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Etoricoxib provides analgesic efficacy to patients after knee or hip replacement surgery: a randomized, double-blind, placebo-controlled study.
Rasmussen GL, Malmstrom K, Bourne MH, Jove M, Rhondeau SM, Kotey P, Ang J, Aversano M, Reicin AS; Etoricoxib Postorthopedic Study Group.
Orthopedic Specialty Hospital, Murray, Utah, USA.
In this randomized, double-blind, placebo-controlled, multicenter study we assessed the analgesic effect of etoricoxib (a new cyclooxygenase-2 inhibitor) in patients having had knee or hip replacement surgery. A total of 228 patients with moderate or severe pain were randomly allocated within 72 h after surgery to receive etoricoxib 120 mg, controlled-release naproxen sodium 1100 mg, or placebo (1:1:1) on day 1 followed by etoricoxib and placebo (1:2) on days 2 to 7. Patients reported pain scores, rescue (opioid-combination) medication use, and the response to study drug. On day 1, etoricoxib provided an analgesic effect superior to placebo and similar to controlled-release naproxen sodium as demonstrated by the total pain relief score over 8 h, the primary end-point; least-squares mean scores were 11.0, 11.5, and 5.6, respectively (P < 0.001 versus placebo). Similarly, a larger percentage of patients receiving etoricoxib and naproxen sodium than those receiving placebo reported good to excellent responses to study drug: 53%, 60%, and 26% respectively. On days 2-7, etoricoxib demonstrated a significant reduction of rescue medication use, 35% (P < 0.001 versus placebo). The clinical relevance of the decrease was confirmed by Patient's Global Evaluation (P < 0.05 versus placebo). Patients receiving etoricoxib also experienced significantly less "worst" and "average" pain than did those on placebo. Etoricoxib was generally well tolerated in this study; the incidence of adverse experiences was infrequent and similar across treatment groups. In summary, etoricoxib provided analgesia that was similar to controlled-release naproxen sodium on day 1 and superior to placebo with reduced supplemental opioid use over 7 days. IMPLICATIONS: In a postsurgery setting (knee and hip replacements), etoricoxib 120 mg provided analgesia superior to placebo and similar to controlled-release naproxen sodium 1100 mg. Patients receiving etoricoxib suffered less pain and took less opioid rescue medication compared with patients on placebo.
Publication Types:
PMID: 16192529 [PubMed - indexed for MEDLINE]
Headache children with temporomandibular disorders have several types of pain and other symptoms.
Liljestrom MR, Le Bell Y, Anttila P, Aromaa M, Jamsa T, Metsahonkala L, Helenius H, Viander S, Jappila E, Alanen P, Sillanpaa M.
Institute of Dentistry, University of Turku, Turku, Finland.
Headache children with temporomandibular disorders have several types of pain and other symptoms. Cephalalgia 2005. London. ISSN 0333-1024 The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13-14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.
PMID: 16232157 [PubMed - in process]
Shock Wave Therapy for Chronic Achilles Tendon Pain: A Randomized Placebo-controlled Trial.
Costa ML, Shepstone L, Donell ST, Thomas TL.
From *The Norfolk and Norwich University Hospital, Norwich, UK; daggerThe Institute of Health, University of East Anglia, Norwich, UK; and the double daggerDepartment of Orthopaedics, Colchester General Hospital, Colchester, UK.
Shock wave therapy has been used for treatment of several soft tissue disorders that are characterized by chronic pain. We sought to determine if shock wave therapy reduces chronic Achilles tendon pain. Forty-nine patients were enrolled in a double-blind randomized placebo-controlled trial. Each patient was treated once a month for 3 months. The primary outcome measure was a reduction in Achilles tendon pain during walking. At the end of the trial, we found no difference in pain relief between the shock wave therapy group and the control group. There were two patients (62 years and 65 years) with tendon ruptures in the treatment group, suggesting caution when treating older patients. These results provide no support for the use of shock wave therapy for treatment of patients with chronic Achilles tendon pain. However, the confidence intervals include the potential for a clinically relevant treatment effect.Level of Evidence: Therapeutic study, Level I (systematic review of Level I RCTs-and study results were homogenous). See the Guidelines for Authors for a complete description of levels of evidence.
PMID: 16239807 [PubMed - as supplied by publisher]
Reduction of pain on injection of propofol using meperidine and remifentanil.
Basaranoglu G, Erden V, Delatioglu H, Saitoglu L.
