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

Sixty-two patients with intractable pain secondary to cancer of the pelvic organs were managed with intrathecal injections of morphine. Forty-six patients experienced pain relief from an initial test dose that ranged from 0.5 to 2.0 mg. In order to provide long-term pain relief, these 46 patients were further treated with repeated single injections (14 patients), external catheter (28 patients), or implanted pump (4 patients). Twenty-four of the 46 patients received pain relief without developing tolerance or side effects or experiencing mechanical failure of the application systems. When side effects developed, they were generally itching, sphincter disorder and somnolence. No serious respiratory depression was noted. Intrathecal morphine offers a hopeful alternative to systemic narcotics or ablative neurosurgical procedures in the management of terminal cancer pain.
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PMID:Intrathecal morphine for intractable pain secondary to cancer of pelvic organs. 383 82

In pre-terminal and terminal gynaecological patients with persistent cancer pain, now it is possible to carry out some anthalgic methods associated or not to parenteral administration of non-narcotic or narcotic analgesic, i.e. intrathecal neurolytic injections and epidural narcotic administration. Many favourable results have been obtained by means of single or repeated 7% phenol in glycerine injections to patients with advanced but not terminal cancer affected by somatic and segmental pain or by perineal pain. In order to control more extensive pains, epidural injections of morphine in saline have been employed in preterminal patients. This method appears to be the best answer to many problems complained by the patients: pain, depression, malaise. As a matter of fact, low doses of epidural morphine induce both complete pain relief and sedation or slight drowsiness.
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PMID:New trends for pain relief in gynaecologic oncology. 619 83

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.
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PMID:Oral morphine in chronic cancer pain. 620 Aug 18

Preliminary reports of continuous intraspinal morphine analgesia have been enthusiastic regarding the resultant cancer pain control. Reports of continuous intraspinal infusion have not documented the duration of useful analgesia, need for concomitant analgesic therapies, or complication rates. Thus, the overall outcomes and complications of six chronic intrathecal and eight epidural morphine infusions were analyzed in the first 14 cancer pain patients implanted with continuous intraspinal morphine infusion reservoirs at this clinic. A five-point scale was used to assess the analgesic therapy required to maintain pain control during three consecutive intervals of intraspinal morphine infusion (zero to two months, two to six months, after six months). Comparison with pre-implant narcotic requirements revealed equal or reduced narcotic use for up to six months of therapy, with a definite trend toward escalation of intraspinal narcotics, systemic analgesia, and adjunctive procedures after two months. This occurred most likely due to narcotic tolerance and disease progression. Failure of pain control was the rule with continuous intraspinal morphine after six months. Three patients ultimately required neurolytic blocks. No clear difference was found in pain control requirements between epidural and intrathecal morphine infusion. No infection or respiratory depression occurred as a direct result of the intraspinal morphine implanted system.
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PMID:Outcomes and complications of continuous intraspinal narcotic analgesia for cancer pain control. 621 Mar 51

Buprenorphine sublingual tablets (0.2 mg) were investigated in therapy of cancer pain. In 67 patients there was a good analgetic effect in 60%, even in those cases treated with other opiates before. The induction time was quite long (60 min.) but is no problem in chronic administration. Effective pain relief was obtained even in final stages of cancer. The mean daily dose of buprenorphine had been 1.2-1.7 mg, the mean duration of analgesia being 6-8 hours with a single dose of 0.2-1.0 mg buprenorphine. Typical opiate-side-effects were registered and well tolerated after some days' treatment. There was no respiratory depression. Buprenorphine sublingual tablets are certainly a good alternative in orally available opioids.
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PMID:[Sublingual buprenorphine tablets: initial clinical experiences in long-term therapy of cancer pain]. 640 40

