Browsing by Subject "Analgesics"
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Item Additional Validation of the Pain Medication Questionnaire in a Sample of Patients with Chronic Pain(2009-09-04) Buelow, Amanda; Silver, CherylThe present study represents an initial stage in the formal attempt to aid in developing a psychometrically sound, self-report screen tool used for assessing potential pain medication misuse risk. This study follows previous studies of Adams and colleagues (2004) and Holmes and colleagues (2006). The Pain Medication Questionnaire (PMQ), initially a 26-item instrument, was studied as a 23-item questionnaire designed to measure risk for opioid misuse. This revised PMQ showed good reliability and validity. This study also examined the ability of the revised PMQ to predict pain medication misuse in a heterogeneous sample of chronic pain patients. The PMQ was administered to 1,540 patients at a pain center that provided interdisciplinary pain management, including medication, psychological, and physical therapy disciplines. The risk of a patient's pain medication misuse, as predicted by the PMQ, was found to significantly decrease following interdisciplinary intervention. Cut-off scores were created from the distributed PMQ scores by assessing a frequency scatter plot and determined that those participants with scores below a 21 on the PMQ made up the lowest (L-PMQ) group, scores including and between 21 to 30 on the PMQ made up the middle (M-PMQ) group, and scores above 30 made up the highest (H-PMQ) group. A comparison using the H-PMQ and L-PMQ groups revealed that those participants in the H-PMQ group, after completing an interdisciplinary treatment program, had significantly decreased PMQ scores at post-treatment. In addition, the H-PMQ group was significantly associated with greater levels of non-compliance or drop out from treatment, early pain medication refill requests, and endorsement of having a history of alcohol abuse or history of rehab for alcohol or drugs. Finally, the present study also examined the relationship of total PMQ score with measures of physical impairment and perceived pain. Findings suggest that higher scores on the PMQ are minimally associated with higher levels of impairment of physical functioning and perceived pain.Item The Impact of Chronic Morphine on Adult Hippocampal Progenitor Cells and the Neurogenic Niche(2009-06-15) Arguello, Amy; Eisch, Amelia J.The birth of new neurons persists in the adult hippocampal subgranular zone (SGZ). Adult neurogenesis is dynamically regulated and thought to be important for certain types of spatial learning and memory. SGZ proliferation and neurogenesis are decreased by chronic morphine, yet how this alteration occurs is unknown. It is unclear if morphine causes alterations in cell cycle progression, progenitor cell maturation, or indirectly inhibits progenitor cells by altering the hippocampal neurogenic niche. I first examined a time course of morphine's effect on the progenitor cell cycle, cell death and immature SGZ neurons. I found that S phase cycling cells were vulnerable to morphine at early time points with a concurrent increase in cell death. I found that although the total population of SGZ immature neurons remained unchanged, the proportion of progenitor cells that progressed to a more mature stage decreased. I next asked whether decreased levels of proliferation resulted from shortened S phase length. Using a modified double injection paradigm of halogenated thymidine analogs, I found that chronic morphine did not alter the length of S phase of progenitor cells. Next, I asked if chronic morphine could have an indirect inhibitory effect on progenitor cells by altering growth factors and neurovasculature within the hippocampal neurogenic niche. I found that protein levels of factors within the niche were maintained or upregulated (e.g. vascular endothelial growth factor) to compensate for the morphine-induced decrease in proliferation. Lastly, I asked whether chronic morphine would decrease proliferation in an inducible nestin-CreERT2/R26R-yellow fluorescent protein transgenic mouse. I found that proliferation in this transgenic mouse was not altered after a particular paradigm of morphine exposure. Together these findings suggest that morphine alters adult hippocampal proliferation through multiple effects: both on the progenitor cells themselves (cell cycle, maturation) and indirectly by alteration of the neurogenic niche. Additional work is needed to understand the mechanism of the morphine-induced changes in progenitor cell cycle and the neurogenic niche. The present findings will benefit both the addiction field by offering new avenues for treatment and neural stem cell biology by demonstrating stages of neurogenesis that are more vulnerable to exogenous stimuli.