Clonidine against Pain - Research Paper Example

Clonidine against Pain Introduction Pain is a serious alarm of the organism informing about damaging of tissues. To take control over pain and to deal with it, different researchers and scientists provided patients with a great care, but, of course, medical treatment was necessary too. There is a lacking of universal and appropriate means of pain treatment and management. Therefore, a huge number of patients are suffering from pain and are looking forward to some appropriate medical decisions, which will facilitate their suffering for sure. Of course, physicians can provide aggressive pain management, but it is better to find both effective and less damaging solutions to treat the organisms of the patients appropriately (Bergendahl, Lonnqvisy, Eksborg, Ruthstrom, Nordenberg, Bianchi, Ginggen, Tardy 2008, p. 973). Numerous researches and studies of the modernity are devoted to the discussion about the usage of clonidine in medical treatment. In spite of the fact that the majority of researches were devoted to the involvement of this drug in the field of hypertension treatment a lacking of attention is paid to usage of clonidine for pain treatment. Heroin or similar drugs can be found as alternative for the people suffering from chronic pain. When a patient is treated with clonidine in the process of heroine abuse relief, or when detoxification of the organism occurs a physical discomfort can be released. Clonidine in medicine: literature review There are different forms of this medication. An option to use a pain-release tablet is appropriate for the patients with a long-term pain. In this case a tablet brings an essential relief. Clonidine can be also given to cancer patients and it is provided in the form of an epidural. It is possible to combine clonidine with morphine (Amany&Ashraf 2012, p. 8). Another article is devoted to the problem of clonidine usage for chronic low back pain (LBP). The usage of clonidine can be effective and improve motor function. In this research it was found out that: “the addition of low-dose systemic clonidine improves therapeutic outcome in measures of both axial and radiating pain. Combination therapy could be of enormous benefit to patients suffering from chronic LBP” (Tajerian, Millecamps, Stone 2012, p. 150843).Clonidine is alpha-agonist direct actor. There are some essential negative outcomes after using clonidine for pain release, when (35%) of patients suffered from sedation orlethargy; became anxious, agitated, depressed, experienced insomnia etc. The principle of clonidine operation is thenoradrenergic basis (Miller, Miller, Jolley 2001, p. 1227).   This study revealed that clonidine reduces shivering among patients after operations and decreases pain among children (Daviss W., Patel, N., Robb, A., McDermott M., Bukstein O., Pelham Jr W., Palumbo D., Harris P. et al 2008). There is no doubt that clonidine though leading to negative outcomes, it can be saving for the patients with a chronic pain. Clonidine produces sedative functions, as a rule. The researchers claim: “The use of intravenous clonidine infusions in critically ill children has been reported as safe and efficacious without occurrence of complication or need for intervention or support due to sedation, heart rate or blood pressure changes” (Vranken, van Kan, ven der Vegt 2006, p. 298). Another modern study conducted by Hildebrand, Elsberry and Hassenbusch (2003) is devoted specifically to analgesic qualities of clonidine. They were analyzed at the spinal level through stimulation of cholinergic interneurons in the spinal cord. In spite of usage of clonidine in the form of injections, there were conflicting results in this study. Clonidine evoked the neuropathic pain relieving action of NMDA antagonist MK–801, but there were no neurotoxic side effects. With respect to the current researches and studies it was found out that the main emphasis in the modern medicine is focused on combinatory approaches to pain treatment. On the example of 25 patients, who underwent cementless total endoprosthesis replacement of a hip joint, implementation of clonidine in this treatment was used. Surgery was performed under subarachnoidanesthesia with preserved spontaneous breathing of the patients (Hildebrand, Elsberry, Hassenbusch 2004, p. 466). To study the analgesic effect hypothalamic-pitituitary suprarenal capsule condition was investigated. A subjective perception of pain was assessed by visual scale. To determine the functional condition of the cardiovascular system the factors of the central hemodynamics were investigated. In the majority of the studies it was found out that clonidine analgesia has several important advantages: non-opioid mechanism, addiction safety, a lack of respiratory depression, a slow development of tolerance to the analgesic effect (Alvarez, De Mazancourt, Chartier-Kastler, Denys 2004, p. 269). Clonidine also significantly potentiates the effect of opioid analgesia and improves tolerance against them. According to the same study more promising could be the usage of another adrenopositive medicine - guanfacine, which has exerted a less analgesic effect on blood circulation and a more prolonged analgesic effect. In the end of the study it was claimed that analgesic effect of clonidine and its structural analogs (guanfacine, lofexidine, ksilozin etc.) as opposed to opioids is associated with effective prevention of hemodynamic-related nociceptive afference and provides adequate analgesia in the