Drugs For Pain Management Research Articles

Abordaje multidisciplinario del dolor inguinal crónico luego de hernioplastia inguinal

Background: Chronic postoperative inguinal pain represents a complication that alters the quality oflife after inguinal hernioplasty. Its incidence is variable with reports of up to 16%. Objective: To describe the treatment and results in patients with chronic inguinal pain after an inguinal hernioplasty with mesh.Material and methods: Descriptive, observational and retrospective study. The postoperative chronic inguinal pain was defined as the presence of inguinal pain due to nerve damage or involvement of the somatosensory tissue system that persists for more than 6 months after the initial surgery. The medical records of patients in the postoperative period of conventional and laparoscopic inguinal hernioplasty in the period 2010-2018 were reviewed. The EuraHS Quality of life score pre and post multidisciplinary therapeutic approach was used to evaluate changes in pain and restriction of physical activity. The results were analyzed and compared.Results: 8 patients with severe chronic postoperative inguinal pain were identified. 100% were evaluated by the pain management service and required 3 or more drugs for pain management. Subsequently, they required block guided by computed tomography due to persistence of symptoms. 3 (50%) surgical examinations were performed with removal of prosthetic material and 2 triple neurectomies. A statistically significant decrease (p <0.05) was observed in pain at rest, pain during activity and pain experienced in the last week.Conclusion: The multidisciplinary and step up approach would allow selecting the patients who will benefit from the surgical treatment.

Antinociceptive activity of the Psidium brownianum Mart ex DC. leaf essential oil in mice

Chronic pain management has several adverse effects and research looking for new and effective pain management drugs posing lower undesirable effects is necessary. Given the above, the pharmacological investigation of medicinal plants significantly contributes to the dissemination of plant-derived therapeutics. The aim of this study was to evaluate the antinociceptive activity of the Psidium brownianum Mart ex DC. leaf essential oil (PBEO) and the participation of the opioid pathway in this effect in mice. Swiss Mus musculus male mice were tested using acute nociception models (acetic acid induced abdominal contortions, formalin, capsaicin and hot plate tests). The possible myorelaxant action of the PBEO was tested using the rotarod test. The essential oil reduced animal nociception in chemical and heat models, with this action being devoid of a myorelaxant effect. Naloxone (2 mg/kg, intraperitoneally – i.p.) partially antagonized the PBEO activity, possibly acting via opioid receptors. The results obtained provide evidence that the traditional Psidium brownianum use may be effective for pain treatment.

Pharmacokinetics and pharmacodynamics of mitragynine, the principle alkaloid of Mitragyna speciosa: present knowledge and future directions in perspective of pain.

Mitragyna speciosa, commonly known as Ketum or Biak in Malaysia and Kratom in Thailand, is a native plant to Southeast Asia and has various pharmacological benefits. Mitragynine (MG) is the principal alkaloid found in the leaves of Mitragyna speciosa and has been reported to be responsible for the plant's therapeutic actions. Traditionally, local communities use Kratom preparations for relief from different types of pain. The potential analgesic effects of MG using rodent models have been reported in literatures. We have reviewed the published analgesic and pharmacokinetic studies and all of these findings showed the routes of drug administration, doses employed, and type of vehicles used to solubilize the drug, varied considerably; hence this posted difficulties in predicting the drug's pharmacokinetic-response relationship. A rational approach is warranted for accurate prediction of dose-response relationship; as this is essential for the development of MG as an alternative medicinal drug for pain management. PKPD modeling would serve as a better method to understand the dose-response relationship in future MG preclinical and clinical studies.

Abstract # 3217 Glial fibrillary acidic protein (GFAP) expression in astrocytes following the administration of different pain management drugs

Abstract # 3217 Glial fibrillary acidic protein (GFAP) expression in astrocytes following the administration of different pain management drugs

Molecular Basis of Cancer Pain Management: An Updated Review.

Pain can have a significantly negative impact on the quality of life of patients. Therefore, patients may resort to analgesics to relieve the pain. The struggle to manage pain in cancer patients effectively and safely has long been an issue in medicine. Analgesics are the mainstay treatment for pain management as they act through various methods on the peripheral and central pain pathways. However, the variability in the patient genotypes may influence a drug response and adverse drug effects that follow through. This review summarizes the observed effects of analgesics on UDP-glucuronosyl (UGT) 2B7 isoenzyme, cytochrome P450 (CYP) 2D6, μ-opioid receptor μ 1 (OPRM1), efflux transporter P-glycoprotein (P-gp) and ATP-binding cassette B1 ABCB1/multiple drug resistance 1 (MDR1) polymorphisms on the mechanism of action of these drugs in managing pain in cancer. Furthermore, this review article also discusses the responses and adverse effects caused by analgesic drugs in cancer pain management, due to the inter-individual variability in their genomes.

