Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined oxycodone and naloxone tablets

Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined... Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188The size of pain referral patterns from a tonicpainful mechanical stimulus is increased inwomenOxycodone and macrogol 3350 treatmentreduces anal sphincter relaxation compared tocombined oxycodone and naloxone tabletsQ.G. Liu b,c,∗ , T.S. Palsson b , L.B. Sørensen b , T.Graven-Nielsen aJakob Lykke Poulsen a,∗ , Christina Brock a,b ,Debbie Grønlund a , Klaus Krogh c , Asbjørn MohrDrewes a,daCenter for Neuroplasticity and Pain (CNAP), SMI,Department of Health and Science Technology,Faculty of Medicine, Aalborg University, Aalborg,Denmarkb SMI, Department of Health and Science Technology,Faculty of Medicine, Aalborg University, Aalborg,Denmarkc Department of Sport Rehabilitation, School ofKinesiology, Shanghai University of Sport, Shanghai,ChinaE-mail address: tgn@hst.aau.dk (Q.G. Liu).Aims: The purpose of this study was to investigate potential gender differences in pain referral patterns induced by a tonic painfulmechanical stimulus.Methods: Forty-five healthy adults (22 women) participated inthis study. Pressure pain thresholds (PPTs) were assessed at theinfraspinatus, the brachioradialis and the gastrocnemius muscleson the dominant side, using handheld algometry. Following this,painful pressure at the infraspinatus muscle was induced usingthe algometer by rapidly increasing the pressure until it reachedthe level of 7 cm on VAS (PVAS7). This pressure was kept constantfor 60 s. Upon release, the subject was asked to indicate the areaof the pressure-induced pain on a digital body chart. PPT values,PVAS7 and the pain area (number of pixels) were extracted for dataanalysis.Results: No gender differences were found in PPT values(P > 0.05). The pressure needed to reach 7 cm on the VAS was significantly lower in the female group (687.4 ± 50.5 kPa) compared withmales (971.0 ± 49.6 kPa; unpaired t-test: P < 0.05). The size of thepain area following PVAS7 stimulation for 60 s was significantlylarger in the female group (12,578.5 ± 17,280.3 pixels) comparedwith the male group (6175.0 ± 9518.5 pixels; Mann–Whitney-U;P < 0.05).Conclusions: Despite comparable PPT values, women demonstrated larger pain areas compared with men although thestandardized painful stimulus which intensity was perceived similarly as 7 cm on the VAS scale in both groups. These findings suggestthat there are gender-specific differences in pain distribution andreferred pain but it is unclear through which mechanism they aremediated.179aMech-Sense, Department of Gastroenterology andHepatology, Aalborg University Hospital, Aalborg,Denmarkb Department of Drug Design and Pharmacology,University of Copenhagen, Copenhagen, Denmarkc Neurogastroenterology Unit, Department ofHepatology and Gastroenterology, Aarhus UniversityHospital, Aarhus, Denmarkd Department of Clinical Medicine, AalborgUniversity, Aalborg, DenmarkE-mail address: jakob.poulsen@rn.dk (J.L. Poulsen).Background: Opioid analgesics inhibit anal sphincter functionand contribute to opioid-induced bowel dysfunction. However, itis unknown if the inhibition can be reduced by opioid antagonismwith oral naloxone, and how this compares to osmotic laxativetreatment.Aims: To compare the effects of oxycodone and macrogol3350 treatment (OX + PEG) versus combined oral oxycodone andnaloxone (OXN) on anal sphincter function and gastrointestinalsymptoms.Methods: A randomised, double-blind, crossover trial wasconducted in 20 healthy, male volunteers. Participants were randomised to five days treatment of OX + PEG or OXN. Anal restingpressure, anal canal distensibility, and rectoanal inhibitory reflexinduced sphincter relaxation were evaluated at baseline and onday 5. The Patient Assessment of Constipation questionnaire (PACSYM), stool frequency, and stool consistency were assed daily.Results: Sphincter relaxation was reduced after OX + PEG treatment compared to OXN (difference = −17.6% [95% CI; −25.2, −10.2];P < 0.001). Anal resting pressure and anal canal distensibility didnot differ between the treatments. PAC-SYM abdominal symptomsubscale increased during OX + PEG compared to OXN (cumulatedscore: 3.2 ± 2.3 vs. 0.2 ± 1.8; P = 0.002). Number of bowel movements was higher during OX + PEG vs. OXN (5.4 ± 1.5 vs. 4.2 ± 1.2;P = 0.035), but there was no difference in stool consistency (3.5 ± 0.5vs. 3.2 ± 0.4; P = 0.14).Conclusions: Sphincter relaxation was significantly reducedafter OX + PEG compared to OXN. Evaluation of the rectoanalinhibitory reflex may serve as an important objective measure infuture trials on treatment of opioid-induced bowel dysfunction.http://dx.doi.org/10.1016/j.sjpain.2017.04.042http://dx.doi.org/10.1016/j.sjpain.2017.04.043The effect of UVB-induced skin inflammationon histaminergic and non-histaminergicevoked itch and painS. Lo Vecchio a,∗ , H.H. Andersen a , J. Elberling b , L.Arendt-Nielsen aaLaboratory for Experimental Cutaneous Pain®Research, SMI , Department of Health Science andTechnology, Faculty of Medicine, Aalborg University,Denmarkb The Allergy Clinic, Copenhagen University Hospital,Gentofte, Copenhagen, DenmarkE-mail address: LAN@hst.aau.dk (L. Arendt-Nielsen).Aims: Itch often occurs in cutaneous conditions characterizedby some degree of inflammation, e.g. atopic dermatitis, psoriasis http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined oxycodone and naloxone tablets

