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)

In 70 patients (maxillo-facial-, neurosurgical-, abdominal- and gynaecological operations) the technique of "analgetic anaesthesia" using high doses of fentanyl (0.025 mg/kg body weight) and naloxone as its antagonist (0.02 mg/kg body weight) has been employed. All patients were artificially ventilated with N2O/O2 in a 3:1 ratio. Muscle relaxation was achieved with pancuronium-bromide (0.08 mg/kg). The patients had no apparent heart or lung disease. The youngest patient was 4 years of age, the oldest 82 years of age (average age 48.9). The necessity for a reinjection of fentanyl (half the initial dose) was determined by continously monitoring heart rate. This variable appeared to be the most subtle index indicating a reduction in analgesia. Sufficient analgesia was maintained once the heart rate stayed 20% below preanaesthetic levels. At the end of the operation naloxone reversed the respiratory depression. There was no evidence indicating postoperative pain, which may have required administration of additional analgesics. If deep analgesia was maintained up to the last surgical procedures no emesis appeared in the post operative period. The incidence of emesis was higher 10% compared to the classical neuroleptanalgesia with droperidol this was often noted in cases where blood accumulated in the stomach (maxillo-facial operations) (70%). In 3% of all cases psychomotor agitation with delirium appeared right after the injection of naloxone. This lasted for about 15 minutes. We suspect that due to the sudden and powerful effect of naxolone, in replacing fentanyl from its receptor site, acute withdrawal symptoms may be precipitated.
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PMID:[High doses of fentanyl as the sole anaesthetic agent and naloxone as its antagonist (author's transl)]. 113 60

Intrauterine (PGF) prostaglandin F2alpha (5 mg) was administered for termination of early pregnancy in 14 healthy volunteers. With 11 complete abortions, the efficiency rate of this technique is below conventional methods. In addition, the incidence of infection was high, occurring in 12 out of 14 subjects. Because of persistent bleeding, 6 patients underwent a dilatation and curettage. Other significant side effects included transient hypertension, pain, nausea, and restlessness. In the patients with a complete abortion, the mean plasma progesterone concentration fell 37% after 8 hours post-PGF2alpha instillation and 90% 14 days later. The mean plasma estradiol-17beta fell 26% over the initial 8 hour period and 75% over the next 14 days.
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PMID:Intrauterine instillation of prostaglandin F2ALPHA IN EARLY PREGNANCY. 116 90

An experience of pain according to Merskey's definition was found in 24 out of 40 consecutive patients with depressive disorders. No age or sex differences were found between patients with and those without an experience of pain. In a comparison of ratings using the Cronholm-Ottosson depression rating scale, patients with an experience of pain were found to have a more severe type of depression, more psychic and vegetative anxiety, more motoric restlessness, more local tension, more thoughts of suicide, more hypochondriacal ideas, more sleep disturbances and a higher total depression score. On the other hand, no difference was found as regards depressive ideas, intellectual, conative or emotional inhibition or psychomotoric retardation. In the experimental part of the study, 30 patients -- 18 with an experience of pain -- were investigated with pain measures and visual averaged evoked responses. No differences were found in pain measures between patients with and those without an experience of pain. Out of 18 patients with an experience of pain, 15 were found to be augmenters as measured by visual averaged evoked responses. In the group of patients without pain only 4 out of 12 patients were augmenters.
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PMID:The exerience of pain in depressed patients. A clinical and experimental study. 123 57

Today's technology provides portable pumps which facilitate continuous infusion of drugs to relieve suffering in terminal disease. Subcutaneous and epidural infusion is now frequently used in our hospital. The most common indications are gastrointestinal obstruction, impaired absorption of drugs, refractory side effects of oral medication or poor compliance because good pain relief is no longer possible orally. During the last days of life, this method may be the only possible approach to good comfort and relief from terminal agitation and anxiety. Of the patients referred to the advisory group for seriously ill and dying in 1990, 64% received subcutaneous infusions and 15% epidural infusions during the last days or weeks of life. Continuous infusion of drugs from portable pumps has become an almost indispensible method of treatment in an ordinary clinic.
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PMID:[Continuous drug infusion in terminal cancer]. 137 57

