Browsing by Subject "chronic pain"

Now showing 1 - 8 of 8
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    Characterization of a novel opioid combination for the treatment of chronic pain
    (2020-08) Bruce, Daniel
    The peripherally-restricted combination of loperamide and oxymorphindole is a potent and efficacious preclinical analgesic treatment that relieves the behavioral hyperalgesia caused by inflammatory, post-operative and neuropathic pain states. The combination displayed analgesic synergy across all assays, pain conditions and species tested here, and was also effective in a non-evoked measure of spontaneous pain. From a clinical translation standpoint, the combination confers a protective phenotype relative to clinically approved opioids, demonstrated by the lack of constipation at therapeutic doses, no respiratory depression even at supratherapeutic doses, chronic therapeutic dosing that is devoid of analgesic tolerance, and significantly limited risk for self-administration. Mechanistically, the combination exerts its analgesic action by binding to opioid receptors¬—specifically MOR-DOR heteromers—on peripheral sensory afferent neurons, preferentially activating G protein-dependent signaling cascades to reduce neuronal excitability. Taken together, this thesis provides strong support for the continued investigation into peripheral opioid mechanisms and analgesic synergy as a path forward in our continued fight to develop better pharmacological pain treatment paradigms.
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    Chronic pain: information resources on the internet
    (Haworth, 2010-01) McGuire, Lisa A
    Chronic pain is pain that lasts longer than one month after onset, or pain that recurs after onset of injury or illness. Millions of Americans suffer from chronic pain conditions, whether from diseases such as diabetes or HIV infection, or as a result from injured nerves, bones, or other tissues. The socioeconomic burden of chronic pain is immense. Estimates of the economic impact alone from healthcare expenses, lost productivity, and lost wages are $100 billion annually. This article provides a general overview of non-cancer causes of chronic pain symptoms, conditions, disease burden, and treatments. Authoritative web sites for chronic pain information and patient resources are included.
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    Epidemiology of chronic low back pain in US adults: The National Health and Nutrition Examination Survey 2009-2010
    (2016-05) Shmagel, Anna
    Abstract Objective: To describe epidemiologic characteristics and associations with increased healthcare utilization in US adults with chronic low back pain (cLBP). Methods: NHANES back pain survey 2009-2010, administered to adults aged 20- 69 (N = 5103). cLBP was defined as pain in the area between the lower posterior margin of the rib cage and the horizontal gluteal fold, with a history of pain lasting almost every day for at least 3 months. Demographic and behavioral characteristics were compared between those with cLBP and without. Factors, associated with ≥10 healthcare visits/year were evaluated in the cLBP subgroup (N=700). Results: cLBP associations with adjusted odds ratios (aORs) ≥2 included age 50-69, education less than high school, annual household income <$20 000, income from disability, depression, sleep disturbances, and medical comorbidities. Subjects with cLBP were more likely to be covered by government-sponsored insurance plans: aOR 3.23 ([95% CI] 2.19-4.75) for Medicaid, aOR 2.25 (1.57-3.22) for Medicare (p < 0.0001), and visited healthcare providers more frequently: aOR 3.35 (2.40-4.67) for ≥10 healthcare visits in the past year (p < 0.0001). In the cLBP subgroup aORs ≥2 were found for associations between ≥10 visits per year and unemployment, income from disability, depression, and sleep disturbances. Conclusion: US adults with cLBP are socio-economically disadvantaged, make frequent healthcare visits and are often covered by government-sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with cLBP.
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    How to make your opioid contract work for you
    (2008-11-24) Walsh, Amy
    A better understanding of opioids and other treatment options for chronic pain will empower patients and help them feel like an active participant in their pain management. Helping patients understand what is expected of them when using narcotics will reduce the risk of developing the adversarial relationship that sometimes accompanies opioid agreements.
