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Correlation of change in visual analog scale with pain relief in the ED.
Fosnocht DE, Chapman CR, Swanson ER, Donaldson GW.
Abstract Objectives To evaluate the validity of change in visual analog Scale (VAS) as a measure of pain relief using a verbal descriptor Scale (VDS) of change in pain. Methods A prospective observational study of emergency department patients measured pain with VAS and recorded verbal report of change in pain. Results One thousand four hundred ninety patients yielded 1999 comparisons between change in VAS and VDS. Correlation of change in VAS and VDS of change in pain was rho = 0.667 ( P < .001). A wide range of change in VAS, large standard deviations for the mean change in VAS, and discordance in the direction of change in VAS were present within each verbal descriptor category. Conclusions Change in VAS is moderately correlated with a VDS of change in pain. Wide variability in change in VAS and discordance with a VDS demonstrate that change in VAS is not a valid indicator of pain relief for individual patients.
PMID: 15672339 [PubMed - in process]
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Water bath evaluation technique for emergency ultrasound of painful superficial structures.
Blaivas M, Lyon M, Brannam L, Duggal S, Sierzenski P.
Department of Emergency Medicine, Medical College of Georgia, 1120 15th Street, Atlanta, GA 30912-4007, USA. blaivas@pyro.net
Researchers have described the use of bedside emergency ultrasound as an effective way to evaluate for and accurately drain potential abscesses. Similarly, descriptions exist of long bone fracture evaluation in the wrist and hands. Tendon injury can also be detected with ultrasound and exploration can be obviated or at least focused. Sonographic examination of painful extremity pathology such as abscesses or lacerations involving the hand or foot can be challenging. Patients may be uncooperative if they experience significant pain when the transducer is placed on the area of interest. While ample amounts of ultrasound gel can decrease the need for firm transducer contact with the skin it is still difficult to obtain a good evaluation without causing any discomfort. The solution may lie in an old technique that has been recently brought back to life for use in hand evaluation in which the patient's extremity is placed in a water bath. The water bath replaces the need for ultrasound gel or contact between the ultrasound transducer and the patient's skin, thus eliminating discomfort. We describe 7 cases in which, despite aggressive attempts at pain control, adequate evaluation of extremity pathology was not possible without the use of the water bath technique. Patients reported no discomfort and superior quality images were obtained due to the water bath properties. Emergency sonologists should keep this technique in mind when contact between skin and the ultrasound transducer is likely to cause a patient significant discomfort.
PMID: 15666267 [PubMed - in process]
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Mandated pain scales improve frequency of ED analgesic administration.
Nelson BP, Cohen D, Lander O, Crawford N, Viccellio AW, Singer AJ.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
A retrospective study design was used to determine the effect of introducing a mandated verbal numeric pain scale on the incidence and timing of analgesic administration in the ED. Consecutive patients presenting with renal colic, extremity trauma, headache, ophthalmologic trauma, and soft tissue injury were included. 521 encounters were reviewed before and 479 encounters after the introduction of the pain scale. Groups were similar in baseline characteristics. Analgesic use increased from 25% to 36% (p < 0.001), and analgesics were administered more rapidly after the scale was introduced (113 minutes vs. 152 minutes, p = 0.09). Analgesic use correlated with pain severity. Patients undergoing diagnostic testing were less likely to receive analgesics, especially when presenting with a headache (p < 0.001). We conclude that use of a pain scale at triage significantly increases use of analgesia, and shortens the time till its administration. Patients undergoing diagnostic workups were less likely to receive analgesia.
PMID: 15666265 [PubMed - in process]
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Clinical features, triage, and outcome of patients presenting to the ED with suspected acute coronary syndromes but without pain: a multicenter study.
Coronado BE, Pope JH, Griffith JL, Beshansky JR, Selker HP.
Center for Cardioivascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Dept. of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
We studied the impact on triage and outcome of patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndromes (ACS) but without a complaint of pain. Data from a prospective clinical trial of patients with symptoms suggesting an ACS in the EDs of 10 US hospitals comparing patient demographics, clinical variables, and outcomes was used to perform a secondary analysis. Of 10,783 subjects, a final diagnosis of an ACS was confirmed in 24% of which 35% had acute myocardial infarction (AMI) and 65% unstable angina pectoris (UAP). Pain was absent in 6.2% of patients with acute ischemia and in 9.8% of those with AMI. Compared to similar patients who presented with pain, patients with painless ischemia were older, were more commonly women, had more cardiac and related diseases. Among patients with AMI, fewer patients without pain were admitted to critical care units compared to similar patients with pain. Among patients with AMI, logistic regression predicting lack of pain identified age, heart failure and diabetes, with only age and heart failure among all with ACS. After controlling for clinical features, lack of pain during acute ischemia predicted increased hospital mortality. We concluded that age and heart failure are independently associated with painless ACS, in addition to diabetes among those with AMI. Lack of pain predicts increased hospital mortality in patients with ACI through mechanisms that remain to be elucidated. There is a need for greater awareness in the general public of the different manifestations of ACS to enhance the recognition of and prompt response to their symptoms.
PMID: 15666263 [PubMed - in process]
Caudal morphine for pain relief in pediatric liver transplantation: did it help?
Kim TW.
PMID: 15673919 [PubMed - in process]
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Caudal morphine for pain relief in pediatric liver transplantation: did it help?
Mayhew JF.
Publication Types:
PMID: 15673914 [PubMed - in process]
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The effect of propofol on thermal pain perception.
Frolich MA, Price DD, Robinson ME, Shuster JJ, Theriaque DW, Heft MW.
Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, Birmingham, AL 35249-6810, USA. froelich@uab.edu
We studied the effect of propofol, a widely used sedative-hypnotic drug, on pain perception. Eighteen subjects received propofol in two sedative concentrations that were balanced and randomized in order. Painful (45 degrees C, 47 degrees C, and 49 degrees C) stimulation temperatures were presented in random order, and nonpainful 31 degrees C stimuli were presented on alternate trials. We used a target-controlled infusion and chose effect site concentrations of 0.5 mug/mL for mild sedation and 1.0 mug/mL for moderate sedation. Using a visual analog scale, subjects rated both pain intensity and unpleasantness higher when sedated with propofol. The average pain intensity was 28/100 for placebo, 35/100 for mild, and 40/100 for moderate sedation. Pain unpleasantness was 23/100 for placebo, 29/100 for mild, and 33/100 for moderate sedation. This effect was unexpected and may be explained by a difference of subjective pain experience by a patient and the perceived level of analgesia by a health care provider in sedated patients. This finding calls further attention to the need for adequate analgesia in patients sedated with propofol.
