Strong Painkillers Research Articles

Identification of Potential Inhibitors for the Treatment of Alkaptonuria Using an Integrated In Silico Computational Strategy.

Alkaptonuria (AKU) is a rare genetic autosomal recessive disorder characterized by elevated serum levels of homogentisic acid (HGA). In this disease, tyrosine metabolism is interrupted because of the alterations in homogentisate dioxygenase (HGD) gene. The patient suffers from ochronosis, fractures, and tendon ruptures. To date, no medicine has been approved for the treatment of AKU. However, physiotherapy and strong painkillers are administered to help mitigate the condition. Recently, nitisinone, an FDA-approved drug for type 1 tyrosinemia, has been given to AKU patients in some countries and has shown encouraging results in reducing the disease progression. However, this drug is not the targeted treatment for AKU, and causes keratopathy. Therefore, the foremost aim of this study is the identification of potent and druggable inhibitors of AKU with no or minimal side effects by targeting 4-hydroxyphenylpyruvate dioxygenase. To achieve our goal, we have performed computational modelling using BioSolveIT suit. The library of ligands for molecular docking was acquired by fragment replacement of reference molecules by ReCore. Subsequently, the hits were screened on the basis of estimated affinities, and their pharmacokinetic properties were evaluated using SwissADME. Afterward, the interactions between target and ligands were investigated using Discovery Studio. Ultimately, compounds c and f were identified as potent inhibitors of 4-hydroxyphenylpyruvate dioxygenase.

Patient experiences and preferences during treatment and recovery of Lisfranc fractures: A qualitative interview study

AimTo determine from a patient perspective what improves the quality of care and patient satisfaction during the treatment and recovery process of Lisfranc fractures and to reveal possible points for improvement in this process. MethodsWe performed a qualitative study based on semi-structured interviews with patients treated for a Lisfranc fracture-dislocation in the Netherlands with either open reduction and internal fixation or primary arthrodesis, until data saturation was reached, focusing on the quality of care during treatment and recovery, from a patient perspective. ResultsData saturation was reached after interviewing 10 patients. The main themes emerging from the analysis were expectation management regarding the recovery period; communication with and between health care providers; information provided during consultations; and support during the recovery period. Participants expressed a need for improved provision of information about the different treatment options, the different kinds of pain that can arise, the expected duration of the recovery period, education on strong pain killers, likelihood of a second surgery, risks of osteoarthritis, risks of the surgery itself, allied health care and patient experiences. Participants mentioned the importance of good allied health care and a preference for starting allied health care as soon as possible. Insoles and compression socks were also appreciated by various participants. Finally, multiple patients saw a positive attitude on the part of the health care providers towards the recovery period as a key factor in recovery. ConclusionThis study found that patients value more tailored approaches to the pre-and post-operative care program, more guidance regarding allied health care (physiotherapy), and a broader scope of available references and information for patients, both oral (during consultations and in informative videos) and written, such as brochures or evidence-based web pages and mobile platforms, which may be offered during consultations or when being discharged from the hospital.

Nocebo language in anaesthetic patient written information.

Recent evidence suggests that how anaesthesia information is presented may influence patient treatment outcomes. We conducted an observational study of anaesthetic-based patient information leaflets across NHS Trusts in England for their nocebo terms vs. therapeutic terms, and how adverse effects were presented. In this study, 'nocebo' is wording that may predispose the patient to expect adverse events such as pain or nausea. Data were extracted and analysed for word frequency, weighted proportion and thematic analysis. In total, 42 patient information leaflets from 61 NHS Trusts were analysed. 'Pain' was the second most common word across the leaflets, median (IQR [range]) 0.82 (0.50-1.0 [0.12-1.47]) per 100 words, second only to 'anaesthesia'. In comparison, 'safe' was the most common positively valanced word which featured eight times less frequently than 'pain' 0.10 (0.07-0.18 [0.0-0.84]) and 'comfort' featured 16.5 times less than 'pain' 0.02 (0.0-0.05 [0.0-0.13]). Multiple examples of phrasing that could have potential nocebo effects included, 'you will need strong painkillers' suggesting 'strong pain' and the need for 'painkillers' rather than using therapeutic terms focusing on 'comfort', 'healing' and 'recovery'. Our results suggest a dominance of phrases with negative content in the presentation of anaesthesia information provided to patients. Clinicians need to be aware of inadvertent generation of nocebo-weighted vs. comfort-weighted communication with patients. Our study findings suggest an opportunity for more emphasis to be placed on therapeutic outcomes and effective mitigation strategies of anaesthesia risks to avoid potential unintended nocebo effects of anaesthesia information leaflets or websites.

