OBJECTIVES:Treatment guidelines discourage long-term opioid treatment for patients with chronic pain and major depression, but this treatment occurs commonly, producing higher daily doses, longer ...duration, and more adverse events.
METHODS:Review of prospective cohort, retrospective cohort, and other observational studies of the relation between depression and opioid use, abuse, and addiction.
RESULTS:Depressed patients initiate opioid therapy slightly more often than non-depressed patients, but are twice as likely to transition to long-term use. This adverse selection of high-risk patients with depression into long-term high-dose opioid therapy appears to be a process of self-selection. Opioids may be used by patients with chronic pain and depression to compensate for a reduced endogenous opioid response to stressors. Depressed patients appear to continue opioid use at lower pain intensity levels and higher levels of physical function than do non-depressed patients. In studies that carefully control for confounding by indication, it has been shown that long-term opioid therapy increases the risk of incident, recurrent and treatment-resistant depression. Depressed patients tend to overuse opioids because they use them to treat insomnia and stress. Depression also appears to increase the risk of abuse or non-medical use of prescription opioids among adults and adolescents. This increased rate of non-medical opioid use may be the path through which depression increases the risk of Opioid Use Disorder among patients with chronic pain.
DISCUSSION:It is not possible to understand long-term opioid therapy for chronic pain without understanding the close and multifaceted relationship of this therapy with depression.
Borrowing treatment principles from acute and end-of-life pain care, particularly a focus on pain intensity, has had harmful consequences for patients with chronic pain. Multimodal therapy, by ...contrast, aims to reduce pain-related distress, disability, and suffering.
Pain causes widespread suffering, disability, social displacement, and expense. Whether the issue is viewed from a moral, political, or public health perspective, pain that can be relieved should be relieved. Yet the most rapidly effective drugs for relieving pain — opioids — are caught up in a morass of concerns about addiction. Achieving a balance between the benefits and potential harms of opioids has become a matter of national importance.
The United States recently established a national plan to address pain, as Canada, Australia, Portugal, and Malaysia have previously done.
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This National Pain Strategy grew out of recognition by the . . .
The current International Association for the Study of Pain (IASP) definition of pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or ...described in terms of such damage" was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.
The importance of serine metabolism in cancer Mattaini, Katherine R; Sullivan, Mark R; Vander Heiden, Matthew G
The Journal of cell biology,
08/2016, Volume:
214, Issue:
3
Journal Article
Peer reviewed
Open access
Serine metabolism is frequently dysregulated in cancers; however, the benefit that this confers to tumors remains controversial. In many cases, extracellular serine alone is sufficient to support ...cancer cell proliferation, whereas some cancer cells increase serine synthesis from glucose and require de novo serine synthesis even in the presence of abundant extracellular serine. Recent studies cast new light on the role of serine metabolism in cancer, suggesting that active serine synthesis might be required to facilitate amino acid transport, nucleotide synthesis, folate metabolism, and redox homeostasis in a manner that impacts cancer.
Copper-exchanged zeolites can continuously and selectively catalyze the partial oxidation of methane to methanol using only oxygen and water at low temperatures, but the genesis and nature of the ...active sites are currently unknown. Herein, we demonstrate that this reaction is catalyzed by a Cu–O–Cu2+ motif that forms via a hypothesized proton-aided diffusion of hydrated Cu ions within the cages of SSZ-13 zeolites. While various Cu configurations may be present and active for methane oxidation, a dimeric Cu motif is the primary active site for selective partial methane oxidation. Mechanistically, CH4 activation proceeds via rate-determining C–H scission to form a surface-bound C1 intermediate that can either be desorbed as methanol in the presence of H2O/H+ or completely oxidized to CO2 by gas-phase O2. High partial oxidation selectivity can be obtained with (i) high methane and water partial pressures and (ii) maximizing Cu dimer formation by using zeolites with high Al content and low Cu loadings.
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IJS, KILJ, NUK, PNG, UL, UM
The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an ...evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the taxonomy. In this article, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider "general" psychosocial variables such as negative affect, childhood trauma, and social support, as well as "pain-specific" psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions.
The AAPT is an evidence-based chronic pain classification system in which psychosocial concepts and processes are essential in understanding the development of chronic pain and its effects. In this article we review psychosocial processes that influence the onset, exacerbation, and maintenance of chronic pain disorders.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Metallic–acidic bifunctionality of molybdenum carbidic catalytic formulations can be tuned by oxygen cofeed and reductive pretreatments to control carbonyl hydrodeoxygenation (HDO). Acetone is ...deoxygenated over activated Mo2C via sequential hydrogenation of acetone to equilibrium and subsequent dehydration of isopropyl alcohol (IPA). Dehydration to propylene occurs over Brønsted acid sites with an intrinsic activation energy of 103 ± 1 kJ mol–1 and a rate-determining step of β-hydrogen scission, as inferred from a kinetic isotope effect (KIE) of 1.85. HDO rate-determining dehydration rates were kinetically independent of H2 and oxygenate pressure from 10 to 82 kPa and from 0.05 to 4 kPa, respectively. Both the kinetics and the deoxygenation reaction pathway were shown to be similar for the aldehyde group of propanal. Oxygen treatment of activated carbides via 13.5 kPa O2 cofeed was shown to decrease the catalyst surface area from 68 to 9 m2 g–1 and to suppress metallic hydrogenation of acetone to IPA. IPA dehydration rates per gram of catalyst could be altered by a factor of ∼60; a longer activation time under H2 flow at 773 K increased dehydration activation energies from 103 to 140 kJ mol–1, decreased Brønsted acid site densities, and decreased 2,6-di-tert-butylpyridine-normalized dehydration turnover frequencies, indicative of a reduction-induced change in the number and nature of the acid sites.
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IJS, KILJ, NUK, PNG, UL, UM
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