PMID: 15673879 [PubMed - in process]
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The cyclooxygenase-2-specific inhibitor parecoxib sodium is as effective as 12 mg of morphine administered intramuscularly for treating pain after gynecologic laparotomy surgery.
Malan TP Jr, Gordon S, Hubbard R, Snabes M.
Department of Anesthesiology, The University of Arizona, 1501 N. Campbell Ave., PO Box 245114, Tucson, AZ 85724-5114, USA. malan@u.arizona.edu
Parecoxib sodium, the injectable prodrug of valdecoxib, is a cyclooxygenase-2-specific inhibitor that is effective in the treatment of postoperative pain. In this randomized, double-blind, placebo-controlled study, we compared the efficacy of a single dose of parecoxib sodium 40 mg IM with single doses of morphine 6 and 12 mg IM in treating postoperative pain after gynecologic surgery requiring a laparotomy incision. By nearly all efficacy measures (including total pain relief and patient's global evaluation of study medication), parecoxib sodium 40 mg IM demonstrated pain relief and a decrease in pain intensity that was statistically similar to that with morphine 12 mg IM and superior to that with morphine 6 mg IM. Parecoxib sodium 40 mg IM-treated patients also demonstrated a longer time to use of rescue medication than patients treated with both morphine doses, and this dose provided sustained pain relief over the 12-h study period. The incidence of adverse events in the active treatment groups was similar to that observed with placebo. Parecoxib sodium, 40 mg IM, has been shown to be as effective as clinically relevant doses of morphine in patients after gynecologic laparotomy surgery.
PMID: 15673875 [PubMed - in process]
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The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy.
Wu CT, Borel CO, Lee MS, Yu JC, Liou HS, Yi HD, Yang CP.
Division of Anesthesiology, Armed Forces Taoyuan General Hospital, #168 Chongshin Road, Lungtan 325, Taoyuan, Taiwan, Republic of China.
Both dextromethorphan (DM) and IV lidocaine improve postoperative pain relief. In the present study, we evaluated the interaction of DM and IV lidocaine on pain management after laparoscopic cholecystectomy (LC). One-hundred ASA physical status I or II patients scheduled for LC were randomized into four equal groups to receive either: (a) chlorpheniramine maleate (CPM) intramuscular injection (IM) 20 mg and IV normal saline (N/S) (group C); (b) DM 40 mg IM and IV N/S (group DM); (c) CPM 20 mg IM and IV lidocaine 3 mg . kg(-1) . h(-1) (group L); or (d) DM 40 mg IM and IV lidocaine (group DM+L). All treatments were administered 30 min before skin incision. Analgesic effects were evaluated using visual analog scale pain scores at rest and during coughing, time to meperidine request, total meperidine consumption, and the time to first passage of flatus after surgery. Patients of the DM+L group exhibited the best pain relief and fastest recovery of bowel function among groups. Patients in the DM and L groups had significantly better pain relief than those in the C group. The results showed an additional effect on pain relief and a synergistic effect on recovery of bowel function when DM was combined with IV lidocaine after LC.
PMID: 15673874 [PubMed - in process]
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Unintentional intrapleural insertion of an epidural catheter: should we remove it or leave it in situ to provide perioperative analgesia?
Inoue S, Nishimine N, Furuya H.
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. seninoue@naramed-u.ac.jp
We report three patients who had intrapleural insertion of an intended thoracic epidural catheter. These misplaced catheters were used for local anesthetic administration. Bupivacaine injection via these catheters in two cases was effective for reducing postoperative pain. We conclude that if an intended thoracic epidural catheter is found to be in the intrapleural cavity at the time of surgery and if correct replacement of the catheter into the epidural space is not believed to be feasible after surgery, then the administration of local anesthetic through the intrapleural catheter could be considered as a potential alterative analgesic method.
Publication Types:
PMID: 15616089 [PubMed - indexed for MEDLINE]
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Intrathecal morphine for analgesia after postpartum bilateral tubal ligation.
Habib AS, Muir HA, White WD, Spahn TE, Olufolabi AJ, Breen TW.
Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. habib001@mc.duke.edu
Postpartum bilateral tubal ligation (PPBTL) causes postoperative pain. We designed this study to determine the efficacy of 50 microg intrathecal morphine for analgesia after PPBTL. Sixty-five women received spinal anesthesia with 12.75 mg hyperbaric bupivacaine, 20 microg of fentanyl, and either 50 microg of morphine (morphine group) or 0.05 mL of saline (control group). Postoperative analgesia was provided with regular naproxen 500 mg and oxycodone 5 mg/acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P=0.003) and pain was less intense at rest (P=0.008) and on movement (P <0.0001) in the morphine group. There was no significant overall difference in nausea, pruritus, or sedation scores, but vomiting occurred more frequently in the morphine group (21.4% versus 3.5%; P=0.052). In post hoc comparisons, pain at rest within the morphine group was significantly less at 4 h (P=0.006), pain on movement was significantly less at 4 h (P=0.002) and 12 h (P=0.0004), and pruritus was significantly more frequent at 12 h (P=0.002) compared with the control group. Oxycodone 5 mg/acetaminophen 325 mg mixture consumption was significantly smaller (P=0.006) and the time to first request of analgesia was significantly longer (P=0.006) in the morphine group. We conclude that the addition of 50 microg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provides improved postoperative analgesia in women undergoing PPBTL.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15616084 [PubMed - indexed for MEDLINE]
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The evolving and important role of anesthesiology in palliative care.
Fine PG.
