Displaying publications 41 - 60 of 1283 in total

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  1. Bhardwaj A, Nagandla K
    Postgrad Med J, 2014 Aug;90(1066):450-60.
    PMID: 24904047 DOI: 10.1136/postgradmedj-2013-132377
    Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.
    Matched MeSH terms: Pain Measurement; Low Back Pain/diagnosis*; Low Back Pain/physiopathology; Low Back Pain/prevention & control; Pelvic Girdle Pain/diagnosis*; Pelvic Girdle Pain/physiopathology; Pelvic Girdle Pain/prevention & control
  2. Loh KY, Kew ST
    Aust Fam Physician, 2007 Nov;36(11):941.
    PMID: 18050541
    Matched MeSH terms: Pain/etiology*; Pain Management
  3. Ho SE, Choy YC, Rozainee A
    Medicine & Health, 2009;4(1):47-52.
    MyJurnal
    Post operative pain is an expected adverse outcome following surgery and it often delays mobilization and overall recovery. Acute post operative pain is subjective and cannot be measured directly. The objective of this study was to determine nurses’ knowledge and attitude towards post operative pain management. A cross sectional study was conducted in surgical wards and the Intensive Care Unit of Universiti Kebangsaan Malaysia Medical Centre from February to April 2008. A 28 item questionnaire which comprised of two domains: knowledge and attitude towards post operative pain management was used. Eighty four respondents successfully responded to the study. Twenty respondents (25%) possessed high level, 58 respondents (69%) possessed moderate level and 5 respondents (6%) had low knowledge level of post operative pain management. Positive attitude towards post operative pain management was reported by 66 respondents (78.5%). There was a significant relationship between nurses’ academic qualifications and attitude towards post operative pain management (χ² =29.96, p
    Matched MeSH terms: Pain, Postoperative; Pain Management; Acute Pain
  4. Tamrin SBM, Ai LP, Hamzah R, Abdullah MY, Hanafi SS
    Objective: A cross-sectional study was conducted to determine and evaluate the effects of schoolbag load on electromyography (EMG) activity of the erector spinae muscle.
    Methods: Eighty-four primary schoolchildren were selected from two national medium primary schools in Seri Kembangan, 42 from Primary Two (P2) and 42 from Primary Five (PS), aged 8 and 11 respectively. Data were collected through interviews, anthropometries measurements, the weight of schoolbag load and surface electromyography (SEMG) of the erector spinae using Muscle Tester ME3000f'®. SurfaceAg-AgCl electrodes were used to measure: unloaded standing and walking, and loaded standing and walking.
    Results: The study revealed that the erector spinae was found to be more efficient in loaded standing probably due to other trunk muscle co-activity compared to unloaded standing (p<0.05). However, the erector spinae was less efficient when loads were carried on the back while walking, compared to unloaded walking. When the schoolbag was carried over both shoulders, forces generated by the erector spinae were reduced and resulted in a more efficient use of the erector spinae compared to other asymmetrical carrying methods (p<0.05).
    Conclusions: Bending slightly forward when carrying schoolbag was found to reduce the forces generated by the erector spinae compared to normal sagittal posture (p<0.05), however no significant difference was found between the different frontal postures. A significant inverse relationship (p<0.01) between the weight of schoolbag load and the average electromyography (AEMG), showed that the signifieance of the erector spinae muscle was reduced when a heavier schoolbag load was carried, owing to other trunk muscles co-activity. The study also revealed that apart from age of schoolchildren, family history of back pain, exposure to environmental tobacco smoke (ETS), weight of the schoolbag and method of carrying schoolbag also play important role as risk factors for back pain.
