Resource consumption and costs of treating pain in patients affected by cancer in a district of northeast Italy

Roggeri, Daniela Paola; Saramin, C.; Terrazzani, G.; Zusso, Morena; Giusti, Pietro; Chinellato, Alessandro

doi:10.1016/j.phrs.2007.08.001

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…- Use of NSAIDs was measured as the number of defined daily doses (DDD) used over each study period, which were then summed and studied as mean daily DDD used [23-25]. Drugs were summed globally.…”

Section: Methodsmentioning

confidence: 99%

Phytalgic®, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial

et al. 2009

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IntroductionThe medicinal treatment of osteoarthritis (OA) is mostly symptomatic to relieve pain and incapacity with analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), drugs with well-known risks. Complementary medicines might reduce the symptoms of OA and decrease the need for NSAIDs. This study tested the effects of a food supplement, Phytalgic®, on pain and function in patients with osteoarthritis and their use of analgesic and NSAIDs.MethodsA randomized double-blind parallel-groups clinical trial compared Phytalgic® (fish-oil, vitamin E, Urtica dioica) to a placebo for three months, in 81 patients with OA of the knee or hip using NSAIDs and/or analgesics regularly. The main outcome measures were use of NSAIDs (in Defined Daily Doses per day - DDD/day) or analgesics (in 500 mg paracetamol-equivalent tablets per week (PET/week) measured each month, and Western Ontario-McMaster University Osteo-Arthritis Index (WOMAC) function scales.ResultsAfter three months of treatment, the mean use of analgesics in the active arm (6.5 PET/week) vs. the placebo arm (16.5) was significantly different (P < 0.001) with a group mean difference of -10.0 (95% CI: -4.9 to -15.1). That of NSAIDs in the active arm (0.4 DDD/day) vs the placebo arm (1.0 DDD/day) was significantly different (P = 0.02) with a group mean difference of - 0.7 DDD/day (95% CI: -0.2 to -1.2). Mean WOMAC scores for pain, stiffness and function in the active arm (respectively 86.5, 41.4 and 301.6) vs the placebo arm (resp. 235.3, 96.3 and 746.5) were significantly different (P < 0.001) with group mean differences respectively of -148.8 (95% CI: -97.7 to -199.9), -54.9 (95% CI: -27.9 to -81.9) and -444.8 (95% CI: -269.1 to -620.4).ConclusionsThe food supplement tested appeared to decrease the need for analgesics and NSAIDs and improve the symptoms of osteoarthritis.Trial registrationClinicaltrials.gov NCT00666523.

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Section: Methodsmentioning

confidence: 99%

Phytalgic®, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial

et al. 2009

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“…Important progress has been made in the development of opioids derived from opiates in the last century, but several of their side effects persist ( 5 ). An Italian study revealed that the average duration of opioid treatment in patients with cancer is ~105 days ( 6 ). Long-term opioid treatment results in decreased analgesic efficacy via increased tolerance and an increased potential for addiction ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Molecular mechanisms of opioid tolerance: From opioid receptors to inflammatory mediators (Review)

Zhou

Ying

et al. 2021

Exp Ther Med

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Opioids are considered the most effective analgesics for the treatment of both acute and chronic pain. However, prolonged opioid use can induce a certain level of tolerance to its analgesic effects, leading to a reduction in its effectiveness, addiction and abuse. A better understanding of the mechanisms underlying opioid tolerance may provide insights into this phenomenon and aid in the development of novel methods to combat the side effects of opioid tolerance. The present review focused on two major contributors to tolerance, opioid receptors and inflammatory mediators. The molecular mechanisms involved in the desensitization of the opioid receptors were briefly described, including their phosphorylation, internalisation and recycling. Subsequently, the effects of Toll like receptor 4/NOD-like receptor family pyrin domain containing 3-mediated proinflammatory responses in opioid tolerance were discussed, aiming in supporting the identification of novel therapeutic targets. Contents 1. Introduction 2. Opioid receptors 3. Molecular mechanisms of opioid tolerance 4. Proinflammatory cytokines in morphine tolerance 5. Conclusions

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“…It has been reported that as many as 3-5% of adults in the United States are prescribed long-term opioid therapy [12]. A recent survey of persistent pain patients showed that 60% were prescribed morphine, 37% fentanyl, and 2.5% buprenorphine, with an average length of treatment of 105 days [13]. While opioids are highly effective and often necessary for the management of many persistent and severe pain conditions, prolonged use results in decreased analgesic efficacy (i.e., tolerance) and the requirement for steadily larger doses of opioids for pain management (i.e., dose-escalation) [14,15].…”

Section: Introductionmentioning

confidence: 99%

Neuronal and glial factors contributing to sex differences in opioid modulation of pain

Averitt

Eidson

Doyle

et al. 2018

Neuropsychopharmacol

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Morphine remains one of the most widely prescribed opioids for alleviation of persistent and/or severe pain; however, multiple preclinical and clinical studies report that morphine is less efficacious in females compared to males. Morphine primarily binds to the mu opioid receptor, a prototypical G-protein coupled receptor densely localized in the midbrain periaqueductal gray. Anatomical and physiological studies conducted in the 1960s identified the periaqueductal gray, and its descending projections to the rostral ventromedial medulla and spinal cord, as an essential descending inhibitory circuit mediating opioid-based analgesia. Remarkably, the majority of studies published over the following 30 years were conducted in males with the implicit assumption that the anatomical and physiological characteristics of this descending inhibitory circuit were comparable in females; not surprisingly, this is not the case. Several factors have since been identified as contributing to the dimorphic effects of opioids, including sex differences in the neuroanatomical and neurophysiological characteristics of the descending inhibitory circuit and its modulation by gonadal steroids. Recent data also implicate sex differences in opioid metabolism and neuroimmune signaling as additional contributing factors. Here we cohesively present these lines of evidence demonstrating a neural basis for sex differences in opioid modulation of pain, with a focus on the PAG as a sexually dimorphic core of descending opioid-induced inhibition and argue for the development of sex-specific pain therapeutics.

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Resource consumption and costs of treating pain in patients affected by cancer in a district of northeast Italy

Cited by 11 publications

References 26 publications

Phytalgic®, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial

Phytalgic®, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial

Molecular mechanisms of opioid tolerance: From opioid receptors to inflammatory mediators (Review)

Neuronal and glial factors contributing to sex differences in opioid modulation of pain

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