Excessive Use Of Analgesics Research Articles

Comparative analysis of the efficacy of different treatment strategies in medication overuse headache: an open-label prospective trial

Medication overuse headache (MOH) is a common form of chronic headache with a high risk of relapse after therapy. Excessive use of analgesics most frequently leads to the development of MOH in migraine patients.Objective: to analyze the short- and long-term efficacy of MOH therapy in patients with chronic migraine (CM) using different programs to discontinue the abused drug and a detoxification regimen.Material and methods. The study included 44 patients with MOH and CM who were divided into two groups. Group A comprised 18 patients who discontinued the drug that triggered MOH and were simultaneously prescribed preventive treatment for migraine without undergoing "detoxification" therapy". Group B comprised 26 patients who received a multimodal therapeutic strategy including "detoxification treatment".Results. The strategy of complex therapy with a "detoxification treatment" was significantly more effective during the 12-month observation period. In group B, a significant (p<0.01) decrease in the number of days with migraine per month was observed (before therapy – 22.6±7.4 days, after 3 months – 15.1±8.9 days, after 6 months – 12.7±9.1 days and after 12 months – 10.2±8.7 days). In the first 6 months, a similar dynamic was observed in group A, whereby the frequency of migraine increased in the 12th month of observation. Twelve months after the start of therapy, migraine occurred in episodes in the majority (84%) of patients in group B, which is significantly more than in group A (58.9%; p<0.01).Conclusion. A comprehensive approach in the treatment of patients with CM and MOH with "detoxification" therapy" showed high efficacy in terms of reducing the number of headache days per month and converting CM to episodic migraine.

Clinical and psychoemotional characteristics of patients with medication overuse headache

The available data indicate the important role of personality profile, psychoemotional disorders and psychosocial aspects in the development and maintenance of medication overuse headache (MOH). It is therefore important to identify predictors for the development and factors that influence the course and prognosis of treatment for this disorder.Objective: to analyze the clinical and psychological profile of patients and to identify predictors of the course of MOH in order to develop a prognostic model.Material and methods. We performed a comparative analysis of the characteristics of 117 patients with MOH (group 1) and 23 patients with chronic migraine (CM) without MOH (group 2) using clinical data and questionnaire data to determine the neuropsychological profile (PCS, Spielberger-Khanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, Leeds Dependence Questionnaire – LDQ) at the time of admission to hospital and 9 months after the start of treatment.Results. The study showed that 100% of patients with CM and MOH had various psychoemotional disorders. At the same time, the pre-therapy baseline indicators for the level of personal anxiety, pain catastrophizing scales, impulsive behavior, alexithymia and LDQ parameters were significantly higher in the group of patients with CM and MOH than in the group with CM without excessive analgesic use. Using multiple linear regression, it was found that an increase in the severity of depression by 1 point is significantly associated with an increase in the number of days with headache (HA) by 0.33 days per month. In addition, a significant direct correlation was found between the degree of addiction according to LDQ and the extent of pain catastrophizing and situational anxiety, as well as the level of cognitive functions (according to the SAGE questionnaire) in an inverse relationship. At the same time, the frequency of analgesics use per day in the group of patients with CM and MOH is significantly related to the level of pain catastrophizing, depression and personal anxiety.Conclusion. The results obtained confirm the biobehavioral concept of MOH development. Effective therapy of the primary form of HA (in our study – CM) is significantly associated with a decrease in the severity of anxiety, depression, catastrophizing and the frequency of taking analgesics. Personality traits, especially the tendency to impulsive behavior, remain unchanged against the background of chronic HA treatment. The presented results emphasize the need for complex treatment of patients with CM and MOH.

