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    Item type:Publication,
    Latin-American guidelines for opioid use in chronic nononcologic pain
    (2017)
    Argelia Lara-Solares
    ;
    Carlos Aguayo Zamora
    ;
    César Amescua García
    ;
    João Batista Santos Garcia
    ;
    María del Rosario Berenguel Cook
    <jats:p>Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.</jats:p>
      3Scopus© Citations 18
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    A Novel Morphine Drinking Model of Opioid Dependence in Rats
    (2022)
    BERRIOS CARCAMO, PABLO ANDRES  
    ;
    Mauricio Quezada
    ;
    Daniela Santapau
    ;
    Paola Morales
    ;
    OLIVARES, MARIA BELEN  
    <jats:p>An animal model of voluntary oral morphine consumption would allow for a pre-clinical evaluation of new treatments aimed at reducing opioid intake in humans. However, the main limitation of oral morphine consumption in rodents is its bitter taste, which is strongly aversive. Taste aversion is often overcome by the use of adulterants, such as sweeteners, to conceal morphine taste or bitterants in the alternative bottle to equalize aversion. However, the adulterants’ presence is the cause for consumption choice and, upon removal, the preference for morphine is not preserved. Thus, current animal models are not suitable to study treatments aimed at reducing consumption elicited by morphine itself. Since taste preference is a learned behavior, just-weaned rats were trained to accept a bitter taste, adding the bitterant quinine to their drinking water for one week. The latter was followed by allowing the choice of quinine or morphine (0.15 mg/mL) solutions for two weeks. Then, quinine was removed, and the preference for morphine against water was evaluated. Using this paradigm, we show that rats highly preferred the consumption of morphine over water, reaching a voluntary morphine intake of 15 mg/kg/day. Morphine consumption led to significant analgesia and hyperlocomotion, and to a marked deprivation syndrome following the administration of the opioid antagonist naloxone. Voluntary morphine consumption was also shown to generate brain oxidative stress and neuroinflammation, signs associated with opioid dependence development. We present a robust two-bottle choice animal model of oral morphine self-administration for the evaluation of therapeutic interventions for the treatment of morphine dependence.</jats:p>
      1Scopus© Citations 17
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    Undertreatment of pain and low use of opioids in Latin America
    (2018)
    César Amescua García
    ;
    Joao Batista Santos Garcia
    ;
    María del Rosario Berenguel Cook
    ;
    Frantz Colimon
    ;
    José Alberto Flores Cantisani
    <jats:p> Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries. </jats:p>
      8Scopus© Citations 22