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Deutsches Arzteblatt International Mar 2023Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted...
BACKGROUND
Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes.
METHODS
In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi. org/10.17605/OSF.IO/VQ94D) and carried out in PubMed and SURF. The publications identified (25 survey studies, 12 analyses of doping control forms, 18 reviews) were evaluated in standardized manner using the Newcastle Ottawa Scale (NOS) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews).
RESULTS
Analgesic use is widespread in elite sports. The prevalence varies between 2.8% (professional tennis) and 54.2% (professional soccer). Pain medication is also taken prophylactically in the absence of symptoms in some non-elite competitive sports. In the heterogeneous field of amateur sports the data are sparse and there is no reliable evidence of wide-reaching consumption of painkillers. Among endurance athletes, 2.1% of over 50 000 persons stated that they used analgesics at least once each month in connection with sports.
CONCLUSION
Analgesic use has become a problem in many areas of professional/ competitive sports, while the consumption of pain medication apparently remains rare in amateur sports. In view of the increasing harmful use of or even addiction to painkillers in society as a whole, there is a need for better education and, above all, restrictions on advertising.
Topics: Male; Humans; Female; Sports; Athletes; Soccer; Analgesics; Pain
PubMed: 36655316
DOI: 10.3238/arztebl.m2023.0003 -
Scandinavian Journal of Trauma,... Dec 2021Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not... (Review)
Review
BACKGROUND
Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology.
METHODS
The systematic review includes studies from 2000 and up to 2020 that focus on children's prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results.
RESULTS
The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious.
CONCLUSION
The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.
Topics: Acute Pain; Analgesics; Analgesics, Opioid; Child; Emergency Medical Services; Fentanyl; Humans
PubMed: 34895311
DOI: 10.1186/s13049-021-00974-3 -
International Journal of Molecular... Mar 2022One of the strategies in the search for safe and effective analgesic drugs is the design of multitarget analgesics. Such compounds are intended to have high affinity and... (Review)
Review
One of the strategies in the search for safe and effective analgesic drugs is the design of multitarget analgesics. Such compounds are intended to have high affinity and activity at more than one molecular target involved in pain modulation. In the present contribution we summarize the attempts in which fentanyl or its substructures were used as a μ-opioid receptor pharmacophoric fragment and a scaffold to which fragments related to non-opioid receptors were attached. The non-opioid 'second' targets included proteins as diverse as imidazoline I binding sites, CB cannabinoid receptor, NK tachykinin receptor, D dopamine receptor, cyclooxygenases, fatty acid amide hydrolase and monoacylglycerol lipase and σ receptor. Reviewing the individual attempts, we outline the chemistry, the obtained pharmacological properties and structure-activity relationships. Finally, we discuss the possible directions for future work.
Topics: Analgesics; Analgesics, Opioid; Fentanyl; Receptors, Drug; Receptors, Opioid, mu; Structure-Activity Relationship
PubMed: 35269909
DOI: 10.3390/ijms23052766 -
Pharmaceutical Biology Dec 2023Linn (Leguminosae) is often used in Yi ethnic medicine to treat pain, fracture, and rheumatism.
CONTEXT
Linn (Leguminosae) is often used in Yi ethnic medicine to treat pain, fracture, and rheumatism.
OBJECTIVE
To explore the therapeutic potential of doliroside B (DB) from and its disodium salt (DBDS) and the underlying mechanism in pain.
MATERIALS AND METHODS
In the writhing test, Kunming mice were orally treated with DB and DBDS at doses of 0.31, 0.62, 1.25, 2.5, and 5 mg/kg. Vehicle, morphine, indomethacin, and acetylsalicylic acid were used as negative and positive control on the nociception-induced models, respectively. In the hot plate test, mice were orally treated with DB and DBDS at doses of 2.5, 5, 10, and 20 mg/kg. In the formalin test, mice were orally treated with DB and DBDS at doses of 2.5, 5, 10, and 20 mg/kg. In the meanwhile, lipopolysaccharide-induced inflammatory model in RAW264.7 macrophages was adopted to study the mechanism of pain alleviation for DBDS.
RESULTS
DBDS (5 mg/kg) inhibited the writhing number by 80.2%, which exhibited the highest antinociceptive activity in pain models. DBDS could selectively inhibite the activity of COX-1. Meanwhile, it also reduced the production of NO, iNOS, and IL-6 by 55.8%, 69.0%, and 49.9% inhibition, respectively. It was found that DBDS also positively modulated the function of GABA receptor.
