About Entrez
NCBI Toolbar
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorials
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
Special Queries
LinkOut
My NCBI
Related Resources
Order Documents
NLM Mobile
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
| Display Show |
 |
|
|
Post-cesarean delivery analgesia.
Gadsden J, Hart S, Santos AC.
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center of Columbia University, New York, New York, USA.
Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. Pain and anxiety may also reduce the ability of a mother to breast-feed effectively. It is necessary that pain relief be safe and effective, that it not interfere with the mother's ability to move around and care for her infant, and that it result in no adverse neonatal effects in breast-feeding women. The most commonly used modalities are systemic administration of opioids, either by intramuscular injection or i.v. by patient-controlled analgesia, and neuraxial injection of opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific advantages and disadvantages which will be discussed in this review. In addition, there are new drug applications of potential benefit for the treatment of post-cesarean delivery pain.
Publication Types:
PMID: 16334493 [PubMed - indexed for MEDLINE]
[Low doses ketamine: antihyperalgesic drug, non-analgesic]
[Article in French]
Richebe P, Rivat C, Rivalan B, Maurette P, Simonnet G.
Departement d'anesthesie et de reanimation 3, hopital Pellegrin, place Amelie-Raba-Leon, 33076 Bordeaux cedex, France.
Recent data in animal experiments as in clinical trials have clearly reported that pain modulation is related to an equilibrium between antinociceptive and pronociceptive systems. Therefore, the apparent pain level could not only be a consequence of a nociceptive input increase but could also result from a pain sensitization process. Glutamate, via NMDA receptors, plays a major role in the development of such a neuronal plasticity in the central nervous system, leading to a pain hypersensitivity that could facilitate chronic pain development. By an action on NMDA receptors opioids also induce, in a dose dependent manner, an enhancement of this postoperative hypersensitivity. "Antihyperalgesic" doses of ketamine, an NMDA receptor antagonist, were able to decrease this central sensitization not only in painful animal but also in human volunteers exposed to different pain models, or in the postoperative period. Many studies have reported that ketamine effects are elicited when this drug is administered the following manner: peroperative bolus (0.1 to 0.5 mg/kg), followed by a constant infusion rate (1 to 2 microg/kg per min) during the peroperative period and for 48 to 72 hours after anaesthesia. Those ketamine doses improved postoperative pain management by reducing hyperalgesia due to both surgical trauma and high peroperative opioid doses. This antihyperalgesic action of ketamine also limited the postoperative morphine tolerance leading to a decrease in analgesic consumption and an increase in the analgesia quality.
Publication Types:
PMID: 16115745 [PubMed - indexed for MEDLINE]
Frozen shoulder.
Dias R, Cutts S, Massoud S.
Royal Orthopaedic Hospital, Birmingham B31 2AP.
Publication Types:
PMID: 16356983 [PubMed - indexed for MEDLINE]
Do diagnostic segmental nerve root blocks in chronic low back pain patients with radiation to the leg lack distinct sensory effects? A preliminary study.
Wolff AP, Groen GJ, Wilder-Smith OH, Richardson J, van Egmond J, Crul BJ.
Pain Centre, Institute for Anaesthesia, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
BACKGROUND: The present preliminary study documents the effects of a selective nerve root block (SNB) with short or long acting local anaesthetic compared with baseline measurements in patients with chronic low back pain radiating to the leg with maximum pain in one dermatome (L4). METHODS: Ten consecutive patients underwent 20 controlled SNBs at L4 with ropivacaine 0.25% and lidocaine 1% in a prospective, randomized, double blind, crossover fashion. Baseline measurements included sensory function (assessed by pinprick on both unaffected and painful leg) and pain (Verbal Numeric Rating Scale; VNRS, 0-10). A change in size of areas with altered sensory function >10% and a VNRS change of 2 points were considered clinically significant. P-values<0.05 were considered statistically significant. RESULTS: Asymptomatic hypoaesthesia, variable in extent and non-dermatomal in distribution, was present in seven patients at baseline. It appeared to be more extensive and distal with longer duration of pre-existing pain. SNB produced no consistent changes in extent and distribution of hypoaesthetic areas. Change in VNRS did not correlate with the extent of pre-block or post-block hypoaesthesia. No differences in effects were found between lidocaine and ropivacaine. CONCLUSIONS: Pre-block assessment of sensory function is essential to assess the net effect of SNBs. In this small study group, SNBs failed to demonstrate uniform or distinct effects on sensory function.
