1 6283 133 THE POTENTIAL OF A KETOGENIC DIET TO MINIMIZE EFFECTS OF THE METABOLIC FAULT IN GLYCOGEN STORAGE DISEASE V AND VII. PURPOSE OF REVIEW: TO EXPLORE THE POTENTIAL OF A LOW CARBOHYDRATE KETOGENIC DIET (LCKD) TO COUNTER PHYSICAL ACTIVITY INTOLERANCE, PAIN AND MUSCLE DAMAGE FOR GLYCOGEN STORAGE DISEASE (GSD) V AND VII, AND HIGHLIGHT THE REALISTIC POSSIBILITY THAT NUTRITION COULD BE KEY. RECENT FINDINGS: CARBOHYDRATE (CHO) INGESTION DURING PHYSICAL ACTIVITY IN GSDV AND A LCKD FOR GSDVII IS COMMON. FOR THE LATTER, A LONG-TERM STUDY DEMONSTRATED IMPROVEMENT IN PHYSIOLOGICAL MARKERS WHILE ON A LCKD. THIS INCLUDED IMPROVEMENT IN AEROBIC POWER AND ACTIVITY TOLERANCE. IN GSDV, PRELIMINARY RESEARCH ON A LCKD SUGGEST A DIET OF 75% FAT, 15% PROTEIN, 10% CHO, IS BEST FOR IMPROVED FUNCTION AND COMPLIANCE. KETONES PROVIDE IMMEDIATE FUEL FOR ACUTE PHYSICAL ACTIVITY, AND HAVE AN EPIGENETIC ROLE, IMPROVING KETONE AND LIPID USE. EVIDENCE FROM ELITE ATHLETES FOUND A LCKD CAN INCREASE FAT OXIDATION AND IS OPTIMAL AT 70% VO2MAX. THIS SUGGESTS THE NEED TO ALSO IMPROVE CONDITIONING VIA EXERCISE TO MAXIMIZE THE BENEFIT OF A LCKD. SUMMARY: A HIGH CHO DIET IN GSDV AND VII COMES WITH A RESTRICTED PHYSICAL ACTIVITY CAPACITY ALONGSIDE SIGNIFICANT PAIN, MUSCLE DAMAGE AND RISK OF RENAL FAILURE. MOUNTING EVIDENCE SUGGESTS A LCKD IS EFFICACIOUS FOR BOTH DISORDERS PROVIDING AN IMMEDIATE FUEL SOURCE WHICH MAY NEGATE THE NEED FOR A 'WARM-UP' PRIOR TO EVERY ACTIVITY AND RESTORE 'NORMAL' FUNCTION. 2020 2 4672 31 NEW INSIGHTS INTO THE MECHANISMS OF THE KETOGENIC DIET. PURPOSE OF REVIEW: HIGH-FAT, LOW-CARBOHYDRATE KETOGENIC DIETS HAVE BEEN USED FOR ALMOST A CENTURY FOR THE TREATMENT OF EPILEPSY. USED TRADITIONALLY FOR THE TREATMENT OF REFRACTORY PEDIATRIC EPILEPSIES, IN RECENT YEARS THE USE OF KETOGENIC DIETS HAS EXPERIENCED A REVIVAL TO INCLUDE THE TREATMENT OF ADULTHOOD EPILEPSIES AS WELL AS CONDITIONS RANGING FROM AUTISM TO CHRONIC PAIN AND CANCER. DESPITE THE ABILITY OF KETOGENIC DIET THERAPY TO SUPPRESS SEIZURES REFRACTORY TO ANTIEPILEPTIC DRUGS AND REPORTS OF LASTING SEIZURE FREEDOM, THE UNDERLYING MECHANISMS ARE POORLY UNDERSTOOD. THIS REVIEW EXPLORES NEW INSIGHTS INTO MECHANISMS MOBILIZED BY KETOGENIC DIET THERAPIES. RECENT FINDINGS: KETOGENIC DIETS ACT THROUGH A COMBINATION OF MECHANISMS, WHICH ARE LINKED TO THE EFFECTS OF KETONES AND GLUCOSE RESTRICTION, AND TO INTERACTIONS WITH RECEPTORS, CHANNELS, AND METABOLIC ENZYMES. DECANOIC ACID, A COMPONENT OF MEDIUM-CHAIN TRICLYCERIDES, CONTRIBUTES TO SEIZURE CONTROL THROUGH DIRECT ALPHA-AMINO-3-HYDROXY-5-METHYL-4-ISOXAZOLEPROPIONIC ACID (AMPA) RECEPTOR INHIBITION, WHEREAS DRUGS TARGETING LACTATE DEHYDROGENASE REDUCE SEIZURES THROUGH INHIBITION OF A METABOLIC PATHWAY. KETOGENIC DIET THERAPY ALSO AFFECTS DNA METHYLATION, A NOVEL EPIGENETIC MECHANISM OF THE DIET. SUMMARY: KETOGENIC DIET THERAPY COMBINES SEVERAL BENEFICIAL MECHANISMS THAT PROVIDE BROAD BENEFITS FOR THE TREATMENT OF EPILEPSY WITH THE POTENTIAL TO NOT ONLY SUPPRESS SEIZURES BUT ALSO TO MODIFY THE COURSE OF THE EPILEPSY. 2017 3 3882 27 KETONE BODIES AS METABOLITES AND SIGNALLING MOLECULES AT THE CROSSROAD BETWEEN INFLAMMATION AND EPIGENETIC CONTROL OF CARDIOMETABOLIC DISORDERS. FOR MANY YEARS, IT HAS BEEN CLEAR THAT A WESTERN DIET RICH IN SATURATED FATS AND SUGARS PROMOTES AN INFLAMMATORY ENVIRONMENT PREDISPOSING A PERSON TO CHRONIC CARDIOMETABOLIC DISEASES. IN PARALLEL, THE EMERGENCE OF KETOGENIC DIETS, DEPRIVED OF CARBOHYDRATES AND PROMOTING THE SYNTHESIS OF KETONE BODIES IMITATING THE METABOLIC EFFECTS OF FASTING, HAS BEEN SHOWN TO PROVIDE A POSSIBLE NUTRITIONAL SOLUTION TO ALLEVIATING DISEASES TRIGGERED BY AN INFLAMMATORY ENVIRONMENT. THE MAIN KETONE BODY, BETA-HYDROXYBUTYRATE (BHB), ACTS AS AN