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Imbriaco G, Capitano M, Rocchi M, Suhan A, Tacci A, Monesi A, Sebastiani S, Samolsky Dekel BG. Relationship between noise levels and intensive care patients' clinical complexity: An observational simulation study. Nurs Crit Care 2024; 29:555-563. [PMID: 37265028 DOI: 10.1111/nicc.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Noise pollution in intensive care units is a relevant problem, associated with psychological and physiological consequences for patients and healthcare staff. Sources of noise pollution include medical equipment, alarms, communication tools, staff activities, and conversations. AIMS To explore the cumulative effects of noise caused by an increasing number and type of medical devices in an intensive care setting on simulated patients with increasing clinical complexity. Secondly, to measure medical device alarms and nursing activities' sound levels, evaluating their role as potentially disruptive noises. STUDY DESIGN Observational simulation study (reported according to the STROBE checklist). Using an electronic sound meter, the sound levels of an intensive care room in seven simulated clinical scenarios were measured on a single day (09 March 2022), each featuring increasing numbers of devices, hypothetically corresponding to augmented patients' clinical complexity. Secondly, noise levels of medical device alarms and specific nursing activities performed at a distance of three meters from the sound meter were analysed. RESULTS The empty room's mean baseline noise level was 37.8 (±0.7) dBA; among the simulated scenarios, noise ranged between 45.3 (±1.0) and 53.5 (±1.5) dBA. Alarms ranged between 76.4 and 81.3 dBA, while nursing tasks (closing a drawer, opening a saline bag overwrap, or sterile packages) and speaking were all over 80 dBA. The noisiest activity was opening a sterile package (98 dBA). CONCLUSION An increased number of medical devices, an expression of patients' higher clinical complexity, is not a significant cause of increased noise. Some specific nursing activities and conversations produce higher noise levels than medical devices and alarms. This study's findings suggest further research to assess the relationships between these factors and to encourage adequate noise reduction strategies. RELEVANCE TO CLINICAL PRACTICE Excessive noise level in the intensive care unit is a clinical issue that negatively affects patients' and healthcare providers' well-being. The increase in baseline room noise from medical devices is generally limited. Typical nursing tasks and conversations produce higher noise levels than medical devices and alarms. These findings could be helpful to raise awareness among healthcare professionals to recognize noise sources. The noisiest components of the environment can be modified by staff behaviour, promoting noise reduction strategies and improving the critical care environment.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Prehospital Emergency Dispatch Center, Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Martina Capitano
- Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Margherita Rocchi
- Intensive Care Unit, Nuovo San Giovanni di Dio hospital, AUSL Toscana Centro, Florence, Italy
| | - Aglaia Suhan
- Medical Department (COVID-19), Madre Teresa di Calcutta hospital, Padova, Italy
| | - Alice Tacci
- Neonatal Intensive Care Unit, Maggiore Hospital, AOU Parma, Parma, Italy
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- Intensive Care Unit, Maggiore hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Evidence for the BUAS-test ability to diagnose lumbar radicular pain. Br J Pain 2022; 16:23-33. [PMID: 35111311 PMCID: PMC8801693 DOI: 10.1177/20494637211005794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients' history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability. METHODS Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant (t-test) and ⩾2 points V2-V1 differences for each of the BPI-item's score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes' dependence upon independent variables. RESULTS Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes. CONCLUSION Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
- Boaz Gedaliahu Samolsky Dekel, Department of Medicine and Surgery Sciences, University of Bologna, Via Massarenti n. 9, 40138 Bologna, Italy.
