Rhythmic pattern of PCA opioid demand in adults with cancer pain

Schießl, Christine; Schestag, I.; Sittl, Reinhard; Drake, Ross; Zernikow, Boris

doi:10.1016/j.ejpain.2009.06.009

Cited by 19 publications

(5 citation statements)

References 40 publications

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“…Next, Kavaliers et al also demonstrated that the change of daily rhythms alters the analgesia of morphine in mice, with an enhanced analgesic effect in the dark cycle [ 12 ]. A clinical retrospective study observed a lower demand for self-administered morphine in adults with cancer pain at night [ 13 ]. Furthermore, morphine showed considerable pharmacokinetic variation depending on the time of injection during the day [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Circadian Hormone Melatonin Inhibits Morphine-Induced Tolerance and Inflammation via the Activation of Antioxidative Enzymes

et al. 2020

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Opioids are commonly prescribed for clinical pain management; however, dose-escalation, tolerance, dependence, and addiction limit their usability for long-term chronic pain. The associated poor sleep pattern alters the circadian neurobiology, and further compromises the pain management. Here, we aim to determine the correlation between constant light exposure and morphine tolerance and explore the potential of melatonin as an adjuvant of morphine for neuropathic pain treatment. Methods: Wistar rats were preconditioned under constant light (LL) or a regular light/dark (LD) cycle before neuropathic pain induction by chronic constriction injury. An intrathecal (i.t.) osmotic pump was used for continued drug delivery to induce morphine tolerance. Pain assessments, including the plantar test, static weight-bearing symmetry, and tail-flick latency, were used to determine the impact of the light disruption or exogenous melatonin on the morphine tolerance progression. Results: constant light exposure significantly aggravates morphine tolerance in neuropathic rats. Continued infusion of low-dose melatonin (3 μg/h) attenuated morphine tolerance in both neuropathic and naïve rats. This protective effect was independent of melatonin receptors, as shown by the neutral effect of melatonin receptors inhibitors. The transcriptional profiling demonstrated a significant enhancement of proinflammatory and pain-related receptor genes in morphine-tolerant rats. In contrast, this transcriptional pattern was abolished by melatonin coinfusion along with the upregulation of the Kcnip3 gene. Moreover, melatonin increased the antioxidative enzymes SOD2, HO-1, and GPx1 in the spinal cord of morphine-tolerant rats. Conclusion: Dysregulated circadian light exposure significantly compromises the efficacy of morphine’s antinociceptive effect, while the cotreatment with melatonin attenuates morphine tolerance/hyperalgesia development. Our results suggest the potential of melatonin as an adjuvant of morphine in clinical pain management, particularly in patients who need long-term opioid treatment.

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Section: Introductionmentioning

confidence: 99%

The Circadian Hormone Melatonin Inhibits Morphine-Induced Tolerance and Inflammation via the Activation of Antioxidative Enzymes

et al. 2020

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“…However, studying analgesic consumptions is difficult, analgesic consumptions of acute pain differ across not only the patients but also time. 8 , 9 Although the evidence showed patterns of morphine reduction from postoperative day 1 to day 3 and a possible biological rhythm pattern existing, 5 , 10 , 11 studies to reveal the analgesic patterns are very rare. 10 , 11 …”

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confidence: 99%

Serial Analgesic Consumptions and Predictors of Intravenous Patient-controlled Analgesia with Cluster Analysis