Department of Anesthesiology, Pain Management Center, Ste. 200, 615 Arapeen Dr., University of Utah, Salt Lake City, UT 84109, USA. fine@aros.net
A small but clinically significant proportion of dying patients experience severe physically or psychologically distressing symptoms that are refractory to the usual first-line therapies. Anesthesiologists, currently poorly represented in the rapidly evolving specialties of hospice and palliative medicine, are uniquely qualified to contribute to the comprehensive care of patients who are in this category. Anesthesiologists' interpersonal capabilities in the management of patients and families under duress, their knowledge and comfort level with the application of potent analgesic and consciousness-altering pharmacology, and their titrating and monitoring skills would add a valuable dimension to palliative care teams. This article summarizes the state of the art and means by which anesthesiologists might contribute to improvements in the important end-of-life outcome of safe and comfortable dying.
Publication Types:
PMID: 15616075 [PubMed - indexed for MEDLINE]
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Nefopam and ketamine comparably enhance postoperative analgesia.
Kapfer B, Alfonsi P, Guignard B, Sessler DI, Chauvin M.
Department of Anesthesia, Hopital Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne 92100, France.
Opioids alone sometimes provide insufficient postoperative analgesia. Coadministration of drugs may reduce opioid use and improve opioid efficacy. We therefore tested the hypothesis that the administration of ketamine or nefopam to postoperative patients with pain only partly alleviated by morphine reduces the amount of subsequent opioid necessary to produce adequate analgesia. Patients (n=77) recovering from major surgery were given up to 9 mg of IV morphine. Those who still had pain were randomly assigned to blinded administration of 1) isotonic saline (control group; n=21), 2) ketamine 10 mg (ketamine group; n=22), or 3) nefopam 20 mg (nefopam group; n=22). Three-milligram morphine boluses were subsequently given at 5-min intervals until adequate analgesia was obtained, until 60 min elapsed after the beginning of study drug administration, or until ventilation became insufficient (respiratory rate <10 breaths/min or saturation by pulse oximetry <95%). Supplemental morphine (i.e., after test drug administration) requirements were significantly more in the control group (mean +/- sd; 17 +/- 10 mg) than in the nefopam (10 +/- 5 mg; P <0.005) or ketamine (9 +/- 5 mg; P <0.001) groups. Morphine titration was successful in all ketamine and nefopam patients but failed in four control patients (two because of respiratory toxicity and two because of persistent pain). Tachycardia and profuse sweating were more frequent in patients given nefopam, and sedation was more intense with ketamine; however, the incidence of other potential complications did not differ among groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15616073 [PubMed - indexed for MEDLINE]
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Isobaric ropivacaine 5 mg/ml for spinal anesthesia in children.
Kokki H, Ylonen P, Laisalmi M, Heikkinen M, Reinikainen M.
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland. hannu.kokki@kuh.fi
In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34-210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.
Publication Types:
PMID: 15616053 [PubMed - indexed for MEDLINE]
[National survey of emergency management of acute pain in prehospital setting]
[Article in French]
Galinski M, Ruscev M, Pommerie F, Hubert G, Srij M, Lapostolle F, Adnet F.
Samu 93, EA 3409, hopital Avicenne, universite Paris-XIII, 125, route de Stalingrad, 93006 Bobigny, France. Michel.galinski@avc.ap-hop-paris.fr
OBJECTIVES: Assessment of skill of physicians staffed Mobile Intensive Care Units (MICU) in severe acute pain (SAP) management. METHODS: This study was conducted with a phone questionnaire addressed to emergency physicians of all metropolitan Smur (N =360). This questionnaire included medical teaching, professional position, means of severe acute pain assessment and definition of SAP, treatment, analgesic drug availability, locals guidelines and personal assessment of national guidelines were studied. RESULTS: Exhaustivity was more than 99% (359/360). Eighty percent of physicians were specialized in emergency care, 8% were anaesthesiologists (or intensivists), 78% worked in emergency department and 76% were full time. Forty nine percent of physicians did not know French Society of Anesthesiology and Intensive Care guidelines and 63% did not have locals analgesics guidelines. To define SAP, Visual Analogic Scale (VAS) or Numeric Scale (NS) >6/10 were mentioned only by 17%. Therapeutic efficiency was assessed and defined by VAS or NS <3/10 by 14%. Morphine was available in 90% of MICU, fentanyl in 79% and nalbuphine in 64%. Morphine was used in first intention by 71% of physicians. Guidelines about doses and waiting periods between 2 administrations were followed respectively by 6% and 28%. Ninety percent of physicians combined at least two treatments, 58 % combined at least three and 39%, at least four. CONCLUSION: This survey showed a low knowledge about severe acute pain management in out-of-hospital setting, both for pain assessment and treatment. There were few locals guidelines to overcome this deficiency. A training work is essential to improve care of acute pain in out-of-hospital setting.
PMID: 15589354 [PubMed - indexed for MEDLINE]
Opioids for persistent non-cancer pain.
Kalso E.
Publication Types:
PMID: 15661760 [PubMed - indexed for MEDLINE]
The effect of propranolol on glyceryltrinitrate-induced headache and arterial response.
Tvedskov JF, Thomsen LL, Thomsen LL, Iversen HK, Williams P, Gibson A, Jenkins K, Peck R, Olesen J.
