buprenorphine and Abdominal-Pain

Acute pancreatitis is an acute inflammatory process of the pancreas that may also involve adjacent tissues and/or remote organ systems. Abdominal pain is the main symptom and is usually accompanied by nausea, vomiting and fever. Opoids are commonly used to manage pain in acute pancreatitis but there are still some uncertainties about their clinical effectiveness and safety.. To assess the effectiveness and safety of opioids for treating acute pancreatitis pain.. The search strategy included the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 6), MEDLINE (from 1950 to June 2013) and EMBASE (from 1980 to June 2013). There were no restrictions by language or publication status.. We considered randomised clinical trials (RCTs) assessing the effectiveness of any opioid drug used for treating acute pancreatitis pain.. Two review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RRs) for dichotomous data and calculated a 95% confidence interval (CI) for each RR. We performed an intention-to-treat (ITT) analysis. We undertook meta-analysis for some outcomes.. We included five RCTs with a total of 227 participants (age range 23 to 76 years; 65% men) with acute pancreatitis pain. The opioids assessed were intravenous and intramuscular buprenorphine, intramuscular pethidine, intravenous pentazocine, transdermal fentanyl and subcutaneous morphine.One RCT, comparing subcutaneous morphine with intravenous metamizole reported non-significant reduction in the number of participants with improvements in pain intensity (primary outcome) (RR 0.50, 95% CI 0.19 to 1.33). Three studies compared analgesia using opioids with non-opioid treatments. After excluding one study that used opioids through continuous intravenous infusion, there was a decrease in the number of patients requiring supplementary analgesia (RR 0.53, 95% CI 0.30 to 0.93). In a single study, there were no differences in the number of patients requiring supplementary analgesia between buprenorphine and pethidine (RR 0.82, 95% CI 0.61 to 1.10).Pancreatitis complications were not associated with a significant difference between the drugs tested. No clinically serious or life-threatening adverse events occurred related to treatment. No differences for this outcome were found between opioid and non-opioid treatments, or for type of adverse event (nausea-vomiting and somnolence-sedation). One death in the procaine group was reported across all the trials.One RCT comparing pethidine with intramuscular buprenorphine reported non-significant differences of supplementary analgesic, adverse events or deaths. One RCT comparing fentanyl with placebo found no difference in adverse events.The findings of this review are limited by the lack of information to allow full appraisal of the risk of bias, the measurement of relevant outcomes and the small numbers of participants and events covered by the trials.. Opioids may be an appropriate choice in the treatment of acute pancreatitis pain. Compared with other analgesic options, opioids may decrease the need for supplementary analgesia. There is currently no difference in the risk of pancreatitis complications or clinically serious adverse events between opioids and other analgesia options.Future research should focus on the design of trials with larger samples and the measurement of relevant outcomes for decision-making, such as the number of participants showing reductions in pain intensity. The reporting of these RCTs should also be improved to allow users of the medical literature to appraise their results accurately. Large longitudinal studies are also needed to establish the risk of pancreatitis complications and adverse events related to drugs.

Topics: Abdominal Pain; Acute Disease; Analgesics, Opioid; Buprenorphine; Fentanyl; Humans; Meperidine; Morphine; Pancreatitis; Pentazocine; Randomized Controlled Trials as Topic

Abdominal pain is the most challenging symptom in chronic intestinal pseudoobstruction (CIPO) syndrome, because of its severity and the limited availability of suitable opioid formulations, especially in pediatric patients with digestive problems. Most of the children with CIPO cannot tolerate oral formulations.. We present 4 cases of children with CIPO and severe intractable abdominal pain, and report on the use of a recently available form of opioid, transdermal buprenorphine in a dosage of 5 mcg/h.. CIPO and the unique pharmacological profile of buprenorphine are reviewed briefly.

Topics: Abdominal Pain; Analgesics, Opioid; Buprenorphine; Child; Child, Preschool; Humans; Intestinal Pseudo-Obstruction; Male; Pain Measurement

Acute pancreatitis is commonly associated with severe abdominal pain, making early pain relief a primary goal of the treatment. This study was undertaken to assess the efficacy of a continuous intravenous (i.v.) infusion of procaine compared with that of a placebo infusion in providing pain relief in patients with acute pancreatitis.. 42 patients with acute pancreatitis were prospectively randomized to receive, in a double-blind setting, a continuous i.v. infusion of a 1% solution of procaine (procaine group) or placebo (placebo group, receiving a 0.9% saline solution) on the first three days of treatment in a hospital setting. The maximal infusion rate of the procaine solution was 8 ml/h, i.e. 1.92 g/24 h. The rate and total amount of infused fluid was similar in the placebo group. Additionally buprenorphine (Temgesic, sublingual [s.l.]) were given on demand for additional pain relief.. The gender ratio and the severity of the pancreatitis (APACHE II score, Ranson score) were comparable between the two groups, while the patients of the control group were eight years older (50.1 2.3 vs. 58.4 3.1; p = 0.039). The i.v. infusion of procaine did not reduce the demand for buprenorphine in the procaine group and was similar to that in the placebo group (p=0.88). Furthermore, explorative data analysis revealed that patients of the procaine group had higher bodily discomfort and nausea scores and also tended to feel more pain than the patients of the placebo group.. These data do not indicate a clinically meaningful analgesic effect of i.v. infusion of procaine (maximal amount. 1.92 g/24h) in patients with acute pancreatitis, but suggested that this infusion actually increased the feeling of bodily discomfort and nausea. We thus conclude that a constant i.v. infusion of procaine should no longer be recommended for pain relief in patients with acute pancreatitis anymore.

