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)

Drug-induced akathisia is a significant and common iatrogenic disorder. It involves both a subjective component of a disturbing sense of compulsion to move and an objective component of motor restlessness. Akathisia is being seen with increasing frequency in medical and surgical patients. This is due to the increased use of anti-emetics or novel adjuncts to pain control as well as more widespread use of the major psychoactive drugs throughout medicine. This review focuses on diagnostic features of the disorder as well as on possible treatment approaches. In addition, the disorder demonstrates the close anatomic and functional relationship between cortical and subcortical dopaminergic pathways. Akathisia is thus both an increasingly significant clinical problem and a fascinating glimpse at the relationship between brain function and behavior.
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PMID:Review: drug induced akathisia in medical and surgical patients. 329 1

In the United States, depression is the most common psychiatric disorder and is the psychiatric problem most often seen by the generalist. Thus, it is essential for the primary-care physician to have a thorough understanding of the diagnosis and management of depression. Patients often present with complaints such as weight loss, appetite changes, sleep disturbances, pain, psychomotor agitation or retardation, decreased sexual drive, loss of energy, and somatic complaints. When depression is suspected, the clinician should first rule out secondary depression attributable to other psychiatric or medical illnesses, or medications. In addition, certain age categories--children, adolescents, and elderly individuals--have characteristic symptoms and behavior patterns suggestive of depression. Identifying the suicidal patient is another important aspect in the treatment of depressed individuals. In addressing this issue, questions have been formulated to help identify patients who may be potentially suicidal. Treatment modalities for depression include exercise regimens, psychotherapy, and pharmacotherapy. The standard pharmacotherapy has been the administration of tricyclic antidepressant agents; newer drugs are currently available that have comparable efficacy, and perhaps better safety profiles than the tricyclic agents.
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PMID:Diagnosis and treatment of depression. 332 Nov 26

Morphine sulfate in doses of 90 to 150 micrograms/3 microliters evoke a prominent behavioral syndrome characterized by 1) periodic bouts of spontaneous agitation during which the rat scratches and bites at the skin of the caudal dermatomes and 2) vigorous agitation, vocalization and coordinated efforts to bite and escape evoked by a light tactile stimulus applied to the flank, suggestive of a pain state (allodynia). The phenomenon is not reversed by naltrexone or is it subject to tolerance. The ordering of activity of an opioid alkaloid related agent in producing this touch-evoked agitation is: noroxymorphone-3-glucuronide, morphine-3-glucuronide, morphine-3-ethereal sulfate, dihydromorphine, noroxymorphone dihydrate, hydromorphone, dihydrocodeine tartrate, morphine sulfate, dihydroisomorphine, morphine-HCl, 6-acetylmorphine, N-normorphine-HCl and (+)-morphine. The following agents were essentially without effect at the highest doses examined: 3,6-diacetylmorphine, N-normeperidine-HCl, nalorphine-HCl, alfentanil, sufentanil, naloxone, naltrexone, methadone, dextrorphan tartrate, meperidine-HCl, oxycodone, levorphanol, oxymorphone, codeine phosphate, thebaine, nalbuphine and naltrexone-3-glucuronide. The observations that the sulfated and conjugated metabolites are 10 to 50 times more potent than their unmetabolized precursor suggest the possibility that, in high concentrations certain phenanthrene opioid alkaloids with a free 3-OH position, an ether bridge and no N-methyl extension will be subject to conjugation and this metabolite will alter the processing of otherwise innocuous tactile stimuli. The fact that the phenomenon appeared at least partially stereospecific may reflect upon the fact that other laboratories have shown that glucuronyl transferase may preferentially convert (-)-morphine to the 3-glucuronide and (+)-morphine to the 6-glucuronide which may be less active.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacology of the allodynia in rats evoked by high dose intrathecal morphine. 334 33