DISCUSSION AND CONCLUSIONS
DBDS displayed antinociceptive activity by acting on both the peripheral and central nervous systems, which may act on multitargets. Further work is warranted for developing DBDS into a potential drug for the treatment of pain.
Topics: Animals; Mice; Analgesics; Pain; Plant Extracts
PubMed: 36628487
DOI: 10.1080/13880209.2022.2163407 -
Journal of the American Academy of... Sep 2023The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip... (Review)
Review
The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip arthroplasty. These surgeries are associated with increased hospital length of stay and, consequently, higher costs. Despite the benefits of outpatient surgery, only a small percentage of total joint arthroplasties (TJAs) are done in this manner. We reviewed the most up-to-date trends for outpatient TJA and discussed essential factors for a successful outpatient program, including the proper patient selection process and best available anesthetic and analgesic options, along with their risks and benefits. Risk stratification tools, such as the Outpatient Arthroplasty Risk Assessment, are helpful for predicting outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the currently recommended peripheral nerve blocks for total hip arthroplasty and total knee arthroplasty are the fascia iliaca compartment block and adductor canal block, respectively. However, blocks should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.
Topics: Humans; Aged; Outpatients; Anesthesiology; Analgesics; Arthroplasty, Replacement, Knee; Anesthesia, Conduction
PubMed: 37669101
DOI: 10.5435/JAAOSGlobal-D-22-00259 -
Acta Orthopaedica Jan 2022Background and purpose - Total hip arthroplasty (THA) is an effective and common procedure. However, persistent pain and analgesic requirement up to 2 years after THA...
Background and purpose - Total hip arthroplasty (THA) is an effective and common procedure. However, persistent pain and analgesic requirement up to 2 years after THA surgery are common. We examined the trends in the utilization of analgesics before and after THA, overall, and in relation to socioeconomic status (SES) in a populationbased cohort. Patients and methods - We used the Danish Hip Arthroplasty Register to identify 103,209 patients who underwent THA between 1996 and 2018. Data on prescriptions and SES markers was obtained from Danish medical databases. Prevalence rates of redeemed prescriptions for analgesics with 95% confidence intervals were calculated for 4 quarters before and 4 quarters after THA for the entire THA population, and by 3 SES markers (education, cohabiting status, and wealth). Results - Overall, the prevalence of analgesic use prior to surgery was 42% at 9-12 months and 59% at 0-3 months before the THA. The prevalence of analgesics reached its highest at 64% 0-3 months after THA but declined to 27% at 9-12 months after THA. Low education, living alone, and having low wealth (low SES) were associated with higher prevalence of analgesics use both before and after THA. Interpretation - 59% of patients used analgesics 0-3 months before surgery, which could indicate that THA might not be considered the last option for treatment and that surgery criteria might depend more on factors such as patient preferences or hip function. Moreover, health professionals should prioritize the use of a detailed plan when phasing out analgesics after THA to counteract unnecessary use, especially when treating patients with low SES.
Topics: Analgesics; Arthroplasty, Replacement, Hip; Cohort Studies; Humans; Social Class
PubMed: 34981126
DOI: 10.2340/17453674.2021.955 -
Anaesthesia Feb 2013Eighteen published trials have examined the use of neuraxial magnesium as a peri-operative adjunctive analgesic since 2002, with encouraging results. However, concurrent... (Review)
Review
Eighteen published trials have examined the use of neuraxial magnesium as a peri-operative adjunctive analgesic since 2002, with encouraging results. However, concurrent animal studies have reported clinical and histological evidence of neurological complications with similar weight-adjusted doses. The objectives of this quantitative systematic review were to assess both the analgesic efficacy and the safety of neuraxial magnesium. Eighteen trials comparing magnesium with placebo were identified. The time to first analgesic request increased by 11.1% after intrathecal magnesium administration (mean difference: 39.6 min; 95% CI 16.3-63.0 min; p = 0.0009), and by 72.2% after epidural administration (mean difference: 109.5 min; 95% CI 19.6-199.3 min; p = 0.02) with doses of between 50 and 100 mg. Four trials monitored for neurological complications: of the 140 patients included, only a 4-day persistent headache was recorded. Despite promising peri-operative analgesic effect, the risk of neurological complications resulting from neuraxial magnesium has not yet been adequately defined.
Topics: Analgesics; Headache; Humans; Magnesium Sulfate; Pain, Postoperative; Postoperative Complications; Treatment Outcome
PubMed: 23121635
DOI: 10.1111/j.1365-2044.2012.07337.x -
Journal of Science and Medicine in Sport Oct 2022To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes.
