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

Administration of morphine by the oral route is not possible in cancer patients who are unable to swallow or are intolerant of oral morphine. Thus, there is a need for reliable alternate routes of drug administration. We compared the bioavailability of two prototype 30-mg morphine sulfate controlled-release suppository formulations (high and low viscosity) with 30-mg oral controlled-release morphine sulfate tablets in a 14-subject single-dose randomized, three-way crossover study. Venous blood samples were obtained immediately prior to and for 24 hr following each dose. Morphine concentrations were determined by radioimmunoassay. Compared with oral controlled-release morphine, the high- and low-viscosity suppository formulations had significantly greater bioavailability (AUC0-24 72.7 +/- 13.2 for the oral preparation versus 98.6 +/- 35.7 and 105.8 +/- 37.3 ng.hr/mL for the suppositories, respectively, P < 0.05), later peak concentration (tmax 2.3 +/- 0.8 versus 3.1 +/- 2.3 and 5.0 +/- 1.5 hr, respectively, P < 0.05), and longer half-value duration (4.3 +/- 1.6 versus 10.4 +/- 5.5 and 9.5 +/- 4.3 hr, respectively, P < 0.05). Peak concentration for the high-viscosity suppository formulation (Cmax 7.75 +/- 2.66 ng/mL) was significantly lower than the low-viscosity suppository (Cmax 9.23 +/- 2.85 ng/mL) and the oral tablet (Cmax 10.4 +/- 2.78 ng/mL) formulations (P < 0.05). The increased bioavailability observed with the two controlled-release suppositories may be the result of partial avoidance of hepatic biotransformation with rectal administration.
J Pain Symptom Manage 1992 Oct
PMID:Pharmacokinetics of two novel rectal controlled-release morphine formulations. 148 93

A retrospective review of pharmacy records during a 7-year period at the Johns Hopkins Oncology Center revealed that 6 patients received greater than 4 g of morphine sulfate per day by continuous infusion (CI). Three patients received high-dose infusions for more than 24 h. Two of these 3 patients developed grand mal seizures, while the third was receiving a neuromuscular blocking agent making detection of seizures difficult. Prolonged administration of high concentrations of the sodium bisulfite preservative contained in the morphine solution is a possible explanation for the development of these seizures. Caution is suggested in using CI, preservative-containing morphine at high doses.
Pain 1992 Nov
PMID:Grand mal seizures associated with high-dose intravenous morphine infusions: incidence and possible etiology. 148 21

One hundred twenty patients with osteoarthritis of the knees and hips were entered into a randomized, placebo-controlled, double-blind trial designed to evaluate the effectiveness of chondroitin sulfate (Structum). The three-month treatment phase was followed by a two-month treatment-free phase to allow evaluation of carry-over effects. The main endpoint was use of nonsteroidal antiinflammatory drugs (expressed as mg of diclofenac equivalent). At completion of the three-month treatment phase, patients taking chondroitin sulfate (4 capsules/day) were using significantly less NSAIDs; this decrease persisted throughout the two-month treatment-free follow-up phase. The other parameters studied including visual analog scale assessment of pain, the Lequesne pain-function index, and overall patient and physician assessments, all showed a similar significant tendency. Tolerance was outstanding and no patients required premature withdrawal. These findings indicate that chondroitin sulfate is useful for the treatment of osteoarthritis, both as an agent slowly effective against symptoms and to reduce the need for NSAIDs. The carry-over effect of the drug suggests that intermittent administration may be appropriate.
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PMID:[Chondroitin sulfate in the treatment of gonarthrosis and coxarthrosis. 5-months result of a multicenter double-blind controlled prospective study using placebo]. 148 36

A 36-year-old man with acquired immunodeficiency syndrome had incapacitating dysuria and vesical pain secondary to interstitial cystitis. When medical management and suprapubic urinary diversion failed to control the symptoms the patient was started on subarachnoid morphine sulfate. Bupivacaine was added 1 year later via an implanted Therex M-3000 implantable continuous infusion pump, which has continued successfully for more than 18 months. We believe that subarachnoid narcotics and other analgesic agents, such as clonidine, bupivacaine hydrochloride and baclofen, may prove equally valuable in the treatment of bladder spasm and pain. Furthermore, implanted intrathecal ports and pumps may have less associated risk of infection than the percutaneous vascular access catheters presently used for the continuous delivery of medications in immunosuppressed patients.
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PMID:Continuous infusion of intrathecal morphine to control acquired immunodeficiency syndrome-associated bladder pain. 153 58

In the current study, 55 patients undergoing elective cholecystectomy were randomly allocated to receive postoperative analgesia (morphine sulfate) administered through either patient-controlled intravenous (PCA) or standard intramuscular (IM) routes. There were no significant differences in length of hospitalization or required dose of morphine sulfate. Patients randomized to PCA reported significantly improved subjective relief from pain and a smaller percentage of time in pain during each of the first two postoperative days. In addition, they reported less sedation and less interference with both postoperative breathing and pulmonary recovery than patients who received IM morphine. Theoretically, PCA regimens can deliver narcotic analgesia at a higher and more varied rate (with fewer side effects) compared with standard IM narcotic delivery, which is more limited by considerations of clinical doses. In PCA dosing, patients should experience less time in pain and sedation. The results of the current study support this premise.
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PMID:A randomized comparison of patient-controlled versus standard analgesic requirements in patients undergoing cholecystectomy. 154 38