| | - Maria Cristina Sorella
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Samolsky Dekel BG, Gori A, Gunnellini M, Gioia A, Di Marco M, Casale G, Bevilacqua M, Bersani P, Melotti RM. The Italian Questionnaire for Cancer Breakthrough Pain Diagnosis, a Multicenter Validation Study. Pain Ther 2021; 10:1171-1188. [PMID: 34091817 PMCID: PMC8586321 DOI: 10.1007/s40122-021-00274-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/17/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The literature lacks formally validated and reliable tools for the diagnosis of breakthrough cancer pain (BTcP). The Italian Questionnaire for BTcP diagnosis (IQ-BTP) is an 11-item questionnaire aimed at detecting potential-BTP and classifying it into three likelihood classes: high, intermediate, and low. METHODS A multicenter, prospective, and observational study was designed to validate the IQ-BTP. In three consecutive visits with each cancer patient, the demographic and clinical details of the patient, the Brief Pain Inventory (BPI) scores, IQ-BTP outcomes, and clinicians' autonomous BTcP diagnosis (gold standard) and the agreement of this diagnosis with IQ-BTP outcomes were recorded. The assessed domains for IQ-BTP validation were: Validity, including content and face validity, construct validity (hypothesis testing, and cross-cultural validity\measurement invariance), and criterion validity; Reliability (internal consistency, reliability, and measurement error); Interpretability, and Responsiveness. RESULTS Seven palliative and pain management facilities in Italy recruited 280 patients, yielding 753 evaluations. Using the IQ-BTP, the rate of potential-BTcP was 27.2%, of which its likely presence was high in 52.7% of patients, intermediate in 38.5, and low in 8.8%. The BPI item scores differed significantly between the two IQ-BTP classes (no-BTcP and potential-BTcP classes). The correlation of the latter class with BPI items was significant but low. The IQ-BTcP showed two principal components, accounting for 66.6% of the variance. Cronbach's α was 0.71. The agreement rate between the gold standard and IQ-BTP outcomes was 82%. Cohen's [Formula: see text] was 0.535. The IQ-BTP showed sensitivity and specificity of 69 and 86%, respectively. CONCLUSIONS The IQ-BTP extensive formal validation showed satisfactory psychometric and validity properties. Its content, face, construct, and criterion validities and its reliability, interpretability, and responsiveness were shown. Its use enabled potential-BTcP to be identified and differentiated into three likelihood classes with direct therapeutic and epidemiological implications. The latter may be confirmed in future studies.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, via Massarenti n. 9, 40138, Bologna, Italy. .,Anesthesia and Pain Therapy Unit, IRCCS AOSP di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy. .,Post Graduate School of Anaesthesia, Intensive Care and Pain Medicine, University of Bologna, Via Massarenti n. 9, 40138, Bologna, Italy.
| | - Alberto Gori
- grid.6292.f0000 0004 1757 1758Post Graduate School of Anaesthesia, Intensive Care and Pain Medicine, University of Bologna, Via Massarenti n. 9, 40138 Bologna, Italy
| | - Marco Gunnellini
- Medical Oncology and Paliative Care Unit, USL Umbria 1, Presidio Ospedaliero di Gubbio, Gualdo Tadino, Largo Unità D’Italia, 1, 06024 Gubbio, Italy ,Ospedale Media Valle del Tevere, Vocabolo Buda, Todi, 06059, Perugia, Italy
| | - Angela Gioia
- Hospice, UF Cure Palliative, Azienda USL Toscana NordOvest, via Cocchi, 7-9, Pisa, Italy
| | - Mariacristina Di Marco
- grid.412311.4Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Via Albertoni, 15, Bologna, Italy
| | - Giuseppe Casale
- Antea Foundation Research Group, piazza Santa Maria della pietà 5, 00135 Rome, Italy
| | - Marzio Bevilacqua
- Dipartimento di Anestesia, Rianimazione e Terapia Intensiva U.O.C. di Medicina e Terapia del Dolore, ULSS2, Marca Trevigiana, Treviso, Italy
| | - Pietro Bersani
- Gigi Ghirotti Association, Home Care, Corso Europa, 50/9, 16132 Genoa, Italy
| | - Rita Maria Melotti
- grid.6292.f0000 0004 1757 1758Department of Medicine and Surgery Sciences, University of Bologna, via Massarenti n. 9, 40138 Bologna, Italy ,grid.412311.4Anesthesia and Pain Therapy Unit, IRCCS AOSP di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758Post Graduate School of Anaesthesia, Intensive Care and Pain Medicine, University of Bologna, Via Massarenti n. 9, 40138 Bologna, Italy
