β2-Adrenergic receptor functionality and genotype in two different models of chronic inflammatory diseases: Liver Cirrhosis and Osteoarthrosis

Abstract

August 2015 e13 MAnAgeMent Of IAtrOgenICAlly InduCed OpIOId dependenCe A.M. Peiro; C. Puga; B. Planelles; L. Mira; M. Puerto; L. Gomez; J.F. Horga; and C. Margarit Hospital General Universitario de Alicante (HGUA), Spain; The Foundation for the Promotion of Health and Biomedical Research of the Valencian. Community (FISABIO), Spain; and Occupational Observatory, University Miguel Hernandez (UMH), Spain Introduction: Opioids are valuable analgesics, capable of providing pain relief and functional improvement also in chronic non–cancerrelated pain (NCP) patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. Methodology: A prospective study was performed with 70 NCP outpatients diagnosed with opioid iatrogenic DSMIV dependence and severe pain intensity. The study focused on analgesic efficacy, opioid withdrawal syndrome prevention, adverse side effects, functional status, and aberrant drug-related behaviour. We design a contractual agreement on opioid therapy, including goals, side effects, and criteria to finish the opioid therapy. Genotyping of the OPRM (rs1799971), COMT (rs4680), and ABCB (rs1045642) genes was performed. Results: Results from 73% (50 of 70) of the patients are presented. After a structured and progressive opioid conversion to buprenorphine/tramadol, a significant reduction of 47% of the total daily dose (TDD) with no withdrawal symptoms (OWS reduction of 9 points) was achieved, maintaining a moderate relief and pain intensity score. Quality of life tends to improve, as do the number of adverse reactions reported by the patients throughout the visits. OPRM and COMT gene variant distribution but ABCB variants were more prevalent (9% C/C, 65% C/T, 26% T/T) vs general population distribution (21% C/C, 49% C/T, 25% T/T). Psychosocial risk was associated to a high prevalence of opioid iatrogenic dependence. Conclusions: The indication for the prescription of opioids must be very carefully weighed in the presence of any risk factors. In these cases the integration into a multimodal, interdisciplinary therapy program is mandatory.