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

Although anxiety is known to enhance a patient's response to pain, the exact relationship is unclear. This problem is particularly acute among psychiatric patients where analgesics are frequently both used and abused. This study attempts to evaluate factors associated with analgesic use among these patients with the hypothesis that anxiety, other measures of psychopathology, and ward tension would be associated with frequent analgesic use. An unselected series of psychiatric admissions during a three month period were administered the State-Trait Anxiety Inventory, MMPI, and a questionnaire dealing with prior drug use. Propoxyphene napsylate (Darvon-N) was made freely available on request from nurses who recorded details of the interaction on a prepared card. The nursing staff also recorded unusual incidents on the unit and evaluated daily the level of ward tension. The results indicate that, when made freely available to psychiatric inpatients, propoxyphene was used very conservatively and for appropriate complaints. Factors associated with drug seeking behavior are discussed in relation to other research regarding the use and abuse of analgesics.
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PMID:Propoxyphene on demand. Analgesic-seeking behavior in psychiatric inpatients. 26 17

A double-blind randomized parallel group trial was undertaken to compare the acceptability and efficacy of 2 forms of analgesic treatment, DI-Antalvic (Houde Laboratories, Puteaux, France) (30 mg dextropropoxyphene and 400 mg paracetamol per capsule) and Efferalgan-Codeine (UPSA Laboratories, Rueil Malmaison, France) (30 mg codeine and 500 mg paracetamol per tablet) prescribed for 1 week at doses of 6 capsules/day and 6 tablets/day, respectively, in 141 outpatients with active osteoarthritis of the knee or hip. The principal aim of the trial was concerned with acceptability, with efficacy as its secondary aim. The principal trial criterion was defined as overall assessment of acceptability by the patient at the end of the trial (success or failure) or by treatment dropouts because of an adverse effect (failure). Comparability of the groups was confirmed before any treatment regarding the physical characteristics of the patients, characteristics of osteoarthritis, and the initial level of pain and functional consequences of pain. Results show that the analgesic efficacy of the treatment was similar, but that the acceptability of Efferalgan-Codeine was significantly worse than that of DI-Antalvic: 53% failure with Efferalgan-Codeine versus 29% failure with DI-Antalvic (P = .005). Other trials of the same type would seem necessary (comparison of lower doses, other types of pain) before being able to generally extrapolate such findings.
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PMID:Acceptability and efficacy of two associations of paracetamol with a central analgesic (dextropropoxyphene or codeine): comparison in osteoarthritis. 147 72

A 41-year-old white man with a 2-year history of irritable bowel syndrome (IBS) was referred for psychological treatment. At the time of assessment he was being treated with Metamucil and Darvocet N-100s with little success. A detailed psychosocial assessment indicated several areas for cognitive-behavioral intervention. Nine months after the patient began treatment, the frequency of IBS episodes had greatly reduced, he was off narcotic pain medication, and his general health was improved as measured by clinic and emergency room visits. We suggest that psychological interventions of the type described here can be an efficacious and cost-effective treatment for IBS.
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PMID:Cognitive-behavioral intervention for irritable bowel syndrome. 355 10

The analgesic effects of dextropropoxyphene and paracetamol and that of a combination of the two drugs were assessed in 24 patients who suffered from either rheumatoid arthritis or osteoarthritis. Dextropropoxyphene, which had a marginal effect on pain score, led to a more significant effect on patient well-being, particularly when it was the first drug given in the sequence. The addition of paracetamol had more of a negative than a positive effect on pain score and well-being.
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PMID:Further look at dextropropoxyphene with or without paracetamol in the treatment of arthritis. 669 28

A questionnaire was sent to the pharmacies of 88 Finish hospitals with surgical departments to inquire about the consumption of opioids during 1990. Another questionnaire was sent to 480 members of the Finnish Society of Anaesthesiologists to ask how they administer opioids to adult patients. Answers were received from 95% of hospitals and 67% of anaesthetists. Dextropropoxyphene was the most common oral opioid and oxycodone was the most common parenteral opioid used in Finland. Parenteral opioids were consumed almost totally in the hospitals. The anaesthetists reported oxycodone to be the opioid of choice for premedication, postoperative pain and sedation of critically ill patients. Fentanyl was the opioid most commonly used intravenously during balanced anaesthesia and in epidural administration. Epidural opioids were administered by 77% of anaesthetists and patient-controlled analgesia (PCA) technique mostly for intravenous administration by 19%. Only 10% of Finnish anaesthetists were actively involved in the management of chronic pain; the methods they use are discussed. The majority of anaesthetists were satisfied with the currently available opioids.
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PMID:Opioids in anaesthesia: a questionnaire survey in Finland. 791 67