Sex-specific and Age-specific Analgesia for Early Postoperative Pain Management After Lumbar Decompressive Surgery: A Randomized Clinical Trial.

This was a randomized clinical trial. To compare the efficacy and safety of nonsteroidal anti-inflammatory drug and opioid for acute pain management after lumbar decompressive surgery. Multimodal analgesia is associated with synergistic effects while reducing opioid-related adverse effects. However, there is no consensus on the ideal multimodal analgesic regimen. We assumed that each agent in various multimodal regimens under different conditions may have different effects. This prospective randomized clinical trial recruited adult patients who underwent single-level lumbar decompressive surgery. Patients were randomized to receive our postoperative analgesic regimen including either nonsteroidal anti-inflammatory drug (celecoxib) or opioid (extended-release oxycodone) from postoperative day 3 to 14. The Visual Analog Scale (VAS) and Oswestry Back Pain Disability Index (ODI) were used to evaluate effectiveness preoperatively and on postoperative days 2, 3, 7, and 14, and at 6 months. Drug-related adverse effects were also recorded. One hundred patients were enrolled and 93 patients (46 patients with celecoxib vs. 47 patients with oxycodone) were randomized. No differences were observed in patient demographics and preoperative VAS and ODI between the 2 groups. VAS and ODI were not different at all postoperative time points. However, subanalysis according to sex and age, revealed significant differences in efficacy: celecoxib was effective in female individuals and oxycodone was effective in male individuals on postoperative days 7 and 14; oxycodone was effective in patients aged above 65 years on postoperative days 7 and 14. Although nausea/vomiting and constipation were more common in the oxycodone group than in the celecoxib group, other adverse effects were not different. In patients who underwent single-level lumbar decompressive surgery, treatment with celecoxib and oxycodone for postoperative pain management showed no significant differences in efficacy. However, subanalysis showed that each drug was effective in different ages and sex groups. Level II.

Update on the pharmacogenomics of pain management.

Pharmacogenomics is the study of genetic variants that impact drug effects through changes in a drug’s pharmacokinetics and pharmacodynamics. Pharmacogenomics is being integrated into clinical pain management practice because variants in individual genes can be predictive of how a patient may respond to a drug treatment. Pain is subjective and is considered challenging to treat. Furthermore, pain patients do not respond to treatments in the same way, which makes it hard to issue a consistent treatment regimen for all pain conditions. Pharmacogenomics would bring consistency to the subjective nature of pain and could revolutionize the field of pain management by providing personalized medical care tailored to each patient based on their gene variants. Additionally, pharmacogenomics offers a solution to the opioid crisis by identifying potentially opioid-vulnerable patients who could be recommended a nonopioid treatment for their pain condition. The integration of pharmacogenomics into clinical practice creates better and safer healthcare practices for patients. In this article, we provide a comprehensive history of pharmacogenomics and pain management, and focus on up to date information on the pharmacogenomics of pain management, describing genes involved in pain, genes that may reduce or guard against pain and discuss specific pain management drugs and their genetic correlations.

Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature.

This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: “analgesia”, “sedation”, “coronary artery bypass grafting”, CABG”, and “opioids”. Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.

Nonsteroidal anti-inflammatory drugs for management of pelvic pain in women

Pelvic pain is one of the common causes for visiting a doctor, which can be the main symptom of gynecological diseases and an independent pathological condition. Acute pelvic pain is most often caused by an infection that affects the organs of a woman’s reproductive system. Non-infectious causes of pain are also associated with inflammation, and estrogens support pain and inflammation in women, which increases the risk of chronic pelvic pain (CPP). The urgency of the pelvic pain problem is considered not only in connection with an adequate diagnosis of its causes, but also from the perspective of managing the pain symptoms themselves. The anaesthesia strategy significantly improves the quality of life and prevents the development of chronic inflammatory diseases and CPP syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in pain therapy, and their effect consists in reducing the synthesis of prostaglandins and is pathogenetically substantiated both in the complex treatment of acute pelvic infections and in the treatment of idiopathic menstrual pain. The article presents clinical observations of the use of NSAIDs with the specified purpose.