Characterization of adult patients with a diagnosis of migraine and osmophobia: the osmograine study

IntroductionOsmophobia is associated with a greater intensity of the headache, a more significant presence of affective symptoms, and the appearance of cutaneous allodynia.ObjectivesTo determine the sociodemographic and clinical characteristics of patients with episodic and chronic migraine associated with osmophobia.MethodsA cross-sectional analytical observational study, 100 patients were included.Results65% of the patients presented osmophobia, 64.6% of patients with osmophobia had chronic migraine, and 35.4% had episodic migraine without statistically significant differences p=0.120. Regarding the clinical characteristics, pulsatile pain was the most frequent in 49%, and severe intensity was present in 81%. Statistically significantrelationships were found between osmophobia and photophobia [(95.4 vs 77.1]; p=0.005), phonophobia ([96.9 vs 74.3); p=0.001) and allodynia ([75.4 vs 45.7); p=0.002). The that become chronic factors were more frequent in the group with osmophobia, in which an association with the excessive use of analgesics ([43.8%vs. 22.9%]; p=0.029) and a history of anxiety and depression ([32.8% vs. 14.3%]; p=0.045). In the multivariate model, the variables associated with osmophobia with statistically significant differences were photophobia, allodynia, and botulinum toxin application.ConclusionsIn this first study of osmophobia in migraine in Colombia, osmophobia is a frequent symptom in patients with chronic migraine; it has related to markers of central sensitization; it is also related to that become chronic factors and the use of botulinum toxin. Therefore, it is likely that osmophobia can predict the risk of that factor, causing the disease to become chronic.

Study protocol for a randomized controlled trial of neurofeedback mindfulness in chronic migraines

Chronic migraine is a debilitating headache disorder that is associated with excessive analgesic use. As the long-term use of analgesics could cause additional headaches due to medication overuse, there is a need to probe efficient nonprophylactic alternatives and migraineurs’ long-term adherence to such possible treatments. This protocol investigates the integration of neurofeedback and mindfulness which are the two common nonpharmacological therapies for migraines. We offer the use of portable EEG headbands for easy home-based data collection and consistent data access from researchers. In order to evaluate the efficacy of this recommended intervention, this is a protocol for a randomized control trial with a waitlisted group and an intervention group consisting of a daily attention task. The protocol presents important criteria which should be checked for consistency in longitudinal data collection from adults with chronic migraine.

Comparison of First Analgesic Demand in Post-Operative Period Among Diclofenac Group Versus Paracetamol Group

Background: Pain after major surgery causes delays in patients' postoperative recovery, extended hospitalization periods, excessive use of analgesics, and is extremely stressful for both surgery and anesthesia. Preemptive analgesia is a treatment that begins before surgery to prevent the development of central sensitization caused by incisional and inflammatory damage that occur during surgery and in the early postoperative period. Opioids and nonsteroidal anti-inflammatory medications (NSAIDs) are commonly used for this purpose. Diclofenac sodium is a typical, inexpensive NSAIDS. Preemptive analgesia can reduce the severity and duration of pain while also delaying it. Objectives: The aim of the study was to evaluate the Comparison of first analgesic demand in post-operative period among Diclofenac group versus Paracetamol group. Methods: This randomized controlled trial study was carried out in the Department of Anaesthesiology & ICU Bangladesh Medical College Hospital Dhaka, Bangladesh during 18th January 2020 to 17th July 2020. A total of 50 patients were participated in the study. Sample was selected by random sampling in two groups distributed as- group A (Oral diclofenac sodium), group B (Oral paracetamol). Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The majority of patients (63.0%) were between 40 and 59 years old, with a mean age of 48.3 ± 11.2 years. In groups A (58%) and B (56%), nearly two-thirds of the patients had an ASA grade of one. There was no statistically significant difference between the two groups (p>0.05). At baseline, no significant change in heart rate, SBP, or DBP was seen across groups. The postoperative heart rate and other haemodynamic state were assessed at two, six-, and twelve-hours following surgery. Conclusion: Preemptive oral Diclofenac sodium had significant effect on reducing postoperative pain and postoperative .......

