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Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up

Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher doses to achieve the same...

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Autores principales: Polati, Enrico, Nizzero, Marta, Rama, Jacopo, Martini, Alvise, Gottin, Leonardo, Donadello, Katia, Del Balzo, Giovanna, Varrassi, Giustino, Marinangeli, Franco, Vittori, Alessandro, Secchettin, Erica, Schweiger, Vittorio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9603806/
https://www.ncbi.nlm.nih.gov/pubmed/36293936
http://dx.doi.org/10.3390/ijerph192013354
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author Polati, Enrico
Nizzero, Marta
Rama, Jacopo
Martini, Alvise
Gottin, Leonardo
Donadello, Katia
Del Balzo, Giovanna
Varrassi, Giustino
Marinangeli, Franco
Vittori, Alessandro
Secchettin, Erica
Schweiger, Vittorio
author_facet Polati, Enrico
Nizzero, Marta
Rama, Jacopo
Martini, Alvise
Gottin, Leonardo
Donadello, Katia
Del Balzo, Giovanna
Varrassi, Giustino
Marinangeli, Franco
Vittori, Alessandro
Secchettin, Erica
Schweiger, Vittorio
author_sort Polati, Enrico
collection PubMed
description Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher doses to achieve the same analgesic effect, may limit their use. Animal models suggest that ultra-low doses of opioid antagonists combined with opioid agonists can decrease or block the development of opioid tolerance. In this retrospective study, we tested this hypothesis in humans. In 2019, 53 patients suffering from CLBP were treated with either Oxycodone and Naloxone Prolonged Release (27 patients, OXN patients) or Oxycodone Controlled Release (26 patients, OXY patients). The follow-up period lasted 2 years, during which 10 patients discontinued the treatment, 5 out of each group. The remaining 43 patients reached and maintained the targeted pain relief, but at 18 and 24 months, the OXY patients showed a significantly higher oxycodone consumption than OXN patients to reach the same level of pain relief. No cases of respiratory depression or opioid abuse were reported. There were no significant differences in the incidence of adverse effects between the two treatments, except for constipation, more common in OXY patients. From our results, we can affirm that a long-term opioid treatment with oxycodone-naloxone combination, when compared with oxycodone only, may significantly hinder the development of opioid tolerance. We were also able to confirm, in our cohort, the well known positive effect of naloxone in terms of opioid-induced bowel dysfunction incidence reduction.
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spelling pubmed-96038062022-10-27 Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up Polati, Enrico Nizzero, Marta Rama, Jacopo Martini, Alvise Gottin, Leonardo Donadello, Katia Del Balzo, Giovanna Varrassi, Giustino Marinangeli, Franco Vittori, Alessandro Secchettin, Erica Schweiger, Vittorio Int J Environ Res Public Health Article Chronic low back pain (CLBP) due to osteoarthritis represents a therapeutic challenge worldwide. Opioids are extensively used to treat such pain, but the development of tolerance, i.e., less susceptibility to the effects of the opioid, which can result in a need for higher doses to achieve the same analgesic effect, may limit their use. Animal models suggest that ultra-low doses of opioid antagonists combined with opioid agonists can decrease or block the development of opioid tolerance. In this retrospective study, we tested this hypothesis in humans. In 2019, 53 patients suffering from CLBP were treated with either Oxycodone and Naloxone Prolonged Release (27 patients, OXN patients) or Oxycodone Controlled Release (26 patients, OXY patients). The follow-up period lasted 2 years, during which 10 patients discontinued the treatment, 5 out of each group. The remaining 43 patients reached and maintained the targeted pain relief, but at 18 and 24 months, the OXY patients showed a significantly higher oxycodone consumption than OXN patients to reach the same level of pain relief. No cases of respiratory depression or opioid abuse were reported. There were no significant differences in the incidence of adverse effects between the two treatments, except for constipation, more common in OXY patients. From our results, we can affirm that a long-term opioid treatment with oxycodone-naloxone combination, when compared with oxycodone only, may significantly hinder the development of opioid tolerance. We were also able to confirm, in our cohort, the well known positive effect of naloxone in terms of opioid-induced bowel dysfunction incidence reduction. MDPI 2022-10-16 /pmc/articles/PMC9603806/ /pubmed/36293936 http://dx.doi.org/10.3390/ijerph192013354 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Polati, Enrico
Nizzero, Marta
Rama, Jacopo
Martini, Alvise
Gottin, Leonardo
Donadello, Katia
Del Balzo, Giovanna
Varrassi, Giustino
Marinangeli, Franco
Vittori, Alessandro
Secchettin, Erica
Schweiger, Vittorio
Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title_full Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title_fullStr Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title_full_unstemmed Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title_short Oxycodone-Naloxone Combination Hinders Opioid Consumption in Osteoarthritic Chronic Low Back Pain: A Retrospective Study with Two Years of Follow-Up
title_sort oxycodone-naloxone combination hinders opioid consumption in osteoarthritic chronic low back pain: a retrospective study with two years of follow-up
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9603806/
https://www.ncbi.nlm.nih.gov/pubmed/36293936
http://dx.doi.org/10.3390/ijerph192013354
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