RE: Dr. Brookoff's articles Please read and pass out copies ..
Posted Jul 2, 2001 1:58 AM
For those who do not have time to read both of Dr.. Brookoff's articles, (they are excellent so don't let the bio-cell chemistry bother you, push on and the over-all picture comes through loud and clear ) I hope everyone reads these articles , makes copies, take ,send, mail, fax, E-mail these copies to any MD you think still lives in a cave. In Brookoff's second article he brings out a point I have tried to stress. When Dr. B was reviewed before the med board this is the data I sent to him for a defense. It's has become quite evident and compelling research , that if your med is not working, or you cannot get pain control you need to
read and send/take Part 2 of Brookoff's paper to your MD, and you and hopefully your MD can go back to the drawing board as this
reiterates the point loud and clear. . .
Clinical Opiology
Choosing the right opioid for a particular patient is usually a matter of guesswork. Even though opioids have been in use as long as any other class of medications, the base of knowledge on how to use them most effectively is surprisingly small, particularly with regard to combining them with nonopioid medications and with each other.
Much of the human research has involved patients who were not in pain or who experienced limited episodes of acute pain. As a result, we often see disparities between the guidance of the medical literature and empiric clinical practice. That tables of drug equivalence are still published attests that many clinicians think opioids are interchangeable. Imagine the reaction if someone were to publish a conversion table for antibiotics showing how to convert milligrams of ampicillin into milligrams of gentamicin!
The opioid medications currently in use act largely through the µ-opioid receptor, but nearly all of them stimulate kappa- and delta-opioid receptors and some nonopioid receptors as well. In addition to their inhibitory functions, some opioid receptors appear to have stimulatory functions that may be responsible for some adverse effects of opioids. According to recent studies, these stimulatory effects can be inhibited by miniscule doses of opioid antagonists such as naltrexone and nalmefene. As we get more sophisticated in using these medications, we may be able to combine opioid agonists and antagonists both to enhance pain relief and to attenuate dependence and other side effects. This exciting field of analgesic research has recently been reviewed by R. F. Crain and S. M. Shen.
While there is general agreement that µ-opioid receptors predominate in mediating opioid-induced analgesia, we still do not know the consequences of stimulating other opioid receptors, including how they affect different groups of patients. Kappa-opioid agonists, for example, produce greater analgesia in women than in men. Until recently, most clinical pain research was conducted in men to reduce the variability caused by hormonal fluctuations.
There are also wide metabolic variabilities within groups of pain patients that may be determined by genetics or influenced by interacting drugs. Yet we have little information to guide the selection of dosages. For patients on chronic opioid therapy, it may soon be reasonable to periodically assess serum levels of the drugs and their metabolites to guide therapy, much as we do with antiarrhythmics and other medications.