Department of Anesthesiology, Vakif Gureba Hospital, Istanbul, Turkey.
PMID: 16225729 [PubMed - in process]
Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain.
Singh M, Mohta M, Sethi AK, Tyagi A.
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and G.T.B. Hospital Delhi, India.
PMID: 16225728 [PubMed - in process]
Atlas of Interventional Pain Management, 2nd edition : S. D. Waldman. Saunders, Elsevier: Philadelphia, USA, 2004, 618 pp; indexed, illustrations by J. I. Bloch and C. H. Duckwall ISBN: 0-7216-0108-1; Price pound130.00.
Hester J.
London, UK.
PMID: 16223451 [PubMed - in process]
Analgesic properties of the novel compound M43068 in rat models of acute and neuropathic pain.
Akada Y, Mori R, Kato Y, Yamasaki F, Mochizuki H.
Pharmaceutical Research Center, Mochida Pharmaceutical Co., Ltd. 722 Jimba-aza-Uenohara, Gotemba, Shizuoka 412-8524, Japan.
We investigated the effects of 2-(4-hydroxybenzoyl)amino-2-methylpropionic acid (M43068), a novel analgesic agent, in rat models of acute and neuropathic pain. Oral M43068 (10-100 mg/kg) suppressed only the late phase of formalin-induced nociceptive behaviors. In the neuropathic pain model, oral M43068 (10-100 mg/kg) suppressed mechanical allodynia in the nerve-injured paw without affecting normal thresholds. On the other hand, i.v. M43068 (30 mg/kg) mainly suppressed the Abeta-fiber-mediated response with the Neurometer. I.c.v. pretreatment with the alpha(1)-adrenoceptor antagonist, prazosin, or i.p. pretreatment with the gamma-aminobutyric acid (GABA)(B) receptor antagonist, saclofen, abolished the M43068-induced antinociception. However, oral M43068 (30-300 mg/kg) had no influence on blood pressure and motor function, unlike the alpha(1)-adrenoceptor and the GABA(B) receptor agonists. These data indicate that M43068 shows antinociceptive and anti-allodynic effects with reduced risks of side effects. It is suggested that the descending noradrenergic system is involved in the analgesic effects of M43068.
PMID: 16226249 [PubMed - in process]
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The novel analgesic, F 13640, produces intra- and postoperative analgesia in a rat model of surgical pain.
Kiss I, Degryse AD, Bardin L, Gomez de Segura IA, Colpaert FC.
Klinik fur Anasthesie, Intensivmedizin und Schmerztherapie, Alfried Krupp Krankenhaus, 45117 Essen, Germany.
F 13640 is a newly discovered high-efficacy 5-HT(1A) receptor agonist that produces exceptional analgesia in animal models of tonic and chronic, nociceptive and neuropathic pains by novel molecular and neuroadaptive mechanisms. Here we examined the effects of F 13640 and remifentanil (0.63 mg/kg with either compound) when injected i.p. either before or 15 min after rats underwent orthopedic surgery. Surgery consisted of the drilling of a hole in the calcaneus bone and of an incision of the skin, fascia and plantar muscle of one foot. During surgery, the concentration of volatile isoflurane was progressively incremented depending on the animal's response to surgical maneuvers. Other experiments examined the dose-dependent effects of F 13640 (0.04 to 0.63 mg/kg) on surgical pain as well as on the Minimum Alveolar Concentration of isoflurane. Both F 13640 and remifentanil markedly reduced the intra-operative isoflurane requirement. F 13640 also reduced measures of postoperative pain (i.e., paw elevation and flexion). With these postoperative measures, remifentanil produced short-lived analgesia followed by hyperalgesia. F 13640 significantly reduced both surgical pain and the isoflurane Minimum Alveolar Concentration from 0.16 mg/kg onward. F 13640 produced powerful intra- and postoperative analgesia in rats undergoing orthopedic surgery. Unlike the opioid, remifentanil, F 13640 caused no hyperalgesia with ongoing postoperative pain, and should remain effective with protracted postoperative use.
PMID: 16226246 [PubMed - in process]
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Implementation of a massage therapy program in the home hospice setting.
Polubinski JP, West L.
The Hospice Institute of the Florida Suncoast, 300 East Bay Drive, Largo, FL 33770-3770, USA.
Publication Types:
PMID: 16043014 [PubMed - indexed for MEDLINE]
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Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial.
