The cognitive and psychomotor effects of morphine in healthy subjects: a randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo

OʼNeill, William M.; Hanks, G W; Simpson, P. M.; Fallon, Marie; Jenkins, Emma; Wesnes, Keith

doi:10.1016/s0304-3959(99)00274-2

Cited by 75 publications

(56 citation statements)

References 20 publications

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“…The RA and FM groups reported greater use of opioid medications compared with the MSK group. However, although a variety of medications, including opioids, are known to affect cognitive function, recent data have shown that attentional functioning is either not disrupted or improves in individuals, including chronic pain patients, following opioid consumption using both performance and electrophysiological measures (17)(18)(19)(20)(21)(22). In our study, patients who received opioid medications did not perform significantly differently from patients who did not receive opioids.…”

Section: Discussioncontrasting

confidence: 52%

Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients

Dick¹,

Eccleston²,

Crombez³

2002

Arthritis & Rheumatism

240

147

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Objectives. To investigate whether chronic pain patients have deficits in attentional functioning compared with pain-free controls, and whether fibromyalgia patients have larger deficits in attentional functioning compared with rheumatoid arthritis and musculoskeletal pain patients. Methods. Sixty patients (20 in each of 3 patient groups) and 20 pain-free controls completed measures assessing pain intensity, mood, pain-related disability, somatic awareness, and catastrophic thinking about pain. Attentional functioning was assessed using an age-standardized, ecologically valid test battery. Analyses were made of between-group differences. Results. Sixty percent of patients had at least one score in the clinical range of neuropsychological impairment, independent of demography and mood. Fibromyalgia patients were more anxious and somatically aware than rheumatoid arthritis or musculoskeletal pain patients, but did not show larger attentional deficits than other patient groups. Conclusion. All 3 groups of chronic pain patients, regardless of diagnosis, had impaired cognitive functioning on an ecologically sensitive neuropsychological test of everyday attention.

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Section: Discussioncontrasting

confidence: 52%

Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients

Dick¹,

Eccleston²,

Crombez³

2002

Arthritis & Rheumatism

240

147

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“…The classes of drugs which are prescribed for inducing sleep, reducing anxiety or reducing a histaminic response have well documented side effects including reduction in activity during wake [22,23] and impairment of mental ability and alertness in the acute phase following drug administration [28,29]. Drug-induced reduction in activity has been studied in 'spontaneous' activity [29] and there are some data to suggest that actigraphy is able to detect "hangover effects" [18,22,28,[30][31][32][33]. These studies, however, have employed different actigraphs and not the Actiwatch® (Cambridge Neurotechnology Ltd., UK) which has been used in this present study.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine‐induced reduction in activity mirrors decrements in cognitive and psychomotor performance

Dawson

Boyle

Stanley

et al. 2008

Human Psychopharmacology

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What this paper addsWhat is already knownThe evaluation of psychotropic drug effects has been conducted utilising psychometric test batteries to assess changes in daytime cognition and psychomotor functioning and PSG to assess changes in sleep. Actigraphy is widely accepted as a non-invasive tool for assessing sleep-wake patterns in different groups. However, there is limited data to show that actigraphy can reliably measure the daytime and night-time characteristics of a CNS drug. What this study adds -This study provides further evidence that actigraphy is sensitive not only to the sedating effects of a hypnotic drug but also to the hangover effects of the drug the following morning. It confirms that the actiwatch is able to detect the effects of a hypnotic on actigraphically measured sleep. Further evidence that actigraphy can provide a reliable and sensitive indication of the time course of action of psychoactive drugs. Lorazepam-induced reduction in activity 3 ABSTRACTAim: To assess whether actigraphy is sensitive to lorazepam-induced changes in cognitive and psychomotor performance by measuring activity levels following placebo and lorazepam (LZP) dosing.Methods: Healthy volunteers were randomised to a double-blind, placebocontrolled, crossover trial. Activity was recorded by actigraphy throughout each test period and pooled into 30 min bins for analysis. Following LZP dosing (2.5 mg at 18.00 h) psychomotor and cognitive tests were conducted at regular intervals.Results: Activity levels were significantly reduced between the psychometric tests (P < 0.02) at 2, 3 and 5 h post dose and during the psychometric tests (P < 0.02) at 2.5 and 4.5 h post dose. Subjects only felt sedated (P < 0.01) at 4.5 h post dose. Activity levels were also significantly reduced (P < 0.05) during sleep (23:00-07:00 h), and the following morning, activity levels remaining suppressed (P < 0.02) at 13.5 and 14 h post dose. Cognitive and psychomotor performance reflected changes in activity levels with significant impairment (P < 0.05) at 2.5, 3.5, 4.5 and 14.5 h post dose.Conclusion: This study showed that actigraphic activity levels were significantly reduced following LZP dosing. These changes were mirrored by impairment of cognitive and psychomotor performance. Actigraphy is therefore sensitive to the sedating effect of LZP and appears able to detect changes in sleep behaviour (hypnotic efficacy) and residual effects the following morning. Actigraphy may thus be a useful tool in assessing the psychopharmacology of CNS medication. Lorazepam-induced reduction in activity4