clinic. Despite the long study of the serotoninergic system and its role in the pain formation and analgesic process is not defined yet (Classen, Wimbish, Kupiec 2004, p. 605). Drugs of this type are mainly used for severe neuropathic chronic pain syndromes that are resistant to opioids. Analgesic effect of clonidine and its structural analogs identified in the process of animal experiments with different methods of administration and are confirmed by clinical studies. Analgesia, which occurs under clonidine influence on the segmental level is not associated with opioidergic mechanism, but is rather formed by the activation of postsynaptic a1-adrenergic spinal cord receptors (Hollenwaeger, Borquin Challandes, Fallab, Schaad, Zelger 2009, p. 4). Analgesia is developed at suprasegment level by means of central presynaptic a2-adrenergic receptors stimulation, but at this level the interaction of adrenergic and opiat systems is revealed. This fact can be proven by antagonism of clonidine and naloxone when administered in ventricles of the brain and potentiation of the analgesic effect of opiates influencing on a medium gray matter of the brain (Godwin, Kim, Zuniga 2012, p. 952). There are the following possible techniques of anesthesia, providing different routes of administration of clonidine: 1) ataralgesia in combination with intravenous clonidine in providing surgical, gynecological and urological surgery: 2) ataralgesia combined with epidural administration of clonidine in surgical, gynecological and urological operations interventions: 3) the use of intravenous clonidine in the general anesthesia neurosurgical operations; 4) spinal anesthesia, clonidine in combination with lidocaine for urologic surgery; 5) epidural clonidine analgesia after operations on the abdominal cavity; 6) intravenous clonidine analgesia in the immediate postoperative period; 7) epidural clonidine analgesia in patients of vessels affect of lower limbs (Schmetzer 2003, p. 35). The main advantage of the suggested method of anesthesia is hemodynamic stability in phases of anesthesia, which is characterized by a lack of hypertensive reactions and tachycardia at tracheal intubation, skin incision and traumatic stages of the operation, which cannot be always reduced by means of general anesthesia, such as leptoanalgezia and ataralgesia. Therefore, this technique anesthesia, especially for patients with cardiovascular illnesses (CHD, hypertension, atherosclerotic and myocardial infarction) with respect to the fact that a lack of nociceptive changes promotes more "economical" cardiac activity, not going beyond compensatory eligible patients (Neil 2011, p. 285). In addition, the advantage of this method is the possibility of anesthesia dose reduction used for general anesthesia means, including narcotic analgesics, which promotes rapid awakening of patients, restoration of effective spontaneous breathing after surgery. Reducing of some doses of opioids on the background of nonopiatic analgesia reduces the risk of the abuse of these drugs, which is also an advantage of the proposed method of anesthesia (Oster, McKenzie, Larrivee-Elkins 2002, p. 46). There are many appropriate methods of anesthesia, but in the modern medicine scientists and doctors are looking for the most optimal ways for dealing with a chronic pain treatment among their patients (Svedberg , McKenzie, Larrivee-Elkins 2002, p. 41). Very often the methods of peridural administration of clonidine were implemented. Nevertheless, some modern researches and studies underline that this method is ineffective. This method can be widely applied for patients suffering from long-term and traumatic surgery, or patients with concomitant diseases of the cardiovascular system. Neurosurgical patients often suffer from a high blood pressure, problems with breathing and blood circulation problems, which appear in the result of some challenges of the central nervous system. Consequently, in these complicated cases it is appropriate to ensure the patients’ recovery after implementation of drugs used for brain cells protection and controlling hypotension and blood loss (Marinangeli, Ciccozzi, Donatelli, Di Pietro, Iovinelli, Rawal, Paladini, Varrassi 2002, p. 34). Clonidine can be effective with respect to these features. In the study conducted by Xu, Trissel and Pham (2002) clonidine is also positioned as appropriate medicine used for pain release after major thoracic surgery. After this type of surgery patients suffer from chronic post-thoracotomy pain. On the example of the study conducted on twenty-one patients with intractable post-thoracotomy pain, the majority of the patients confirmed a great release and they did not feel much pain in comparison with those, who did not use clonidine. Nevertheless, there were evident drawbacks after the usage of clonidine injections. The patients claim that they felt serious changes in their appetite and their sleep was disturbing. Statistic results of the study are the following: “the number of patients requiring opioid rescue medications was reduced from 61.5% to 15.3% during the 6-month duration of study. Injection caused transient hypotension in 46.2% of patients. Mild sedation was noted in 30.7% of patients receiving injection; 15.3% of the patients had localized back pain at the site of injection” (Shields, Montenegro 2007, p. 8). In this study the researchers came to the conclusion that it is relevant to apply a combinatory approach to treatment of a chronic pain. They used thoracic epidural