    Keywords: Electromyography, schoolbag, primary school, back pain
    Matched MeSH terms: Back Pain; Pain; Low Back Pain
  5. Abd Rahman NA, Li S, Schmid S, Shaharudin S
    Phys Ther Sport, 2023 Jan;59:60-72.
    PMID: 36516512 DOI: 10.1016/j.ptsp.2022.11.011
    Low back pain (LBP) can result in increased direct medical and non-medical costs to patients, employers, and health care providers. This systematic review aimed to provide a better understanding of the biomechanical factors associated with chronic non-specific LBP in adults. SCOPUS, ScienceDirect, MEDLINE, and Web of Science databases were searched. In total, 26 studies were included and significant differences were noted between healthy controls and LBP patients in various motion. Biomechanical factors among adults with non-specific LBP were altered and differed as compared to healthy controls in various motion might be to compensate the pain during those motions. This review highlighted the biomechanical differences across those with non-specific LBP and healthy adults. Both groups showed a similar level of pain during functional tasks but LBP patients suffered from a moderate level of disability. Future studies should not rely on questionnaire-based pain scale only. The biomechanical factors summarized in this review can be used to diagnose non-specific LBP accurately, and as modifiable targets for exercise-based intervention.
    Matched MeSH terms: Pain Measurement; Low Back Pain*
  6. Masiran R, Ilias MNA, Yubbu P
    BMJ Case Rep, 2023 Nov 27;16(11).
    PMID: 38011950 DOI: 10.1136/bcr-2023-255187
    A young child was diagnosed with autism spectrum disorder with comorbid attention-deficit/hyperactivity disorder. His hyperactivity, impulsivity and absence of awareness towards danger increased his risk of harm and hence methylphenidate was indicated. Unfortunately, he developed chest pain eight months after the treatment initiation. We then stopped the stimulant and changed his treatment to atomoxetine, after which he no longer had chest pain. In the following illustrated case, we will discuss the cardiac side effect of methylphenidate.
    Matched MeSH terms: Chest Pain/chemically induced; Chest Pain/drug therapy
  7. Subramanian P, Ramasamy S, Ng KH, Chinna K, Rosli R
    Int J Nurs Pract, 2016 Jun;22(3):232-8.
    PMID: 25355297 DOI: 10.1111/ijn.12363
    Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P = 0.038), education level (P ≤ 0.001), previous operation status (P = 0.032) and operation status (P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery.
    Matched MeSH terms: Pain, Postoperative/therapy*; Pain Management/methods*
  8. Chen CK, Nizar AJ
    Korean J Pain, 2011 Jun;24(2):100-4.
    PMID: 21716607 DOI: 10.3344/kjp.2011.24.2.100
    BACKGROUND: Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder.
    METHODS: This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment.
    RESULTS: The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ(2) = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P < 0.001) in Visual Analogue Score (VAS) and Modified Oswestry Disability Score (MODS) with standard management during three consecutive visits at six-month intervals.
    CONCLUSIONS: MPS prevalence among chronic back pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome.
    KEYWORDS: chronic back pain; myofascial pain syndrome; trigger point
    Study site: Pain Management Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Back Pain; Myofascial Pain Syndromes*; Musculoskeletal Pain
  9. Martínez-Nicolás I, Ángel-García D, Saturno PJ, López-Soriano F
    Rev Calid Asist, 2016 Jan-Feb;31(1):55-63.
    PMID: 26420516 DOI: 10.1016/j.cali.2015.06.009
    OBJECTIVE: Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue.