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    Measuring chronic pain, non-drug pain therapy, and opioid-related mortality
    (2021-12) Goldsmith, Elizabeth
    Chronic pain comprises three of the top five causes of physical disability in the United States (U.S.) and affects over 60% of U.S. military veterans seen in Veterans Affairs primary care clinics. The opioid epidemic stems in part from health systems’ efforts to treat chronic pain pharmacologically, leading to opioid addiction and opioid-related mortality. Many non-drug therapies are effective for chronic pain but are clinically underused. Managing the widespread problems of chronic pain and opioid-related mortality requires valid and reliable measurement approaches. This dissertation addresses measurement challenges in assessment of chronic pain, non-drug pain therapy use, and opioid-related mortality. The first manuscript examines relationships between physical performance measures and patient-reported outcome measures of pain-related functional interference and pain severity among U.S. military veterans in a 12-month randomized clinical trial of opioid vs. non-opioid medication therapy for chronic musculoskeletal pain. The second manuscript explores patterns of use of non-drug pain therapies among a national cohort of U.S. military veterans prescribed long-term opioid therapy for chronic pain. The third manuscript adapts expert elicitation approaches from Bayesian statistics to incorporate physician opinion into a quantitative bias analysis of potential age-related misclassification in opioid-related mortality data from death certificates in the U.S.
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    TARGETING THE AGMATINERGIC SYSTEM USING AN AAV-BASED GENE THERAPY FOR THE TREATMENT OF CHRONIC PAIN
    (2019-12) Pflepsen, Kelsey
    The complex mechanisms underlying chronic pain and the challenges of current pharmacotherapy leave many chronic pain patients without adequate treatment due to negative physical and social side effects. Thus, there is a critical need to develop new pain management therapies with long-term effectiveness and minimal adverse effects. Using an adeno-associated virus (AAV) gene therapy to treat chronic pain has gained interest in the last twenty years because of several therapeutic advantages. AAV gene therapy allows for selective gene expression directly to sites of interest for chronic pain treatment with the potential for sustained expression following a single injection. In an effort to treat chronic pain using an AAV gene therapy, we have created a viral vector using recombinant adeno-associated virus which encodes the biosynthetic enzyme, human arginine decarboxylase (hADC). Arginine decarboxylase (ADC) is an endogenous enzyme that catalyzes the metabolism of L-arginine into agmatine. Agmatine is an endogenous small molecule that acts as a neurotransmitter and has been previously shown to modulate neuroplastic events by antagonizing the GluN2B subunit of the N-methyl-D-aspartate (NMDA) receptor. When agmatine is delivered centrally, a reduction in pain behavior following nerve injury is observed. The central hypothesis of this body of work is that overexpression of arginine decarboxylase using an adeno-associated viral vector construct results in long-term reduction of neuropathic pain due to the production of agmatine and subsequent antagonism of the GluN2B NMDA receptor by agmatine. The experiments presented in this dissertation build upon our agmatine-based pharmacotherapy for the treatment of chronic neuropathic pain. Specifically, this work furthers our AAV-based gene therapy by understanding intrathecal AAV kinetics, evaluating how therapeutic efficacy changes with age and with the use of cell-specific promoters, and interpreting associated behavioral implications.
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    Vitamin D Deficiency
    (2010-07-29) Nio, Kusuma
    Symptomatic vitamin D deficiency has become increasingly prevalent particularly among the Somali immigrant group living in the Twin Cities Area. Serum vitamin D level should be assessed and the diagnosis of vitamin D deficiency should be considered when dealing with adult Somali females presenting with symptoms of chronic musculoskeletal pain. Additionally, physicians should also consider nutritional screening and provide nutritional guidance or supplementation of vitamin D in asymptomatic patients.
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    Vitamin D replacement in fibromyalgia patients does not improve pain.
    (2009-05-04) Olejniczak, Megan
    This handout is a basic education tool for patients regarding Vitamin D deficiency. It highlights the importance of Vitamin D in healthy bones, describes sources of Vitamin D and comments briefly on the current evidence regarding the link between Vitamin D deficiency and chronic pain.