PMID: 16390859 [PubMed - in process]
14-year-old Boy with Forearm Pain.
Hosalkar HS, Barroeta JE, Torbert JT, Lackman RD.
From the *Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; and the daggerDepartment of Pathology, Pennsylvania Hospital, Philadelphia, PA.
PMID: 16394773 [PubMed - as supplied by publisher]
-
Antinociceptive effect of oxycodone in diabetic mice.
Nozaki C, Saitoh A, Tamura N, Kamei J.
Department of Pathophysiology and Therapeutics, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, Shinagawa-ku, Tokyo, Japan.
The effect of oxycodone on thermal hyperalgesia in streptozotocin-induced diabetic mice was examined. The antinociceptive response was assessed by recording the latency in the tail-flick test using the radiant heat from a 50-W projection bulb on the tail. The tail-flick latency in diabetic mice was significantly shorter than that in non-diabetic mice. When diabetic mice were treated with oxycodone (5 mg/kg, s.c.), the tail-flick latency in diabetic mice was prolonged to the level considerably longer than the baseline latencies of non-diabetic mice. However, s.c. administration of morphine (5 mg/kg) did not produce a significant inhibition of the tail-flick response in diabetic mice. Oxycodone, at doses of 1.25-5.0 mg/kg administered s.c., produced a dose-dependent increase in the tail-flick latencies in both diabetic and non-diabetic mice. The antinociceptive effect of oxycodone was antagonized by pretreatment with a selective delta-opioid receptor antagonist, beta-funaltrexamine (20 mg/kg, s.c.), in both non-diabetic and diabetic mice. In non-diabetic mice, pretreatment with a selective kappa-opioid receptor antagonist, nor-binaltorphimine (20 mg/kg, s.c.) had no effect on the peak antinociceptive effect of oxycodone observed 30 min after administration, however, it slightly but significantly reduced oxycodone-induced antinociception observed 60 and 90 min after administration. On the other hand, pretreatment with nor-binaltorphimine practically abolished the peak (30 min) and persistent (60 and 90 min) antinociceptive effects of oxycodone in diabetic mice. Naltrindole (35 mg/kg, s.c.), a selective delta-opioid receptor antagonist, had no effects on the antinociceptive effect of oxycodone in both non-diabetic and diabetic mice. These results suggest that the antinociceptive effects of oxycodone may be mediated by mu- and kappa-opioid receptors in diabetic mice, whereas it may interact primarily with mu-opioid receptors in non-diabetic mice.
PMID: 16256106 [PubMed - indexed for MEDLINE]
Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation.
Isaacs RE, Podichetty VK, Santiago P, Sandhu FA, Spears J, Kelly K, Rice L, Fessler RG.
Duke University Medical Center, Durham, North Carolina 27710, USA. podichv@ccf.org
OBJECT: The authors have developed a novel technique for percutaneous fusion in which standard microendoscopic discectomy is modified. Based on data obtained in their cadaveric studies they considered that this minimally invasive interbody fusion could be safely implemented clinically. The authors describe their initial experience with a microendoscopic transforaminal lumbar interbody fusion (METLIF) technique, with regard to safety in the placement of percutaneous instrumentation, perioperative morbidity, and early postoperative results. METHODS: The METLIF procedure was performed unilaterally in 20 patients with single-level lumbar spondylolisthesis or pure mechanical back pain with endoscopic assistance, hemilaminectomy, unilateral facetectomy, and microdiscectomy. Two interbody grafts were placed via the lateral exposure of the disc space. Bilateral percutaneous pedicle screws were then inserted. Compared with patients who had undergone single-level posterior LIF at the same institutions, intraoperative blood loss, hospital length of stay (LOS), and postoperative narcotic agent use were significantly lower in the METLIF group. The mean LOS for the percutaneous fusion group was 3.4 days (5.1 days in those who underwent PLIF; p < 0.02). There have been no procedure-related complications in this series to date. CONCLUSIONS: The METLIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, postoperative pain, total narcotic use, and the risk of transfusion.
PMID: 16370298 [PubMed - indexed for MEDLINE]
-
Mechanisms involved in the nociception produced by peripheral protein kinase c activation in mice.
Ferreira J, Triches KM, Medeiros R, Calixto JB.
