New and emerging analgesics and analgesic technologies for acute pain management

Heitz, James W.; Witkowski, Thomas A.; Viscusi, Eugene R.

doi:10.1097/aco.0b013e32833041c9

Cited by 21 publications

(19 citation statements)

References 59 publications

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“…Second, awareness of pain relief has increased substantially in the recent past . Third, new products including slow‐release formulations have been introduced with aggressive marketing by pharmaceutical companies . Fourth, there is a greater willingness by the medical profession to prescribe POA, in part reversing a decadal trend of ‘under‐treatment’ of chronic pain .…”

Section: Discussionmentioning

confidence: 99%

Prescription opioid analgesics for pain management in Australia: 20 years of dispensing

Islam

McRae

Mazumdar

et al. 2016

Internal Medicine Journal

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Prescription opioid dispensing increased substantially over the study period. With an ageing population, this trend is likely to continue in future. A growing concern about harms associated with opioid use warrants balanced control measures so that harms could be minimised without reducing effective pain treatment. Research examining utilisation in small geographic areas may help design spatially tailored interventions. A real-time drug-monitoring programme may reduce undue prescribing and dispensing.

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Section: Discussionmentioning

confidence: 99%

Prescription opioid analgesics for pain management in Australia: 20 years of dispensing

Islam

McRae

Mazumdar

et al. 2016

Internal Medicine Journal

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“…10, 23,43 Recently, evidence has emerged that single doses prior to surgery in the form of extended-release liposomal injections in the lumbar region, with no need to place an epidural catheter, reliably provide good, long-lasting (up to 48 hours) analgesia, with reasonable levels of tolerance for side effects. [44][45][46]67 Clinical trials have also shown that the administration of lipophilic opioids by continuous epidural infusion does not cause analgesia by direct spinal action [48][49][50][51][52][53][54][55][56][57][58][59][60] (in contrast to epidural bolus injections of fentanyl, where sufficient concentrations of the drug can reach the spinal site of action 61 ). On the other hand, the addition of opioids, including lipophilic opioids, may enable a reduction in the dose of LA and a commensurate reduction in LArelated side effects.…”

Section: Discussionmentioning

confidence: 99%

“…The balance between all of these processes, described in terms of the spinal bioavailability of the drug, determines its clinical characteristics and relates to the overall effectiveness 14,23 (Table 1). Clinical trials have demonstrated that hydrophilic opioids like morphine, 9,10 especially when given as a continuous infusion plus LA, 23,43 or by extended-release epidural injections, [44][45][46] provide good postoperative analgesia but are associated with a relatively high rate of adverse effects. 47 Most of the analgesic effect of epidural lipophilic opioids such as fentanyl, [48][49][50][51][52] sufentanil, [53][54][55][56] and alfentanil [57][58][59] is due to systemic uptake.…”

Section: Clinical Recommendations For Postoperative Painmentioning

confidence: 99%

Spinal Opioid Bioavailability in Postoperative Pain

Bujedo

2013

Pain Practice

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Opioids have been used for spinal analgesia for more than a century, and their injection epidurally and intrathecally has a key role in the control of postoperative pain. Since the discovery of the endogenous opioid system, 3 decades ago, their use has become more generalized in obstetric analgesia, the management of chronic pain, and acute postoperative pain. To use opioids effectively for this type of analgesia, it is important to understand the pharmacokinetics and clinical pharmacology of these drugs, specifically those that produce analgesia by an intrinsic spinal mechanism. Evidence from animal and human experiments indicates that hydrophilic opioids (such as hydromorphone and morphine) bind more strongly to specific receptors within the dorsal horn of the spinal cord than lipophilic opioids (such as alfentanil, fentanyl, and sufentanil). This can be understood by considering the spinal cord selectivity and bioavailability of these opioids. This difference is attributable to differences in the pharmacokinetic and pharmacodynamic properties of the 2 groups. It is more difficult for lipophilic opioids to reach and remain at sufficiently high concentrations at the site of action due to their sequestration in epidural fat and rapid plasma clearance from both epidural and intrathecal spaces, resulting in analgesia with a limited spread and duration, as well as the appearance of early supraspinal side effects. In contrast, morphine has very different properties, including greater spinal bioavailability and therefore administered neuraxially, it is suitable choice for the treatment of acute postoperative pain. However, when using morphine, a greater incidence of adverse effects can be expected, and it requires careful patient selection.

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“…There is no ideal analgesic regimen, as none encompasses the characteristics of a fast onset of action, good costeffectiveness profile, absence of short and long-term adverse effects, nil interaction with other drugs and/or metabolites, and ease of administration, both for the patients and healthcare personnel. Furthermore, technical deficiencies in the drug-delivery systems have contributed to a worsening of this situation, which is why, over the past few years, new and more precise mechanisms have appeared to allow us to improve the overall quality of analgesic regimens, "making old drugs new", especially those in the opioids family [2].…”

Section: Introductionmentioning

confidence: 99%