1 257 161 ADVANCES IN ONCOANAESTHESIA AND CANCER PAIN. INTRODUCTION: THE GROWING INTEREST ON HOW PERI-?OPERATIVE INTERVENTIONS, ESPECIALLY REGIONAL ANESTHESIA, DURING CANCER SURGERY CAN ALTER ONCOLOGICAL OUTCOME INCREASING DISEASE FREE SURVIVAL IS PROBABLY RESPONSIBLE FOR THE BIRTH OF THE NEW SUBSPECIALTY CALLED ONCO-ANESTHESIA. A PARADIGM SHIFT IN THE CONCEPT OF ANESTHETIC MANAGEMENT HAS OCCURRED RECENTLY OWING TO THE INNUMERABLE DIVERSE REVELATIONS FROM THE ONGOING RESEARCH IN THIS FIELD. DISCUSSION: LONG LASTING BUT REVERSIBLE EPIGENETIC CHANGES CAN OCCUR DUE TO SURGICAL STRESS AND PERIOPERATIVE ANESTHETIC MEDICATIONS. THE EXACT RELATIONSHIP BETWEEN THESE FACTORS AND TUMOR BIOLOGY IS BEING STUDIED FURTHER. A POPULAR TOPIC UNDER RESEARCH NOW IS THE INFLUENCE OF REGIONAL ANESTHESIA ON CANCER RECURRENCE. COMBINING NERVE BLOCKS WITH TOTAL INTRAVENOUS ANESTHESIA (TIVA) BRINGS DOWN THE REQUIREMENT OF OPIOIDS AND VOLATILE ANESTHETIC AGENTS IMPLICATED IN CANCER RECURRENCE. THE STUDY OF MECHANISM OF PAIN AT THE MOLECULAR LEVEL HAS LED TO THE DISCOVERY OF NOVEL MODES OF PREVENTION OF CHRONIC POST-SURGICAL PAIN. NEWER COMBINATION AGGRESSIVE TREATMENT THERAPIES -INTRAOPERATIVE CHEMOTHERAPY AND RADIOTHERAPY, ISOLATED LIMB PERFUSION, PHOTODYNAMIC THERAPY AND ROBOTIC SURGERY REQUIRE SPECIALIZED ANESTHETIC MANAGEMENT. THE COVID PANDEMIC INTRODUCED NEW GUIDELINES FOR SAFE MANAGEMENT OF ONCOSURGICAL PATIENTS .USE OF GENOMIC MAPPING TO PERSONALIZE PAIN MANAGEMENT WILL BE THE BREAKTHROUGH OF THE DECADE. CONCLUSION: THE DISCOVERY THAT ANESTHETIC STRATEGY COULD HAVE SIGNIFICANT ONCOLOGICAL SEQUEL IS A QUANTUM LEAP FORWARD. AVOIDING SOME ANESTHETIC MEDICATIONS MAY DECREASE CANCER RECURRENCE. COMPREHENSIVE CANCER CARE AND TRANSLATIONAL RESEARCH WILL PAVE THE WAY TO UNCOVER SAFE ANESTHETIC PRACTICES. 2021 2 4532 32 MULTIMODAL ANALGESIA FOR PERIOPERATIVE MANAGEMENT OF PATIENTS PRESENTING FOR SPINAL SURGERY. MULTIMODAL, NON-OPIOID BASED ANALGESIA HAS BECOME THE CORNERSTONE OF ERAS PROTOCOLS FOR EFFECTIVE ANALGESIA AFTER SPINAL SURGERY. OPIOID SIDE EFFECTS, DEPENDENCE AND LEGISLATION RESTRICTING LONG TERM OPIOID USE HAS LED TO A RESURGENCE IN INTEREST IN OPIOID SPARING TECHNIQUES. THE INCREASING ARRAY OF MULTIMODAL OPIOID SPARING ANALGESICS AVAILABLE FOR SPINAL SURGERY TARGETING NOVEL RECEPTORS, TRANSMITTERS, AND ALTERING EPIGENETICS CAN HELP PROVIDE AN OPTIMAL PERIOPERATIVE EXPERIENCE WITH LESS OPIOID SIDE EFFECTS AND LONG-TERM DEPENDENCE. EPIGENETIC MECHANISMS OF PAIN MAY ENHANCE OR SUPPRESS GENE EXPRESSION, WITHOUT ALTERING THE GENOME ITSELF. SUCH MECHANISMS ARE COMPLEX, DYNAMIC AND RESPONSIVE TO ENVIRONMENT. ALTERATIONS THAT OCCUR CAN AFFECT THE PATHOPHYSIOLOGY OF PAIN MANAGEMENT AT A DNA LEVEL, MODIFYING PERCEIVED PAIN RELIEF. IN THIS REVIEW, WE PROVIDE A BRIEF OVERVIEW OF EPIGENETICS OF PAIN, SYSTEMIC LOCAL ANESTHETICS AND NEURAXIAL TECHNIQUES THAT CONTINUE TO REMAIN USEFUL FOR SPINAL SURGERY, NEUROPATHIC AGENTS, AS WELL AS OTHER COMMON AND LESS COMMON TARGET RECEPTORS FOR A TRULY MULTIMODAL APPROACH TO PERIOPERATIVE PAIN MANAGEMENT. 