A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score &gt;3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

Current strategies toward safer mu opioid receptor drugs for pain management

ABSTRACTIntroduction: Pain relief remains a major public health challenge. The most efficient available painkillers are opioids targeting the mu opioid receptor (MOR). MORs are expressed in the areas of the brain [including pain and respiratory centers] that are important for processing reward and aversion. Thus, MOR activation efficiently alleviates severe pain, but the concomitant reward and respiratory depressant effects pose a threat; patients taking opioids potentially develop opioid addiction and high risk for overdose.Areas covered: Ongoing efforts to generate safer opioid analgesics are reviewed here. The design of biased compounds that trigger MOR induced G protein over β-arrestin signaling, peripheral opioids, drugs targeting MORs in heteromers and drugs enhancing endogenous opioid activity are discussed.Expert opinion: There is evidence that throttling MOR signaling may lead to an era of opioids that are truly efficient painkillers with lower side effects and risk of overdose. However, few of the drugs derived from the advanced approaches outlined here, are getting approval by regulatory committees for use in clinical settings. Thus, there is an urgent need to (i) better clarify mechanisms underlying the hazardous physiological effects of MOR activation, and (ii) fully validate the safety of these new MOR-based therapies.

Opioids and matrix metalloproteinases: the influence of morphine on MMP-9 production and cancer progression.

Opioids are widely administered to alleviate pain, including chronic pain in advanced cancer patients. Among opioids, morphine is one of the most clinically effective drugs for the palliative management of severe pain. In the last few decades, there has been a debate around the possible influence of opioids such as morphine on tumour growth and metastasis. Whilst several in vitro and in vivo studies suggest the possible modulatory effects of morphine on tumour cells, little is known about the impact of this analgesic drug on other mediators such as matrix metalloproteinases (MMPs) that play a key role in the control of cancer cell invasion and metastasis. MMP-9 has been considered as one of the principal mediators in regulation of not only the initial steps of cancer but during the invasion and spreading of cancer cells to distant organs. Herein, current studies regarding the direct and indirect effects of morphine on regulation of MMP-9 production are discussed. In addition, drawing from previous in vivo and in vitro studies on morphine action in regulating MMP-9 production, the potential roles of several underlying factors are summarised, including nuclear factor kappa-B and intracellular molecules such as nitric oxide.

THE EFFECT OF SILODOSIN AND SODIUM DICLOFENAC TO REDUCE PAIN AFTER DJ STENT REMOVAL IN SOETOMO HOSPITAL: DOUBLE-BLINDED RANDOMIZED-CONTROLLED TRIAL

Objective: To analyze, measure, compare, prove, and evaluate effectiveness of silodosin, diclofenac sodium, and the combination of both drugs in pain management after stent removal. Materials &amp; Methods: Thirty-three patients were divided into three groups. Group I was given diclofenac Sodium 50 mg, group II was given silodosin 8 mg and group III was given the combination of diclofenac sodium 50 mg and silodosin 8 mg. The Wong Baker Pain Scale (WBPS) was assessed serially: two hours before the DJ stent removal, during DJ stent removal, and after the DJ stent removal (2 hours and 24 hours after). The data was analyzed by ANOVA and Kruskal-Wallis test. Results: In this study, 33 patients who underwent DJ stent removal were obtained. Wong Baker was presented in median (min-max) form. The WBPS study in each group did not differ statistically significant. Lowest WBPS during DJ stent removal was found in group III. Group III was better and statistically significant in reducing pain compared to group I and group II (p&lt;0.05). WBPS two hours after removal in each group decreased and group III was better and statistically significant in reducing pain compared to group II, whereas group III compared to group I had an equivalent effectiveness. While the WBPS 24 hours after removal had the same value and did not differ significantly. No side effects or adverse events were found in the use of diclofenac sodium, silodosin, and their combinations. Conclusion: Single oral dose of diclofenac sodium combined with silodosin is effective to reduce pain after DJ stent removal.

Attitude and Awareness of Dentists Practicing in Southern India Toward Non-steroidal Anti-inflammatory Drugs.