Influence of sleep and physical exercise in migraine patients

IntroductionThe prevalence of headache and sleep disorders is quite high in the general population. Both are chronic pathologies considered factors of daily disability which often coexists in migraine patients. A cause-and-effect relationship between migraine attacks and sleepless nights has not been confirmed yet, but it is already recognized that they have in common neuropeptides and functional anatomy in their pathogenesis. Because of this high prevalence, there are several studies on treatment options and prophylactic measures for migraine. The regular practice of physical exercises is identified as an important prevention factor for migraine attacks. However, daily intense physical activities are identified as triggers for these attacks. ObjectivesTo investigate the correlation between sleep time and frequency of physical activity with headache days per month, migraine disability, allodynia, hyperacusis, anxiety and depression. MethodsCross-sectional study composed of 466 individuals of both sexes diagnosed with migraine. Patient data such as age, sex, race, body mass index (BMI), waist circumference, presence of hypertension and diabetes were analyzed. It was obtained information about the type of migraine (episodic or chronic; with or without aura), age of symptoms onset, duration of illness, use of prophylactic medication and excessive use of analgesics, as well as hours of sleep per night and frequency of practice of physical activity. Patients answered questionnaires to evaluate disability (Migraine Disability Assessment - MIDAS) and the impact of migraine (HIT-6), as well as questionnaires for anxiety (STAI Y1 and STAI Y2), depression (Beck Depression Scale), allodynia (ASC-12) and hyperacusis. Spearman's correlation test was performed and a statistical difference was considered when p ≤ 0.05. (To see the complete abstract, please, check out the PDF).

Pain prevalences and analgesic use in junior athletes – a recent narrative review

Problem: Children and adolescents are exposed to high peak loads at an early age in junior competitive sports. Little is known in this age group about the injury-free occurrence of pain and the sport-related consumption of painkillers. Methodology: Narrative review with multivariate and paired keyword search for studies that evaluated localization-dependent, injury-free prevalence of pain, analgesic use, and determinants of use in junior competitive sports. Results: Derived from the few existing studies, a pronounced willingness to participate in competitions and training despite pain (“playing hurt”) is found in junior competitive sports among injury-free junior athletes. Analogous to adult competitive sports, analgesics, especially from the group of non-steroidal anti-inflammatory drugs, are used at an early stage. Especially in adolescents with increasing performance progress, in particular female athletes, the use of analgesics for joint pain has been documented. The consumption takes place for the compensation of post-exposure pain conditions but also prophylactically. The use of analgesics and the decision to take them are influenced by the immediate care environment in 2/3 of cases. A physician is involved in only 1 of 3 analgesic use decisions. Discussion: For exertional pain, a displacement mentality exists among many stakeholders in the junior setting. There is early, with age increasingly uncritical and excessive analgesic use. This consumption behavior harbors a high potential for abuse due to self-defined indications, procurement, dosage and duration of use. There is an individual need for a stronger appreciation of pain conditions by the caregivers in junior competitive sports with early consultation with a doctor, combined with the question of how much pain is allowed.

“Recurrent Papillary Necrosis and Nephrocalcinosis Induced by Nonsteroidal Anti-Inflammatory Drugs for Gouty Arthritis Associated with Congenital Chloride-Losing Diarrhea: A Major Risk for Kidney Loss”

Congenital chloride-losing diarrhea (CCLD) is a rare genetic disorder due to autosomal recessive mutation in the SLC26A3 gene on chromosome 7. It is characterized with chronic watery diarrhea with high fecal chloride (Cl: >90 mmol/L), low potassium (K), and metabolic alkalosis with low urinary Cl and K. The overall long-term prognosis is favorable with optimal life-long salt and K supplementation. In this case report, we describe a man with progressive renal failure and small kidneys that showed nephrocalcinosis and papillary necrosis. His disease was diagnosed since birth and was confirmed by our tests. He was incompliant with therapy and had developed gout. The latter complication of his disease has led to excessive NSAID use over the past years. Reinstitution of diet, drug therapy, and allopurinol had stabilized his renal disease for 1 year of follow-up. In conclusion, excessive analgesic use is a risk factor for renal failure in CCLD.