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“…23 Impairment of cognitive and psychomotor testing appears to be more pronounced when an opioid is administered parenterally, 24,25 as opposed to orally. 20,21 Furthermore, opioid-related impairment appears to be dose-related, 22 but in general the magnitude of impairment is markedly less than that associated with lorazepam. 20,21 Again, caution must be exercised when extrapolating the findings of these studies to the cancer population, on the grounds that volunteers are healthy and in no pain.…”

Section: Prevalence and Pattern Of Cognitive Effects Associated With mentioning

confidence: 99%

“…The presence of pain has been suggested by some authors to moderate the potentially negative influence of opioids on alertness and cognition. 21 The presence of pain as an antagonist to the sedative opioid effects is tentatively analogous to the effect of pain on the respiratory depressant effects of opioids, in which opioid-associated respiratory depression emerges when the pain stimulus is removed. 46 -48 Prospective studies in cancer patients that specifically examined opioid-related cognitive dysfunction are summarized in Table 3.…”

Section: Prevalence and Pattern Of Cognitive Effects Associated With mentioning

confidence: 99%

The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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BACKGROUNDOpioids have an essential role in the management of pain in cancer patients, particularly those with advanced disease. Cognitive dysfunction is a recognized complication of opioid use. However, misconceptions and controversy surround the nature and prevalence of its occurrence. A projected increase in the aging cancer population highlights the need for a better understanding of this phenomenon.METHODSA critical appraisal of the literature evidence in relation to the pattern, pathophysiology, assessment, impact, and management of cognitive dysfunction due to opioid use in cancer pain management is given.RESULTSStudies in cancer patients with less advanced disease reveal subtle evidence of cognitive impairment, largely related to initial dosing or dose increases. In advanced cancer, opioid‐induced cognitive dysfunction usually occurs in the form of delirium, a multifactorial syndrome. The presence of both cognitive impairment and delirium frequently is misdiagnosed or missed. Potential risk factors include neuropathic and incidental pain, opioid tolerance, somatization of psychologic distress, and a history of drug or alcohol abuse. Elevation of opioid metabolites with renal impairment may contribute to cognitive dysfunction. Recognition of opioid‐related cognitive dysfunction is improved by objective screening. Successful management requires either dose reduction or a change of opioid, in addition to addressing other reversible precipitants such as dehydration or volume depletion.CONCLUSIONSOpioid‐related cognitive dysfunction tends to be subtle in the earlier stages of cancer, whereas delirium, a more florid form with behavioral disturbance is likely to be present in the advanced cancer population. In patients with advanced disease, an optimal management approach requires careful clinical assessment, identification of risk factors, objective monitoring of cognition, maintenance of adequate hydration, and either dose reduction or switching to a different opioid. Cancer 2002;94:1836–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10389

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The cognitive and psychomotor effects of morphine in healthy subjects: a randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo

Cited by 75 publications

References 20 publications

Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients

Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients

Benzodiazepine‐induced reduction in activity mirrors decrements in cognitive and psychomotor performance

The panorama of opioid‐related cognitive dysfunction in patients with cancer

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