Management Of Nociceptive Pain Research Articles

Trends in Pain Medication Use in Patients With Type 2 Diabetes: NHANES 2005–2018

The aim of this research was to compare pain medication use trends among adults with and without type 2 diabetes in the US. This cross-sectional study used data of adults with and without (type 2) diabetes from the National Health and Nutrition Examination Survey waves 2005–2018. Use of pain medication including opioids, prescription nonsteroidal anti-inflammatory drugs, gabapentinoids, serotonin norepinephrine reuptake inhibitors, skeletal muscle relaxants, and headache treatment agents was compared by diabetes status and within select social determinants of health and clinical factors. Adults with type 2 diabetes were twice as likely to be prescribed pain medications compared to those without a diabetes diagnosis (16.2% vs 8.6%). Females and those with a history of smoking or arthritis were more likely to be on pain medications. Opioid use was the most prevalent regardless of diabetes status, and use was twice as high among those with diabetes (10.8% vs 5.5%). Patients with type 2 diabetes in the US are twice as likely to be prescribed pain medications overall as well as opioids compared with those without diabetes. Clinical guideline recommendations are necessary to find pharmacologic and nonpharmacologic nociceptive pain management specific for patients with diabetes.

Tricyclic Antidepressants in Nociceptive and Neuropathic Pain: A Review of Their Analgesic Properties in Combination With Opioids.

Objectives: To determine the efficacy and safety of commonly prescribed tricyclic antidepressants (TCAs) as analgesics for nociceptive and neuropathic pain in combination with opioids. Data Sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Scopus, and Web of Science using the following search terminology: "Amitriptyline" OR "Doxepin" OR "Desipramine" OR "Imipramine" OR "Nortriptyline" OR "Clomipramine" OR "Trimipramine" AND "Analgesia." Reports of adult patients who received any TCA as an adjunctive analgesic to opioids were included. Study Selection and Data Extraction: A total of 293 results were obtained from the initial database inquiries, following which exclusion criteria were applied and 6 articles were included in this review. Three of the reports detailed the use of TCAs in the perioperative setting, whereas the remaining 3 evaluated their effect on different etiologies of neuropathic pain. Data Synthesis: Tricyclic antidepressants were found to have modest, yet not insignificant, independent analgesic properties, although the ability to provide pain relief was relegated to a select few agents. Desipramine has the most data available for use in nociceptive, postoperative pain through its ability to potentiate and prolong the analgesic effects of opioids and was not associated with adverse drug effects. Conclusions: The efficacy of TCAs for neuropathic pain was not corroborated by this review, and the anticholinergic adverse effects associated with this drug class were found to be significant. Further research is needed to quantify the efficacy of TCAs in the management of nociceptive pain.

Oral splints in the management of nociceptive pain and migraines: A scoping review.

Temporomandibular disorders (TMDs) are characterized by numerous pain manifestations. Their treatment often involves the use of an oral splint. Recent research has found a relationship between migraines, nociceptive pain and TMDs. The aim of the present study was to perform a scoping review of studies in order to evaluate the effectiveness of the various types of oral splint in the treatment of migraine or nociceptive pain. Publications were retrieved from seven databases (PubMed, Web of Science, EMBASE, Scopus, ProQuest, SpringerLink and Ovid). Out of the 15 included publications, three studies were before and after studies, with no control group, whereas the other twelve studies were clinical trials, among which two publications were crossover studies. A clear, single distinction of pain was difficult to describe. Therefore, numerous publications focused on a combination of various types of pains, including myofascial, temporomandibular joint, headaches and migraine-like symptoms, all of which mimicked TMD pain. Overall, six studies used the stabilization splint (SS), three explored the comparison between the SS and the nociceptive trigeminal inhibition splint (NTIS) and two the NTIS. The majority of publications reported a positive outcome of splint therapy. Regarding the type of oral splint usage, the most commonly used one was the SS, followed by the NTIS. The definition and assessment of pain were heterogenous in the identified articles. The findings of the current study showed that occlusal splints may help with pain management, and that effective treatment of TMD-related pain at an early stage can enhance the quality of life of patients.