Danish Headache Centre, University of Copenhagen and Department of Neurology, Glostrup University Hospital, Glostrup, Denmark. tvedskov@dadlnet.dk
Prophylactic drug trials in migraine are long-lasting and expensive and require long-term toxicology information. A human migraine model would therefore be helpful in testing new drugs. Immediate headache and delayed migraine after glyceryltrinitrate (GTN) has been well characterized. We have recently shown that sodium valproate has prophylactic effect in the GTN model. Here we report our experience with propranolol in this model. Nineteen subjects with migraine without aura and 16 sex- and aged-matched healthy subjects were included in a two-centre randomized double-blind cross-over study. Fourteen migraine subjects and 14 healthy subjects completed the study and results from comparison of the 28 subjects are reported. Randomly propranolol 160 mg or placebo were each given daily for 14 days to both migraine and healthy subjects. A 20-min intravenous infusion of GTN 0.25 microg/kg per min was administered on a study day at the end of both pretreatment periods. Headache was registered for 12 h after GTN infusions. Its intensity was scored on a numerical verbal rating scale from 0 to 10. Fulfilment of International Headache Society (HIS) criteria was recorded for 24 h. Radial and superficial temporal artery diameters and blood velocity of both middle cerebral arteries were measured. All migraine subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 5, range 0-7) compared with placebo (median 5, range 0-10) (P = 0.441). Eight of the 14 completing migraine subject developed IHS 1.1 migraine after GTN, two subjects on both days, three subjects only after placebo, and three subjects only after propranolol. No reduction of GTN-induced migraine was found after propranolol compared with placebo (5 vs. 5, P = 1.000). All healthy subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 2, range 1-5) compared with placebo (median 1, range 1-7) (P = 0.315). Two subjects fulfilled IHS criteria 1.1 for migraine without aura after propranolol but not after placebo. The fulfilment was short lasting and did not require rescue medication. Headache after GTN was more pronounced in migraine subjects than in healthy subjects both with (P = 0.003) and without pretreatment with propranolol (P = 0.017). We found that 2 weeks of propranolol constricted the radial artery in healthy subjects but not in migraine subjects. GTN-induced vasodilatation abolished this difference. Mean maximum blood flow velocity in the middle cerebral artery was higher in healthy subjects than in migraine patients (P = 0.003-0.033) and unaffected by propranolol. We observed no effect of propranolol on GTN-induced headache and migraine. This could indicate that GTN induces migraine at a deeper level of the pathophysiological cascade of migraine than the prophylactic effect of propranolol. Propranolol does not constrict cerebral arteries, which therefore cannot be part of its mechanism of action in migraine.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15566422 [PubMed - indexed for MEDLINE]
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SUNCT syndrome in the elderly.
Cohen AS, Matharu MS, Goadsby PJ.
Headache Group, Institute of Neurology, Queen Square, London, UK.
Publication Types:
PMID: 15154862 [PubMed - indexed for MEDLINE]
Screening to identify patients at risk: profiles of psychological risk factors for early intervention.
Boersma K, Linton SJ.
Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden. katja.boersma@orebroll.se
There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.
Publication Types:
PMID: 15599130 [PubMed - indexed for MEDLINE]
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Lower back pain and mass in a 13-year-old girl.
Ricchetti ET, Erol B, Stern J, Russo P, States L, Dormans JP.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Publication Types:
PMID: 15662332 [PubMed - in process]
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Broad analgesic profile of buprenorphine in rodent models of acute and chronic pain.
Christoph T, Kogel B, Schiene K, Meen M, De Vry J, Friderichs E.
Department of Pharmacology, Grunenthal GmbH Research and Development, Zieglerstrasse 6, D-52078 Aachen, Germany.
Buprenorphine is a potent opioid analgesic clinically used to treat moderate to severe pain. The present study assessed its analgesic efficacy in a broad range of rodent models of acute and chronic pain. In the phenylquinone writhing, hot plate, and tail flick mouse models of acute pain, full analgesic efficacy was obtained (ED(50) values: 0.0084-0.16 mg/kg i.v.). Full analgesic efficacy was also obtained in yeast- and formalin-induced inflammatory pain (ED(50) values: 0.0024-0.025 mg/kg i.v., rats and mice) and in mustard-oil-induced spontaneous pain, referred allodynia, and referred hyperalgesia in mice (ED(50) values: 0.018-0.025 mg/kg i.v.). Buprenorphine strongly inhibited mechanical and cold allodynia in mononeuropathic rats, as well as mechanical hyperalgesia and cold allodynia in polyneuropathic rats (ED(50) values: 0.055 and 0.036 mg/kg i.v. and 0.129 and 0.038 mg/kg i.p., respectively). It is concluded that buprenorphine shows a broad analgesic profile and offers the opportunity to treat different pain conditions, including neuropathic pain.
PMID: 15659298 [PubMed - in process]
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Amitriptyline produces multiple influences on the peripheral enhancement of nociception by P2X receptors.
Waldron JB, Reid AR, Sawynok J.
Department of Pharmacology, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, Canada B3H 1X5.
Peripherally administered amitriptyline exhibits potential to be a locally active analgesic, while ATP augments peripheral nociception by interacting with P2X(3) receptors on sensory afferents. The present study examined the effects of amitriptyline on flinching and biting/licking behaviours and thermal hyperalgesia produced by alphabeta-methylene-ATP (alphabeta-MeATP), a ligand for P2X(3) receptors, following intraplantar administration into the hindpaw of rats. Coadministration of low doses of amitriptyline (up to 100 nmol) with alphabeta-MeATP augmented thermal hyperalgesia and flinching behaviours. The most active dose of amitriptyline (100 nmol) had no intrinsic effect. Augmentation of alphabeta-MeATP actions appears to be due to increased tissue levels of biogenic amines resulting from inhibition of uptake, as phentolamine (alpha(1)/alpha(2)-adrenergic receptor antagonist) and methysergide (5-hydroxytryptamine or 5-HT(1)/5-HT(2) receptor antagonist) inhibit the augmented flinching produced by alphabeta-MeATP/amitriptyline. When noradrenaline and 5-HT were coadministered with alphabeta-MeATP (both increase the effect of alphabeta-MeATP), amitriptyline had no effect on flinching produced by alphabeta-MeATP/noradrenaline but inhibited flinching produced by alphabeta-MeATP/5-HT. In the presence of low concentrations of formalin (0.5%, 1%; which also increase the effect alphabeta-MeATP), amitriptyline inhibited augmented behaviours. Higher doses of amitriptyline (300-1000 nmol) increased thermal thresholds, suppressed thermal hyperalgesia produced by alphabeta-MeATP, and inhibited flinching produced by alphabeta-MeATP. Collectively, these results indicate that amitriptyline produces complex influences on peripheral pain signaling by P2X receptors. Lower doses augment nociception by alphabeta-MeATP (probably by inhibiting noradrenaline and 5-HT uptake) but inhibit alphabeta-MeATP responses in the presence of inflammatory mediators (perhaps reflecting receptor blocking properties); higher doses uniformly inhibit nociception by alphabeta-MeATP (perhaps reflecting local anesthetic properties).
PMID: 15381049 [PubMed - indexed for MEDLINE]
Diversion and abuse of methadone prescribed for pain management.
Cicero TJ, Inciardi JA.
