Addressing opioid tolerance and opioid‐induced hypersensitivity: Recent developments and future therapeutic strategies

Khan, Faris; Mehan, Aman

doi:10.1002/prp2.789

Cited by 18 publications

(11 citation statements)

References 133 publications

(239 reference statements)

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“…Side effects include severe drowsiness, dry mouth, dizziness, breathing difficulties, and constipation, with the constipation persisting throughout treatment. [82][83][84] Although persistent constipation can now be medically managed, 8,85 in the US, patients with legitimate need for opioids now face stigma, fear, and guilt for using opioids. 86 US patients also face access issues relating to pharmacy obstacles to filling prescriptions, insurance companies' rules about types or amounts of medication allowed, and decreased manufacturing of opioids as a measure to limit inappropriate access.…”

Section: Discussion and Further Researchmentioning

confidence: 99%

The Burden of Metastatic Cancer–Induced Bone Pain: A Narrative Review

Colosia¹,

Njue²,

Bajwa³

et al. 2022

JPR

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Bone pain is one of the most common forms of pain reported by cancer patients with metastatic disease. We conducted a review of oncology literature to further understand the epidemiology of and treatment approaches for metastatic cancer–induced bone pain and the effect of treatment of painful bone metastases on the patient’s quality of life. Two-thirds of patients with advanced, metastatic, or terminal cancer worldwide experience pain. Cancer pain due to bone metastases is the most common form of pain in patients with advanced disease and has been shown to significantly reduce patients’ quality of life. Treatment options for cancer pain due to bone metastases include nonsteroidal anti-inflammatory drugs, palliative radiation, bisphosphonates, denosumab, and opioids. Therapies including palliative radiation and opioids have strong evidence supporting their efficacy treating cancer pain due to bone metastases; other therapies, like bisphosphonates and denosumab, do not. There is sufficient evidence that patients who experience pain relief after radiation therapy have improved quality of life; however, a substantial proportion are nonresponders. For those still requiring pain management, even with available analgesics, many patients are undertreated for cancer pain due to bone metastases, indicating an unmet need. The studies in this review were not designed to determine why cancer pain due to bone metastases was undertreated. Studies specifically addressing cancer pain due to bone metastases, rather than general cancer pain, are limited. Additional research is needed to determine patient preferences and physician attitudes regarding choice of analgesic for moderate to severe cancer pain due to bone metastases.

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Section: Discussion and Further Researchmentioning

confidence: 99%

The Burden of Metastatic Cancer–Induced Bone Pain: A Narrative Review

Colosia¹,

Njue²,

Bajwa³

et al. 2022

JPR

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“…In other groups, opioid dose stabilization was considered successful because chronic pain patients often suffer from worsening pain and increasing medication requirements over time. 21…”

Section: Outcomementioning

confidence: 99%

Machine Learning to Predict Successful Opioid Dose Reduction or Stabilization After Spinal Cord Stimulation

et al. 2022

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BACKGROUND: Spinal cord stimulation (SCS) effectively reduces opioid usage in some patients, but preoperatively, there is no objective measure to predict who will most benefit. OBJECTIVE: To predict successful reduction or stabilization of opioid usage after SCS using machine learning models we developed and to assess if deep learning provides a significant benefit over logistic regression (LR). METHODS: We used the IBM MarketScan national databases to identify patients undergoing SCS from 2010 to 2015. Our models predict surgical success as defined by opioid dose stability or reduction 1 year after SCS. We incorporated 30 predictors, primarily regarding medication patterns and comorbidities. Two machine learning algorithms were applied: LR with recursive feature elimination and deep neural networks (DNNs). To compare model performances, we used nested 5-fold cross-validation to calculate area under the receiver operating characteristic curve (AUROC). RESULTS: The final cohort included 7022 patients, of whom 66.9% had successful surgery. Our 5-variable LR performed comparably with the full 30-variable version (AUROC difference <0.01). The DNN and 5-variable LR models demonstrated similar AUROCs of 0.740 (95% CI, 0.727-0.753) and 0.737 (95% CI, 0.728-0.746) (P = .25), respectively. The simplified model can be accessed at SurgicalML.com. CONCLUSION: We present the first machine learning-based models for predicting reduction or stabilization of opioid usage after SCS. The DNN and 5-variable LR models demonstrated comparable performances, with the latter revealing significant associations with patients' pre-SCS pharmacologic patterns. This simplified, interpretable LR model may augment patient and surgeon decision making regarding SCS.

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“…In addition to the well‐known addictive risk associated with opioid use, practitioners have to be careful about the appearance of opioid tolerance, which may develop with chronic opioid administration producing adaptations within mu opioid receptors downstream signalling pathways. This is a long‐term adaptation that may persist after opioid usage has stopped and is responsible for the reduction in opioid efficacy 35 Topical anaesthetics can be used for blood draws, for intravenous access and for skin biopsies even though systemic absorption of these agents specifically in EB has not been studied extensively. For chronic pain, tricyclic antidepressants such as amitriptyline or anti‐epileptics, e.g.…”

Section: Part II Common Clinical Concerns In Eb: Practical Recommenda...mentioning

confidence: 99%

“…This is a long-term adaptation that may persist after opioid usage has stopped and is responsible for the reduction in opioid efficacy. 35 • Topical anaesthetics can be used for blood draws, for intravenous access and for skin biopsies even though systemic absorption of these agents specifically in EB has not been studied extensively.…”

Section: Management Of Pain and Pruritus In Ebmentioning

confidence: 99%

Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases

Has

Hachem

Bučková

et al. 2021

Acad Dermatol Venereol

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Inherited epidermolysis bullosa (EB) comprises rare disorders that manifest with fragility and blistering of the skin and mucous membranes, with variable clinical severity. Management of EB is challenging due to disease rarity and complexity, the wide range of extracutaneous manifestations and a profound impact on daily life for the patient and family members. Although reference centres providing multidisciplinary care for EB exist in each European country, it is common for healthcare professionals that are not specialized in this rare disorder to treat EB patients. Here, experts of the European Reference Network for Rare and Undiagnosed Skin Diseases (ERN‐Skin, https://ern-skin.eu) propose practical recommendations for the diagnosis and management of the commonest clinical issues, skin blisters and wounds, oral manifestations, pain and itch.

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Addressing opioid tolerance and opioid‐induced hypersensitivity: Recent developments and future therapeutic strategies

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 18 publications

References 133 publications

The Burden of Metastatic Cancer–Induced Bone Pain: A Narrative Review

The Burden of Metastatic Cancer–Induced Bone Pain: A Narrative Review

Machine Learning to Predict Successful Opioid Dose Reduction or Stabilization After Spinal Cord Stimulation

Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases

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