Authors: Robert G. Smith.
The lower extremity specialist may have come to appreciate and respect that medical treatments that can be enhanced by an understanding of pharmacodynamics, pharmacogenomics, and pharmacokinetics of selected medications to include analgesics specifically opioids. Furthermore, these same foot and ankle specialist may fine- tune their prescribing abilities with analgesics by familiarizing himself or herself with the science of chronotherapy. The primary goal of chronotherapy is to determine times for drug delivery that allows for low toxicity and an increase in a medication’s efficacy. Chrono pharmaceutics has been described as a branch of pharmaceutics devoted to the design of drug delivery system to ensure that a bioactive agent’s release at a rhythm ideally matches the biological requirement of a given disease. The primary purpose of this narrative review is to describe, explore and present Chrono therapeutic concepts as they intersect with analgesics within the context of pain management and circadian rhythms. First, data and theories on the interaction of pain pathology and circadian rhythm will be introduced. Secondly, the science of pharmacogenomics and circadian rhythms as mediators of analgesic properties, specifically opioid drug-drug interactions grounded in the effects of pharmacokinetic metabolism will be presented. Lastly, relevant technology will be described to allow a lower extremity specialist to appreciate Chrono therapeutic drug delivery systems of a specific opioid analgesic.
View/Download pdf