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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Morphine and other strong opioids are still, more than 180 years after the syntheses of morphine, not adequately used in clinical practice and many patients suffer unnecessarily severe pain in consequence. Governments limit morphine usage by legal restrictions. The underuse of morphine and its restriction in many countries is mostly due to prejudice and myths which clinical experience does not show to be true. Morphine is a very safe drug, correctly prescribed in chronic pain therapy, the only severe side effect being constipation.
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PMID:Morphine myths: sedation, tolerance, addiction. 175 13

Seventy-six cancer patients were studied on the use of controlled-release morphine sulphate (MS Contin) for cancer pain relief in the hospice of Yodogama Christian Hospital in Japan. The mean initial and maximum dosages were 81.4 mg and 178.6 mg respectively. While 46 patients (61%) did not need an increase in the initial dosage, 26 patients (34%) needed an increase ranging between 8 and 125%. Four patients (5%) required an increment of more than 500% of the initial dosage, because of apparent nerve involvement. This clinical survey showed that the total effectiveness was 92% and that 90% of the patients could experience control of pain with a daily dosage of 240 mg or less of MS Contin. Side effects observed were as follows: drowsiness 21%, nausea 11%, vomiting 8%, constipation 8%, confusion 7%, hallucination 3%. In conclusion, MS Contin offers effective cancer pain relief with minimal side effects in the majority of patients.
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PMID:A clinical survey of controlled-release morphine sulphate for cancer pain relief in a Japanese hospice. 175 22

An open pilot study was performed to assess the analgesic efficacy and acceptability of a controlled-release oral morphine preparation. Between March 1989 and August 1990, 50 patients were treated with MS Contin (morphine sulphate tablets-MS Continus) for the pain caused by advanced cancer. The participants consisted of 28 males and 22 females ranging in age from 8 to 78 years (median 52 years). Twenty-two patients were actively receiving either cancer chemotherapy (15 patients), radiotherapy (2 patients), combined chemoradiotherapy (3 patients) or hormonal treatment (2 patients). Most of the subjects had pain caused by visceral disease and bone metastasis. A combination of causes was also present in 19 patients. The patients had a wide variety of cancers the most common being stomach cancer. In 24 patients, concomitant non-opioid or non-morphine opioid analgesics were combined with MS Contin. The median duration between cancer diagnosis and MS Contin initiation was 11.0 months. MS Contin was given on average for 1.5 months. The median survival after study enrollment was 1.8 months. Of the 50 enrolled patients, three left the study in the early phase due to drug-related adverse effects. In almost all the patients the effective dose was 60 mg/day with 45 days of response duration. The required duration for dose adjustment was nine days. The most common side effects were constipation and vomiting, which were controlled with conservative care. Two patients withdrew because of intractable vomiting and one because of mental drowsiness. In conclusion, twice-a-day moderate dose oral MS Contin therapy for cancer pain offers effective pain relief with minimal, tolerable side effects in the majority of patients in Korea.
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PMID:Experience with a controlled-release oral morphine for cancer pain management. 175 23

The outcome in 40 patients who underwent colectomy for idiopathic megacolon and megarectum over an 18 year period was evaluated. All patients had a radiologically dilated bowel and a bowel frequency of less than two per week. Twenty two patients had a caecorectal anastomosis, 11 had an ileorectal anastomosis (including one with a previous caecorectal anastomosis and four with a previous sigmoid resection), and seven had a sigmoid resection. The mean (range) age at operation was 35 (17-69) years. All three operations resulted in a normal bowel frequency in more than 80% of patients but no patient with an ileorectal anastomosis experienced recurrent constipation. Thirty four patients experienced pain preoperatively and this was still present in 14 patients postoperatively. One patient died and four required subsequent laparotomy for bowel obstruction. The functional outcome in patients with dilatation of the whole colon and in those with dilatation of the left colon did not differ. Subsequent surgery for constipation was performed in three patients. Colectomy offers good results with few complications in the treatment of idiopathic megacolon, and an ileorectal anastomosis is the preferred operation.
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PMID:Colectomy for idiopathic megarectum and megacolon. 177 63

The autonomic nervous system may have a role in the pathogenesis of irritable bowel syndrome. If so, the occurrence of irritable bowel symptomatology in patients with autonomic neuropathy might indicate which, if any, of these symptoms are dependent on autonomic innervation. The prevalence of abdominal pain, abdominal distension and an abnormal bowel habit was recorded in 200 patients with diabetes, screened for autonomic neuropathy, and 200 matched controls. Constipation was significantly more common in patients with autonomic neuropathy than in those without, or controls (22.0% vs 9.2% vs 6.8%). The prevalence of abdominal pain and abdominal distension was no different in patients with and without autonomic neuropathy and their respective controls. The results of this study suggest that control of bowel habit is more dependent on the total integrity of the autonomic nervous system than the perception of pain or the production of distension.
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PMID:Functional bowel symptoms in diabetes--the role of autonomic neuropathy. 177 25

