Multimodal Pharmacological Analgesia in Pain Management

The knowledge of the pathophysiology of pain has gradually evolved in recent years, allowing the development of new management strategies, more specifically addressing single pain types and patient profiles. Despite these advancements, pain management still remains an open issue, given the limitations of single agent therapies, the potential abuse/misuse of opioids and the risk of adverse events. The advent of multimodal analgesic strategies paves the way for major improvements in pain management, combining increased efficacy with better tolerability and an opioid-sparing effect. The association of analgesics with different mechanisms of action represents a successful strategy for a wide range of pain conditions, minimizing side effects and taking advantage of the additive or synergistic actions of individual agents. Last but not least, the increasing availability of oral fixed-dose combinations of analgesics will offer further advantages over extemporaneous combinations, by increasing ease of administration and patient adherence to treatment

Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review

Ibuprofen first came to market about 50 years ago and rapidly moved to over-the-counter (OTC) sales. In April 2019, the National Agency for the Safety of Medicines and Health Products (ANSM) of France issued a warning for NSAID uses by patients with infectious diseases based on an analysis of 20 years of real-world safety data on ibuprofen and ketoprofen. Nevertheless, ibuprofen remains a mainstay in the analgesic armamentarium and with numerous randomized clinical trials, head-to-head studies, and decades of clinical experience. The authors offer a review of the safety of ibuprofen and how it may differ from other NSAIDs. Ibuprofen is associated with certain well-known gastrointestinal adverse effects that are related to dose and patient population. Among nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen has a comparatively low risk of cardiovascular adverse effects. It has been associated with renal and hepatic adverse effects, which appear to depend on dose, concomitant medications, and patient population. The association of ibuprofen with infections is more complex in that it confers risk in some situations but benefits in others, the latter in cystic fibrosis. Emerging interest in the literature is providing evidence of the role of ibuprofen as a possible endocrine disrupter as well as its potential antiproliferative effects for cancer cells. Taken altogether, ibuprofen has a favorable safety profile and is an effective analgesic for many acute and chronic pain conditions, although it—like other NSAIDs—is not without risk. After 50 years, evidence is still emerging about ibuprofen and its unique safety profile among NSAIDs. The Rapid Service Fee was funded by Abbott Established Pharmaceuticals Division (EPD)

Time-resolved optical studies, heat dissipation and melting of Ag and Au nanoparticle systems and arrays

Transient absorption spectroscopy has been extensively used in recent years to examine the temporal response of isolated nanoparticles (NPs) to the absorption of light [1]. These studies are largely based on the use of the surface plasmon resonance (SPR) to monitor characteristics of the NP such as electronic and lattice temperature, shape and morphology as a function of time. In the case of extended Au/Ag NP structures the plasmon resonance is strongly distorted due to the inter-particle coupling effects. For example, we have observed this effect in Rhodamine dye functionalized Au nanoparticles which undergo self-assembly to form nanostructures due to the interactions between the dye molecules attached to the surfaces of the nanoparticles. Indeed the SPR splits into two with one resonance remaining in the vicinity of that of the isolated AuNPs and is generally called the transverse SPR while a second resonance due to an extended excitation spanning across multiple particles appears to the lower energies. The precise spectral energy and shape of the extended plasmon resonance depends on the inter-particle distance, the particle disposition and the number of particles involved. When the plasmon band or interband spectral region of the NP is excited by an intense pulse the photon energy absorbed by the electrons is transferred to the lattice of the NP as heat through electron-phonon coupling. Depending on the intensity of the light pulse and thus the initial electron temperature a number of outcomes are possible. The first aim of this work is to use low intensity pump pulses to study the wavelength dependence of the sub 10 ps dynamics which reflects the electron-photon scattering within the nanoparticle structure. On the other hand, the interaction of more intense light with the NPs can modify the morphology of NP systems, for example by reshaping gold nanorods into nanospheres or, in general, mediate the synthesis of metallic nanostructures. At medium intensities the initial temperature is sufficient to induce melting of the NPs which can lead to morphological changes of the NP structure. Higher intensities can cause other effects such as photofragmentation of the NPs, release of stabiliser molecules from the surface of the NPs or even Coulomb explosion due to multiple ionisation events. The second aim of this work is to concentrate on the effects of medium intensity laser excitation of a self-assembled Au/Ag NP systems. The NP system is excited by a femtosecond laser pulse of different wavelengths allowing selective deposition of energy and the subsequent heat dissipation through phonon-phonon coupling and morphological changes are monitored in time by recording transient absorption spectra in the visible range. This wavelength range makes it possible to follow the phonon-phonon coupling effects on the recovery of the bleaching of both the transverse and extended plasmon resonances of the NP system. As the intensity of the pump pulse is increased it can be seen that the NPs are no longer able to dissipate all of the heat before arrival of subsequent laser pulses thus leading to melting of the NP structure and strong changes in the plasmon response of the system. The overall aim of this study is to fully understand the delocalized electron-phonon coupling in the extended plasmon region of the NP structures and to use this knowledge to control the melting in nanostructures. The methods developed can be useful for plasmon mediated nano-engineerin

Non-Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review.