2019 3 3010 34 GENETICS AND EPIGENETICS IN PERIOPERATIVE MEDICINE. PURPOSE OF REVIEW: TO SUMMARIZE IS TO REVIEW RECENT PROGRESS IN 'GENOMIC' SCIENCE AND HOW THIS MAY BE APPLIED TO THE PERIOPERATIVE ENVIRONMENT. ALTHOUGH INVESTIGATIONS THAT RELATE GENETIC VARIATION TO PERIOPERATIVE OUTCOMES CONTINUE, IT IS INCREASINGLY APPARENT THAT EPIGENETIC MECHANISMS MAY CONTRIBUTE TO MUCH OF THE OBSERVED VARIATION IN COMPLEX OUTCOMES NOT OTHERWISE EXPLAINED BY DIFFERENCES IN GENETIC SEQUENCE. RECENT FINDINGS: EXAMPLES OF RECENT FINDINGS RELATING TO THE ROLE OF EPIGENETIC MODIFICATIONS IN COMPLEX DISEASE AND OUTCOMES ARE DERIVED FROM RESEARCH INTO TYPE 1 DIABETES, PAIN, AND THE HYPOXIC RESPONSE. THESE STUDIES PROVIDE MODELS FOR FUTURE COHORT STUDY DESIGN, POTENTIAL PERIOPERATIVE DRUG TARGETS, AND HYPOTHESIS DEVELOPMENT. GENETIC AND EPIGENETIC FACTORS COMBINE TO ALTER BOTH GENE EXPRESSION AND DRUG RESPONSES AT BOTH PHARMACOKINETIC AND PHARMACODYNAMIC LEVELS. THESE FACTORS IMPACT ON THE EFFICACY AND SAFETY OF MULTIPLE DRUG CLASSES USED IN PERIOPERATIVE MEDICINE. SUMMARY: ENHANCING OUR UNDERSTANDING OF THE WAY IN WHICH PATIENTS AS GENOMIC ORGANISMS INTERACT WITH THE PERIOPERATIVE ENVIRONMENT REQUIRES A MORE SOPHISTICATED APPRECIATION OF THE FACTORS GOVERNING GENE EXPRESSION THAN HAS BEEN THE CASE TO DATE. EPIGENETIC MECHANISMS ARE SURE TO PLAY A PIVOTAL ROLE IN WHAT IS ESSENTIALLY AN ACQUIRED PHENOTYPE. 2012 4 6805 33 [EPIGENETICS : IMPORTANT ASPECTS FOR ANESTHESIOLOGISTS, PAIN AND INTENSIVE CARE PHYSICIANS]. EPIGENETICS, I.E. AN ALTERED READING OF THE GENOME WITHOUT ALTERING THE GENES THEMSELVES IS A GROWING SCIENTIFIC FIELD. A DISTINCTION IS MADE BETWEEN CHANGES IN THE DNA BY MODIFICATION OF THE HISTONES AND NON-CODING RNA THAT ALTER THE MESSENGER (M)RNAS. EPIGENETIC MODIFICATIONS CAN BE TRIGGERED BY PERSONAL CIRCUMSTANCES OR OTHER EXTERNAL FACTORS AND THEREFORE INFLUENCE THE OCCURRENCE OF DISEASES. EPIGENETICS ARE THEREFORE OF PARTICULAR INTEREST TO ANESTHESIOLOGISTS, PAIN SPECIALISTS AND INTENSIVE CARE PHYSICIANS, AS ANESTHETIC DRUGS MAY HAVE A LONG-TERM INFLUENCE ON PROTEIN TRANSCRIPTION LEADING FOR EXAMPLE TO ALTERATIONS IN NEUROCOGNITION AFTER ANESTHESIA, CHRONIFICATION OF POSTOPERATIVE PAIN AND IMMUNE RESPONSE IN SEPSIS. NON-CODING MICRORNAS KNOWN TO BE ALTERED IN A VARIETY OF PERIOPERATIVELY RELEVANT DISEASES E. G. HEART INFARCT, MIGHT SERVE AS PROGNOSTIC FACTORS OF PERIOPERATIVE OUTCOME. MOREOVER, THERE ARE WAYS TO INFLUENCE EPIGENETIC CHANGES THROUGH LIFE STYLE AND CERTAIN MEDICATIONS. IN THIS REVIEW ARTICLE, EXAMPLES OF ANESTHESIA, INTENSIVE CARE AND PAIN MEDICINE-RELEVANT DISEASES AND THE INFLUENCE OF EPIGENETICS ON THEM ARE PRESENTED. 