's tree frog (). We hypothesized that tramadol and morphine would provide dose-dependent antinociception, as measured by significant increases in hindlimb withdrawal latency after exposure to a noxious thermal stimulus. Two randomized, placebo-controlled, complete crossover studies were performed, with tramadol ( = 12) administered at 15, 25, and 40 mg/kg PO and morphine ( = 12) administered at 5 and 10 mg/kg SC. Hindlimb withdrawal latency was measured for a maximum of 72 h. No adverse side effects or signs of sedation were observed with any dose or drug evaluated. No significant difference in withdrawal latency was detected between the control and either tramadol or morphine. These negative results were surprising, suggesting that the thermal nociceptive model may not be biologically relevant in amphibian species.
Topics: Analgesics; Analgesics, Opioid; Animals; Anura; Morphine; Pain; Pain, Postoperative; Tramadol
PubMed: 34753536
DOI: 10.30802/AALAS-JAALAS-21-000009 -
Molecules (Basel, Switzerland) Feb 2015The N-acylhydrazone (NAH) moiety is considered a privileged structure, being present in many compounds with diverse pharmacological activities. Among the activities...
The N-acylhydrazone (NAH) moiety is considered a privileged structure, being present in many compounds with diverse pharmacological activities. Among the activities attributed to NAH derivatives anti-inflammatory and analgesic ones are recurrent. As part of a research program aiming at the design of new analgesic and anti-inflammatory lead-candidates, a series of cyclohexyl-N-acylhydrazones 10-26 were structurally designed from molecular modification on the prototype LASSBio-294, representing a new class of cycloalkyl analogues. Compounds 10-26 and their conformationally restricted analogue 9 were synthetized and evaluated as analgesic and anti-inflammatory agents in classical pharmacologic protocols. The cyclohexyl-N-acylhydrazones 10-26 and the cyclohexenyl analogue 9 showed great anti-inflammatory and/or analgesic activities, but compound 13 stood out as a new prototype to treat acute and chronic painful states due to its important analgesic activity in a neuropathic pain model.
Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Disease Models, Animal; Hydrazines; Mice; Neuralgia
PubMed: 25685912
DOI: 10.3390/molecules20023067 -
Journal of Managed Care & Specialty... Mar 2022In the United States, asthma occurs in a vast proportion of children and adolescents. Asthma exacerbation is an acute episodic event typically characterized by...
In the United States, asthma occurs in a vast proportion of children and adolescents. Asthma exacerbation is an acute episodic event typically characterized by difficulty in breathing, chest tightness, coughing, or wheezing. Severe asthma exacerbation can be life-threatening and lead to service utilizations such as hospitalizations and emergency department (ED) visits. Opioid analgesic use can trigger an asthma exacerbation through 2 pharmacological mechanisms. Despite the potential mechanisms, there is lack of empirical evidence to determine the risk of asthma exacerbation and its association with opioid use. To evaluate the risk of asthma exacerbation in children with current asthma receiving an opioid vs a nonopioid analgesic. Eligible individuals aged under 18 years with current asthma and receiving an incident analgesic prescription were identified from a large Medicaid managed care database during 2013-2018. Current asthma was defined as receipt of an asthma diagnosis and an antiasthmatic medication in the 12 months before analgesic medication initiation. Asthma exacerbation was defined as a hospitalization or ED visit with asthma as either the primary or secondary diagnosis within 3 days of receipt of an analgesic prescription. A weighted multivariable logistic regression using inverse probability treatment weighting was performed to test the association between use of analgesic medication and risk of asthma exacerbation. This study included 13,359 children with current asthma who filled either an incident opioid (n = 5,363, 40.1%) or nonopioid analgesic (n = 7,996, 59.9%) prescription. Asthma exacerbation was observed in 24 (0.5%) opioid analgesic recipients and 22 (0.3%) nonopioid analgesic recipients within 3 days of analgesic initiation. Weighted logistic regression results showed that children receiving opioid analgesics (adjusted odds ratio = 1.6, 95% CI = 0.9-2.9) did not have a statistically significantly higher risk of asthma exacerbation than their nonopioid analgesic recipient counterparts in the propensity score-weighted multivariable analysis. Asthma exacerbation associated with analgesic use in children with current asthma was an uncommon event, and the risk was comparable among children receiving opioid vs nonopioid analgesics. This study was supported and funded by the Agency for Healthcare Research and Quality (AHRQ), Project Number: 1R03HS026790-01A1. The study content was solely the responsibility of the authors, and AHRQ had no role in the design and conduct of the study. The authors have nothing to disclose.