A controlled investigation was conducted to compare the effectiveness of diclofenac and papaveretum in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 3 and 13 years of age were randomly allocated to receive rectal diclofenac 2 mg/kg, intramuscular papaveretum 0.2 mg/kg or no medication immediately after induction of anaesthesia. Pain and appearance were assessed 1, 3 and 6 hours postoperatively, and the following morning. The assessments were double-blind and performed by the same observer. No significant differences in postoperative pain were found between the groups at any time. The use of diclofenac was associated with a significantly more rapid return to calm wakefulness and had significantly less effect upon respiratory rate. Consumption of paracetamol on the day of operation was significantly less in the diclofenac group. Diclofenac may offer advantages compared to papaveretum with regard to safety and convenience for use in the treatment of pain after tonsillectomy in children.
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PMID:A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy. 337 47

Circumcision in neonates is performed, almost universally, without anesthesia or analgesia. It is associated with pain, crying, agitation, and physiologic stress. Twenty infants receiving penile nerve block for circumcision were compared with ten infants having circumcision without anesthesia. Heart rate and blood pressure rose 34 and 15%, respectively, in unblocked infants, and were unchanged in infants receiving local anesthesia. Oxygen saturation declined 16% in unanesthetized infants compared with 6% in blocked infants (P less than .03). Anesthetized infants were less agitated and cried less. Peak plasma concentrations of the local anesthetic lidocaine averaged 0.51 +/- 0.17 microgram/mL (range 0.1-1.6), well below accepted toxic levels. There were no local or systemic complications.
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PMID:Penile nerve block for newborn circumcision. 362 93

A phase I study of the intracarotid administration of PCNU was conducted in patients with intracerebral tumors recurring after cranial radiation. Seventeen patients were treated including 16 with recurrent gliomas or glioblastomas and 1 with recurrent brain metastases from adenocarcinoma of the lung. An additional patient received a vertebral artery infusion of PCNU for a recurrent glioblastoma. Seven of 17 patients receiving intracarotid PCNU responded for a response rate of 41%. If only evaluable patients with gliomas are considered, the response rate was 44%. Tumor grade at time of initial diagnosis, exposure to prior chemotherapy, and dose of PCNU did not appear to have a major impact on response rate. Zubrod performance status 3 patients had a lower response rate (25%) than did patients with performance status 1 or 2 (response rate 63%). Thrombocytopenia and reversible central nervous system toxicity were dose limiting at a PCNU dose of 110 mg/m2. Two patients had possible permanent central nervous system toxicity. Three patients had permanent ipsilateral visual impairment, including one at the lowest dose used into the carotid artery (60 mg/m2). Orbital pain appeared to be substantially less than that seen with intracarotid BCNU but headaches may have been somewhat more common. The single patient receiving a vertebral artery infusion developed marked headaches and restlessness after receiving 25 mg/m2 of a planned 75 mg/m2 treatment into the vertebral artery and the treatment had to be discontinued. Symptoms were rapidly reversible upon stopping the medication. Our overall impression is that intracarotid PCNU causes less ocular pain but more transient central nervous system toxicity than does intracarotid BCNU.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Phase I study of intracarotid PCNU. 368 87

A national survey was conducted to determine beliefs about neonatal pain and agitation, current methods of assessment, and standards for treatment. The results indicated a lack of consistency in both attitudes and practices among neonatal intensive care unit staff with regard to pain assessment and management in neonates. Methods for assessing the presence of pain or evaluating the effectiveness of treatment appeared inadequate for critically ill infants, particularly intubated and paralyzed infants. Agitation in neonatal intensive care unit infants was identified as a problem by a majority of the respondents surveyed. Infants with chronic lung disease were identified as being particularly affected by agitation. These infants were noted to have an increased incidence of feeding problems and were more often medicated for agitation.
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PMID:A national survey of the assessment and treatment of pain and agitation in the neonatal intensive care unit. 369 6