Department of Pharmacology, Centre of Biological Sciences, Universidade Federal de Santa Catarina, 88015-420 Florianopolis, SC, Brazil. ferreiraj99@bol.com.br
Protein kinase C (PKC) is able to phosphorylate several cellular components that serve as key regulatory components in signal transduction pathways of nociceptor excitation and sensitisation. Therefore, the present study attempted to assess some of the mechanisms involved in the overt nociception elicited by peripheral administration of the PKC activator, phorbol 12-myristate 13-acetate (PMA), in mice. The intraplantar (i.pl.) injection of PMA (16-1600 pmol/paw), but not its inactive analogue alpha-PMA, produced a long-lasting overt nociception (up to 45 min), as well as the activation of PKCalpha and PKCepsilon isoforms in treated paws. Indeed, the local administration of the PKC inhibitor GF109203X completely blocked PMA-induced nociception. The blockade of NK1, CGRP, NMDA, beta1-adrenergic, B2 or TRPV1 receptors with selective antagonists partially decreased PMA-induced nociception. Similarly, COX-1, COX-2, MEK or p38 MAP kinase inhibitors reduced the nociceptive effect produced by PMA. Notably, the nociceptive effect promoted by PMA was diminished in animals treated with an antagonist of IL-1beta receptor or with antibodies against TNFalpha, NGF or BDNF, but not against GDNF. Finally, mast cells as well as capsaicin-sensitive and sympathetic fibres, but not neutrophil influx, mediated the nociceptive effect produced by PMA. Collectively, the results of the present study have shown that PMA injection into the mouse paw results in PKC activation as well as a relatively delayed, but long-lasting, overt nociceptive behaviour in mice. Moreover, these results demonstrate that PKC activation exerts a critical role in modulating the excitability of sensory neurons.
PMID: 16099101 [PubMed - indexed for MEDLINE]
-
Pronociceptive role of peripheral and spinal 5-HT7 receptors in the formalin test.
Rocha-Gonzalez HI, Meneses A, Carlton SM, Granados-Soto V.
Departamento de Farmacobiologia, Centro de Investigacion y de Estudios Avanzados del Instituto Politecnico Nacional, Calzada de los Tenorios 235, Colonia Granjas Coapa, 14330 Mexico, D.F., Mexico.
The possible pronociceptive role of peripheral and spinal 5-HT7 receptors in the formalin test was assessed. Local administration of 5-HT7 (SB-269970, 2.5-77.1 nmol/paw), but not 5-HT(1A) (WAY-100635, 1-60 nmol/paw), receptor antagonist significantly reduced formalin-induced flinching. Local 5-hydroxytryptamine (5-HT, 3-100 nmol/paw) or 5-carboxamidotryptamine (5-CT, 0.3-3 nmol/paw) (a 5-HT7/1A receptor agonist) augmented, in a dose-dependent manner, 0.5% formalin-induced nociceptive behavior. The local pronociceptive effect of 5-HT or 5-CT was significantly reduced by SB-269970 (25 and 77.1 nmol/paw), but not by WAY-100635 (10 nmol/paw). 5-HT7 receptors were observed in myelinated and unmyelinated axons of the digital nerves in rat hindpaw. Intrathecal SB-269970 (2.5-77.1 nmol/rat) or WAY-100635 (1-50 nmol/rat) did not modify 1% formalin-induced nociceptive behavior. Spinal 5-HT (25-200 nmol/rat) significantly reduced formalin-induced flinching behavior during phase 2. At lower doses (0.1-3 nmol/rat) intrathecal 5-CT dose-dependently increased flinching during phase 2. In contrast, higher doses (10-30 nmol/rat) of 5-CT reduced formalin-induced nociceptive behavior during both phases. The spinal pronociceptive effect of 5-CT was reduced by SB-269970 (7.7-77 nmol/rat), but not by WAY-100635 (10 nmol/rat). In addition, the spinal antinociceptive effect of 5-CT was partially reversed by WAY-100635 (10 nmol/rat). The spinal antinociceptive effect of 5-HT was unaffected either by SB-269970 (77 nmol/rat) or WAY-100635 (10 nmol/rat). Data suggest that 5-HT7, but not 5-HT1A, receptors play a pronociceptive role in peripheral and spinal sites in the rat formalin test.
PMID: 16098671 [PubMed - indexed for MEDLINE]
-
Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women.
Foster DC, Dworkin RH, Wood RW.