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Imbriaco G, Rondelli R, Maroni F, Mazzolani S, Sasso S, Sebastiani S, Samolsky Dekel BG. Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey. J Pain Res 2021; 14:1827-1835. [PMID: 34163237 PMCID: PMC8215928 DOI: 10.2147/jpr.s303998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician’s remote supervision. Information about such protocols in Italian EMS is lacking. Objective Evaluation of the availability of nurse’s standard analgesia protocols in Italy’s prehospital EMS settings. Methods A cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ2-analysis and Spearman-rank correlation to look for associations between geographical areas’ dependence upon independent variable categories and their correlations. Results Of all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses’ prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols. Conclusion Despite international consensus on the necessity, efficacy, and safety of nurses’ prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.,Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Riccardo Rondelli
- Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Federica Maroni
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.,Emergency Department, Bufalini Hospital, Cesena, Italy
| | - Selene Mazzolani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.,Intensive Care Unit, Infermi Hospital, Faenza, Italy
| | - Silvia Sasso
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.,Surgical Unit, State Hospital, San Marino, San Marino Republic
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Reply to the Letter "Regarding Samolsky Dekel et al. Reliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain". Pain Pract 2020; 20:951-952. [PMID: 32677268 DOI: 10.1111/papr.12941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Reliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain. Pain Pract 2020; 20:829-837. [PMID: 32237018 DOI: 10.1111/papr.12890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Low-back pain (LBP) pathophysiological conditions include nociceptive back pain, somatic referred pain, radicular pain (RP), and radiculopathy. Differential diagnosis is challenging; guidance may come from patients' thorough clinical history and physical examination and, particularly for lumbar RP, from the evaluation of subjective responses of injured lumbar nerves to a strain applied at the buttock (buttock applied strain [BUAS] test). METHODS In a sample of 395 consecutive patients with LBP, sensitivity, specificity, and prior probability (positive predictive values [PPVs] and negative predictive values [NPVs]) of the BUAS test were evaluated against 2 reference tests: the straight leg raising test (SLRT) and the painDETECT (PD) questionnaire. Multinomial logistic regression (MLR) and χ2 analyses were used to evaluate the BUAS test outcomes' dependence upon independent variables (gender, age group, pain localization, SLRT outcomes, and PD outcomes). Cohen's kappa statistic was used to assess inter-rater agreement. RESULTS Compared with the PD questionnaire, the BUAS test showed a sensitivity of 92%, specificity of 100%, PPV of 100%, and NPV of 82%; compared with the SLRT, the BUAS test showed a sensitivity of 82%, NPV of 82%, specificity of 40%, and PPV of 40%. Inter-rater agreement of Cohen's kappa was 0.911. Significant associations were found between BUAS test outcomes and pain localization, SLRT outcomes, and PD outcomes, but not with the predictors gender or age group. MLR showed significant congruent relationships between BUAS test and PD outcomes. CONCLUSION Among patients with LBP, the BUAS test showed satisfactory sensitivity, specificity, prior probability, and inter-rater reliability; thus, it may be considered a useful adjunctive tool to diagnose RP in patients with LBP. For more generalized results, more research, in clinical settings other than pain clinics, is needed.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Samolsky Dekel BG, Sorella MC, Vasarri A, Gori A, Melotti RM. Opioid-induced constipation in mixed chronic pain patients: Prevalence and predictors analysis. J Opioid Manag 2019; 15:375-387. [PMID: 31849029 DOI: 10.5055/jom.2019.0527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Assessment of opioid-induced constipation (OIC) prevalence and relationship with demographic, clinical, and drug predictors in our daily practice. DESIGN Observational and retrospective study. SETTING Chronic pain (CP) center of Bologna's Teaching Hospital, Italy. SUBJECTS Mixed consecutive CP opioid-user outpatients (n = 128). MAIN OUTCOME MEASURE(S) OIC was assessed with the Bowel Function Index (BFI) in three consecutive visits. Absolute difference and Student's t-test were used to compare BFI scores. Predictors (opioid compound and type, morphine-equivalent daily-dose [MEDD], and laxatives) were retrieved from the patients' charts. BFI and predictors relationships were checked by multinomial logistic regression (MLR); independent predictors of BFI scores