Continuous Opioid Treatment for Chronic Noncancer Pain: A Time for Moderation in Prescribing

Colameco, Stephen; Coren, Joshua S.; Ciervo, Carman A.

doi:10.3810/pgm.2009.07.2032

Cited by 12 publications

(7 citation statements)

References 38 publications

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“…Also, 3 patients out of 25 (12%) have serum FSH and LH levels lower than control. This is also in agreement with [9] in their study of opioid-induced endocrinopathy.…”

Section: Discussionsupporting

confidence: 92%

Male Sex Hormone affection in patients with Tramadol dependance

Darweesh

Khalifa

Gabra

et al. 2020

Middle East Curr Psychiatry

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Background Tramadol is a centrally active synthetic opioid analgesic that is used extensively among Egyptian males for premature ejaculation as a self-medication. The present work conducted to outline male sex hormone affection in patients with tramadol dependence and its relation to sexual satisfaction. Results Tramadol-dependent patients have significantly lower mean serum level of testosterone compared to the control group and lower mean Sexual Satisfaction Scale than the control group. Conclusions The results provide evidence for the association between male sex hormone suppression in patients with tramadol dependence with high Addiction Severity Index of tramadol dependence.

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“…Also, 3 patients out of 25 (12%) have serum FSH and LH levels lower than control. This is also in agreement with [9] in their study of opioid-induced endocrinopathy.…”

Section: Discussionsupporting

confidence: 92%

Male Sex Hormone affection in patients with Tramadol dependance

Darweesh

Khalifa

Gabra

et al. 2020

Middle East Curr Psychiatry

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“…No other drug provides better relief from the sensory and affective components of pain. Unfortunately, long-term opioid treatment results in reduced therapeutic efficacy and in turn leads to an increase in the dose required to produce equivalent pain relief, break-through, or insurmountable pain (Carroll et al, 2004 ; Angst and Clark, 2006 ; Colameco et al, 2009 ; Fishbain et al, 2009 ; Silverman, 2009 ; Zernikow et al, 2009 ; Bekhit, 2010 ; Crofford, 2010 ), increased adverse side-effects (Mercadante, 1999 ; Mercadante and Portenoy, 2001 ) and may progress to opioid dependence and addiction (Banta-Green et al, 2009 ; Shurman et al, 2010 ). Despite the clinical importance of diminishing the development of analgesic tolerance and decades of research into the neurobiological consequences of chronic opioid administration (COA), the mechanism is still poorly understood and only limited intervention strategies are available (Huxtable et al, 2011 ; Labianca et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

MicroRNAs Are Involved in the Development of Morphine-Induced Analgesic Tolerance and Regulate Functionally Relevant Changes in Serpini1

Tapocik

Ceniccola

Mayo

et al. 2016

Front. Mol. Neurosci.

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Long-term opioid treatment results in reduced therapeutic efficacy and in turn leads to an increase in the dose required to produce equivalent pain relief and alleviate break-through or insurmountable pain. Altered gene expression is a likely means for inducing long-term neuroadaptations responsible for tolerance. Studies conducted by our laboratory (Tapocik et al., 2009) revealed a network of gene expression changes occurring in canonical pathways involved in neuroplasticity, and uncovered miRNA processing as a potential mechanism. In particular, the mRNA coding the protein responsible for processing miRNAs, Dicer1, was positively correlated with the development of analgesic tolerance. The purpose of the present study was to test the hypothesis that miRNAs play a significant role in the development of analgesic tolerance as measured by thermal nociception. Dicer1 knockdown, miRNA profiling, bioinformatics, and confirmation of high value targets were used to test the proposition. Regionally targeted Dicer1 knockdown (via shRNA) had the anticipated consequence of eliminating the development of tolerance in C57BL/6J (B6) mice, thus supporting the involvement of miRNAs in the development of tolerance. MiRNA expression profiling identified a core set of chronic morphine-regulated miRNAs (miR's 27a, 9, 483, 505, 146b, 202). Bioinformatics approaches were implemented to identify and prioritize their predicted target mRNAs. We focused our attention on miR27a and its predicted target serpin peptidase inhibitor clade I (Serpini1) mRNA, a transcript known to be intricately involved in dendritic spine density regulation in a manner consistent with chronic morphine's consequences and previously found to be correlated with the development of analgesic tolerance. In vitro reporter assay confirmed the targeting of the Serpini1 3′-untranslated region by miR27a. Interestingly miR27a was found to positively regulate Serpini1 mRNA and protein levels in multiple neuronal cell lines. Lastly, Serpini1 knockout mice developed analgesic tolerance at a slower rate than wild-type mice thus confirming a role for the protein in analgesic tolerance. Overall, these results provide evidence to support a specific role for miR27a and Serpini1 in the behavioral response to chronic opioid administration (COA) and suggest that miRNA expression and mRNA targeting may underlie the neuroadaptations that mediate tolerance to the analgesic effects of morphine.

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“…Opioid use in the management of chronic noncancer pain can be problematic [1]. In addition to known intrinsic opioid side effects such as constipation, sedation, and pruritus, tolerance to opioids often sets in, resulting in dose escalation [2].…”

Section: Introductionmentioning

confidence: 99%