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)

Pain from ureteral stones is believed to be due to spasm and hyper-peristalsis of the involved ureter. Nifedipine has been shown to decrease human ureteral spasm in vitro. Conflicting results have been reported concerning the clinical efficacy of nifedipine in relieving acute renal colic. This prospective, double-blind, crossover clinical trial evaluated the acute pain relief obtained in 30 patients who had ureteral stones. All patients had ureteral stones documented either by plain abdominal radiograph (six), intravenous pyelogram (16), or passage of the stone(s) in the urine (eight). Each patient served as his own control. The mean pain relief scores for placebo versus 10 to 20 mg oral nifedipine were 0.7 +/- 1.8 and 1.2 +/- 2.5, respectively, as measured on a visual analogue scale (P = .404). Seven patients received clinically significant relief associated with nifedipine, and three patients received relief from placebo (P = .300). Twenty patients (66%) did not experience clinically significant relief from either treatment. We conclude that nifedipine does not differ significantly from placebo in providing relief from acute renal colic.
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PMID:Nifedipine for the relief of renal colic: a double-blind, placebo-controlled clinical trial. 238 74

The value of emergency room renal scan in acute renal colic was evaluated. Based on obstructive pattern on renal scan, 53 cases were admitted. The results indicate that only in 13 cases (25%) there was a need for further inpatient investigation followed by interventional treatment. In all 13 cases, either elevated fever, impaired renal function or intractable pain were present, in addition to an obstructive renal scan pattern. In the majority (75%) of cases, when there were no adjunctive ominous signs, hospital admission based only on an obstructed renal scan, showed need for conservative therapy only and was rather unjustified.
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PMID:The value of renal scan in acute renal colic--a clinical viewpoint. 265 38

The octapeptide form of CCK predominates in the central nervous system (CNS) of mammalian species, including man. Many of the physiological roles of CCK in the CNS are unknown, but it is believed to be involved in nociception. CCK is distributed throughout cortical grey matter, periaqueductal grey matter, ventromedial thalamus and spinal dorsal horn, all of which are areas known to be associated with pain modulation. CCK receptor subtypes have been identified and may be classified according to their affinity for the sulphated and desulphated forms of CCK-8 and the recently described selective antagonist. MK-329. CCK-A receptors have high affinity for sulphated CCK-8 and for MK-329 but low affinity for desulphated CCK-8 and CCK-4 whilst CCK-B sites bind MK-329 with low affinity and discriminate poorly between sulphated and desulphated CCK-8. CCK-A receptors are found predominantly in peripheral tissues but they also exist in discrete regions of the primate CNS, including the spinal cord. CCK-B receptors are found ubiquitously throughout other regions of the neuraxis. The results of studies on the effects of CCK-8 and the decapeptide analogue caerulein on pain thresholds are conflicting. Some workers suggest that large doses of CCK-8 and caerulein induce naloxone-reversible analgesia in certain pain models. However, it appears likely that analgesia induced by large doses of CCK and caerulein in animals may be a pharmacological rather than a physiological phenomenon. Accordingly, others have found that small (and most probably, physiological) doses of CCK-8 attenuate the analgesic effects of morphine, and of endogenous opioids. Thus, it has been proposed that CCK may act as an endogenous opiate antagonist. Studies in rats with the selective CCK antagonist MK-329 have helped clarify the interaction between CCK and morphine-induced analgesia. Treatment with MK-329 enhances morphine analgesia and chronic treatment with MK-329 prevents the development of tolerance to morphine analgesia. However, the antagonist does not prevent naloxone-precipitated withdrawal symptoms in morphine-dependent rats. In man, caerulein prevents pain associated with gall-bladder contraction, probably by relaxation of the sphincter of Oddi. Caerulein has also been shown to reduce renal colic and the pain of intermittent claudication. Preliminary clinical studies with the weak, non-selective, CCK antagonist proglumide, indicate an enhancement of morphine analgesia. As yet, no studies have demonstrated analgesic effects of CCK antagonists in man when administered alone.(ABSTRACT TRUNCATED AT 400 WORDS)
Pain 1989 Dec
PMID:The role of CCK caerulein, and CCK antagonists in nociception. 269 75

The inhibition of prostaglandin synthesis by nonsteroidal anti-inflammatory drugs can alleviate the pain and inflammation associated with a variety of disorders. Nonsteroidal anti-inflammatory drugs have a role, therefore, in the treatment of nonrheumatic conditions as well as in the treatment of rheumatic diseases, an area in which these agents have been used and studied more extensively. In clinical conditions marked by acute or chronic pain and inflammation, such as oral surgery, dysmenorrhea, low back pain, renal colic, and biliary colic, as well as in post-traumatic and postoperative conditions, diclofenac sodium, a nonsteroidal anti-inflammatory drug with potent prostaglandin synthetase inhibition, has been shown to be an effective analgesic agent. In the current studies, diclofenac was given orally or by intramuscular injection in doses ranging from 50 to 75 mg daily, or up to 150 mg per day for longer-term use. When compared with placebo, diclofenac provided consistently superior relief of symptoms. Comparisons with other nonsteroidal anti-inflammatory drugs or with opioids, such as pentazocine or Spasmofen, demonstrate that symptom relief with diclofenac was either comparable to or better than that obtained with these agents.
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PMID:Use of diclofenac in analgesia. 293 15