Publication Types:
PMID: 15657321 [PubMed - indexed for MEDLINE]
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Headache: triumphs in translational research.
Lipton RB, Bigal ME.
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. rlipton@aecom.yu.edu
Publication Types:
PMID: 15620852 [PubMed - indexed for MEDLINE]
Comment on:
Case 29-2004: a woman with acute onset of chest pain and fever.
Medford AR.
Publication Types:
PMID: 15659741 [PubMed - indexed for MEDLINE]
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Pain.
Bowsher D.
Neurological Science, Pain Research Institute, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, UK.
Publication Types:
PMID: 15661454 [PubMed - in process]
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Extensive abscess formation after repeated paravertebral injections for the treatment of chronic back pain.
Puehler W, Brack A, Kopf A.
Klinik fur Anaesthesiologie und operative Intensivmedizin, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany.
Paravertebral injections are commonly used for the treatment of chronic back pain despite the lack of evidence for their efficacy. Here, we report a case in which repeated paravertebral injections of local anesthetics, corticosteroids and botulinum toxin resulted in extensive abscess formation involving the entire paravertebral musculature descending to the level of the midthighs. These abscesses induced a systemic inflammatory response syndrome and required surgical drainage as well as broad-spectrum antibiotic therapy.
PMID: 15661453 [PubMed - in process]
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Confirmatory factor analysis of the Pain Catastrophizing Scale in African American and Caucasian Workers' Compensation claimants with low back injuries.
Chibnall JT, Tait RC.
Department of Psychiatry, Saint Louis University School of Medicine, 1221 South Grand Boulevard, St Louis, MO 63108, USA.
Pain catastrophizing is an important cognitive construct that has been linked with many aspects of the pain experience, including pain intensity, emotional distress, pain-related disability, and pain behavior. The Pain Catastrophizing Scale (PCS), an instrument often used to assess this construct, reflects three aspects of catastrophizing: Rumination, Magnification, and Helplessness. Its factor structure, however, has never been examined in clinical samples of persons with occupational injury or as a function of race. In this study, exploratory and confirmatory factor analyses were used to examine the factor structure of the PCS in a large, racially diverse sample of Workers' Compensation claimants with low back injuries. Results indicated that a two-factor model of the PCS (Rumination and 'Powerlessness,' the latter a combination of the PCS Magnification and Helplessness scores) was the most parsimonious fit to the data, particularly in the African American sample. Future research in other clinical samples that include African Americans is needed to examine the stability of the results reported here.
PMID: 15661446 [PubMed - in process]
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Vagal stomach afferents inhibit somatic pain perception.
Sedan O, Sprecher E, Yarnitsky D.
Technion Medical School, Rambam Medical Center, Haifa, Israel.
Vagal stimulation inhibits systemic pain perception in animals, probably via the nucleus tractus solitarius and its connections with descending nuclei in the brainstem which inhibit pain. Pain-inhibiting effects of such stimulation in humans, obtained from epileptic patients treated by vagal stimulation, are controversial. The aim of our study was to evaluate whether vagal stomach afferent activation inhibits pain perception in healthy humans. Pain thresholds, magnitude of tonic heat pain at 46 degrees C stimulation, pain temporal summation and laser pain evoked potentials were measured at the hand before and immediately after rapid drinking of 1500ml water in 31 volunteers. We found an increase in heat pain threshold from 43.3+/-2.6 to 44.7+/-2.2 degrees C, P<0.0001, a decrease of peak pain magnitude to tonic heat from 56.3+/-26.2 to 43.7+/-25.8 (on 0-100 VAS), P<0.0001, a lowering of area under the curve during tonic noxious heat stimulus from 1962+/-984 to 1411+/-934, P<0.001. Additionally, we observed a decrease in the peak to peak evoked potential amplitude from 19.2muV+/-1.2 to 15.6muV+/-1.2 (P=0.005) together with a decrease in the estimation of mean laser induced pain from 52.28+/-18.00 to 48.14+/-20.18 (P=0.025). Mechanical pain thresholds and temporal summation did not change significantly. We conclude that vagal stomach afferents exert an inhibitory effect on somatic pain perception in humans.
PMID: 15661444 [PubMed - in process]
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Long-term effects of neonatal surgery on adulthood pain behavior.
Sternberg WF, Scorr L, Smith LD, Ridgway CG, Stout M.
Department of Psychology, Haverford College, 370 Lancaster Avenue, Haverford, PA 19041, USA.
The long-term consequences of neonatal noxious stimulation on adulthood pain behavior were investigated in male and female mice. On the day of birth, mouse pups were exposed to a laparotomy under cold anesthesia followed by an analgesic dose of morphine (10mg/kg) post-operatively, or a saline control. An additional group of subjects was exposed to the non-noxious aspects of the surgical procedure (cold exposure, separation from the dam, injection) comprising a 'sham' surgery control group, whereas another group of control subjects was administered an injection of saline or morphine, but was otherwise undisturbed. Behavioral observations of the pups immediately following the procedure indicated that the laparotomy produced increased distress vocalizations in the ultrasonic range (40kHz) compared to both groups of control subjects. During 90min observations periods following the surgery and 1-week later, maternal care did not vary among treatment conditions. In adulthood, offspring were tested for nociceptive sensitivity on the hot-plate (HP; 53 degrees C), tail-withdrawal (TW; 50 degrees C) and acetic acid abdominal constriction test (AC). On both the TW and the AC tests, neonatal surgery decreased pain behavior relative to both groups of control subjects, an effect that was reversed by post-operative morphine treatment. On the HP test, both groups of subjects exposed to the stressful aspects of neonatal surgery (laparotomy or sham surgery) exhibited decreased pain behavior in adulthood. These findings suggest that early exposure to noxious and/or stressful stimuli may induce long-lasting changes in pain behavior, perhaps mediated by alterations in the stress-axis and antinociceptive circuitry.
PMID: 15661443 [PubMed - in process]
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Significantly higher methadone dose for methadone maintenance treatment (MMT) patients with chronic pain.
Peles E, Schreiber S, Gordon J, Adelson M.
The Dr Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel-Aviv Elias Sourasky Medical Center, 1 Henrietta Szold Street, Tel Aviv 64924, Israel.
