• Korean Journal of Clinical Pharmacy
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• v.25 no.3
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• pp.145-150
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• 2015

Objective: Pain is very common in the elderly, so there is a high prevalence of analgesic use among this population. The purpose of this study was to assess patterns of analgesic use and evaluate factors associated with analgesic use in elderly patients. Method: The subjects of this study were patients over 65 years old hospitalized in a teaching hospital located in Chuncheon-si, Korea between January 1, 2014 and March 31, 2014. Data collection regarding analgesic prescriptions and baseline characteristics was conducted using computerized hospital database by medical information team. Logistic regression analysis was used to identify factors related to analgesic use. Results: A total of 2,394 patients were finally included. Among these patients, 700 (29.2%) took analgesics; 521 (74.4%) out of these 700 patients were received opioid analgesics and 179 (25.6%) were received only non-opioid analgesics. The most frequently prescribed opioid analgesic was pethidine (45.7%), and the most frequently prescribed non-opioid analgesic was acetaminophen (44.1%). Fracture was associated with increased odds of opioid analgesic prescriptions (OR = 2.766, 95% CI = 2.019-3.790, p < 0.001) and any analgesic prescriptions (OR = 2.394, 95% CI = 1.766-3.244, p < 0.001). Stroke or cerebral infarction was associated with decreased odds of opioid analgesic prescriptions (OR = 0.636, 95% CI = 0.471-0.858, p = 0.003). Conclusion: A significant proportion of hospitalized elderly patients use analgesics. Health care professionals should consider factors associated with analgesic use in this population to improve pain management.

• Toxicological Research
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• v.11 no.1
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• pp.63-68
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• 1995

N-methyl-D-aspartate(NMDA) receptor has been well known as an important mediator of several forms of neural and behavioral plasticity. But different results were reported about the effect of MK-801 or dextromethorphan on opioid dependence. The present studies examined whether NMDA receptor antagonists can alter the opioid dependence and tolerance in rodents. Naloxone precipitated withdrawal symptoms and changes of locomotor activities were observed in MK-801 or dextromethorphan pretreated morphine-dependent rats. Tail-flick assay was used for morphine analgesia and tolerance was found after 4 day's consecutive injections (10 mg/kg, s.c., twice/day) of morphine in mice. Locomotor activity was increased and the withdrawal symptoms were decreased by the pretreatment of MK-801 in morphine-dependent rats. But 0.3 mg/kg i.p. of MK-801 intensified the body weight loss and produced severe ataxia and rotation although some withdrawal signs were attenuated. Morphine induced analgesic tolerance was inhibited by the pretreatment of MK-801 and dextromethorphan. Dextromethorphan was more potent than MK-801 in inhibiting the development of the analgesic tolerance in mice. These results suggest that NMDA system may be involved in opioid withdrawal and analgesic tolerance but appropriate caution should be requested when MK-801 is used in combination with opioid because of untoward neurologic signs.

• YAKHAK HOEJI
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• v.58 no.4
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• pp.268-276
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• 2014

Background: World Health Organization considers opioid analgesic use as an important measure in the treatment of pain relief. However, there are limited data about the pattern of opioid analgesic use in tertiary care hospitals in Korea. The aim of this study was to describe the trends in the prescribed amount of the opioid for 13 years from 2000 to 2012 in a single tertiary care hospital. Methods: The data from the prescribed amount of opioid use in patients aged over 18 years were retrieved from medical charts and longitudinal pharmacy records of Seoul National University Hospital. Yearly prescribed amount of opioids were calculated using defined daily dose adjusted by hospital stay (DDD/1000${\bullet}$HS). Results: Over the 13 years of the study period, overall use of opioid has increased by 64.1%. Although, the opioid use by hospitalized patients comprised 98%~99% of total amount of opioid use, the proportions of opioid use by outpatient and by cancer patient increased from 1.1% to 2.2% and from 60.5% to 69.3%, respectively. The use of non-injectable opioids has increased by 47% and that of injectables has increased by 70%. While the amount of codeine and morphine use has decreased, the use of both transdermal and injection formulation of fentanyl has increased dramatically. Also, the use of oxycodone has increased, especially in outpatient setting. Conclusion: This longitudinal study showed that opioid analgesic use in tertiary hospital, especially in outpatient is continuously increasing. Improvement in pain management in tertiary care hospital can be cautiously inferred based on this results.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.713-716
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• 2013