Sphenopalatine Ganglion Block in Endoscopic Sinus Surgery: A Comparative Study

Objectives: The aim of this study was to find the effect of sphenopalatine ganglion block given via greater palatine foramen in managing intraoperative bleeding, postoperative pain and its effect on functional outcome and postoperative adverse effects in Functional Endoscopic Sinus Surgery (FESS). Methods: In this prospective study, a total of 60 consenting patients posted for FESS for chronic sinusitis were selected and randomised into two groups. Group A received sphenopalatine ganglion block via greater palatine foramen and group B did not. Intraoperative surgical field visibility was measured by Average Category Scale by Fromm and Boezaart. Postoperatively those with pain score more than 4 in VAS were given diclofenac injection. Functional outcome was measured by SNOT 22. Results: There was no significant difference in age and sex distribution of patients in both groups. Preoperative SNOT scores were comparable in both groups. There was improvement noted in surgical field in block group compared to non- block group. Significantly lesser requirement of postoperative analgesics was noted in this study with p value <.01. Postoperatively functional outcome with SNOT22 scores significantly improved in both groups compared to preoperative SNOT 22 scores. Better improvement was seen in block (A) group. Mean postoperative SNOT22 score in group B (14.3) was significantly higher than that in group A (5.2). Number of adverse effects reported in both groups was comparable. Conclusion: Intraoperative bleeding which reduces surgical field visibility and postoperative pain which results in excessive use of analgesics are common problems faced by endoscopic sinus surgeons. In this study, addition of sphenopalatine ganglion block to general anesthesia was tried in FESS to overcome these problems and to improve the outcome. This study showed a significantly reduced need for postoperative analgesics with use of SPG block. Patients who received SPG block showed better improvement in functional outcome and comparable occurrence of adverse effects with the no block recipients. Even though there was improvement in surgical field in SPG block group, we couldn’t establish a statistically significant outcome.

Preclinical Evaluation of Ropivacaine in 2 Liposomal Modified Systems

(Anesth Analg. 2019;129(2):387–396) Postoperative pain management is a challenge, with only 1 in 4 surgical patients in the United States reporting adequate pain relief. This can lead to unwanted consequences, such as excessive analgesic use. The authors of this study recently developed new liposomal delivery models for ropivacaine (RVC), and they sought to assess these formulations for postoperative pain control in animal models.

Factors influencing use of analgesics among construction workers in the Ga-East municipality of the Greater Accra region, Ghana

Analgesics also known as painkillers are widely used for pain relief. There are severe health implications associated with excessive use of analgesics. This paper examines factors influencing the use of analgesics among construction workers in the Ga-East Municipality (GEM) of the Greater Accra region of Ghana. This is a cross-sectional study involving 206 construction workers randomly sampled from 7 construction sites in the GEM. A structured questionnaire was used to elicit responses on knowledge of analgesics, types of analgesics used and factors influencing the use of analgesics. Chi-square test analysis was used to examine factors influencing analgesic use. The majority of workers were aged between 15 to 44 years (89.8%) and 51.9 percent of respondents had completed Junior high school. Many respondents (68.0%) used Brand 1 a locally manufactured analgesic with paracetamol, aspirin and caffeine as the active ingredients and 31.6 percent of respondents had no knowledge of possible side effects of continuous use of analgesics. Chi square analysis showed that age was significantly associated with use of analgesics (p<0.01). Knowledge of the types of analgesics, dosage and side effects did not influence use (p>0.05). Television and radio advertisements influenced use of analgesics (p<0.01). Knowledge on analgesic use and knowledge of probable serious side effects was inadequate. Pharmacists and chemists involvement in education of clients of the side effects of analgesics is highly recommended to minimise misuse. The Food and Drugs Authority should regulate the proliferation of advertisements for analgesics in the media. None declared.