ALTERNATIVE FUEL, AND ALSO AS A SUBSTRATE FOR A NOVEL HISTONE POST-TRANSLATIONAL MODIFICATION, BETA-HYDROXYBUTYRYLATION. BETA-HYDROXYBUTYRYLATION INFLUENCES THE STATE OF CHROMATIN ARCHITECTURE AND PROMOTES THE TRANSCRIPTION OF MULTIPLE GENES. BHB HAS ALSO BEEN SHOWN TO MODULATE INFLAMMATION IN CHRONIC DISEASES. IN THIS REVIEW, WE DISCUSS, IN THE PATHOLOGICAL CONTEXT OF CARDIOVASCULAR RISKS, THE CURRENT UNDERSTANDING OF HOW KETONE BODIES, OR A KETOGENIC DIET, ARE ABLE TO MODULATE, TRIGGER, OR INHIBIT INFLAMMATION AND HOW THE EPIGENOME AND CHROMATIN REMODELING MAY BE A KEY CONTRIBUTOR. 2022 4 128 37 A UNIFYING MECHANISM OF KETOGENIC DIET ACTION: THE MULTIPLE ROLES OF NICOTINAMIDE ADENINE DINUCLEOTIDE. THE ABILITY OF A KETOGENIC DIET TO TREAT SEIZURES AND RENDER A NEURONAL NETWORK MORE RESISTANT TO STRONG ELECTRICAL ACTIVITY HAS BEEN OBSERVED FOR A CENTURY IN CLINICS AND FOR DECADES IN RESEARCH LABORATORIES. ALONGSIDE ONGOING EFFORTS TO UNDERSTAND HOW THIS THERAPY WORKS TO STOP SEIZURES, METABOLIC HEALTH IS INCREASINGLY APPRECIATED AS CRITICAL BUFFER TO RESISTING AND RECOVERING FROM ACUTE AND CHRONIC DISEASE. ACCORDINGLY, LINKS BETWEEN METABOLISM AND HEALTH, AND THE BROADER EMERGING IMPACT OF THE KETOGENIC DIET IN IMPROVING DIVERSE METABOLIC, IMMUNOLOGICAL AND NEUROLOGICAL CONDITIONS, HAVE SERVED TO INTENSIFY THE SEARCH FOR ITS KEY AND/OR COMMON MECHANISMS. HERE WE REVIEW DIVERSE EVIDENCE FOR INCREASED LEVELS OF NAD(+), AND THUS AN ALTERED RATIO OF NAD(+)/NADH, DURING METABOLIC THERAPY WITH A KETOGENIC DIET. WE PROPOSE THIS AS A POTENTIAL UNIFYING MECHANISM, AND HIGHLIGHT SOME OF THE EVIDENCE LINKING ALTERED NAD(+)/NADH WITH REDUCED SEIZURES AND WITH A RANGE OF SHORT AND LONG-TERM CHANGES ASSOCIATED WITH THE BENEFICIAL EFFECTS OF A KETOGENIC DIET. AN INCREASE IN NAD(+)/NADH IS CONSISTENT WITH MULTIPLE LINES OF EVIDENCE AND HYPOTHESES, AND THEREFORE WE SUGGEST THAT INCREASED NAD(+) MAY BE A COMMON MECHANISM UNDERLYING BENEFICIAL EFFECTS OF KETOGENIC DIET THERAPY. 2020 5 2616 29 EPIGENOME MODULATION INDUCED BY KETOGENIC DIETS. KETOGENIC DIETS (KD) ARE DIETARY STRATEGIES LOW IN CARBOHYDRATES, NORMAL IN PROTEIN, AND HIGH, NORMAL, OR REDUCED IN FAT WITH OR WITHOUT (VERY LOW-CALORIES KETOGENIC DIET, VLCKD) A REDUCED CALORIC INTAKE. KDS HAVE BEEN SHOWN TO BE USEFUL IN THE TREATMENT OF OBESITY, METABOLIC DISEASES AND RELATED DISORDERS, NEUROLOGICAL DISEASES, AND VARIOUS PATHOLOGICAL CONDITIONS SUCH AS CANCER, NONALCOHOLIC LIVER DISEASE, AND CHRONIC PAIN. SEVERAL STUDIES HAVE INVESTIGATED THE INTRACELLULAR METABOLIC PATHWAYS THAT CONTRIBUTE TO THE BENEFICIAL EFFECTS OF THESE DIETS. ALTHOUGH EPIGENETIC CHANGES ARE AMONG THE MOST IMPORTANT DETERMINANTS OF AN ORGANISM'S ABILITY TO ADAPT TO ENVIRONMENTAL CHANGES, DATA ON THE EPIGENETIC CHANGES ASSOCIATED WITH THESE DIETARY PATHWAYS ARE STILL LIMITED. THIS REVIEW PROVIDES AN OVERVIEW OF THE MAJOR EPIGENETIC CHANGES ASSOCIATED WITH KDS. 2022 6 486 33 ASENAPINE TRANSDERMAL PATCH FOR THE MANAGEMENT OF SCHIZOPHRENIA. PURPOSE OF REVIEW: THIS IS A COMPREHENSIVE REVIEW OF THE LITERATURE REGARDING THE USE OF ASENAPINE FOR THE TREATMENT OF SCHIZOPHRENIA (SZ) IN ADULTS. IT COVERS AN INTRODUCTION, EPIDEMIOLOGY, RISK FACTORS, PATHOPHYSIOLOGY, AND CURRENT TREATMENT MODALITIES REGARDING SZ, PROVIDES A BACKGROUND ON THE MECHANISM OF ACTION OF ASENAPINE, AND THEN REVIEWS THE EXISTING EVIDENCE FOR USE OF ASENAPINE IN BOTH ITS SUBLINGUAL AND TRANSDERMAL FORMULATION IN THE TREATMENT OF SZ. RECENT FINDINGS: SZ IS A COMPLEX AND MULTIFACTORIAL MENTAL DISORDER WHICH IS THOUGHT TO COMBINE SEVERAL GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS CAUSING ABNORMALITIES IN THE DOPAMINERGIC SYSTEM. SYMPTOMS ARE CATEGORIZED IN DELUSIONS, HALLUCINATIONS, DISORGANIZATION, AND