Development of a patient journey map for people living with cervical dystonia

BackgroundPatient journey maps are increasingly used as a tool that enables healthcare providers to refine their service provision to best meet patient needs. We developed a cervical dystonia patient journey map (CDPJM) that describes the holistic patient experience from pre-diagnosis through to long-term treatment.MethodsThe CDPJM was developed in 2 stages; a patient survey (open questions and multichoice) of 15 patients with CD was conducted to inform the design of the CDPJM, which was then refined and validated by an expert-patient focus group.ResultsQualitative analysis of the patient survey supported five key stages of the patient journey: symptom onset, diagnosis and therapeutic relationship with healthcare professionals, initiation of care for CD, start of CD treatment, and living with treated CD. Following symptom onset, survey respondents described having multiple visits to their family doctor who prescribed strong pain killers and muscle relaxants and referred their patient to up to 10 different specialists for diagnosis. Over half (53.3%) of respondents had received ≥ 1 misdiagnosis. Respondents reported relief at having a diagnosis but a lack of understanding of the prognosis and treatment options; 46.7% said their neurologist did not spend enough time addressing their concerns. Survey respondents reported using a variety of alternative sources of information, including the internet (86.7%), self-help groups (66.7%) and information leaflets provided by health care professionals (60.0%). While botulinum toxin (BoNT) was consistently discussed as the main treatment option, some neurologists also mentioned physiotherapy, counselling, and other complementary approaches. However, patients were often left to seek complementary services themselves. Patients reported a ‘rollercoaster’ of relief with BoNT treatment with symptoms (and subsequent impact on daily life) returning towards the end of an injection cycle. “When BoNT works well I can return to an almost normal life … when the injections stop working so well, I have to rest more and avoid going to work and experience life restrictions.”ConclusionsWe present the first patient journey map for CD that can be used to guide local service mapping and to compare current provision with what patients say they want and need.

Behaviours of Patients Who Take Their Strong Opioids as Unmeasured ‘Sips’

ContextSome patients take their strong opioid painkillers as unmeasured sips. ObjectivesTo investigate how and why patients take their medication in this way. MethodsPatient receiving specialist palliative care who take their strong opioid painkillers as unmeasured sips were recruited. Measurement was made of the mass of two sips per patient and qualitative interviews using a topic guide were conducted. Interview transcripts were thematically analyzed using a phenomenological approach. ResultsOnly two of 16 patients were taking within 20% of the correct dose of their breakthrough liquid strong analgesia. Many varied the dose depending on the severity of the pain episode. Convenience, confusion about the correct dose, and issues with spoons were the other main reasons for people choosing to sip. ConclusionThis is the first published study exploring the behavior of patients who take their strong analgesia as unmeasured sips. Knowing that patients who sip are likely to be taking an incorrect dose, and the reasons behind sipping may help clinicians to help these patients to manage their pain better.

