جستجوی مقالات مرتبط با کلیدواژه « opioid » در نشریات گروه « پزشکی »

Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery.

This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia.

 After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group.

The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.

Pain is an unpleasant experience and a subjective term that is associated with tissue damage. Cancer patients experience pain for a myriad of reasons, from disease related to treatment causes and unrelated to both of these categories.
Opioids are the mainstay in the treatment of moderate to severe cancer pain. Progressive opioid dose increases can cause opioid-induced hyperalgesia (OIH).
OIH has no definite management, here we present a 47-year-old cancer patient with OIH and her management.

The diversity of the portfolio of pharmaceutical and non-pharmacological services is an undeniable necessity; however, we must remember that the thinking of harm reduction should govern this process. If we only pay attention to the variety of drugs and their different forms, eventually the noble goal of harm reduction will suffer. In an article that Pedersen et al. prepared about the slow-release form of buprenorphine, there are structural and content problems that will be addressed in this article. This article criticizes the rapid change in the provision of harm reduction services and discusses the impact of structural changes in the provision of services and the location of service provision.

Regarding the unpleasant pain sensation and the public’s desire to use traditional herbs, the present study aimed to assess the analgesic and anti-inflammatory effect of Chenopodium botrys L. The present research was divided into two main sections to assess the analgesic and anti-inflammatory effect of Chenopodium botrys L. in male mice. To investigate the analgesic effect of Chenopodium botrys L., thirty-six male mice were randomly classified into six groups vehicle (receiving normal saline), experimental groups received morphine (a well-known opioid, 1 mg/kg), hydroalcoholic extracts of Chenopodium botrys L. (30, 100, and 300 mg/kg), and naloxone (opioid receptor antagonist) with the highest dose of Chenopodium botrys L. concurrently for one week. Thirty mice were divided into five groups to receive normal saline, various doses of extract (30, 100, and 300 mg/kg), and dexamethasone (a well-known anti-inflammatory drug, 10 mg/kg) to assess the anti-inflammatory effect of Chenopodium botrys L. In both sections, after the last doses of the treatment, the animals got ready for behavioral study related to pain. Overall, the highest doses of Chenopodium botrys L. demonstrated much better results than other doses, which were comparable to opioids and dexamethasone, a well-known analgesic and anti-inflammatory medicines, respectively. Regarding present findings, the Chenopodium botrys L. plant can be a new candidate as an analgesic agent, which needs more investigation in the search and pharmaceutical development.

Klotho is an aging-suppressor gene that encodes a single-pass transmembrane protein and acts as a hormone. In this study, we aim to investigate the serum α-Klotho level in male opioids addicts with normal kidney function compared to healthy male non-smokers and smokers in Tabriz, Iran.

Participnts were 87 men with normal kidney function referred to Sina Educational Research and Treatment Center in Tabriz, Iran (29 opioids addicts, 29 healthy non-smokers, and 29 healthy smokers). Blood samples were collected to measure the soluble a-Klotho level using an ELISA kit. Furthermore, blood creatinine (Cr) and hemoglobin (Hb) levels was measured. Body mass index (BMI) was also calculated for all participants.

In addicts, BMI, Hb, and Cr levels were significantly lower than in healthy non-smokers and smokers, but their Klotho level was higher (P>0.05). The Klotho level in healthy smokers was significantly lower than in healthy non-smokers and addicts. The Klotho level of healthy smokers decreased as the pack year increased, but the duration of opioid addiction had no significant association with the Klotho level. There was no significant difference in the Klotho level between control groups (non-smokers and smokers) and men with addiction to different types of opioids.

The Klotho level in male opioid addicts is significantly higher than in smokers. There is a significant negative correlation between BMI and Klotho levels among men with normal BMI and overweight. Further studies are recommended in these fields.

 Peripheral nerve blocks (PNBs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. PNBs aim to decrease overall perioperative pain and lower systemic analgesic requirements. Short-acting anesthetic agents are commonly given as single-injection PNBs for pain relief, typically lasting less than 24 hours. Liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection PNB and may allow patients to recover postoperatively with a lower need for opioid analgesics.

 This study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus PNB for hand surgery.

 A retrospective review of patients who underwent a long-acting PNB using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between July 2020 and May 2023 in Florida, USA. Patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics.

 One hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). Patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the PNB to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. Nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used NSAIDs postoperatively.

 Liposomal bupivacaine PNBs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. Patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. Given these results, long-acting PNBs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.