NEGATIVE PRESENTATIONS LIKE AFFECTIVE FLATTENING AND APATHY. CURRENT TREATMENT FOCUSES ON ANTIPSYCHOTIC MEDICATIONS BY MEANS OF ORAL ADMINISTRATION OR LONG-ACTING INJECTION. ASENAPINE IS A SECOND-GENERATION ANTIPSYCHOTIC WITH 5HT-2A ANTAGONIST AND 5HT-1A/1B PARTIAL AGONIST PROPERTIES, WHICH PROVIDES A FAVORABLE PROFILE IN TARGETING SCHIZOPHRENIC SYMPTOMS, WHILE REDUCING MOTOR SIDE EFFECTS AND IMPROVING MOOD AND COGNITION. ASENAPINE IN ITS SUBLINGUAL FORMULATION WAS FDA APPROVED FOR TREATMENT OF SZ AND BIPOLAR I DISORDER IN ADULTS IN AUGUST OF 2009 AND HAS BEEN PROVEN TO BE BOTH EFFECTIVE AND SAFE. TRANSDERMAL PATCH OF ASENAPINE (SECUADO) WAS FDA APPROVED IN OCTOBER OF 2019, THE FIRST AND ONLY FDA APPROVED PATCH FOR SZ IN ADULTS, WHICH OFFERS ANOTHER STRATEGY FOR TREATMENT TO IMPROVE COMPLIANCE AND EASE OF ADMINISTRATION. SUMMARY: SZ IS A CHRONIC AND DEBILITATING DISEASE WHICH IS STILL NOT WELL UNDERSTOOD AND COMES AT GREAT COST WITH REGARDS TO THE QUALITY OF LIFE FOR PATIENTS. MEDICATION SIDE-EFFECTS AND COMPLIANCE ARE ENORMOUS ISSUES WHICH TAKE A TOLL ON HEALTH CARE SYSTEMS IN INDUSTRIALIZED NATIONS AND KEEP PATIENTS FROM ACHIEVING STABILITY WITH THEIR DISEASE. TRANSDERMAL ASENAPINE IS A NEW FIRST-IN-CLASS DOSAGE FORM AND PROVIDES A NOVEL MODALITY OF ADMINISTRATION. IT HAS BEEN SHOWN TO BE EFFECTIVE IN REDUCING POSITIVE, AS WELL AS NEGATIVE SYMPTOMS, WHILE STILL MAINTAINING A FAVORABLE SIDE-EFFECT PROFILE. 2020 7 6577 21 TREATMENT STRATEGIES FOR COMPLEX BEHAVIORAL INSOMNIA IN CHILDREN WITH NEURODEVELOPMENTAL DISORDERS. PURPOSE OF REVIEW: THIS REVIEW DESCRIBES RECENT RESEARCH IN PEDIATRIC BEHAVIORAL INSOMNIAS IN NEURODEVELOPMENTAL DISORDERS AND THEIR TREATMENT. RECENT FINDINGS: INSOMNIA IN CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD) AND OTHER NEURODEVELOPMENTAL DISORDERS (NDDS) IS TYPICALLY COMPLEX, CHRONIC, AND DIFFICULT TO ADEQUATELY CONTROL. ABNORMALITIES IN GENETIC AND/OR EPIGENETIC REGULATION OF SLEEP/WAKEFULNESS AND ITS TIMING PREDISPOSE PATIENTS WITH NDD TO INSOMNIA, ALTHOUGH POOR SLEEP HYGIENE, MALADAPTIVE ASSOCIATIONS, AND LIMIT-SETTING ARE LIKELY TO CONTRIBUTE. PARENTS ARE AGENTS FOR CHANGE IN PROBLEMATIC SLEEP BEHAVIORS IN PATIENTS WITH NDD. WE REVIEW THE BENEFITS OF BEHAVIORAL THERAPIES AND MELATONIN TO TREAT SLEEP PROBLEMS IN CHILDREN WITH NDD. PROBLEMATIC SLEEP IS SO PREVALENT IN SOME NEURODEVELOPMENTAL SYNDROMES (RETT, ANGELMAN, WILLIAMS, AND SMITH-MAGENIS) THAT IT IS PART OF THEIR DIAGNOSTIC CRITERIA. SUMMARY: CHILDREN AND ADOLESCENTS WITH NEUROLOGICAL DISORDERS FREQUENTLY HAVE COMPLEX SLEEP DISORDERS THAT REQUIRE TREATMENT. UNDERSTANDING THE BASIC PATHOLOGY AND TREATMENT STRATEGIES PROVIDES AN OPPORTUNITY TO IMPROVE WELL BEING AND QUALITY OF LIFE IN THOSE AFFECTED BY NDD AND THEIR FAMILIES. 2013 8 4418 26 MOLECULAR AND EPIGENETIC ASPECTS OF OPIOID RECEPTORS IN DRUG ADDICTION AND PAIN MANAGEMENT IN SPORT. OPIOIDS ARE SUBSTANCES DERIVED FROM OPIUM (NATURAL OPIOIDS). IN ITS RAW STATE, OPIUM IS A GUMMY LATEX EXTRACTED FROM PAPAVER SOMNIFERUM. THE USE OF OPIOIDS AND THEIR NEGATIVE HEALTH CONSEQUENCES AMONG PEOPLE WHO USE DRUGS HAVE BEEN STUDIED. TODAY, OPIOIDS ARE STILL THE MOST COMMONLY USED AND EFFECTIVE ANALGESIC TREATMENTS FOR SEVERE PAIN, BUT THEIR USE AND ABUSE CAUSES DETRIMENTAL SIDE EFFECTS FOR HEALTH, INCLUDING ADDICTION, THUS IMPACTING THE USER'S QUALITY OF LIFE AND CAUSING OVERDOSE. THE MESOCORTICOLIMBIC DOPAMINERGIC CIRCUITRY REPRESENTS THE BRAIN CIRCUIT MEDIATING BOTH NATURAL REWARDS AND THE REWARDING ASPECTS OF NEARLY ALL DRUGS OF ABUSE, INCLUDING OPIOIDS. HENCE, UNDERSTANDING HOW OPIOIDS AFFECT THE FUNCTION OF DOPAMINERGIC CIRCUITRY MAY BE USEFUL FOR BETTER KNOWLEDGE OF THE PROCESS AND TO DEVELOP EFFECTIVE THERAPEUTIC STRATEGIES IN ADDICTION. THE AIM OF THIS REVIEW WAS TO SUMMARIZE THE MAIN FEATURES OF OPIOIDS AND OPIOID RECEPTORS AND FOCUS ON THE MOLECULAR AND UPCOMING EPIGENETIC MECHANISMS LEADING TO OPIOID ADDICTION. SINCE SYNTHETIC OPIOIDS CAN BE EFFECTIVE FOR PAIN MANAGEMENT, THEIR ABILITY TO INDUCE ADDICTION IN ATHLETES, WITH THE RISK OF INCURRING DOPING, IS ALSO DISCUSSED. 