2018 5 2561 30 EPIGENETICS IN THE PERIOPERATIVE PERIOD. THE PERIOPERATIVE PERIOD IS CHARACTERIZED BY PROFOUND CHANGES IN THE BODY'S HOMOEOSTATIC PROCESSES. THIS REVIEW SEEKS TO ADDRESS WHETHER EPIGENETIC MECHANISMS MAY INFLUENCE AN INDIVIDUAL'S REACTION TO SURGERY AND ANAESTHESIA. EVIDENCE FROM ANIMAL AND HUMAN STUDIES SUGGESTS THAT EPIGENETIC MECHANISMS CAN EXPLAIN MANY FACETS OF SUSCEPTIBILITY TO ACUTE AND CHRONIC PAIN, MAKING THEM POTENTIAL THERAPEUTIC TARGETS. MODERN PAIN MANAGEMENT IS STILL BASED UPON OPIATES, AND BOTH THE DEVELOPMENTAL EXPRESSION OF OPIOID RECEPTORS AND OPIOID-INDUCED HYPERALGESIA HAVE BEEN LINKED TO EPIGENETIC MECHANISMS. IN GENERAL, OPIATES SEEM TO INCREASE GLOBAL DNA METHYLATION LEVELS. THIS IS IN CONTRAST TO LOCAL ANAESTHETICS, WHICH HAVE BEEN ASCRIBED A GLOBAL DEMETHYLATING EFFECT. EVEN THOUGH NO DIRECT INVESTIGATIONS HAVE BEEN CARRIED OUT, THE POTENTIAL INFLUENCE OF EPIGENETICS ON THE INFLAMMATORY RESPONSE THAT FOLLOWS SURGERY SEEMS A PROMISING AREA FOR RESEARCH. THERE IS A CONSIDERABLE BODY OF EVIDENCE THAT SUPPORTS THE INVOLVEMENT OF EPIGENETICS IN THE COMPLEX PROCESS OF WOUND HEALING. EPIGENETICS IS AN IMPORTANT EMERGING RESEARCH TOPIC IN PERIOPERATIVE MEDICINE, WITH A HUGE POTENTIAL TO POSITIVELY INFLUENCE PATIENT OUTCOME. 2015 6 2571 27 EPIGENETICS OF CHRONIC PAIN AFTER THORACIC SURGERY. PURPOSE OF REVIEW: CHRONIC PAIN AFTER SURGERY IS A MAJOR PUBLIC HEALTH PROBLEM AND A MAJOR CONCERN FOR PERIOPERATIVE PHYSICIANS. THORACIC SURGERY PRESENTS A UNIQUE CHALLENGE, AS THORACOTOMY IS AMONG THE HIGHEST RISK SURGERIES TO DEVELOP PERSISTENT POSTSURGICAL PAIN. THE PURPOSE OF THIS REVIEW IS TO DISCUSS THE RELEVANCE OF RESEARCH IN PAIN EPIGENETICS TO PATIENTS WITH PERSISTENT PAIN AFTER THORACIC SURGERY. RECENT FINDINGS: RECENT ADVANCES HAVE LINKED CHRONIC PAIN STATES TO GENETIC AND EPIGENETIC CHANGES. PROGRESS IN OUR UNDERSTANDING OF CHRONIC PAIN HAS HIGHLIGHTED THE IMPORTANCE OF IMMUNE MODULATION OF PAIN. IT IS POSSIBLE THAT EPIGENETIC CHANGES DRIVING CHRONIC PAIN OCCUR IN THE PERIOPERATIVE SETTING VIA HISTONE MODIFICATION AND DNA METHYLATION. SUMMARY: THE TRANSITION FROM ACUTE TO CHRONIC PAIN AFTER THORACIC SURGERY MAY BE MEDIATED BY EPIGENETICS. HERE, WE DISCUSS EPIGENETIC MODIFICATIONS THAT HAVE BEEN DISCOVERED IN ANIMAL MODELS OF CHRONIC PAIN THAT MAY PREDISPOSE PATIENTS TO PERSISTENT NEUROPATHIC PAIN AFTER THORACIC SURGERY. 