During a 2 year period nitrous oxide was used as a sole or supplementary analgesic during 173 vascular or interventional procedures including peripheral angiography and endourologic and endobiliary procedures. The decision to administer nitrous oxide to a given patient was a matter of physician preference. Patients with bowel obstruction, pneumothorax, or chronic obstructive pulmonary disease were excluded from this method of analgesia. The nitrous oxide was administered by a radiology nurse under the supervision of an attending radiologist. Nitrous oxide was used without premedication for 39 procedures and with premedication (usually meperidine 1 mg/kg, promethazine 0.3 mg/kg, or atropine 0.01 mg/kg) in 134 procedures. In 74% of nonpremedicated individuals analgesia was adequate with nitrous oxide alone; 26% required supplemental intravenous medication. In 61% of premedicated individuals pain relief was adequate with nitrous oxide; 39% required supplemental intravenous medication. Complications, including nausea, vomiting, and agitation, occurred in eight patients, but were minor and easily reversed by decreasing the concentration of nitrous oxide. Nasally administered nitrous oxide is a safe, easily used, and effective analgesic.
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PMID:Nitrous oxide: effective analgesic for vascular and interventional procedures. 387 37

Sixty male and female patients, scheduled for colonoscopy were premedicated with glycopyrrolate 0.4 mg intramuscularly. Anaesthesia was induced with 2 mg/kg propofol ('Diprivan') and maintained with a continuous infusion of propofol at a rate of 3, 6 or 9 mg/kg/h randomly allocated. Patients lost consciousness within 60.6 +/- 18.7 (s.d.) s. Preservation of the hypnotic effect was infusion-rate dependent as 15, 40 and 85% of the patients were unconscious on infusion rates of 3, 6 or 9 mg/kg/h propofol, respectively. A high degree of sedation was observed in the remaining patients with an incidence of 40, 35 and 0% in the different series. Sedation was light in the remainder of the patients. To increase the acceptability of the procedure, a supplemental bolus of propofol and/or an increase in the infusion rate were required in 40, 15 and 10% of the 3, 6 and 9 mg/kg/h infusion rate groups, respectively. The incidence of amnesia was similar in all three groups (80, 90 and 95%, respectively). Recovery was significantly longer with increasing infusion rate, but remained rapid. The longest time was 7.3 +/- 4.0 min to open eyes on command and 10.6 +/- 4.6 min to answer correctly. The most important side effects were pain on injection (50%) and some restlessness during maintenance (25%). Blood pressure decreased, but heart rate was unaffected. Patients breathed room-air spontaneously. Respiratory rate slowed after induction then increased rapidly above baseline values. The incidence of apnoea was 48% with a mean duration of 51 +/- 22s (s.d.). The technique was evaluated as good or adequate in 95% of the cases. We suggest than an analgesic premedication followed by an average of 6 mg/kg/h propofol by infusion might be a simple and convenient method of achieving good conditions for colonoscopy.
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PMID:Infusion of propofol ('Diprivan') as sedative technique for colonoscopies. 387 79

A controlled investigation was conducted to compare the effectiveness of morphine and nalbuphine in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 4 and 12 years old were randomly allocated to receive intramuscular morphine 0.2 mg/kg, nalbuphine 0.3 mg/kg or no medication approximately 5 minutes before the conclusion of surgery. Pain and restlessness were assessed 1 and 2 hours after injection, and side effects were recorded. The assessments were made double-blind. Both nalbuphine and morphine decreased restlessness and pain 1 hour (p less than 0.01) and 2 hours (p less than 0.05) after surgery. No significant differences were found between the two groups of patients who received opioids. Both nalbuphine and morphine caused more drowsiness than placebo 2 hours after surgery (p less than 0.001). Other side effects were uncommon. Nalbuphine may offer advantages compared with morphine in regard to safety and convenience of use for the treatment of post-tonsillectomy pain in children.
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PMID:Controlled comparison of nalbuphine and morphine for post-tonsillectomy pain. 390 39


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