2023 9 440 20 ANTIOXIDATIVE EFFECTS OF RHODIOLA GENUS: PHYTOCHEMISTRY AND PHARMACOLOGICAL MECHANISMS AGAINST THE DISEASES. RHODIOLA AS ONE OF TRADITIONAL MEDICINES HAS BEEN USED FOR CLINICAL TREATMENTS DUE TO ITS STRONG ANTIOXIDANT PROPERTIES. PHYTOCHEMICAL ANALYSIS REVEALED THE PRESENCE OF FLAVONOIDS, PHENYLPROPANOIDS, PHENYLETHANOL/BENZYL ALCOHOL DERIVATIVES, CYANOGENIC GLYCOSIDES AND TERPENOIDS. THE BIOACTIVE COMPOUNDS HAD BEEN DEMONSTRATED TO BE EFFECTIVE AT SCAVENGING REACTIVE OXYGEN SPECIES (ROS). THE STRUCTURES CONTAIN PHENOLIC HYDROXYL GROUPS AND UNSATURATED BONDS. THIS ARTICLE REVIEWS ANTIOXIDANT CAPACITIES OF THE EXTRACTS AND BIOACTIVE COMPONENTS DERIVED FROM RHODIOLA PLANTS. AS THE MAJOR PHARMACOLOGICAL INGREDIENT, SALIDROSIDE IS RIGOROUSLY INVESTIGATED AND USED IN SCIENTIFIC RESEARCHES AND CLINICAL PRACTICES. ACCUMULATED EVIDENCES INDICATED THAT EXTRACTS OF RHODIOLA PLANTS OR SALIDROSIDE COULD BE ABLE TO REVERSE DNA DAMAGE AND ALTER EXPRESSION OF CYTOKINES AND ANTIOXIDATIVE ENZYMES INDUCED BY ROS. THE UNDERLYING MECHANISMS FOR THE ANTIOXIDATIVE EFFECTS OF THE HERB HAVE BEEN INVESTIGATED IN THE LAST TWO DECADES. WE SUMMARIZE THE POSSIBLE EFFECTS AND ACTING PATHWAYS FOR THE HERB INVOLVED IN SEVERAL CHRONIC DISEASES IN CARDIOVASCULAR, RESPIRATORY, AND NERVOUS SYSTEMS, AS WELL AS POTENTIAL EPIGENETIC INFLUENCES. THE INFORMATION GENERATED FROM EXPERIMENTAL AND CLINICAL STUDIES OFFERED VALUABLE INSIGHTS FOR FURTHER INVESTIGATIONS OF MEDICAL POTENTIALS OF RHODIOLA PLANTS. 2017 10 4847 30 OPIOID DEPENDENCE AND PREGNANCY: MINIMIZING STRESS ON THE FETAL BRAIN. INCREASE IN THE NUMBER OF OPIOID-DEPENDENT PREGNANT WOMEN DELIVERING BABIES AT RISK FOR NEONATAL ABSTINENCE SYNDROME PROMPTED A US GOVERNMENT ACCOUNTABILITY OFFICE REPORT DOCUMENTING DEFICITS IN RESEARCH AND PROVIDER KNOWLEDGE ABOUT CARE OF THE MATERNAL/FETAL UNIT AND THE NEONATE. THERE ARE 3 GENERAL SOURCES OF DEPENDENCE: UNTREATED OPIOID USE DISORDER, PAIN MANAGEMENT, AND MEDICATION-ASSISTED TREATMENT WITH METHADONE OR BUPRENORPHINE. A SURVEY OF METHADONE PATIENTS' EXPERIENCES WHEN TELLING A PHYSICIAN OF THEIR PREGNANCY AND OPIOID DEPENDENCE DEMONSTRATED PHYSICIAN CONFUSION ABOUT PROPER CARE, FREQUENT NEGATIVE INTERACTIONS WITH THE MOTHER, AND FAILURES TO PROVIDE APPROPRIATE REFERRAL. PATIENTS IN PAIN MANAGEMENT WERE DISCHARGED WITHOUT REFERRAL WHEN THE PHYSICIAN WAS TOLD OF THE PREGNANCY. METHADONE AND BUPRENORPHINE WERE FREQUENTLY SEEN NEGATIVELY BECAUSE THEY "CAUSED" NEONATAL ABSTINENCE SYNDROME. MOST MOTHERS SURVEYED HAD TO FIND OPIOID TREATMENT ON THEIR OWN. HOW DEPENDENCE IS MANAGED MEDICALLY IS A CRITICAL DETERMINANT OF THE LEVEL OF STRESS ON BOTH MOTHER AND FETUS, AND THEREFORE ANOTHER DETERMINANT OF NEONATAL HEALTH. THE EFFECTS OF BOTH OPIOID WITHDRAWAL STRESS AND MATERNAL EMOTIONAL STRESS ON NEONATAL AND DEVELOPMENTAL OUTCOMES ARE REVIEWED. CURRENTLY, THERE HAVE BEEN EFFORTS TO CRIMINALIZE MATERNAL OPIOID DEPENDENCE AND TO ENCOURAGE OR COERCE PREGNANT WOMEN TO UNDERGO WITHDRAWAL. THIS PRACTICE POSES BOTH ACUTE RISKS OF FETAL HYPOXIA AND LONG-TERM RISKS OF ADVERSE EPIGENETIC PROGRAMMING RELATED TO CATECHOLAMINE AND CORTICOSTEROID SURGES DURING WITHDRAWAL. CONTEMPORARY STUDIES OF THE EFFECTS OF WITHDRAWAL STRESS ON THE DEVELOPING FETAL BRAIN ARE URGENTLY NEEDED TO ELUCIDATE AND QUANTIFY THE RISKS OF SUCH PRACTICES. AT BIRTH, INCONSISTENCIES IN THE HOSPITAL MANAGEMENT