The aim of this study is to characterize patients with chronic pain in methadone maintenance treatment (MMT). Between September and December, 2003, 170 consecutive patients from an MMT clinic participated in a questionnaire survey on pain (duration and severity). Chronic pain was defined as current pain lasting for >/=6 months. The patients' maintenance methadone dosage and urine tests for drug abuse during the month before and of the survey were recorded. Of the 170 patients, 94 (55.3%) experienced chronic pain. They had a significantly higher proportion of chronic illness (74.5%) compared to non-pain patients (44.7%) (Fisher's Exact Test P<0.0005). Twelve (12.8%) of the chronic pain patients scored their pain as mild, 38 (40.4%) as moderate, 22 (23.4%) as severe and 22 (23.4%) as very severe. Pain duration significantly correlated with pain severity (Pearson R=0.3, P>0.0005) and was significantly associated with methadone daily dosage: patients with pain duration of >/=10 years (n=26) were receiving the highest methadone dosage (182.1+/-59.2mg/day), those with pain duration from 1 to 10 years (n=59) 160.9+/-56.2mg/day, and those with pain duration of <1 year (n=9) 134.2+/-73.2mg/day. Patients in the non-pain group (n=76) were receiving 147.1+/-52.8mg/day of methadone (ANOVA, F=3.1, P=0.03). We conclude that pain duration and severity significantly correlated. Although methadone was not prescribed for the treatment of pain but rather for opiate addiction, the patients in the MMT clinic with prolonged pain were prescribed a significantly higher methadone dosage compared to patients with short pain duration, and non-pain patients.
PMID: 15661442 [PubMed - in process]
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Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication.
Von Korff M, Crane P, Lane M, Miglioretti DL, Simon G, Saunders K, Stang P, Brandenburg N, Kessler R.
Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA.
This paper investigates comorbidity between chronic back and neck pain and other physical and mental disorders in the US population, and assesses the contributions of chronic spinal pain and comorbid conditions to role disability. A probability sample of US adults (n=5692) was interviewed. Chronic spinal pain, other chronic pain conditions and selected chronic physical conditions were ascertained by self-report. Mood, anxiety and substance use disorders were ascertained with the Composite International Diagnostic Interview (CIDI). Role disability was assessed with questions about days out of role and with impaired role functioning. The 1 year prevalence of chronic spinal pain was 19.0%. The vast majority (87.1%) of people with chronic spinal pain reported at least one other comorbid condition, including other chronic pain conditions (68.6%), chronic physical conditions (55.3%), and mental disorders (35.0%). Anxiety disorders showed as strong an association with chronic spinal pain as did mood disorders. Common conditions not significantly comorbid with chronic spinal pain were diabetes, heart disease, cancer, and drug abuse. Chronic spinal pain was significantly associated with role disability after controlling for demographic variables and for comorbidities. However, comorbid conditions explained about one-third of the gross association of chronic spinal pain with role disability. We conclude that chronic spinal pain is highly comorbid with other pain conditions, chronic diseases, and mental disorders, and that comorbidity plays a significant role in role disability associated with chronic spinal pain. The societal burdens of chronic spinal pain need to be understood and managed within the context of comorbid conditions.
PMID: 15661441 [PubMed - in process]
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A trial of an activating intervention for chronic back pain in primary care and physical therapy settings.
Von Korff M, Balderson BH, Saunders K, Miglioretti DL, Lin EH, Berry S, Moore JE, Turner JA.
Group Health Cooperative, Center for Health Studies, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA.
In primary care and physical therapy settings, we evaluated an intervention for chronic back pain patients which incorporated fear reducing and activating techniques. Primary care patients seen for back pain in primary care were screened to identify persons with significant activity limitations 8-10 weeks after their visit. Eligible and willing patients were randomized (N=240). A brief, individualized program to reduce fear and increase activity levels was delivered by a psychologist and physical therapists. Over a 2 year follow-up period, intervention patients reported greater reductions in pain-related fear (P<0.01), average pain (P<0.01) and activity limitations due to back pain (P<0.01) relative to control patients. The percent with greater than a one-third reduction in Roland Disability Questionnaire scores at 6 months was 42% among Intervention patients and 24% among control patients (P<0.01). Over the 2 year follow-up, fewer intervention patients reported 30 or more days unable to carry out usual activities in the prior 3 months (P<0.01). The adjusted mean difference in activity limitation days was 4.5 days at 6 months, 2.8 days at 12 months, and 6.9 days at 24 months. No differences were observed in the percent unemployed or the percent receiving worker's compensation or disability benefits, but these outcomes were relatively uncommon. We conclude that an intervention integrating fear reducing and activating interventions into care for chronic back pain patients produced sustained reductions in patient fears, common activity limitations related to back pain, and days missed from usual activities due to back pain.
PMID: 15661440 [PubMed - in process]
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Rofecoxib attenuates both primary and secondary inflammatory hyperalgesia: a randomized, double blinded, placebo controlled crossover trial in the UV-B pain model.
Sycha T, Anzenhofer S, Lehr S, Schmetterer L, Chizh B, Eichler HG, Gustorff B.
Department of Neurology, Medical University of Vienna, Wahringer-Gurtel 18-20 A-1090 Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna,Vienna, Austria.
The analysis of drug's influence on peripheral and central sensitisation can give useful information about its mode of action and can lead to more efficacy in the treatment of pain. Peripheral inflammation is associated with peripheral expression and up-regulation of cyclooxygenase 2 (COX-2) in the CNS. The relative contribution of COX-2 mediated central sensitisation may be prominent under inflammatory conditions. In this randomized, double blinded, placebo controlled cross-over trial the effects of multidoses of the COX-2 selective inhibitor rofecoxib on primary and secondary hyperalgesia were evaluated in the UVB pain model. Twenty-four hours after local UVB irradiation at the upper leg of 42 healthy volunteers heat pain perception (HPPT) and heat pain tolerance thresholds (HPTT) were assessed within the inflammation. The area of secondary hyperalgesia was determined by pin prick test. Subjects received oral rofecoxib 50, 250, 500mg or placebo. Pain testing was repeated after 3 and 6h. Compared to placebo, rofecoxib significantly increased HPPT (1.55 and 1.08 degrees C, P<0.0001 and P=0.0333), HPTT (1.74 and 1.58 degrees C, P<0.0001 and P<0.0001), and reduced the mean area of secondary hyperalgesia by 15.6% (P=0.007) and 16.8% (P<0.001) after 3 and 6h. No significant difference between the three dosage groups was observed. These data confirm peripheral effects of rofecoxib in a human inflammatory UV-B pain model and provide circumstantial evidence that even a standard clinical dose of rofecoxib reduces central hyperalgesia in inflammatory pain. We confirm that the effect of single oral dose of rofecoxib plateaus at 50mg.