Topics: Abdominal Pain; Administration, Sublingual; Analgesics, Opioid; Anesthetics, Local; APACHE; Buprenorphine; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pain Measurement; Pancreatitis; Procaine; Prospective Studies; Treatment Failure

The opioid and nociceptin systems play a crucial role in the maintenance of homeostasis in the gastrointestinal (GI) tract. The aim of this study was to characterize the effect of BU08070, a novel mixed MOP/NOP agonist, on mouse intestinal contractility in vitro and GI motility in vivo in physiological conditions and in animal models mimicking symptoms of irritable bowel syndrome (IBS), including diarrhea and abdominal pain. The effect of BU08070 on muscle contractility in vitro was characterized in the ileum and colon. To assess the effect of BU08070 in vivo, the following parameters were assessed: whole GI transit, gastric emptying, geometric center, colonic bead expulsion, fecal pellet output and time to castor oil-induced diarrhea. The antinociceptive activity of BU08070 was characterized in the mustard oil (MO)-induced abdominal pain model and the writhing test, alone and in the presence of MOP and NOP antagonists. in vitro, BU08070 (10(-10)-10(-6) M) inhibited colonic and ileal smooth muscle contractions in a concentration-dependent manner. in vivo, BU08070 prolonged the whole GI transit and inhibited colonic bead expulsion. The antitransit and antidiarrheal effects of BU08070 were observed already at the dose of 0.1 mg/kg (i.p.). BU08070 reversed hypermotility and reduced pain in mouse models mimicking IBS-D symptoms. Our results suggest that BU08070 has a potential of becoming an efficient drug in IBS-D therapy. Here we also validate mixed NOP/MOP receptor targeting as possible future treatment of functional GI diseases.

Topics: Abdominal Pain; Analgesics, Opioid; Animals; Buprenorphine; Castor Oil; Colon; Diarrhea; Disease Models, Animal; Gastric Emptying; Gastrointestinal Motility; Ileum; In Vitro Techniques; Irritable Bowel Syndrome; Male; Mice, Inbred BALB C; Muscle Contraction; Muscle, Smooth; Mustard Plant; Nociceptin Receptor; Plant Oils; Receptors, Opioid; Receptors, Opioid, mu

Prevention of unnecessary pain in laboratory animals requires reliable and practically useful tools for assessing pain severity and analgesic efficacy. We have used a behaviour-based pain scoring system to determine the duration of pain resulting from laparotomy, and the duration of analgesia afforded by orally administered (p.o.) buprenorphine and subcutaneously administered (s.c.) carprofen or buprenorphine in rats. One hour before laparotomy Fisher 344 rats received either saline as a control (0.2 ml/100 g s.c.), carprofen (5 mg/kg s.c.) or buprenorphine (0.05 mg/kg s.c. or 0.4 mg/kg p.o.). The rats were housed singly for 10-min periods of behaviour recording, beginning 30 min after completing surgery. Recording was repeated at three time points every 2 h. The behaviour of controls was distinct from that of the analgesic-treated animals throughout recording; however, the major signs of pain (back-arching, staggering and writhing) were prominent during only the first 270 min in the saline group. This was followed by a period of more subtle differences between the saline- and drug-treated groups. It was concluded that the most acutely painful effects of surgery in this model lasted for between 270 and 390 min, and that this was alleviated throughout its duration by subcutaneously administered carprofen or buprenorphine, and also buprenorphine administered orally. The study demonstrates a clinically relevant and practically useful approach to assessing the duration of post-surgical abdominal pain and analgesic effects in rats.

