Rethinking Chronic Pain Treatment with Opioids

Abstract

Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. The International Association for the Study of Pain's widely used definition states, "pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" [1][2] . Pain mechanism is a complex phenomenon in which pain is induced by numerous pain modulating systems [2] , sensitized by the neurophysiological systems. Pain can be influenced by the different factors like psychological conditions, health status and sociological factors [3] .Pain is classified into two types, acute and chronic pain. If the pain persists for less than a month is called as acute pain. Clinically, if the pain persists more than three months after the injury, it is called as chronic pain [4,5] . This type of pain may or may not be driven by the tissue injury. The two forms of pains are nociceptive and neuropathic pain [5][6][7] . Stimulation of the pain receptors is considered as the nociceptive pain whereas damage or dysfunctional to the central and peripheral nervous system is considered as the neuropathic pain. Pain signalling and inhibition pathways:Inflammatory mediators like bradykinin, serotonin, prostaglandins and cytokines [8] are released from damaged tissues, which stimulate nociceptors [8][9][10] . Nociceptors are the specialized sensory receptors responsible for the detection of noxious (unpleasant) stimuli, transforming the stimuli into electrical signals, which are then conducted to the central nervous system (CNS) by primary afferent Aδ, C and Aβ fibers that are distributed throughout the body [10] . They can be stimulated by mechanical, thermal or chemical stimuli, called as primary sensitization. Aδ and C fibres transmit information to nociceptive specific neurons in Rexed laminae I and II of the dorsal horn in spinal cord, in addition to projections to other laminae. Primary afferent terminals release a number of excitatory neurotransmitters including glutamate and substance P [10][11][12][13] .Spinothalamic and spinoreticular tract are the two important pathways that carry signals to the higher centers of the brain. Spinothalamic tract is important

Correlation between the glucose level and the development of acute pancreatitis

“…Furthermore, studies are also required to explore the relevant mechanism. For patients at an early stage of AP, the severity and importance of organs involved in the injuries are more than the pancreas itself (Liu et al, 2006, Dos Santos et al, 2018, Alsharidah et al, 2018, Yildiz et al, 2017, Pati et al, 2017, Tatar et al, 2017), while multi-organ injuries are strongly associated with the inflammatory responses caused by hyperglycemia. Thus, in clinical treatment of AP, great attention should be paid to the glucose level, and rational control of glucose might be critical to the development and treatment of AP through affecting the inflammatory responses.…”

Effects of Baihe Dihuang powder on chronic stress depression rat models

“…Studies have shown that there is immune activation in patients with depression. Thymus and spleen are two important immune organs in the body (Wan et al, 2017, Tong, 2014, Naveed et al, 2018, Babenko et al, 2017, Pati et al, 2017, Tatar et al, 2017, Peng et al, 2017, Gao et al, 2017). The pathological changes of spleen and thymus in chronic stress depression rats can be improved significantly after intervention, indicating that it can alleviate the pathological development of depression by interfering with the immune system.…”

manejo del dolor crónico –no oncológico–: un reto bioético emergente

“…El dolor crónico -como enfermedad-representa -al mismo tiempo-uno de los problemas médicos, jurídicos y sociales (14,23,56,57) más preocupantes y silenciosos para la sociedad del siglo XXI. A lo largo de los últimos años, la reflexión e investigación se ha priorizado en este sentido, generándose mayor conciencia en cuanto al sufrimiento relacionado con la salud (19,58).…”