Memantine in Nociceptive Pain Management: A Case Report

BACKGROUND: Memantine is a N-methyl-D-aspartate receptor antagonist that is prominently known as an Alzheimer’s disease medication. In recent years, it has started to receive attention for pain management purposes, especially for neuropathic pain. There has been little focus on its use for nociceptive pain. We present a case where the use of memantine for nociceptive pain in a patient yielded significant associated improvement. CASE REPORT: A 49-year-old man presented with a one-year history of severe nociceptive left neck pain subsequent to a whiplash injury. The patient failed multiple first-line therapies and pursued consults with multiple specialties without symptomatic improvement. He was put on memantine with subsequent sustained resolution of his nociceptive neck pain. CONCLUSIONS: Memantine’s optimal safety profile and effectiveness in this case make it important that more human patient research be conducted to further explore its efficacy for nociceptive pain. KEY WORDS: Nociceptive pain, memantine, inflammation, chronic pain, case report

Safety Issues of Pharmacological Acute Pain Treatment in Children.

Acute nociceptive pain management in children is a major public health concern. Effective and safe pain treatment is essential, but safety data cannot be simply extrapolated from adults to children due to pharmacokinetic and pharmacodynamic specificities. In addition, the frequent absence of child-specific data, the difficulty to assess drug tolerability, and the infants' inability to communicate properly and voluntarily report adverse drug reactions make children more vulnerable to safety issues. Awareness of the possible toxicity of analgesics is important but should not lead to suboptimal dosing and underuse of analgesia. A better assessment and individualization of treatment should allow effective prescribing of analgesics in more secure conditions. This article aims to review the safety of acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids in children and the precautions that should be taken.

Bupropion attenuates morphine tolerance and dependence: Possible role of glutamate, norepinephrine, inflammation, and oxidative stress.

Morphine - the main pillar of nociceptive pain management - systemic use is associated with development of tolerance and dependence. Tolerance and dependence lay a heavy burden in clinical pain management settings. An added weight to this dilemma is that effective, safe, and tolerable solution to this problem is still beyond reach. Antidepressants were reported as possible alleviators of opioid tolerance and dependence. One of the increasingly used antidepressant in clinical practice is bupropion given its high safety and tolerability profile. The study was performed on male Balb-c mice weighing 20-30g. Hot plate test was used for assessment of bupropion (5mg/kg, ip) possible analgesic activity and enhancement of morphine acute analgesia (1 and 5mg/kg, sc). Repeated morphine (5mg/kg, sc) administration for 9days developed tolerance and dependence, bupropion (5mg/kg, ip) was concurrently administered to evaluate its potential to modulate these processes. We also biochemically analyzed bupropion effect on these phenomena through modulation of neurotransmitters (glutamate and norepinephrine), inflammatory status (nitric oxide), and pro-antioxidant balance (malondialdehyde and reduced glutathione). Bupropion was devoid of intrinsic analgesic activity and did not enhance morphine acute analgesia. However, bupropion significantly attenuated morphine tolerance and dependence development and abstinence syndrome with corresponding suppression of morphine induced changes in glutamate, norepinephrine, inflammatory status, and prooxidant-antioxidant balance. Bupropion efficacy in attenuation of morphine tolerance and dependence with its high safety and tolerability profile provide an alternative option to conventional agents e.g., ketamine and clonidine to modulate these phenomena.

Fluoxetine uses in nociceptive pain management: a promising adjuvant to opioid analgesics.