Since the mid-1970s, evidence has accumulated that cholecystokinin (CCK) has a role as a neuromodulator or neurotransmitter in the central nervous system as well as in the periphery. CCK has been shown to have a variety of effects on gastrointestinal functions and is one of the main candidates for a role as a peripheral negative feedback signal to stop feeding behavior. CCK produces satiety not only in animals but also in man: it reduces appetite and activation arising from the preparation of a meal and inhibits intake of liquid and solid food in both lean and obese subjects. The closely related peptide caerulein has similar effects. The site of action of peripherally administered CCK seems to be on an abdominal organ innervated by gastric vagal branches and relayed to the brain by afferent vagal fibres, since selective gastric vagotomy blocks the satiety effect, but pharmacological antagonism of vagal motor effects or lesions of the ventromedial hypothalamus do not. CCK also may have a role in the regulation of pain perception. In mice, CCK and caerulein were shown to produce a decrement in response to noxious stimulation after peripheral and central administration. In man, caerulein was demonstrated to relieve pain originating from biliary and renal colic as well as from cancer and ischemia. A series of studies in healthy man revealed that caerulein also alleviates experimentally induced cutaneous pain. Data from animal studies suggest that CCK-like peptides not only are able to produce analgesic effects on their own, but also are involved in the modulation of opioid systems mediating analgesia. Further study of these effects of CCK should elucidate the regulatory connections between the life-sustaining functions of feeding and pain sensation.
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PMID:Effects of cholecystokinin and caerulein on human eating behavior and pain sensation: a review. 308 29

Idiopathic hypercalciuria (IH) in adults is recognized as a cause of urolithiasis. If IH is symptomatic, the symptoms are hematuria, renal colic, or obstructive uropathy with or without infection. In children, IH has been linked to the spectrum of urinary symptoms including hematuria, pyuria, dysuria, recurrent urinary infections, abdominal or suprapubic pain, proteinuria, and the frequency-urgency syndrome. Hematuria may appear prior to the appearance of stones, and thiazide therapy appears to prevent stone formation by decreasing urinary calcium excretion. This report describes an older adolescent with hematuria and flank pain. His urinary chemistry values were not consistently typical of IH, but a thiazide trial with withdrawal challenge was diagnostic. His case is remarkable because, though essentially an adult, his disease was typical of prepubertal disease. Adolescents with unexplained urinary symptoms should be evaluated for IH. The urinary calcium-creatinine ratio may not be elevated, and timed urinary calcium may be equivocal. In some cases a thiazide trial may be valuable and cost effective.
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PMID:Atypical idiopathic hypercalciuria in an adolescent. 318 67

The management of the patient presenting to the Emergency Department with nephrolithiasis or renal colic should include evaluation of the patient for concurrent diseases, risk factors for stone formation, and possible etiologies for stones. Suspicion of ureterolithiasis is based on a cogent history and physical examination and reinforced by a finding of hematuria. Diagnosis should be based upon a promptly performed intravenous pyelogram, unless the patient is truly allergic to contrast media or has substantial risk of a contrast-induced renal failure. A solitary flat plate of the abdomen adds no useful information and is an unnecessary expense to the patient. Essential laboratory data include a urinalysis, CBC, and electrolyte, BUN, creatinine, and serum calcium levels. A urine culture should be obtained in all patients because urinalysis alone may not be sufficient to exlude a urinary tract infection. Initial treatment of the patient with an uncomplicated renal colic should include hydration, relief of pain, and reassurance. Evaluation by a consultant may be done as an outpatient on a nonemergent basis. If the colic has not resolved after 72 hours, hospitalization generally is recommended. If the patient has vomiting, dehydration, a complete obstruction, or a solitary kidney, hospitalization in indicated and urgent consultation recommended. If the patient has fever or other signs of infection, emergent consultation and immediate hospitalization are essential. Retained obstructing stones are generally managed by urologic consultants. It is in the care of the patient with the retained stone that greatest advances have been made in the past 10 years. Patients should be counseled that the retained stone no longer calls for extended hospitalization and convalescence.
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PMID:Nephrolithiasis. 329 30

In a prospective double-blind, cross-over study, 61 patients with acute renal colic were treated with either indomethacin (50 mg) or oxycone-papaverine (5 mg + 50 mg) administered intravenously. For those patients requiring a second injection the drugs were reversed. The intensity of pain was evaluated before and 20 min after each injection according to an analogue visual scale 0 to 100. Both drug regimens provided comparable and significant pain relief; a pain score of less than 20 appeared to be satisfactory and was achieved in almost all cases.
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PMID:Intravenous indomethacin and oxycone-papaverine in the treatment of acute renal colic. A double-blind study. 329 30

A randomized, double-blind clinical trial in 50 patients was done to compare the efficacy and tolerance of single doses of intramuscular diclofenac 75 mg and dipyrone 2 g in acute renal colic. Both drugs were equally effective, but diclofenac was better in terms of complete relief of pain. Vital signs were affected according to the stress and pain.
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PMID:Diclofenac versus dipyrone in acute renal colic: a double-blind controlled trial. 332 48

The analgesic efficacy and safety of butorphanol tartrate are discussed in 2 groups of patients who underwent urological procedures. The first group of 83 patients is presented as a retrospective review of the postoperative use of butorphanol. The second group of patients was involved in a double-blind, randomized comparative trial of butorphanol (2 or 4 mg) and meperidine (80 mg) for the relief of moderate to severe pain due to renal colic. Eighty-three patients with documented upper urinary tract calculi were evaluated for efficacy; 120 patients were evaluated for safety. Butorphanol 4 mg (i.m.) was more effective than butorphanol 2 mg (i.m.) and equivalent to meperidine 80 mg (i.m.). There were no statistically significant differences among the three treatment groups in regard to side effects. Overall, in the urology patients studied, butorphanol was found to be an effective and well tolerated agent that possesses important safety advantages when compared with the narcotic analgesics.
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PMID:Urological applications of butorphanol tartrate: postoperative pain and renal colic. 334 97


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