APS Press Room
News Highlights from The Journal of Pain • Febrary 2005
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
GLENVIEW, Ill, Feb. 18, 2005 -- The following news highlights summarize selected articles in the current (February 2005) issue of The Journal of Pain (Vol.6, No. 2 ), the peer-reviewed scientific journal of the American Pain Society (APS). Based in Glenview, Ill., APS is a multidisciplinary educational and scientific organization dedicated to serving people in pain.
The opinions and ideas expressed in articles appearing in the Journal of Pain do not necessarily reflect those of the editor and publisher or of the American Pain Society.
MORPHINE RESPONSES AND EXPERIMENTAL PAIN: SEX DIFFERENCES IN SIDE EFFECTS AND CARDIOVASCULAR RESPONSES BUT NOT ANALGESIA
Roger B. Filligim, et al, University of Florida College of Dentistry
Opioids are the most widely used medications for managing moderate-to severe pain, but the analgesic affect can be variable from patient to patient. In recent years, several articles in The Journal of Pain and other medical journals have focused on sex differences in patient responses to opioids. Filligim and colleagues have examined variability in responses to morphine in men and women using laboratory pain measures.
In the study, 61 women and 39 men were given intravenous morphine in response to heat, pressure or ischemic pain.
In all subjects, the morphine doses provided adequate analgesia to all pain stimuli without noticeable sex differences. Women, however, reported more side effects, such as nausea, vomiting, dizziness and profuse perspiration. In men, there were greater increases in resting blood pressure than in women. Further, morphine attenuated the cardiovascular responses in men to the application of tourniquet pressure, but did not in women. The researchers concluded there are no sex differences in the analgesic affect of morphine whereas there are considerable gender-based differences in the frequency of side effects and cardiovascular responses to the drug.
PAIN CATASTROPHIZING AND CONSEQUENCES OF MUSCULOSKELETAL PAIN; A PROSPECTIVE STUDY IN THE DUTCH COMMUNITY
Rudy Severeijns, University Hospital of the Maastrict, Netherlands
The objective of this study was to determine whether pain catastrophizing could predict the development of chronic pain in a population of 2,789 subjects in the Dutch Musculoskeletal Complaints and Consequences Cohort Study. The subjects returned a 28-page survey questionnaire covering a wide range of health status questions.
Catastrophizing is a response by those who exaggerate negative beliefs about pain and believe it threatens them. Pain-related fear, therefore, leads to avoidance behaviors, hypervigilance to body sensations, depression and disability. The authors noted that little is known about the possible role of catastrophizing in the development of chronic complaints and of the prospective relationship between pain catastrophizing and several pain outcomes in general populations.
Results showed there was no evidence that pain catastrophizing predicted behaviors exhibited by those who complain about chronic pain, such as specialist consultation, use of pain medications and absenteeism. There also was no evidence that pain regions or intensity moderated the relationship between catastrophizing and chronicity. The authors noted the results contradict the prevailing notion that catastrophizing plays a significant role in chronic pain. A possible explanation is the low level of catastrophizing found in their general population survey. The authors also concluded the results may indicate the role of pain catastrophizing in the development of chronic pain is more or less dependent on whether the subjects studied are in a general, clinical or outpatient population.
ALVIMOPAN: AN ORAL,PERIPHERALLY ACTING MU OPIOID RECEPTOR AGONIST FOR TREATMENT OF OPIOID INDUCED BOWEL DYSFUNCTION
Daniel M. Paulson, et al, VA Medical Center, Richmond Va.
In many patients, opioids impair normal bowel function and also cause nausea and vomiting. For this study, researchers evaluated oral alvimopan, a novel peripheral opioid receptor antagonist, as a possible agent to reverse the inhibitory effect of opioids on gastrointestinal transit without influencing analgesia. The efficacy of the drug was studied vs. placebo for 21 days in 168 patients with opioid-induced bowel dysfunction. The outcome of the study showed that alvimopan was well tolerated, did not compromise analgesia, and demonstrated significant efficacy for management of opioid-induced bowel dysfunction.
TREATMENT OF PAIN IN PATIENTS WITH RENAL INSUFFICIENCY; THE WHO THREE-STEP LADDER ADAPTED
Vincent Launay-Vachner, et al, Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France
The World Health Organization’s three-step approach to managing pain introduces opioids in Step 2 in combination with aspirin and other drugs to treat moderate to severe pain, and in Step 3 for moderate to severe pain primarily in cancer patients unable to get relief from the combinations in Step 2. This approach has been widely adopted for treating all types of pain, but it has been critically evaluated for patients with renal insufficiency. In this article, the authors evaluate the pharmacokinetics of numerous types of pain medications to assess their potential nephrotoxicity.
Modifications to the WHO approach were recommended for treating pain in patients with renal insufficiency:
- For patients whose creatinine clearance is within 80 and 50 mL/min no pain medication adjustments are required.
- For hemodialysis patients, renal tolerance isn’t a problem, therefore, the renal effects of NSAIDS should not be considered as a reason to limit their use.
- For kidney transplant patients treated with immunosuppressive drugs that might be nephrotoxic, use of pain medications with risk for renal toxicity is not recommended.