Social and behavioral scientists have proposed that a person's belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between analgesic beliefs, analgesic adherence and pain experience amongst Taiwanese cancer outpatients. The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). Beliefs about pain and opioids demonstrated a significant relationship with patients' opioid adherence (r = -0.30, p < 0.01). The more negative beliefs regarding opioids and pain the patient had, the worse their adherence to around the clock (ATC) analgesic regimen. However, there was no significant correlation between opioid belief and pain experience. As well, there were no significant relationships between adherence to opioid regimen and any of the measures of pain experience. The study highlights the potential importance of a patient's pain and opioid beliefs in adherence to pain medication.

• The Korean Journal of Pain
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• v.32 no.2
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• pp.79-86
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• 2019

Background: The use of aroma oils dates back to at least 3000 B.C., where it was applied to mummify corpses and treat the wounds of soldiers. Since the 1920s, the term "aromatherapy" has been used for fragrance therapy with essential oils. The purpose of this study was to determine whether the essential oil of Eucalyptus (EOE) affects pain pathways in various pain conditions and motor coordination. Methods: Mice were subjected to inhalation or intraperitoneal injection of EOE, and its analgesic effects were assessed by conducting formalin, thermal plantar, and acetic acid tests; the effects of EOE on motor coordination were evaluated using a rotarod test. To determine the analgesic mechanism, 5'-guanidinonaltrindole (${\kappa}$-opioid antagonist, 0.3 mg/kg), naltrindole (${\delta}$-opioid antagonist, 5 mg/kg), glibenclamide (${\delta}$-opioid antagonist, 2 mg/kg), and naloxone (${\mu}$-opioid antagonist, 4, 8, 12 mg/kg) were injected intraperitoneally. Results: EOE showed an analgesic effect against visceral pain caused by acetic acid (EOE, 45 mg/kg); however, no analgesic effect was observed against thermal nociceptive pain. Moreover, it was demonstrated that EOE did not have an effect on motor coordination. In addition, an anti-inflammatory effect was observed during the formalin test. Conclusions: EOE, which is associated with the ${\mu}$-opioid pain pathway, showed potential effects against somatic, inflammatory, and visceral pain and could be a potential therapeutic agent for pain.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.21-25
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• 2007

Background: Intrathecal sildenafil has produced antinociception by increasing the cGMP through inhibition of phosphodiesterase 5. Spinal opioid receptor has been reported to be involved in the modulation of nociceptive transmission. The aim of this study was to examine the role of opioid receptor in the effect of sildenafil on the nociception evoked by formalin injection. Methods: Rats were implanted with lumbar intrathecal catheters. Formalin testing was used as a nociceptive model. Formalin-induced nociceptive behavior (flinching response) was observed. To clarify the role of the opioid receptor for the analgesic action of sildenafil, naloxone was administered intrathecally 10 min before sildenafil delivery, and formalin was then injected 10 min later. Results: Intrathecal sildenafil produced dose-dependent suppression of flinches in both phases during the formalin test. Intrathecal naloxone reversed the analgesic effect of sildenafil in both phases. Conclusions: Sildenafil is active against the nociceptive state that's evoked by a formalin stimulus, and the opioid receptor is involved in the analgesic action of sildenafil at thespinal level.

• YAKHAK HOEJI
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• v.43 no.4
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• pp.411-418
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• 1999

Intracerebroventricular (ICV) infusion of morphine (MOR) produces strong analgesia in man and animals. The analgesic effect is thought to be mediated by the centrifugal inhibitory control. But neural mechanisms of the analgesic effect of ICV morphine are not well understood. In the present study, we found that ICV MOR had dual actions on the activity of dorsal horn heurons: it produced both inhibition and excitation of dorsal horn neurons. Since MOR exerts its action via three different types of opioid receptors, we further sought to investigate if there are differential effects of opioid receptor agonists on dorsal horn neurons when administered intracerebroventricularly. Effects of ICV MOR were tested in 28 dorsal horn neurons of the spinal cord in the cat. ICV MOR inhibited, excited and did not affect the heat responses of dorsal horn neurons. ICV DAMGO and DADLE, $\mu$- and $\delta$-opioid agonist, respectively, exhibited the excitation of dorsal horn neurons. In contract, U-50488, a k-opioid agonist, exhibited both the inhibition and excitation of dorsal horn neurons. These results suggest that opioid receptors have different actions on activity of dorsal horn neuron and that the inhibitory action of k-opioid agonist may subserve the analgesia often produced by ICV MOR.

