Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management.

AIM To compare the efficacy and tolerability of combined pregabalin (PGB) and milnacipran (MLN) in female patients with fibromyalgia (FM) versus PGB as a monotherapy. METHODS The present randomized open study included 58 female patients diagnosed with FM (registered on 4/2/19: NCT03905486). Patients were randomly divided into 2 groups (2:2); group 1 included 29 patients who received PGB monotherapy (150 mg twice daily) and group 2 included 29 patients who received combined PGB (150 mg twice daily) and MLN (50 mg twice daily) for 3 months. At the initial visit, patients were subjected to demographic data collection and assessed by the visual analog scale (VAS) for pain and the FM impact questionnaire (FIQ). Outcome measures after 3 months: FIQ, VAS and Leeds Sleep Evaluation Questionnaire. RESULTS The median disease duration was 2 years in group 1 (6 months to 5 years) and 2 years in group 2 (6 months to 12 years). The dropout rate was 20.7% in group 1 (n = 6) and 10.3% in group 2 (n = 3). At the follow-up evaluation, a statistically significant improvement was observed in VAS and FIQ scores in both groups (P < 0.001). Although the percentage of patients demonstrating significant improvement in pain, disease impact and sleep pattern were higher in group 2, this did not reach statistical significance. CONCLUSION Although PGB as a monotherapy and in combination with MLN have both shown adequate efficacy in the treatment of patients with FM, the combined therapy did not demonstrate superiority over the monotherapy.

Efficacy of pregabalin as a monotherapy versus combined pregabalin and milnacipran in the management of fibromyalgia.

Introduction. Recent studies have shown that SSRIs have anti-inflammatory effects, and their administration prevents their production by acting on inflammatory cytokines. Emphasizing that we did not find a study on Dapoxetine and its effect on neuropathic pain, in this study, we examined the effect of Dapoxetine on neuropathic pain in rats. Material and methods. 42 rats were divided into six groups of 7, which included: sham, control, gabapentin, Duloxetine and Dapoxetine 1 and 3. Except for the sham group, other groups were induced with neuropathy, and no drug treatment was performed in the sham group. The groups were treated with normal saline, gabapentin (30 mg/kg/day), Duloxetine at (30 mg/kg/day) and Dapoxetine (1 and 3 mg/kg/day), respectively by intraperitoneal injection. Then, thermal hyperalgesia and mechanical and thermal allodynia experiments were performed on rats. Results. The Dapoxetine-treated groups’ mean response to thermal hyperalgesia and mechanical allodynia increased on days 7 and 14. The mean response of the 3 mg/kg Dapoxetine group on day 7 was significantly higher than the control group (P <0.05). Mean response to mechanical and thermal allodynia-induced stimulation and thermal hyperactivity in the Dapoxetine group 3 mg/kg at 14 days, compared with the Dapoxetine group 1 mg/kg showed significantly better results (P <0.05). Conclusion. Dapoxetine effectively reduces the behavioral response to painful and non-painful thermal and mechanical stimuli and painful thermal and mechanical stimuli. In addition to its short-term analgesic effects, it also has long-term effects.

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The effect of Dapoxetine on Chronic Constriction Injury (CCI) induced neuralgia in rats

Serotonin has a particular place in the modulation of pain. Experimental studies have described 5-HT1–7 receptors and their effects on facilitation or inhibition of nociceptive input. Selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors showed efficient and safer than tricyclic antidepressants in neuropathic pain. Although there is evidence regarding the beneficial impact of SSRIs in the multimodal acute pain management, studies are still searching for the potentially favorable effect of these drugs in the prevention of chronic postoperative pain. The scope of this chapter would be to update the knowledge regarding serotonin involving in pain pathways and to highlight the importance and contribution of serotonin reuptake inhibitors in the multimodal pain management schemes.

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Cristina Petrișor

Papers

Serotonin Reuptake Inhibitors and Their Role in Chronic Pain Management