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)

This randomized, double-blind study compared epidural (EP) and intramuscular (IM) morphine in 24 healthy parturients for 24 h after cesarean section. The 11 EP subjects received 5 mg of EP morphine and normal saline intramuscularly, and the 13 IM patients received 5 mg of IM morphine and normal saline epidurally. Both injections were given simultaneously just after delivery and then upon request with at least 30 min between each pair of injections. Blood pressure, visual analogue scale pain score, somnolence score, and presence of nausea, vomiting, or pruritus were assessed every 30 min for 1 h after each dose and then hourly. Oxyhemoglobin saturation (Spo2) and respiratory rate (RR) and pattern were monitored continuously with pulse oximetry and respiratory inductive plethysmography. The EP group had significantly lower pain scores (less pain) than the IM (0.9 +/- 0.3 vs. 3.3 +/- 1.3; mean +/- SD; P less than 0.001) with less morphine (0.3 +/- 0.2 vs. 2.2 +/- 0.6 mg patient-1 h-1; P less than 0.001). There was no difference between groups for RR, Spo2, incidence or frequency of slow respiratory rate (SRR, 5-min mean RR less than 10) and apneas (AP, greater than or equal to 15 s of less than 100 ml tidal volume), incidence of nausea and/or vomiting, pruritus, or hypotension, and hours asleep or drowsy. There were no major respiratory abnormalities. During control monitoring of nine EP and 11 IM subjects while asleep postoperatively, the RR, Spo2, and incidence and frequency of SRR and AP were similar to the study period in both groups. In conclusion, EP morphine was a more effective analgesic than IM morphine, but the side effects of both were similar.
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PMID:A comparison of epidural and intramuscular morphine in patients following cesarean section. 240 43

Immediately following thoracotomy, 22 patients were entered into a randomized, double blind study comparing the effects of three lumbar epidural doses of sufentanil on postoperative pain and respiratory pattern. Patients were given either 30 micrograms (group I), 50 micrograms (group II), or 75 micrograms (group III) of epidural sufentanil in 20 ml N saline. Repeat doses were given on request for the 24-h study period. Linear analogue pain score (PS), heart rate (HR), and mean arterial pressure (MAP) were measured at 15-min intervals after each dose. Respiratory depression was assessed by the presence of: 1) slow respiratory rate (SRR--less than 10 breaths per minute for greater than 5 min), 2) apnea (AP--cessation of tidal ventilation for greater than 15 s), and 3) increased PaCO2 in arterial blood gases (ABG) drawn at regular intervals. SRR and AP were measured using respiratory inductive plethysmography (RIP). A further group of ten patients (group IV) underwent preoperative RIP monitoring during sleep and in the absence of any drug. Maximum analgesia was achieved within 15 min after a dose of sufentanil for all groups. Analgesia was not significantly prolonged by increasing the dose of sufentanil. SRR occurred in all four groups (group I: 2/9; group II: 2/6; group III: 7/7; group IV: 2/10 P less than 0.05 I, IV:II, I, IV:III, II:III). The number of episodes of SRR/hr was highest in group II (group I: 0.6 +/- 0.8, group II: 4.12 +/- 0.6, group III: 1.8 +/- 2.0, group IV: 0.5 +/- 0.2) (NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analgesic and respiratory effects of epidural sufentanil in patients following thoracotomy. 289 1

This study investigated the effects of three types of laboratory stressors (stressful imagery, mental arithmetic, pain) on temporal artery, skeletal muscle, general autonomic [digital blood volume pulse (DBVP), spontaneous resistance responses (SRR's)] and self-report measures of distress in chronic migraine, mixed, muscle contraction and non-headache controls. All subjects were female, free of medication at time of testing and equated for age. Headache subjects reported a 19 year history of headache. Results revealed a pattern of digital BVP (constriction), SSR's (increase) and frontal EMG (increase) indicative of a general autonomic-skeletal muscle arousal response to all three stressors in all groups, while the temporal artery response to the pain stimulus was vasodilation. Distress ratings were elevated during the stress periods for all four group. Pain threshold and tolerance and the tendency to utilize cognitive coping strategies during exposure to pain did not differ across the four groups. The results do not support the general autonomic dysfunction theory of migraine or the specificity hypothesis implicating an overreactive temporal artery or skeletal muscle response to stress in migraine and muscle contraction headache, respectively. Despite epidemiological research supporting the stress-headache relationship, the present results indicate that the psychophysiological mechanism underlying this relationship does not appear to involve abnormal tonic levels or phasic response to stress. It is argued that the temporal artery dilation response to pain questions the role of stress in triggering the two stage vasoconstriction-dilation mechanism of migraine and suggests the need to evaluate a four stage model as a potential psychophysiological mechanism underlying the stress-headache relationship.
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PMID:Stress and chronic headache: a psychophysiological analysis of mechanisms. 707 48