Controlled-release oxycodone for pain in diabetic neuropathy

Gimbel, Joseph; Richards, P.; Portenoy, Russell K.

doi:10.1212/01.wnl.0000057720.36503.2c

Cited by 439 publications

(246 citation statements)

References 31 publications

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“…This may be caused by differences in drug distribution and kinetics between control and diabetic rats that make direct comparisons of systemically delivered drug efficacy difficult to interpret [44], although recent reports indicate that diabetic rats also show impaired function of spinal mu opiate receptors [45]. There is emerging experimental evidence that delta and kappa opioid receptors can provide plausible alternative targets for alleviating painful diabetic neuropathy [46] and recent clinical trials with oxycodone, a mixed mu and kappa opioid receptor agonist [47,48] also support this approach. Asimadoline may provide a local therapeutic approach to treating diabetic painful neuropathy that avoids the sedation and dysphoria occurring with KOR agonists that penetrate the central nervous system [49] and also avoids the respiratory depression and potential for abuse associated with mu opioid agonists [50].…”

Section: Discussionmentioning

confidence: 99%

Dynorphin A, kappa opioid receptors and the antinociceptive efficacy of asimadoline in streptozotocin-induced diabetic rats

et al. 2006

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Aims/hypothesis We investigated spinal and peripheral kappa opioid systems in diabetic rats. Materials and methods Dynorphin A, N-methyl-D-aspartate (NMDA) and kappa opioid receptor (KOR) were measured in spinal cord, dorsal root ganglia, peripheral nerves and foot skin of control and streptozotocin-induced diabetic rats by immunoassay and Western blotting. Behavioural assessments of paw tactile sensitivity and formalin-evoked hyperalgesia were performed in normal and diabetic rats before and after treatment with asimadoline. Results Dynorphin A protein levels were significantly increased in peripheral nerves and footpad skin of diabetic rats. Dynorphin A exhibits both anti-and pro-nociceptive properties depending on activation of either KOR or NMDA receptors. Spinal protein levels of these receptors were not changed by diabetes, while KOR levels in the sciatic and peroneal nerves were significantly increased. Exploiting the presence and elevated levels of KOR in the periphery, we investigated the effect of the peripheral KOR agonist asimadoline on formalin-evoked hyperalgesia and tactile allodynia in diabetic rats. Both formalin-evoked hyperalgesia and tactile allodynia in diabetic rats were acutely ameliorated by asimadoline. To confirm that the effect of asimadoline was related to its property as KOR agonist, diabetic rats were pretreated with the selective KOR antagonist nor-binaltorphimine. Intraplantar norbinaltorphimine abolished the ability of asimadoline to alleviate tactile allodynia in diabetic rats. Systemic and intrathecal nor-binaltorphimine partially inhibited the effect of asimadoline against formalin-evoked hyperalgesia in diabetic rats. Conclusions/interpretation Using selective peripheral KOR agonists to take advantage of elevated peripheral KOR expression may provide a novel therapeutic approach for painful diabetic neuropathy.

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Section: Discussionmentioning

confidence: 99%

Dynorphin A, kappa opioid receptors and the antinociceptive efficacy of asimadoline in streptozotocin-induced diabetic rats

et al. 2006

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“…Controlled-release oxycodone improved pain scores in two single-center trials in patients with painful diabetic neuropathy, one of which had a small sample size (132,133). It may provide additional analgesia for patients on a2-d ligand treatment (134).…”

Section: Opioid and Atypical Opioid Analgesicsmentioning

confidence: 99%

“…Despite the demonstrated effectiveness of opioids in the treatment of neuropathic pain (15,132,134,135), there is a high risk of addiction, abuse, sedation, and other complications and psychosocial issues even with short-term opioid use. For these reasons, opioids are not recommended in the treatment of painful DSPN before failure of other agents that do not have these associated concerns (136)(137)(138).…”

Section: Warnings On All Opioidsmentioning

confidence: 99%

Diabetic Neuropathy: A Position Statement by the American Diabetes Association

et al. 2016

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“…13 In a crossover study comparing 4-week treatment periods, venlafaxine and imipramine were found to be superior to placebo in relieving DPNP. 14 Other drugs reported to manage DPNP are "anticonvulsants," 15,16 selective serotonin reuptake inhibitors, 17 controlled-release oxycodone, 18,19 and the synthetic cannabinoid CT-3. 20 Duloxetine hydrochloride (Cymbalta ® , Eli Lilly and Company, Indianapolis, IN) is a selective 5-HT and NE reuptake inhibitor that is relatively balanced in its affinity for both 5-HT and NE reuptake inhibition.…”

Section: Introduction Dmentioning

confidence: 99%

Duloxetine versus Routine Care in the Long-Term Management of Diabetic Peripheral Neuropathic Pain

Raskin

Smith

Wong³

et al. 2006

Journal of Palliative Medicine

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Introduction: Duloxetine hydrochloride is a dual reuptake inhibitor of both serotonin and norepinephrine. In the present open-label study, the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks was evaluated and compared to routine care in the therapy of patients diagnosed with diabetic peripheral neuropathic pain (DPNP).Methods: Patients who completed a 13-week, double-blind, duloxetine and placebo acute therapy period were rerandomly assigned in a 2:1 ratio to therapy with duloxetine 60 mg BID (N ‫؍‬ 161) or routine care (N ‫؍‬ 76) for an additional 52 weeks. Routine care consisted primarily of gabapentin, amitriptyline, and venlafaxine. The study included male or female outpatients 18 years of age or older with a diagnosis of DPNP caused by type 1 or type 2 diabetes.Results: A higher percentage of routine care-treated patients experienced 1 or more serious adverse events. No statistically significant therapy-group difference was observed in the overall incidence of treatment-emergent adverse events (TEAEs). The TEAEs reported by 10% or more of duloxetine 60 mg BID-treated patients were nausea, and by the routine care-treated patients were peripheral edema, pain in the extremity, somnolence, and dizziness. Duloxetine did not appear to adversely affect glycemic control, lipid profiles, nerve function, or the course of DPNP. There were no statistically significant therapy-group differences observed in the 36-item Short-Form Health Survey subscales or in the EuroQol 5-Dimension Questionnaire.Conclusions: In this study, duloxetine was safe and well tolerated compared to routine care in the long-term management of patients with DPNP.

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Controlled-release oxycodone for pain in diabetic neuropathy

Abstract: In this 6-week trial, CR oxycodone was effective for the treatment of moderate to severe pain due to diabetic neuropathy. Adverse events were typical of opioid-related side effects.

Cited by 439 publications

References 31 publications

Dynorphin A, kappa opioid receptors and the antinociceptive efficacy of asimadoline in streptozotocin-induced diabetic rats

Dynorphin A, kappa opioid receptors and the antinociceptive efficacy of asimadoline in streptozotocin-induced diabetic rats

Diabetic Neuropathy: A Position Statement by the American Diabetes Association

Duloxetine versus Routine Care in the Long-Term Management of Diabetic Peripheral Neuropathic Pain

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