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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Flupirtine is a novel non-opiate centrally acting analgesic agent with muscle relaxant properties, advocated for use in a number of pain states. Preliminary evidence suggests that flupirtine 100 to 200mg orally or 150mg rectally 3 to 4 times daily (maximum daily dose 600mg) is more effective than placebo in relieving moderate acute pain of various types. For the relief of pain due to surgery, traumatic injury, dental procedures, headache/migraine and abdominal spasms, flupirtine has proved at least as effective as the opiate analgesics codeine, dihydrocodeine and pentazocine, the nonsteroidal anti-inflammatory agents suprofen, diclofenac and ketoprofen, as well as dipyrone and paracetamol (acetaminophen). Although evidence to support a role in the treatment of chronic pain is limited, flupirtine has been found as effective as pentazocine in short term trials of patients with muscular or neuralgiform pain, dysmenorrhoea, soft tissue rheumatism or cancer pain. The safety profile of flupirtine has not yet been fully established, although initial evidence suggests that adverse reactions, while frequent, are usually minor in nature. The most common reactions are drowsiness, dizziness, dry mouth and various gastrointestinal complaints. In comparison with opiate drugs, flupirtine appears to produce fewer central nervous system effects, no respiratory or cardiovascular depression, and no overt tolerance or physical dependence on prolonged administration. If these initially favourable results are confirmed in larger long term trials, then flupirtine would appear to represent an effective analgesic for the relief of moderate pain, particularly that of musculoskeletal origin.
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PMID:Flupirtine. A review of its pharmacological properties, and therapeutic efficacy in pain states. 768 75

Survivors of spinal cord injury (SCI) have a range of sensory experiences following the trauma. Acute pain commonly accompanies the injury and recedes as healing occurs. Following the initial event, most spinal cord-injured individuals experience phantom sensations and many suffer chronic pain. In extreme cases, chronic pain can become the most disabling sequela, leading to chemical dependency, severe depression and even suicide. Pain arising from injury to peripheral and central neural structures possesses unique characteristics that distinguish it from persisting acute pain and phantom sensations. Ironically, it is experienced in regions of the body that are anesthetic or possess diminished or altered sensation as a consequence of the injury. The qualitative features of the pain have been linked to structural and functional alterations that have been documented in peripheral and central neural structures following SCI. An understanding of these unique relationships provides direction for future research.
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PMID:Understanding chronic pain after spinal cord injury. 781 15

The efficacy of inpatient psychosomatic psychotherapy was proved by a naturalistic prospective study with 50 psychogenic pain patients over an average time period of 12 weeks. At the end of inpatient psychotherapy about 60% of all patients achieved pain mitigation. According to the aim of our therapeutic concept to specially improve the perception and verbalization of their own conflicts or affects about 86% of all patients judged to have an enhanced competence in problem solving. The hypothesis that depression may often occur as a consequence of several years lasting chronic pain, could not be confirmed in our study. In contrast no remarkable correlation was found between symptom duration and depressive or anxious mood respectively. Concerning prognosis it seems to be significant that an increased tendency for rationalization or intellectualization diminished clinical outcome success as well as it occurred with enhanced acute pain sensation.
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PMID:[Inpatient psychotherapy with chronic psychogenic pain patients]. 797 47

We describe the experience of the acute pain service of the University Hospital of Galicia, Spain since its inception. We have treated 1214 patients using either patient-controlled analgesia (PCA) with morphine (72%), or patient-controlled epidural analgesia with fentanyl + bupivacaine (22%). Three hundred and five patients had minor complications, mainly pruritus (35%) in patients with patient-controlled epidural analgesia. Three (0.33%) patients using PCA had respiratory depression treated with naloxone; no patient with patient-controlled epidural analgesia had respiratory depression. In our experience the creation of an acute pain service and the associated development of pain-treatment protocols and the training of hospital personnel produced excellent results.
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PMID:One year's experience with an acute pain service in a Spanish University Clinic hospital. 798 88