• Biomolecules & Therapeutics
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• v.7 no.3
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• pp.278-284
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• 1999

DK1001 is a thebain derivative, which is newly synthesized as an alkaloid analgesic. This study was designed to study effects of DK1001 on the ligands binding to the opioid receptor subtypes, and general pharmacology of DK1001. DK1001 inhibited the binding of [$^3H$]DAMGO, a selective mu-subtype agonist, to the opioid receptor of rat forebrain in a concentration-dependent manner. $EC_{50}$ of DK1001 was significantly lower than that of morphine. DK1001 inhibited the binding of 〔$^3$H〕DPDPE, a selective delta-subtype agonist concentration-dependently. DK1001(0.5 mg/kg) had no effects on behavior, body temperature, blood pressure. respiratory rate, and intestinal charcoal propulsion of mice. In addition, DK1001 did not affect on the contractilities of isolated muscle strips of aorta, ileum, and trachea of rats. These results suggest that DK1001 might be a potent analgesic without serious side effects.

• Health Policy and Management
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• v.31 no.4
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• pp.409-422
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• 2021

The growing use of prescription analgesic opioids has rapidly escalated the treatment of chronic pain since the 1990s; however, it is also highly needed to control opioid-related issues, including opioids misuse, abuse, and addiction. In 2018, Organization for Economic Cooperation and Development (OECD) secretariat administered the survey on opioids use and policies to OECD countries and presented it at the Health Committee meeting of December 2018. This study aimed to review the opioids use in OECD countries and their policies to prevent and reduce associated harms, also seek the available policy lessons from OECD countries. More recently, opioids prescribing rate have been increased 14.7% between 2011-2013 and 2014-2016 and steadily focused on the main substance misused and abused in Korea. In addition, policy efforts have contributed to developing a guideline for prescribing opioids to steer the appropriate use of prescription analgesic opioids since 2000 in Korea, so it is not enough to control opioids compared with other OECD countries. Therefore, taking a people-centered and public health perspective, it will consider the health system policies and interventions at a national level to improve their preparation and approach to control opioid-related issues.

• Journal of Acupuncture Research
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• v.20 no.2
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• pp.85-97
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• 2003

Introduction : In this study, the analgesic effect and its mechanism of bee venom aqua-acupuncture on complete Freund's adjuvant-induced arthritis in rats was investigated. It has been reported from a neurochemical standpoint that bee venom exerts antinociceptive effects on inflammation and that the opioid system and adrenergic system play important roles in acupuncture analgesia. however, it is not known whether central opioid and ${\alpha}2$-adrenergic components of the intrinsic descending analgesic system are activated after bee venom aqua-acupuncture. Methods : Bee venom(1mg/kg) was subcutaneously aqua-acupunctured into Joksamni($ST_{36}$) of rats with complete Freund's adjuvant(CFA)- induced arthritis and was checked of increase in TFL. Opioid and ${\alpha}_2$-adrenergic neurotransmitter system were examined by naloxone as an opioid receptor antagonist, and yohimbine as ${\alpha}_2$-adrenoceptor antagonist prior to bee venom aqua-acupuncture. Results : The following results have been obtained. 1. The tail flick latency in the rat model with adjuvant-induced arthritis was significantly decreased in 2 weeks. 2. The tail flick latency in the rat model with adjuvant-induced arthritis was increased in bee venom aqua-acupuncture group compared to the normal saline aqua-acupuncture group. 3. Analgesic effect of bee venom was antagonized by yohimbine not by naloxone pretreatment in the rat model adjuvant-induced arthritis. Conclusions : Bee venom aqua-acupuncture has an analgesic effect on the rat model of adjuvant-induced of adjuvant-induced arthritis and has antinociception mediated by ${\alpha}_2$-adrenergic system.