Toradol (ketorolac tromethamine; Syntex Labs, Palo Alto, CA) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. Its action is peripheral. Therefore, it seemed appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total of 60 mg (2 cc) are used, divided among the quadrants resected. Four hours postoperatively, 30 mg are given intramuscularly, and the patient is discharged. Any patient who required medication stronger than Darvocet-N-100 (propoxyphene napsylate and acetaminophen; Eli Lilly and Co., Indianapolis, IN) for pain was considered a failure. Seventeen of 100 patients (17 percent) failed to have their pain controlled. Unexpectedly, only two patients (2 percent) needed catheterization for urinary retention. The usual incidence is 20 to 30 percent. To date we have seen none of the complications associated with the use of anti-inflammatory drugs.
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PMID:Use of Toradol in anorectal surgery. 844 38

Interviews were conducted with 265 orthopedic and chronic pain patients, using a structured diagnostic instrument (ADDIS/SUDDS) concerning their use of analgesics. Twenty-two percent of the patients met criteria for analgesic use disorders in accordance with DSM-III-R; 18.5% fulfilled DSM-IV criteria. Dextropropoxyphene was the most common analgesic prescribed and was used by 47% of the patients who met criteria for analgesic use disorders. It is concluded that patients with chronic pain using narcotic analgesics are at considerable risk of developing analgesic use disorders. Assessment of the use of analgesics should be offered to pain patients taking narcotic drugs.
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PMID:Analgesic use disorders among orthopedic and chronic pain patients at a rehabilitation clinic. 960 76

Ten healthy subjects (four male) of mean age 31 years (range 25-40) took part in a randomized double-blind four-way crossover study to examine the cognitive and psychomotor effects of repeated oral doses of dextropropoxyphene and morphine. Four treatments were compared: dextropropoxyphene napsylate 100 mg, morphine sulphate 10 mg, lorazepam 0.5 mg and placebo. Four doses of each drug were given at 4-h intervals to each subject on four separate study days at least 1 week apart. Cognitive function was assessed using choice reaction time, number vigilance, memory scanning, immediate and delayed word recall, word recognition, picture recognition, critical flicker fusion threshold (CFFT) and subjective measures of alertness, calmness and contentment. Lorazepam impaired the speed of responding on all tasks in which speed was recorded (except digit vigilance) and increased subjective ratings of calmness. Morphine had one major effect, which was to increase the accuracy of responding on the choice reaction time task, at every assessment. Morphine produced some sporadic effects in other tests and an increase in subjective calmness. Dextropropoxyphene impaired performance on choice reaction time and picture recognition. These data show that oral morphine may enhance performance in some measures of cognitive function, whereas dextropropoxyphene (in usual therapeutic doses) seems more likely to cause impairment. Neither opioid has substantial effects on cognition and psychomotor function compared with lorazepam.
Pain 2000 Mar
PMID:The cognitive and psychomotor effects of morphine in healthy subjects: a randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo. 1069 20

An HIV-positive Pennsylvania inmate, [name removed], filed a lawsuit claiming that prison physicians were indifferent to his medical needs because they tried to wean him from addictive analgesics. [Name removed]'s suit alleged deliberate indifference to his pain. Prison physicians first prescribed Darvon, and then Percocet, a very powerful painkiller, to lessen [name removed]'s discomfort. However, a new medical director at the State Correction Institution at Mahanoy City determined that Percocet was not warranted, and initiated a gradual reduction in the dosage. [Name removed]'s lawsuit was dismissed by a Pennsylvania Federal judge.
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PMID:Denial of specific medicine is not 'deliberate indifference'. 1136 68

Ketamine may prevent postoperative hyperalgesia. In patients undergoing arthroscopic meniscectomy using general anesthesia, we tested whether a single intraoperative dose of ketamine enhanced postoperative analgesia and improved functional outcome compared with a typical multimodal analgesic regimen. After the induction of anesthesia, 50 patients were randomly assigned to ketamine (0.15 mg/kg IV just after the induction of anesthesia) or a vehicle placebo. Standardized general anesthesia included propofol, alfentanil, and nitrous oxide. Bupivacaine (0.5%) and morphine (5 mg) were given intraarticularly at the end of surgery. Postoperative analgesia was initially provided with morphine and subsequently with naproxen sodium (550 mg orally twice daily) and Di-Antalvic (400 mg acetaminophen and 30 mg dextropropoxyphene) as needed. Pain scores, analgesic requirements, side effects, and ability to walk were assessed in the ambulatory unit and at home for three postoperative days. Times to awakening and to discharge were similar in the two groups. However, the Ketamine group had significantly less postoperative pain at rest and during mobilization on Days 0, 1, and 2. Furthermore, they consumed significantly fewer Di-Antalvic tablets than the control group (13 [7-17] vs 27 [16-32], median [25%-75% interquartile range]). Patients given ketamine were also able to walk for longer periods of time on the first postoperative day. In conclusion, adding small-dose ketamine to a multimodal analgesic regimen improved postoperative analgesia and functional outcome after outpatient knee arthroscopy.
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PMID:Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. 1152 27


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