Does co-treatment with ultra-low-dose naloxone and morphine provide better analgesia in renal colic patients?

Hosseininejad, Seyed Mohammad; Amiri, Mehdi Mohammadian; Bozorgi, Farzad; Montazar, Seyyed Hosein; Firouzian, Abolfazl; Moosazadeh, Mahmood; Khatir, Iraj Goli; Shahbakhti, Niloufar; Darvishi‐Khezri, Hadi

doi:10.1016/j.ajem.2018.08.038

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…Rivera et al (2002) showed that following the addition of BDNF to the culture medium, the expression patients did not report a significant analgesic effect between the group receiving naloxone (0.001 mg/kg IV.) plus morphine (0.1 mg/kg) with the group receiving only morphine (34). We suggest that the simultaneous administration of an ultra-low dose of naloxone affects the expression and secretion of BDNF and KCC2 regulation and consequently reduces the tolerance and hyperalgesia induced by chronic morphine administration.…”

Section: Discussionmentioning

confidence: 87%

Investigating the effect of Ultra-low dose naloxone on spinal BDNF and KCC2 cotransporter in morphine tolerant and hyperalgesia rats

Baratzadeh

Danialy

Zaringhalam

et al. 2020

Preprint

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Background: Chronic opioids administration could lead to several side effects including morphine tolerance and opioid induced hyperalgesia (OIH). Tolerance and hyperalgesia to opiates reduce their effectiveness in the treatment of severe pain. Although the mechanisms are unclear. Recently, we have shown that repeated morphine treatments induced increases in spinal PKCᵧ and GAT-1 expression. In this study we investigate the BDNF and KCC2 expression through ultra-low dose of naloxone coadministration of morphine.Results: In morphine group, rats received 10 mg i.p. morphine and in treatment group 15ng ultra-low dose of naloxone with morphine for consecutive 8 days. Behavioral tests were performed on day 1 before and after the morphine injection, day 5, 8 (tolerance test) and 10, 48h after last morphine injection (opioid induced hyperalgesia OIH test). A number of rats were sacrificed on day 8 and others on day 10, then expression of BDNF and KCC2 were analyzed by western blot and immunohistochemistry techniques, respectively. Behavioral tests suggested that following 8 days of chronic morphine injection tolerance developed. OIH was shown 48 hours after the last morphine injection. Expression of BDNF significantly was increased and KCC2 downregulated in rats that developed morphine tolerance and OIH respectively. Ultra-low dose of naloxone by decreasing BDNF and increasing KCC2 was able to suppress development of OIH and alleviated morphine tolerance.Conclusions: Our data suggest that BDNF and KCC2 maybe candidate molecules which are involved in tolerance and OIH. Ultra-low dose of naloxone along morphine might be a valuable therapeutic potential for controlling hypersensitivity following chronic morphine administration.

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Section: Discussionmentioning

confidence: 87%

Investigating the effect of Ultra-low dose naloxone on spinal BDNF and KCC2 cotransporter in morphine tolerant and hyperalgesia rats

Baratzadeh

Danialy

Zaringhalam

et al. 2020

Preprint

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“…Moderate to severe pain, either acute or chronic, is among the conditions for which morphine sulfate is FDA approved. Morphine, which is most frequently used in pain management, significantly reduces pain in individuals [9]. The management of palliative/end-of-life care, ongoing cancer treatment, and vaso-occlusive pain during sickle cell crises are clinical scenarios that benefit greatly from morphine medication [10].…”

Section: Postoperative Pain Relieversmentioning

confidence: 99%

Recent Advances in Electroanalysis Techniques Used for Morphine in Managing Postoperative Pain

Latwal,

Panday

2024

Pain Management - From Acute to Chronic and Beyond

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Determination of a particular drug in pharmaceutical preparations and biological fluids is critically important in pharmaceutical and medical sciences to avoid its overdose. Effective analysis requires sensitivities at ppb level or even less in the biological fluids with high selectivity. Morphine is a potent analgesic drug that is used to relieve severe pains like postoperative pain, labor pain, and cardiac pain. It is a μ-opioid agonist which acts directly on the central nervous system to relieve pain. It is very important to monitor the doses of morphine in the patient’s body under examination since the overdose may cause disruption to the central nervous system. As the applications of analytical instruments are progressing, modern electrochemical methods are attracting interest for the analysis of therapeutic agents or their metabolites in medical samples since these methods are economic and can detect extremely low concentrations approximately 10 ng/ml. A review of the principles and application of modern electroanalytical techniques, namely, cyclic voltammetry, differential pulse voltammetry, square wave voltammetry, and amperometry, is presented. The use and advantages of these techniques at different electrodes for the detection of morphine have been discussed. The analytical applications of these techniques to pharmaceutical compounds in dosage forms and biological media are also discussed.

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“…Some researchers are exploring the concurrent use of opioids and low-dose naloxone for analgesia. 21,[23][24][25] Other opioid-nonopioid combinations being studied as possible combinations to reduce OIRD include respiratory stimulants that target serotonin (5-HT), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, and blockers of N-methyl-D-aspartic acid receptors. 21,26 Tolerance and Hyperalgesia Tolerance and hyperalgesia are adaptive changes that occur at the cellular level.…”

Section: Respiratory Depressionmentioning

confidence: 99%

“…Whatever the reason, research suggests that naloxone doses of less than 25 μg (administered over 1 minute) will enhance analgesia. Some researchers are exploring the concurrent use of opioids and low-dose naloxone for analgesia 21,23-25 …”

Section: Adverse Effectsmentioning

confidence: 99%

Opioids

Hines

Owings

2021

Dimens Crit Care Nurs

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In the last decade, critical-care nurses have seen a surge in acute opioid overdose admissions to intensive care units; there have also been significant increases in intensive care unit admissions due to opioid-related illness such as dependence, tolerance, and hyperalgesia. Despite these issues, opioids continue to be the criterion standard of pain management, and the search for opioid alternatives has not produced a clear replacement. A contributor to this problem has been the prevailing opinion that once bound to a receptor, all opioids engaged in the same types of intracellular signaling, which resulted in the same types of responses, only differing in the magnitude of those responses.Contemporary research with G-protein-coupled receptor models (eg, opioids) has demonstrated that this oversimplification is incorrect or incomplete. Understanding the complexity of opioid pharmacodynamics and pharmacokinetics helps us to grasp the intricacies of opioid-related adverse effects. Although there are many potential adverse effects related to opioids, this review focuses on the major adverse effects commonly seen in critical care, namely, respiratory depression, tolerance, hyperalgesia, and central sensitization. In addition, a case study has been incorporated to aid in understanding of strategies nurses can incorporate into their practices: that help mitigate the development of these effects.

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Does co-treatment with ultra-low-dose naloxone and morphine provide better analgesia in renal colic patients?

Cited by 8 publications

References 35 publications

Investigating the effect of Ultra-low dose naloxone on spinal BDNF and KCC2 cotransporter in morphine tolerant and hyperalgesia rats

Investigating the effect of Ultra-low dose naloxone on spinal BDNF and KCC2 cotransporter in morphine tolerant and hyperalgesia rats

Recent Advances in Electroanalysis Techniques Used for Morphine in Managing Postoperative Pain

Opioids

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