naloxone and Back-Pain

During the past 15 years, we prospectively followed 68 patients with chronic pain syndromes who underwent deep brain stimulation (DBS). The objective of our study was to analyze the long-term outcomes to clarify patient selection criteria for DBS.. Patients were referred from a multidisciplinary pain clinic after conservative treatment failed. Electrodes for DBS were implanted within the periventricular gray matter, specific sensory thalamic nuclei, or the internal capsule. Each patient was followed on a 6-monthly follow-up basis and evaluated with a modified visual analog scale.. Follow-up periods ranged from 6 months to 15 years, with an average follow-up period of 78 months. The mean age of the 54 men and 14 women in the study was 51.3 years. Indications for DBS included 43 patients with failed back syndrome, 6 with peripheral neuropathy or radiculopathy, 5 with thalamic pain, 4 with trigeminal neuropathy, 3 with traumatic spinal cord lesions, 2 with causalgic pain, 1 with phantom limb pain, and 1 with carcinoma pain. After initial screening, 53 of 68 patients (77%) elected internalization of their devices; 42 of the 53 (79%) continue to receive adequate relief of pain. Therefore, effective pain control was achieved in 42 of 68 of our initially referred patients (62%). Patients with failed back syndrome, trigeminal neuropathy, and peripheral neuropathy fared well with DBS, whereas those with thalamic pain, spinal cord injury, and postherpetic neuralgia did poorly.. DBS in selected patients provides long-term effective pain control with few side effects or complications.

Topics: Adult; Aged; Back Pain; Denervation; Electric Stimulation Therapy; Electrodes, Implanted; Equipment Failure; Female; Follow-Up Studies; Herpesviridae Infections; Humans; Male; Middle Aged; Morphine; Naloxone; Neostriatum; Neuralgia; Nociceptors; Pain, Intractable; Periaqueductal Gray; Prospective Studies; Thalamic Nuclei; Treatment Outcome; Work Capacity Evaluation

In the runner study, as measured by tourniquet ischemic pain, exercise stress produced hypoalgesia 20 minutes post-run, followed by hyperalgesia and euphoria at 30 minutes. The hypoalgesia and euphoria were reversed by naloxone. Exercise stress also produced a decrease in P(A), suggesting hypoalgesia to the thermal cutaneous stimulation. However, this analgesia was not naloxone reversible. Nor did exercise stress produce analgesia to cold-pressor pain. In the acupuncture study, noxious electrical stimulation of classical acupuncture sites failed to produce analgesia either during or after stimulation. However, expectation did produce a change in the pain report criterion, but only in the acupunctured arm. Noxious electrical stimulation (TENS) of the median nerve produced no analgesia outside of the related segmental area, that is, acute electrical pain did not produce generalized hypoalgesia. Thus, the effects of the stress produced by noxious electrical stimulation differ from that produced by exercise. In contrast to the results of the acute pain studies, chronic clinical pain, which combines mental stress and pain stress, produced strong hypoalgesia and anesthesia. Again, in contrast to the acute experimental pain studies, the emotional stress of mental illness produces hypoalgesia, but not anesthesia. Finally, the somatosensory system is not the only the sensory system affected by stress. Cold-pressor pain decreases visual sensitivity both during and for a few minutes following stimulation, and does not interfere with short-term (supra-digit span) memory.

Topics: Acupuncture Therapy; Acute Disease; Adult; Back Pain; Chronic Disease; Cold Temperature; Discrimination Learning; Electric Stimulation; Emotions; Female; Hormones; Hot Temperature; Humans; Ischemia; Male; Memory; Mental Disorders; Naloxone; Pain; Physical Exertion; Sensory Thresholds; Stress, Physiological; Visual Perception

A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain.. In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks. Changes in pain intensity and quality of life (QoL) were measured using a numeric rating scale (NRS, 0-10) and the Korean-language EuroQol-five dimensions questionnaire, respectively.. Among 209 patients assessed for efficacy, the mean NRS pain score was reduced by 25.9% between baseline and week 8 of treatment (. Prolonged-release oxycodone/naloxone provided significant and clinically relevant reductions in pain intensity and improved QoL in Korean patients with chronic spinal disorders. (ClinicalTrials.gov identifier: NCT01811238).