Self-reported health problems due to prescription drug use and non-medical use of prescription drugs – a population-based study

ABSTRACT Objective We examined the association between the non-medical use of prescription drugs (NMUPD) and self-reported health problems due to the use of prescription drugs (hypnotics, sedatives, or strong painkillers), and whether it differed by social background among the general Finnish population. Methods Population-based (aged 15–69) Drug Surveys conducted in Finland in 2014 and 2018 were used. NMUPD was measured by the past-year use and social background by the educational level and employment status. Self-reported health problems due to prescription drug use was used as an outcome. A multinomial logistic regression was used. Results NMUPD was associated with self-reported health problems due to prescription drug use. The effect was modified by the social background and hazardous alcohol use: NMUPD was associated with health problems among those who had a high education, were employed or outside the workforce, and who used alcohol hazardously. Conclusions Although the findings may partly be explained by the differences in health literacy, they indicate health problems with NMUPD despite the social background. Therefore, when prescribing psychoactive prescription drugs, it is important to monitor the non-medical use of these drugs and inform patients of their possible association with health problems, irrespective of the patient’s social background.

Pharmacists find purpose in end-of-life care

Pharmacists find purpose in end-of-life care

Troels Staehelin Jensen-dissecting pain.

Troels Staehelin Jensen-dissecting pain.

Opioid use could increase risk of hip fracture in people with Alzheimer’s disease

People using moderate or strong opioid painkillers have a higher risk of sustaining a hip fracture than those not using opioids, new research has revealed.

New therapies to relieve pain: The search for more efficient and safer alternatives to opioid pain killers.

EMBO Reports (2018) e46925 Opioids are a largely efficient medication for relieving severe pain and are prescribed for a wide variety of indications including metastatic cancer, arthritis, neuropathy or post‐surgical pain. These drugs target opioid receptors to produce effects similar to morphine and include moderately strong painkillers such as oxycodone and hydrocodone (Vicodin), and strong drugs like fentanyl, which resembles opium‐derived morphine and heroin. The great efficiency of opioids in treating severe pain has also been the major drawback for longer‐term use given their addictive power. This does not matter for short‐term use, for instance to ease post‐operative pain, or terminal cancer when the primary requirement is to relieve suffering. Yet, the addictive side effect has become a huge societal problem; in addition, opioids do not work against all types of chronic pain, including some of the most severe cases such as cancer‐induced bone pain or some cases of neuropathy resulting from nerve damage. These problems have spurred efforts to develop new drugs for treating pain with some success in developing derivatives with reduced side effects. The other major avenue of research is the identification of relevant pain pathways or protein binding sites including those involved in the placebo effect. Their efficiency has spurred physicians to prescribe opioids too readily, while drug companies have heavily advertised their effects and understated the side effects to boost usage. This three‐way collusion between patients, doctors and pharmaceutical companies has stoked the ongoing epidemic of opioid addiction that has afflicted the USA and Canada in particular, but also other developed countries in Europe and Asia. Apart from exacting a heavy social toll through loss of motivation or loss of jobs, impact on relationships, crime and so on, opioid addiction has dangerous physiological effects, notably on the respiratory system, which causes most of the overdose …

Consensus approach: Prior to the construction of an evaluation scale of risk constipation patients hospitalized for nursing practice

Constipation is a frequent issue during hospitalization. Multiple causes such as the existence of irregular habits, lack of exercise as well as medical history have been identified. Drugs such as strong painkillers, central nervous system therapies and treatments of the digestive tract are a major cause of constipation. Additionally, unbalanced diet, fluid deficiency, and anxiety may aggravate constipation. The consideration of all these risk factors being under the responsibility of nurses. The difficulty to take into account such a multifactorial aetiology in nursing practice and the fact that there is no easy to use and validated tool to assess the risk of constipation in current nurse practice has led us to consider the development of a Risk Assessment scale of Constipation in Patient Hospitalized (ERCoPH) to facilitate preventive management of this trouble. We present here the first step of the elaboration of this scale, the identification of risk factors through a consensus approach after a systematic literature review. The key informants consensus-based approach proposed by Pineault and Daveluy is based on five steps: (1) a literature review to identify risk factors for constipation; (2) the elaboration of a questionnaire containing the factors identified in the first step; (3) pre-select a panel of experts; (4) submission the questionnaire to the panel; (5) analysis the results of the consensus survey. Only factors that received a rating>6by at least 80% of the experts were retained. The systematic literature review identified 69risk factors submitted to the 23experts of the panel. Fifteen risk factors were retained after analyzing the answers of the experts. The Scientific Committee added eight risk factors because of their importance in the literature and decided to group together some factors of the same domain. A total of 19risk factors were selected and grouped by major class (age, physical activity, medication, social data, food/hydration, medical and surgical history and environmental data). These factors have been tested among 300patients enrolled in different clinical settings as part of the construction and validation of ERCoPH.