In a randomized, multicenter, double-blind study involving a total of 97 patients, the effectiveness and tolerance of Gelofalk, a new type of antacid combination comprising smectite--a natural alum earth, the specific molecular structure of which permits it to bind aggressive substances particularly well--aluminium hydroxide and magnesium hydroxide were investigated in comparison with a commercially available aluminium hydroxide antacid used by patients with gastritis, esophagitis and functional upper abdominal complaints over a treatment period of 4 weeks. The buffering capacity of a daily dose of Gelofalk was 135 mval, in the case of the reference antacid 210 mval. In terms of pain relief, reduction of accompanying symptoms, and endoscopic healing properties, Gelofalk proved very effective. Because of its particular properties, the preparation proved significantly superior to an aluminium hydroxide suspension in the case of most test parameters, in particular pain relief, onset of effect and heartburn. Gelofalk was very well tolerated; constipation or diarrhea occurred in only 2 cases each.
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PMID:[Antacid therapy of upper abdominal symptoms. Double-blind study on the effect and tolerance of 2 antacids in gastritis , esophagitis and functional upper abdominal symptoms]. 178 46

Quality of symptoms registration on three different models of nursing records was reviewed to assess whether a more patient oriented nursing record could influence completedness and precision of symptoms registration. A group of nurses set minimum criteria for five symptoms (pain, emesis, diarrhea, fever and constipation), according to the nursing process: description of written registrations of 517 symptoms were assessed. No differences appear to exist among the three different models of records, except for evaluation of the results of the interventions, more reported in the patient oriented nursing records.
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PMID:[The evaluation of the quality of nursing records: a comparison between departments that use the card, the nursing chart and the traditional order. The Nursing Research Group of Monza]. 185 95

To investigate whether the novel, potent and highly selective 5-hydroxytryptamine3 (5-HT3) receptor antagonist ICS 205-930 can prevent migraine attacks, we conducted simultaneously two randomized, double-blind, placebo-controlled, multicentre, international trials, involving a total of 204 patients, suffering from classic or common migraine. Both trials had the same parallel-group design (1 month baseline observation, followed by 3 months treatment) and both produced remarkably similar results. The primary efficacy parameter was the proportional reduction in attack frequency recorded after 3 months of treatment. Twenty-two patients withdrew prematurely from the trials and could not be assessed for efficacy. Mild to severe constipation was reported by about 50% of the patients on active treatment. None of the doses of ICS 205-930 tested (50 mg, 25 mg and 15 mg daily) produced a statistically significantly better result to reduce attack frequency than did placebo. However, confidence intervals for the difference in effect with placebo were wide, indicating that 15 mg ICS 205-930 may produce a 57% reduction in attack frequency as compared to placebo. The most unusual finding was that, for all efficacy parameters, the best results were obtained with the lowest dose (15 mg), the worst results with the highest dose (50 mg) and an intermediate effect with 25 mg. Such an inverse relation between dose and efficacy suggests a bell-shaped dose-response curve, implying that doses lower than 15 mg might well prove to be more effective. Thus, the present study has produced inconclusive, but intriguing results. Lower doses should be further investigated before drawing any definite conclusion on the efficacy of ICS 205-930 in the prophylactic treatment of migraine.
Pain 1991 Jun
PMID:Efficacy of ICS 205-930, a novel 5-hydroxytryptamine3 (5-HT3) receptor antagonist, in the prevention of migraine attacks. A complex answer to a simple question. ICS 205-930 Migraine Study Group. 187 37

One hundred and three patients with moderate and severe cancer pain were given a sublingual analgesic agent--dihydroetorphine hydrochloride (DHE). Relief of cancer pain was moderate or complete in 89.3% (92/103). The average relief time (ART) was 3.9 hours and the average time before effectiveness was 20 minutes. In patients with acute or chronic cancer pain, moderate and complete pain-relief rates were 91.3% and 82.2% (P = 0.237). Difference of ART between them was insignificant (P = 0.299). The main clinical side-effects were somnolence (60%), dizziness (72%), nausea (30%), vomiting (16.5%), constipation (5%) and shortness of breath (8%). In two of the patients, the administration of DHE had to be stopped due to its side-effects. Age, sex and site of cancer pain were not related to the analgesic effects of DHE, but the pain-relief in patients with bladder cancer was poor (P less than 0.001). Within certain range, increase in dose was able to enhance its analgesic effect (P less than 0.001) and reduce drug resistance (P less than 0.001).
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PMID:[Dihydroetorphine hydrochloride for moderate and severe cancer pain]. 188 41

Erythrocyte porphobilinogen synthase deficiency was confirmed by the determination of its activity in blood and also by the high levels of both porphyrins and 5-aminolaevulinic acid in the urine of two siblings. They presented with a picture of porphyric attack characterized by abdominal colic pain, high blood pressure, tachycardia and severe constipation. The profile of both porphyrins and their precursors in urine and blood resembled lead poisoning. However, this was ruled out because both patients had normal blood levels of lead. Furthermore, porphobilinogen synthase activity did not normalize when it was determined in the presence of dithiothreitol or dithiothreitol plus zinc chloride. No other causes to account for a deficiency in porphobilinogen synthase activity were identified. The simultaneous occurrence of similar clinical and biochemical symptoms suggests that the same triggering factor was present. Because the activity of porphobilinogen synthase was less than 4% of normal values, it is possible that these patients were homozygotes with respect to this defect, which could explain the presence of clinical symptoms. We propose that this metabolic defect is not uncommon and it should be kept in mind when diagnosing of porphyrias or heavy metal intoxications.
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PMID:Deficiency of porphobilinogen synthase associated with acute crisis. Diagnosis of the first two cases in Chile by laboratory methods. 189 53


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