Intracranial aneurysm as extra-renal manifestation of polycystic kidney disease: A case report

Introduction. Polycystic kidney disease is a hereditary kidney disease characterized by the occurrence of cysts (fluid-filled enlargements) in cortex or medula of the kidney, and is inherited in an autosomal dominant or autosomal recessive manner. In addition to multiple cysts in kidneys, there may be many extra-renal manifestations (cysts of the liver, pancreas, lungs, heart, etc.), among which the most serious one is intracranial aneurysms. Case report. A 57-year-old female patient with polycystic kidney disease and stage IV renal failure was hospitalized at our clinic due to decreased renal function, the development of urinary tract infections, headaches and unregulated blood pressure despite the usual treatment. This patient also had a number of associated diseases: obesity, diabetes mellitus (the insulindependent type), hypothyroidism, and depression syndrome. After better regulation of blood pressure, resolved urinary tract infections and improved renal function, there were still persistent headaches (resulting in the excessive use of analgesics). With adequate preparation, multislice computed tomography (MSCT) angiography of blood vessels of the head was performed. As a result, we diagnosed the saccular intracranial aneurysm (IA) with anterior localization. Regarding the symptoms, age and comorbidity, digital subtraction angiography (DSA) was performed, and showed saccular IA (5.2 mm ? 4 mm), with wide neck affecting both middle cerebral artery branches (MCA). During the procedure the stent was placed, which filled the aneurysm with spirals, cutting it off from circulation. After the successful procedure and without further complications, the patient no longer had headaches and blood pressure was maintained within the required limits with stable parameters of chronic renal failure. Conclusion. The case of the patient with polycystic kidney disease, stage IV chronic renal failure, with a number of comorbidities (headache, obesity, hypertension, diabetes mellitus, hypothyroidism) and diagnosed with symptomatic intracranial aneurysm was successfully solved with a multidisciplinary approach, emphasizing the importance of teamwork in daily practice.

Caffeine and headache: specific remarks

Caffeine is the most widely used psychostimulant worldwide. Excessive caffeine consumption induces a series of both acute and chronic biological and physiological changes that may give rise to cognitive decline, depression, fatigue, insomnia, cardiovascular changes, and headache. Chronic consumption of caffeine promotes a pro-nociceptive state of cortical hyperexcitability that can intensify a primary headache or trigger a headache due to excessive analgesic use. This review offers an in-depth analysis of the physiological mechanisms of caffeine and its relationship with headache.

The pain of a heart being broken: pain experience and use of analgesics by caregivers of patients with Alzheimer's disease.

BackgroundIt has been observed that psychical suffering (e.g. the feeling of losing a significant person) tends to reduce the physical pain tolerance threshold, as well as to increase the subjective sense of painfulness. The purpose of this study was to assess pain sensation among a group of caregivers of patients with Alzheimer’s disease, and to determine the psychological factors (emotional and relational) that contribute to both pain perception and coping with pain via the use of analgesics.MethodsThe study comprised 127 caregivers of patients with Alzheimer’s disease. Questionnaires were used to elicit pain intensity, strength of emotional relationship between caregiver and patient, sense of painfulness of the loss experienced, depression level, and somatic ailments.ResultsA large majority (87.4 %) of participants reported pain complaints, while 93 % took analgesics without a doctor’s recommendation at least once a week; 8 % took painkillers daily. The strongest predictors of both perceived pain and tendency to use analgesics were sense of loss and painfulness of loss in relation to the patient’s deteriorating condition.ConclusionsThe pain experienced by caregivers may be connected to social pain resulting from the experience of losing someone they are close to. Caregivers may resort to excessive use of analgesics as a pain-coping strategy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0571-1) contains supplementary material, which is available to authorized users.

Cafeína y cefalea: consideraciones especiales

Caffeine is the most widely used psychostimulant worldwide. Excessive caffeine consumption induces a series of both acute and chronic biological and physiological changes that may give rise to cognitive decline, depression, fatigue, insomnia, cardiovascular changes, and headache. Chronic consumption of caffeine promotes a pro-nociceptive state of cortical hyperexcitability that can intensify a primary headache or trigger a headache due to excessive analgesic use. This review offers an in-depth analysis of the physiological mechanisms of caffeine and its relationship with headache.