DESIGN
Systematic review and meta-analysis.
METHODS
Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15-24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively.
RESULTS
Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance.
CONCLUSIONS
Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.
Topics: Adolescent; Analgesics; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Athletes; Humans; Prevalence
PubMed: 36100523
DOI: 10.1016/j.jsams.2022.08.018 -
Pharmacology Research & Perspectives Dec 2021Chemotherapy-induced peripheral neuropathy (CIPN) frequently occurs in cancer patients. This side effect lowers the quality of life of patients and may cause the... (Review)
Review
Chemotherapy-induced peripheral neuropathy (CIPN) frequently occurs in cancer patients. This side effect lowers the quality of life of patients and may cause the patients to abandon chemotherapy. Several medications (e.g., duloxetine and gabapentin) are recommended as remedies to treat CIPN; however, usage of these drugs is limited because of low efficacy or side effects such as dizziness, nausea, somnolence, and vomiting. From ancient East Asia, the decoction of medicinal herbal formulas or single herbs have been used to treat pain and could serve as alternative therapeutic option. Recently, the analgesic potency of medicinal plants and their phytochemicals on CIPN has been reported, and a majority of their effects have been shown to be mediated by glial modulation. In this review, we summarize the analgesic efficacy of medicinal plants and their phytochemicals, and discuss their possible mechanisms focusing on glial modulation in animal studies.
Topics: Analgesics; Animals; Antineoplastic Agents; Humans; Neoplasms; Neuralgia; Neuroglia; Phytochemicals; Plant Preparations; Plants, Medicinal; Quality of Life
PubMed: 34676990
DOI: 10.1002/prp2.819 -
Molecules (Basel, Switzerland) Jul 2023Neuropathic pain is a debilitating condition that affects millions of people worldwide. Numerous studies indicate that this type of pain is a chronic condition with a... (Review)
Review
Neuropathic pain is a debilitating condition that affects millions of people worldwide. Numerous studies indicate that this type of pain is a chronic condition with a complex mechanism that tends to worsen over time, leading to a significant deterioration in patients' quality of life and issues like depression, disability, and disturbed sleep. Presently used analgesics are not effective enough in neuropathy treatment and may cause many side effects due to the high doses needed. In recent years, many researchers have pointed to the important role of chemokines not only in the development and maintenance of neuropathy but also in the effectiveness of analgesic drugs. Currently, approximately 50 chemokines are known to act through 20 different seven-transmembrane G-protein-coupled receptors located on the surface of neuronal, glial, and immune cells. Data from recent years clearly indicate that more chemokines than initially thought (CCL1/2/3/5/7/8/9/11, CXCL3/9/10/12/13/14/17; XCL1, CX3CL1) have pronociceptive properties; therefore, blocking their action by using neutralizing antibodies, inhibiting their synthesis, or blocking their receptors brings neuropathic pain relief. Several of them (CCL1/2/3/7/9/XCL1) have been shown to be able to reduce opioid drug effectiveness in neuropathy, and neutralizing antibodies against them can restore morphine and/or buprenorphine analgesia. The latest research provides irrefutable evidence that chemokine receptors are promising targets for pharmacotherapy; chemokine receptor antagonists can relieve pain of different etiologies, and most of them are able to enhance opioid analgesia, for example, the blockade of CCR1 (J113863), CCR2 (RS504393), CCR3 (SB328437), CCR4 (C021), CCR5 (maraviroc/AZD5672/TAK-220), CXCR2 (NVPCXCR220/SB225002), CXCR3 (NBI-74330/AMG487), CXCR4 (AMD3100/AMD3465), and XCR1 (vMIP-II). Recent research has shown that multitarget antagonists of chemokine receptors, such as CCR2/5 (cenicriviroc), CXCR1/2 (reparixin), and CCR2/CCR5/CCR8 (RAP-103), are also very effective painkillers. A multidirectional strategy based on the modulation of neuronal-glial-immune interactions by changing the activity of the chemokine family can significantly improve the quality of life of patients suffering from neuropathic pain. However, members of the chemokine family are still underestimated pharmacological targets for pain treatment. In this article, we review the literature and provide new insights into the role of chemokines and their receptors in neuropathic pain.
Topics: Humans; Analgesics, Opioid; Quality of Life; Neuralgia; Neuroglia; Analgesics; Receptors, Chemokine
PubMed: 37570736
DOI: 10.3390/molecules28155766