OF NEONATES AT RISK FOR NEONATAL ABSTINENCE SYNDROME HAVE BEEN OBSERVED. NEGLECT OF THE CRITICAL ROLE OF MATERNAL COMFORTING IN NEONATAL ABSTINENCE SYNDROME MANAGEMENT IS AN IATROGENIC AND PREVENTABLE CAUSE OF POOR OUTCOMES AND LONG HOSPITALIZATIONS. ROOMING-IN ALLOWS FOR CONTINUOUS CARE OF THE BABY AND MATERNAL/NEONATAL ATTACHMENT, OFTEN UNWITTINGLY DISRUPTED BY THE NEONATAL INTENSIVE CARE UNIT ENVIRONMENT. RECOMMENDATIONS ARE MADE FOR FURTHER RESEARCH INTO PHYSICIAN/PATIENT INTERACTIONS AND INTO OPTIMAL DOSING OF METHADONE AND BUPRENORPHINE TO MINIMIZE MATERNAL/FETAL WITHDRAWAL. 2017 11 1683 19 DRUG-RESISTANT EPILEPSY: DRUG TARGET HYPOTHESIS AND BEYOND THE RECEPTORS. EPILEPSY IS A CHRONIC NEUROLOGICAL DISORDER THAT AFFECTS MORE THAN 50 MILLION PEOPLE WORLDWIDE. DESPITE A RECENT INTRODUCTION OF ANTISEIZURE DRUGS FOR THE TREATMENT OF EPILEPTIC SEIZURES, ONE-THIRD OF THESE PATIENTS SUFFER FROM DRUG-RESISTANT EPILEPSY (DRE). THE THERAPEUTIC TARGET HYPOTHESIS IS A CITED THEORY TO EXPLAIN DRE. ACCORDING TO THE TARGET HYPOTHESIS, THE FAILURE TO ACHIEVE SEIZURE FREEDOM LEADS TO ALTERATION OF THE STRUCTURE AND/OR FUNCTION OF THE ANTISEIZURE MEDICATION (ASM) TARGET. HOWEVER, THIS HYPOTHESIS FAILS TO EXPLAIN WHY PATIENTS WITH DRE DO NOT RESPOND TO ANTISEIZURE MEDICATIONS OF DIFFERENT TARGETS. THIS REVIEW PRESENTS DIFFERENT CONDITIONS, SUCH AS EPIGENETIC MECHANISMS AND PROTEIN-PROTEIN INTERACTIONS THAT MAY RESULT IN ALTERATIONS OF DIVERSE DRUG TARGETS USING DIFFERENT MECHANISMS. THESE NOVEL CONDITIONS REPRESENT NEW TARGETS TO CONTROL DRE. 2022 12 4855 29 OPTIMIZE DIETARY INTAKE OF VITAMIN D: AN EPIGENETIC PERSPECTIVE. PURPOSE OF REVIEW: VITAMIN D HAS RECEIVED GLOBAL ATTENTION BECAUSE OF ITS MANY HEALTH BENEFITS. ALTHOUGH THERE IS GENERAL AGREEMENT ABOUT THE IMPORTANCE OF VITAMIN D FOR BONE HEALTH, THERE REMAINS SKEPTICISM ABOUT THE NONSKELETAL HEALTH BENEFITS OF VITAMIN D. THIS REVIEW WILL NOT ONLY FOCUS ON THE VITAMIN D DEFICIENCY PANDEMIC AND WAYS TO TREAT AND PREVENT VITAMIN D DEFICIENCY BUT WILL ALSO EXPLORE THE EPIGENETIC MECHANISMS OF VITAMIN D THAT COULD HELP EXPLAIN MANY OF THE NONSKELETAL BENEFITS OF ENHANCING VITAMIN D STATUS. RECENT FINDINGS: THE INSTITUTE OF MEDICINE AND THE ENDOCRINE SOCIETY HAVE MADE NEW RECOMMENDATIONS FOR VITAMIN D INTAKE TO PREVENT VITAMIN D DEFICIENCY. VITAMIN D DEFICIENCY IS DEFINED AS A 25-HYDROXYVITAMIN D LEVEL BELOW 20 NG/ML AND VITAMIN D INSUFFICIENCY IS DEFINED AS 21-29 NG/ML. RECENT OBSERVATIONS HAVE SUGGESTED THAT VITAMIN D CAN INFLUENCE EPIGENETICS WHICH MAY HELP EXPLAIN THE NONSKELETAL HEALTH BENEFITS THAT HAVE BEEN REPORTED FOR VITAMIN D. SUMMARY: THERE IS GENERAL AGREEMENT THAT VITAMIN D DEFICIENCY IS A WORLDWIDE HEALTH PROBLEM. THIS IS DUE IN PART TO THE LACK OF APPRECIATION THAT SUNLIGHT IS AN IMPORTANT SOURCE OF VITAMIN D. THERE IS NO DOWNSIDE TO INCREASING VITAMIN D INTAKE AND RECENT OBSERVATIONS SUGGESTING THAT VITAMIN D INFLUENCES EPIGENETICS PROVIDE A NEW INSIGHT FOR THE IMPORTANCE OF VITAMIN D IN UTERO IN REDUCING RISK OF CHRONIC DISEASES LATER IN LIFE. 2012 13 2841 28 FREQUENCY OF THE DOPAMINE RECEPTOR D3 (RS6280) VS. OPIOID RECEPTOR MICRO1 (RS1799971) POLYMORPHIC RISK ALLELES IN PATIENTS WITH OPIOID USE DISORDER: A PREPONDERANCE OF DOPAMINERGIC MECHANISMS? WHILE OPIOIDS ARE A POWERFUL CLASS OF DRUGS THAT INHIBIT TRANSMISSION OF PAIN SIGNALS, THEIR USE IS TARNISHED BY THE CURRENT EPIDEMIC OF OPIOID USE DISORDER (OUD) AND OVERDOSE DEATHS. NOTWITHSTANDING PUBLISHED REPORTS, THERE REMAIN GAPS IN OUR KNOWLEDGE OF OPIOID RECEPTOR MECHANISMS AND THEIR ROLE IN OPIOID SEEKING BEHAVIOR. THUS, NOVEL INSIGHTS INTO MOLECULAR, NEUROGENETIC AND NEUROPHARMACOLOGICAL BASES OF OUD ARE NEEDED. WE PROPOSE THAT AN ADDICTIVE ENDOPHENOTYPE MAY NOT BE