were assessed with χ2 analysis. RESULTS Of the 384 evaluations, 85 percent were on strong opioids with a MEDD range of 11-50 mg per day in the majority (60 percent) and 64 percent showed moderate constipation; 42 percent did not use laxatives while 24 percent used macrogol with significant decrease in the BFI. MLR showed that oxycodone was associated with a risk for moderate constipation. Lactulose and glycerin suppositories were associated with severe constipation. Non-opioid users and cancer patients were associated with normal bowel function and severe constipation, respectively. CONCLUSIONS OIC was found in almost all evaluations of weak or strong opioidusers (97 percent); moderate to severe OIC was found in 72 percent of the evaluations. Cancer patients were associated with severe constipation. Macrogol was superior to other laxatives. In our experience, macrogol relieved constipation in those on the combination of oxycodone and naloxone and in those on fentanyl patches. Lactulose and glycerol suppositories were associated with severe constipation.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Alberto Gori
- Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Protti M, Catapano MC, Samolsky Dekel BG, Rudge J, Gerra G, Somaini L, Mandrioli R, Mercolini L. Determination of oxycodone and its major metabolites in haematic and urinary matrices: Comparison of traditional and miniaturised sampling approaches. J Pharm Biomed Anal 2018; 152:204-214. [DOI: 10.1016/j.jpba.2018.01.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 02/06/2023]
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Samolsky Dekel BG, Palma M, Sorella MC, Gori A, Vasarri A, Melotti RM. Development and performance of a diagnostic/prognostic scoring system for breakthrough pain. J Pain Res 2017; 10:1327-1335. [PMID: 28615964 PMCID: PMC5459964 DOI: 10.2147/jpr.s126132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Variable prevalence and treatment of breakthrough pain (BTP) in different clinical contexts are partially due to the lack of reliable/validated diagnostic tools with prognostic capability. We report the statistical basis and performance analysis of a novel BTP scoring system based on the naïve Bayes classifier (NBC) approach and an 11-item IQ-BTP validated questionnaire. This system aims at classifying potential BTP presence in three likelihood classes: "High," "Intermediate," and "Low." METHODS Out of a training set of n=120 mixed chronic pain patients, predictors associated with the BTP likelihood variables (Pearson's χ2 and/or Fisher's exact test) were employed for the NBC planning. Adjusting the binary classification to a three-likelihood classes case enabled the building of a scoring algorithm and to retrieve the score of each predictor's answer options and the Patient's Global Score (PGS). The latter medians were used to establish the NBC thresholds, needed to evaluate the scoring system performance (leave-one-out cross-validation). RESULTS Medians of PGS in the "High," "Intermediate," and "Low" likelihood classes were 3.44, 1.53, and -2.84, respectively. Leading predictors for the model (based on score differences) were flair frequency (ΔS=1.31), duration (ΔS=5.25), and predictability (ΔS=1.17). Percentages of correct classification were 63.6% for the "High" and of 100.0% for either the "Intermediate" and "Low" likelihood classes; overall accuracy of the scoring system was 90.9%. CONCLUSION The NBC-based BTP scoring system showed satisfactory performance in classifying potential BTP in three likelihood classes. The reliability, flexibility, and simplicity of this statistical approach may have significant relevance for BTP epidemiology and management. These results need further impact studies to generalize our findings.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna.,Department of Emergency-Urgency, Bologna's University Teaching Hospital, Policlinic S. Orsola-Malpighi.,University of Bologna, Post Graduate School of Anaesthesia and Intensive Care
| | - Marco Palma
- Collegio Superiore, Istituto di Studi Superiori - ISS, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna.,Department of Emergency-Urgency, Bologna's University Teaching Hospital, Policlinic S. Orsola-Malpighi.,University of Bologna, Post Graduate School of Anaesthesia and Intensive Care
| | - Alberto Gori
- University of Bologna, Post Graduate School of Anaesthesia and Intensive Care
| | - Alessio Vasarri
- University of Bologna, Post Graduate School of Anaesthesia and Intensive Care
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna.,Department of Emergency-Urgency, Bologna's University Teaching Hospital, Policlinic S. Orsola-Malpighi.,University of Bologna, Post Graduate School of Anaesthesia and Intensive Care