    MATERIALS AND METHODS: A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness.

    RESULTS: Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one.

    CONCLUSIONS: The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve.
    Matched MeSH terms: Pain Management*; Cancer Pain/therapy*
  10. Maharajan MK, Yong YJ, Yip HY, Woon SS, Yeap KM, Yap KY, et al.
    J Anesth, 2020 02;34(1):95-103.
    PMID: 31535218 DOI: 10.1007/s00540-019-02680-y
    Globally, chronic pain is a major therapeutic challenge and affects more than 15% of the population. As patients with painful terminal diseases may face unbearable pain, there is a need for more potent analgesics. Although opioid-based therapeutic agents received attention to manage severe pain, their adverse drug effects and mortality rate associated with opioids overdose are the major concerns. Evidences from clinical trials showed therapeutic benefits of cannabis, especially delta-9-tetrahydrocannabinol and cannabinoids reduced neuropathic pain intensity in various conditions. Also, there are reports on using combination cannabinoid therapies for chronic pain management. The association of cannabis dependence and addiction has been discussed much and the reports mentioned that it can be comparatively lower than other substances such as nicotine and alcohol. More countries have decided to legalise the medicinal use of cannabis and marijuana. Healthcare professionals should keep themselves updated with the changing state of medical cannabis and its applications. The pharmacokinetics and safety of medical cannabis need to be studied by conducting clinical research. The complex and variable chemically active contents of herbal cannabis and methodological limitations in the administration of cannabis to study participants, make the clinical research difficult.
    Matched MeSH terms: Pain Management
  11. Salwana Ku Md Saad, Koik, Boon Hong, Nur Faradilla Mohamad Bakri, Abdul Nasir Mohamed Abdul Kadher, Karniza Khalid
    Q Bulletin, 2020;1(29):4-14.
    MyJurnal
    Neonates in Special Care Nursery (SCN) are constantly exposed to routine procedures that are painful. Repetitive painful exposures in neonates are known to have long-term deleterious effects that may surpass adulthood. A quality improvement project was designed to reduce the pain experienced by neonates during routine minor procedures in SCN unit of Hospital Tuanku Fauziah (HTF), a tertiary state hospital in Perlis, Malaysia. The Neonatal Infant Pain Scale (NIPS) was used as a pain assessment tool in neonates throughout the study. Several factors contributing to neonatal painful experience during routine procedures were identified, including poor awareness on neonatal pain perception, poor procedural etiquette among paediatric house officers, and lack of non-pharmacological pain relief used during the procedures. Interventional measures included adjunctive use of non-nutritive sucking via orthodontic Avent® pacifier, use of adjustable swaddling blanket via SwaddleMe® size S, and introduction of a clinical training module for the house officers. There were 159 neonates recruited in the pre-intervention period and 163 neonates evaluated in the post-intervention period. Our study revealed a significant decrease in neonatal painful experience during routine procedures, from 49.7% to 17.8% (p
    Matched MeSH terms: Pain; Pain Measurement; Pain Perception; Pain Management
  12. Karobari MI, Assiry AA, Mirza MB, Sayed FR, Shaik S, Marya A, et al.
    Int J Dent, 2021;2021:6625126.
    PMID: 33747083 DOI: 10.1155/2021/6625126
    Introduction: Patients experience various levels of discomfort during orthodontic treatment, i.e., after placement of separators, orthodontic implant placement, and archwire placement and during debonding. Various pain control methods have been developed to relive pain during debonding, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR).

    Aim: To analyse various pain scales commonly used to determine the effect of different pain control methods during debonding of orthodontic brackets. Study Design. A comparative cross-sectional study performed on a sample of 60 patients (n = 60) including 14 males and 46 females who were ready for debonding and who were divided into three groups, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR).

    Materials and Methods: A 100 mm Visual Analog Scale (VAS) was used to record the pain intensity for each tooth. Another scale known as Pain Catastrophizing Scale (PCS) was used to evaluate the patient's general attitude towards pain perception. The armamentarium and operator were kept same for all the patients. Statistical analysis used was the Kruskal-Wallis test, used for intergroup and intragroup comparison of pain scores.

    Results: Lowest total pain score was recorded in the FP group (P=0.043) on intergroup comparison, while on intragroup comparison, higher pain scores were recorded in lower anterior region (P=0.02) in all three groups. There was no significant difference between the pain scores reported by the male and female subjects.

    Conclusion: FP is an effective method of pain control. And teeth in the anterior region of lower and upper arches are more sensitive to pain. In terms of cognitive-affective constructs, although the VAS has been widely used in previous studies, the PCS has been detailed to show the most reliable association with physical discomfort and emotional distress.

    Matched MeSH terms: Pain; Pain Measurement; Pain Perception; Pain Management
  13. Nayak R, Nagaraj KN, Gururaj G
    Indian J Pediatr, 2020 05;87(5):353-358.
    PMID: 31989459 DOI: 10.1007/s12098-020-03182-6
    OBJECTIVES: To compare the efficacy of orally administered 10% dextrose, breast milk and sterile water on pain prevention during screening examination for Retinopathy of prematurity (ROP) in preterm neonates as measured by Premature infant pain profile (PIPP).

