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

Renewed interest in analgesic models has been stimulated by the development of several new nonsteroidal anti-inflammatory drugs. Many of these new analgesic agents appear to have higher peak effects and longer durations of action than acetylsalicylic acid. Sensitive models are necessary to determine the dose-effect relationships and relative analgesic efficacies of these new agents. The basic principles of clinical methods--double-blinding, identical appearance of study medications, and random allocation of treatments to subjects--must be adhered to. However, additional precautions must also be taken. The choice of pain models and further subdivision of subjects within a pain model are critical for assay sensitivity. The dental pain model has become popular because the surgical procedures can be easily categorized, and each subpopulation is relatively homogeneous. There now is a body of data that substantiates the assay sensitivity of the dental pain model, and its usefulness in predicting the general analgesic efficacy of nonsteroidal anti-inflammatory drugs. Other pain models, including general postsurgical, orthopedic postsurgical, and postpartum pain, also have demonstrated adequate assay sensitivity to determine the relative efficacy of new nonsteroidal anti-inflammatory drugs.
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PMID:Models for clinical assessment of oral analgesics. 635 64

Pain following tonsillectomy is an important problem. It is caused by the surgical trauma of excision and haemostasis. Numerous surgical and pharmacological solutions have been tried, with disappointing results. Fibrin sealant is a widely used atraumatic haemostatic agent. This study aims to determine whether tonsillectomy with fibrin sealant haemostasis results in less post-operative pain than that with the conventional technique of diathermy. Fifty consecutive adult patients undergoing tonsillectomy were prospectively studied. They were randomized to receive either fibrin sealant or diathermy haemostasis. Other pain variables were controlled. Pain was measured by a visual linear analogue scale and inter-incisor distance on both the day of operation and the first post-operative day. The patients and pain measurer were blind to the randomization. The results showed that tonsillectomy with fibrin sealant haemostasis was significantly (P < 0.05) less painful than that with diathermy on both days studied and by both methods of pain measurement.
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PMID:The effect of fibrin sealant haemostasis on post-operative pain in tonsillectomy. 789 85

The purpose of this study was to measure the pain intensity of children with sickle cell disease during vaso-occlusive episodes (VOEs) and to describe their home pain management techniques. This research was guided by Orem's (1991) Self-Care Deficit Theory of Nursing. The instruments used were the African American Oucher Scale (Denyes & Villarruel, 1990) and a pain diary. The study's convenience sample consisted of 30 4- to 18-year-old children attending the Sickle Cell Center at a large Midwestern children's hospital. At the onset of the VOE, 43% of the children reported intense pain levels, and 60% of the children reported levels comparable to that of someone experiencing minor surgery or injury. Older children tended to report higher levels of pain than younger children. There was no statistically significant difference according to gender. The most frequently used pain management tools were Tylenol with codeine, fluid, and ibuprofen. Other pain management techniques used fairly often included application of heat, sleeping, reading, and exercising. The only differences in pain levels associated with the management techniques used were that children who used heat (dry and/or moist) reported higher pain intensity prior to its application than those who did not. This study shows the importance of using an ethnic-appropriate scale to quantify the children's sickle cell pain, which was found to range from intense to minor in nature. The study also identifies numerous self-care actions that children use to manage their pain at home. The pain intensity experienced during VOEs may become worse with age. Evaluation of children's self-care behaviors during VOEs in the home is important because being able to remain in their normal environment helps convince the children that they have some control over their disease.
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PMID:Pain intensity and home pain management of children with sickle cell disease. 911 14