Opioid Addiction what's Going on and what Might Stop it

Though opiates are the most effective form of painkillers, they are highly addictive and many of these opiate addictions lead to heroin addictions or death. The medical community has worsened this problem by over prescribing and prescribing strong painkillers for routine surgeries in which patients do not need high-strength medication. Because opiates are expensive, many abusers sum to heroin instead which is cheaper and does not require a prescription, and heroin usage often results in overdose and fatality. However, research being conducted in the medical research field shows signs of optimism in the development of alternative, Jess addictive painkillers. In confronting the issue at hand, lives will be saved and addiction rates will be significantly lowered by maintaining strict prescribing parameters to patients who actually need the opiates.

Opiates for the people

Why are an increasing number of vulnerable patients who are in chronic pain being deprived of strong painkillers?

Driving under the influence of drugs: Perceptions and attitudes of New Zealand drivers

This study explored the patterns of drug driving in New Zealand by investigating 1) drivers’ perceptions about impairment caused by legal and illegal drugs 2) countermeasures employed by drivers when under the influence of drugs (e.g., decisions not to drive) 3) drivers’ attitudes about police enforcement of drug driving and 4) the factors that predict the likelihood of engaging in drug driving. Participants (n=434) were licensed drivers who completed an online questionnaire. Results of the questionnaire indicated that drivers rated hallucinogens and opiates as being the illegal drugs producing the highest level of driving impairment and cannabis the lowest. For legal drugs, sedatives were rated as having the highest driving impairment and anti-nausea and anti-depressants the lowest. Respondents’ drug use history had an effect on their ratings of impairment for anti-anxiety drugs, anti-depressants, kava, sedatives, cannabis and hallucinogens such that drug users reported higher impairment ratings than Non-user. Making a decision not to drive after taking drugs was reported by users of alcohol (73.6%), cannabis (57.0%), strong painkillers (42.5%), and anti-depressants (10.0%). Respondents who reported drink driving were 3.26 times more likely to report drug driving than those reporting no drink driving. Respondents also showed greater acceptance towards driving under the influence of legal drugs (43.5%) compared to illegal drugs (10.3%). Those who did not have favourable attitudes about drug driving were less likely to report having driven under the influence of drugs. Drivers in this sample were less aware of the potential negative effects of legal drugs on driving compared to illegal drugs. More than half the respondents from this study acknowledged drug driving as a road safety issue which needs more resources dedicated to it.

Prevalence of psychotropic drug use prior to driving

Abstract The prevalence and adverse consequences of alcohol-impairment in drivers of motor vehicles is well documented. By comparison, driving under the influence of legal and illegal psychotropic drugs is poorly characterised in most countries. This study was conducted to investigate the prevalence of drugged driving in New Zealand, and to obtain a profile of the types of drugs most commonly taken prior to driving. A stratified sample (n=2000) of drivers (representative of the age distribution of licensed drivers) from across NZ completed a telephone survey (41% male, mean age 47.26 years). Additional participants completed the survey online (n=434; 28% male, mean age 34.54 years) Participants were asked to report their use of 17 different types of prescription and non-prescription psychoactive drugs in the previous 12 months and to indicate if they had taken them less than 3 h prior to driving. The legal drugs most commonly taken prior to driving (other than alcohol, consumed by 13% of the sample) were strong painkillers (11%), antidepressants (7%) anti-nausea medication (4%) and anti-anxiety medication (3%). Other than cannabis, taken by 4% of the sample, the prevalence of illegal drug use less than 3 h before driving was generally low (

Palliative care: The other opioid issue.