Background:Pain management is an everyday challenge in dentistry. Analgesics are the group of drugs prescribed for effective pain management, of which nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs. Selection of NSAIDs must be judiciously made considering their pharmacological properties and adverse effects.Aim:This study aimed to analyze the attitude toward analgesic prescription among practicing dentists and the awareness to update their knowledge about them.Materials and Methods:The study was carried out among 100 dental practitioners, where a questionnaire consisting of 16 questions was formulated based on the awareness of indication and contraindication, actual practice, and required future trends for updating the knowledge. The questionnaire was distributed among the practitioners; the answered questionnaire was collected and tabulated. Statistical analysis included χ2 test to evaluate the significance.Results:Of 100 dental practitioners, 63% prescribed drugs based on the diagnosis. Aceclofenac was found to be the effective drug in postoperative pain management, whereas paracetamol was considered to be the safest among NSAIDs in clinical conditions such as bleeding disorders, gastric irritation, chronic kidney disease, and during pregnancy. All practicing dentists showed their willingness to participate in awareness programs in updating their knowledge.Conclusion:This study showed that dental clinical practitioners are well aware of the drugs to be prescribed in different clinical conditions but pitfalls have been observed in areas of systemic complication, where continuous educational programs are needed to overcome the same.

Effects of pain catastrophizing and anxiety on analgesic use after surgical removal of impacted mandibular third molars.

BackgroundIn dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar.MethodsWe recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use.ResultsIn this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05).ConclusionThe postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.

Survey of cow-calf producer perspectives on management strategies and industry challenges. Part 2. Marketing and selection decisions.

The objective of this study was to benchmark how cow-calf producers were marketing their calves, their priorities when selecting replacements, and if producers saw value in a quality assessment focusing on animal handling and care. A total of 1,414 responses from cow-calf producers in 44 states were collected through a survey conducted in partnership with BEEF. Thirty questions were asked of respondents to gather demographic information, establish at what age and through what avenue respondents were marketing their calves, and gauge respondent perspectives on selection decisions, pain management and a quality assessment outlining handling and care guidelines. The percentage of respondents who marketed their calves at certain ages varied by herd size (P < 0.001). Respondents with 50 head or less or more than 1,000 head most commonly retained their calves through finishing and respondents with 51 to 200 head and 201 head to 500 head more frequently backgrounded and then sold their calves. Respondents’ top priorities when selecting bulls were calving ease, followed by growth and feed efficiency traits. When selecting females, top priorities were reproductive efficiency, followed by mothering ability. The percentage of respondents using pain management differed by whether a veterinarian had offered to administer a drug for pain management (P < 0.001). 13.5% of respondents answered yes, and a veterinarian had offered to administer a drug for pain management when castrating or dehorning. Of those 13.5% who responded yes pain management had been offered, and 54.55% of respondents chose to use a pain relief method. A higher percentage of respondents that precondition also more frequently indicated that they used a pain relief method when castrating or dehorning, though it was still a low percentage (P = 0.006). Overall, 46.3% of respondents saw value in handling and care guidelines and 54.9% of respondents saw value in a program including source and age verification, a vaccination plan, and handling and care guidelines. Respondents who were Beef Quality Assurance (BQA) certified had a beef cow inventory of 501 to 1,000 head, who preconditioned their calves and backgrounded them before selling, and who lived in the West most commonly saw value in a quality assessment outlining handling and care guidelines.

Neurokinin-1 receptor-based bivalent drugs in pain management: The journey to nowhere?

Hybrid compounds (also known as chimeras, designed multiple ligands, bivalent compounds) are chemical units where two active components, usually possessing affinity and selectivity for distinct molecular targets, are combined as a single chemical entity. The rationale for using a chimeric approach is well documented as such novel drugs are characterized by their enhanced enzymatic stability and biological activity. This allows their use at lower concentrations, increasing their safety profile, particularly when considering undesirable side effects. In the group of synthetic bivalent compounds, drugs combining pharmacophores having affinities toward opioid and neurokinin-1 receptors have been extensively studied as potential analgesic drugs. Indeed, substance P is known as a major endogenous modulator of nociception both in the peripheral and central nervous systems. Hence, synthetic peptide fragments showing either agonism or antagonism at neurokinin 1 receptor were both assigned with analgesic properties. However, even though preclinical studies designated neurokinin-1 receptor antagonists as promising analgesics, early clinical studies revealed a lack of efficacy in human. Nevertheless, their molecular combination with enkephalin/endomorphin fragments has been considered as a valuable approach to design putatively promising ligands for the treatment of pain. This paper is aimed at summarizing a 20-year journey to the development of potent analgesic hybrid compounds involving an opioid pharmacophore and devoid of unwanted side effects. Additionally, the legitimacy of considering neurokinin-1 receptor ligands in the design of chimeric drugs is discussed.

Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review.

Background and aims Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management. Methods Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus. Results From the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10-72%) and opioids (12 studies, range of use 5-72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities. Conclusions A wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported. Implications Comprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.

