جستجوی مقالات مرتبط با کلیدواژه « اپیوئیدها » در نشریات گروه « پزشکی »

Common cellular and molecular mechanisms are not only involved in the development of neuropathic pain caused by neurological damage but also in the occurrence of the tolerance/hyperalgesia phenomenon caused by chronic use of opioids. It seems that the activation of the neuroimmune system in the brain and spinal cord is one of the most important mechanisms involved in the initiation and maintenance of neuropathic pains and reducing the antinociceptive effect of morphine after nerve injury. Plus, it also plays an important role in the development of tolerance/hyperalgesia due to chronic opioid consumption. Glial cells, especially microglia, are resident immune cells in the nervous system and get activated in response to many exogenous and endogenous factors. When activated, glial cells undergo structural and functional changes and can secrete various inflammatory factors such as IL1β, IL6 and TNFα. These changes increase the irritability and spontaneous firing of neurons, which play an important role in creating and maintaining neuropathic pain as well as reducing the analgesic effect of opioids and bringing about the onset of opioid tolerance/hyperalgesia phenomenon. In this review, we have tried to observe recent studies on the role of the neuroimmune system of the brain and spinal cord in the development of neuropathic pain and of opioid tolerance/hyperalgesia. In our view, a prevention of activation or a diminished activity of the neuroimmune system via appropriate drug compounds can be useful as a new strategy in the treatment of neuropathic pain and in the decrease of morphine tolerance/hyperalgesia, which will in turn result in an increase of the clinical efficacy of opioids.

Background and Considering the importance of pain management in cancer patients, this study aimed to assess the prevalence of pain, its severity, analgesics used to control pain, and the extent of pain control in cancer patients attending a medical center in North of Iran.
One hundred cancer patients attending Ramsar Imam Sajjad Hospital (2015) were prospectively enrolled in the study. Clinical and demographic data and all analgesics used were recorded. Pain intensity were determined based on the Numeric Rating Scale from 0 (pain-free) to 10 (the most severe pain ever experienced) in two sequential visits, 3 weeks apart.
The average age of participants was 54.7±3 years. NSAIDs (98 cases, 98%) and opioids (49 cases, 49%) were the most common analgesics prescribed. Among opioids, codeine (67.3%) and morphine (24.5%) were used more frequently. The pain score was 3.94±0.342 at first visit and 3.65±.316 following analgesic use (P=0.002). For opioid users, the pain scores were 4.29±0.53 and 3.84±0.506, respectively (P=0.007).
The pain scores statistically reduced, however, the decrease was not clinically prominent since the pain severity was between 3 and 4 in NRS scale. More attention to pain control is recommended in cancer patients while considering the standard pain management guidelines.

Chronic drug use has been associated with a wide range of neuropsychological deficits. Therefore, this study aimed to evaluate the performance of the neuropsychological functions among three groups of opioids abusers, treated with methadone and non-user individuals.
The causal-comparative research method was used in this study. The participants were selected through purposeful sampling method. 90 participants were divided into three groups; opioids abusers (n=30), treated with methadone (n=30) and non-user participants groups (n=30). All subjects were completed the Wisconsin card sorting test and self-reported mental effort scale, and their performance on these tasks was measured and evaluated by both processing efficiency and performance effectiveness. The results were analyzed using one-way ANOVA, Tukey post hoc test and SPSS software (Ver 23).
The results showed that in treated with methadon and opioids abusers groups, in two dimensions of performance effectiveness and efficiency of processing were meaker than the non-user group (p This result that the treated with methadone participants had better performance effectiveness rather than opioids abusers group could have important implications in pathology and treatment of substance abuse. From this perspective, recognizing the underlying mechanisms that have helped to methadone users for having more effective functions, can be effective in developing of cognitive rehabilitation programs in these patients.

