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Biomedical subjects

Robert L. Barkin

Publications and source records attributed to Robert L. Barkin.

6 recordsLinked to original sources
PubMed2003

Antidepressant Use in Chronic Pain Management: Is There Evidence of a Role for Duloxetine?

BACKGROUND: Duloxetine is a novel antidepressant that is anticipated to be clinically available soon. It exerts simultaneous noradrenergic and serotonergic neurotransmitter effects. Because of these influences, it is postulated to have a role in management of pain. DATA SOURCES: An Index Medicus search from 1997 to 2003 was conducted using the search terms duloxetine, Cymbalta, and pain. DATA ANALYSIS: Preclinical animal studies suggest that duloxetine may have a direct analgesic role. Premarketing studies have emphasized its utility in alleviating somatic, specifically pain, complaints among patients with major depression. CONCLUSION: Although promising, these results cannot be generalized to patients with pain disorders; the reasons for this are discussed herein. While duloxetine may be useful among somatizing depressed patients and possibly chronic pain patients with comorbid depression, its analgesic role has yet to be elucidated in future research.

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PubMed1999

A Trilogy Case Review Highlighting the Clinical and Pharmacologic Applications of Mirtazapine in Reducing Polypharmacy for Anxiety, Agitation, Insomnia, Depression, and Sexual Dysfunction.

BACKGROUND: Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), is characterized by a unique receptor-specific pharmacologic profile and tolerable side-effect profile in comparison to other antidepressants. It has been reported to have a low incidence of agitation, anxiety, and insomnia, which may be due to blockade of 5-HT(2) and 5-HT(3) receptors. This unique multireceptor-mediated clinical pharmacologic profile may reduce the need for polypharmacy in selected patients. CASE REPORTS: Three cases are presented. In case 1, mirtazapine was able to rapidly treat anxiety and agitation in a 90-year-old woman. This was confirmed with 3 consecutive challenges with mirtazapine. In case 2, both a mood disorder and insomnia were successfully treated with rapid resolution in a patient by using mirtazapine. In case 3, the patient experienced sexual dysfunction while receiving sertraline and developed insomnia with the addition of bupropion. The addition of mirtazapine and the discontinuation of sertraline and bupropion resolved the sexual dysfunction and insomnia. Polypharmacy interventions were decreased in these patients through receptor-specific events from mirtazapine. CONCLUSION: The new antidepressant mirtazapine appears to be an effective strategy for treating anxiety, agitation, and insomnia and for diminishing SSRI-related sexual dysfunction without compromising the patient's therapeutic response to the medication while decreasing the need for additional pharmacotherapies. More than 70% of patients with major depression will have anxiety symptoms. The 5-HT(2) receptor seems to play a major role in the regulation of anxiety. The anxiolytic properties of mirtazapine may be due to its antagonism of 5-HT(2) receptors and can appear as early as the first week of treatment.

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PubMed1995

Alternative Agents in Pharmacological Management of Sickle Cell Pain Crisis Complicated by Acute Pancreatitis.

Pain is a prominent presenting complaint in the vaso-occlusive crisis of sickle cell anemia and that of acute pancreatitis. The treatment of pain may extend for hours or days up to weeks for an episode. Treatment by pharmacotherapy often includes opiate/opioid analgesics, nonopiate analgesics and coanalgesics. Repeated acute painful episodes expose the patient to opiate induced effects. This case report describes a treatment option that was developed in order to provide effective analgesia while minimizing the iatrogenic effects produced by commonly used opioids. The use of partial agonists, mixed agonists, nonsteroidal anti-inflammatory agents and coanalgesics can provide objective and subjective analgesia without precipitating drug seeking behaviors or significant iatrogenic effects. Pain management in this clinical setting requires a balanced biopsychosocial approach.

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PubMed1994

A Primary Care Clinician's and Consultant's Guide to Medicating for Pain and Anxiety Associated with Outpatient Procedures.

This article offers clinical suggestions for the design of a patient-specific outpatient treatment plan for managing and reducing short-term pain associated with outpatient procedures. These procedures may actually produce pain, or they may be perceived as causing pain and anxiety. The article will also focus on the design of a patient-specific outpatient treatment plan for managing and reducing short-term procedural-induced anxiety, as perceived pain and anxiety or pain and anxiety themselves may be a reason for which patients are noncompliant with their office visits. The treatment plan will focus on pre-procedure, peri-procedure, and post-procedure interventions using nonsteroidal anti-inflammatory drugs and anxiolytics (benzodiazepines, opiate agonists, and sedative hypnotics). The plan also includes adjuvant therapy to decrease the patient's perception of pain, anxiety, fear of procedure, and fear of outcomes in order to facilitate a higher degree of compliance with office procedures. This article also accounts for the patient's physiology, pathophysiology, pathology, and iatrogenic effects from drug treatment plans.

Journal Article↗
PubMed1994

Noncardiac Chest Pain: A Focus on Psychogenic Causes.

Patients presenting with noncardiac chest pain of psychogenic origin are one of the more challenging clinical dilemmas to primary care medicine. Key aspects to recognition of these patients are predominance of autonomic complaints, multiple presentations, clustering of physical complaints and a repeated history of negative cardiac pathology, a clinical profile of anxiety or panic disorder. Therapy can be achieved by the use of benzodiazepines. Psychiatric consultation is to be sought following successful symptom abatement from a parenteral benzodiazepine challenge in the emergency department on successive occasions.

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