Addiction and Corticotropin-Releasing Hormone Type 1 Receptor Antagonist Medications.
Addiction and corticotropin-releasing hormone type 1 receptor antagonist medications.
Filed under: Addiction Rehab
Ann N Y Acad Sci. 2013 Feb 11;
Contoreggi C, Lee MR, Chrousos G
Derangements in corticotropin-releasing hormone (CRH) through its type 1 receptor (CRHR1) have been identified in many pathologic conditions. Preclinical models of addiction find that small-molecule antagonists of CRHR1 can limit induction, maintenance, and relapse to drugs of abuse. Neuropsychiatric clinical trials of CRHR1 antagonists have shown mixed efficacy; treatment of addictive disorders has not been established, but finding effective treatments for addictive disorders is critical. Establishing effectiveness for substance abuse treatment will require a different design approach than was used for depression and anxiety trials. Focusing on active versus passive outcome measures, such as resilience to external stressful stimuli, may provide signals in curbing craving and relapse. Study design should include measures of abstinence and drug exposure, but additional elements of stress prevention should also be incorporated. Agents that could provide preemptive protection from drug use and relapse are novel and untested. An understanding of the evolutionary significance of the stress system and preclinical models suggests that these agents may provide protection in this manner. Investigators designing future trials might refocus their understanding of addiction and treatment in this new direction.
HubMed – addiction
Conversation with Judith Mackay.
Filed under: Addiction Rehab
Addiction. 2013 Feb 11;
Conversation with Juan Carlos Negrete.
Filed under: Addiction Rehab
Addiction. 2013 Feb 11;
Chronic and acute pain and pain management for patients in methadone maintenance treatment.
Filed under: Addiction Rehab
Am J Addict. 2013 Jan; 22(1): 75-83
Eyler EC
Many individuals receiving methadone maintenance treatment (MMT) for opioid addiction also require treatment for acute or chronic pain, and the presence of pain is known to have a negative impact on patient health and function. However, effective pain management in this population is complicated by many factors, including heightened pain sensitivity, high opioid tolerance, illicit substance use, and variable cross-tolerance to opioid pain medications. This article reviews the recent literature on acute and chronic pain among, and pain treatment of, patients receiving MMT for opioid addiction and discusses the implications for effective pain management. Acute pain management among women maintained on methadone during and after labor and delivery is also discussed, as well as common concerns held by patients and providers about appropriate pain management strategies in the context of methadone maintenance and addiction treatment.One hundred nine articles were identified in a PubMed/MEDLINE electronic database search using the following search terms: methadone, methadone maintenance, methadone addiction, pain, pain management, chronic pain, and acute pain. Abstracts were reviewed for relevance, and additional studies were extracted from the reference lists of articles identified in the original search.The pain sensitivity and pain responses of MMT patients differ significantly from those of patients not maintained on opioids, and few data are available to guide patient care.Rigorous studies are needed to identify and evaluate effective pain management approaches for this unique patient population and to improve patient treatment outcomes. (Am J Addict 2012;XX:000-000) (Am J Addict 2013;22:75-83).
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