Lin

Chang

Tsou

et al. 2016

The Clinical Journal of Pain

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Objectives:To elucidate the dynamics of analgesic consumption regarding intravenous patient controlled analgesia (IVPCA) during postoperative period is rather complex partly due to between-patient variation and partly due to within-patient variation. A statistical method was proposed to classify serial analgesic consumption into different classifications that were further taken as the multiple outcomes on which to explore the associated predictors.Methods:We retrospectively included 3284 patients administrated by IVPCA for 3 days after surgery. A repeated measurement design corresponding to serial analgesic consumption variables defined as six-hour total analgesic consumptions was adopted. After determining the numbers of clusters, serial analgesic consumptions were classified into several homogeneous subgroups. Factors associated with new classifications were identified and quantified with a multinominal logistic regression model.Results:Three distinct analgesic classifications were aggregated, including “high”, ”middle” and “low” level of analgesic consumption of IVPCA. The mean analgesic consumptions on 12 successive analgesic consumptions at 6-hour interval of each classification consistently revealed a decreasing trend. As the trends were almost parallel with time, this suggests the time-invariant proportionality of analgesic consumption between the levels of analgesic consumption of IVPCA. Patient’s characteristics, like age, gender, weight, height, and cancer status, were significant factors associated with analgesic classifications. Surgical sites had great impacts on analgesic classifications.Discussion:The serial analgesic consumptions were simplified into 3 analgesic consumptions classifications. The identified predictors are useful to recognize patient’s analgesic classifications before using IVPCA. This study explored a new approach to analysing dynamic changes of postoperative analgesic consumptions.

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“…Cancer pain sufferers appear to experience more breakthrough pain (BTP) during the late morning around 9:45 -10:15 (Saini et al, 2012). Consistent with these results, Schiessl et al (2010), evaluated the use of an opioid-PCA for the treatment of BTP in adults with cancer pain. They found that opioid analgesia was least demanded from 22:00 to 6:00 compared to any other time of the day with a significant 34% less self-administered opioid within these hours.…”

Section: Circadian Rhythm In Pain Perceptionmentioning

confidence: 68%

Circadian variation of pain as a measure of the analgesia requirements during the first 24-postoperative hours in patients using an opioid Patient Controlled Analgesia delivery system

Sandoval

2017

J Current Med Res Opinion

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Circadian rhythms have governed the everyday life of every single organism that has lived on Earth. The present study addresses the rhythms of cortisol and melatonin, their analgesic properties and the potential circadian rhythm of pain as a driver of the frequency of self-administered analgesia in postoperative patients with an opioid Patient Controlled Analgesia (PCA) delivery system. It aims to determine if acute 24-hour post-operative pain displays a circadian variation by analysing the number of times that patients self-administered morphine for pain relief and incidentally to determine if gender has any association with the frequency of self-administered analgesia. For that purpose, the frequencies of self-administered analgesia were divided into four periods of six hours each (three of them approximately corresponded to the day, and 1 to the night). A Multi-level Poisson regression analysis compared frequencies during period 4 (night) to all others (1, 2 and 3). The results show that there was a statistically significant difference between the frequencies of self-administered opioids in the night period compared to any other day period (p-value of <0.001, for periods 1, 2 and 3 respectively compared to period 4). Differences in terms of gender were also statistically significant (p < 0.001) with men’s opioid consumption almost double that of women’s but with much steeper rate of decline (p<0.001). These results may be partly explained by the rhythms of melatonin, cortisol and ß-endorphine, morphine’s chronopharmacology and possibly by oestrogen and progesterone.

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Rhythmic pattern of PCA opioid demand in adults with cancer pain

Abstract: PCA met individual patient's opioid needs in a safe and effective manner despite a large inter-individual variability in opioid consumption. Moreover, the study indicated a pattern of less opioid requirement at night.

Cited by 19 publications

References 40 publications

The Circadian Hormone Melatonin Inhibits Morphine-Induced Tolerance and Inflammation via the Activation of Antioxidative Enzymes

The Circadian Hormone Melatonin Inhibits Morphine-Induced Tolerance and Inflammation via the Activation of Antioxidative Enzymes

Serial Analgesic Consumptions and Predictors of Intravenous Patient-controlled Analgesia with Cluster Analysis

Circadian variation of pain as a measure of the analgesia requirements during the first 24-postoperative hours in patients using an opioid Patient Controlled Analgesia delivery system

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