Fluoxetine, a commonly prescribed antidepressant, use in nociceptive pain management represents one of the unsettled issues of fluoxetine therapeutics. By reviewing the literature about fluoxetine's possible roles in this setting, those could be solitary antinociceptive effect, enhancement of acute morphine analgesia, blocking morphine tolerance development, and blocking dependence development and associated abstinence syndrome. In this study, we examined those four alleged roles of fluoxetine. Moreover, as effective alleviation of morphine tolerance, dependence, and abstinence syndrome represents one of the most challenging medical needs, we biochemically analyzed fluoxetine effect on these phenomena. Fluoxetine (10 mg/kg, IP) was examined in hot plate test for assessment of possible analgesic activity and enhancement of morphine acute analgesia (1 and 5 mg/kg, SC). Repeated morphine (5 mg/kg, SC) administration for 9 days developed tolerance and dependence; fluoxetine was co-administered to evaluate its potential to modulate these processes. We also determined concomitant changes in neurotransmitters (glutamate and noradrenaline), inflammatory status, and prooxidant-antioxidant balance. Our results indicated that fluoxetine did not possess significant analgesia solely and did not enhance acute morphine analgesia. However, fluoxetine administration with morphine significantly attenuated tolerance and dependence development and abstinence syndrome with corresponding suppression of morphine-induced changes in neurotransmitters (glutamate and noradrenaline), inflammatory status, and prooxidant-antioxidant balance. These biochemical results may reflect both direct and indirect effects of fluoxetine. Our conclusion is that despite fluoxetine possesses low - if any - analgesic activity, it significantly adds to opioids not via enhancing analgesic activity but through modulation of tolerance and dependence development.

A Review of Chronic Musculoskeletal Pain: Central and Peripheral Effects of Diclofenac.

Diclofenac is widely used to manage chronic inflammatory and degenerative joint diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, and extra-articular rheumatism. Its various mechanisms of action make it particularly effective in treating nociceptive pain, but it is also an alternative for treating spinal and chronic central pain. Osteoarthritis and rheumatoid arthritis are the most frequently encountered arthritic conditions in adults. The management of nociceptive pain requires a sequential hierarchical approach, with the initial NSAID treatment being characterized by the replacement of one drug with another, or complete discontinuation usually because of insufficient pain control. OA- and RA-related pain is complex and multifactorial, and due to physiological interactions between the signaling of the central and peripheral nervous systems. The mechanisms of action of diclofenac make it particularly effective in treating both nociceptive pain and chronic central pain. This review underlines the mechanisms of diclofenac involved in chronic and acute joint pain, the most relevant adverse events.

When the Safe Alternative Is Not That Safe: Tramadol Prescribing in Children.

Children represent a vulnerable population in which management of nociceptive pain is complex. Drug responses in children differ from adults due to age-related differences. Moreover, therapeutic choices are limited by the lack of indication for a number of analgesic drugs due to the challenge of conducting clinical trials in children. Furthermore the assessment of efficacy as well as tolerance may be complicated by children’s inability to communicate properly. According to the World Health Organization, weak opioids such as tramadol and codeine, may be used in addition to paracetamol and ibuprofen for moderate nociceptive pain in both children and adults. However, codeine prescription has been restricted for the last 5 years in children because of the risk of fatal overdoses linked to the variable activity of cytochrome P450 (CYP) 2D6 which bioactivates codeine. Even though tramadol has been considered a safe alternative to codeine, it is well established that tramadol pharmacodynamic opioid effects, efficacy and safety, are also largely influenced by CYP2D6 activity. For this reason, the US Food and Drug Administration recently released a boxed warning regarding the use of tramadol in children. To provide safe and effective tramadol prescription in children, a personalized approach, with dose adaptation according to CYP2D6 activity, would certainly be the safest method. We therefore recommend this approach in children requiring chronic or recurrent nociceptive pain treatment with tramadol. In case of acute inpatients nociceptive pain management, prescribing tramadol at the minimal effective dose, in a child appropriate dosage form and after clear instructions are given to the parents, remains reasonable based on current data. In all other situations, morphine should be preferred for moderate to severe nociceptive pain conditions.

Neuropathic pain in people with cancer (part 2): pharmacological and non-pharmacological management.

