Opioids and the immune system: implications for clinical practice

Już ponad 100 lat temu obserwowano niekorzystny wpływ opioidów na układ immmunologiczny. Od tego czasu zgromadzono wiele dowodów na to, że opioidy oddziałują na różne elementy tego układu, takie jak makrofagi, granulocyty, komórki NK czy cytokiny. Jednakże większość wniosków oparta jest na badaniach in vitro albo na modelach zwierzęcych. Prawdopodobnie istnieją trzy mechanizmy immunosupresji wywołanej opioidami, a mianowicie bezpośrednie działanie na receptory opioidowe na komórkach immunologicznych oraz działanie pośrednie - poprzez wpływ na układ adrenergiczny i uwalnianie steroidów. Nadal nie wiadomo, jakie znaczenie w praktyce klinicznej mają wszystkie te obserwacje. W artykule omówiono między innymi różne kontrowersyjne problemy dotyczące wpływu leczenia opioidami na rozwój infekcji, przebieg zakażenia HIV-1 czy oddziaływania na chorobę nowotworową. Nadal istnieje potrzeba przeprowadzenia badań klinicznych, które pozwoliłyby na wyjaśnienie tych wątpliwości.The first observations of the adverse effects of opiods on the immune system were made more than a century ago. Since then there have been many reports that show that opioids have immunomodulating effects on different parts of the immune system such as macrophages, granulocytes, NK-cells, or different cytokines. However, most conclusions are based on observations from in vitro or animal studies. There are 3 proposed mechanisms of immunosuppression by opioids, including a direct impact on opioid receptors on immune cells and an indirect effect on the adrenergic system and opioid-induced steroid release. Nevertheless, it is unclear whether these findings have any clinical relevance. This article will present the controversies concerning the impact of opioid therapy on different clinical concerns such as infections, HIV-1 promotion and cancer. There is still an urgent need for studies in clinical settings with clinical parameters

Expectations and Self-Care of Family Members in Palliative Care. The Analysis of Needs and Workshop Plan

The practice has shown that it is the most emotional and difficult situation when family members care for their beloved ones, who suffer from cancer, all the time and without rest.During care of their ill family members they have not only different emotional reactions, but they have special needs in the field of care and support as well. The purpose of this study was to analyze and describe family members’ needs and expectations during the process of care, and according to the analysis, to create a training course for family members who look after relatives with cancer. The study involved both qualitative descriptive methods based on face-to-face interview focused on self-care, needs, problems and support to family members as well as expectations addressed at hospice staff. Ten family members of patients who were under palliative care (hospitalized in palliative care in-patient department) were asked to give interviews in the field of their expectations, needs and difficulties as caregivers while caring about their beloved ones with cancer. The results have shown, that among caregivers, 90% reported the need for self-care in the field: being listened to, information, ability to deal with stress, communications skills. Only one person did not think about her/himself while looking after their beloved ones suffering from cancer. All of the 90% family members needed: information about the clinical situation of their beloved ones with cancer, conversations about their experience while caring, and information on what they can do better for their relatives. Overall, caregivers preferred to receive knowledge and information about diet, physical and emotional self-care, communication with relatives about their illness, dying and death. According to that, the curriculum of workshops for family members was created including the course of communication, basic information about the illness and opportunities of care in terms of both physical and emotional health, interpersonal relations, and increasing the feeling of security as well. Conclusion of this study is that caregivers have their own needs and expectations while caring for their family members with cancer. The formal education for the family in the form of workshop may help them in both: caring for the patient and for themselves

Is Kinesio Taping useful for advanced cancer lymphoedema treatment? A case report

Lymphoedema is a common and distressing symptom in palliative care. The classic physiotherapy treatment for lymphoedema includes a combination of manual lymph drainage (MLD), compression therapy (multi-layer bandaging, compression garments), decongestive exercises and skin care. Lymphoedema therapy in advanced cancer patients should be adapted to their general condition and the intensity of other symptoms. In this article we present a case of an advanced cancer patient whose painful skin tension, caused by lymphoedema, was successfully reduced with the use of Kinesio Taping. Adv. Pall. Med. 2010; 9, 4: 141–144Lymphoedema is a common and distressing symptom in palliative care. The classic physiotherapy treatment for lymphoedema includes a combination of manual lymph drainage (MLD), compression therapy (multi-layer bandaging, compression garments), decongestive exercises and skin care. Lymphoedema therapy in advanced cancer patients should be adapted to their general condition and the intensity of other symptoms. In this article we present a case of an advanced cancer patient whose painful skin tension, caused by lymphoedema, was successfully reduced with the use of Kinesio Taping. Adv. Pall. Med. 2010; 9, 4: 141–14

The effect of gabapentin and pregabalin on symptoms other than pain and seizures. A review of the evidence

Gabapentin and pregabalin are drugs that act through reduction of the central sensitization. They are useful in conditions such as partial seizures and neuropathic pain. However, in the last decade these drugs appear to have been effective against a variety of other symptoms, such as pruritus, hot flushes in post-menopausal women and intractable hiccups. The drugs are probably also effective for many other symptoms related to central sensitization but the paucity of data does not allow for support of these claims. Both gabapentin and pregabalin have a good safety record.Gabapentin and pregabalin are drugs that act through reduction of the central sensitization. They are useful in conditions such as partial seizures and neuropathic pain. However, in the last decade these drugs appear to have been effective against a variety of other symptoms, such as pruritus, hot flushes in post-menopausal women and intractable hiccups. The drugs are probably also effective for many other symptoms related to central sensitization but the paucity of data does not allow for support of these claims. Both gabapentin and pregabalin have a good safety record

Opioid-induced hyperalgesia as a problem in pain management. Mechanisms of onset, diagnosis and treatment

Opioids have been used for centuries to control pain. One of the problems with their use is the development of tolerance in some patients. This problem is usually solved by an increase in the dose. However, this does not solve all the difficulties encountered. In some patients, the opioid doses needs rise very quickly. It seems that this phenomenon depends on changes in the opioid receptors and on the organization of the functions of the central nervous system. This phenomenon is known as opioid-induced hyperalgesia. Changes may include the facilitation of pain conveyance which may more or less counteract the analgesic effect of the same drug. Until now, several putative mechanisms have been identified. Here we shall explore the changes of opioid receptors and changes in the glutaminergic system. In addition, the spinal cord and probably also the liver are producing a specific peptide, Dynorphin A, which has an excitatory effect. The organization and function of the On-Off cells in the brain are also changed. In this article, we discuss strategies for the treatment of opioid-induced hyperalgesia. These strategies have the potential to improve the quality of opioid analgesia.Opioids have been used for centuries to control pain. One of the problems with their use is the development of tolerance in some patients. This problem is usually solved by an increase in the dose. However, this does not solve all the difficulties encountered. In some patients, the opioid doses needs rise very quickly. It seems that this phenomenon depends on changes in the opioid receptors and on the organization of the functions of the central nervous system. This phenomenon is known as opioid-induced hyperalgesia. Changes may include the facilitation of pain conveyance which may more or less counteract the analgesic effect of the same drug. Until now, several putative mechanisms have been identified. Here we shall explore the changes of opioid receptors and changes in the glutaminergic system. In addition, the spinal cord and probably also the liver are producing a specific peptide, Dynorphin A, which has an excitatory effect. The organization and function of the On-Off cells in the brain are also changed. In this article, we discuss strategies for the treatment of opioid-induced hyperalgesia. These strategies have the potential to improve the quality of opioid analgesia