A survey of postoperative pain management practices was mailed to the 56 Canadian university-affiliated teaching hospitals in December 1991. The aims of the survey were (1) to determine the prevalence, structure, and function of Acute Pain Services and (2) to determine the use and management of patient-controlled analgesia (PCA) and epidural opiate analgesia (EOA) in teaching hospitals. Responses were received from 47 hospitals, representing a return rate of 84%. Twenty-five hospitals (53%) operated an Acute Pain Service and an additional 17 (35%) were attempting to organize one. "Time commitment" was given as the primary reason why hospitals were unable to offer an Acute Pain Service. Most commonly used methods of pain relief were EOA and PCA. Most services were multidisciplinary, with 60% having a nurse and 29% a pharmacist. Irrespective of the presence of an Acute Pain Service, PCA was used at 32 (68%) hospitals, and EOA was used at 41 (87%); however, only 15 provided EOA on general wards. Complications have occurred with both PCA and EOA, with 14 of 32 hospitals indicating that they have had a major or serious complication. The data suggest an estimated incidence of severe respiratory depression of 0.03% with PCA and 0.13% with EOA. No deaths were reported at the time of the survey. Epidural opioid-local anaesthetic EOA-LA combinations were used at 26 (63%) hospitals; however, only six administered these combinations on general words. We conclude that a multidisciplinary team approach to manage postoperative pain is viable in university teaching hospitals of all sizes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Postoperative pain management and acute pain service activity in Canada. 791 73

1. Relaxation with guided imagery (RGI) has been successfully used for controlling acute pain, emotional distress, anxiety, and depression in a chronically ill population. Only a few studies have examined RGI as a therapeutic modality for reducing psychological distress and facilitating improvement in health behaviors. 2. The purpose of this study was to examine the effects of RGI on decreasing psychological distress and improving health seeking behaviors with a working population. 3. The practice of RGI did not significantly reduce employees' psychological distress or improve their health seeking behaviors. However, anecdotal data suggest that RGI may be useful for some individuals. 4. Because RGI is a simple, inexpensive, and non-invasive technique that most employees can do on their own, additional research efforts are needed to support its effectiveness.
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PMID:Relaxation with guided imagery: effects on employees' psychological distress and health seeking behaviors. 803 22

Despite major advances in knowledge and development of efficient techniques for pain control, many patients on surgical wards suffer from modest to severe pain following surgery or trauma. Therefore, in the University Hospital of Kiel, Germany, an anaesthesiology-based acute pain service (APS) was started in 1985 to improve this situation. Organization of an APS. The anaesthesiologist in training who manages the recovery unit serves as an APS for surgical wards and is supervised by a consultant. The anaesthesists on call are responsible after regular working hours. The activities of the APS are as follows: 1. Induction of sufficient postoperative analgesia in the recovery unit for all surgical patients. 2. Clinical rounds on all patients receiving epidural analgesia (EA), other forms of regional analgesia, or patient-controlled analgesia (PCA) every morning and throughout the day if necessary. 3. Additional consultations for postoperative pain management for other patients on request. 4. Assessment and documentation of the clinical status of the patient, quality of analgesia, and side effects. 5. Writing orders for further treatment. 6. Continuing consultations and informal education for ward nurses, physiotherapists, and surgical staff; formal medical training for ward nurses in postoperative pain management. Activity of the APS. From 1985 to 1992, 1947 patients on normal wards were treated (EA: 1736, PCA: 183). Epidural analgesia was performed using a standard protocol with bupivacaine 0.175%-0.25% infused continuously with top-ups if needed (mean 240 mg/day, range 75-600 mg; median duration 7 days, range 1-53, Table 1). Demand for further treatment was proved by day-to-day withdrawal. Since the introduction of an APS, complications of EA such as hypotension (1985/1986:5.1%; 1987/1992:0.5%, Table 3) and insufficient analgesia due to dislocation or other technical complications could be reduced significantly (Table 3). Dermal infections were seen in 2.6% of patients, with a significantly higher incidence in patients with arteriosclerotic diseases (4.1%). Epidural opioids were used in only 46 selected cases on surgical wards. Nevertheless, 2 cases of marked respiratory depression occurred. The overall risk of complications during postoperative EA could be reduced from 1:11 cases in the first 2 years to 1:20 in the last 6 years since introducing the APS. For other regional procedures (e.g., interpleural analgesia) no complications were recorded. PCA was performed using a standard protocol with tramadol or piritramide without background infusion (Table 6). The loading dose was titrated in the recovery unit.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Postoperative pain therapy at general nursing stations. An analysis of eight year's experience at an anesthesiological acute pain service]. 804 73