The management of the final 24 hours of life of 100 patients, dying in Our Lady's Hospice is reviewed. This review suggests that management might be improved by better contact between general hospitals and hospice/home care teams concerning the timing of patient transfer. The frequency of symptoms in the dying patient, even where many are semi-comatose, is highlighted. The main distressing symptoms are pain, excessive respiratory secretions and agitation. Our review confirms reliance on standard palliative medications such as morphine, however identifies the benefit of such newer preparations as hydromorphone and midazolam. Management might be improved by the earlier usage of hyoscine subcutaneously and stopping the use of intramuscular diazepam. Attention to potential hyoscine toxicity and untreated pyrexia may ease pre-terminal agitation. The dying patient's family also needs attention to complete the optimal management of the final 24 hours.
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PMID:Management of the final 24 hours. 138 75

The intrathecal administration of prostaglandin F2 alpha to conscious mice resulted in spontaneous agitation and touch-evoked agitation (allodynia) in the animals. The maximum allodynia induced by prostaglandin F2 alpha was observed at 10-15 min after intrathecal injection, and the response did not disappear by 120 min. Prostaglandin F2 alpha produced allodynia over a wide range of dosage from 0.1 pg to 2.5 micrograms/mouse. Dose dependency of prostaglandin F2 alpha for allodynia showed a skewed bell-shaped pattern, and the maximal allodynic effect was observed at 1.0 microgram. This allodynia was dose-dependently relieved by alpha 1-adrenergic (methoxamine), alpha 2-adrenergic (clonidine), and A1-adenosine (RPIA) agonists. Clonidine was 1.5 orders of magnitude more potent than methoxamine in blocking prostaglandin F2 alpha-induced allodynia. The blockade by clonidine was dose-dependently reversed by the alpha 2-adrenergic antagonist yohimbine but not by the alpha 1-adrenergic antagonist prazosin. These results demonstrate that prostaglandin F2 alpha administered intrathecally induces allodynia in conscious mice and that the allodynia involves the alpha 2-adrenergic and A1-adenosine systems. Because this allodynia has a clear resemblance to the characteristics of chronic pain in patients with causalgia and reflex sympathetic dystrophy, prostaglandin F2 alpha may be involved in allodynia observed with these disorders.
Pain 1992 Aug
PMID:Allodynia evoked by intrathecal administration of prostaglandin F2 alpha to conscious mice. 140 21

Forty-three patients recruited from general practice with symptom-producing chronic venous insufficiency in the lower limbs participated in a randomized double-blind clinical trial with Venoruton (300 mg x 3) or a placebo for 28 days. Twenty-eight patients were treated with Venoruton and 19 with a placebo. None of the patients received other forms of treatment for chronic venous insufficiency. No differences were observed between the two groups as regards changes in symptoms (swelling, pain, heaviness, restlessness, itching and cramps) the subjective assessment of the discomfort in the extremities or the circumference of the limbs. Venoruton does not appear to have any effect on chronic venous insufficiency in the lower limbs.
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PMID:[Effect of 0-(beta-hydroxyethyl)-rutoside (Venoruton) on symptomatic venous insufficiency in the lower limbs]. 141 83

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.
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PMID:Pattern of use of antidepressants in long-term care facilities for the elderly. 141 68

In the dying patient, coma is preceded by either progressive sedation or the development of the organic brain syndrome of delirium. More than one-third of dying patients experience some difficulties during the last 48 hours of life with noisy and moist breathing, pain, and agitation and restlessness the most common. The great majority of these terminal symptoms can be managed by reassurance or drug intervention. Sublingual lorazepam and continuous subcutaneous infusion of midazolam can be effective in controlling terminal restlessness.
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PMID:The last few days. 145 27

One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.
Pain 1992 Dec
PMID:Reflex sympathetic dystrophy in brain-injured patients. 149 58


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