PAIN IN OBESITY IS NOT OBESITY AND PAIN

ABSTRACT: The article clarifies that pain in obesity is not obesity and pain. The authors reviewed the literature and surveyed the clinical data about pain in people with abnormal body weight. The conclusion was made that pain in obese patients needs adequate management. Data for pharmacokinetic and pharmacodynamics characteristics of frequently used analgesic drugs are summarized. The authors include useful schemas of pharmacotherapy with nonopioid as well as opioid analgesics and practical guidelines for pain management in clinical ward or outpatient departments. Key words: obesity, pain, analgesic drugs, pharmacokinetics, pharmacotherapy Excess body weight is the most widespread nonphysiological condition affecting people in modern industrial societies. In the United States, the relative share of overweight people is menacingly increasing. Meanwhile, more than 50% of individuals over 50 years of age demand medical care due to pain of different etiology. That's why the fact that the number of overweight individuals experiencing chronic pain is high, is not surprising PAIN IN OBESITY IS NOT OBESITY AND PAIN Elimination: The excessive body weight does not result in substantial change of functional hepatic blood flow, regardless of the increased liver size, which in turn is most likely a result of its fatty infiltratio

Type 2 diabetes mellitus and osteoarthritis

Objectives: Type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) are common diseases that frequently co-exist, along with overweight/obesity. While the mechanical impact of excess body weight on joints may explain lower limb OA, we sought to explore whether T2DM is linked to OA outside of excess weight and whether T2DM may play a role in OA pathophysiology. The consequence of T2DM on OA outcomes is a question of research interest. Methods: We conducted a critical review of the literature to explore the association between T2DM and OA, whether any association is site-specific for OA, and whether the presence of T2DM impacts on OA outcomes. We also reviewed the literature to assess the safety of anti-OA treatments in patients with T2DM. Results: T2DM has a pathogenic effect on OA through 2 major pathways involving oxidative stress and low-grade chronic inflammation resulting from chronic hyperglycemia and insulin resistance. T2DM is a risk factor for OA progression and has a negative impact on arthroplasty outcomes. Evidence is mounting for safety concerns with some of the most frequently prescribed anti-OA medications, including paracetamol, non-steroidal anti-inflammatory drugs, and corticosteroid injections, while other anti-OA medications may be safely prescribed in OA patients with T2DM, such as glucosamine and intra-articular hyaluronic acid. Conclusions: Future research is needed to better understand whether diabetes control and prevention can modulate OA occurrence and progression. The selection of therapy to treat OA symptoms in patients with T2DM may require careful consideration of the evidence based to avoid untoward safety issues.The meeting was funded by the ESCEO, a Belgian not-for-profit organization. The authors thank the Chair for Biomarkers of Chronic Diseases and the International Scientific Partnership Program (ISPP#0111) at King Saud University, Riyadh, Saudi Arabia for their suppor

Correction to: Is There Enough Evidence for Osteosarcopenic Obesity as a Distinct Entity? A Critical Literature Review

n/

Algorithm for the use of biochemical markers of bone turnover in the diagnosis, assessment and follow-up of treatment for osteoporosis

Introduction Increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication. Methods A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Results Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence. Conclusion In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy

Nociceptin/orphanin FQ: the novel peptide with multiple old regulatory functions

The identification some years ago of the opioid-like heptadecapeptide nociceptin/orphanin FQ (NOFQ) as the endogenous ligand of orphan opioid like-1 (ORL1) receptor evoked a rapidly growing interest in understanding the physiological significance of this peptide. This initiated a great number of investigations aimed at studying the cellular and integrative effects of NOFQ and disclosing the mechanism of its action. The number of publications in this field is increasing constantly and a great deal of information along with some controversial data is being already accumulated. In the present article we attempted to summarise most of the current information about NOFQ generation, metabolism, mechanisms of action and the cellular and integrative effects and to emphasise the possibilities for clinical implications.Biomedical Reviews 2000; 11: 1-17