While there are increasing demands for improved post-operative analgesia and the implementation of Acute Pain Services (APS), the safety of such an approach remains under discussion. This paper analyses the safety outcome of 3016 consecutive post-operative patients treated under the care of a formalised Acute Pain Service. No serious complication resulting in morbidity or mortality occurred. Potentially severe complications without sequelae were discovered in 16 patients (0.53%); this incidence was similar for techniques of systemic opioid administration and continuous regional analgesia. Patient-controlled analgesia (PCA) alone had a significantly lower rate of respiratory depression than PCA with a background infusion or continuous morphine infusion. In 1069 patients receiving continuous regional analgesia (epidural, interpleural, peripheral) no trauma to nervous structures, no infection and no local anaesthetic toxicity occurred. In conclusion, an anaesthesiology-based APS can provide postoperative pain relief using a wide range of relatively invasive techniques without endangering patient safety.
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PMID:Safety assessment of postoperative pain management by an acute pain service. 812 1

Postoperative pain is commonly treated with significant doses of narcotics, occasionally resulting in side effects including nausea, pruritus, and respiratory depression. One potential advantage of regional anesthesia is profound postoperative analgesia that reduces exposure to potent narcotics. To evaluate the efficacy of two long-acting local anesthetics, bupivacaine and etidocaine, in providing pain relief after major shoulder surgery, we randomized 20 patients to receive either bupivacaine or etidocaine for brachial plexus block as the primary anesthetic for shoulder surgery. Surgeons, patients, and the acute pain service were blinded as to drug selection. After the patient was sedated, an interscalene block was placed with the use of a nerve stimulator to facilitate proper needle placement. Forty milliliters of either 0.5% bupivacaine or 0.75% etidocaine containing 5 micrograms/mL epinephrine was injected into the brachial plexus sheath. An additional 8 mL of local anesthetic was administered for superficial cervical plexus blockade. Intraoperative sedation was accomplished with an intravenous infusion of methohexital as needed. After surgery, patients received a standard patient-controlled analgesia protocol providing incremental doses of morphine. The degree of postoperative analgesia resulting from residual local anesthetic effect was expressed as the time until first morphine requirement and the total dose of morphine required during the first 24 hours postoperatively. We found no statistically significant intergroup differences either in time of initial use of morphine or in the total dose of morphine required in the first 24 hours. Both etidocaine and bupivacaine provide prolonged analgesia after major shoulder surgery when injected into the brachial plexus. Bupivacaine, however, possesses significant cardiotoxicity and has a relatively delayed onset in peripheral neural blockade. Etidocaine is less cardiotoxic and also has a more rapid onset of effect. Thus etidocaine may be a preferable agent for interscalene block for major shoulder surgery.
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PMID:Postoperative analgesia after major shoulder surgery with interscalene brachial plexus blockade: etidocaine versus bupivacaine. 815 80

The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) route. The efficacy, safety and resource implications were assessed. The results showed that pain control was good, with the majority of patients (66%) experiencing mild pain during the first 24 hours. The pump was used by each patient for an average of 4.32 days. The mean total dose of morphine used was 105.2 mg via the IV route and 114.6 mg via the SC route. Over the 10 months, the 25 PCA pumps worked 80,000 pump-hours; only 3 pumps malfunctioned. A total of 86,861 mg morphine was used during this period with rare morbidity and no mortality. Only 1 patient experienced sedation and respiratory depression. The benefits of an APRS with PCA to patients and medical staff alike are discussed.
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PMID:Introducing a patient-controlled analgesia-based acute pain relief service into southern Africa--the first 10 months. 821 90


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