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Samolsky Dekel BG, Donati G, Vasarri A, Croci Chiocchini AL, Gori A, Cavallari G, Di Nino G, Mercolini L, Protti M, Mandrioli R, Melotti RM, La Manna G. Dialyzability of Oxycodone and Its Metabolites in Chronic Noncancer Pain Patients with End-Stage Renal Disease. Pain Pract 2016; 17:604-615. [PMID: 27589376 DOI: 10.1111/papr.12483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/21/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. METHODS We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone. Chromatographic techniques were used to evaluate the studied compounds' plasma concentrations at three different time points during dialysis. RESULTS Mean plasma concentrations of oxycodone and noroxycodone in the sample showed an overall reduction trend over time, but it was less enhanced for noroxycodone. Mean reduction in oxycodone and noroxycodone arterial concentrations was significant and higher with HDF (54% and 27%, respectively) than with HD (22% and 17%, respectively). Analysis of the regression of these compounds' clearance on their increasing arterial concentration showed a more stable and linear clearance prediction with HDF (roughly 85 mL/min); with HD, for increasing arterial concentration, clearance of oxycodone decreased while noroxycodone clearance increased. DISCUSSION While no oxymorphone or noroxymorphone metabolites were detected, limited dialyzability of oxycodone and noroxycodone was documented along with insignificant postdialysis pain increment. This evidence will contribute toward considerations as to the safety of the use of oxycodone in dialysis patients in the future.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Nephrology, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Anna Laura Croci Chiocchini
- Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Nephrology, University of Bologna, Bologna, Italy
| | - Alberto Gori
- Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Giuseppe Cavallari
- Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Nephrology, University of Bologna, Bologna, Italy
| | - Gianfranco Di Nino
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Michele Protti
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Roberto Mandrioli
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesiology and Intensive Care Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Nephrology, Dialysis and Renal Transplant Unit, University of Bologna's Teaching Hospital, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Nephrology, University of Bologna, Bologna, Italy
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11
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Samolsky Dekel BG, Gori A, Vasarri A, Sorella C, Di Nino G, Melotti RM. The influence of medical evidence moderators on pain rating agreement between inpatients and nurses. Pain Res Manag 2015:17103. [PMID: 26357688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
As cancer is earlier diagnosed and its treatments improve, palliative care is increasingly playinga vital role in the oncology population. The concept and the timing of application of palliativecare have evolved in the last decades. The WHO pain ladder and the greater understanding ofappropriate multimodal pain control treatments have dramatically improved the managementof cancer pain. Integration of palliative care, which appears crucial for a proper management ofpatients, can be defined as the provision of palliative care both during curative cancer treatmentand after curative treatment has ceased. Clinical assistance should be delivered by specialisedphysicians in different fields, psychologists and nurses, and should include all aspects of advancedcancercare, from diagnosis to the treatment of symptoms. A further aspect of integration ofpalliative care concerns the role of the continuity of care in acute or emergency contexts bothfor out- and inpatients. Further improvements in the management of cancer pain are needed.First, the WHO ladder should be modified with further steps, like those of interventional paincontrol procedures and techniques, with the aim of being effective also for the small proportion ofnonresponsive patients. Second, more research is needed to find out which interventions aimingto improve continuity of care of cancer patients are beneficial to improve patient, providerand process of care outcomes and to identify which outcomes are the most sensitive to change.Of crucial importance would be the development of a standardised instrument to measure thecontinuity of care in cancer patients.This article is a brief overview on the management of cancer pain, from the pharmacologicaltreatments reported by WHO ladder, to the need for integration and continuity of care.