2014 7 6185 36 THE IMPACT OF GENERAL ANESTHESIA ON REDOX STABILITY AND EPIGENETIC INFLAMMATION PATHWAYS: CROSSTALK ON PERIOPERATIVE ANTIOXIDANT THERAPY. WORLDWIDE, THE PREVALENCE OF SURGERY UNDER GENERAL ANESTHESIA HAS SIGNIFICANTLY INCREASED, BOTH BECAUSE OF MODERN ANESTHETIC AND PAIN-CONTROL TECHNIQUES AND BECAUSE OF BETTER DIAGNOSIS AND THE INCREASED COMPLEXITY OF SURGICAL TECHNIQUES. APART FROM DEVELOPING NEW CONCEPTS IN THE SURGICAL FIELD, RESEARCHERS AND CLINICIANS ARE NOW WORKING ON MINIMIZING THE IMPACT OF SURGICAL TRAUMA AND OFFERING MINIMAL INVASIVE PROCEDURES DUE TO THE RECENT DISCOVERIES IN THE FIELD OF CELLULAR AND MOLECULAR MECHANISMS THAT HAVE REVEALED A SYSTEMIC INFLAMMATORY AND PRO-OXIDATIVE IMPACT NOT ONLY IN THE PERIOPERATIVE PERIOD BUT ALSO IN THE LONG TERM, CONTRIBUTING TO MORE DIFFICULT RECOVERY, INCREASED MORBIDITY AND MORTALITY, AND A NEGATIVE FINANCIAL IMPACT. DETAILED MOLECULAR AND CELLULAR ANALYSIS HAS SHOWN AN OVERPRODUCTION OF INFLAMMATORY AND PRO-OXIDATIVE SPECIES, RESPONSIBLE FOR AUGMENTING THE SYSTEMIC INFLAMMATORY STATUS AND MAKING POSTOPERATIVE RECOVERY MORE DIFFICULT. MOREOVER, THERE ARE A SERIES OF CHANGES IN CERTAIN EPIGENETIC STRUCTURES, THE MOST IMPORTANT BEING THE MICRORNAS. THIS REVIEW DESCRIBES THE MOST IMPORTANT MOLECULAR AND CELLULAR MECHANISMS THAT IMPACT THE SURGICAL PATIENT UNDERGOING GENERAL ANESTHESIA, AND IT PRESENTS A SERIES OF ANTIOXIDANT THERAPIES THAT CAN REDUCE SYSTEMIC INFLAMMATION. 2022 8 4418 30 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 4608 24 NEONATAL ANESTHESIA AND DYSREGULATION OF THE EPIGENOMEDAGGER. EACH YEAR, MILLIONS OF INFANTS AND CHILDREN ARE ANESTHETIZED FOR MEDICAL AND SURGICAL PROCEDURES. YET, A SUBSTANTIAL BODY OF PRECLINICAL EVIDENCE SUGGESTS THAT ANESTHETICS ARE NEUROTOXINS THAT CAUSE RAPID AND WIDESPREAD APOPTOTIC CELL DEATH IN THE BRAINS OF INFANT RODENTS AND NONHUMAN PRIMATES. THESE ANIMALS HAVE PERSISTENT IMPAIRMENTS IN COGNITION AND BEHAVIOR MANY WEEKS OR MONTHS AFTER ANESTHESIA EXPOSURE, LEADING US TO HYPOTHESIZE THAT ANESTHETICS DO MORE THAN SIMPLY KILL BRAIN CELLS. INDEED, ANESTHETICS CAUSE CHRONIC NEUROPATHOLOGY IN NEURONS THAT SURVIVE THE INSULT, WHICH THEN INTERFERES WITH MAJOR ASPECTS OF BRAIN DEVELOPMENT, SYNAPTIC PLASTICITY, AND NEURONAL FUNCTION. UNDERSTANDING THE PHENOMENON OF ANESTHESIA-INDUCED DEVELOPMENTAL NEUROTOXICITY IS OF CRITICAL PUBLIC HEALTH IMPORTANCE BECAUSE CLINICAL STUDIES NOW REPORT THAT ANESTHESIA IN HUMAN INFANCY IS ASSOCIATED WITH COGNITIVE AND BEHAVIORAL DEFICITS. IN OUR SEARCH FOR MECHANISTIC EXPLANATIONS FOR WHY A YOUNG AND PLIABLE BRAIN CANNOT FULLY RECOVER FROM A RELATIVELY BRIEF PERIOD OF ANESTHESIA, WE HAVE ACCUMULATED EVIDENCE THAT NEONATAL ANESTHESIA CAN DYSREGULATE EPIGENETIC TAGS THAT INFLUENCE GENE TRANSCRIPTION SUCH AS HISTONE ACETYLATION AND DNA METHYLATION. IN THIS REVIEW, WE BRIEFLY SUMMARIZE THE PHENOMENON OF ANESTHESIA-INDUCED DEVELOPMENTAL NEUROTOXICITY. WE THEN DISCUSS CHRONIC NEUROPATHOLOGY CAUSED BY NEONATAL ANESTHESIA, INCLUDING DISTURBANCES IN COGNITION, SOCIO-AFFECTIVE BEHAVIOR, NEURONAL MORPHOLOGY, AND SYNAPTIC PLASTICITY. FINALLY, WE PRESENT EVIDENCE OF ANESTHESIA-INDUCED GENETIC AND EPIGENETIC DYSREGULATION WITHIN THE DEVELOPING BRAIN THAT MAY BE TRANSMITTED INTERGENERATIONALLY TO ANESTHESIA-NAIVE OFFSPRING. 