Leukocyte-derived opioid peptides and inhibition of pain.

Posted on December 11, 2007 by Maurice Preter MD
J Neuroimmune Pharmacol. 2006 Mar;1(1):90-7.
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Leukocyte-derived opioid peptides and inhibition of pain.

Machelska H, Stein C.

Klinik für Anaesthesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany. halina.machelska@charite.de

In peripheral inflamed tissue interactions between leukocyte-derived opioid peptides and opioid receptors on sensory neurons lead to potent, clinically relevant inhibition of pain. Opioid receptors are present on peripheral terminals of sensory neurons and are upregulated in inflammation. Their endogenous ligands, opioid peptides, are synthesized in circulating immune cells, which migrate to injured tissues directed by chemokines and adhesion molecules. Under stressful stimuli or in response to releasing agents (e.g., corticotropin-releasing factor, cytokines, catecholamines) leukocytes can secrete opioids. These peptides activate peripheral opioid receptors and produce analgesia by inhibiting the excitability of sensory nerves and/or the release of excitatory neuropeptides. These effects occur without central opioid side effects such as depression of breathing, clouding of consciousness, or addiction. Future research should elucidate the selective targeting of opioid peptide-containing immune cells to sites of painful tissue injury and the augmentation of opioid peptide and receptor synthesis.

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PMID: 18040794 [PubMed – in process]

Posted in News | Tagged |

Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care.

Posted on December 11, 2007 by Maurice Preter MD
Respir Med. 2007 Nov 29 [Epub ahead of print]
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Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care.

Schneider A, Löwe B, Meyer FJ, Biessecker K, Joos S, Szecsenyi J.

Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany.

INTRODUCTION: Depression and panic disorder are widely acknowledged as complicating factors in asthma patients. However, their impact on health outcomes in primary care patients is less well examined. This study prospectively evaluated the impact of depression and panic disorder on outcomes of primary care patients with asthma over 1 year. METHODS: At baseline, 256 asthma patients from 43 primary care practices completed self-report questionnaires including the Patient Health Questionnaire (PHQ), the Asthma Quality of Life Questionnaire (AQLQ), and a structured questionnaire evaluating asthma severity, hospitalisation and emergency visits. One year later, 185 (72.3%) patients completed the same questionnaire. RESULTS: At baseline, 3.9% of patients suffered from major depressive disorder, 22.7% from minor depressive disorder, and 7.8% from panic disorder. In the year under evaluation, 17 patients (9.2%) received emergency home visits and 10 patients (5.4%) were admitted to a hospital. Depression at baseline predicted hospitalisation within the subsequent year (OR 6.1; 95% CI 1.5-24.6) and panic disorder predicted unscheduled emergency home visits (OR 4.8; 95% CI 1.3-17.7). Depression but not panic disorder predicted the AQLQ scales activity (p=0.001), symptoms (p=0.001), emotions (p=0.001) and environment (p=0.001) at follow-up. CONCLUSIONS: Although rates of hospitalisation and emergency visits in primary care are low, the impact of psychiatric comorbidity on health outcomes for patients with asthma is substantial. It might be helpful to identify patients with psychiatric comorbidity by analysing reasons for hospitalisation and emergency visits. For these patients, intensifying care with psychiatric interventions might help to reduce inappropriate healthcare utilisation and avoid adverse outcomes.

PMID: 18061424 [PubMed – as supplied by publisher]

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History of childhood maltreatment is associated with comorbid depression in women with migraine.

Posted on December 6, 2007 by Maurice Preter MD
 
Neurology. 2007 Sep 4;69(10):959-68.
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History of childhood maltreatment is associated with comorbid depression in women with migraine.

Tietjen GE, Brandes JL, Digre KB, Baggaley S, Martin VT, Recober A, Geweke LO, Hafeez F, Aurora SK, Herial NA, Utley C, Khuder SA.

Department of Neurology, College of Medicine, The University of Toledo-Health Science Campus, Toledo, OH 43614, USA. gretchen.tietjen@utoledo.edu

BACKGROUND: A bidirectional relationship between migraine and depression suggests a neurobiological link. Adverse experiences, particularly childhood maltreatment, may alter neurobiological systems, and predispose to a multiplicity of adult chronic disorders. Our objective is to determine, within a headache clinic population of women, if depression moderates the abuse-migraine relationship. METHODS: At six headache specialty clinics, women with migraine were diagnosed using ICHD-II criteria, and frequency was recorded. A questionnaire regarding maltreatment history, headache characteristics, current depression, and somatic symptoms was completed. RESULTS: A total of 949 women with migraine completed the survey: 40% had chronic headache (> or =15 headache days/month) and 72% had “very severe” headache-related disability. Major depression was recorded in 18%. Physical or sexual abuse was reported in 38%, and 12% reported both physical and sexual abuse in the past. Migraineurs with current major depression reported physical (p < 0.001) and sexual (p < 0.001) abuse in higher frequencies compared to those without depression. Women with major depression were more likely to report sexual abuse occurring before age 12 years (OR = 2.30, 95% CI: 1.14 to 4.77), and the relationship was stronger when abuse occurred both before and after age 12 years (OR = 5.08, 95% CI: 2.15 to 11.99). Women with major depression were also twice as likely to report multiple types of maltreatment (OR = 2.07, 95% CI: 1.27 to 3.35) compared to those without depression. CONCLUSIONS: Childhood maltreatment was more common in women with migraine and concomitant major depression than in those with migraine alone. The association of childhood sexual abuse with migraine and depression is amplified if abuse also occurs at a later age.

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PMID: 17785664 [PubMed – indexed for MEDLINE]

Posted in Aging |

Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study.

Posted on December 4, 2007 by Maurice Preter MD
Hypertension. 2007 Oct;50(4):693-700. Epub 2007 Sep 4.
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Erratum in:

  • Hypertension. 2007 Nov;50(5):e170.

Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study.

Cappuccio FP, Stranges S, Kandala NB, Miller MA, Taggart FM, Kumari M, Ferrie JE, Shipley MJ, Brunner EJ, Marmot MG.

Clinical Sciences Research Institute, Warwick Medical School, Coventry, United Kingdom. sleepresearch@warwick.ac.uk

Sleep deprivation (<or=5 hour per night) was associated with a higher risk of hypertension in middle-aged American adults but not among older individuals. However, the outcome was based on self-reported diagnosis of incident hypertension, and no gender-specific analyses were included. We examined cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension in a cohort of 10,308 British civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). Data were gathered from phase 5 (1997-1999) and phase 7 (2003-2004). Sleep duration and other covariates were assessed at phase 5. At both examinations, hypertension was defined as blood pressure >or=140/90 mm Hg or regular use of antihypertensive medications. In cross-sectional analyses at phase 5 (n=5766), short duration of sleep (<or=5 hour per night) was associated with higher risk of hypertension compared with the group sleeping 7 hours, among women (odds ratio: 1.72[corrected]; 95% CI: 1.07[corrected] to 2.75[corrected]), independent of confounders, with an inverse linear trend across decreasing hours of sleep (P=0.037[corrected]). No association was detected in men. In prospective analyses (mean follow-up: 5 years), the cumulative incidence of hypertension was 20.0% (n=740) among 3691 normotensive individuals at phase 5. In women, short duration of sleep was associated with a higher risk of hypertension in a reduced model (age and employment) (6 hours per night: odds ratio: 1.56 [95% CI: 1.07 to 2.27]; <or=5 hour per night: odds ratio: 1.94 [95% CI: 1.08 to 3.50] versus 7 hours). The associations were attenuated after accounting for cardiovascular risk factors and psychiatric comorbidities (odds ratio: 1.42 [95% CI: 0.94 to 2.16]; odds ratio: 1.31 [95% CI: 0.65 to 2.63], respectively). Sleep deprivation may produce detrimental cardiovascular effects among women.

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PMID: 17785629 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology |

Complicated Pain Management in a CYP450 2D6 Poor Metabolizer.

Posted on November 12, 2007 by Maurice Preter MD
Pain Pract. 2007 Nov 6; [Epub ahead of print]
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Complicated Pain Management in a CYP450 2D6 Poor Metabolizer.

Foster A, Mobley E, Wang Z.

Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia, USA.

We describe the case of a patient with significant adverse effects from posttraumatic analgesic therapy with opioid analgesics who was found by microarray analysis to have a CYP2D6 genotype predictive of a poor metabolizer phenotype. In addition to her poor tolerance and limited response to opioid analgesics, she developed further discomfort when the antiemetic promethazine was administered to treat her gastrointestinal adverse effects. In our discussion we review the literature about the clinical impact of CYP450 2D6 polymorphisms in treatment with the commonly used opioid analgesics codeine, oxycodone, hydrocodone, hydromorphone, and morphine, as well as the antiemetic promethazine. The case we present, as well as the literature we review, demonstrates the clinical utility of CYP2D6 genotyping in patients with adverse effects from analgesia therapy.

PMID: 17986163 [PubMed – as supplied by publisher]

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