Cognitive flexibility is associated with psychiatric disorders. Drug addicts experience more psychiatric disorders. This research aimed to examine depression and suicidal ideation among those receiving opioid maintenance treatment (OMT), taking into account the mediating role of cognitive flexibility.

This cross-sectional research was conducted on patients who were enrolled in the OMT program in Semnan in 2021 and abstained from opioid use for at least one year. 126 participants (115 males and 11 females) were randomly selected from among patients in three therapeutic groups (42 from each of the methadone, buprenorphine, and opium tincture groups). The main data collection tools were the Beck Scale for Suicide Ideation (BSSI), Cognitive Flexibility Inventory (CFI), and Beck Depression Scale (BDI-II). Data analysis was done through logistic regression models.

Correlation analysis between depression scores, suicidal ideation, and cognitive flexibility showed a significant correlation between each of them. Adjusting for the type of treatment, the increase in cognitive flexibility was associated with a decreasing chance of depression (odds ratio [OR] = 0.87; 95% CI [0.82, 0.92]), and the use of buprenorphine (OR = 15.1) and opium tincture (OR = 9.3), compared to methadone, were associated with a depression increase. Yet, multivariate analysis did not show an independent and significant association between cognitive flexibility and the risk of suicide.

Based on the results, patients receiving maintenance treatments are in different conditions in terms of depression and suicide, and psychological flexibility is in correlation with depression and suicidal thinking and behavior in them. This suggests that these patients seem to benefit from cognitive training, at least in reducing their depression.

Despite recognizing the traditional coronary artery disease (CAD) risk factors, some secondary factors, such as opioid substance abuse, have to be considered. We aimed to assess the relationship between opioid consumption and emergency percutaneous coronary intervention (PCI) revascularization results, according to Thrombolysis in Myocardial Infarction (TIMI) flow and in‑hospital survival outcomes in ST‑elevation myocardial infarction (STEMI) patients.

This case–control study was conducted on 186 patients (93 patients in each group) with acute STEMI, who were referred to Chamran Heart Center, Isfahan, Iran. Opioid addiction was diagnosed by patients’ records and confirmed by conducting an interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‑IV) criteria. Patients in both groups were evaluated and compared for angioplasty results based on the TIMI flow grade and in‑hospital cardiovascular events and complications.

Ninety‑one patients (97.84%) of each group were male, and opioid‑addicted patients were younger than the non‑opioid users (52.95 9.91 vs. 57.90 12.17, P = 0.003). Among the CAD risk factors, prevalence of dyslipidemia was significantly higher in non‑opioid users, whereas cigarette smoking was higher in opioid‑addicted patients (P < 0.050). There was no significant difference between the two groups regarding pre‑ and post‑procedural myocardial infarction complications as well as mortality rate (P > 0.050). Also, there were no significant differences between the opioid and non‑opioid users regarding TIMI flow grading, and successful PCI rate based on achieving TIMI III was 60.21% versus 59.1% in opiate‑dependent and non‑opioid users, respectively (P = 0.621).

Opioid addiction has no effects on post‑PCI angiographic results and in‑hospital survival outcomes in STEMI patients which undergoing emergency PCI.

Coronavirus disease 2019 (COVID‑19) quickly spread to the world, causing a pandemic. While some studies have found no link between opioid use disorder (OUD) and COVID‑19, the role of opioid on COVID‑19 is challenging. The present study aimed to determine the relationship between OUD and COVID‑19.

This was a prospective cohort study. We used data from the third phase of the Shahroud Eye Cohort Study on 4394 participants which started in September 2019 and ended before the COVID‑19 epidemic in Shahroud in February 2020. The participants were followed for about 13 months till March 26, 2021. COVID‑19 was detected by RT‑PCR on swap samples from the oropharynx and nasopharynx. The incidence of COVID‑19 compared in OUD and non‑OUD participants, and relative risk was calculated in log‑binomial regression models.

Among the 4394 participants with a mean age of 61.1 years, 120 people had OUD. The incidence of COVID‑19 in participants with OUD and non‑OUD was 4.17% and 6.22%, respectively (P‑value: 0356). The relative risk of OUD for COVID‑19 was 0.60 (95% confidence intervals: 0.25–1.44; P value: 0.251).

OUD was not associated with COVID‑19. The claim that people with OUD are less likely to develop COVID‑19 is not supported by these data.

Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients.

This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05.

About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval.

Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Considering the side effects of high doses of opioids taken postoperatively for pain control, paracetamol and magnesium sulfate may be able to aid in pain control. This study assessed the effects of paracetamol and magnesium sulfate on the level of pain and opioid intake following orthognathic surgery.   

In this double-blind randomized clinical trial, patients scheduled for bimaxillary orthognathic surgery were randomly assigned to two groups of 25. Group 1 patients received 1 g infusion of intravenous acetaminophen (paracetamol) administered within 20 minutes while group 2 patients received 50 mg/kg magnesium sulfate infusion one hour prior to completion of surgery. The patients were asked to express their level of pain prior to discharge from the recovery, and every 4 hours for 12 hours using a visual analog scale (VAS). Patients with pain score > 5 at any time received 30 mg pethidine. The total received dosage of pethidine postoperatively was recorded and those that received pethidine were not included in pain score analysis. Data were analyzed by generalized estimating equation (GEE), and Mann-Whitney U, Chi-square, and t-tests.

The pain score was not significantly different between the two groups at the time of recovery and 4 and 8 hours (P>0.05). The magnesium sulfate group had significantly lower pain score at 12 hours (P=0.009). The difference in pethidine dosage was not significant (P>0.05).

Both magnesium sulfate and paracetamol decreased postoperative pain and the need for opioid consumption, but magnesium sulfate was slightly more effective.

The use of opioids is considered a risk factor for laryngeal cancer. A retrospective study was performed to explore the relationship between recreational drug exposure and laryngeal cancer.

Patients diagnosed between the 1st of January 2013 and the 31st of December 2017 using ICD-10 CD-32 coding were identified from the Head and Neck Multidisciplinary Team database. We divided the study population into two cohorts (RD and non-RD) and compared the demographics, morbidity, and outcomes of these two populations. In addition, we performed case-matched analysis to control for potential confounding factors including gender, alcohol use and cigarette smoking.

329 patients in Glasgow, Scotland were included with a mean age of 64.96 ± 10.94 and a follow-up of 24 ± 13.91 months. Of these, 39 reported recreational drug use (RD). RD was associated with younger age (53.0 vs. 66.6, p<0.001) at diagnosis with laryngeal cancer. A greater proportion of tumours occurred in the supraglottic subsite (p=0.041). Furthermore, these patients were more likely to undergo tracheostomy (RR=2.50, 95% CI: 1.41-4.44, p=0.008) and laryngectomy (RR=2.25, 95% CI: 1.57-3.21, p<0.001). Recreational drug users were more likely to require enteral feeding support (RR= 1.44, 95% CI: 1.13-1.84, p=0.02) during oncological treatment. No survival differences were noted at 1, 2, or 3-years (plog-rank=0.83). Case matched analysis correcting for smoking, alcohol and gender confirmed that recreational drug users were younger at diagnosis with a predilection for the supraglottic subsite.

Recreational drug use is associated with an increased burden of disease and morbidity in laryngeal cancer. We suggest that clinicians view recreational drug exposure as a red flag in those with suspected laryngeal cancer regardless of patient age.

Medicinal plants have revealed much attention as an alternative or complementary treatment for opioid withdrawal syndrome. The current review collects all available literature to verify the efficiency of herbal remedies in the management of symptoms associated with opioid withdrawal.

A systematic literature search was conducted from January 1990 to May 2021 on four bibliographic databases (Scopus, PubMed, Embase, and Web of Science) using the search terms “medicinal plant”, “withdrawal syndrome”, “opioid”, and all their equivalents. All randomized controlled trials (RCTs), published in the English language were included for data synthesis. The search was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The Cochrane risk of bias tool was used to verify the quality of the included clinical trials.

A total of 12 RCTs were collected and used for data synthesis. The results of these studies indicated that herbal medicines were effective in treating opioid withdrawal syndrome and could alleviate the withdrawal symptoms, such as abdominal constrictions, diarrhea, bone pain, perspiration, and insomnia, when compared to conventional medications such as buprenorphine, clonidine, and methadone. However, more than 30% of RCTs were found to be at high risk of bias in the areas of selection, performance, detection, attrition, and reporting.

Although several RCTs have proven that herbal remedies are effective in reducing opioid withdrawal symptoms, the findings need to be viewed more carefully. Further RCTs with more participants, longer duration, and less risk of bias are needed in the claimed cases.

This short letter briefly reviews the significance of opioid overdose as well as the existing approaches to combat the epidemic. It also signifies the importance of naloxone, its commercially available dosage forms, and the unmet need for developing safe and effective naloxone dosage forms that can easily be administered in emergency settings.