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Neuroscience and Biobehavioral Reviews Mar 2022Concomitant use of tobacco and opioids represents a growing public health concern. In fact, the mortality rate due to smoking-related illness approaches 50% among SUD... (Review)
Review
Concomitant use of tobacco and opioids represents a growing public health concern. In fact, the mortality rate due to smoking-related illness approaches 50% among SUD patients. Cumulative evidence demonstrates that the vulnerability to drugs of abuse is influenced by behavioral, environmental, and genetic factors. This review explores the contribution of genetics and neural mechanisms influencing nicotine and opioid reward, respiration, and antinociception, emphasizing the interaction of cholinergic and opioid receptor systems. Despite the substantial evidence demonstrating nicotine-opioid interactions within the brain and on behavior, the currently available pharmacotherapies targeting these systems have shown limited efficacy for smoking cessation on opioid-maintained smokers. Thus, further studies designed to identify novel targets modulating both nicotinic and opioid receptor systems may lead to more efficacious approaches for co-morbid nicotine dependence and opioid use disorder.
Topics: Analgesics, Opioid; Humans; Nicotine; Opioid-Related Disorders; Receptors, Nicotinic; Tobacco Use Disorder
PubMed: 34968525
DOI: 10.1016/j.neubiorev.2021.12.030 -
Molecules (Basel, Switzerland) May 2022A few neurotransmitter systems have fascinated the research community, as muchas the opioid system (i.e., opioid ligands and their receptors) [...].
A few neurotransmitter systems have fascinated the research community, as muchas the opioid system (i.e., opioid ligands and their receptors) [...].
Topics: Analgesics, Opioid; Drug Discovery; Ligands; Receptors, Opioid
PubMed: 35630616
DOI: 10.3390/molecules27103140 -
Paediatric Anaesthesia Jan 2014Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and... (Review)
Review
Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.
Topics: Acetaminophen; Analgesics, Opioid; Anesthesia, Conduction; Humans; Infant, Newborn; Pain; Pain Management; Pain Measurement
PubMed: 24330444
DOI: 10.1111/pan.12293 -
Cancer Jan 2021
Topics: Analgesics, Opioid; Epidemics; Humans; Opioid Epidemic; Practice Patterns, Physicians'; Surgeons
PubMed: 33002194
DOI: 10.1002/cncr.33199 -
Pain Medicine (Malden, Mass.) Oct 2015Patients with chronic pain frequently experience concomitant sleep disorders. There has been controversy on whether opioids have a beneficial or deleterious effect on... (Review)
Review
OBJECTIVE
Patients with chronic pain frequently experience concomitant sleep disorders. There has been controversy on whether opioids have a beneficial or deleterious effect on sleep quality, duration and efficiency. There is also concern regarding the association between chronic opioid therapy (COT) and sleep disordered breathing (SDB) and the increased risk for unintentional opioid related overdose. This article provides a narrative review of the literature on the effect of opioids on sleep disorders and discusses risk assessment and mitigation strategies.
DESIGN
A narrative review of the current literature on the effect of prescription opioids on sleep quality and efficiency, the relationship between opioids and sleep disorders and potential risk factors in patients with chronic pain.
RESULTS
There is conflicting evidence regarding the benefit of opioids in improving sleep quality, duration and efficiency with several studies and reviews suggesting a beneficial effect of opioids on sleep and other studies demonstrating the opioids can cause sleep disturbance leading to hyperalgesia. There was credible evidence of a strong relationship between opioids and SDB with noted risk factors including use of methadone, high opioid dosing (>200 mg MED) and combining opioids with benzodiazepines.
CONCLUSIONS
Further research is required to elucidate the effect of prescription opioids on sleep quality and pain intensity and the risks associated with opioids and SDB. The risk of SDB should be routinely assessed in patients on COT.
Topics: Analgesics, Opioid; Benzodiazepines; Chronic Pain; Drug Overdose; Humans; Methadone; Sleep Wake Disorders
PubMed: 26461072
DOI: 10.1111/pme.12910 -
Canadian Family Physician Medecin de... Mar 2018
Topics: Analgesics, Opioid; Chronic Pain; Humans; Opioid-Related Disorders; Physician-Patient Relations
PubMed: 29540394
DOI: No ID Found -
Expert Opinion on Drug Metabolism &... Feb 2020: Opioids continue to be used widely for pain management. Widespread availability of prescription opioids has led to opioid abuse and addiction. Besides steps to reduce... (Review)
Review
: Opioids continue to be used widely for pain management. Widespread availability of prescription opioids has led to opioid abuse and addiction. Besides steps to reduce inappropriate prescribing, exploiting opioid pharmacology to make their use safer is important.: This article discusses the pathology and factors underlying opioid abuse. Pharmacokinetic and pharmacodynamic properties affecting abuse liability of commonly abused opioids have been highlighted. These properties inform the development of ideal abuse deterrent products. Mechanisms and cost-effectiveness of available abuse deterrent products have been reviewed in addition to the pharmacology of medications used to treat addiction.: The opioid crisis presents unique challenges to managing pain effectively given the limited repertoire of strong analgesics. The 5-point strategy to combat the opioid crisis calls for better preventive, treatment, and recovery services, better data, better pain management, better availability of overdose-reversing drugs and better research. There is an urgent need to decrease the cost of abuse deterrent opioids which deters their cost-effectiveness. In addition, discovery of novel analgesics, further insight into central and peripheral pain mechanisms, understanding genomic risk profiles for efficient targeted efforts, and education will be key to winning this fight against the opioid crisis.
