The Lived Experience of Managing HIV and Chronic Pain: Qualitative Interviews with Patients and Healthcare Providers

AIDS and Behavior - People living with HIV (PLWH) experience higher rates of comorbid chronic pain conditions compared to the general population. Managing HIV and chronic pain, two stigmatized...     

Impact of chronic nicotine on the development and maintenance of neuropathic hypersensitivity in the rat

Rationale Clinical data support a correlation between smoking and the incidence and severity of some chronic pain conditions. However, the impact of nicotine on neuropathic pain has been largely ignored in the laboratory setting.Objectives The purpose of these studies was to determine if chronic nicotine would alter mechanical hypersensitivity after spinal nerve ligation.Materials and methods Rats were implanted with osmotic mini pumps to administer either saline or nicotine (4, 10, or 24 mg/kg/day) for 7 or 21 days. On day 7 of saline/nicotine administration, rats receiving 24 mg/kg/day nicotine underwent spinal nerve ligation. Mechanical thresholds to pressure were measured across nicotine exposure and spinal cords were collected on days 7 or 21. Spinal cord slices were immunostained for phosphorylation of cAMP response element binding protein (pCREB), to determine general neuronal activity, and for cleaved caspase-3, as a marker for apoptosis.Results Chronic nicotine produced a dose-dependent and stable mechanical hypersensitivity, which could be blocked with the α4β2-selective antagonist, dihydro-β-erythroidine (DHβE). Spinal nerve ligation also produced a stable mechanical hypersensitivity, which was exacerbated in the presence of chronic nicotine. Differences in mechanical sensitivity were reflected in spinal pCREB, which was highly correlated with the degree of mechanical hypersensitivity. Chronic nicotine also altered the number of pro-apoptotic cells in the spinal cord as measured by cleaved caspase-3.Conclusions These findings demonstrate that chronic nicotine produces a stable, long-lasting, mechanical hypersensitivity that exacerbates mechanical sensitivity resulting from peripheral nerve injury. The mechanism of this may involve an increase in spinal neuronal activity and apoptosis.     

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability,barriers and attitudes

Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, and 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts.