Faculty Bibliography

A majority of patients with acute and chronic pain experience breakthrough pain above their baseline, despite a fixed regimen. The characteristics of current short-acting oral medications are not optimal because they often peak too late and last beyond the duration of pain. Oral absorption limits the onset time, whereas the development of newer routes can shorten onset times. A number of medications, both opioid and nonopioid, are being developed for intranasal delivery with promising results. In addition to the intranasal administration route being efficacious, it also provides better patient satisfaction by allowing the patient to titrate their own pain medication. There are legitimate concerns for abuse and addiction with these medications, which will need to be minimized with proper dispensing modifications. A number of nonopioid agents are also entering the market that will allow for multimechanistic analgesic plans. Although ketamine is not a common component of current pain treatment plans, the development of an intranasal formulation may potentially produce wider acceptance. Many traditional medications, including ibuprofen and acetaminophen, have been developed for parenteral administration. Intravenous ibuprofen or diclofenac can be administered for a longer duration and have a lower bleeding risk then ketorolac. Intravenous acetaminophen can provide balanced analgesia when nonsteroidal anti-inflammatory drugs are contraindicated, as is common in the postoperative period. The role of individual agents in each specialty is not currently clear, but the future treatment of pain, both acute and chronic, is brighter with the addition of these formulations

Previous work demonstrated that Ixodes spinipalpis ticks maintained an enzootic cycle of Borrelia bissettii and the agent of human granulocytic ehrlichiosis (aoHGE) within woodrats (Neotoma mexicana) and deer mice (Peromyscus maniculatus) in northern Colorado (USA). Because I. spinipalpis is the only known vector of B. bissettii and aoHGE in Colorado, this study was designed to determine the reservoir status of other hosts of I. spinipalpis in five distinct ecological zones along the front range and foothills of Colorado. One hundred and twelve rodents of nine species were examined and 11 (10%) were polymerase chain reaction (PCR) positive for aoHGE; 37 (33%) were culture positive for B. bissettii, and five (4%) were coinfected with both organisms based on PCR and culture. Of these, three chipmunk species (Tamias minimus, T. quadrivittatus, and T. umbrinus) were culture positive for B. bissettii, with a single T. minimus coinfected with B. bissettii and aoHGE. In addition, one golden-mantled ground squirrel (Spermophilus lateralis) was positive for both B. bissettii and aoHGE. This is the first report of a golden-mantled ground squirrel harboring either B. bissettii or aoHGE and the initial observation that chipmunks may be a reservoir for B. bissettii in Colorado