    METHODS: A three-limbed double-blinded randomized control trial was conducted in a Level 3 neonatal intensive care unit. Forty five preterm neonates undergoing ROP screening were included. Eligible babies were randomly assigned to one of the three groups that orally received either expressed breast milk (n = 14), 10% dextrose solution (n = 14) or sterile water (n = 17), one minute before eye examination. The outcome measure was PIPP score.

    RESULTS: All 3 groups were similar in baseline characteristics. The mean PIPP scores were comparable (p = 0.18) in the three groups (11.8 ± 2.8 vs. 9.8 ± 3.3 vs. 10.2 ± 2.9). The behavioral and physiological variables were also similar across all three groups.

    CONCLUSIONS: Expressed breast milk, 10% dextrose or sterile water administered orally before ROP screening in preterm neonates have similar analgesic effects and do not significantly alleviate pain during the procedure.

    Matched MeSH terms: Pain/diagnosis; Pain/etiology; Pain/prevention & control
  14. Tang SP, Yeo ASH, Cardosa MS
    Lancet Child Adolesc Health, 2021 01;5(1):5-7.
    PMID: 33064996 DOI: 10.1016/S2352-4642(20)30336-9
    Matched MeSH terms: Pain/drug therapy; Pain Management*
  15. Yam MF, Loh YC, Oo CW, Basir R
    Int J Mol Sci, 2020 Jun 19;21(12).
    PMID: 32575378 DOI: 10.3390/ijms21124355
    Pain is the most common sensation installed in us naturally which plays a vital role in defending us against severe harm. This neurological mechanism pathway has been one of the most complex and comprehensive topics but there has never been an elaborate justification of the types of analgesics that used to reduce the pain sensation through which specific pathways. Of course, there have been some answers to curbing of pain which is a lifesaver in numerous situations-chronic and acute pain conditions alike. This has been explored by scientists using pain-like behavioral study methodologies in non-anesthetized animals since decades ago to characterize the analgesic profile such as centrally or peripherally acting drugs and allowing for the development of analgesics. However, widely the methodology is being practiced such as the tail flick/Hargreaves test and Von Frey/Randall-Selitto tests which are stimulus-evoked nociception studies, and there has rarely been a complete review of all these methodologies, their benefits and its downside coupled with the mechanism of the action that is involved. Thus, this review solely focused on the complete protocol that is being adapted in each behavioral study methods induced by different phlogogenic agents, the different assessment methods used for phasic, tonic and inflammatory pain studies and the proposed mechanism of action underlying each behavioral study methodology for analgesic drug profiling. It is our belief that this review could significantly provide a concise idea and improve our scientists' understanding towards pain management in future research.
    Matched MeSH terms: Pain/drug therapy*; Pain/etiology; Pain Measurement
  16. Lai LW, Roslani AC, Yan YW, Bhojwani KM, Jamaluddin MFH
    ANZ J Surg, 2021 05;91(5):896-901.
    PMID: 33522667 DOI: 10.1111/ans.16567
    BACKGROUND: Conventional mass closure uses suture-to-wound length ratio of 4:1 ('long stitch', LS). 'Short stitch' (SS) has a suture-to-wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post-operative pain after laparotomy closure using LS and SS.

    METHODS: Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post-operative patient-controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi-squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann-Whitney U-test.

    RESULTS: Eighty-six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient-controlled analgesia morphine usage 24 h post-operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P = 0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P = 0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P = 0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P = 0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference.

    CONCLUSION: There were no differences in post-operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome.

