Open AccessEstablishment of an Individualized Chronotherapy, Autonomic Nervous System, and Variability-Based Dynamic Platform for Overcoming the Loss of Response to Analgesics
Author(s) -
Henny Azmanov,
Edgar L. Ross,
Yaron Ilan
Publication year - 2021
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2021/24/243
Subject(s) - chronotherapy (sleep phase) , medicine , chronobiology , intensive care medicine , chronic pain , autonomic nervous system , analgesic , circadian rhythm , bioinformatics , pharmacology , physical therapy , heart rate , blood pressure , biology
Background: Control of chronic pain and mainly the partial or complete loss of response toanalgesics is a major unmet need. Multiple mechanisms underline the development of tolerance toanalgesics in general and specifically to opioids. The autonomic nervous system (ANS) plays a rolein the development of analgesic tolerance and chronobiology.Objectives: To review the mechanisms associated with the development of nonresponsivenessto analgesics.Study Design: Literature review.Setting: The review is followed by a description of a new method for overcoming resistance andimproving the response to analgesics.Methods: Conducted a detailed review of the relevant studies describing the mechanisms thatunderlie tolerance to pain medications, and the potential roles of the ANS and chronobiology inthe development of drug resistance.Results: The autonomic balance is reflected by heart rate variability, an example of a fundamentalvariability that characterizes biological systems. Chronotherapy, which is based on the circadianrhythm, can improve the efficacy and reduce the toxicity of chronic medications. In this article,we present the establishment of an individualized variability- and chronobiology-based therapyfor overcoming the compensatory mechanisms associated with a loss of response to analgesics.We describe the premise of implementing personalized signatures associated with the ANS, andchronobiology, as well as with the pathophysiology of pain for establishing an adaptive model thatcould improve the efficacy of opioids, in a highly dynamic system.Limitations: The studies presented were selected based on their relevance to the subject.Conclusions: The described variability-based system may ensure prolonged effects of analgesicswhile reducing the toxicity associated with increasing dosages.Key words: Painkillers, opioids, drug resistance, compensatory mechanisms