Body packing was first described in the medical literature in 1973. However since Sep 11، recognition of body packers has become more in order of tight control in airports and stations. Approach to the body packers has made significant changes in recent 2 decades. Furthermore، because of the new technology of packing، rupture of packs and obstruction become less. Drugs divide in 3 groups: cocaine and amphetamine with fatal toxicity effects without antidotes، opioids which have antidotes and the last group is canabioids which don’t have any fatal toxicity. In all cases with obstruction or peritonitis sign and symptom surgical treatment is suggested. In cases without any signs and symptoms it is better to use laxatives. Surgical managements are recommended for toxic cocaine and amphetamine body packers. Approach to the opioids body packer is to use antidotes. Medical treatment is the best for canabioids body packers. Surgical treatment is recommended in patients with complete bowel obstruction and peritonitis.

Neonatal thrombocytosis is a very rare phenomenon in infants born to addict mothers. It can be due to opioids withdrawal and occurs a few days after delivery. The etiology is unknown and it is eradicated gradually without any complication. The reported neonate was born to a heroin addict mother who has used methadone during pregnancy. The neonate was admitted in 14th day of life in neonatal intensive care unit (NICU) with the diagnosis of withdrawal syndrome and supportive care was administered for him. Thrombocytosis was detected in routine lab tests. There was not any reason for it except his mother’s addiction. The platelet count was 1,168,000 in the first day and decreased gradually during 28 days to 739,000. There was not any complication and no special treatment was administered. This case indicates that thrombocytosis may happen as a part of neonatal abstinence syndrome and is eradicated without any complication

Background and Opioids are frequently added to local anesthetics in order to improve analgesia in neuraxial blocks which may lead to – sometimes intolerable - pruritus in the patients. In this study the effect of meperidine on pruritus following the preh1ion of opioids (in the scale and dose of mg) in regional anesthesia was investigated. Methods and Materials: This clinical trial was conducted on 54 patients in two groups of 27. The patients included those hospitalized fro cesarean section in the midwifery ward as well as those in the surgical-orthopedic ward. Both groups received anesthetic and opioids (meperidine in mg doses). The first group i.e. the control group received a certain volume of physiologic serum and the second group i.e. the experimental group received the same volume of physiologic serum plus IV meperidine (nanogram dose). Pruritus was measured in the conventional scale at hours 0 6 12 and 24 after surgery. In the statistical analysis Mann Whitney U Fisher's exact test and chi-square were used. in the experimental group incidence and intensity of pruritus (in case of occurring) were significantly lower than the control group (intensity score being one). Using nano-doses of opioids (meperidine) is effective in preventing pruritus.

The use of opioids to control pain during and after surgeries is a current method in anesthesia, but the side effects of these drugs like nausea, vomiting and respiratory depression have made us decrease their use. One proposal is to use NSAIDs in order to decrease the doses of opioid drugs. One of these drugs is paracetamol which can be used intravenously. In this study we administered two different doses of intravenous paracetamol to help control pain in patients who had upper limb surgeries. The aim of the present study is to investigate whether intravenous paracetamol has a role in decreasing the use of opioids for pain control during and after surgeries. And if the answer is positive, what dose might be effective. Patients and This is a double-blind study which was carried out on 60 ASA(American Society of Anesthesiology) class I patients between the ages of 20 and 40. The subjects were divided into 3 groups, each of which included 20 patients. Group A received 15mg/kg and group B received 30mg/kg intravenous paracetamol before the induction of anesthesia. Group C was the control group. The method of induction and maintenance of anesthesia and pain control during and after surgery was the same in the three groups. The amount of recommended opioids in the three groups was measured and recorded according to a similar protocol. The obtained results were assessed by Chi-square, ANOVA and Scheffe tests. With regard to the amount of administered fentanyl at the time of surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant(P=0.01). With regard to the amount of administered pethedin for pain control 6 hours after surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant(P=0.01). It is recommended that 30mg/kg intravenous paracetamol be administered before the induction of anesthesia to decrease the doses of opioids for pain control during and until 6 hours after upper limb surgeries.