PubMed · 14220596
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G T SPENCER. 1964. ANESTHESIA TODAY.. https://pubmed.ncbi.nlm.nih.gov/14220596/
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Progress in the control and treatment of pain may be facilitated by a better understanding of mechanisms underlying nociceptive processing. Here we show that mice subjected to an intermittent fasting diet (IFD) display markedly reduced responses in models of thermal and visceral pain compared with mice fed ad libitum (AL). Pharmacological analyses suggest that a change in the endogenous kappa-opioid system underlies IFD-induced analgesia. The levels of prodynorphin mRNA and kappa-opioid receptors in the spinal cord are higher in IFD than in AL mice. Furthermore, in spinal cord nuclear protein extracts, the activity of the transcriptional repressor DREAM (downstream regulatory element antagonist modulator), the main regulator of prodynorphin expression, is lower in IFD than in AL mice. Finally, c-Fos expression in dorsal spinal cord after noxious stimulation is significantly lower in IFD than in AL animals, indicating that dynorphin could block nociceptive information at the spinal cord. These results suggest that dietary restriction together with administration of kappa-opioid agonists could be useful as a new therapeutic approach for pain relief.
A double-blind, randomized controlled trial was conducted with infants born <31 weeks of gestational age and recruited within 48 h of life. The infants were randomized to receive up to three doses of 0.1 ml of either 24% sucrose or sterile water (placebo) for every painful procedure during the 1st week of life. The purpose of this study was to test the efficacy of treating all procedural pain with sucrose on overall physiological stability. The hypotheses were that infants who received 24% sucrose for all painful procedures would be less stressed as measured by salivary cortisol, and more physiologically stable as measured by pulse rate variability than those who received placebo. Salivary cortisol was measured before and 30 min after a painful procedure, whereas the pulse rate was continuously recorded, from second to second, from a pulse oximeter. There were no group differences in the cortisol response to a painful stimulus or in pulse rate variability over time. There was, however, a significant correlation between standard deviation of pulse rate and number of doses of sucrose only in the group who received high doses of sucrose.
Chemical dependency is a common, chronic disease that affects up to 25 percent of patients seen in primary care practices. The treatment goal for patients recovering from chemical dependency should be to avoid relapse. This requires physicians to have an open, nonjudgmental attitude and specific expertise about the implications of addiction for other health problems. First-line treatment for chemical dependency should be nonpharmacologic, but when medication is necessary, physicians should avoid drugs that have the potential for abuse or addiction. Medications that sedate or otherwise impair judgment also should be avoided in the recovering patient. Psychiatric illnesses should be aggressively treated, because untreated symptoms increase the risk of relapse into chemical dependency. Selective serotonin reuptake inhibitors may help to lower alcohol consumption in depressed patients, and desipramine may help to facilitate abstinence in persons addicted to cocaine. If insomnia extends beyond the acute or postacute withdrawal period, trazodone may be an effective treatment. If nonpharmacologic management of pain is not possible, nonaddictive medications should be used. However, if non-addictive medications fail, long-acting opiates used under strict supervision may be considered. Uncontrolled pain in itself is a relapse risk.