2021 10 3598 18 IMPLICATIONS ON HYPNOTHERAPY: NEUROPLASTICITY, EPIGENETICS AND PAIN. WE PROVIDE A BRIEF REVIEW ABOUT THE SIGNIFICANCE OF HYPNOSIS WITH RESPECT TO APPLICATIONS AND PHYSIOLOGICAL PROCESSES IN HYPNOTHERAPY. OUR REVIEW CONCLUDES THAT HYPNOSIS IS A PROMISING METHOD TO MANAGE ACUTE AND CHRONIC PAIN. IN ADDITION, WE DISCUSS INDICATIONS POINTING TOWARD THE VIEW THAT HYPNOSIS CAN INDUCE CHANGES IN NEUROPLASTICITY POSSIBLY INVOLVING EPIGENETIC MECHANISMS. 2021 11 3880 22 KETAMINE: REPURPOSING AND REDEFINING A MULTIFACETED DRUG. THIS SHORT REVIEW WILL HIGHLIGHT RECENT CLINICAL AND BASIC RESEARCH THAT SUPPORTS THE THERAPEUTIC UTILITY OF KETAMINE AS A RAPID-ACTING, LIFE-SAVING ANTIDEPRESSANT AND A VERSATILE ANALGESIC. AFTER 50 YEARS OF USE AS A DISSOCIATIVE ANESTHETIC AND MISUSE AS A STREET DRUG, KETAMINE HAS RE-EMERGED AS A USEFUL OFF-LABEL AGENT FOR AMELIORATING VARIOUS TYPES OF PAIN AND RESISTANT DEPRESSION. IN ADDITION TO ITS ABILITY TO INHIBIT N-METHYL-D-ASPARTATE (NMDA) RECEPTORS, THE DIVERSE ACTIONS OF KETAMINE MIGHT INVOLVE EPIGENETIC MECHANISMS SUCH AS MICRORNA REGULATION. THUS, KETAMINE IS TRANSITIONING FROM BEING THE PHARMACOLOGIST'S NIGHTMARE TO ONE OF THE MOST INTERESTING DEVELOPMENTS IN THE PHARMACOLOGY OF DEPRESSION AND PAIN. 2014 12 6838 31 [INTRODUCTION OF TRANSLATIONAL RESEARCH IN OMICS SCIENCE TO CLINICAL ANESTHESIA]. MUCH PROGRESS HAS BEEN MADE IN OMICS RESEARCH FOLLOWING COMPLETION OF THE HUMAN GENOME PROJECT. THIS COMPREHENSIVE ANALYSIS PRODUCED A NEW DISCIPLINE (I.E., BIOINFORMATICS), AND ITS FINDINGS CONTRIBUTED TO THE CLINICAL PRACTICE OF ANESTHESIOLOGY. GENOMES OF PATIENTS SHOW GENETIC VARIATIONS AND MAY PREDICT THE SENSITIVITY TO ANESTHETICS AND ANALGESICS, INCIDENCE OF ADVERSE EFFECTS, AND INTENSITY OF POSTSURGICAL PAIN. CHANGES IN THE TRANSCRIPTOMES OF PATIENTS MAY ALSO REFLECT ANESTHESIA-RELATED EXPRESSION PROFILES OF VARIOUS TYPES OF NEURONS IN THE BRAIN, AND INFORMATION ON SUCH CHANGES MAY CONTRIBUTE TO MOLECULAR TARGETED THERAPY IN ANESTHETIZED PATIENTS. IN ADDITION, NOVEL EPIGENOME RESEARCH MAY EXPLAIN WHY ENVIRONMENTS CHANGE THE PHENOTYPES OF CLINICAL ANESTHESIA. WE CURRENTLY HYPOTHESIZE THAT FEMALE GENDER IS ASSOCIATED WITH DNA METHYLATION IN PAIN-RELATED AND VOMITING-RELATED GENE PROMOTER REGIONS AT THE GENOME-WIDE LEVEL AND THAT EPIGENETIC MECHANISMS ARE INVOLVED IN GENDER DIFFERENCES IN ANESTHESIA PRACTICE. 