PMID: 15661439 [PubMed - in process]
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Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions.
Sullivan MJ, Lynch ME, Clark AJ.
Department of Psychology, University of Montreal, C.P. 6128 Succ Centre Ville, Montreal, Que., Canada H3C 3J7.
The objective of the present study was to examine the relative contributions of different dimensions of catastrophic thinking (i.e. rumination, magnification, helplessness) to the pain experience and disability associated with neuropathic pain. Eighty patients with diabetic neuropathy, post-herpetic neuralgia, post-surgical or post-traumatic neuropathic pain who had volunteered for participation in a clinical trial formed the basis of the present analyses. Spontaneous pain was assessed with the sensory and affective subscales of the McGill Pain Questionnaire. Pinprick hyperalgesia and dynamic tactile allodynia were used as measures of evoked pain. Consistent with previous research, individuals who scored higher on a measure of catastrophic thinking (Pain Catastrophizing Scale; PCS) also rated their pain as more intense, and rated themselves to be more disabled due to their pain. Follow up analyses revealed that the PCS was significantly correlated with the affective subscale of the MPQ but not with the sensory subscale. The helplessness subscale of the PCS was the only dimension of catastrophizing to contribute significant unique variance to the prediction of pain. The PCS was not significantly correlated with measures of evoked pain. Catastrophizing predicted pain-related disability over and above the variance accounted for by pain severity. The findings are discussed in terms of mechanisms linking catastrophic thinking to pain experience. Treatment implications are addressed.
PMID: 15661438 [PubMed - in process]
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Neonatal procedural pain exposure predicts lower cortisol and behavioral reactivity in preterm infants in the NICU.
Grunau RE, Holsti L, Haley DW, Oberlander T, Weinberg J, Solimano A, Whitfield MF, Fitzgerald C, Yu W.
Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Canada; Children's and Women's Health Centre of British Columbia, Vancouver, Canada.
Data from animal models indicate that neonatal stress or pain can permanently alter subsequent behavioral and/or physiological reactivity to stressors. However, cumulative effects of pain related to acute procedures in the neonatal intensive care unit (NICU) on later stress and/or pain reactivity has received limited attention. The objective of this study is to examine relationships between prior neonatal pain exposure (number of skin breaking procedures), and subsequent stress and pain reactivity in preterm infants in the NICU. Eighty-seven preterm infants were studied at 32 (+/-1 weeks) postconceptional age (PCA). Infants who received analgesia or sedation in the 72h prior to each study, or any postnatal dexamethasone, were excluded. Outcomes were infant responses to two different stressors studied on separate days in a repeated measures randomized crossover design: (1) plasma cortisol to stress of a fixed series of nursing procedures; (2) behavioral (Neonatal Facial Coding System; NFCS) and cardiac reactivity to pain of blood collection. Among infants born </=28 weeks gestational age (GA), but not 29-32 weeks GA, higher cumulative neonatal procedural pain exposure was related to lower cortisol response to stress and to lower facial (but not autonomic) reactivity to pain, at 32 weeks PCA, independent of early illness severity and morphine exposure since birth. Repeated neonatal procedural pain exposure among neurodevelopmentally immature preterm infants was associated with down-regulation of the hypothalamic-pituitary-adrenal axis, which was not counteracted with morphine. Differential effects of early pain on development of behavioral, physiologic and hormonal systems warrant further investigation.
PMID: 15661436 [PubMed - as supplied by publisher]
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Self-management of chronic pain: a population-based study.
Blyth FM, March LM, Nicholas MK, Cousins MJ.
Pain Management and Research Institute, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
While effective self-management of chronic pain is important, clinic-based studies exclude the more typical pattern of self-management that occurs in the community, often without reference to health professionals. We examined specific hypotheses about the use of self-management strategies in a population-based study of chronic pain subjects. Data came from an Australian population-based random digit dialling computer-assisted telephone survey and included 474 adults aged 18 or over with chronic pain (response rate 73.4%). Passive strategies were more often reported than active ones: passive strategies such as taking medication (47%), resting (31.5%), and using hot/cold packs (23.4%) were most commonly reported, while the most commonly reported active strategy was exercising (25.8%). Only 33.5% of those who used active behavioural and/or cognitive strategies used them exclusively, while 67.7% of those who used passive behavioural and/or conventional medical strategies did so exclusively. Self-management strategies were associated with both pain-related disability and use of health services in multiple logistic regression models. Using passive strategies increased the likelihood of having high levels of pain-related disability (adjusted OR 2.59) and more pain-related health care visits (adjusted OR 2.9); using active strategies substantially reduced the likelihood of having high levels of pain-related disability (adjusted OR 0.2). In conclusion, we have shown in a population-based study that clinical findings regarding self-management strategies apply to the broader population and advocate that more attention be given to community-based strategies for improving awareness and uptake of active self-management strategies for chronic pain.
PMID: 15661435 [PubMed - in process]
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The effect on mechanical pain threshold over human muscles by oral administration of granisetron and diclofenac-sodium.
Christidis N, Kopp S, Ernberg M.
Department of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Box 4064, SE-141 04 Huddinge, Sweden.
