Articles

Although human oral fluid has become more routine for quantitative drug detection in pain management, detecting a large scope of medications and substances is costly and technically challenging for laboratories. This paper presents a quantitative assay for 64 pain medications, illicit substances, and drug metabolites in human oral fluid. The novelty of this assay is that it was developed on an older model AB SCIEX 4000 instrument and renders obscure the need for more technical and expensive laboratory equipment. This method includes addition of internal standard and a 2-step liquid-liquid extraction and dry-down step to concentrate and clean the samples. The samples were suspended in 50% MeOH in water and separation and detection was accomplished using triple quadrupole mass spectrometry (LC-MS/MS). Separation was achieved using reverse-phase liquid chromatography with detection by LC-MS/MS. A second injection was done in negative mode to determine THC-COOH concentration as an indicator of THC. An aliquot of the (already) extracted samples was analyzed for D- and L- isomers of amphetamine and methamphetamine using a chiral column. The standard curve spanned from 5 to 2000 ng/mL for most of the analytes (1 to 2000 ng/mL for fentanyl and THC-COOH) and up to 1000 ng/mL for 13 analytes. Pregabalin and gabapentin ranged from 25 to 2000 ng/mL. The result is a low-cost method for the sensitive detection of a wide-ranging oral fluid menu for pain management. This assay has a high sensitivity, and good precision and accuracy for all analytes with an older model mass spectrometer.

There is a growing body of evidence that the number of individuals suffering from chronic and acute pain is under-reported and the burden of the veteran, aging, athletic, and working populations is rising. Current pain management is limited by our capacity to collaborate with individuals continuing normal daily functions and self-administration of pain treatments outside of traditional healthcare appointments and hospital settings. In this review, the current gap in clinical care for real-time feedback and guidance with pain management decision-making for chronic and post-operative pain treatment is defined. We examine the recent and future applications for predictive analytics of opioid use after surgery and implementing real-time neural networks for personalized pain management goal setting for particular individuals on the path to discharge to normal function. Integration of personalized neural networks with longitudinal data may enable the development of future treatment personalizations paired with electrical simulations.

NSAIDs are aberrantly used for pain management but pain and discomforts exerted from viral infections like COVID-19, Dengue, and Chikungunya should strictly be treated according to clinical guidelines and weighing risk-benefits, among such patients.