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de Gruyter
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© 2017 Scandinavian Association for the Study of Pain
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1877-8860
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1877-8879
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10.1016/j.sjpain.2017.04.043
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Abstract

Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188The size of pain referral patterns from a tonicpainful mechanical stimulus is increased inwomenOxycodone and macrogol 3350 treatmentreduces anal sphincter relaxation compared tocombined oxycodone and naloxone tabletsQ.G. Liu b,c,∗ , T.S. Palsson b , L.B. Sørensen b , T.Graven-Nielsen aJakob Lykke Poulsen a,∗ , Christina Brock a,b ,Debbie Grønlund a , Klaus Krogh c , Asbjørn MohrDrewes a,daCenter for Neuroplasticity and Pain (CNAP), SMI,Department of Health and Science Technology,Faculty of Medicine, Aalborg University, Aalborg,Denmarkb SMI, Department of Health and Science Technology,Faculty of Medicine, Aalborg University, Aalborg,Denmarkc Department of Sport Rehabilitation, School ofKinesiology, Shanghai University of Sport, Shanghai,ChinaE-mail address: tgn@hst.aau.dk (Q.G. Liu).Aims: The purpose of this study was to investigate potential gender differences in pain referral patterns induced by a tonic painfulmechanical stimulus.Methods: Forty-five healthy adults (22 women) participated inthis study. Pressure pain thresholds (PPTs) were assessed at theinfraspinatus, the brachioradialis and the gastrocnemius muscleson the dominant side, using handheld algometry. Following this,painful pressure at the infraspinatus muscle was induced usingthe algometer by rapidly increasing the pressure until it reachedthe level of 7 cm on VAS (PVAS7). This pressure was kept constantfor 60 s. Upon release, the subject was asked to indicate the areaof the pressure-induced pain on a digital body chart. PPT values,PVAS7 and the pain area (number of pixels) were extracted for dataanalysis.Results: No gender differences were found in PPT values(P > 0.05). The pressure needed to reach 7 cm on the VAS was significantly lower in the female group (687.4 ± 50.5 kPa) compared withmales (971.0 ± 49.6 kPa; unpaired t-test: P < 0.05). The size of thepain area following PVAS7 stimulation for 60 s was significantlylarger in the female group (12,578.5 ± 17,280.3 pixels) comparedwith the male group (6175.0 ± 9518.5 pixels; Mann–Whitney-U;P < 0.05).Conclusions: Despite comparable PPT values, women demonstrated larger pain areas compared with men although thestandardized painful stimulus which intensity was perceived similarly as 7 cm on the VAS scale in both groups. These findings suggestthat there are gender-specific differences in pain distribution andreferred pain but it is unclear through which mechanism they