2013 13 5154 30 PRAKRITI-BASED MEDICINE: A STEP TOWARDS PERSONALIZED MEDICINE. THE CONCEPT OF PERSONALIZED MEDICINE HAS BEEN AROUND FOR AS LONG AS PEOPLE HAVE BEEN PRACTICING MEDICINE. FROM CHARAKA TO HIPPOCRATES, ALL HAVE PRACTICED THE PERSONALIZED APPROACH FOR TREATING A DISEASE. IN THE 21(ST) CENTURY, PERSONALIZED MEDICINE IS ALL ABOUT DNA. WHEREAS THE SINGLE NUCLEOTIDE POLYMORPHISM (SNP) AND EPIGENETIC FACTORS INFLUENCE DRUG RESPONSE AND FORM THE BASIS OF PERSONALIZED MEDICINE, THE TRIDOSHA THEORY FORMS THE BASIS OF PRAKRITI-BASED MEDICINE. IT IS WELL ESTABLISHED BY NOW THAT WESTERN ALLOPATHIC MEDICINE IS EXCELLENT IN HANDLING ACUTE MEDICAL CRISES, WHEREAS AYURVEDA HAS SUCCESSFULLY DEMONSTRATED AN ABILITY TO MANAGE CHRONIC DISORDERS THAT WESTERN MEDICINE HAS BEEN UNABLE TO CURE. WITH EFFECTIVE INTEGRATION OF 'OMICS' PRAKRITI-BASED MEDICINE CAN PLAY A VITAL ROLE IN THIS CHANGING SCENARIO OF GLOBAL HEALTH WISDOM AS AYURVEDA OFFERS ITS MODALITIES BY WAY OF AHARA (DIET), VIHARA (LIFESTYLE), AND AUSHADHI (MEDICATION), WHICH ARE THE THREE PILLARS OF PRAKRITI-BASED MEDICINE MAKING IT A HOLISTIC SCIENCE. PRAKRITI-BASED MEDICINE AND OTHER TRADITIONAL MEDICINE SYSTEMS HAVE THE POTENTIAL TO OFFER REMEDIES TO THE CHALLENGING HEALTH ISSUES LIKE ADVERSE DRUG REACTIONS, DRUG WITHDRAWALS, AND ECONOMIC DISPARITIES AMONG FEW. AN INTEGRATIVE GLOBAL APPROACH COULD DO WONDERS TO HEALTH SCIENCES BENEFITING A BROAD SPECTRUM OF PATIENTS. 2011 14 4599 24 NATURE AND NURTURE OF HUMAN PAIN. HUMANS ARE VERY DIFFERENT WHEN IT COMES TO PAIN. SOME GET PAINFUL PIERCINGS AND TATTOOS; OTHERS CAN NOT STAND EVEN A FLU SHOT. INTERINDIVIDUAL VARIABILITY IS ONE OF THE MAIN CHARACTERISTICS OF HUMAN PAIN ON EVERY LEVEL INCLUDING THE PROCESSING OF NOCICEPTIVE IMPULSES AT THE PERIPHERY, MODIFICATION OF PAIN SIGNAL IN THE CENTRAL NERVOUS SYSTEM, PERCEPTION OF PAIN, AND RESPONSE TO ANALGESIC STRATEGIES. AS FOR MANY OTHER COMPLEX BEHAVIORS, THE SOURCES OF THIS VARIABILITY COME FROM BOTH NURTURE (ENVIRONMENT) AND NATURE (GENES). HERE, I WILL DISCUSS HOW THESE FACTORS CONTRIBUTE TO HUMAN PAIN SEPARATELY AND VIA INTERPLAY AND HOW EPIGENETIC MECHANISMS ADD TO THE COMPLEXITY OF THEIR EFFECTS. 2013 15 5814 19 STRESS AND FELINE HEALTH. IN THE HEALTH SCIENCES, STRESS OFTEN IS DEFINED IN TERMS OF STRESSORS; EVENTS THAT ARE PERCEIVED AS THREATS TO ONE'S PERCEPTION OF CONTROL. FROM THIS PERSPECTIVE, A STRESSOR IS ANYTHING THAT ACTIVATES THE CENTRAL THREAT RESPONSE SYSTEM (CTRS). RECENT RESEARCH SHOWS THAT THE CTRS CAN BE SENSITIZED TO ENVIRONMENTAL EVENTS THROUGH EPIGENETIC MODULATION OF GENE EXPRESSION. WHEN CTRS ACTIVATION IS CHRONIC, HEALTH AND WELFARE MAY BE HARMED. ENVIRONMENTAL MODIFICATION CAN MITIGATE THE HARMFUL EFFECTS OF CHRONIC CTRS ACTIVATION BY REDUCING THE INDIVIDUAL'S PERCEPTION OF THREAT AND INCREASING ITS PERCEPTION OF CONTROL, WHICH IMPROVES HEALTH AND WELFARE. 