Genetics and genomics in postoperative pain and analgesia

Palada, Vinko; Kaunisto, Mari A.; Kalso, Eija

doi:10.1097/aco.0000000000000633

Cited by 31 publications

(18 citation statements)

References 55 publications

(36 reference statements)

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“…However, the two cases of naloxone administration was thoroughly documented and left no uncertainty regarding opioid overdose as the cause of respiratory depression. The large variation in opioid consumption in our sample does not surprise considering the variation in surgical procedures and an inter-individual variation in pain intensity which has been shown even after similar surgical procedures [5,6]. In our material, average opioid consumption after 24 h equaled 55.5 mg morphine and more than 10% of the patients received more than 100 mg during a time period of 24 h. For one patient the total opioid dose equaled 309 mg morphine.…”

Section: Discussionsupporting

confidence: 48%

Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Andersen

Kvarstein

2020

Scandinavian Journal of Pain

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ObjectivesOpioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression.MethodsThe study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected.ResultsTwo patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients.ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.

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Section: Discussionsupporting

confidence: 48%

Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Andersen

Kvarstein

2020

Scandinavian Journal of Pain

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“…COMT is an enzyme inactivating catecholamines such as dopamine, noradrenaline, and adrenaline [61]. The Val158Met polymorphism, a common genetic variant in Caucasian populations, influences the activity of the COMT enzyme, and it has been suggested that interactions between OPRM1 and COMT might contribute to the development of post-surgery pain and sensitivity to opioids [62]. The SLC6 family of the human genome includes transporters for neurotransmitters, and they have a crucial role in neurotransmission [63].…”

Section: Markersmentioning

confidence: 99%

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Calapai¹,

Esposito

Puzzo³

et al. 2021

Life

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After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.

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“…MC4R agonism results in BDNF production ( 157 ) and, although BDNF production is dependent on cre-Response Element Binding Protein (CREB) induction by PKA, recent studies have indicated that MC4R may generate BDNF through exchange factors (EPACs) via ERK1/2, and not via a PKA-dependent mechanism ( 158 ). Polymorphisms within the BDNF gene are correlated with susceptibility toward addictive behaviors, including alcohol abuse ( 159 ) and chronic pain phenotypes ( 160 ). Hypofunction of BDNF may be involved in the molecular processes that underlie excessive alcohol intake ( 161 ).…”

Section: Discussionmentioning

confidence: 99%

The Role of Melanocortin Plasticity in Pain-Related Outcomes After Alcohol Exposure

Sharfman

Gilpin

2021

Front. Psychiatry

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The global COVID-19 pandemic has shone a light on the rates and dangers of alcohol misuse in adults and adolescents in the US and globally. Alcohol exposure during adolescence causes persistent molecular, cellular, and behavioral changes that increase the risk of alcohol use disorder (AUD) into adulthood. It is established that alcohol abuse in adulthood increases the likelihood of pain hypersensitivity and the genesis of chronic pain, and humans report drinking alcohol to relieve pain symptoms. However, the longitudinal effects of alcohol exposure on pain and the underlying CNS signaling that mediates it are understudied. Specific brain regions mediate pain effects, alcohol effects, and pain-alcohol interactions, and neural signaling in those brain regions is modulated by neuropeptides. The CNS melanocortin system is sensitive to alcohol and modulates pain sensitivity, but this system is understudied in the context of pain-alcohol interactions. In this review, we focus on the role of melanocortin signaling in brain regions sensitive to alcohol and pain, in particular the amygdala. We also discuss interactions of melanocortins with other peptide systems, including the opioid system, as potential mediators of pain-alcohol interactions. Therapeutic strategies that target the melanocortin system may mitigate the negative consequences of alcohol misuse during adolescence and/or adulthood, including effects on pain-related outcomes.

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Genetics and genomics in postoperative pain and analgesia

Cited by 31 publications

References 55 publications

Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

The Role of Melanocortin Plasticity in Pain-Related Outcomes After Alcohol Exposure

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