American journal of therapeutics最新文献

Background: Pain management remains a critical challenge in medical practice. There is a complex interplay between chronic pain and opioid use disorder, 2 prevalent problems of significant public health concern. Research into new treatment strategies is increasingly important.

Study question: This study aims to highlight the analgesic effect of morphine through its exclusive action on peripheral opioid receptors in carrageenan-induced inflammatory pain.

Study design: The first experiment aimed to establish a dose-effect relationship for intraplantar morphine administration in a rat model of carrageenan-induced inflammation by testing successive doses after carrageenan injection. The second experiment assessed whether a 5-mg/kg dose of intraplantar morphine has only local, not central nervous system, analgesic effects by comparing it with 5- and 10-mg/kg doses given intraperitoneally.

Measures and outcomes: For each rat, paw pain sensitivity was measured using the Ugo Basile Plantar Test-Hargreaves Apparatus.

Results: In the first part, lower doses (2.5 mg/kg) did not significantly affect paw withdrawal latency, whereas higher doses (5 and 10 mg/kg) increased it significantly, suggesting maximum receptor activation at 5 mg/kg intraplantarly. The 20-mg/kg intraplantar dose caused central nervous system effects, indicating systemic absorption. The second part compared intraplantar versus intraperitoneal morphine, finding that the 5-mg/kg intraplantar dose produced significant local analgesia, whereas the same intraperitoneal dose did not-supporting peripheral receptor involvement.

Conclusions: Our findings suggest that morphine administered locally in experimentally inflamed tissue acts predominantly via peripheral opioid receptors. This opens the possibility for developing localized opioid delivery systems offering safer, more selective pain management.

Background: Scorpion envenomation is a significant public health concern in specific regions and can have severe consequences in pediatric patients. The efficacy of antivenom treatment remains controversial.

Objective: To compare the clinical course and outcomes of pediatric scorpion envenomation in patients receiving SCORPIFAV antivenom versus supportive care alone.

Methods: We conducted a retrospective study of children aged 0-18 years presenting with grade ≥2 scorpion envenomation to the pediatric emergency department at Soroka University Medical Center, Israel, between 2014 and 2020. Clinical outcomes were compared between patients who received SCORPIFAV and those treated with supportive care alone.

Results: A total of 194 children were included (median age: 3 years, interquartile range: 2-8 years); 125 received SCORPIFAV and 69 received supportive care only. Patients treated with SCORPIFAV required less sedation (10.3% vs. 23.4%, P = 0.02), less analgesia (53.3% vs. 81.3%, P < 0.001), and fewer antihypertensive medications (0% vs. 17.2%, P < 0.001). SCORPIFAV administration was associated with higher odds of requiring minimal additional treatment (OR = 2.568, 95% CI, 1.168-5.646, P = 0.019). No significant differences were found in pediatric intensive care unit admission rates or length of stay.

Conclusions: In pediatric patients with grade ≥2 scorpion envenomation, SCORPIFAV use was associated with reduced need for sedatives, analgesics, and antihypertensive medications. These findings suggest that early administration of SCORPIFAV in the emergency setting may help attenuate the sympathetic response and reduce overall treatment intensity.