2020 16 1 17 ON DECEMBER 5, 2017, THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE HOSTED A PUBLIC WORKSHOP TITLED NUTRIGENOMICS AND THE FUTURE OF NUTRITION IN WASHINGTON, DC, TO REVIEW CURRENT KNOWLEDGE IN THE FIELD OF NUTRIGENOMICS AS IT RELATES TO NUTRITION. WORKSHOP PARTICIPANTS EXPLORED THE INFLUENCE OF GENETIC AND EPIGENETIC EXPRESSION ON NUTRITIONAL STATUS AND THE POTENTIAL IMPACT OF PERSONALIZED NUTRITION ON HEALTH MAINTENANCE AND CHRONIC DISEASE PREVENTION. THIS PUBLICATION SUMMARIZES THE PRESENTATIONS AND DISCUSSIONS FROM THE WORKSHOP. 2018 17 6784 19 [CHRONIC STRESS AND EPIGENETICS. RELATION BETWEEN ACADEMIC SCIENCES AND THEOLOGY]. THE AUTHOR GIVES A SHORT ACCOUNT ON THE PRINCIPLES OF SELYE'S STRESS THEORY, AND DISCUSSES SIMILARITIES AND DISSIMILARITIES OF ACUTE AND CHRONIC STRESS. BOTH THE EXTERNAL, AND THE INTERNAL ENVIRONMENT, AS WELL AS THE PSYCHO-MENTAL STATUS ARE INVOLVED IN THE NOTION OF THE ENVIRONMENT. BASIC PRINCIPLES OF EPIGENETICS ARE REVIEWED: INTERACTION BETWEEN ENVIRONMENT AND GENES, NEUROENDOCRINE AND ENZYMATIC MECHANISMS INVOLVED IN SILENCING AND ACTIVATION OF GENES, NOTIONS OF PHENOTYPIC PLASTICITY, AND EPIGENETIC REPROGRAMMING ARE DISCUSSED. EPIGENETIC MECHANISMS OF INTERRELATION BETWEEN PATHOLOGICAL CLINICAL STATES (DISEASES) AND THE CHARACTERISTIC PHENOTYPES, CAUSATIVE ROLE OF PSYCHO-MENTAL STATUS IN EVOKING PATHOLOGICAL SOMATIC ALTERATIONS, AND THE POTENTIAL THERAPEUTIC CONSEQUENCES ARE BRIEFLY DISCUSSED. THE ETIOLOGICAL ROLE OF CHRONIC, CIVILIZATION STRESS IN PRODUCING THE WORLDWIDE INCREMENT OF CARDIOVASCULAR MORBIDITY IS CITED, ARGUMENTATION AND CRITICISM OF THE CURRENT THERAPEUTICAL PRACTICE IS DISCUSSED. THE AUTHOR CONCLUDES THAT RECENT ADVANCES IN EPIGENETIC KNOWLEDGE SEEM TO SOLVE THE CONTROVERSY BETWEEN THE ACADEMIC AND THEOLOGICAL SCIENCES. 2012 18 5852 23 SUBLIMINAL (LATENT) PROCESSING OF PAIN AND ITS EVOLUTION TO CONSCIOUS AWARENESS. BY UNCONSCIOUS OR COVERT PROCESSING OF PAIN WE REFER TO NASCENT INTERACTIONS THAT AFFECT THE EVENTUAL DELIVERANCE OF PAIN AWARENESS. THUS, INTERNAL PROCESSES (VIZ., REPEATED NOCICEPTIVE EVENTS, INFLAMMATORY KINDLING, REORGANIZATION OF BRAIN NETWORKS, GENETIC) OR EXTERNAL PROCESSES (VIZ., ENVIRONMENT, SOCIOECONOMIC LEVELS, MODULATION OF EPIGENETIC STATUS) CONTRIBUTE TO ENHANCING OR INHIBITING THE PRESENTATION OF PAIN AWARENESS. HERE WE PUT FORWARD THE NOTION THAT FOR MANY PATIENTS, ONGOING SUB-CONSCIOUS CHANGES IN BRAIN FUNCTION ARE SIGNIFICANT PLAYERS IN THE EVENTUAL MANIFESTATION OF CHRONIC PAIN. IN THIS REVIEW, WE PROVIDE CLINICAL EXAMPLES OF NASCENT OR WHAT WE TERM PRE-PAIN PROCESSES AND THE NEUROBIOLOGICAL MECHANISMS OF HOW THESE CHANGES MAY CONTRIBUTE TO PAIN, BUT ALSO POTENTIAL OPPORTUNITIES TO DEFINE THE PROCESS FOR EARLY THERAPEUTIC INTERVENTIONS. 