|
1
|
De Rosa F, Giannatiempo B, Charlier B, Coglianese A, Mensitieri F, Gaudino G, Cozzolino A, Filippelli A, Piazza O, Dal Piaz F, Izzo V. Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain. Pharmaceutics 2023; 15:2088. [PMID: 37631302 PMCID: PMC10457775 DOI: 10.3390/pharmaceutics15082088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports.
Collapse
Affiliation(s)
- Federica De Rosa
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
| | - Bruno Giannatiempo
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
| | - Bruno Charlier
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
| | - Albino Coglianese
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pathology and Clinical Biochemistry, University of Salerno, 84084 Fisciano, Italy
| | - Francesca Mensitieri
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Giulia Gaudino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Armando Cozzolino
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry, Postgraduate School of Clinical Pharmacology and Toxicology, University of Salerno, 84084 Fisciano, Italy; (F.D.R.); (B.G.); (B.C.); (A.C.); (A.F.)
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Ornella Piazza
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Fabrizio Dal Piaz
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| | - Viviana Izzo
- University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy; (A.C.); (O.P.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy; (F.M.); (G.G.)
| |
Collapse
|
|
2
|
Noguri T, Hatakeyama D, Kitahashi T, Oka K, Ito E. Profile of dorsal root ganglion neurons: study of oxytocin expression. Mol Brain 2022; 15:44. [PMID: 35534837 PMCID: PMC9082903 DOI: 10.1186/s13041-022-00927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
Although dorsal root ganglion (DRG) neurons have been so far classified according to the difference in their fibers (Aβ, Aδ, and C), this classification should be further subdivided according to gene expression patterns. We focused on oxytocin (OXT) and its related receptors, because OXT plays a local role in DRG neurons. We measured the mRNA levels of OXT, OXT receptor (OXTR), vasopressin V1a receptor (V1aR), transient receptor potential cation channel subfamily V member 1 (TRPV1), and piezo-type mechanosensitive ion channel component 2 (Piezo2) in single DRG neurons by using real-time PCR, and then performed a cluster analysis. According to the gene expression patterns, DRG neurons were classified into 4 clusters: Cluster 1 was characterized mainly by Piezo2, Cluster 2 by TRPV1, Cluster 4 by OXTR, and neurons in Cluster 3 did not express any of the target genes. The cell body diameter of OXT-expressing neurons was significantly larger in Cluster 1 than in Cluster 2. These results suggest that OXT-expressing DRG neurons with small cell bodies (Cluster 2) and large cell bodies (Cluster 1) probably correspond to C-fiber neurons and Aβ-fiber neurons, respectively. Furthermore, the OXT-expressing neurons contained not only TRPV1 but also Piezo2, suggesting that OXT may be released by mechanical stimulation regardless of nociception. Thus, mechanoreception and nociception themselves may induce the autocrine/paracrine function of OXT in the DRG, contributing to alleviation of pain.
Collapse
Affiliation(s)
- Taisei Noguri
- Department of Biology, Waseda University, Tokyo, 162-8480, Japan
| | - Dai Hatakeyama
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, 770-8514, Japan
| | - Takashi Kitahashi
- Kushiro Nature Conservation Office, Ministry of the Environment, Kushiro, 085-8639, Japan
| | - Kotaro Oka
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Yokohama, 223-8522, Japan
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
- Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Etsuro Ito
- Department of Biology, Waseda University, Tokyo, 162-8480, Japan.
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, 169-8555, Japan.
- Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
| |
Collapse
|