The aim of this paper is to provide an overview of the management of neuropathic pain associated with cancer and to provide helpful clinical advice for nurses working with patients who may have neuropathic pain. While cancer pain is a mixed-mechanism pain, this article will focus only on neuropathic pain management. The impact of neuropathic pain on patients' quality of life is great and while many patients recover from their cancer, a significant number continue to suffer from a neuropathic pain syndrome. Management of neuropathic pain is significantly different from management of nociceptive pain with respect to pharmacological and non-pharmacological strategies. Neuropathic pain is complex, and as such requires complex management using pharmacological as well as non-pharmacological approaches. Specific drugs for neuropathic pain may be effective for some patients, but not all; therefore, ongoing and comprehensive assessment and management are required. Furthermore, these patients may require trials of several drugs before they find one that works for them. It is important for nurses to understand neuropathic pain, its manifestation, impact on quality of life and management when nursing patients with neuropathic pain associated with cancer.

Treatment of Type 2 Diabetes for Third-Year Medical Students

OPEN ACCESSNovember 21, 2012Treatment of Type 2 Diabetes for Third-Year Medical Students Mona P. Nasrallah, MD, Nathalie K. Zgheib, MD, Asma Arabi, MD, MSc Mona P. Nasrallah, MD American University of Beirut Google Scholar More articles by this author , Nathalie K. Zgheib, MD American University of Beirut Google Scholar More articles by this author , Asma Arabi, MD, MSc American University of Beirut Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9273 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: This resource is a team-based learning (TBL) module on the treatment of type 2 diabetes. The goal is for students to be able to assess and formulate a plan of action for glycemic control in type 2 diabetes. More specifically, each student should be able to define goals of glycemic control as appropriate for a given scenario, be familiar with the different classes of hypoglycemic therapies, and choose a specific therapeutic plan. Methods: Included are a student presession document, a readiness assurance test, a group application exercise, and an instructor guide. The session lasts for 1.5 hours. The group of students divides into six teams of six to seven students each. This case was designed to be used in a standard TBL format, which consists of repeating sequences of three phases. Phase 1 is the individual preclass preparation of the contents to be later discussed in class; phase 2 is the individual readiness assurance testing that assesses the knowledge acquired by students in phase 1 and also includes group readiness tests, discussion with the instructor, and appeals; phase 3 involves a higher level of learning: applying course concepts using small-group assignments. Results: Evaluation of this resource showed that medical students were highly satisfied with the course and the teaching approach and that their performance on prescription writing and formulary development improved. Discussion: We originally asked teams to report their prescriptions orally, but the process was not very efficient. So, we shifted to simultaneous reporting on charts on the wall. The reading material is time sensitive; thus, one needs to regularly update it and, accordingly, update the test answers. Educational Objectives By the end of this session, learners will be able to: Compare therapeutic options for the management of hyperglycemia with efficacy and side-effect profile.Compose an individualized drug therapy management plan for type 2 diabetes mellitus, including therapeutic end points, dosage regimens, and monitoring parameters.Communicate and work effectively in a small-group setting with peers.Write a prescription. ReferencesDrugs for type 2 diabetes. Treat Guidel Med Lett. 2011;9(108):47–54.Medline, Google ScholarInzuchchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. a position statement of the ADA and EASD. Diabetes Care. 2012;35:1364–1379.Medline, Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Application Exercise.doc Instructor's Guide.doc Presession Document.doc RAT.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format Venous Thromboembolism (VTE) Prophylaxis in Hospitalized Medical Patients for Third-Year Medical Students Treatment of Chronic Obstructive Pulmonary Disease (COPD) for Third-Year Medical Students Management of Nociceptive Pain for Third-Year Medical Students-Team Based Learning (TBL) Format Treatment of Type 2 Diabetes for Third-Year Medical Students Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: Team-Based Learning Copyright & Permissions© 2012 Nasrallah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsTherapeuticsDiabetes MellitusTeam-Based LearningTBL Disclosures None to report. Funding/Support None to report. Loading ...