Previous studies indicate that plasma levels of serotonin (5-HT) and intramuscular prostaglandin E(2) (PGE(2)) participate in determining the mechanical pain threshold and tolerance level to pressure applied on the skin over healthy muscles. Other studies reported gender differences regarding responses to noxious stimuli. The present study aimed to determine whether the mechanical pain threshold of healthy muscles is influenced by oral administration of 5-HT(3) or PGE(2)-inhibitors and if there are any gender differences in this respect. Ten healthy female subjects and 10 age-matched healthy male subjects participated in the study, which was randomized and double blind with crossover design. Granisetron (5-HT(3)-antagonist), diclofenac-sodium (PGE(2)-antagonist) and placebo were administered for 3 days. The pressure pain threshold (PPT) was recorded bilaterally with an algometer over certain orofacial, trunk, and limb muscles before and after administration of the antagonists. The PPT over all muscles combined increased after administration of granisetron. There was no change after administration of placebo. The difference between granisetron and placebo was significant for the trapezius and tibialis anterior muscles. Diclofenac-sodium did not influence the PPT and there was no difference compared to placebo. Although the basal PPT values were lower in females, the PPT response to granisetron differed significantly between genders only in the tibialis anterior muscle. In conclusion, the results of this study showed that oral administration of the 5-HT(3)-antagonist granisetron increased the PPT over healthy trunk and limb muscles but not over orofacial muscles, and that the response in the limb muscles was greater in males.
PMID: 15661432 [PubMed - in process]
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The effects of racemic ketamine on painful stimulation of skin and viscera in human subjects.
Strigo IA, Duncan GH, Catherine Bushnell M, Boivin M, Wainer I, Rodriguez Rosas ME, Persson J.
Department of Anesthesia, Centre for Research on Pain, McGill University, 3640 University Street, Rm. M/19, Montreal, Que. H3A 2B2, Canada.
Evidence suggests that NMDA receptors may have a differential role in the modulation of visceral and somatic pain. Specifically, animal data indicate an analgesic role of NMDA-R antagonists in acute visceral but not acute somatic pain. In humans analgesic effects are documented in acute somatic pain, while the role of NMDA-R antagonists in acute visceral pain is still questionable. We, therefore, conducted a study in humans comparing the analgesic effects of ketamine in an experimental model of visceral and cutaneous pain. In a double-blind, randomized, cross-over study, 11 healthy volunteers (3M, 8F) participated in two experimental sessions in which they evaluated perceptions induced by balloon distention of the distal esophagus and contact heat on the upper chest during continuous computer-controlled i.v. infusion of either ketamine (60 and 120ng/mL) or saline. Two stimulus intensities producing non-painful and painful sensation were used for each stimulus modality. Subjects reported maximum pain intensity and unpleasantness on visual analog scales (VAS). For noxious visceral stimulation, low dose ketamine produced significant attenuation of both pain intensity and unpleasantness. In contrast, for noxious cutaneous stimulation, ketamine reduced pain unpleasantness, but not perceived intensity. In addition, ketamine did not alter the perception of innocuous stimuli in either modality. Our results confirm the analgesic effects of low-dose ketamine, with minimal side effects, on acute visceral pain and indicate a similar but smaller effect on acute cutaneous pain. A decrease in the unpleasantness but not in the intensity of cutaneous pain may reflect the differential effect of NMDA-R antagonists for the two pain states observed in animal models.
PMID: 15661431 [PubMed - in process]
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Pharmacological treatment of peripheral neuropathic pain conditions based on shared commonalities despite multiple etiologies.
Hansson PT, Dickenson AH.
Neurogenic Pain Unit, Section of clinical pain research, Department of Surgical Sciences, Multidisciplinary Pain Center, Karolinska institutet/university hospital Solna, 171 76 Stockholm, Sweden; Department of Rehabilitation Medicine, Karolinska institutet/university hospital Solna, 171 76 Stockholm, Sweden.
PMID: 15661430 [PubMed - as supplied by publisher]
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Active self-management of chronic pain in the community.
Smith BH, Elliott AM.
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK.
Publication Types:
PMID: 15661429 [PubMed - in process]
The role of tramadol in cancer pain treatment-a review.
Leppert W, Luczak J.
Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Osiedle Rusa 25 A, 61-245, Poznan, Poland, wojciechleppert@wp.pl.
In most cancer patients pain can be successfully treated with pharmacological measures using opioid analgesics alone or in combination with adjuvant analgesics (coanalgesics). Weak opioids are usually recommended in the treatment of moderate cancer pain. There is still a debate as to whether the second step of the WHO analgesic ladder comprising opioid analgesics such as tramadol, codeine, dihydrocodeine, and dextropropoxyphene is still needed for the treatment of cancer pain. On the basis of our experience and review of the literature we think that there is definitely a place for weak opioids in the treatment of moderate cancer pain. One of the most interesting and useful weak opioids is tramadol (Adolonta, Contramal, Nobligan, Top-Algic, Tramal, Tramal Long, Tramal Retard, Tramundin, Trodon, Ultram, Zydol). Its unique mechanism of action, analgesic efficacy and profile of adverse reactions have been the reason of performing many experimental and clinical studies with tramadol. In this article we summarize data on pharmacology, mechanisms of action, pharmacokinetics, side effects and clinical experience assessing analgesic efficacy, adverse reactions and safety of tramadol in cancer pain.
PMID: 15668743 [PubMed - in process]
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Radiotherapy, morphine, and bone pain: a difficult relationship?
Sbanotto A, Banfi M, Alterio D, Rocca A.
Medical Oncology Division, European Institute of Oncology, Via Ripamonti 435, 20141, Milano, Italy, alberto.sbanotto@ieo.it.
PMID: 15657687 [PubMed - as supplied by publisher]
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Relationship between morphine and radiotherapy for management of symptomatic bone metastases from lung cancer.
Ishiyama H, Shibata A, Niino K, Hosoya T.
Department of Radiology, Faculty of Medicine, Yamagata University, Iidanishi, 2-2-2 Yamagata City, Yamagata, Japan. hishiyam@kitasato-u.ac.jp
To determine whether radiotherapy is effective for reducing morphine dose in patients with bone metastasis from lung cancer, a retrospective study was undertaken of 58 patients who had undergone palliative radiotherapy. Mean dose of radiotherapy was 20.26 (range 8-60) Gy. Daily morphine dose after start of radiotherapy was significantly greater than before radiotherapy, and dose of morphine did not significantly decrease. Radiotherapy appears ineffective for reducing morphine dose in patients with bone metastasis from lung cancer.
PMID: 15290428 [PubMed - indexed for MEDLINE]
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