This thesis aims to describe certain novel approaches and pharmacological interventions in the treatment of acute and chronic pain. It demonstrates that the efficacy of the mu-opioid receptor... Show moreThis thesis aims to describe certain novel approaches and pharmacological interventions in the treatment of acute and chronic pain. It demonstrates that the efficacy of the mu-opioid receptor agonist and noradrenaline reuptake inhibitor tapentadol in the treatment of chronic pain is highest in specific patient phenotypes. This highlights the importance of patient phenotyping to get a detailed indication of the characteristics of the different aspects of the pain syndrome (such as involvement and activity of excitatory versus inhibitory pathways) without the need for knowledge on underlying mechanisms or related illnesses. Additionally, it demonstrates that treatment with the non-conventional treatment option cannabis shows potential but efficacy in the chosen patient population was limited. This thesis is also designated to treatment of acute pain with sublingual sufentanil and a non-opioid alternative option (ice-popsicle). Both show efficacy and seem possible alternatives as part of the multimodal therapy of acute pain. Show less
Endogenous pain modulation is a complex phenomenon involved in the perception of pain. It consists of top-down inhibitory and facilitatory pathways that originate at higher sites within the central... Show moreEndogenous pain modulation is a complex phenomenon involved in the perception of pain. It consists of top-down inhibitory and facilitatory pathways that originate at higher sites within the central nervous system and converge at dorsal horn neurons in the spinal cord, to modulate incoming afferent nociceptive information. Dysfunction of inhibitory pain pathways or a shift in the balance between pain facilitation and pain inhibition has been associated with the development of chronic pain. This thesis describes the effect of several central-acting drugs on descending control of pain in both healthy volunteers and chronic pain patients to further understand the underlying mechanism of endogenous pain control in health and disease. Show less