Effects of extended abstinence on cognitive functions in tramadol‐dependent patients: A cohort study

Hassaan, Shehab H; Khalifa, H.; Darwish, Alaa M.

doi:10.1002/npr2.12188

Cited by 4 publications

(6 citation statements)

References 35 publications

(36 reference statements)

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“…Several other consequences of NMU of tramadol do not neatly fit into these categories but have been reported in our scoping review findings. These include the negative impact on cognitive performance [ 64 ], decreased sexual self-esteem and increased sexual depression and preoccupation [ 56 ], a significant association with risky sexual behaviours [ 62 ], and potential impairment in the reabsorption function of nephrons [ 67 ]. Additionally, a significant correlation has been found between the NMU of tramadol and reduced life value moderated by moral identity [ 112 ].…”

Section: Resultsmentioning

confidence: 99%

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Boun,

Omonaiye,

Yaya

2024

PLOS Glob Public Health

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Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O’Malley’s (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol’s prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review’s main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being. Systematic review registration: Open Science Framework: https://osf.io/ykt25/.

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Section: Resultsmentioning

confidence: 99%

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Boun,

Omonaiye,

Yaya

2024

PLOS Glob Public Health

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“…Thus, the impairments in motivation and goal‐directed control observed during early morphine withdrawal were relatively short‐lived and not the result of long‐term cognitive dysfunction, consistent with clinical findings that cognitive and executive deficits at least partially recover with extended opioid abstinence. 7 , 8 , 9 It is also notable that prior preclinical research showing that repeated psychostimulant exposure does not impair flexible, goal‐directed choice behaviour 39 , 40 , 41 has typically evaluated performance after at least 1 week of drug cessation. Thus, it remains to be determined whether goal‐directed control is more markedly impaired during early than late psychostimulant withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…This loss of adaptive goal‐directed behaviour is multifaceted, comprising distinct emotional, motivational and cognitive components 4 and is positively correlated with withdrawal symptoms and craving in abstinent opioid users 5,6 . Cognitive impairments associated with opioid use tend to persist into drug abstinence and are often exacerbated during early withdrawal 7–9 . However, even after prolonged drug abstinence, exposure to opioid‐related cues can trigger cognitive dysfunction 10 and induce a disruptive attentional bias that is associated with eventual relapse 11,12 …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Cognitive impairments associated with opioid use tend to persist into drug abstinence and are often exacerbated during early withdrawal. [7][8][9] However, even after prolonged drug abstinence, exposure to opioidrelated cues can trigger cognitive dysfunction 10 and induce a disruptive attentional bias that is associated with eventual relapse. 11,12 Endogenous opioid systems are important regulators of feeding and food-motivated behaviour 13 and are persistently altered by chronic opioid exposure.…”

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confidence: 99%

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Differential effects of acute and prolonged morphine withdrawal on motivational and goal‐directed control over reward‐seeking behaviour

Halbout,

Hutson,

Agrawal

et al. 2024

Addiction Biology

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Opioid addiction is a relapsing disorder marked by uncontrolled drug use and reduced interest in normally rewarding activities. The current study investigated the impact of spontaneous withdrawal from chronic morphine exposure on emotional, motivational and cognitive processes involved in regulating the pursuit and consumption of food rewards in male rats. In Experiment 1, rats experiencing acute morphine withdrawal lost weight and displayed somatic signs of drug dependence. However, hedonically driven sucrose consumption was significantly elevated, suggesting intact and potentially heightened reward processing. In Experiment 2, rats undergoing acute morphine withdrawal displayed reduced motivation when performing an effortful response for palatable food reward. Subsequent reward devaluation testing revealed that acute withdrawal disrupted their ability to exert flexible goal‐directed control over reward seeking. Specifically, morphine‐withdrawn rats were impaired in using current reward value to select actions both when relying on prior action‐outcome learning and when given direct feedback about the consequences of their actions. In Experiment 3, rats tested after prolonged morphine withdrawal displayed heightened rather than diminished motivation for food rewards and retained their ability to engage in flexible goal‐directed action selection. However, brief re‐exposure to morphine was sufficient to impair motivation and disrupt goal‐directed action selection, though in this case, rats were only impaired in using reward value to select actions in the presence of morphine‐paired context cues and in the absence of response‐contingent feedback. We suggest that these opioid‐withdrawal induced deficits in motivation and goal‐directed control may contribute to addiction by interfering with the pursuit of adaptive alternatives to drug use.

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“…The following tests were used to record position-dependent cognition: the Stroop Colour and Word Test (Stroop) [ 31 ], a short, easy to learn and well-established test for executive function, which was also used in previous studies to assess the executive function in patients with PoTS [ 3 , 8 , 9 ], the Wechsler Memory Scale-Revised (WMS-R) forward and backward [ 32 ], providing global values for general short- and long-term memory [ 33 ]—it is one of the most widely used tests for evaluation of memory function in adults [ 34 ], the Corsi block-tapping task (Block) [ 35 ], a simple yet powerful test [ 36 ] that is effectively used to record visual spatial short-term memory [ 35 ], and the Trail Making Test subtest B (TMT-B) [ 37 ], used as a well-established test to assess cognitive flexibility [ 38 ]. It was already used in patients with PoTS in a prior study [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

Cognitive functioning in postural orthostatic tachycardia syndrome among different body positions: a prospective pilot study (POTSKog study)

Maier,

Schopen,

Thiel

et al. 2023

Clin Auton Res

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Purpose Approximately 96% of patients with postural orthostatic tachycardia syndrome (PoTS) report cognitive complaints. We investigated whether cognitive function is impaired during sitting and active standing in 30 patients with PoTS compared with 30 healthy controls (HCs) and whether it will improve with the counter manoeuvre of leg crossing. Methods In this prospective pilot study, patients with PoTS were compared to HCs matched for age, sex, and educational level. Baseline data included norepinephrine plasma levels, autonomic testing and baseline cognitive function in a seated position [the Montreal Cognitive Assessment, the Leistungsprüfsystem (LPS) subtests 1 and 2, and the Test of Attentional Performance (TAP)]. Cognitive functioning was examined in a randomized order in supine, upright and upright legs crossed position. The primary outcomes were the cognitive test scores between HCs and patients with PoTS at baseline testing, and among the different body positions. Results Patients with PoTS had impaired attention (TAP median reaction time) in the seated position and impaired executive functioning (Stroop) while standing compared with HC. Stroop was influenced by position (supine versus upright versus upright legs crossed) only in the PoTS group. Leg crossing did not result in an improvement in executive function. In patients with PoTS, there was a negative correlation of Stroop with norepinephrine plasma levels while standing. Conclusion Compared with HCs, PoTS participants showed impaired cognitive attention and executive function in the upright position that did not improve in the legs crossed position. Data provide further evidence for orthostatic cognitive deterioration in patients with PoTS. Trial Registration Information The study was registered at ClinicalTrials.gov (NCT03681080).

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Effects of extended abstinence on cognitive functions in tramadol‐dependent patients: A cohort study

Cited by 4 publications

References 35 publications

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Differential effects of acute and prolonged morphine withdrawal on motivational and goal‐directed control over reward‐seeking behaviour

Cognitive functioning in postural orthostatic tachycardia syndrome among different body positions: a prospective pilot study (POTSKog study)

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