Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Conditions in which antidepressants have been used include diabetic neuropathy, postherpetic neuralgia, headaches, arthritis, chronic back pain, cancer, thalamic pain, facial pain, and phantom limb pain. Although much of the available information is derived from inadequately controlled trials, it seems that antidepressants provide analgesia in many of these disorders. The analgesic effects tend to be independent of antidepressant effects, and doses of heterocyclic antidepressants used for analgesia seem to be lower than those considered effective in the treatment of depression. Doses should be started low and gradually increased until the patient reaches the highest tolerable dose. Onset of analgesia is variable, ranging from 1 day to 10 weeks. Common side effects include dry mouth, drowsiness, urinary retention, orthostatic hypotension, and constipation. Optimum dosages and schedules have not been established.
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PMID:Antidepressants in the management of chronic pain syndromes. 214 20

A disulfiram suspension (propylenglycol and water) was used to treat 45 alcoholic patients. Inactive suspension was given to 8 control alcoholic patients. Pain, local inflammation, thirst and drowsiness were related to disulfiram suspension, but not to solvent administration. Patients receiving disulfiram who drank alcohol experimented the known reaction which was related to subsequent abstinence from alcohol. 67% of patients receiving disulfiram remained abstinent after 1 year of follow up.
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PMID:[Clinical study of disulfiram in intravenous suspension. A new alternative in the treatment of alcoholism]. 215 28

Sixty healthy patients scheduled for elective cesarean delivery under epidural anesthesia were randomized to receive either lidocaine or 2-chloroprocaine as the primary local anesthetic agent. When patients first complained of postoperative pain in the recovery room, they were given either fentanyl 50 micrograms or butorphanol 2 mg, epidurally, in a randomized, blinded fashion. Postoperative analgesia, quantitated on a visual analogue scale, as well as time elapsed until first request for supplemental opioid, did not differ for patients receiving butorphanol after either 2-chloroprocaine or lidocaine anesthesia. In contrast, epidural fentanyl produced a shorter and lesser degree of sensory analgesia after 2-chloroprocaine use, whereas epidural fentanyl after lidocaine anesthesia provided pain relief similar to that seen in the butorphanol groups. Side effects were limited to somnolence with butorphanol and pruritus with fentanyl. No evidence of respiratory depression was seen in any patient. We conclude that 2 mg of butorphanol epidurally provides approximately 2 to 3 h of effective analgesia after cesarean delivery with either lidocaine or 2-chloroprocaine anesthesia. Epidural fentanyl seems to be antagonized when 2-chloroprocaine, but not lidocaine, is used as the primary local anesthetic agent. We suggest a possible mu-receptor-specific etiology for this effect.
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PMID:Chloroprocaine antagonism of epidural opioid analgesia: a receptor-specific phenomenon? 217 43

To compare the analgesic efficacy and plasma concentration of intramuscular (IM) versus epidural (EP) clonidine, 20 patients recovering from orthopedic or perineal surgery were randomly divided into two groups of ten. Clonidine (2 micrograms/kg) was administered epidurally in group 1 and intramuscularly in group 2. Analgesia was assessed using a visual analog scale (VAS) over a period of 6 h following clonidine administration. Venous blood samples were obtained at specific intervals for radioimmunoassay determination of plasma clonidine concentrations. The maximum reduction in VAS pain score was 78.5 +/- 20.6% in the EP group and 68.1 +/- 31.5% in the IM group (NS). Onset of analgesia was similar (within 15 min of injection), but duration tended to be longer after epidural than intramuscular administration (208 +/- 87 min vs. 168 +/- 95 min, mean +/- SD, P greater than 0.05). The peak plasma clonidine concentration after EP injection was 0.82 +/- 0.22 ng/ml and 1.02 +/- 0.76 ng/ml after IM injection. Hypotension, bradycardia, and drowsiness occurred with both methods of administration. None of these effects required treatment. Thus, in postoperative patients clonidine produces similar analgesia and side effects after parenteral or EP administration.
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PMID:Clonidine-induced analgesia in postoperative patients: epidural versus intramuscular administration. 217 93

A double-blind randomised investigation with placebo control was undertaken to investigate the effect of 10 mg diazepam rectally or 1 g acetyl salicylic acid as effervescing tablets on pain and nervousness during and after outpatient cervical curettage and biopsy from the vaginal cervix or the cervical endothelium. A total of 97 women participated and were subdivided at random. Three patients were, however, excluded as they did not participate as planned. No differences were found between the three groups as regards pain and nervousness during the intervention and fatigue and drowsiness after the intervention. No statistically significant difference was found in the degree of satisfaction with the treatment in the various therapeutic groups.
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PMID:[Treatment with rectal diazepam or acetylsalicylic acid in effervescing tablets in ambulatory cervical curettage and biopsy. A double-blind randomized study]. 218 10