The 'war on drugs' has left many in developing nations with no access to strong painkillers. But governments in these countries are learning to stop worrying and love the poppy.

Patterns of Chest Injuries among Yemeni Patients: a Retrospective Analysis

Objective: To investigate the patterns of thoracic injuries and the methods used for their management.Methods: A retrospective descriptive analysis of 275 chest trauma cases managed at the University of Science and Technology Hospital over the period 2010–2013.Results: Of 275 consecutive patients with chest trauma, 72.7% were males and 7.27% were females with a mean age of 33.6 years old. Blunt injuries represented 51% (125 males and 15 females) while penetrating injuries represented 49% (130 males and five females) of the cases. Among the penetrating injury group, three patients (1.1%) were with direct sustaining cardiac injuries. The most common presenting features associated with injuries were pain (100%), dyspnea (78.6%) and hemorrhagic shock (17%). Concurrent extrathoracic injuries were found in 22.2% (61/275) of the total chest injuries; spinal cord injuries (3.3%; 9/275), brain injuries (6.2%; 17/275) and intraperitoneal injuries (4.4%; 12/275) and bone fractures (7.3%; 23/275). The first three types of extrathoracic injuries were mostly due to penetrating injuries that necessitated a thoracoabdominal approach or chest tube drainage (CTD) and laparotomy. Computerized tomography scan, chest X-ray, ultrasound and echocardiography were the main diagnostic tools, being used for the diagnosis of 95.27%, 96.72%, 9.73% and 9.33% of cases, respectively. Intercostal tube thoracostomy was required for the management of 96.3% (130/135) of patients with penetrating injuries; early thoracotomy was performed in 25.9% (35/135) of patients to control over bleeding while late thoracotomy was performed in 16.3% (22/135) of patients for removal of retained foreign body and empyema. The CTD was performed in 76.4% (107/140) of patients with blunt injuries, whereas 23.6% (33/140) patients had conservative management and only 2.9% (4/140) of patients underwent thoracotomy. The average hospital length of stay was 6 days for penetrating trauma group and about 7 days for blunt trauma group. Out of all admitted cases, 94.5% (260/275) were cured while 5.5% (15/275) died.Conclusions: It is concluded that CTD is the most appropriate method of treating complicated chest injuries; however, the penetrating trauma has a higher rate of internal damage that requires early intervention to save life, especially for severe or progressive intrathoracic bleeding and cardiac injury. Pulmonary contusion and rib fracture were the most common complications of chest traumas, for which strong painkillers, anti-infective therapy, respiratory care measures and mechanical ventilation are the components of an effective treatment strategy. The associated extrathoracic injuries constitute a major prognostic factor in chest traumas, which were higher in blunt traumas.

