Pharmacologic Management of Cancer-Related Pain in Pregnant Patients

Zerfas, Isabelle; McGinn, Reagan; Smith, Michael A.

doi:10.1007/s40265-023-01906-4

“…GBP was originally developed as an analgesic and, indeed GBP's efficacy for neuropathic pain and postherpetic neuralgia is well-established, with its use as monotherapy or adjunctive therapy supported by case reports and reviews [44]. GBP treatments have also shown efficacy in diabetic peripheral neuropathy [45]; postherpetic neuralgia (PHN) [46], trigeminal neuralgia [47]; neuropathic pain further to paclitaxel chemotherapy [48]; and cancer-related pain in pregnant patients [49]. Pain control in pediatric patients has also been described [50,51].…”

Section: Pain Managementmentioning

confidence: 99%

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

Rusciano

2024

Pharmaceuticals

1

0

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Gabapentin (GBP) was originally developed as a potential agonist for Gamma-Amino-Butyric-Acid (GABA) receptors, aiming to inhibit the activation of pain-signaling neurons. Contrary to initial expectations, it does not bind to GABA receptors. Instead, it exhibits several distinct pharmacological activities, including: (1) binding to the alpha-2-delta protein subunit of voltage-gated calcium channels in the central nervous system, thereby blocking the excitatory influx of calcium; (2) reducing the expression and phosphorylation of CaMKII via modulation of ERK1/2 phosphorylation; (3) inhibiting glutamate release and interfering with the activation of NMDA receptors; (4) enhancing GABA synthesis; (5) increasing cell-surface expression of δGABA_A receptors, contributing to its antinociceptive, anticonvulsant, and anxiolytic-like effects. Additionally, GBP displays (6) inhibition of NF-kB activation and subsequent production of inflammatory cytokines, and (7) stimulation of the purinergic adenosine A1 receptor, which supports its anti-inflammatory and wound-healing properties. Initially approved for treating seizures and postherpetic neuralgia, GBP is now broadly used for various conditions, including psychiatric disorders, acute and chronic neuropathic pain, and sleep disturbances. Recently, as an eye drop formulation, it has also been explored as a therapeutic option for ocular surface discomfort in conditions such as dry eye, neurotrophic keratitis, corneal ulcers, and neuropathic ocular pain. This review aims to summarize the evidence supporting the molecular effects of GBP, with a special emphasis on its applications in ocular surface diseases.

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“… 44 While there have been no studies of buprenorphine for chronic pain during pregnancy, the fetal safety established in several OUD studies 45 , 46 suggests that the generally lower doses of buprenorphine used for pain are at least as safe in this population. 47 …”

Section: Older Adults or Special Populationsmentioning

confidence: 99%

Frontline Perspectives on Buprenorphine for the Management of Chronic Pain

Adler,

Mallick-Searle,

Garofoli

et al. 2024

JMDH

0

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Due to the prevalence of chronic pain and high-impact chronic pain in the US, a significant percentage of the population is prescribed opioids for pain management. However, opioid use disorder is associated with reduced quality of life, along with fatal opioid overdoses, and is a significant burden on the US economy. Considering the clinical needs of patients with intractable chronic pain and the potential harms associated with prescribed and illicit opioids in our communities, having a deep understanding of current treatment options, supporting evidence, and clinical practice guidelines is essential for optimizing treatment selections. Buprenorphine is a Schedule III opioid with a unique mechanism of action, allowing effective and long-lasting analgesia at microgram doses with fewer negative side effects and adverse events, including respiratory depression, when compared with other immediate-release, long-acting, and extended-release prescription opioids. Due to its relatively lower risk for overdose and misuse, buprenorphine was recently added to the Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain as a first-line treatment for chronic pain managed by opioids by the US Departments of Defense and Veterans Affairs, and the Department of Health and Human Services recommends that buprenorphine be made available for the treatment of chronic pain. In this narrative review, we discuss the different buprenorphine formulations, clinical efficacy, advantages for older adults and other special populations, clinical practice guideline recommendations, and payer considerations of buprenorphine and suggest that buprenorphine products approved for chronic pain should be considered as a first-line treatment for this indication.

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“…GBP was originally developed as an analgesic, and indeed GBP's efficacy for neuropathic pain and postherpetic neuralgia is well-established, with its use as monotherapy or adjunctive therapy supported by case reports and reviews [43]. GBP treatments have also shown efficacy in diabetic peripheral neuropathy [44]; postherpetic neuralgia (PHN) [45], trigeminal neuralgia [46]; neuropathic pain further to paclitaxel chemotherapy [47], and cancer-related pain in pregnant patients [48]. Pain control in pediatric patients has also been described [49,50].…”

Section: Pain Managementmentioning

confidence: 99%

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

Rusciano

2024

Preprint

1

0

View full text Add to dashboard Cite

Gabapentin (GBP) was originally developed as a potential agonist for Gamma-Amino-Butyric-Acid (GABA) receptors, aiming to inhibit the activation of pain-signaling neurons. Contrary to initial expectations, it does not bind to GABA receptors. Instead, it exhibits several distinct pharmacological activities, including: (1) binding to the alpha-2-delta protein subunit of voltage-gated calcium channels in the central nervous system, thereby blocking the excitatory influx of calcium; (2) reducing the expression and phosphorylation of CaMKII via modulation of ERK1/2 phosphorylation; (3) inhibiting glutamate release and interfering with the activation of NMDA receptors; (4) enhancing GABA synthesis; (5) increasing cell-surface expression of δGABA_A receptors, contributing to its antinociceptive, anticonvulsant, and anxiolytic-like effects. Additionally, GBP displays (6) inhibition of NF-kB activation and subsequent production of inflammatory cytokines, and (7) stimulation of the purinergic adenosine A1 receptor, which supports its anti-inflammatory and wound-healing properties. Initially approved for treating seizures and postherpetic neuralgia, GBP is now broadly used for various conditions, including psychiatric disorders, acute and chronic neuropathic pain, and sleep disturbances. Recently, as an eye drop formulation, it has also been explored as a therapeutic option for ocular surface discomfort in conditions such as dry eye, neurotrophic keratitis, corneal ulcers, and neuropathic ocular pain. This review aims to summarize the evidence supporting the molecular effects of GBP, with a special emphasis on its applications in ocular surface diseases.

show abstract

Pharmacologic Management of Cancer-Related Pain in Pregnant Patients

Cited by 4 publications

References 89 publications

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

Frontline Perspectives on Buprenorphine for the Management of Chronic Pain

Molecular Mechanisms and Therapeutic Potential of Gabapentin with a Focus on Topical Formulations to Treat Ocular Surface Diseases

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