The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerg...The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.展开更多
A G6P2032 female, prior cesarean x3 with history of opioid addiction maintained on buprenorphine presented for scheduled repeat cesarean section. Pre-operatively, her maintenance dose of medication was held secondary ...A G6P2032 female, prior cesarean x3 with history of opioid addiction maintained on buprenorphine presented for scheduled repeat cesarean section. Pre-operatively, her maintenance dose of medication was held secondary to concerns for partial agonist effect. Post-operative pain control was suboptimal with the patient ultimately proceeding to withdrawal. Doses of hydromorphone were titrated to 10 mg every 3 hours to avoid further withdrawal. Review of expert opinion after discharge recommended against holding buprenorphine therapy in the post-operative period. Pain management options include maintenance therapy with additional doses of opioid and non-opioid pain relieving medications.展开更多
Introduction: Tramadol* is a synthetic opioid agonist used as an analgesic. Despite its minor potential of addiction, it created recently a lot of concern. Its misuse may be motivated by a need to control the pain or ...Introduction: Tramadol* is a synthetic opioid agonist used as an analgesic. Despite its minor potential of addiction, it created recently a lot of concern. Its misuse may be motivated by a need to control the pain or by looking for her euphoric character. The aim of our study was to proceed a psychopathological reading of a case of addiction to Tramadol in a sickle cell patient with histrionic personality traits. Methods: We report the case’s management of a patient with addiction to Tramadol in a sickle cell patient with histrionic personality traits. The diagnosis was based on the DSM IV criteria. The review was done in the model of semi-structured interviews. Observation: Miss DP is 23 years old, sickle cell patient (AS profile). It is addressed to us for the management of an excessive consumption of Tramadol* started 4 years ago. Because of the difficulties of care in outpatient, we conducted hospitalization. The interviews highlight the histrionic personality traits and disruption of family dynamics. Discussion: Painful chronic diseases require a long analgesic treatment. It is a factor of dependence specially when the patient has a personality disorder. Multidisciplinary treatment between psychiatrist and addiction specialist and medical doctor is a guarantee of success.展开更多
The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that argini...The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that arginine vasopressin (AVP) antinociception in the caudate nucleus (CdN) relates with the acetylcholine (Ach) system mainly. The communication was de-signed to investigate the interrelations between Ach system and EOP system at the spinal level during pain process. The results showed that: 1) pain stimulation increased L-enkephalin (L-Ek), β-endorphin (β-Ep), dynorphin A1-13(DynA1-13), Ach and choline (Ch, an Ach metabolic product) concentrations in the spinal cord;2) Ach increased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord;and 3) Atropine (M-receptor inhibitor) or hexahydric gallamine (N-receptor inhibitor) decreased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord. The data suggested that Ach antinociception was involved in the EOP system at the spinal level.展开更多
文摘The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
文摘A G6P2032 female, prior cesarean x3 with history of opioid addiction maintained on buprenorphine presented for scheduled repeat cesarean section. Pre-operatively, her maintenance dose of medication was held secondary to concerns for partial agonist effect. Post-operative pain control was suboptimal with the patient ultimately proceeding to withdrawal. Doses of hydromorphone were titrated to 10 mg every 3 hours to avoid further withdrawal. Review of expert opinion after discharge recommended against holding buprenorphine therapy in the post-operative period. Pain management options include maintenance therapy with additional doses of opioid and non-opioid pain relieving medications.
文摘Introduction: Tramadol* is a synthetic opioid agonist used as an analgesic. Despite its minor potential of addiction, it created recently a lot of concern. Its misuse may be motivated by a need to control the pain or by looking for her euphoric character. The aim of our study was to proceed a psychopathological reading of a case of addiction to Tramadol in a sickle cell patient with histrionic personality traits. Methods: We report the case’s management of a patient with addiction to Tramadol in a sickle cell patient with histrionic personality traits. The diagnosis was based on the DSM IV criteria. The review was done in the model of semi-structured interviews. Observation: Miss DP is 23 years old, sickle cell patient (AS profile). It is addressed to us for the management of an excessive consumption of Tramadol* started 4 years ago. Because of the difficulties of care in outpatient, we conducted hospitalization. The interviews highlight the histrionic personality traits and disruption of family dynamics. Discussion: Painful chronic diseases require a long analgesic treatment. It is a factor of dependence specially when the patient has a personality disorder. Multidisciplinary treatment between psychiatrist and addiction specialist and medical doctor is a guarantee of success.
文摘The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that arginine vasopressin (AVP) antinociception in the caudate nucleus (CdN) relates with the acetylcholine (Ach) system mainly. The communication was de-signed to investigate the interrelations between Ach system and EOP system at the spinal level during pain process. The results showed that: 1) pain stimulation increased L-enkephalin (L-Ek), β-endorphin (β-Ep), dynorphin A1-13(DynA1-13), Ach and choline (Ch, an Ach metabolic product) concentrations in the spinal cord;2) Ach increased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord;and 3) Atropine (M-receptor inhibitor) or hexahydric gallamine (N-receptor inhibitor) decreased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord. The data suggested that Ach antinociception was involved in the EOP system at the spinal level.