Research progress in the role of glial cell line-derived neurotrophic factor family in pain mechanism

Background Glial cell line-derived neurotrophic factor (GDNF) family ligands have potent neurotrophic activity and play an important role in the survival and development of central and peripheral neurons. The members of GDNF family, GDNF, artemin and their specific receptors: GDNF family receptor (GFR) α1 and GFRα3 are crucial in the pathogenesis of pain. They are novel targets for the development of analgesics and pain management drugs. Objective It is promising to develop novel pain treatments drugs that targets GDNF, artemin and their specific receptors GFRα1 and GFRα3. Content This article reviews the advances of basic and clinical studies on the involvement of GDNF, artemin and their specific receptors GFRα1 and GFRα3 in the pathogenesis of pain and related drug development. Trend Both basic and clinical studies have shown that GDNF, artemin and their specific receptors GFRα1 and GFRα3 play pivotal role in pain. But their roles in pain may be distinct in different kinds of pain. If new drugs targeting GDNF, artemin or their specific receptors can be developed and be used to treat a specific type of pain, it will be a great progress in pain treatment. Key words: Glial cell line-derived neurotrophic factor; Receptor; Pain

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Ken B. JohnsonKen B. JohnsonKen B. Johnson, MD is an anesthesiologist at the University of Utah, USA. His clinical interests are in acute pain management and anesthetic drug pharmacology. He is the Vice Chair for Research in the Department of Anesthesiology. His research interests are in anesthetic drug interactions, developing pain biomarkers, and medical device development to better capture adverse respiratory events. Dr Johnson has received extramural support from government, foundations, and industry to support his work. He has enjoyed collaborating with researchers in bioengineering, neuroscience, and pharmacology. Dr Johnson's education interests are in screen-based and high-fidelity simulation. He serves as the Co-Director of the Center for Simulation within the Department of Anesthesiology. He directs simulation courses that meet selected requirements for Maintenance of Certification in Anesthesia established by the American Board of Anesthesiology. He is a member of the team that has developed both online and high-fidelity simulation training for moderate and deep sedation endorsed by the American Society of Anesthesiologists. By way of professional service, Dr Johnson is a Section Editor for Anesthesia and Analgesia, a member of the American Society of Anesthesiologist's Simulation Education Editorial Board, and a Part II examiner (oral board examiner) for the American Board of Anesthesiologists. He also serves on the American Board of Anesthesiologists Observed Structured Clinical Examination Development Committee. Mark S. WeissMark S. WeissMark S. Weiss is an Assistant Professor of Anesthesiology and Critical Care at the University of Pennsylvania, USA. He is the Section Chief of Inpatient Endoscopy, and works both in the Operating Room and Non-Operating Room setting. Dr Weiss earned his medical degree from the University of Cincinnati, USA. He completed his Residency at Yale University, USA, after which he completed a Specialization Year in Cardiac and High-Risk Anesthesia. He moved to Penn after several years as a private practice anesthesiologist. The combination of experience, efficiency, and collaboration has led him and his team to develop and implement measures designed to improve patient flow as well as patient care. He is keenly interested in developing standards for patient care and resident education. Since joining Penn, Dr Weiss has written several papers and chapters. He has also been asked to edit several monographs, and is very proud of his current association with Current Opinion in Anesthesiology. Working with Dr Lee Fleisher, Dr Weiss has produced a textbook, Non-Operating Room Anesthesia. Dr Weiss was a founding member of the Society of Non-Operating Room Intervention and Anesthesia (SONORIA), in response to the astounding growth of Non-Operating Room Anesthesia (NORA) cases. SONORIA recently merged with the Association of Anesthesia Clinical Directors (AACD), where Dr Weiss sits on the Board of Directors. In addition to writing, Dr Weiss developed a NORA course for residents at the University of Pennsylvania, one of the first such courses in the United States. Shortly after, the Accreditation Council for Graduate Medical Education (ACGME) mandated the two week NORA rotation for all accredited residency programs. This broad mandate is vague as to what is to be taught. Different programs have different levels of ability or resources to expose residents to the full spectrum of the NORA setting. In order to standardize both anesthesia provider training as well as improve patient care, Dr Weiss, through Penn, has developed an online training program: NORAlink. NORAlink is designed to provide an integrated teaching platform across the spectrum of NORA, through a multi-modal approach. NORAlink has value not only to residency training programs, but can also be the standard teaching tool for the entire anesthesia provider team, including Staff Anesthesiologists, Certified Registered Nurse Anesthetists, and Procedural Physicians supervising the delivery of anesthesia in the NORA setting.