ENTIRELY SPECIFIC TO THE DRUG OF CHOICE BUT RATHER MAY BE GENERALIZABLE TO ALTERED BRAIN REWARD CIRCUITS IMPACTING NET MESOCORTICOLIMBIC DOPAMINE RELEASE. WE SUGGEST THAT GENETIC OR EPIGENETIC ALTERATIONS ACROSS DOPAMINERGIC REWARD SYSTEMS LEAD TO UNCONTROLLABLE SELF-ADMINISTRATION OF OPIOIDS AND OTHER DRUGS. FOR INSTANCE, DIMINISHED AVAILABILITY VIA KNOCKOUT OF DOPAMINE D3 RECEPTOR (DRD3) INCREASES VULNERABILITY TO OPIOIDS. BUILDING UPON THIS CONCEPT VIA THE USE OF A SOPHISTICATED POLYMORPHIC RISK ANALYSIS IN A HUMAN COHORT OF CHRONIC OPIOID USERS, WE FOUND EVIDENCE FOR A HIGHER FREQUENCY OF POLYMORPHIC DRD3 RISK ALLELE (RS6280) THAN OPIOID RECEPTOR MICRO1 (RS1799971). IN CONCLUSION, WHILE OPIOIDERGIC MECHANISMS ARE INVOLVED IN OUD, DOPAMINE-RELATED RECEPTORS MAY HAVE PRIMARY INFLUENCE ON OPIOID-SEEKING BEHAVIOR IN AFRICAN AMERICANS. THESE FINDINGS SUGGEST OUD-TARGETED NOVEL AND IMPROVED NEUROPHARMACOLOGICAL THERAPIES MAY REQUIRE FOCUS ON DRD3-MEDIATED REGULATION OF DOPAMINERGIC HOMEOSTASIS. 2022 14 747 26 CANNABIS-INDUCED HYPODOPAMINERGIC ANHEDONIA AND COGNITIVE DECLINE IN HUMANS: EMBRACING PUTATIVE INDUCTION OF DOPAMINE HOMEOSTASIS. OVER YEARS, THE REGULAR USE OF CANNABIS HAS SUBSTANTIALLY INCREASED AMONG YOUNG ADULTS, AS INDICATED BY THE RISE IN CANNABIS USE DISORDER (CUD), WITH AN ESTIMATED PREVALENCE OF 8. 3% IN THE UNITED STATES. RESEARCH SHOWS THAT EXPOSURE TO CANNABIS IS ASSOCIATED WITH HYPODOPAMINERGIC ANHEDONIA (DEPRESSION), COGNITIVE DECLINE, POOR MEMORY, INATTENTION, IMPAIRED LEARNING PERFORMANCE, REDUCED DOPAMINE BRAIN RESPONSE-ASSOCIATED EMOTIONALITY, AND INCREASED ADDICTION SEVERITY IN YOUNG ADULTS. THE ADDICTION MEDICINE COMMUNITY IS INCREASING CONCERN BECAUSE OF THE HIGH CONTENT OF DELTA-9-TETRAHYDROCANNABINOL (THC) CURRENTLY FOUND IN ORAL AND VAPING CANNABIS PRODUCTS, THE COGNITIVE EFFECTS OF CANNABIS MAY BECOME MORE PRONOUNCED IN YOUNG ADULTS WHO USE THESE CANNABIS PRODUCTS. PRELIMINARY RESEARCH SUGGESTS THAT IT IS POSSIBLE TO INDUCE 'DOPAMINE HOMEOSTASIS,' THAT IS, RESTORE DOPAMINE FUNCTION WITH DOPAMINE UPREGULATION WITH THE PROPOSED COMPOUND AND NORMALIZE BEHAVIOR IN CHRONIC CANNABIS USERS WITH CANNABIS-INDUCED HYPODOPAMINERGIC ANHEDONIA (DEPRESSION) AND COGNITIVE DECLINE. THIS PSYCHOLOGICAL, NEUROBIOLOGICAL, ANATOMICAL, GENETIC, AND EPIGENETIC RESEARCH ALSO COULD PROVIDE EVIDENCE TO USE FOR THE DEVELOPMENT OF AN APPROPRIATE POLICY REGARDING THE DECRIMINALIZATION OF CANNABIS FOR RECREATIONAL USE. 2021 15 265 42 ADVERSE EFFECTS OF RECREATIONAL AND MEDICAL CANNABIS. PURPOSE OF REVIEW: THIS COMPREHENSIVE REVIEW DISCUSSES THE ADVERSE EFFECTS KNOWN TODAY ABOUT MARIJUANA, FOR EITHER MEDICAL OR RECREATIONAL USE. IT REVIEWS THE ROLE OF CANNABIS IN THE TREATMENT OF CHRONIC PAIN, COGNITIVE AND NEUROLOGICAL ADVERSE EFFECTS, SPECIAL CASES AND ADDICTION. RECENT FINDINGS: CANNABINOIDS WORK THROUGH THE ENDOCANNABINOIDS SYSTEM AND INHIBIT THE RELEASE OF GABA AND GLUTAMATE IN THE BRAIN, IMPACT NEUROMODULATION, AS WELL AS DOPAMINE, ACETYLCHOLINE AND NOREPINEPHRINE RELEASE. THEY AFFECT REWARD, LEARNING AND PAIN. THE USE OF CANNABIS IS INCREASING NATIONALLY AND WORLD-WIDE FOR BOTH RECREATIONAL AND MEDICINAL PURPOSES, HOWEVER, THERE IS RELATIVELY ONLY LOW QUALITY EVIDENCE TO THE EFFICACY AND ADVERSE EFFECTS OF THIS. CANNABIS AND ITS DERIVATIVES MAY BE USED FOR TREATMENT OF CHRONIC PAIN. THEY ARE VIA CB1 RECEPTORS THAT ARE THOUGHT TO MODULATE NOCICEPTIVE SIGNALS IN THE BRAIN. CB2 RECEPTORS IN THE DRG LIKELY AFFECT PAIN INTEGRATION IN THE AFFERENT PATHWAYS, AND PERIPHERALLY CB2 ALSO AFFECTS NORADRENERGIC PATHWAYS INFLUENCING PAIN. A LARGE PROPORTION OF USERS MAY SEE MORE THAN 50% OF CHRONIC PAIN ALLEVIATION COMPARED WITH PLACEBO. CANNABIS AFFECTS COGNITION, MOST NOTABLY EXECUTIVE