A single-dose, randomized, double-blind, parallel-treatment study was performed in 200 outpatients with acute pain caused by the surgical removal of impacted third molars. Meclofenamate 100 mg plus codeine 60 mg, meclofenamate 50 mg plus codeine 30 mg, meclofenamate 100 mg, codeine 60 mg, and placebo treatment groups were compared for sum of pain intensity differences, peak pain intensity difference, sum of pain relief scores, peak pain relief, number of observations at which pain was half relieved, overall evaluation of effectiveness, and time to remedication with a backup analgesic. Meclofenamate 100 mg plus codeine 60 mg was significantly more effective (P less than .005) than codeine 60 mg for all variables except number of observations at which pain was half relieved. Both meclofenamate-codeine combinations and meclofenamate 100 mg alone were significantly more effective (P less than .005) than placebo for all variables. Eleven adverse experiences were reported in 7 patients (3.5%); the most common was somnolence in 1 patient receiving meclofenamate 100 mg plus codeine 60 mg, in 2 treated with meclofenamate 50 mg plus codeine 30 mg, and in 1 treated with codeine 60 mg.
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PMID:Double-blind comparison of meclofenamate sodium plus codeine, meclofenamate sodium, codeine, and placebo for relief of pain following surgical removal of third molars. 219 81

The influence of two different doses of oral naltrexone on the adverse effects and the analgesia associated with intrathecal morphine was compared in a double-blind, placebo-controlled study. Thirty-five patients undergoing cesarean section were provided postoperative analgesia by 0.25 mg intrathecal morphine. Sixty minutes later they were given 6 mg naltrexone, 3 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale. Requirements for additional analgesics and side effects were recorded. Duration of analgesia was shorter in the 3- and 6-mg naltrexone groups than in the placebo group, 10.0 +/- 2.6, 12.4 +/- 2.6, and 19.2 +/- 4.5 h (mean +/- SEM), respectively, but values did not reach statistical significance. The incidence of pruritus and vomiting was significantly less in the 6-mg naltrexone group than in the other two groups (P less than 0.05). Somnolence was significantly less in the 3- and 6-mg naltrexone groups than in the placebo group (P less than 0.05). Naltrexone (6 mg) is an effective oral prophylactic against the pruritus and vomiting associated with intrathecal morphine for analgesia after cesarean section, but it is associated with shorter duration of analgesia.
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PMID:Prophylactic oral naltrexone with intrathecal morphine for cesarean section: effects on adverse reactions and analgesia. 220 28

We analysed the effect of sustained-release morphine tablets in 174 patients with severe cancer pain. A good relief of pain could be obtained in 65% of the patients within the first week and in 80% of the patients at the end of therapy. The mean daily dose was at 178 mg morphine, six patients needed more than 1000 mg per day. The sustained-release morphine was given at fixed intervals, in 80% of the cases every eight hours. No severe side-effects were associated with long-term morphine therapy. We often saw nausea and vomiting, constipation and drowsiness, but these side-effects decreased after the first weeks of treatment. Only in ten patients we had to stop therapy because of side-effects. Morphine can be used successfully in the treatment of cancer pain for long periods without concern about tolerance.
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PMID:[Long-term therapy of tumor pain using morphine-retard tablets]. 223 10

The effect of ketamine infusion to control the intractable pain which had not responded to ordinary procedures in 12 patients with advanced cancer were evaluated. Ketamine 250 mg or 500 mg in 500 ml of transfusion fluid with or without 10 to 20 mg of droperidol was administered intravenously at the rate of 3 to 20mg of ketamine per hour. The pain scores by VAS in most of the patients decreased significantly with an averaged value of 8.3 before the treatment to 1 during the procedure. The durations of this therapy lasted from over 6 hours to 48 days. Slight disorientation in one patient and drowsiness in 5 were seen during the infusion. No cardiovascular or respiratory complications were noted. These results indicate that ketamine infusion is a useful therapeutic procedure to treat cancer pain which resist ordinary pain therapies.
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PMID:[Ketamine infusion for control of pain in patients with advanced cancer]. 225 43

Two hundred forty-one elderly depressed patients entered the 8-week, double-blind phase of this parallel-group, multicenter study; 161 patients were randomized to receive sertraline (50-200 mg/day) and 80 were randomized to receive amitriptyline (50-150 mg/day). Among evaluable patients, there were no statistically significant differences between treatments in any of the primary efficacy variables: change in total Hamilton Rating Scale for Depression (HAM-D) score (17 items), percentage change in HAM-D score, change in HAM-D Item 1, change in Clinical Global Impressions (CGI) Severity score, change in the Depression Factor of the 56-item Hopkins Symptom Checklist, and the CGI Improvement score at the last visit. Similar results were obtained using data from all patients (intention-to-treat analysis), except that amitriptyline was superior in HAM-D Total score (p = .044). The two drugs produced a similar degree of response: on the basis of the HAM-D criterion, 69.4% of sertraline patients and 62.5% of amitriptyline patients responded, and, on the basis of CGI criterion, 79.5% of sertraline and 73.4% of amitriptyline patients responded. Twenty-eight percent of the sertraline patients withdrew from the study because of a treatment-related side effect and 2.5% (4) because of a laboratory abnormality. In comparison, 35% of the amitriptyline patients withdrew because of treatment-related side effects. Sertraline was associated with a statistically lower frequency of somnolence, dry mouth, constipation, ataxia, and pain and a higher frequency of nausea, anorexia, diarrhea/loose stools, and insomnia; thus, anticholinergic effects were less common and gastrointestinal effects were more common with sertraline than with amitriptyline.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. 225 79


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