Recent Management Advances in Acute Postoperative Pain

Acute postoperative pain remains a major problem, with both undertreatment and overtreatment leading to serious consequences, including increased risk of persistent postoperative pain, impaired rehabilitation, increased length of stay and/or hospital readmission, and adverse events related to excessive analgesic use, such as oversedation. New analgesic medications and techniques have been introduced that target the preoperative, intraoperative, and postoperative periods to better manage acute postoperative pain, with improvements in analgesic efficacy and safety over more traditional pain management approaches. This review provides an overview of these new analgesic medications and techniques. Specific topics that are discussed include the use of preoperative nonsteroidal anti-inflammatory drugs, anxiolytics, and anticonvulsants; intraoperative approaches such as neuraxial analgesia, continuous local anesthetic wound infusion, transversus abdominis plane block, extended-release epidural morphine, intravenous acetaminophen, and intravenous ketamine; and postoperative use of intravenous ibuprofen, new opioids (eg, tapentadol) or opioid formulations (morphine-oxycodone), and patient-controlled analgesia. New, targeted, analgesic medications and techniques may provide a safer and more effective approach to the management of acute postoperative pain than traditional approaches such as postoperative oral analgesics.

Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers–Danlos syndrome, hypermobility type): Principles and proposal for a multidisciplinary approach

Joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) hypermobility type (EDS-HT), is a underdiagnosed heritable connective tissue disorder characterized by generalized joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive dysfunctions. Deterioration of quality of life is mainly associated with pain and fatigue. Except for the recognized effectiveness of physiotherapy for some musculoskeletal features, there are no standardized guidelines for the assessment and treatment of pain and fatigue. In this work, a practical classification of pain presentations and factors contributing in generating painful sensations in JHS/EDS-HT is proposed. Pain can be topographically classified in articular limb (acute/subacute and chronic), muscular limb (myofascial and fibromyalgia), neuropathic limb, back/neck, abdominal and pelvic pain, and headache. For selected forms of pain, specific predisposing characteristics are outlined. Fatigue appears as the result of multiple factors, including muscle weakness, respiratory insufficiency, unrefreshing sleep, dysautonomia, intestinal malabsorption, reactive depression/anxiety, and excessive use of analgesics. A set of lifestyle recommendations to instruct patients as well as specific investigations aimed at characterizing pain and fatigue are identified. Available treatment options are discussed in the set of a structured multidisciplinary approach based on reliable outcome tools.

Treating tension-type headache – an expert opinion

Introduction: Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society.Areas covered: Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training are most likely to be effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are second-choice drugs.Expert opinion: There is an urgent need for more research in nonpharmacological as well as pharmacological treatment possibilities of TTH. Future studies should examine the relative efficacy of the various treatment modalities and clarify how treatment programs can be optimized and combined to best suit the individual patient. Frequent TTH may be difficult to treat, but an acceptable result can usually be obtained by a combination of nonpharmacological and pharmacological treatments.

An Overview of the Recent European Federation of Neurological Societies Guidelines on the Treatment of Tension-type Headache

Tension-type headache (TTH) is the most prevalent headache type and causes a high degree of disability. This paper provides an overview of the recently published European Federation of Neurological Societies guideline on the treatment of TTH, which recommended that non-drug management should always be considered for this condition. For example: information, reassurance and identification of trigger factors may be rewarding; electromyograph biofeedback has a documented effect in TTH; cognitive-behavioural therapy and relaxation training most likely also are effective; and physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and non-steroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Excessive use of analgesics should be avoided to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the first choice for prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine may be used second line.

Headache in the elderly: primary forms

In elderly patients, the differential diagnosis of primary headache complicated by clinical characteristics may suggest symptomatic headache. In addition, the frequent presence of chronic comorbidity illness and excessive analgesic use may aggravate a pre-existing headache or give rise to new headache to complicate headache management in elderly patients. This study reviews epidemiologic data, clinical characteristics and treatment options for primary headaches in elderly people.