Tag Archives: medication

Novel Opioid Receptor Agonist Found Effective[?]

Novel Opioid Receptor Agonist Found Effective for Chronic Low Back Pain – Clinical Pain Advisorby Amit Akirov, MD – Aug 2019

The main appeal of this very mild opioid pain reliever is that it enters the nervous system very slowly compared to current opioids, which supposedly makes it less addictive.

NKTR-181 was found to be a safe, effective, and well tolerated treatment over the long term in patients with moderate to severe chronic low back pain (CLBP), according to results from a phase 3 trial published in Pain Medicine.

NKTR-181, a novel μ-opioid receptor agonist, has several advantages compared with conventional opioid drugs, including

  • a slower entry into the central nervous system,
  • delayed receptor binding, and [why would a delay of pain relief be desireable?]
  • long duration of effect.

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Scheduled vs Pain-Contingent Opioid Dosing

Time-Scheduled versus Pain-Contingent Opioid Dosing in Chronic Opioid Therapy – free full-text /PMC3098951/Jun 2012

This is an important topic for me because I’ve always taken my opioids on an “as needed” basis. Even when I have to take them every morning (as soon as my spine is compressed by gravity), the quantity varies according to my pain level, just as it does for the rest of the day. Some days I need twice as much as others, so taking them on a regular schedule doesn’t make sense for me.

Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT).

The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief,…

This assumes that chronic pain is exactly the same all day every day, which may be true for some, but has not been my experience at all.  Continue reading

Safety concerns for nerve growth inhibitor drugs

Lilly, Pfizer’s phase 3 pain data show mixed efficacy, clear safety issues – by Nick Paul Taylor | Apr 19, 2019

The only things I’m surprised about is how long it took to discover the damage from such medications.

A phase 3 trial has painted a mixed picture of the safety and efficacy of Eli Lilly and Pfizer’s painkiller tanezumab.

Neither dose of the nerve growth factor (NGF) inhibitor hit all the co-primary efficacy goals, and both fared worse than placebo on the safety assessments.

I was always convinced that taking an “anti-nerve-growth” medication long term would lead to all kinds of unexpected and undesired insidious effects. While preventing new nerves from growing could conceivably lead to fewer nerves signaling pain, these drugs are not localized and affect the whole body.

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SSRIs May Impair Effectiveness of Some Opioids

SSRIs May Impair Effectiveness of Prodrug Opioids For Post-op Pain – Pain Medicine NewsJun, 2019

A multidisciplinary team of researchers from Stanford University and the VA Palo Alto Healthcare System recently published findings that indicate patients taking selective serotonin reuptake inhibitors (ssRIs) and treated with prodrug opioids to manage postsurgical pain may have worse pain outcomes than those prescribed active opioids (PLoS One 2019;14[2]:e0210575).

“An anesthesiologist came to us with information about this relationship that’s showing up in bench labs,” Dr. Hernandez-Boussard told Pain Medicine News, explaining how one of her co-authors was intrigued by an increasing body of research pointing to potentially antagonistic interactions between prodrug opioids and ssRIs affecting the cytochrome enzyme CYP2D6 in the liver (Acad Emerg Med 2014;21[8]:879-885).   Continue reading

First Generic Versions of Lyrica Approved by FDA

First Generic Versions of Lyrica Approved by FDA – Pain Medicine News – based on a press release from the FDA – July 2019

The FDA approved the first generic versions of the pain medication pregabalin, the agency announced. It accepted multiple applications, granting approvals to nine manufacturers, including Teva Pharmaceuticals.

I have to wonder why *nine* manufacturers are lined up to sell this medication. Competition “should” lower the price, but that’s not how things work in pharmaceutical pricing.  Continue reading

Fluoroquinolones and Peripheral Neuropathy

Association Between Peripheral Neuropathy and Exposure to Oral Fluoroquinolone or Amoxicillin-Clavulanate Therapy | Clinical Pharmacy and Pharmacology | JAMA Neurology – April 2019

I’m starting to believe that antibiotics affect far more of our bodies than we ever imagined. We already know about the potential tendon ruptures, but it seems we’re discovering more significant side-effects over time.

Findings  This nested case-control study of 5357 incident peripheral neuropathy cases and 17 285 matched controls showed that current use of systemic fluoroquinolone antibiotics increased the risk of peripheral neuropathy by 47%, causing an additional 2.4 cases per 10 000 patients per year of current use.

Risk appeared to be greater with cumulative exposure, among men, and among those older than 60 years of age but was not significantly associated with amoxicillin-clavulanate.   Continue reading

No one knows what’s in our medications

When Medicine Makes Patients Sicker – Kaiser Health News – By Sydney Lupkin – Jan 2019

This is a horror story about the medications we have to take. No one is tracking where the ingredients are manufactured or what quality standards exist for those manufacturers.

Many come from third world countries where standards are very different than ours and the FDA is overwhelmed by the number of inspections, which are backlogged for years.

Despite the jackhammer-like rhythm of a mechanical ventilator, Alicia Moreno had dozed off in a chair by her 1-year-old’s hospital bed, when a doctor woke her with some bad news: The common stool softener her son, Anderson, was given months earlier had been contaminated with the bacterium Burkholderia cepacia.   Continue reading

‘Scary World’ of Generic Drug Manufacturing

‘Scary World’ of Generic Drug Manufacturing, Revealed Ellie KincaidJune 2019

All my life, I’ve had problems with different batches of generic drugs, first when I switched from brand name drugs to generic, and then when my pharmacy switched suppliers of the same generic. The “new” pills would have different side effects or different potencies for me, yet the pharmacy always insisted that the medication was “the same”.

I hate being condescended to like this, the “all knowing” pharmacist telling the “silly and confused” patient that she’s imagining things. I’m sure this has happened to countless others too, but now articles like this prove that we were right all along.

In 2008, investigative journalist Katherine Eban started digging into the generic drug industry after hearing stories of patients whose generic drugs were not working properly for them.   Continue reading

Hormonal Contraception and Depression

Association of Hormonal Contraception With Depression – JAMA Network – Charlotte Wessel Skovlund, MSc1; Lina Steinrud Mørch, PhD1; Lars Vedel Kessing, MD, DMSc2; et al. – November 2016

Question:  Is use of hormonal contraception associated with treatment of depression?

Spoiler alert: the answer is a resounding “yes”.  all the patients who didn’t get antidepressants (which require a pain or depression diagnosis).

Progesterone is in all birth-control pills, yet women seeking contraception are given these pills almost routinely, and never with the warning that they could cause depression.

This could explain why women tend to be more depressed than men.

Findings:  In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents.   Continue reading

Cochrane Reveiws of Gabapentoids to Relieve Pain

Here are some Cochrane reviews on the efficacy (or lack thereof) of gabapentin (Neurontin) and pregabalin (Lyrica):

These medications seem mildly effective for their FDA-approved conditions, but much less so for chronic pain. Yet… I’ve found Lyrica helpful for episodic pain flares when I take it on an “as needed” basis.