Topics: Adolescent; Aged; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Asthmatic Agents; Asthma; Child; Emergency Service, Hospital; Humans; United States
PubMed: 35199576
DOI: 10.18553/jmcp.2022.28.3.325 -
Molecules (Basel, Switzerland) Jan 2020(Forssk.) DC. is a prostrate or pendent dark green succulent herb found in the southwestern mountain regions of Saudi Arabia. The literature survey of the plant reveals...
(Forssk.) DC. is a prostrate or pendent dark green succulent herb found in the southwestern mountain regions of Saudi Arabia. The literature survey of the plant reveals a lack of phytochemical and pharmacological studies, although traditional uses have been noted. The objective of the present work was to assess the in vivo analgesic and anti-inflammatory activities, as well as, the in vitro cytotoxic potential of the fractions of , and correlate these activities to the plant metabolites. The methanolic extract of was subjected to fractionation with -hexane, ethyl acetate, chloroform, -butanol, and water. The fractions were screened for their analgesic and anti-inflammatory activities, as well as cytotoxic activity against breast, liver, and colon cancer cell lines. The -hexane and chloroform fractions of showed significant cytotoxic activity against all three cancer cell lines tested. The ethyl acetate and chloroform fractions showed significant analgesic and anti-inflammatory activities. The metabolites in these three active fractions were determined using UPLC-PDA-ESI-MS. Thus, the analgesic and anti-inflammatory activities of the plant were attributed to its phenolic acids (caffeoylquinic acid derivatives, protocatechuic, and chlorogenic acids). While fatty acids and triterpenoids such as (tormentic acid) in the hexane fraction are responsible for the cytotoxic activity; thus, these fractions of may be a novel source for the development of new plant-based analgesic, anti-inflammatory, and anticancer drugs.
Topics: Analgesics; Anti-Inflammatory Agents; Antineoplastic Agents, Phytogenic; Cell Proliferation; Cell Survival; Chromatography, High Pressure Liquid; Fabaceae; HCT116 Cells; Hep G2 Cells; Humans; MCF-7 Cells; Mass Spectrometry; Phytochemicals; Plant Extracts; Saudi Arabia; Senecio
PubMed: 31968561
DOI: 10.3390/molecules25020418 -
Biomedicine & Pharmacotherapy =... Aug 2019This work aimed to design and synthesize a safe nonsteroidal anti-inflammatory drug NSAIDs agent based on Naproxen scaffold. The structure of compounds 6-21 established...
This work aimed to design and synthesize a safe nonsteroidal anti-inflammatory drug NSAIDs agent based on Naproxen scaffold. The structure of compounds 6-21 established on the basis of different spectral data. Anti-inflammatory and analgesic profile were examined for synthesizing compounds. The compounds 6 and 17 have shown a higher anti-inflammatory potency than Naproxen. The compounds 16, 19 and 21 have exhibited the highest analgesic potency compared to other tested compounds. The synthesized compounds have shown negligible ulcerogenic effect and may be considered as safer drugs than naproxen for treating inflammatory conditions. The molecular docking against COX-2 was performed, it verified that compound 6, 17 show stronger interactions with COX-2. This may result in a better inhibitory effect on COX-2. The best generated QSAR model shows correlation between BCUT_SMR_3 and vsurf_Wp6 with biological activity. ADMET in silico showed that these compounds are a good oral bioavailability without observed carcinogenesis affect.
Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Drug Design; Ligands; Molecular Docking Simulation; Naproxen; Quantitative Structure-Activity Relationship; Rats
PubMed: 31150990
DOI: 10.1016/j.biopha.2019.109024 -
BMC Public Health Jan 2021Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain...
BACKGROUND
Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting.
METHODS
One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases.
RESULTS
Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain.
DISCUSSION
Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management.
Topics: Aged; Aged, 80 and over; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Finland; Humans; Middle Aged; Quality of Life
PubMed: 33517898
DOI: 10.1186/s12889-021-10272-3