Topics: Aged; Analgesics, Opioid; Back Pain; Chronic Pain; Constipation; Delayed-Action Preparations; Dizziness; Drug Combinations; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Naloxone; Nausea; Oxycodone; Pain Measurement; Quality of Life; Republic of Korea; Severity of Illness Index; Spinal Diseases

Topics: Back Pain; Double-Blind Method; Drug Combinations; Naloxone; Neuralgia; Oxycodone; Pain Measurement; Phenols; Prospective Studies; Tapentadol

This subgroup analysis of a prospective, non-interventional study involving general practitioners and internists investigated the administration of tapentadol prolonged release (tapentadol PR; Palexia retard) for the treatment of patients who have previously received oxycodone/naloxone.. From the overall effectiveness sample (n = 5,002) data of all patients who were previously treated with oxycodone/naloxone in a fixed combination (n = 382) were included in this analysis. Data collection during the 3-month observation period included previous and concomitant analgesic treatment, tapentadol PR dosage, pain intensity, functional impairment, and tolerability of tapentadol PR. Health related quality of life was documented at baseline and at the end of observation by patients using the SF-12 questionnaire.. Back pain was the most common cause of pain. Including all pain diagnoses, mixed type of pain (nociceptive and neuropathic) predominated. The oxycodone/naloxone pretreatment was multifold combined with strong opioids (10.2%), weak opioids (29.3%), non- opioids (78.3%), co-analgesics (56.0%) and analgesic rescue medication (26.9%). Switching to tapentadol PR resulted in a mean pain reduction of 3.41 points from 7.29 ± 1.40 at baseline to 3.88 ± 1.86 at end of observation (NRS 11, 11-point pain scale; descriptive p value ≤ 0.001; n = 373), using a final average daily dosage of 252.9 mg tapentadol PR. In all four categories assessing the pain-related functional impairment, significant improvements have been achieved. In addition to significantly reduced pain-related impairments of everyday activities patients' data documented significant improvements in physical and mental SF-12 total scores, which initially were already at critically low range. A good tolerability of tapentadol PR therapy was reported.. Patients, who were previously treated with oxycodone/naloxone, benefit from a tapentadol PR therapy as well: data analysis shows a clinically relevant improvement of analgesia, functionality and quality of life. Furthermore, the previous analgesic "co"-medication could be reduced during tapentadol PR therapy.

Topics: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Back Pain; Chronic Pain; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Drug Substitution; Female; Germany; Humans; Male; Middle Aged; Naloxone; Oxycodone; Pain Measurement; Patient Satisfaction; Phenols; Prospective Studies; Quality of Life; Tapentadol

Topics: Back Pain; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Naloxone; Neuralgia; Oxycodone; Pain Measurement; Patient Satisfaction; Phenols; Prospective Studies; Tapentadol

Previous work suggests that elevated trait anger-out exacerbates pain responses in part through endogenous opioid dysfunction. The authors examined whether this opioid dysfunction affects not only perceived pain intensity, but also emotional responses to being hurt.. 79 chronic low back pain (LBP) patients and 46 healthy controls received opioid blockade (8 mg naloxone i.v.) and placebo in randomized, counterbalanced order in separate sessions. During each session, participants sequentially experienced finger pressure pain and ischemic forearm pain tasks, with emotional state assessed at baseline and postpain.. Blockade effects indexing opioid modulation of emotional reactivity were derived by subtracting placebo from blockade condition emotional reactivity.. Significant Participant Type x Anger-Out interactions on blockade effects indicated that in LBP participants but not in controls, greater anger-out was associated with deficient opioid modulation of anxiety, anger, and fear reactivity to noxious stimulation. Across participant types, greater anger-in was associated with impaired opioid modulation of anxiety and fear reactivity. Anger-in opioid effects were partially due to overlap with general negative affect.. Opioid dysfunction associated with trait anger-out may affect not only perceived pain intensity, but also pain-related suffering in individuals with chronic pain conditions. Implications for understanding the health effects of anger management styles are discussed.