The hallmark of trigeminal neuralgia is the abrupt onset of short pains in the face or in a part of the face, described as stabbing, lightning or electric shocks. Attacks are often triggered by cutaneous stimuli to the face or the oral cavity, which may be such minor activities as talking, chewing, brushing the teeth, or even wind blowing on the face. As a result, facial hygiene as well as a good diet may be neglected. Although 1% of the patients may eventually develop the disorder bilaterally, pain does not cross the midline during any single episode. The clinical course is characterized by exacerbations and remissions, but as the disorder progresses, remissions become shorter and exacerbations more severe. Carbamazepine is the most powerful drug for this condition, but side effects may occur. Neurosurgical treatment may then be considered; the different techniques and approaches are mentioned. Other pain conditions in the face will be reviewed. If the trigeminal neuralgia may be considered as a nerve irritation, like the glossopharyngeal neuralgia and the nasociliary neuralgia, nerve lesion may elicit neurogenic or neuropathic pain, characterized by chronic burning pain; post-zoster pain, iatrogenic and posttraumatic pain illustrate this condition. Cluster headache (Horton neuralgia), Sluder's neuralgia and auriculotemporal neuralgia may be related to a dysfunction of the autonomous nervous system. Finally, lesion in the mandibular joint may cause unilateral facial pain.
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PMID:[Trigeminal neuralgia and other facial pain--diagnosis and therapy]. 913 10

We studied responses of the parieto-frontal opercular cortex to CO2-laser stimulation of A delta fiber endings, as recorded by intra-cortical electrodes during stereotactic-EEG (SEEG) presurgical assessment of patients with drug-resistant temporal lobe epilepsy. After CO2-laser stimulation of the skin at the dorsum of the hand, we consistently recorded in the upper bank of the sylvian fissure contralateral to stimulation, a negative response at a latency of 135 +/- 18 ms (N140), followed by a positivity peaking around 171 +/- 22 ms (P170). The stereotactic coordinates in the Talairach's atlas of the electrode contacts recording these early responses covered the pre- and post-rolandic part of the upper bank of the sylvian fissure (-27 < y < +12 mm; 31 < x < 57 mm; 4 < z < 23 mm), corresponding to the accepted localization of the SII area in man, possibly including the upper part of the insular cortex. The spatial distribution of these early contralateral responses in the SII-insular cortex fits wit that of the modeled sources of scalp CO2-laser evoked potentials (LEPs) and with PET data from pain activation studies. Moreover, this study showed the likely existence of dipolar sources radial to the scalp surface in SII, which are overlooked in magnetic recordings. Early responses also occurred in the SII area ipsilateral to stimulation peaking 15 ms later than in contralateral SII, suggesting a callosal transmission of nociceptive inputs between the two SII areas. Other pain responsive areas such as the anterior cingulate gyrus, the amygdala and the orbitofrontal cortex did not show early LEPs in the 200 ms post-stimulus. These findings suggest that activation of SII area contralateral to stimulation, possibly through direct thalamocortical projections, represents the first step in the cortical processing of peripheral A delta fiber pain inputs.
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PMID:Intracortical recordings of early pain-related CO2-laser evoked potentials in the human second somatosensory (SII) area. 1034 32

Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. Sodium channel blocking drugs are first choice in treatment of trigeminal neuralgia, operative procedures encompass microvascular decompression,thermocoagulation and percutaneous retrogasserian glycerol rhizotomy. In the acute stage postherpetic neuralgia is treated antivirally and analgesically, in the chronic stage by tricyclic antidepressive substances. Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).
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PMID:[Therapy and prophylaxis of facial neuralgias and other forms of facial pain syndromes -- revised recommendations of the German Society of Migraine and Headache]. 1257 91