Topics: Abuse-Deterrent Formulations; Analgesics, Opioid; Animals; Cost-Benefit Analysis; Drug Overdose; Humans; Inappropriate Prescribing; Opioid Epidemic; Opioid-Related Disorders; Pain
PubMed: 31976778
DOI: 10.1080/17425255.2020.1721458 -
Annals of Palliative Medicine Sep 2023Moral challenges with addiction and overdosing have resulted from the abundance of opioids, but the coronavirus disease of 2019 has prompted reflection on ethical issues...
Moral challenges with addiction and overdosing have resulted from the abundance of opioids, but the coronavirus disease of 2019 has prompted reflection on ethical issues that could arise from a shortage. Driven by a duty to plan, some jurisdictions have formed committees to see if standard allocation considerations extend to cover a shortage of opioid pain medication. The problem, we argue, is that the standard allocation protocols do not apply to a shortage of opioids because prognosis only has limited relevance and the moral disvalue of pain is not dependent upon a patient's status as a frontline worker, age, or residence in a disadvantaged community. While the use of lotteries in allocation schemes has been deemphasized in standard allocation schema, we argue for and outline the details of a tiered lottery that first prioritizes opioids needed for emergent procedures and then moves on to allocate opioids based on the severity of a patient's pain. Additionally, we argue that some deception, in the form of withholding information from patients about the implementation and details of a pain lottery, is ethically permissible to address the unique moral tension between transparency and beneficence that arises for the treatment of pain in conditions of opioid scarcity.
Topics: Humans; Analgesics, Opioid; Pain; Morals
PubMed: 37164967
DOI: 10.21037/apm-22-1278 -
Progress in Brain Research 2018The failure of traditional antidepressant medications to adequately target cognitive impairment is associated with poor treatment response, increased risk of relapse,... (Review)
Review
The failure of traditional antidepressant medications to adequately target cognitive impairment is associated with poor treatment response, increased risk of relapse, and greater lifetime disability. Opioid receptor antagonists are currently under development as novel therapeutics for major depressive disorder (MDD) and other stress-related illnesses. Although it is known that dysregulation of the endogenous opioid system is observed in patients diagnosed with MDD, the impact of opioidergic neurotransmission on cognitive impairment has not been systematically evaluated. Here we review the literature indicating that opioid manipulations can alter cognitive functions in humans. Furthermore, we detail the preclinical studies that demonstrate the ability of mu-opioid receptor and kappa-opioid receptor ligands to modulate several cognitive processes. Specifically, this review focuses on domains within higher order cognitive processing, including attention and executive functioning, which can differentiate cognitive processes influenced by motivational state.
Topics: Analgesics, Opioid; Cognition; Cognitive Dysfunction; Depressive Disorder; Executive Function; Humans; Neuropsychological Tests; Receptors, Opioid, mu
PubMed: 30314565
DOI: 10.1016/bs.pbr.2018.07.007 -
The Neuroscientist : a Review Journal... Dec 2022Chronic pain represents one of the most serious worldwide medical problems, in terms of both social and economic costs, often causing severe and intractable physical and... (Review)
Review
Chronic pain represents one of the most serious worldwide medical problems, in terms of both social and economic costs, often causing severe and intractable physical and psychological suffering. The lack of biological markers for pain, which could assist in forming clearer diagnoses and prognoses, makes chronic pain therapy particularly arduous and sometimes harmful. Opioids are used worldwide to treat chronic pain conditions, but there is still an ambiguous and inadequate understanding about their therapeutic use, mostly because of their dual effect in acutely reducing pain and inducing, at the same time, tolerance, dependence, and a risk for opioid use disorder. In addition, clinical studies suggest that opioid treatment can be associated with a high risk of immune suppression and the development of inflammatory events, worsening the chronic pain status itself. While opioid peptides and receptors are expressed in both central and peripheral nervous cells, immune cells, and tissues, the role of opioids and their receptors, when and why they are activated endogenously and what their exact role is in chronic pain pathways is still poorly understood. Thus, in this review we aim to highlight the interplay between pain and immune system, focusing on opioids and their receptors.
Topics: Humans; Analgesics, Opioid; Chronic Pain; Immune System
PubMed: 34269117
DOI: 10.1177/10738584211030493