Topics: Abdominal Pain; Administration, Oral; Analgesics, Opioid; Animal Welfare; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Drug Therapy, Combination; Injections, Subcutaneous; Laparotomy; Male; Rats; Rats, Inbred F344

The occurrence of an opioid addiction within an opioid treatment of pain or diarrhoea in inflammatory bowel disease is rarely reported. We report on a 36-year-old male with a 14 years lasting left sided chronic ulcerative colitis who developed after the initiation of a therapy with tincture of opium because of abdominal pain and diarrhoea an opioid addiction with the consumption of opium and later buprenorphin. Additionally to the diagnostics and therapy of the ulcerative colitis a detoxication was carried out. The diarrhoea slightly increased during the buprenorphin withdrawal. Diarrhoea refractory to other treatment should be treated by loperamid because of its lacking effects on the central nervous system. In chronic abdominal or musculoskeletal pain in inflammatory bowel disease opioids can be used if no surgical or other medical pain relief is possible. A consequent control of the therapeutic and side effects of the opioid therapy is necessary, especially of an abuse of opioid medication. The published case reports of a therapeutic induction of opioid addiction demonstrate that psychiatric comorbidity is an essential or even necessary risk factor. A checklist with seven criteria of opioid addiction during opioid therapy is presented.

Topics: Abdominal Pain; Adult; Buprenorphine; Colitis, Ulcerative; Combined Modality Therapy; Diarrhea; Dose-Response Relationship, Drug; Humans; Male; Opioid-Related Disorders; Opium; Self Medication; Substance Withdrawal Syndrome

While developing a rat model for human short bowel syndrome, we noted that untreated rats as well as rats administered buprenorphine after intestinal resection exhibited behavior and appearance consistent with visceral pain and distress. To provide appropriate analgesics, we developed criteria to assess pain-related behavioral changes and conducted an experiment to evaluate the effectiveness of buprenorphine versus oxymorphone to alleviate the pain induced by intestinal resection. Rats underwent either small-bowel resection or transection surgery; in addition, animals received jugular catheterization for the delivery of total parenteral nutrition (TPN). Rats treated with buprenorphine received 0.5 mg/kg every 6 h subcutaneously, and rats treated with oxymorphone received 0.03 mg/kg hourly for 32 h via continuous intravenous (i.v.) infusion with TPN solution. Rats treated with buprenorphine exhibited behavior and appearance consistent with pain and distress for as long as 32 h postoperatively, whereas animals treated with oxymorphone exhibited behavior and appearance similar to their preoperative state. Thus, oxymorphone alleviated the pain-related behavioral changes after intestinal resection far better than did buprenorphine. Of interest, we observed that the buprenorphine was associated with a decrease in the volume of urine collected, whereas oxymorphone was associated with urine volumes similar to those of nonresected rats maintained with TPN. Because oxymorphone appeared to be a superior analgesic, we also evaluated three routes for administering this drug. Pain-related behavior changes were alleviated by the administration of oxymorphone by either Alzet mini-pump, bolus i.v. injection, or continuous i.v. infusion. We conclude that compared with buprenorphine, oxymorphone is a superior analgesic for the alleviation of visceral pain due to intestinal resection.

Topics: Abdominal Pain; Analgesics, Opioid; Animals; Buprenorphine; Digestive System Surgical Procedures; Disease Models, Animal; Male; Oxymorphone; Rats; Rats, Sprague-Dawley; Treatment Outcome; Viscera

Despite physiological advances and recent progress in pain relief, early analgesia for patients with acute abdominal pain is not a conventional endpoint. In clinical practice, priority is often given to diagnosis and management decisions. There are few controlled trials to settle the issue and opinions are still divided. recent studies suggest than early and effective analgesia in acute abdomen does not interfere with diagnosis, and even facilitates initial examination. Various modes of analgesia can be considered.

Topics: Abdominal Pain; Analgesia, Epidural; Analgesics; Buprenorphine; Humans; Nalbuphine

The analgesic effects of morphine, buprenorphine and pentazocine examined by behavioral responses to tail-flick (TF) and colorectal distension (CD) were studied in rats. Animals were randomly divided into three groups; morphine (M) groups of 4 mg.kg-1 (n = 7), buprenorphine (B) groups of 0.03 mg.kg-1 (n = 8), pentazocine (P) groups of 3 mg.kg-1 (n = 8). After determinations of TF and CD values, animals were administered each analgesic intraperitoneally, and both procedures were repeated every 5 minutes until 40 minutes. Three drugs produced an almost same degree of increase in pain threshold for TF; % maximum possible effects (%MPEs) were approximately 30%. Similar patterns of increase in pain thresholds for CD were observed in M and B groups; %MPEs were approximately 20%. In contrast, P groups showed a significant increase in thresholds for CD compared to M and B groups; 20 minutes after intraperitoneal administration of P, %MPE was approximately 50%. These results indicate that there are different antinociceptive effects to somatic and visceral stimuli between M, B and P, and suggest that selective opioid agonists modulate responses to different kinds of noxious stimuli.

Topics: Abdominal Pain; Analgesics; Animals; Buprenorphine; Male; Morphine; Pain Threshold; Pentazocine; Random Allocation; Rats; Rats, Wistar