Pain can begin in the first year of life for individuals with sickle cell disease (SCD) and continue in an unpredictably recurrent manner throughout their life span. Sickle vaso-occlusive pain (sickle pain) can also occur simultaneously with pain of other origins, complicating both assessment and management. Aims of this research were to describe the reliability and validity of a daily diary for data collection with children and adolescents with SCD and to describe characteristics of vaso-occlusive sickle pain episodes (VOE) and other pain reported by children and adolescents with SCD along with home pain management strategies. Thirty-nine children and adolescents (mean age, 10.9 +/- 3.6 years) completed diaries twice daily at home for up to 3 years (mean, 417.9 +/- 272.2 diary days) with excellent compliance. Sickle pain alone was reported on 8.4% of days (n = 1515 days), whereas other pain occurred on 2.7% of days (n = 490) and both sickle pain and other pain on 5.7% (n = 1041 days). Other pain only episodes were shorter and involved fewer sites than sickle pain only episodes. Sickle pain occurred in the extremities and hips, whereas most other pain occurred in the head-neck area. Analgesic medication was taken on 85% of days of sickle pain, whereas analgesics were taken on only 60% of days with other pain. The diary used in this study is a valid and reliable self-report tool. The use of home diaries will improve the understanding of sickle pain and its management and assist in identifying other pain syndromes that may require alternative management.
J Pain 2002 Dec
PMID:Characteristics of pain managed at home in children and adolescents with sickle cell disease by using diary self-reports. 1462 32

Interpretation of analgesic and antipyretic responses documented after paracetamol administration is confused because response is not directly related to concentration in the blood, but rather to an effect compartment. The effect compartment does not have real measurable concentrations, but concentrations equate approximately to those observed in the cerebrospinal fluid. A time delay exists before drug reaches the effect compartment, and the equilibration half-time between the central and effect compartment is described by a single first-order parameter (Teq or T(1/2)keo), reported to be approximately 1 h for paracetamol. Paediatric analgesic studies are limited because they have only explored postoperative pain after tonsillectomy or day-stay surgery. Other pain types and pain confounders have not been investigated. Adult studies are also similarly limited. Studies investigating antipyresis have not explored the maximum response, limiting the precision of any EC(50) estimate. The influence of the cyclical nature of fever or initial temperature is seldom accounted for in antipyretic studies. Target effect compartment concentrations of 5 mg/l for fever and 10 mg/l for pain do not seem unreasonable on the basis of current literature. Speed of onset may be shortened by giving a larger initial dose or improving absorption characteristics. Consequent plasma concentration achieved, differences in effect compartment equilibration times, and the shape of the effect compartment concentration-response curve help to explain differences between common analgesic/antipyretic drugs.
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PMID:Paracetamol (acetaminophen) pharmacodynamics: interpreting the plasma concentration. 1782 18

Head and neck cancers can be revealed by pain symptoms caused by an excess of nociception. Other pain sometimes occurs during the cancer's progression such as neuropathic or mixed pain. These should incite the clinician to be watchful so as not to miss recurrence of the cancer. Treatment is complex, requiring management by a multidisciplinary team.
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PMID:[Pain related to head and neck cancers during disease progression]. 1804 62

Neuropathic pain (NP), in view of its non-nociceptive component, is not caused by physiological lesions but by problems in the nervous system itself, whether in the central nervous system (CNS) or peripheral nervous system (PNS). This particular action mechanism makes NP a very difficult-to-treat condition, resistant to most of the commonly used analgesic drugs. A recent study stated that NP has an incidence of 1.24% over the general population, and this percentage increases if we consider acute radiculopathies and some recurrent neuropathies, frequently considered not only neuropathic pain but also nociceptive. Thus, the improvement of NP treatment has become a public health necessity. While WHO recommendations include a three-lined scale in pain treatment -including NSAIDs as the first-line drugs, soft opioids (tramadol or codein) as the second-line, and strong opioids (morphine, oxycodone, and phentanyl) as the third-line- some studies have found this rationale not useful in NP treatment. Based on several studies as STEP, Spanish Pain Society recommendations included antidepressant and anticonvulsant drugs as the first line treatment. Pregabalin, a new neuromodulators class drug, provides a pharmacokinetic profile than its predecessors (phenytoin, carbamazepine, gabapentin, topiramate, oxcarbazepine, and lamotrigine), and showed effectiveness controlling peripheral neuropathic pain. Thus, pregabalin opened the door to a new approach to NP. Other pain societies, such as the Canada Pain Society, have also included pregabalin in the first line treatment of NP. In fact, gabapentin and pregabalin are the current standard care in most of NP-associated diseases.
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PMID:[Pharmacological treatment of neuropathic pain]. 2008 80


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