FUNCTION, MEMORY AND ATTENTION, AND MAY DETERIORATE THE BOUNDARY BETWEEN EMOTIONAL AND EXECUTIVE PROCESSING. CANNABIS IMPAIRS MEMORY IN THE SHORT RUN, WHICH BECOME MORE SIGNIFICANT WITH CHRONIC USE, AND MAY ALSO BE ACCOMPANIED BY POORER EFFORT, SLOWER PROCESSING AND IMPACTED ATTENTION. IT IS GENERALLY BELIEVED THAT LONG-TERM USE AND EARLIER AGE ARE RISK FACTOR FOR NEUROCOGNITIVE DEFICITS; NEUROIMAGING STUDIES HAVE SHOWN REDUCED HIPPOCAMPAL VOLUME AND DENSITY. EXECUTIVE FUNCTIONS AND MEMORY ARE WORSE IN ADOLESCENT USERS VERSUS ADULTS. CANNABIS ADDICTION IS DIFFERENT AND LIKELY LESS COMMON THAN OTHER ADDICTIVE SUBSTANCES, BUT UP TO 10% OF USERS MEET CRITERIA FOR LIFETIME CANNABIS DEPENDENCE. ADDICTION PATTERNS MAY BE LINKED TO GENETIC AND EPIGENETIC DIFFERENCES. IT IS STILL UNCLEAR WHETHER ABSTINENCE REVERSES PATTERNS OF ADDICTION, AND MORE RESEARCH IS REQUIRED INTO THIS TOPIC. SUMMARY: CANNABIS USE HAS BECOME MORE ABUNDANT FOR BOTH MEDICAL AND RECREATIONAL USE. IT CARRIES LIKELY BENEFITS IN THE FORM OF ANALGESIA, ANTI-EMESIS AND IMPROVED APPETITE IN CHRONIC PATIENTS. THE EVIDENCE REVIEWING ADVERSE EFFECTS OF THIS USE ARE STILL LIMITED, HOWEVER, EXITING DATA POINTS TO A CLEAR LINK WITH NEUROCOGNITIVE DETERIORATION, BACKED BY LOSS OF BRAIN VOLUME AND DENSITY. ADDICTION IS LIKELY COMPLEX AND VARIABLE, AND NO GOOD DATA EXISTS TO SUPPORT TREATMENT AT THIS POINT. IT IS BECOMING CLEAR THAT USE IN EARLIER AGES CARRIES A HIGHER RISK FOR LONG-TERM DEFICITS. AS WITH ANY OTHER DRUG, THESE RISKS SHOULD BE CONSIDERED ALONGSIDE BENEFITS PRIOR TO A DECISION ON CANNABIS USE. 2021 16 5518 31 RISK FACTORS AND FUTURE DIRECTIONS FOR PREVENTING AND DIAGNOSING EXERTIONAL RHABDOMYOLYSIS. EXERTIONAL RHABDOMYOLYSIS MAY OCCUR WHEN AN INDIVIDUAL IS SUBJECTED TO STRENUOUS PHYSICAL EXERCISE. IT IS OCCASIONALLY ASSOCIATED WITH MYOGLOBINURIA (I.E. "COLA-COLORED" URINE) ALONGSIDE MUSCLE PAIN AND WEAKNESS. THE PATHOPHYSIOLOGY OF EXERTIONAL RHABDOMYOLYSIS INVOLVES STRIATED MUSCLE DAMAGE AND THE RELEASE OF CELLULAR COMPONENTS INTO EXTRACELLULAR FLUID AND BLOODSTREAM. THIS CAN CAUSE ACUTE RENAL FAILURE, ELECTROLYTE ABNORMALITIES, ARRHYTHMIAS AND POTENTIALLY DEATH. EXERTIONAL RHABDOMYOLYSIS IS OBSERVED IN HIGH-PERFORMANCE ATHLETES WHO ARE SUBJECTED TO INTENSE, REPETITIVE AND/OR PROLONGED EXERCISE BUT IS ALSO OBSERVED IN UNTRAINED INDIVIDUALS AND HIGHLY TRAINED OR ELITE GROUPS OF MILITARY PERSONNEL. SEVERAL RISK FACTORS HAVE BEEN REPORTED TO INCREASE THE LIKELIHOOD OF THE CONDITION IN ATHLETES, INCLUDING: VIRAL INFECTION, DRUG AND ALCOHOL ABUSE, EXERCISE IN INTENSELY HOT AND HUMID ENVIRONMENTS, GENETIC POLYMORPHISMS (E.G. SICKLE CELL TRAIT AND MCARDLE DISEASE) AND EPIGENETIC MODIFICATIONS. THIS ARTICLE REVIEWS SEVERAL OF THESE RISK FACTORS AND PROPOSES SCREENING PROTOCOLS TO IDENTIFY INDIVIDUAL SUSCEPTIBILITY TO EXERTIONAL RHABDOMYOLYSIS AS WELL AS THE RELEVANCE OF PROTEOMICS FOR THE EVALUATION OF POTENTIAL BIOMARKERS OF MUSCLE DAMAGE. 2021 17 1881 18 EMERGING TREATMENTS FOR NEUROPATHIC PAIN. NEUROPATHIC PAIN IS A SERIES OF WELL-KNOWN CONDITIONS CAUSED BY DISEASES OR LESIONS TO THE SOMATOSENSORY SYSTEM. DUE TO THE BETTER UNDERSTANDING OF THE PATHOPHYSIOLOGY OF NEUROPATHIC PAIN, PREVIOUSLY UNEXPLORED THERAPIES HAVE BEEN USED WITH ENCOURAGING RESULTS. AS SUCH, ACETYL-L-CARNITINE (ALC), ALPHA-LIPOIC-ACID (ALA), CANNABINOIDS, CLONIDINE, EMA401, BOTULINUM TOXIN TYPE A, AND NEW VOLTAGE-GATED SODIUM CHANNEL BLOCKERS, CAN BE CITED. FURTHERMORE, NEW MODALITIES IN NEUROMODULATION SUCH AS HIGH-FREQUENCY SPINAL CORD STIMULATION, BURST STIMULATION, DORSAL ROOT GANGLION STIMULATION, TRANSCRANIAL DIRECT CURRENT STIMULATION, AND MANY OTHERS HAVE BEEN SHOWING EXCITING RESULTS. BESIDES, CHANGING PARADIGMS MAY OCCUR WITH THE ADVENT OF OPTOGENETICS AND A BETTER UNDERSTANDING OF EPIGENETIC REGULATION. THIS ARTICLE REVIEWS THE PUBLISHED LITERATURE ON THE TREATMENT OF NP. DESPITE THE INTERESTING RESULTS, RANDOMIZED CONTROLLED TRIALS ARE DEMANDED FOR THE MAJORITY OF THE THERAPIES PREVIOUSLY MENTIONED. 