Topics: Adult; Anger; Anxiety; Arousal; Back Pain; Character; Cross-Over Studies; Double-Blind Method; Emotions; Fear; Female; Humans; Male; Naloxone; Narcotic Antagonists; Opioid Peptides; Pain Threshold

To test the possibility of endorphin release in clinical pain states naloxone was given, alternate with saline, in a double-blind study to 10 patients with chronic neuralgia or low back pain. There was no significant alteration of the levels of spontaneous pain or heat pain thresholds. The results suggest that the endorphin system does not offer protection of any importance in chronic pain.

Topics: Adult; Back Pain; Clinical Trials as Topic; Double-Blind Method; Endorphins; Female; Hot Temperature; Humans; Male; Middle Aged; Naloxone; Pain; Sensory Thresholds

This case report presents data regarding endogenous opioid analgesia in a healthy female subject prior to developing chronic pain, and again 4 and 13 months following onset of chronic daily back pain. At each assessment period, the subject underwent identical protocols involving two sessions one week apart with randomized double-blind crossover administration of saline placebo and naloxone, an opioid antagonist. Each session included a 5-min anger recall interview, followed by finger pressure and ischemic acute pain tasks. Increases in acute pain ratings induced by opioid blockade were interpreted as reflecting endogenous opioid analgesia. When the subject was healthy and pain-free, naloxone produced a mean overall 16% decrease in pain ratings relative to placebo. However, 4 months after onset of chronic pain, a mean naloxone-induced increase of 22% in pain ratings over placebo was observed, consistent with presence of endogenous opioid analgesia. The mean magnitude of this opioid blockade effect for the finger pressure task exceeded the 99% confidence interval for the healthy control population based on a previous study using a similar opioid blockade protocol [4]. At 13-month follow-up, naloxone produced a mean 45% decrease in acute pain ratings compared to placebo, arguing against presence of endogenous opioid analgesia. Although results must be interpreted cautiously, findings are consistent with the hypothesis that chronic pain may initially be associated with upregulation of endogenous opioid analgesic systems which then may become dysfunctional over time.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Analgesics, Opioid; Back Pain; Chronic Disease; Female; Follow-Up Studies; Humans; Middle Aged; Naloxone; Narcotic Antagonists; Pain Measurement

Topics: Aged; Analgesics, Opioid; Back Pain; Drug Therapy, Combination; Female; Humans; Naloxone; Narcotic Antagonists; Tilidine; Time Factors

A technique is described which helps in the differentiation between pain of a mainly physical (organic) and emotional (psychogenic) basis. This is based upon the patients' subjective response to the epidural administration of fentanyl and placebo agents. Patients initially had both physical and psychological assessment in a multidisciplinary pain management unit and because of doubt of the underlying diagnosis, were subjected to this procedure. Eight patients are described in whom the following solutions were administered at 20 min intervals: 2 aliquots of normal saline (5 ml) via an epidural catheter; 1 microgram/kg fentanyl via the epidural catheter; intravenous naloxone 0.4 mg, then, depending upon results obtained, 15-20 ml 2% plain lignocaine via the epidural catheter. If a patient's visual analogue score decreased following epidural fentanyl and subsequently increased following naloxone, then a predominantly physical basis for the pain was likely. In contrast, little change in visual analogue score following fentanyl and naloxone suggested a diagnosis of a predominantly emotional basis for the pain. The diagnoses were substantiated by subsequent follow-up and treatment. It is suggested that this test has both prognostic and diagnostic value when used in the context of thorough physical and psychologic assessment of a patient with chronic pain.

Topics: Adult; Aged; Anesthesia, Epidural; Back Pain; Chronic Disease; Diagnosis, Differential; Female; Fentanyl; Humans; Lidocaine; Male; Middle Aged; Naloxone; Pain; Prognosis; Psychophysiologic Disorders; Sensation; Stress, Psychological

Topics: Adult; Back Pain; Endorphins; Humans; Male; Manipulation, Orthopedic; Middle Aged; Naloxone; Receptors, Opioid