Innovations In Clinical Neuroscience

Pain Management August 2016

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [August 2016] 16 used determined the relation b etween ages and serum total cholesterol levels of patients, the slope and Y-intercept of the linear regression were provided. Fisher's exact test was used to determine w hether the patients with high cholesterol levels have higher possibility to require additional doses of opioids for pain management than those with low cholesterol levels. P values of Fisher's exact test were provided. *,**, and *** were used to indicate a P value lower than 0.05, 0.01, and 0.001 respectively. ADDITIONAL FILES Additional File 1. A list of current patients' information. The records of 282 patients were listed after removing primary information. ID was the reference number provided by the authors for easier accession. "Chol level" represented the serum cholesterol level measured and recorded. "Year" represented when the initial diagnosis of cancer was made. "Initial dose", "stable dose" and "converted dose" represented the initial dose opioid administration, the final dose of opioids used for analysis and the dose when converted to equivalent oxycodone hydrochloride, respectively. The "increased" column, "1" or "0" were used to represented that "stable dose" was higher than "initial dose". If the patient has one or multiple additional measurement of cholesterol during the first month after opioid administration, the cholesterol level with largest difference from initial cholesterol level was selected, recorded in "Chol level with largest difference" column, and normalized to the initial cholesterol level. (XLSX 43 kb) AUTHORS' CONTRIBUTION ZH, DZ, PYL and HHL designed, conceived, and supervised the study. HZ and PYL wrote the manuscript. Other authors collected and analyzed the data. The first three authors, ZH, LL, and LL, contributed equally to the manuscript. All authors read and approved the final manuscript. REFERENCES 1. Schug SA, Chandrasena C. Pain management of the cancer patient. Expert Opin Pharmacother. 2015;16:5–15. 2. Arslan D, Koca T, Akar E, Tural D, Ozdogan M. Cancer pain prevalence and its management. Asian Pac J Cancer Prev. 2014;15:8557–62. 3. Mercadante S. The use of opioids for treatment of cancer pain. Expert Opin Pharmacother. 2015;16:389–94. 4. Raish R, Clamon G. The drug treatment of moderate and severe pain syndromes in cancer patients. Iowa Med. 1985;75:506–11. 5. Zheng H, Pearsall EA, Hurst DP, Zhang Y, Chu J, Zhou Y, et al. Palmitoylation and membrane cholesterol stabilize mu-opioid receptor homodimerization and G protein coupling. BMC Cell Biol. 2012;13:6. 6. Zheng H, Zou H, Liu X, Chu J, Zhou Y, Loh HH, et al. Cholesterol level influences opioid signaling in cell models and analgesia in mice and humans. J Lipid Res. 2012;53:1153–62. 7. Klein G, Rossi GC, Waxman AR, Arout C, Juni A, Inturrisi CE, et al. The contribution of MOR-1 exons 1–4 to morphine and heroin analgesia and dependence. Neurosci Lett. 2009;457:115–9. 8. Rossi GC, Standifer KM, Pasternak GW. Differential blockade of morphine and morphine-6 beta- glucuronide analgesia by antisense oligodeoxynucleotides directed against MOR-1 and G-protein alpha subunits in rats. Neurosci Lett. 1995;198:99–102. 9. Zheng H, Chu J, Qiu Y, Loh HH, Law PY. Agonist-selective signaling is determined by the receptor location within the membrane domains. Proc Natl Acad Sci U S A. 2008;105:9421–6. 10. Patel HH, Murray F, Insel PA. G- protein-coupled receptor-signaling components in membrane raft and caveolae microdomains. Handb Exp Pharmacol. 2008;186:167–84. 11. Qiu Y, Wang Y, Law PY, Chen HZ, Loh HH. Cholesterol regulates micro-opioid receptor-induced beta-arrestin 2 translocation to membrane lipid rafts. Mol Pharmacol. 2011;80:210–8. 12. Zheng H, Loh HH, Law PY. Agonist-selective signaling of G protein-coupled receptor: mechanisms and implications. IUBMB Life. 2010;62:112–9. 13. Chini B, Parenti M. G-protein coupled receptors in lipid rafts and caveolae: how, when and why do they go there? J Mol Endocrinol. 2004;32:325–38. 14. Edidin M. The state of lipid rafts: from model membranes to cells. Annu Rev Biophys Biomol Struct. 2003;32:257–83. 15. Huang P, Xu W, Yoon SI, Chen C, Chong PL, Liu-Chen LY. Cholesterol reduction by methyl- beta-cyclodextrin attenuates the delta opioid receptor-mediated signaling in neuronal cells but enhances it in non-neuronal cells. Biochem Pharmacol. 2007;73:534– 49. 16. Andre A, Gaibelet G, Le Guyader L, Welby M, Lopez A, Lebrun C. Membrane partitioning of various delta-opioid receptor forms before and after agonist activations: the effect of cholesterol. Biochim Biophys Acta. 2008;1778:1483–92. 17. Huang P, Xu W, Yoon SI, Chen C, Chong PL, Unterwald EM, et al. Agonist treatment did not affect association of mu opioid receptors with lipid rafts and cholesterol reduction had opposite effects on the receptor-mediated signaling in rat brain and CHO cells. Brain Res. 2007;1184:46–56. 18. Gaibelet G, Millot C, Lebrun C, Ravault S, Sauliere A, Andre A, et al. Cholesterol content drives distinct pharmacological behaviours of micro-opioid receptor in different microdomains of the CHO plasma membrane. Mol Membr Biol. 2008;25:423–35. 19. Levitt ES, Clark MJ, Jenkins PM, Martens JR, Traynor JR. Differential effect of membrane cholesterol removal on mu- and delta-opioid receptors: a parallel

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