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13
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Samolsky Dekel BG, Tomasi M, Vasarri A, Gori A, Adversi M, Castagnoli A, Di Nino G, Melotti RM. Opioid titration with sustained-release oxycodone and immediate-release morphine for moderate/severe cancer pain: a pilot assessment of the CoDem protocol. J Opioid Manag 2014; 10:29-38. [PMID: 24604567 DOI: 10.5055/jom.2014.0189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/31/2013] [Accepted: 11/05/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Opioid titration is the first challenging stage for rapid control of moderate/severe cancer pain. Evidence shows that sustained-release formulations may be used for opioid titration. We set a pilot assessment of the efficacy and tolerability of our in-house protocol (continuous and on demand opioids [CoDem]) of the association of sustained-release oxycodone and immediate-release morphine as rescue dose for opioid titration/rotation in opioid-naïve (NAOP, n = 13), tolerant to weak (WOP, n = 20), or strong opioids (STOP, n = 44) in-patients with moderate/severe cancer pain. METHODS Observational and retrospective analysis of cancer in-patients treated for ≥7 days with the CoDem protocol. OUTCOME MEASURES Pain intensity (patients self-reported pain with numerical rating scale [NRS] under static [NRSs] and dynamic [NRSd] conditions), amount of drug consumption, opioid adverse effects, and patient satisfaction. EFFICACY ENDPOINTS In more than 50 percent of the patients and in <72 hours, steady NRSs and NRSd score reduction of at least two points, NRSs ≤ 3 and NRSd ≤4; and mean daily morphine consumption < mean of one rescue dose and t1:t6 ratio of mean oxycodone daily dose < 1:2. RESULTS Endpoints were reached within 24 hours both within the sample and subgroups. Only NAOP patients reached NRSd ≤ 4 endpoint within 48 hours. Against moderate and transient adverse effects, most patients (84.4 percent) found pain treatment to be good or excellent. CONCLUSIONS The CoDem protocol was shown to be effective and reasonably tolerated for titration for moderate/severe cancer pain relief in both opioid-naïve or opioid-tolerant cancer in-patients. This pilot assessment warrants prospective and comparative studies with larger samples for more generalized results.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Marco Tomasi
- Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy
| | - Alberto Gori
- Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Marco Adversi
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Anna Castagnoli
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - GianFranco Di Nino
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy
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14
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Melilli G, Samolsky Dekel BG, Frenquelli C, Mellone R, Pannuti F. Transdermal opioids for cancer pain control in patients with renal impairment. J Opioid Manag 2014; 10:85-93. [PMID: 24715663 DOI: 10.5055/jom.2014.0197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 04/04/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES As guidelines for opioid use in renal-impaired patients with cancer are limited, the authors sought to assess the efficacy, safety, and tolerability, of transdermal buprenorphine for moderate/severe cancer pain in renal-impaired outpatients. METHODS In a prospective parallel-group active-controlled study, n = 42 consecutively recruited outpatients with or without renal impairment (serum creatinine ≥1.3 or ≤1.2 mg/dL, respectively) were treated with transdermal buprenorphine (group BUP) or fentanyl (group FEN), respectively. Patients were followed up, at home, by the nonprofit ANT-Italia-foundation physicians in Bologna, Italy. Measurements at 10 (T1), 30 (T2), and 90 (T3) days after enrollment (T0) were pain intensity (Numerical Rating Scale [NRS]), Karnofski score, opioid