Morita T, Takigawa C, Onishi H, Tajima T, Tani K, Matsubara T, Miyoshi I, Ikenaga M, Akechi T, Uchitomi Y; Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology (PRPP) Study Group.
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan.
Although recent studies suggest that opioid rotation could be an effective treatment strategy for morphine-induced delirium, there have been no prospective studies to investigate the treatment effects of opioid rotation using fentanyl. The primary aim of this study was to clarify the efficacy of opioid rotation from morphine to fentanyl in symptom palliation of morphine-induced delirium. Twenty-one consecutive cancer patients with morphine-induced delirium underwent opioid rotation to fentanyl. Physicians recorded the symptom severity of delirium (the Memorial Delirium Assessment Scale, MDAS), pain, and other symptoms (categorical verbal scale from 0: none to 3: severe) and the Schedule for Team Assessment Scale (STAS) (from 0: none to 4: extreme); and performance status at the time of study enrollment and three and seven days after. Of 21 patients recruited, one patient did not complete the study. In the remaining 20 patients, morphine was substituted with transdermal fentanyl in 9 patients and parenteral fentanyl in 11 patients. Total opioid dose increased from 64 mg oral morphine equivalent/day (Day 0) to 98 mg/day (Day 7), and the median increase in total opioid dose was 42%. Treatment success, defined as an MDAS score below 10 and pain score of 2 or less, was obtained in 13 patients on Day 3 and 18 patients on Day 7. The mean MDAS score significantly decreased from 14 (Day 0) to 6.4 and 3.6 (Days 3 and 7, respectively, P < 0.001). Pain scores significantly decreased from 2.2 (Day 0) to 1.3 and 1.1 on the categorical verbal scale (Days 3 and 7, respectively, P < 0.001); from 2.6 (Day 0) to 1.6 and 1.3 on the STAS (Days 3 and 7, respectively, P < 0.001). Symptom scores of dry mouth, nausea, and vomiting significantly decreased, and performance status significantly improved. Opioid rotation from morphine to fentanyl may be effective in alleviating delirium and pain in cancer patients with morphine-induced delirium.
Publication Types:
PMID: 16043013 [PubMed - indexed for MEDLINE]
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Validation and clinical application of the german version of the palliative care outcome scale.
Bausewein C, Fegg M, Radbruch L, Nauck F, von Mackensen S, Borasio GD, Higginson IJ.
Interdisciplinary Center for Palliative Medicine, University of Munich, Munich, Germany.
The Palliative Care Outcome Scale (POS) is a multidimensional instrument covering physical, psychosocial, spiritual, organizational, and practical concerns. This study validated the German version of the POS and used the tool in different palliative care settings in Germany and Austria. Patients and staff were asked to complete the POS three times and evaluate the questionnaire and the translation afterwards. One hundred eighteen patients (44 male, 74 female, mean age 63 years, all suffering from advanced cancer) completed the POS one time, 55 patients two times, and 36 patients three times. Spearman's rho was highly significant for pain, other symptoms, anxiety, and life worthwhile in the first two assessments. The third assessment showed significant correlations for pain, other symptoms, anxiety, and family anxiety. Seventy-seven of 87 patients answered questions regarding the scale and the translation. All questions other than "Over the past 3 days, have you felt good about yourself?" were understandable for patients. Almost half of the staff was undecided whether the tool was reflecting the patients' condition. In contrast, the majority of patients liked it. Thus, the German version of the POS is well accepted by patients and staff and appears to be valid, although there are some areas where the scale would benefit from expansion to more closely capture staff and patient concerns.
Publication Types:
PMID: 16043007 [PubMed - indexed for MEDLINE]
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Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases.
Chow E, Davis L, Holden L, Tsao M, Danjoux C.
Rapid Response Radiotherapy Program, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Ontario, Canada.