2018 19 2865 29 FUNCTIONAL ABDOMINAL PAIN DISORDERS IN CHILDREN. CHRONIC ABDOMINAL PAIN IS A COMMON PROBLEM IN PEDIATRIC PRACTICE. THE MAJORITY OF CASES FULFILL THE ROME IV CRITERIA FOR FUNCTIONAL ABDOMINAL PAIN DISORDERS (FAPDS). AT TIMES, THESE DISORDERS MAY LEAD TO RATHER SERIOUS REPERCUSSIONS. AREA COVERED: WE HAVE ATTEMPTED TO COVER CURRENT KNOWLEDGE ON EPIDEMIOLOGY, PATHOPHYSIOLOGY, RISK FACTORS RELATED TO PATHOPHYSIOLOGY, CLINICAL EVALUATION AND MANAGEMENT OF CHILDREN WITH FAPDS. EXPERT COMMENTARY: FAPDS ARE A WORLDWIDE PROBLEM WITH A POOLED PREVALENCE OF 13.5%. THERE ARE A NUMBER OF PREDISPOSING FACTORS AND PATHOPHYSIOLOGICAL MECHANISMS INCLUDING STRESSFUL EVENTS, CHILD MALTREATMENT, VISCERAL HYPERSENSITIVITY, ALTERED GASTROINTESTINAL MOTILITY AND CHANGE IN INTESTINAL MICROBIOTA. IT IS POSSIBLE THAT THE ENVIRONMENTAL RISK FACTORS INTRICATELY INTERACT WITH GENES THROUGH EPIGENETIC MECHANISMS TO CONTRIBUTE TO THE PATHOPHYSIOLOGY. THE DIAGNOSIS MAINLY DEPENDS ON CLINICAL EVALUATION. COMMONLY USED PHARMACOLOGICAL INTERVENTIONS DO NOT PLAY A MAJOR ROLE IN RELIEVING SYMPTOMS. CENTRALLY DIRECTED, NONPHARMACOLOGICAL INTERVENTIONS SUCH AS HYPNOTHERAPY AND COGNITIVE BEHAVIORAL THERAPY HAVE SHOWN BOTH SHORT AND LONG TERM EFFICACY IN RELIEVING PAIN IN CHILDREN WITH FAPDS. HOWEVER, THESE INTERVENTIONS ARE TIME CONSUMING AND NEED SPECIALLY TRAINED STAFF AND THEREFORE, NOT CURRENTLY AVAILABLE AT GRASS ROOT LEVEL. CLINICIANS AND RESEARCHERS SHOULD JOIN HANDS IN SEARCHING FOR MORE PRAGMATIC AND EFFECTIVE THERAPEUTIC MODALITIES TO IMPROVE OVERALL CARE OF CHILDREN WITH FAPDS. 2018 20 1984 30 EPIGENETIC ALTERATIONS IN PRESCRIPTION OPIOID MISUSE: NEW STRATEGIES FOR PRECISION PAIN MANAGEMENT. PRESCRIPTION OPIOIDS ARE USED FOR SOME CHRONIC PAIN CONDITIONS. HOWEVER, GENERALLY, LONG-TERM THERAPY HAS UNWANTED SIDE EFFECTS WHICH MAY TRIGGER ADDICTION, OVERDOSE, AND EVENTUALLY CAUSE DEATHS. OPIOID ADDICTION AND CHRONIC PAIN CONDITIONS HAVE BOTH BEEN ASSOCIATED WITH EVIDENCE OF GENETIC AND EPIGENETIC ALTERATIONS. DESPITE INTENSE RESEARCH INTEREST, MANY QUESTIONS ABOUT THE CONTRIBUTION OF EPIGENETIC CHANGES TO THIS TYPOLOGY OF ADDICTION VULNERABILITY AND DEVELOPMENT REMAIN UNANSWERED. THE AIM OF THIS REVIEW WAS TO SUMMARIZE THE EPIGENETIC MODIFICATIONS DETECTED IN SPECIFIC TISSUES OR BRAIN AREAS AND ASSOCIATED WITH OPIOID PRESCRIPTION AND MISUSE IN PATIENTS WHO HAVE INITIATED PRESCRIBED OPIOID MANAGEMENT FOR CHRONIC NON-CANCER PAIN. THE REVIEW CONSIDERS THE EFFECTS OF OPIOID EXPOSURE ON THE EPIGENOME IN CENTRAL AND PERIPHERAL TISSUES IN ANIMAL MODELS AND HUMAN SUBJECTS AND HIGHLIGHTS THE MECHANISMS IN WHICH OPIOID EPIGENETICS MAY BE INVOLVED. THIS WILL IMPROVE OUR CURRENT UNDERSTANDING, PROVIDE THE BASIS FOR TARGETED, PERSONALIZED PAIN MANAGEMENT, AND THUS BALANCE OPIOID RISKS AND BENEFITS IN MANAGING CHRONIC PAIN. 2021