aremediated.179aMech-Sense, Department of Gastroenterology andHepatology, Aalborg University Hospital, Aalborg,Denmarkb Department of Drug Design and Pharmacology,University of Copenhagen, Copenhagen, Denmarkc Neurogastroenterology Unit, Department ofHepatology and Gastroenterology, Aarhus UniversityHospital, Aarhus, Denmarkd Department of Clinical Medicine, AalborgUniversity, Aalborg, DenmarkE-mail address: jakob.poulsen@rn.dk (J.L. Poulsen).Background: Opioid analgesics inhibit anal sphincter functionand contribute to opioid-induced bowel dysfunction. However, itis unknown if the inhibition can be reduced by opioid antagonismwith oral naloxone, and how this compares to osmotic laxativetreatment.Aims: To compare the effects of oxycodone and macrogol3350 treatment (OX + PEG) versus combined oral oxycodone andnaloxone (OXN) on anal sphincter function and gastrointestinalsymptoms.Methods: A randomised, double-blind, crossover trial wasconducted in 20 healthy, male volunteers. Participants were randomised to five days treatment of OX + PEG or OXN. Anal restingpressure, anal canal distensibility, and rectoanal inhibitory reflexinduced sphincter relaxation were evaluated at baseline and onday 5. The Patient Assessment of Constipation questionnaire (PACSYM), stool frequency, and stool consistency were assed daily.Results: Sphincter relaxation was reduced after OX + PEG treatment compared to OXN (difference = −17.6% [95% CI; −25.2, −10.2];P < 0.001). Anal resting pressure and anal canal distensibility didnot differ between the treatments. PAC-SYM abdominal symptomsubscale increased during OX + PEG compared to OXN (cumulatedscore: 3.2 ± 2.3 vs. 0.2 ± 1.8; P = 0.002). Number of bowel movements was higher during OX + PEG vs. OXN (5.4 ± 1.5 vs. 4.2 ± 1.2;P = 0.035), but there was no difference in stool consistency (3.5 ± 0.5vs. 3.2 ± 0.4; P = 0.14).Conclusions: Sphincter relaxation was significantly reducedafter OX + PEG compared to OXN. Evaluation of the rectoanalinhibitory reflex may serve as an important objective measure infuture trials on treatment of opioid-induced bowel dysfunction.http://dx.doi.org/10.1016/j.sjpain.2017.04.042http://dx.doi.org/10.1016/j.sjpain.2017.04.043The effect of UVB-induced skin inflammationon histaminergic and non-histaminergicevoked itch and painS. Lo Vecchio a,∗ , H.H. Andersen a , J. Elberling b , L.Arendt-Nielsen aaLaboratory for Experimental Cutaneous Pain®Research, SMI , Department of Health Science andTechnology, Faculty of Medicine, Aalborg University,Denmarkb The Allergy Clinic, Copenhagen University Hospital,Gentofte, Copenhagen, DenmarkE-mail address: LAN@hst.aau.dk (L. Arendt-Nielsen).Aims: Itch often occurs in cutaneous conditions characterizedby some degree of inflammation, e.g. atopic dermatitis, psoriasis

Journal

Scandinavian Journal of Painde Gruyter

Published: Jul 1, 2017

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