The incidence of pruritus after epidural morphine

Ballantyne, Jane C.; Loach, A. B.; Carr, Daniel B.

doi:10.1111/j.1365-2044.1989.tb09116.x

Cited by 39 publications

(15 citation statements)

References 5 publications

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“…Analgetics may induce itch sensation, e.g. by epidural or intrathecal application of opioids or anesthetics [51,52,53]. This can be explained by an itch circuitry which is under a tonic inhibitory control of mechanosensitive neurons (fig.…”

Section: Pathogenesismentioning

confidence: 99%

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Kremer

Bolier

Dijk

et al. 2014

Dig Dis

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Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic pruritus. Serum activity of autotaxin correlated with itch intensity and response to antipruritic treatment in patients with cholestatic pruritus, but not other forms of pruritus. Autotaxin activity thereby represents the first biomarker for pruritus and had a positive predictive value of 70% in differentiating cholestatic pruritus from other forms of pruritus. Treatment options for patients with cholestatic pruritus include the anion exchange resin colestyramine, the PXR agonist rifampicin, the μ-opioid antagonist naltrexone, and the serotonin reuptake inhibitor sertraline. These drugs are recommended by evidence-based guidelines as a stepwise therapeutic approach. Patients unresponsive to these drugs should be referred to specialized centers to receive experimental approaches such as UVB phototherapy, albumin dialysis, plasmapheresis or nasobiliary drainage. This review discusses pruritogen candidates in cholestasis, gives novel insights into the neuronal signaling pathway of pruritus and summarizes evidence-based treatment options for patients suffering from pruritus in cholestasis.

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Section: Pathogenesismentioning

confidence: 99%

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Kremer

Bolier

Dijk

et al. 2014

Dig Dis

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“…An alternative interpretation was submitted as a hypothesis: "increased availability of endogenous opiate [opioid] agonist ligands at central opiate [opioid] receptors may contribute to the pruritus of cholestasis" [13]. The basis for this hypothesis was: (i) the opiate withdrawal-like reaction precipitated by the opiate antagonist nalmefene in patients with cholestasis [12], hence suggesting that central opioid neurotransmission was increased, and (ii) the pruritus associated with the pharmacologic increase in opioidergic neurotransmission (tone) by the central administration of drugs (i.e., morphine) with agonist activity at the opioid receptors (i.e., mu opioid receptor according to current knowledge) that can be prevented and ameliorated by opiate antagonists [14].…”

Section: Pathogenesis Of the Pruritus Of Cholestasismentioning

confidence: 99%

Pruritus

Bergasa

2015

Cirrhosis: A Practical Guide to Management

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“…4 By virtue of its opioid antagonistic actions, it is believed to relieve pruritus in patients with PBC who are often described as having an increase in opioidergic tone. [70][71][72] The recommended maximum daily dose of naltrexone is 50 mg/day, however, it is usually started at a lower dose of 12.5 mg/day and gradually titrated up. The commonest side effects include opioid withdrawal-like reaction during the initial few days of treatment.…”

Section: Management Of Itch In Pbcmentioning

confidence: 99%

Novel strategies and therapeutic options for the management of primary biliary cholangitis

Khanna

Jones

2017

Therap Adv Gastroenterol

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Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease. It has a varied course of progression ranging from being completely asymptomatic to aggressive disease leading to cirrhosis and resulting in liver transplantation. In addition, symptoms can be debilitating and can have a major impact on quality of life. For decades, there was only one anti-cholestatic agent available to target this disease and that was only effective in around half of patients, with little or no effect on symptoms. With increasing understanding of the pathogenic mechanisms of PBC and potential targets for drug treatment, pharmaceutical companies have shown a greater interest in this rare disease. A large number of novel therapeutic molecules have been developed and are currently being evaluated. In this review article all the novel molecules in use and in trials targeting cholestasis and symptoms in PBC are discussed.

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The incidence of pruritus after epidural morphine

Cited by 39 publications

References 5 publications

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Pruritus

Novel strategies and therapeutic options for the management of primary biliary cholangitis

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