Management of Nociceptive Pain for Third-Year Medical Students-Team Based Learning (TBL) Format

Abstract This team-based learning (TBL) module covers the use of nonsteroidal anti-inflammatory drugs (NSAIDs), nonopioid, and opioid analgesics in the treatment of nociceptive pain. Students will ...

Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format

OPEN ACCESSJune 6, 2012Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format Jumana Antoun, MD, Nathalie Zgheib, MD, Zeina Kanafani, MD Jumana Antoun, MD American University of Beirut Google Scholar More articles by this author , Nathalie Zgheib, MD American University of Beirut Google Scholar More articles by this author , Zeina Kanafani, MD American University of Beirut Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9179 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis Team-based learning (TBL) module is one of seven bimonthly TBL modules used in the clinical pharmacology course that is offered to third-year medical students at the American University of Beirut Faculty of Medicine. The main objective of the course is to apply rational prescribing within several clinical case scenarios. Upon completion of this module, students will be able to effectively work together to manage patients with community acquired pneumonia, discuss the choice of appropriate empiric antimicrobials, and write a prescription for their choice.This case was recently introduced based on requests of students. It has so far been used twice, each time with six teams of third-year medical students. There is typically a very high level of interaction during the session. The medical students were highly satisfied with the course and the teaching approach, and their performance on prescription writing and formulary development has improved. Educational Objectives By the end of this session, learners will be able to: Work effectively in small groups to solve a clinical therapeutic case scenario.Determine whether a patient with community acquired pneumonia (CAP) should be treated as inpatient or outpatient.Choose an empiric antimicrobial therapy for the initial outpatient treatment of CAP.Develop a monitoring plan for the efficacy and toxicity of the chosen antimicrobial therapy.Write a prescription. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Application exercise clinical case document.doc CAP Instructor's Guide.doc RAT document.doc Student pre session document.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format Venous Thromboembolism (VTE) Prophylaxis in Hospitalized Medical Patients for Third-Year Medical Students Treatment of Chronic Obstructive Pulmonary Disease (COPD) for Third-Year Medical Students Management of Nociceptive Pain for Third-Year Medical Students-Team Based Learning (TBL) Format Treatment of Type 2 Diabetes for Third-Year Medical Students Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: Team-Based Learning Copyright & Permissions© 2012 Antoun et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsAntimicrobialsTeam-based LearningPneumoniaTBL Disclosures None to report. Funding/Support None to report. Loading ...

Attitudes, beliefs and self‐reported competence about postoperative pain among physicians and nurses working on surgical wards

To investigate attitudes, beliefs and self-reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self-reported competence about postoperative pain. In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years' work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients 'often' or 'very often' achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self-reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain.

Current options in the drug management of nociceptive pain

AbstractStrong opioids are commonly used for severe pain and should not be withheld in chronic noncancer pain. Our Drug review considers the properties and efficacy of the various opioids available, followed by an analysis of prescription data, sources of further infor‐mation and the Datafile. Copyright © 2007 Wiley Interface Ltd

Neuropathic pain in the acute pain service: a prospective survey

Abstract Traditionally the focus of Acute Pain Services (APSs) has been in the management of nociceptive pain. The recognition and management of neuropathic pain has been neglected. The aim of this study was to define the incidence of neuropathic pain in an Acute Pain Service population and to assess the risk of progression of these patients to persistent pain states. We report an incidence of acute neuropathic pain as 1–3% in patients seen by our APS. At follow up 78% of the patients had ongoing pain at 6 months and 56% at 12 months. Although numerically small in terms of overall APS activity the acute neuropathic pain group is significant in terms of the high risk of progression to chronicity. Early recognition of patients with acute neuropathic pain is an important component of APS activity. Further work is needed to clarify the role of pre-emptive strategies and early intervention in modulating progression to chronicity.