Department of Obstetrics and Gynecology and Department of Anaesthesia, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. david_foster@urmc.rochester.edu
Cutaneous response to capsaicin has been used to assess central sensitization in pain research. This study compared the response to intradermal capsaicin in the forearm and foot of vulvar vestibulitis (vestibulodynia)-afflicted cases and controls. We hypothesized that cases will experience greater spontaneous pain, larger cutaneous areas of punctate hyperalgesia and dynamic allodynia, and greater vascular flow than controls. We also hypothesized enhanced post-injection pain in the foot compared to the forearm based on dermatome proximity of the foot and vulva. Methods. Ten vulvar vestibulitis syndrome (VVS) cases and 10 age and ethnically matched controls underwent two randomized, cross-over trials with intra-dermal injections of capsaicin or a saline placebo in the forearm and foot. Outcome measures included spontaneous pain level, surface area of punctate hyperalgesia, surface area of dynamic allodynia, cutaneous blood flow, regional skin temperature and vital signs. Results. VVS cases experienced greater spontaneous pain, punctate hyperalgesia and dynamic allodynia than pain-free controls. Within the VVS group, post-capsaicin spontaneous pain, punctate hyperalgesia and dynamic allodynia were similar in the forearm and foot. Post-capsaicin blood flow did not differ between cases and controls by anatomic site. Measures of depression and anxiety correlated with spontaneous pain intensity but did not correlate with measures of hyperalgesia, allodynia, or blood flow. VVS cases had higher resting pulse rates and lower resting systolic blood pressures than in controls. Conclusion. VVS patients show enhancement of post-capsaicin pain response extending far beyond the anatomic location of the primary complaint.
Publication Types:
PMID: 16087295 [PubMed - indexed for MEDLINE]
-
Erratum in:
- Pain. 2005 Nov;118(1-2):281.
Electrophysiological and in vivo characterization of A-317567, a novel blocker of acid sensing ion channels.
Dube GR, Lehto SG, Breese NM, Baker SJ, Wang X, Matulenko MA, Honore P, Stewart AO, Moreland RB, Brioni JD.
Abbott Laboratories, Neuroscience Research, Building AP9A-Dept. R4ND,Abbott Park, IL 60064-6118, USA. gilles.dube@abbott.com
Acid Sensing Ion Channels (ASICs) are a group of sodium-selective ion channels that are activated by low extracellular pH. The role of ASIC in disease states remains unclear partly due to the lack of selective pharmacological agents. In this report, we describe the effects of A-317567, a novel non-amiloride blocker, on three distinct types of native ASIC currents evoked in acutely dissociated adult rat dorsal root ganglion (DRG) neurons. A-317567 produced concentration-dependent inhibition of all pH 4.5-evoked ASIC currents with an IC50 ranging between 2 and 30muM, depending upon the type of ASIC current activated. Unlike amiloride, A-317567 equipotently blocked the sustained phase of ASIC3-like current, a biphasic current akin to cloned ASIC3, which is predominant in DRG. When evaluated in the rat Complete Freud's Adjuvant (CFA)-induced inflammatory thermal hyperalgesia model, A-317567 was fully efficacious at a dose 10-fold lower than amiloride. A-317567 was also potent and fully efficacious when tested in the skin incision model of post-operative pain. A-317567 was entirely devoid of any diuresis or natriuresis activity and showed minimal brain penetration. In summary, A-317567 is the first reported small molecule non-amiloride blocker of ASIC that is peripherally active and is more potent than amiloride in vitro and in vivo pain models. The discovery of A-317567 will greatly help to enhance our understanding of the physiological and pathophysiological role of ASICs.
PMID: 16061325 [PubMed - indexed for MEDLINE]
-
Increased nerve growth factor after rat plantar incision contributes to guarding behavior and heat hyperalgesia.
Banik RK, Subieta AR, Wu C, Brennan TJ.
Department of Anesthesia, 3000 ML, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. ratan-banik@uiowa.edu
Acutely, nerve growth factor (NGF) exerts profound effects on nociceptive transmission and produces pain and hyperalgesia. In the present study, we sought to determine the tissue levels and role of NGF after a plantar incision. A substantial increase in NGF protein expression occurred in skin 4-h, 1-day and 2-days and 5-days after incision comparing contralateral uninjured skin. Plantar incision did not change NGF levels in the tibial nerve and L4-L6 dorsal root ganglia. The therapeutic effect of a monoclonal antibody against endogenous NGF was evaluated by intraperitoneal administration of a single preoperative dose of anti-NGF. Of three different doses of anti-NGF used, the highest dose 2.8 mg/kg anti-NGF attenuated or almost abolished guarding pain scores at 4-h, 1-day (>80% decrease) and 2-days after incision. This effect is dose dependent in that lower doses (1, 0.1 mg/kg) were effective only at 1-day after incision. Anti-NGF also attenuated heat hyperalgesia at 1-day and 2-days after incision when the highest dose was used. However, treatment by anti-NGF did not affect C-fibers sensitized 1-day after incision in a glabrous skin-tibial nerve in vitro preparation. In conclusion, increased NGF was present in skin after plantar incision. NGF contributes to some incision-induced pain behaviors, guarding and heat hyperalgesia. Anti-NGF did not affect the extent of sensitization of C-fibers observed in vitro.
