Browsing by Subject "opioid"

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Contrasting Pain Management Strategies in a Retrospective Study of Patients with Traumatic Multiple Rib Fractures (TURFs)
(2015-05-01) Patel, Sunny B.; Patricia A. Gwirtz; Claire Kirchhoff
There is a lack of consensus on best practice on pain management in patients with Traumatic Multiple Rib Fractures (TURFs). The objective was a pilot study to describe the use of pain management modalities for TURFs. Descriptive and statistical analyses were conducted on data from retrospective chart review. The number of rib fractures and length of stay (LOS) in the hospital, Trauma Intensive Care Unit (TICU), and on ventilator differed between treatment modalities. This demonstrates the need for a prospective, randomized control trial to determine best practice of pain management in patients with TURFs.
Multimorbidity and chronic pain management with opioids and other therapies among adults in the United States: A cross-sectional study
(Sage Publications, 2024-03-08) Neba, Rolake A.; Wang, Hao; Kolala, Misozi; Sambamoorthi, Usha
BACKGROUND: Multimorbidity, defined as the concurrent presence of >/= 2 chronic conditions, and chronic pain (i.e., pain lasting >/=3 months) often co-exist. Multimodal pain management that includes non-pharmacologic treatment and non-opioid therapy is recommended to prevent serious risks associated with opioids. PURPOSE: Estimate the prevalence of types of pain treatment and analyze their associations with multimorbidity using a nationally representative survey in the United States (US). METHODS: Data was collected from the 2020 National Health Interview Survey among adults with chronic pain and chronic conditions (N= 12,028). Chronic pain management was grouped into four categories: opioid therapy; non-opioid multimodal pain treatment; pain treatment with monotherapy; and no pain treatment. Chi-square tests and multivariable multinomial logistic regressions were used to analyze the association of multimorbidity with types of pain treatment after controlling for age, sex, social determinants of health (SDoH), and lifestyle characteristics. RESULTS: Among NHIS respondents, 68% had multimorbidity. In adjusted multinomial logistic regressions with "pain management with monotherapy" as the reference group, those with multimorbidity were more likely to utilize opioids (AOR=1.63, 95% CI=1.23, 2.17). Those with severe pain were also more likely to use opioid therapy (AOR=19.36, 95% CI=13.35, 28.06) than those with little pain. Those with low income and education were less likely to have multimodal pain management without opioids. CONCLUSION: Seven in 10 adults had multimorbidity. Those with multimorbidity reported severe pain and relied on opioids for pain control. Regardless of multimorbidity status, SDoH was associated with types of chronic pain management.
The Role of Dopamine, Nicotine Acetylcholine, Opioid and Sigma Receptors in Ketamine Self-Administration and Reward
(2000-05-01) Stoffel, Stephen A.; Michael Forster; Glenn Dillon; Robert Luedtke
Stoffel, Stephen A., The Role of Dopamine, Nicotinic Acetylcholine, Opioid and Sigma Receptors in Ketamine Self-Administration and Reward. Doctor of Philosophy in Pharmacology, May 2000, 114 pp 15 figures, bibliography. The rewarding effects of ketamine were postulated to involve dopaminergic neural tracts modulated by nicotinic, sigma, or opioid receptor mechanisms. In support of the hypothesized involvement of dopamine, an increase in extracellular dopamine was detected in the nucleus accumbens using electrochemical chronoamperometry following intravenous ketamine self-administration. When rats were permitted unlimited access to ketamine via self-administration, a greater concentration of dopamine was detected in the nucleus accumbens than was detected in the nucleus accumbens than was detected when self-administration was limited. In a subsequent set of experiments, the effects of agonists or antagonists of dopaminergic, nicotinic, sigma, or opioid receptors were examined for their effect on ketamine self-administration. Decreases in the rate of self-administration following treatment were interpreted to represent an increase in rewarding effect, whereas increases in self-administered were interpreted as a decrease in rewarding effect. The rate of self-administered intraperitoneally prior to ketamine self-administration sessions, but intravenous BMS181-100 would not substitute for ketamine in the self-administration occurred following intraperitoneal (i.p.) administration of: ketamine, SCH23390 (a D1 receptor antagonist), naloxonazine (a mu opioid receptor antagonist), and mecamylamine, a central nicotinic acetylcholine receptor antagonist. An increase in the rate of ketamine self-administration followed nicotine and dihydrexidine (a D1 receptor agonist) intraperitoneal injection. In previous studies, published in the literature, SCH23390 increased the rate of self-administration of amphetamines and cocaine, indicating a competitive effect on drug reward. However, the current studies indicate that the rewarding effects of ketamine were facilitated by SCH23390. The results are consistent with the hypothesis that the rewarding effects of ketamine are mediated through dopaminergic neural pathways. The rewarding effects of ketamine were facilitated by SCH23390. The results are consistent with the hypothesis that the rewarding effects of ketamine are mediated through dopaminergic neural pathways. The rewarding effects of ketamine may be modulated, in an inhibitory fashion, via sigma receptors, presynaptic D1 receptors, nicotinic acetylcholine receptors, and/or μ opioid receptors. Ligands at nicotinic acetylcholine and dopamine receptors yielded effects opposite to that hypothesized based on their ability to modulate the rewarding effects of other abused chemicals.