2015 18 3407 33 HOW WELL DO WE UNDERSTAND THE LONG-TERM HEALTH IMPLICATIONS OF CHILDHOOD BULLYING? ONCE DISMISSED AS AN INNOCUOUS EXPERIENCE OF CHILDHOOD, BULLYING IS NOW RECOGNIZED AS HAVING SIGNIFICANT PSYCHOLOGICAL EFFECTS, PARTICULARLY WITH CHRONIC EXPOSURE. VICTIMS OF BULLYING ARE AT RISK FOR A NUMBER OF PSYCHIATRIC DISTURBANCES, AND GROWING EVIDENCE SUGGESTS THAT THE PATHOPHYSIOLOGICAL EFFECTS OF BULLYING, AS WITH OTHER FORMS OF TRAUMA AND CHRONIC STRESS, CREATE ADDITIONAL HEALTH RISKS. WE REVIEW THE LITERATURE ON THE KNOWN SEQUELAE OF BULLYING, INCLUDING PSYCHIATRIC AND PHYSIOLOGICAL HEALTH EFFECTS, WITH A FOCUS ON IMPLICATIONS FOR THE VICTIM. IN ADDITION, SINCE IT IS NOW WELL ESTABLISHED THAT EARLY AND CHRONIC EXPOSURE TO STRESS HAS A SIGNIFICANT NEGATIVE IMPACT ON HEALTH OUTCOMES, WE EXPLORE THE IMPLICATIONS OF THIS RESEARCH IN RELATION TO BULLYING AND VICTIMIZATION IN CHILDHOOD. IN PARTICULAR, WE EXAMINE HOW ASPECTS OF THE STRESS RESPONSE, VIA EPIGENETIC, INFLAMMATORY, AND METABOLIC MEDIATORS, HAVE THE CAPACITY TO COMPROMISE MENTAL AND PHYSICAL HEALTH, AND TO INCREASE THE RISK OF DISEASE. RESEARCH ON THE RELEVANT MECHANISMS ASSOCIATED WITH BULLYING AND ON POTENTIAL INTERVENTIONS TO DECREASE MORBIDITY IS URGENTLY NEEDED. 2017 19 2858 24 FROM RILUZOLE TO DEXPRAMIPEXOLE VIA SUBSTITUTED-BENZOTHIAZOLE DERIVATIVES FOR AMYOTROPHIC LATERAL SCLEROSIS DISEASE TREATMENT: CASE STUDIES. THE 1,3-BENZOTHIAZOLE (BTZ) RING MAY OFFER A VALID OPTION FOR SCAFFOLD-HOPPING FROM INDOLE DERIVATIVES. SEVERAL BTZS HAVE CLINICALLY RELEVANT ROLES, MAINLY AS CNS MEDICINES AND DIAGNOSTIC AGENTS, WITH RILUZOLE BEING ONE OF THE MOST FAMOUS EXAMPLES. RILUZOLE IS CURRENTLY THE ONLY APPROVED DRUG TO TREAT AMYOTROPHIC LATERAL SCLEROSIS (ALS) BUT ITS EFFICACY IS MARGINAL. SEVERAL CLINICAL STUDIES HAVE DEMONSTRATED ONLY LIMITED IMPROVEMENTS IN SURVIVAL, WITHOUT BENEFITS TO MOTOR FUNCTION IN PATIENTS WITH ALS. DESPITE SIGNIFICANT CLINICAL TRIAL EFFORTS TO UNDERSTAND THE GENETIC, EPIGENETIC, AND MOLECULAR PATHWAYS LINKED TO ALS PATHOPHYSIOLOGY, THERAPEUTIC TRANSLATION HAS REMAINED DISAPPOINTINGLY SLOW, PROBABLY DUE TO THE COMPLEXITY AND THE HETEROGENEITY OF THIS DISEASE. MANY OTHER DRUGS TO TACKLE ALS HAVE BEEN TESTED FOR 20 YEARS WITHOUT ANY SUCCESS. DEXPRAMIPEXOLE IS A BTZ STRUCTURAL ANALOG OF RILUZOLE AND WAS A GREAT HOPE FOR THE TREATMENT OF ALS. IN THIS REVIEW, AS AN INTERESTING CASE STUDY IN THE DEVELOPMENT OF A NEW MEDICINE TO TREAT ALS, WE PRESENT THE STRATEGY OF THE DEVELOPMENT OF DEXPRAMIPEXOLE, WHICH WAS ONE OF THE MOST PROMISING DRUGS AGAINST ALS. 2020 20 4644 19 NEUROPATHIC PAIN TREATMENT: STILL A CHALLENGE. NEUROPATHIC PAIN (NP) IS THE RESULT OF A SERIES OF CONDITIONS CAUSED BY DISEASES OR LESIONS TO THE SOMATOSENSORY SYSTEM. DUE TO THE BETTER UNDERSTANDING OF NP PATHOPHYSIOLOGY PREVIOUSLY UNEXPLORED THERAPIES HAVE BEEN USED WITH ENCOURAGING RESULTS. IN THIS GROUP, ACETYL-L-CARNITINE, ALPHA-LIPOIC-ACID, CANNABINOIDS, CLONIDINE, EMA401, BOTULINUM TOXIN TYPE A AND NEW VOLTAGE-GATED SODIUM CHANNEL BLOCKERS, CAN BE INCLUDED. BESIDES, CHANGING PARADIGMS MAY OCCUR WITH THE ADVENT OF OPTOGENETICS AND A BETTER UNDERSTANDING OF EPIGENETIC REGULATION. WE REVIEWED THE PUBLISHED LITERATURE ON THE PHARMACOLOGICAL TREATMENT OF NP. DESPITE THE INTERESTING RESULTS, RANDOMIZED CONTROLLED TRIALS ARE DEMANDED THE MAJORITY OF THE THERAPIES PREVIOUSLY MENTIONED. IN SPITE OF SEVERAL STUDIES FOR THE RELIEF OF NP, PAIN CONTROL CONTINUES BEING A CHALLENGE. 2016