Patterns of Chest Injuries among Yemeni Patients: a Retrospective Analysis

Objective: To investigate the patterns of thoracic injuries and the methods used for their management. Methods: A retrospective descriptive analysis of 275 chest trauma cases managed at the University of Science and Technology Hospital over the period 2010–2013. Results: Of 275 consecutive patients with chest trauma, 72.7% were males and 7.27% were females with a mean age of 33.6 years old. Blunt injuries represented 51% (125 males and 15 females) while penetrating injuries represented 49% (130 males and five females) of the cases. Among the penetrating injury group, three patients (1.1%) were with direct sustaining cardiac injuries. The most common presenting features associated with injuries were pain (100%), dyspnea (78.6%) and hemorrhagic shock (17%). Concurrent extrathoracic injuries were found in 22.2% (61/275) of the total chest injuries; spinal cord injuries (3.3%; 9/275), brain injuries (6.2%; 17/275) and intraperitoneal injuries (4.4%; 12/275) and bone fractures (7.3%; 23/275). The first three types of extrathoracic injuries were mostly due to penetrating injuries that necessitated a thoracoabdominal approach or chest tube drainage (CTD) and laparotomy. Computerized tomography scan, chest X-ray, ultrasound and echocardiography were the main diagnostic tools, being used for the diagnosis of 95.27%, 96.72%, 9.73% and 9.33% of cases, respectively. Intercostal tube thoracostomy was required for the management of 96.3% (130/135) of patients with penetrating injuries; early thoracotomy was performed in 25.9% (35/135) of patients to control over bleeding while late thoracotomy was performed in 16.3% (22/135) of patients for removal of retained foreign body and empyema. The CTD was performed in 76.4% (107/140) of patients with blunt injuries, whereas 23.6% (33/140) patients had conservative management and only 2.9% (4/140) of patients underwent thoracotomy. The average hospital length of stay was 6 days for penetrating trauma group and about 7 days for blunt trauma group. Out of all admitted cases, 94.5% (260/275) were cured while 5.5% (15/275) died. Conclusions: It is concluded that CTD is the most appropriate method of treating complicated chest injuries; however, the penetrating trauma has a higher rate of internal damage that requires early intervention to save life, especially for severe or progressive intrathoracic bleeding and cardiac injury. Pulmonary contusion and rib fracture were the most common complications of chest traumas, for which strong painkillers, anti-infective therapy, respiratory care measures and mechanical ventilation are the components of an effective treatment strategy. The associated extrathoracic injuries constitute a major prognostic factor in chest traumas, which were higher in blunt traumas.

Ankle block in forefoot reconstruction before or after inflation of tourniquet—Does timing matter?

Forefoot surgery causes postoperative pain frequently requiring strong painkillers. Regional blocks are now increasingly used in order to control postoperative pain especially in the first 24h when the pain is at its worst. We conducted a prospective study to see if timing of ankle block i.e. before or after inflation of tourniquet showed any difference in efficacy in postoperative pain control in first 24h. A prospective randomised study was conducted between September 2010 and August 2011 involving 60 patients. Group A (n=30) had the ankle block administered after and Group B (n=30) had a block before inflation of a thigh tourniquet. Patients were given assessment forms to chart their pain on visual analogue scale (VAS) score at 4h and 24h postoperatively. Both groups demonstrated good postoperative pain control. Average VAS pain score at four and twenty fours after surgery was 2.5 and 4.5 in Group A and 3.9 and 6.3 in Group B respectively. Pain control, both at 4 and 24h surgery was better in Group A but this was statistically significant only at 24h. A regional anaesthetic ankle block should be routinely used in forefoot surgery to control postoperative pain. The ankle block should be applied after the inflation of tourniquet as this appears to provide better pain control.

A European survey of oncology nurse breakthrough cancer pain practices

Purpose of the researchBreakthrough cancer pain (BTCP) is a prevalent type of pain in which the nurse can play an important role in improving patients’ pain symptoms and overall well-being. Nurses’ experience with BTCP (number of patients, and estimates of severity and frequency), the treatment of BTCP (pharmacological and nonpharmacological treatments normally used), ratings of the importance of treatment factors, and reasons given for not advising patients to take strong painkillers are presented in the present paper. Methods and sampleNurses from 12 European countries, who cared for patients with cancer, took part in a survey. In total 1618 nurses were recruited and 1241 completed the survey questionnaire. Key resultsAlmost 90% of the nurses were female, and 50.4% had >9 years of experience in oncology nursing. The majority of the nurses (47%) said that a patient typically suffered from BTCP 2–3 times a day, and the severity of the pain for the patients was described as severe by 75.5%. In all, 38.4% of the nurses were unaware that medications specifically intended for treatment of BTCP exist, and 57% reported that oral opioids were normally prescribed for BTCP at their workplace. While 38% said they did not use nonpharmacological treatments for BTCP, the most common treatment approach was positional change (used by 76.6%). The treatment varied between the European countries. ConclusionPatients do not receive the appropriate medical treatment for their BTCP. Nurses need better training about BTCP in general, and BTCP assessment and management specifically.