    Matched MeSH terms: Pain, Postoperative/diagnosis; Pain, Postoperative/etiology; Pain, Postoperative/epidemiology
  17. Ardilla Hanim Abdul Razak, Ahmad Hafiz Zulkifly, Ramli Musa, Mohd Shukrimi Awang, Goh, Kian Liang
    MyJurnal
    Total knee arthroplasty represents a major advance in the treatment of
    degenerative joint disease. It provides excellent restoration of joint function and pain
    relief. The primary indication for total knee arthroplasty is to relieve pain caused by
    severe arthritis, with or without significant deformity. This study is to assess
    psychological impact pre and post arthroplasty. (Copied from article).
    Matched MeSH terms: Pain
  18. Thevarajah KA, Menon KA
    Family Practitioner, 1973;1(1):20-1.
    Matched MeSH terms: Pain
  19. Daneshwar D, Nordin A
    Medicine (Baltimore), 2022 Jan 14;101(2):e28546.
    PMID: 35029213 DOI: 10.1097/MD.0000000000028546
    INTRODUCTION: In this study, the efficacy of low intensity shock wave therapy (LSWT) in improving symptoms of chronic pelvic pain syndrome (CPPS) and erectile dysfunction (ED) was investigated.

    METHODS: Men diagnosed with CPPS and ED (n = 50) were prescribed with LSWT. The LSWT was administered in 10 sessions over the course of 5 weeks at 3,000 pulses with .25 mJ/mm2 energy flow and 5 Hz frequency. Outcome parameters were measured before and after LSWT.

    RESULTS: Clinical symptoms related to CPPS and ED were measured using four validated questionnaires namely National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function (IIEF), the International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM). The effect of LSWT on each of the three domains of NIH-CPSI, namely Pain, Symptoms, and Quality of Life (QoL) were also analyzed. Uroflowmetry was measured to assess LSWT effect on urine voiding. The mean baseline CPPS symptoms on NIH-CPSI domains of pain, symptoms and QoL were 9.92 ± 5.72 (mean ± SD), 5.14 ± 14.5, and 8.02 ± 3.17, respectively. LSWT resulted in significant reduction of CPPS symptoms on all NIH-CPSI domains (Pain = .9 ± 1.37; Symptoms = .74 ± 1.03; QoL = 1.16 ± 1.78). The baseline means of CPPS symptoms on IIEF, IPSS, and SHIM were 45.42 ± 16.24, 24.68 ± 9.28, and 14.28 ± 6.02, respectively. LSWT significant improved CPPS symptoms on IIEF (49.48 ± 28.30) and IPSS (9.04 ± 7.01) but not on SHIM (16.02 ± 9.85). No statistically significant differences were observed with all uroflowmetry parameters.

    CONCLUSION: The current study demonstrated for the first time the safety and efficacy of LSWT administered in 10 sessions over 5 weeks in improving symptoms of CPPS and ED without causing any significant adverse effect to the patient.

    Matched MeSH terms: Pelvic Pain/therapy*; Chronic Pain/therapy*
  20. Lee MT, Mackie K, Chiou LC
    Br J Pharmacol, 2023 Apr;180(7):894-909.
    PMID: 34877650 DOI: 10.1111/bph.15771
    The use of opioids in pain management is hampered by the emergence of analgesic tolerance, which leads to increased dosing and side effects, both of which have contributed to the opioid epidemic. One promising potential approach to limit opioid analgesic tolerance is activating the endocannabinoid system in the CNS, via activation of CB1 receptors in the descending pain inhibitory pathway. In this review, we first discuss preclinical and clinical evidence revealing the potential of pharmacological activation of CB1 receptors in modulating opioid tolerance, including activation by phytocannabinoids, synthetic CB1 receptor agonists, endocannabinoid degradation enzyme inhibitors, and recently discovered positive allosteric modulators of CB1 receptors. On the other hand, as non-pharmacological pain relief is advocated by the US-NIH to combat the opioid epidemic, we also discuss contributions of peripheral neuromodulation, involving the electrostimulation of peripheral nerves, in addressing chronic pain and opioid tolerance. The involvement of supraspinal endocannabinoid systems in peripheral neuromodulation-induced analgesia is also discussed. LINKED ARTICLES: This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.
    Matched MeSH terms: Pain/drug therapy; Pain/metabolism; Pain Management
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