To prospectively assess patient-rated symptoms in patients with brain metastases treated with whole brain radiotherapy, these patients were asked to rate their symptoms on the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8, and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a scale of 0-10 (0=absence of symptom and 10=worst possible symptom). Patients with a language barrier or significant cognitive impairment were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and P < 0.01 was considered statistically significant. One hundred seventy patients (102 female and 68 male) were included between January 1999 and January 2002. Their median age was 66 years (range 33-84) and the median Karnofsky performance score (KPS) at baseline was 60 (range 20-90). The most common primary cancer sites were lung (99; 58%), breast (32; 19%), gastrointestinal (16; 9%), unknown (14; 8%) and others (9; 6%). One-third had significant weight loss (> or =10% over the last 6 months). All patients were prescribed dexamethasone at varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions, 7 (4%); and others, 25 (15%). The baseline mean +/- SD for ESAS scores were: pain 2.4 +/- 2.8, fatigue 5.3 +/- 2.8, nausea 1.3 +/- 2.2, depression 2.8 +/- 2.7, anxiety 3.6 +/- 3.0, drowsiness 3.5 +/- 2.9, appetite 3.0 +/- 3.2, sense of well-being 3.8 +/- 2.7, and shortness of breath 2.3 +/- 2.5. For the entire cohort, after the delivery of palliative radiotherapy for brain metastases, there were statistically significant deteriorations in the mean differences from the baseline for the following ESAS domains: fatigue 1.0 to 1.8; drowsiness 1.2 to 1.8; and appetite 2.2 to 2.4. The data demonstrate that certain parameters of quality of life worsen after whole brain radiotherapy.
Publication Types:
PMID: 16043003 [PubMed - indexed for MEDLINE]
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Family evaluation of hospice care: results from voluntary submission of data via website.
Connor SR, Teno J, Spence C, Smith N.
National Hospice and Palliative Care Organization, Alexandria, Virginia 22314, USA.
The Family Evaluation of Hospice Care (FEHC) survey is a 61-item questionnaire that surveys family members about care provided to the decedent by the hospice. Hospices submit their data to the National Hospice and Palliative Care Organization (NHPCO), where results are tabulated. For the first two quarters of 2004, a total of 29,292 surveys were tabulated. On average, respondents rated their overall satisfaction with care as 47.1 on a 50-point composite scale of five measures of satisfaction. Opportunities for improvement were identified for attending to family needs for support (18.2% of those surveyed reported at least one unmet need), attending to family needs for communication (10-29%), and coordination of care (22.1%). Surrogate reporting of unmet needs for pain, dyspnea, or emotional support ranged from 5.3% to 9.8%. The FEHC is a useful tool for measuring hospice performance and identifies a number of opportunities for improvement.
PMID: 16043002 [PubMed - indexed for MEDLINE]
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Mini-dose titration of the transdermal fentanyl patch--a novel approach by adjusting the area of absorption.
Peng YR, Sun WZ, Mok MS.
Publication Types:
PMID: 16043001 [PubMed - indexed for MEDLINE]
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Lidocaine intoxication at very small doses in terminally ill cancer patients.
Tei Y, Morita T, Shishido H, Inoue S.
Publication Types:
PMID: 16043000 [PubMed - indexed for MEDLINE]
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Ketamine use for reduction of opioid tolerance in a 5-year-old girl with end-stage abdominal neuroblastoma.
Anghelescu DL, Oakes LL.
Publication Types:
PMID: 16042997 [PubMed - indexed for MEDLINE]
JAMA patient page. Palliative sedation.
Brender E, Burke A, Glass RM.
Publication Types:
PMID: 16219888 [PubMed - indexed for MEDLINE]
Palliative sedation in dying patients: "we turn to it when everything else hasn't worked".
Lo B, Rubenfeld G.
Program in Medical Ethics and the Division of General Internal Medicine in the Department of Medicine at the University of California San Francisco, USA. bernie@medicine.ucsf.edu
Despite skilled palliative care, some dying patients experience distressing symptoms that cannot be adequately relieved. A patient with metastatic breast cancer, receiving high doses of opioids administered to relieve pain, developed myoclonus. After other approaches proved ineffective, palliative sedation was an option of last resort. The doctrine of double effect, the traditional justification for palliative sedation, permits physicians to provide high doses of opioids and sedatives to relieve suffering, provided that the intention is not to cause the patient's death and that certain other conditions are met. Such high doses are permissible even if the risk of hastening death is foreseen. Because intention plays a key role in this doctrine, clinicians must understand and document which actions are consistent with an intention to relieve symptoms rather than to hasten death. The patient or family should agree with plans for palliative sedation. The attending physician needs to explain to them, as well as to the medical and nursing staff, the details of care and the justification for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.
PMID: 16219885 [PubMed - indexed for MEDLINE]
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End-of-life: Jewish perspectives.
Dorff EN.
University of Judaism, 15600 Mulholland Drive, Bel Air, CA 90077-1599, USA. edorff@uj.edu
PMID: 16139662 [PubMed - indexed for MEDLINE]
L-arginine improves the symptoms of strokelike episodes in MELAS.