PAIN IN ELDERLY HAS BEEN OFTEN UNDERESTIMATED

The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments

POSTOPERATIVE AND CANCER PAIN NEED PROPER ANALGESIA

The authors surveyed the clinical data and reviewed the literature on the management of post-operative and cancer pain. The conclusion was made that pain management during post-operative period or in status of advanced cancer necessitates effective pharmacotherapy with non-opioid and opioid analgesics. Data for pharmacokinetics and pharmacodynamics of widely used analgesic drugs are listed. The authors provide practical guidelines for the management of post-operative and cancer pain in clinical wards as well as in outpatients departments

TREATMENT OF PAIN IN PEDIATRIC PATIENTS

The article clarifies that pain is a multidimensional phenomenon both in adults and children. The authors reviewed the literature and surveyed the clinical data on the management of pain in pediatric patients. The conclusion was made that pain management in pediatric patients needs adequate management and effective pharmacotherapy with non-opioid and opioid analgesics. Data for pharmacokinetic and pharmacodynamics characteristics of frequently used analgesic drugs are summarized. The authors include useful schemas of pharmacotherapy with nonopioid as well as opioid analgesics and practical guidelines for pain management in clinical ward or outpatient departments

Preclinic and clinic effectiveness of gabapentin and pregabalin for treatment of neuropathic pain in rats and diabetic patients

Pregabalin and gabapentin are amino-acid derivatives of gamma-aminobutyric acid. They have a high affinity to the α2δ protein in the central nervous system and both have been shown to be effective for neuropathic pain disorder. The aim of this study was to investigate the efficacy of gabapentin and pregabalin in animal models of neuropathic pain, and to correlate with clinical outcomes in patients with diabetic neuropathy. Gabapentin (60 mg/kg) and pregabalin (30 mg/kg) attenuate mechanical, tactile and heat hypersensitivity in rats with chronic constriction injury of the sciatic nerve and streptozotocin (STZ)-induced diabetes. There is no evidence that one of the drugs is superior to another at the different rat models and tests. In the incisional pain model, there was partial efficacy of gabapentin. Our clinical data suggest that relative to the baseline pain score, the treatment with pregabalin at doses of 300 mg/day or gabapentin at doses of 900 mg/day would be effective and well tolerated in patients diagnosed with moderate diabetic polyneuropathy. The study suggested that pregabalin may provide better analgesic outcomes than gabapentin on the sixth month of treatment. In conclusion, the comparative effects of gabapentinoids in animal models of neuropathic pain and neuropathic patients are suggestive of similar pathophysiological mechanisms being involved, but successful outcome is determined by a patient's individuality and the drug nature as well as the drug tolerability

Action of adrenal and gonadal steroid hormones on kainic acid-evoked seizures in a rat model of epileptogenesis

Epilepsy is one of most reported neurological disorders after migraine, stroke and Alzheimer's disease. Empiric clinical data reveal that seizures and epilepsy more likely affect men than women. The aim of present study was to investigate the effect of steroid adrenal and gonadal hormones on the intensity, dynamics and latency of kainic acid-evoked seizure and lethality in a rat model of epileptogenesis. After surgical adrenalectomy/gonadectomy, male rats were at random assorted in groups and treated from postoperative day 1 to day 5 with corticosterone (30 mg/kg), estradiol (0.03 mg/kg), progesterone (75 mg/kg), dihydroprogesterone (75 mg/kg) and dihydrotestosterone (0.75 mg/kg). Spontaneous recurrent seizures generated by kainic acid were assessed. The treatment with corticosterone eliminated the aggravation of kainic acid-evoked seizures produced by adrenalectomy/gonadectomy. The application of corticosterone decreased the seizure intensity by 31% and prevented seizure-associated animal death. The effect of estradiol treatment was quite opposite. Estradiol treatment exacerbated the somatic and behavioural aspects of kainic acid-evoked epilepsy-like syndrome. The hormone increased the intensity of kainic acid-evoked seizures by 31%, decreased the latency of clonic weak seizures by 49% and enhanced the associated lethality by 133%. The treatment with progesterone or dihydroprogesterone produced minor alterations in intensity and latency of kainic acid-evoked seizures in the operated male rats. The application of dihydrotestosterone significantly aggravated the kainic acid-evoked seizures. In summary, hormonal unbalance could play an important role for seizure susceptibility in epileptogenesis. Corticosterone has better anti-seizure activity than progesterone and testosterone has significant pro-convulsive activity