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Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
534
Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

Opioid Analgesics: Morphine and Other Natural Cogeners

187
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
187
CNS Stimulants: Cocaine, Amphetamines and Cannabinoids01:24

CNS Stimulants: Cocaine, Amphetamines and Cannabinoids

165
CNS stimulants, such as cocaine, amphetamines, and cannabinoids, have varying structures and mechanisms of action that lead to different therapeutic effects and side effects. Cocaine, with its molecular formula C17H21NO4, is a tropane alkaloid and a tertiary amino compound. It has two chemical forms: the hydrochloride salt and the "freebase." The former is in powder form, while the latter involves removing the hydrochloride salt to create a form that can be smoked. Cocaine exerts its...
165
Opioid Receptors: Overview01:22

Opioid Receptors: Overview

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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
549
Chemotherapy-Induced Nausea and Vomiting: Cannabinoids01:21

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
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Opioids and Cannabinoids in Neurology Practice.

Friedhelm Sandbrink, Nathaniel M Schuster

    Continuum (Minneapolis, Minn.)
    |October 24, 2024
    PubMed
    Summary

    Opioid and cannabinoid therapies for chronic pain are controversial. Understanding risks and implementing mitigation strategies, like careful patient selection and monitoring, are crucial for optimizing outcomes in neuropathic pain management.

    Area of Science:

    • Pain Management
    • Pharmacology
    • Neurology

    Background:

    • The shift towards a biopsychosocial model in pain care has reduced reliance on opioid therapy for chronic pain.
    • Increased opioid overdose deaths and opioid use disorder are linked to prescribing practices and illicit drug use, particularly fentanyl.
    • Cannabinoid use for chronic pain has seen a rise in the United States.

    Purpose of the Study:

    • To explore the controversial use of opioid and cannabinoid therapies for chronic pain, specifically neuropathic pain.
    • To understand patient and prescribing factors influencing risks associated with these therapies.
    • To highlight the importance of risk mitigation strategies in optimizing treatment outcomes.

    Main Methods:

    • Review of current guidelines and best practices for opioid therapy, including Centers for Disease Control and Prevention (CDC) recommendations.

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  • Examination of risk mitigation strategies for opioid therapy, such as patient selection, education, prescription drug monitoring, and naloxone.
  • Evaluation of evidence supporting the efficacy of cannabinoids for neuropathic pain.

    • Main Results:

    • Opioid therapy is generally not recommended for chronic neuropathic pain but may be considered for short-term use in severe cases as part of a multimodal approach.
    • Effective opioid risk mitigation strategies involve careful patient evaluation, informed consent, prescription drug monitoring, urine drug testing, and naloxone.
    • Cannabinoids show evidence of efficacy for neuropathic pain, with positive response rates in specific patient groups.

    Conclusions:

    • Opioid therapy requires stringent risk mitigation and close patient monitoring for chronic neuropathic pain.
    • Cannabinoids represent a viable therapeutic option for select patients with neuropathic pain.
    • A comprehensive approach integrating patient factors and risk management is essential for effective chronic pain treatment.