Koga Y, Akita Y, Nishioka J, Yatsuga S, Povalko N, Tanabe Y, Fujimoto S, Matsuishi T.
Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka 830-0011, Japan. yasukoga@med.kurume-u.ac.jp
Based on the hypothesis that mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) are caused by impaired vasodilation in an intracerebral artery, the authors evaluated the effects of administering l-arginine, a nitric oxide precursor. Patients were administered L-arginine intravenously at the acute phase or orally at the interictal phase. L-arginine infusions significantly improved all strokelike symptoms, suggesting that oral administration within 30 minutes of a stroke significantly decreased frequency and severity of strokelike episodes.
Publication Types:
PMID: 15728297 [PubMed - indexed for MEDLINE]
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Low back pain among nurses: a follow-up beginning at entry to the nursing school.
Videman T, Ojajarvi A, Riihimaki H, Troup JD.
University of Alberta, Edmonton, Alberta, Canada. tapio.videman@ualberta.ca
STUDY DESIGN: A prospective cohort. OBJECTIVES: To investigate the prevalence of back pain from entering the nursing school through 5 years in nursing and the determinants and modifiers of back pain and disability. SUMMARY OF BACKGROUND DATA: Physical loading, psychologic characteristics, and several other factors have been associated with back pain at work in earlier studies. Because of the lack of the prework entry morbidity data, the nature of the associations between these exposures and the symptoms is unclear. That previous back pain is a predictor of later pain underlines the importance to have pre-employment data in investigations of the role of exposures at work. METHODS: Female nursing students (n = 174) were followed for 7.5 years. Data on constitutional and behavioral factors, occupational exposures, and back-related symptoms and disability were collected. Back pain was grouped into "sciatic," "sudden," or "other" and related disability. RESULTS: The lifetime cumulative prevalence of back pain increased from 31% at entry to nursing school to 72% at the end of the school and further to 82% after 5 years as a nurse. The 1-year prevalence of any back pain was 54% for the first year in nursing school, 57% for the first year as a nurse, and 64% for the fifth year as a nurse. In multivariate analyses, other back pain and related disability as a nurse were associated with back pain history at the entry to nursing school (odds ratio, 7.1; 95% confidence interval, 1.5-34; and 3.6; 1.2-11, respectively), and working in twisted/bent positions (odds ratio, 6.2; 95% confidence interval, 1.7-23; and 7.5; 2.9-20, respectively). Sudden back pain was not associated with any of the studied risk factors. Sciatic back pain was associated only with working positions (odds ratio, 6.9; 95% confidence interval, 2.1-23). CONCLUSIONS: Lifetime prevalence of back pain increased sharply during nursing school but slowly after that. Back pain at entering the nursing school was a predictor for back-related pain and disability. Self- reported occupational physical work load was associated with back pain and related disability. The nature of the association is unclear, but it is likely that back pain is exacerbated during nursing.
PMID: 16227898 [PubMed - in process]
Percutaneous Computed Tomography-Guided Transdiscal Low Cervical Cordotomy for Cancer Pain as a Method to Avoid Sleep Apnea.
Raslan AM.
Department of Neurosurgery, Ain Shams University, Cairo, Egypt and Department of Neurological Surgery, Oregon Health & Science University, Portland, Oreg., USA.
Objective: Study of percutaneous computed tomography (CT)-guided transdiscal low cervical cordotomy undertaken to treat pain in cancer patients. Methods: At the Department of Neurosurgery, Ain Shams University, Cairo, Egypt, 8 cancer pain patients, with either impaired pulmonary function or a previous cordotomy on an opposite side (sleep apnea was a feared complication) that prevented the possibility of undergoing a C(1-2) cordotomy, underwent a percutaneous CT-guided transdiscal low cervical cordotomy (C(4-5) or C(5-6)) to treat cancer pain. Results: Seven patients experienced initial improvement. One patient re-experienced pain within 2 weeks and 1 patient experienced no pain relief. In 6 patients in whom the cordotomy procedure was completed, satisfactory or complete pain relief, throughout a 6-month follow-up period was reported. In contrast, in 2 patients in whom the cordotomy was not completed there was no persistent pain relief. Conclusion: Percutaneous CT-guided cordotomy remains a successful procedure to control pain in cancer patients, and is an affordable viable option under circumstances where economic disadvantage is an overriding determinate. Copyright (c) 2005 S. Karger AG, Basel.
PMID: 16230863 [PubMed - as supplied by publisher]
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