dose (μg/h), rescue-dose consumption, and occurrence of adverse effects. Patients recorded subjective measurements in a personal diary. Upon data analysis, investigators were blinded to the patient group. RESULTS At T0, in groups BUP and FEN, median NRS score was 8.0 (CI, 7.4-8.4); its reduction over time (T3; NRS = 3.0; CI, 2.1-3.8 and 2.0-4.0, respectively) was significant and constant in both groups (t-test; T0-T1, T1-T2, and T2-T3; p < 0.0001, p < 0.001, and p < 0.05, respectively). At all times, there were no significant differences in pain scores between the groups. In all evaluations, adverse effects were reported n = 73/126 times (60.8 percent) and showed no significant association (X(2), p > 0.05) with the study groups. CONCLUSIONS Transdermal buprenorphine, in outpatients with cancer and renal impairment, is as effective, safe, and tolerable as fentanyl in patients without such impairment. These results add further evidence to the notion that buprenorphine, with its peculiar pharmacokinetics, may be an appropriate choice for opioid treatment in patients with renal impairment.
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Melotti RM, Dekel BGS, Carosi F, Ricchi E, Chiari P, D'Andrea R, Nino G. Categories of congruence between inpatient self-reported pain and nurses evaluation. Eur J Pain 2012; 13:992-1000. [DOI: 10.1016/j.ejpain.2008.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 11/23/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
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Raffaeli W, Dekel BGS, Rita M, Righetti D, Caminiti A, Balestri M, Sarti D, Guido F. Long-term intrathecal morphine influence on major compounds of the endocrine system in elderly population. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2009.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Raffaeli W, Samolsky Dekel BG, Landuzzi D, Caminiti A, Righetti D, Balestri M, Montanari F, Romualdi P, Candeletti S. Nociceptin levels in the cerebrospinal fluid of chronic pain patients with or without intrathecal administration of morphine. J Pain Symptom Manage 2006; 32:372-7. [PMID: 17000354 DOI: 10.1016/j.jpainsymman.2006.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 05/10/2006] [Indexed: 10/24/2022]
Abstract
The neuropeptide nociceptin/orphanin FQ (N/OFQ) is the endogenous ligand for the opioid-like receptor ORL-1 and is thought to be involved in pain transmission and modulation. Human studies have not yet defined its role in pain patients. The aims of this study were 1) to verify the presence of N/OFQ in the cerebrospinal fluid (CSF) of human controls and patients with chronic noncancer pain, including those treated with intrathecally administered morphine, and 2) to determine whether pain or treatment with long-term intrathecal morphine influences its levels. The CSF of 27 patients (nine controls and 18 with chronic noncancer pain, of whom 12 were treated chronically with intrathecally administered morphine and six were opioid naïve) was analyzed, blindly, with radioimmunoassay methods. N/OFQ was detected in all patients. Mean CSF concentrations were lowest in the morphine-treated group and highest in the untreated chronic pain patients (12.06+/-1.19 and 57.41+/-10.06 fmol/ml, respectively), and the difference between the morphine-treated group and controls was statistically significant (44.72+/-13.56 fmol/ml, P<0.05). The presence of N/OFQ peptide in human CSF may correlate with biological activities that are influenced by different pain states and long-term intrathecal-morphine treatment. Further studies should verify whether the determination of this peptide CSF level may provide information on opioid treatment efficacy and on the presence of opioid tolerance.
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Affiliation(s)
- William Raffaeli
- Pain Therapy and Palliative Care Unit, Anesthesia Service, Rimini, Italy.
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