Peripheral neuropathic pain (PNP) is defined as the neuropathic pain that arises either acutely or in the chronic phase of a lesion or disease affecting the peripheral nervous system. PNP is associated with a remarkable disease burden, and there is an increasing demand for new therapies to be used in isolation or combination with currently available treatments. The aim of this systematic review was to evaluate the current evidence, derived from randomized controlled trials (RCTs) that assess non-pharmacological interventions for the treatment of PNP.After a systematic Medline search, we identified 18 papers eligible to be included.The currently best available evidence (level II of evidence) exist for painful diabetic peripheral neuropathy. In particular, spinal cord stimulation as adjuvant to conventional medical treatment can be effectively used for the management of patients with refractory pain. Similarly, adjuvant repetitive transcranial magnetic stimulation of the motor cortex is effective in reducing the overall pain intensity, whereas adjuvant static magnetic field therapy can lead to a significant decrease in exercise-induced pain. Weaker evidence (level III of evidence) exists for the use of acupuncture as a monotherapy and neurofeedback, either as an add-on or a monotherapy approach, for treatment of painful chemotherapy-induced peripheral neuropathy CONCLUSIONS: Future RCTs should be conducted to shed more light in the use of non-pharmacological approaches in patients with PNP

Iatrogenic Side Effects of Pain Therapies

Pain regimens, particularly for chronic cancer and noncancer pain, must balance the important analgesic benefits against potential risks. Many effective and frequently used pain control regimens are associated with iatrogenic adverse events. Interventional procedures can be associated with nerve injuries, vascular injuries, trauma to the spinal cord, and epidural abscesses. Although rare, these adverse events are potentially catastrophic. Pharmacologic remedies for pain must also consider potential side effects that can occur even at therapeutic doses of over-the-counter remedies such as paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs. Opioids are effective pain relievers but are associated with many side effects, some of which can be treatment limiting. A prevalent and distressing side effect of opioid therapy is constipation. Opioid-induced constipation is caused by binding to opioid receptors in the gastrointestinal system, making conventional laxatives ineffective. Peripherally acting mu-opioid receptor antagonists are a new drug class that offers the benefits of preserving opioid analgesia without side effects in the gastrointestinal system. An important safety concern, particularly among geriatric patients is the increasingly prevalent condition of polypharmacy. Many senior patients take five or more medications, including some that may be contraindicated in geriatric patients, duplicative of other drugs, have potential pharmacokinetic drug-drug interactions, or may not be the optimal choice for the patient's age and condition. Careful assessment of medications in the elderly, including possibly deprescribing with tapering of certain drugs, may be warranted but should be done systematically and under clinical supervision.</p

Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Viable Therapeutic Option? A Retrospective Observational Study

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Mortality on the Waiting List for Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis: A Single-Centre Experience

Purpose: Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. Methods: A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001–2014 was performed focusing on patients’ characteristics and associated risk factors. Results: Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p &lt; 0.05). No differences in demographic, clinical, radiological data and time spent on the waiting list were observed between IPF patients who underwent to LTX or lost on the waiting list. Patients who died showed significant higher levels of pCO2 and needed higher flows of O2-therapy on effort (p &lt; 0.05). Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Conclusions: Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed

Cytomegalovirus Infection Is Associated with Development of Chronic Lung Allograft Dysfunction

Background Cytomegalovirus (CMV) is the major and most common opportunistic infection complicating lung transplant (LTX). The aim of this study was to analyse the epidemiological aspects of CMV infection in lung transplant patients subject to a pre-emptive anti-CMV approach and to study the impact of this infection on lung transplant outcome, in terms of onset of chronic lung allograft dysfunction (CLAD).Methods This single-centre retrospective study enrolled 87 LTX patients (median age 55.81 years; 41 females, 23 single LTX, 64 bilateral LTX). All patients were managed with a pre-emptive anti-CMV approach. The incidences of the first episode of CMV infection, 1, 3, 6 and 12 months after LTX, were 12.64%, 44.26%, 50.77% and 56.14%. A median interval of 41 days elapsed between LTX and the first episode of CMV infection. The median blood load of CMV-DNA at diagnosis was 20,385 cp/ml; in 67.64% of cases, it was also the peak value. Patients who had at least one episode had shorter CLAD-free survival. Patients who had three or more episodes of CMV infection had the worst outcome.Results CMV infection was confirmed to be a common event in lung transplant patients, particularly in the first three months after transplant. It had a negative impact on transplant outcome, being a major risk factor for CLAD. The hypothesis that lower viral replication thresholds may increase the risk of CLAD is interesting and deserves further investigation. © 2022, The Author(s)