steroid and clonidine mixture and they did not obtain any adverse effects. Nowadays, it is emphasized that clonidine provides its analgesic properties in the intraspinal administration. During the Polyanalgesic Consensus Conference (2007) clonidine was referred to as a second-line drug. When clonidine was applied in a treatment of a secondary pain after a Cesarean section, the patients felt a serious relief. On the one hand, it is possible to use clonidine as a stable analgesic drug, but there is no doubt that this drug can be used as an independent agent in chronic or secondary pain treatment. It is possible to combine this drug in combination with some other opioid analgesics. Of course, the modern researchers are focused on finding a perfectly balanced dose of clonidine administration. In another study implementation of clonidine in peri-operative period after lumbar hemilaminectomy for herniated disk repair was studied. The optimal dose was defined in the following way: clonidine showed a stable haemodynamic profile and there was a low level of sedation after 12 hours of extubation. Twenty patients were divided into 4 separate groups and the best result was obtained after implementation of the higher dose of intravenous clonidine (5 microg/kg) (Huffman 2007, p. 29). Unfortunately, in this case patients suffered from a severe hypotension and sedation was more lasting. Another study underlines that pain of the patients is warning about constant tissue damage. The researchers warn the patients that “Pain serves a vital physiological role, however, severe and uncontrolled pain in the peri-operative setting can adversely affect outcome from surgery and lead to chronic pain” (Sidhu, Kanwaldeep &Balon 2008, p. 62). Side effects of clonidine if this medicine is used systematically often prevented the scientists from appropriate usage of this medicine. Clonidine in pain management is effective for sure, as we have noticed it in previous studies, but nowadays the usage of this medicine is also recommended because of ability to provide neurohumoral response to tissue injury (Zetterqvist&Oddby 2004, p. 1293). Different origins of pain can be treated in the process of clonidine implementation. In such a way, clonidine plays a key role in anaesthetic practices and pain management. Conclusion In accordance with current researches and studies, there are many both positive and negative features of clonidine. Negative features of clonidine are the following ones: reduction in blood pressure, reduced pressure inside eye, a sedative action, a weak analgesic action, a well suited for the relief of hypertensive crisis and increase of blood pressure, which can lead to serious complications. Moreover, ingestion hypotensive effect occurs within 1-2 hours and lasts 6-8 hours. A patient should take a selected dose 2-4 times a day. There are serious complications for patients with severe atherosclerosis, especially the cerebral vessels (almost for all elder patients), patients with high risk of orthostatic effects, when a patient is rising from a horizontal position and rapidly redistributed to the depletion of the blood volume of brain vessels, then he may faint and come across cerebrovascular accidents of different degrees of severity. Therefore, intravenous administration of clonidine requires bed rest, and clonidine in the treatment of blood pressure should be measured in a lying position, and sitting. Perhaps the most serious reason, forcing doctors to consider the possibility of appointment of clonidine, is a "withdrawal" of it. This is a set of symptoms that may develop within 24-48 hours after abrupt withdrawal of clonidine. The following negative features can occur: dry mouth and nose (due to the oppression of salivary glands) constipation; sedation up to apathy, chronic fatigue, slowing of physical and psychological reactions (especially important for drivers and persons whose activities are related to the high concentration of attention). It should be mentioned that clonidine should not be prescribed for depression (depression can increase); this medicine may not be combined with alcohol uncontrolled consumption, which can lead to a collapse, consciousness disorders of varying severity leading to sodium and water retention in the body, leading to the development of drug resistance and decrease of the hypotensive effect. Moreover, it is evident that clonidine can lead to the secretion of gastric juice or reduce sexual activity among middle-aged men or reduce renal blood flow and even worsens kidney function. Many organs may suffer from the usage of clonidine, especially in the result of a systemic use of this medicine. Nevertheless, pain relief is evident among patients and post surgical pain or chronic pain can be significantly released if clonidine is implemented. Currently, the number of antihypertensive and pain sedative drugs is growing. All of them, in our view, benefit from clonidine. Paying tribute to clonidine, we strongly recommend taking control over its systemic administration. Works cited 1. Alvarez, Jean-Claude, de Mazancourt, Philippe, Chartier-Kastler, Emmanuel, Denys, Pierre. “Drug stability testing to support clinical feasibility investigations for intrathecal baclofen-clonidine admixture”. J Pain Symptom Manage 28.3 (2004): 268-272. 2. Ayad, Amany E.; El Masry, Ashraf. “Epidural Steroid and Clonidine for Chronic Intractable Post-thoracotomy Pain: A Pilot Study”. Pain Pract 12.1 (2012 Jan): 7-13. 3. 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