PMID: 16061324 [PubMed - indexed for MEDLINE]
-
Comment on:
Words can help!
Cyna AM, Andrew M.
Publication Types:
PMID: 16040195 [PubMed - indexed for MEDLINE]
-
Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls?: are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level?
Smeets RJ, Wittink H, Hidding A, Knottnerus JA.
Rehabilitation Centre Blixembosch, Eindhoven, The Netherlands. rsmeets@iae.nl
STUDY DESIGN: Prospective case series with historical controls (normative data). OBJECTIVES: To compare the aerobic fitness level of patients with chronic low back pain (CLBP) with healthy controls matched for gender, age, and level of sport activity and to evaluate the association of the difference in aerobic fitness level with pain intensity, duration and degree of disability, fear of injury, and level of activity during work, including household and leisure time. SUMMARY AND BACKGROUND DATA: Controversy exists whether patients with CLBP have a lower level of aerobic fitness and whether this level may partly depend on the patients' activity level. METHODS: A total of 108 CLBP patients completed questionnaires regarding pain, disability, fear of injury, and activity level and performed a modified Astrand submaximal cycling test. The maximum oxygen consumption (VO2max) was calculated and compared with normative data. Multiple linear regression analysis was performed with the difference of the level of aerobic fitness as dependent variable. RESULTS: VO2max could be calculated in 78% of the patients. Both men and women with CLBP had significant lower VO2max than the healthy referents (10 mL/kg LBM x min(-1) and 5.6 mL/kg LBM x min(-1) respectively, P < 0.001), and this difference was significantly greater in men (P = 0.03). Multiple regression analysis showed that the level of aerobic fitness was not associated with the presumed variables. The patients who stopped the test prematurely were older (P = 0.02) and more disabled (P = 0.01). CONCLUSION: CLBP patients, especially men, seem to have a reduced aerobic fitness level compared with the normative population. No explanatory factor for that loss could be identified.
PMID: 16395183 [PubMed - in process]
-
An examination of the reliability of a classification algorithm for subgrouping patients with low back pain.
Fritz JM, Brennan GP, Clifford SN, Hunter SJ, Thackeray A.
Division of Physical Therapy, University of Utah, Intermountain Health Care, Salt Lake City, USA. julie.fritz@hsc.utah.edu
STUDY DESIGN: Test-retest design to examine interrater reliability. OBJECTIVE: Examine the interrater reliability of individual examination items and a classification decision-making algorithm using physical therapists with varying levels of experience. SUMMARY OF BACKGROUND DATA: Classifying patients based on clusters of examination findings has shown promise for improving outcomes. Examining the reliability of examination items and the classification decision-making algorithm may improve the reproducibility of classification methods. METHODS: Patients with low back pain less than 90 days in duration participating in a randomized trial were examined on separate days by different examiners. Interrater reliability of individual examination items important for classification was examined in clinically stable patients using kappa coefficients and intraclass correlation coefficients. The findings from the first examination were used to classify each patient using the decision-making algorithm by clinicians with varying amounts of experience. The reliability of the classification algorithm was examined with kappa coefficients. RESULTS: A total of 123 patients participated (mean age 37.7 [+/-10.7] years, 44% female), 60 (49%) remained stable between examinations. Reliability of range of motion, centralization/peripheralization judgments with flexion and extension, and the instability test were moderate to excellent. Reliability of centralization/peripheralization judgments with repeated or sustained extension or aberrant movement judgments were fair to poor. Overall agreement on classification decisions was 76% (kappa = 0.60, 95% confidence interval 0.56, 0.64), with no significant differences based on level of experience. CONCLUSION: Reliability of the classification algorithm was good. Further research is needed to identify sources of disagreements and improve reproducibility.
PMID: 16395181 [PubMed - in process]
-
Point of view: pain and disc degeneration: a possible link derived from basic science.
Bono CM.
Department of Orthopaedic Surgery, Boston University School of Medicine, Boston University Medical Center, Boston, MA 02118, USA. bonocm@prodigy.net
Publication Types:
PMID: 16395169 [PubMed - in process]
| Display Show |
|
|