Pain is one of the most feared consequences of cancer. Until recently, however, little has been known about its prevalence, severity, and impact on the patient with cancer. The presence of pain, despite efforts to treat it, represents a continued source of frustration for patients, their families, and the health care team. Although often one of the early indicators of the presence of disease, pain is not a significant problem for the majority of patients in the early stages of disease, with 5% to 10% of patients with solid tumors reporting pain at a level that interferes with mood and activity. But when metastatic disease is present, about one in three patients reports significant pain, and our data and those of others indicate that the majority of patients with end-stage disease will report pain of a severity that interferes with several aspects of the patient's quality of life. Site of tumor is also significantly related to the progression of pain. The relationship between pain intensity and depression and anxiety is examined in detail, and the treatment implications of this relationship discussed. Whereas a modest relationship between pain intensity and depression has been found across several studies, the possibility that depression is a causative factor in the pain experienced by the cancer patient may have been overemphasized. Data on the relief of pain in cancer are reported from the perspective of patients as well as the physicians and nurses who treat them. The majority of physicians and nurses specializing in cancer treatment whom we have surveyed believe that cancer patients in general are undermedicated for pain. Patient survey data indicate that only 50% of cancer patients with pain report 70% or greater pain relief with analgesic medication. Although a number of nonsystemic treatments may be useful for cancer pain management (such as nerve blocks, neurosurgery, and behavioral treatments), they are not widely available and there are few controlled studies of their effectiveness. Teaching patients to report the level of their pain on simple pain intensity scales has proven useful in monitoring the effectiveness of pain management, as well as in helping establish pain control goals for the individual patient.
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PMID:The impact of pain on the patient with cancer. 649 54

In 75 patients epidural opiates were applied for relief of chronic cancer pain. In order to avoid local infection during long-term therapy part of the catheter was placed subcutaneously. Different opiates were used separately or in combination with local anaesthetics to define the degree and duration of pain relief after epidural opiate application. Haemodynamic and respiratory parameters, changes in lower extremity blood supply and other side-effects were recorded during epidural pain therapy. Epidural opiate application cause a long-lasting reduction of pain, which may become restricted during long-term or repeated use, especially after a period of systemic opiate therapy. Side-effects, for example slight respiratory depression in the first hour after injection, indicate an initial phase of resorption beeing followed by a long-lasting reduction of pain without attendant symptoms. Keeping in mind certain precautions epidural opiate therapy is superior to systemic opiate application.
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PMID:[Epidural application of opiates in chronic pain due to malignoma (author's transl)]. 730 64

Opioids are underused by physicians for the treatment of cancer pain. Reasons for this include excessive concern about opioid-induced respiratory depression, tolerance, and addiction, as well as the impact of controlled substances regulations. The negative impact of controlled substances regulations on patient care is not well understood. This paper reviews the historical basis and current structure of the regulatory system. Four potential ways in which controlled substances regulations and policies can affect medical care are discussed: (1) by placing restrictions on physician practice, (2) by affecting patient access to opioids, (3) by stigmatizing patients, and (4) indirectly through physicians' perceptions of regulations, resulting in modified medical practices. Physicians are urged to work with state regulatory agencies to identify regulatory impediments to appropriate patient care.
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PMID:Doctors, opioids, and the law: the effect of controlled substances regulations on cancer pain management. 768 31

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

Tramadol is a centrally acting analgesic which possesses opioid agonist properties and activates monoaminergic spinal inhibition of pain. It may be administered orally, rectally, intravenously or intramuscularly. In patients with moderate to severe postoperative pain, intravenous or intramuscular tramadol has generally proved to be of equivalent potency to pethidine (meperidine) and one-fifth as potent as nalbuphine. Intravenous tramadol 50 to 150mg was equivalent in analgesic efficacy to morphine 5 to 15mg in patients with moderate pain following surgery; however, when administered epidurally tramadol was one-thirtieth as potent as morphine. Tramadol has demonstrated efficacy in a few studies in the short term treatment of chronic pain of various origins. Orally administered tramadol was found to be an effective analgesic in step 2 of the World Health Organization's guidelines for the treatment of patients with cancer pain. Tramadol is well tolerated in short term use with dizziness, nausea, sedation, dry mouth and sweating being the principal adverse effects. Respiratory depression has been observed in only a few patients after tramadol infusion anaesthesia. When used for pain relief during childbirth, intravenously administered tramadol did not cause respiratory depression in neonates. The tolerance and dependence potential of tramadol during treatment for up to 6 months appears to be low, although the possibility of dependence with long term use cannot be entirely excluded. Thus, evidence to date of the analgesic effectiveness of tramadol combined with a low respiratory depressant effect and low dependence potential in short term use, suggests that the drug may become a useful alternative to the opioid analgesics currently available for the treatment of patients with moderately severe acute or chronic pain.
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PMID:Tramadol. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. 769 19


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