Rhythm and cues: role of chronobiology in perioperative medicine

Martin, Daniel; McKenna, Helen; Galley, Helen F.

doi:10.1016/j.bja.2018.04.035

Cited by 6 publications

(3 citation statements)

References 38 publications

(32 reference statements)

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“…Scheduling of opioids and nonsteroidal antiinflammatory drugs (NSAIDs) based on the circadian hormonal profile showed improved therapeutic effects and reduced toxicity (57). Administration of opioids in the evening is more effective compared with that during the early morning (67). Improved absorption, more protein binding, which decreases renal toxicity, and more opioid-sparing were observed after morning administration of oral NSAIDs (57).…”

Section: Improving the Efficacy Of Analgesicsmentioning

confidence: 99%

Establishment of an Individualized Chronotherapy, Autonomic Nervous System, and Variability-Based Dynamic Platform for Overcoming the Loss of Response to Analgesics

2021

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Background: Control of chronic pain and mainly the partial or complete loss of response to analgesics is a major unmet need. Multiple mechanisms underline the development of tolerance to analgesics in general and specifically to opioids. The autonomic nervous system (ANS) plays a role in the development of analgesic tolerance and chronobiology. Objectives: To review the mechanisms associated with the development of nonresponsiveness to analgesics. Study Design: Literature review. Setting: The review is followed by a description of a new method for overcoming resistance and improving the response to analgesics. Methods: Conducted a detailed review of the relevant studies describing the mechanisms that underlie tolerance to pain medications, and the potential roles of the ANS and chronobiology in the development of drug resistance. Results: The autonomic balance is reflected by heart rate variability, an example of a fundamental variability that characterizes biological systems. Chronotherapy, which is based on the circadian rhythm, can improve the efficacy and reduce the toxicity of chronic medications. In this article, we present the establishment of an individualized variability- and chronobiology-based therapy for overcoming the compensatory mechanisms associated with a loss of response to analgesics. We describe the premise of implementing personalized signatures associated with the ANS, and chronobiology, as well as with the pathophysiology of pain for establishing an adaptive model that could improve the efficacy of opioids, in a highly dynamic system. Limitations: The studies presented were selected based on their relevance to the subject. Conclusions: The described variability-based system may ensure prolonged effects of analgesics while reducing the toxicity associated with increasing dosages. Key words: Painkillers, opioids, drug resistance, compensatory mechanisms

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Section: Improving the Efficacy Of Analgesicsmentioning

confidence: 99%

Establishment of an Individualized Chronotherapy, Autonomic Nervous System, and Variability-Based Dynamic Platform for Overcoming the Loss of Response to Analgesics

2021

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“…This was observed in certain studies where opioid consumption was found to be more with patientcontrolled analgesia between 8:00 and 12:00 noon compared to evening and night. Circadian variation in secretion of opioid peptides like enkephalin and endorphins could also be responsible for the difference in perception of pain (Martin et al 2018). Analgesics have better efficacy and lesser side effects if administered at a specific time.…”

Section: Chronobiology In Perioperative Painmentioning

confidence: 99%

Scope of chronotherapy in perioperative medicine—a topical review

Nair

Diwan

2019

Ain-Shams J Anesthesiol

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“…Similarly, opioids seems to work effectively when administered in the evening than in morning hours which was also studied in healthy volunteers. [4] These chronopharmacological properties can be used in managing acute postoperative pain quite effectively.…”

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confidence: 99%