D-Ala2]-methionine enkephalinamide (DALA): characterization of antinociceptive, cardiovascular, and autonomic nervous system actions in conscious and pentobarbital-anesthetized rats

The antinociceptive, cardiovascular, and autonomic nervous system actions of [D-Ala2]-methionine enkephalinamide (DALA) were assessed in conscious and pentobarbital-anesthetized rats. Intravenous administration of DALA inhibited the tail-flick reflex evoked by noxious radiant heat in both conscious and pentobarbital-anesthetized rats. In general, the magnitude of the inhibition was not significantly affected by the presence of pentobarbital-anesthesia. DALA also induced hypotension and bradycardia in these rats, but these responses were significantly attenuated by pentobarbital-anesthesia. Arterial blood flows were initially decreased and vascular resistances increased in mesenteric, renal, and hindquarter beds following DALA administration, but these parameters rapidly returned to baseline levels except in the hindquarter bed where flows increased significantly above baseline levels. All of the changes in blood flows were significantly greater in conscious compared to pentobarbital-anesthetized rats. In intact pentobarbital-anesthetized rats, DALA induced inhibition of renal sympathetic nerve activity. However, DALA induced a pressor response with a brief increase in renal sympathetic nerve activity in rats with bilateral vagotomy. Similarly, in the conscious rat with ganglionic blockade, DALA induces a brief pressor response. These outcomes indicate that the brief hypotension observed in the intact rat following administration of DALA is probably the net outcome of a large vagally-induced decrease in sympathetic tone and a small increase in sympathetic tone of either neurogenic or peripheral origin. These outcomes are discussed in terms of cardiovascular-somatosensory interactions.     

Demographic and Clinical Factors Associated With Nonsurgical Osteoarthritis Treatment Among Patients in Outpatient Clinics

Objective

To identify patient demographic and clinical characteristics associated with osteoarthritis (OA) treatment use.

Methods

This was a secondary data analysis of 3 clinical trials among patients with hip or knee OA conducted in Duke Primary Care practices, the Durham Veterans Affairs (VA) Health Care System, and the University of North Carolina–Chapel Hill (UNC). At baseline, participants reported sociodemographic characteristics, OA‐related pain and function, and OA treatment use, including oral analgesics, topical creams, joint injections, and physical therapy. Separate, multivariable logistic models (adjusted for clustering of clinics and providers for the Duke and VA cohorts) were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between participant characteristics and each type of OA treatment.

Results

Oral analgesic use was reported by 70–82% of participants across the 3 cohorts. Physical therapy, knee injections, and topical creams were used by 39–52%, 55–60%, and 25–39% of Duke, VA, and UNC participants, respectively. In multivariable models, worse pain, stiffness, and function, per 5‐unit increase, were associated with greater odds of using any oral analgesic for the cohorts from Duke (OR 1.18 [95% CI 1.08–1.28]) and UNC (OR 1.14 [95% CI 1.05–1.24]), but not for the VA cohort (OR 1.04 [95% CI 0.95–1.14]). For all 3 cohorts, nonwhites had higher odds of using topical creams compared to whites.

Conclusion

Results suggest potential underutilization of therapies other than oral analgesics. Patient characteristics may affect OA treatment use, and understanding the relationship between these factors and OA treatment preferences may improve adherence to OA treatment guidelines.     

Relationship Themes Present between Parents and Children in Recovery Homes

Approximately 12.5% of children have a parent with a substance use disorder. These children are likely to experience developmental delays, especially if they are placed into foster care. Oxford House recovery homes provide a useful setting that allows children to live with their parents after treatment for substance use. A sample of parents and their children who lived in Oxford Houses were interviewed, using mixed methods, and the outcomes suggest that Oxford Houses may provide a stable and supportive setting for parents and their children.