The purpose of this study was to validate an experimental method for quantifying the pain producing potential of intravenously administered solutions. Response was measured in a Broome restraint tube modified by the addition of strain gauges. Struggling caused flexion of the tube, changing strain gauge output and increasing output variance. In experiment 1, five groups of 10 male Sprague Dawley rats were given intravenous injections of 1 ml of saline, acetate, HCl, citric acid vehicles, or KCl over a 1-min period. Results showed significant increases in output variance between saline and treated groups during the infusion period. In experiment 2, five groups of five rats were given intravenous injections of saline or 0.1, 0.05, 0.025, or 0.0125 M KCl. Rats responded in a dose-dependent manner, demonstrating the sensitivity of this technique. In experiment 3, two groups of four rats were given injections of morphine sulfate (2 or 4 mg/kg, ip) prior to administration of 0.05 M KCl. Two additional groups received no pretreatment prior to administration of saline or 0.05 M KCl. Results demonstrate that morphine ablates the response to intravenous administration of KCl. This model provides information concerning the pain producing potential of intravenously delivered compounds or formulations.
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PMID:A novel approach for the determination of the pain-producing potential of intravenously injected substances in the conscious rat. 140 10

Bradykinin (BK), an important mediator of allergic reactions and pain induction, is released by the activation of the plasma kallikrein-kinin (K-K) cascade. Neurotropin is a biological material obtained from inflamed rabbit skin inoculated with vaccinia virus and is widely used clinically in Japan as an effective agent for these disorders. Since its mechanism of action is not clearly known, we have investigated the effects of Neurotropin on the human plasma K-K system. In dextran sulfate-activated plasma, Neurotropin inhibited the formation of BK, the cleavage of high molecular weight kininogen (HK) and the formation of kallikrein-C1 inhibitor and activated coagulation factor XII (FXIIa)-C1 inhibitor complexes. Experiments using purified enzyme of the K-K cascade indicated that Neurotropin inhibited surface-mediated activation of coagulation factor XII (FXII) and the activation of prekallikrein by FXIIa. Neurotropin also inhibited the binding of FXII and HK to the activating surface. These data suggest that the ameliorating effects of Neurotropin in allergic disorders and pain syndromes may be related to this ability to inhibit activation of the K-K cascade and consequently the formation of BK.
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PMID:Effect of Neurotropin on the activation of the plasma kallikrein-kinin system. 156 87

The purpose of this double-blind crossover study was to determine whether a sustained-release morphine sulfate (SRMS) tablet given orally every 12 hours could adequately replace immediate-release morphine sulfate solution (IRMS) given orally every 4 hours in hospitalized patients with chronic pain from advanced cancer. Of 33 patients entered, 27 completed the study and were included in the efficacy and safety analysis. Patients were initially randomized to receive either 30-mg SRMS tablets every 12 hours or IRMS at the same mg/24 hours dose, every 4 hours. After 2 days, a crossover was performed, and patients received the alternate treatment for 3 days. Pain and side effects were assessed using a standard 100 mm visual analogue scale (VAS). There were no statistically significant differences between the two treatment groups for mean VAS pain scores or scores for sleepiness, nausea, depression, and anxiety. The incidence of breakthrough pain was similar for both treatment groups, as was the incidence of confusion and constipation. The results demonstrated that SRMS is a safe, effective analgesic preparation for patients who require oral opioids for cancer pain. The data also support the conclusion that sustained-release morphine tablets administered every 12 hours can replace an immediate-release morphine solution administered every 4 hours.
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PMID:A controlled study of sustained-release morphine sulfate tablets in chronic pain from advanced cancer. 159 Feb 84

We examined the ability of systemic morphine to diminish the sensory discriminative features of noxious heating. Monkeys were trained to perform a thermal detection task, and the time until their detection of small increases in heating was used as a measure of the perceived intensity of pain. Relatively small doses of morphine sulfate (0.1, 0.3 and 1.0 mg/kg, i.m.) increased the time until detection of graded temperature increases (0.4-1.0 degrees C) from a noxious 46 degrees C baseline. These effects were generally dose-dependent, reversed by systemic naloxone, and did not result from changes in attentional, motivational or motoric aspects of the monkeys' behavior. Furthermore, the effects of morphine were more pronounced on detection of temperature shifts that were near threshold. These findings indicate that doses of morphine in the therapeutic dose range for humans alter the perceived intensity of noxious heat in monkeys.
Pain 1992 Apr
PMID:Systemic morphine administration attenuates the perceived intensity of noxious heat in the monkey. 159 74

Many physicians, Certified Registered Nurse Anesthetists (CRNAs), and registered nurses have the clinical impression that either morphine sulfate or meperidine hydrochloride is a better drug to control postoperative pain. In this study, we evaluated pain relief and side effects for these two drugs to assess their potential differences. CRNAs conducted a structured interview of 500 female patients 24 hours after major gynecologic, urologic, or breast surgery. Patients' responses on 4-point scales of none, mild, moderate, and severe were collected for pain intensity, degree of nausea, severity of vomiting and itchiness, and degree of sedation experienced since the operation. There were 91 patients who received morphine patient-controlled analgesia (PCA) and 409 patients administered meperidine PCA. No statistically significant differences for pain intensity, degree of nausea, severity and incidence of vomiting, or degree of sedation were found. However, a significant difference was found in the incidence rates of mild itchiness, which occurred more frequently in the morphine PCA group (P less than .001). Patients vomited more often after vaginal hysterectomy than patients having laparotomy, major oncology, or tuboplasty surgeries (P less than .05), and vaginal repair patients reported more vomiting than patients having major oncology or tuboplasty surgeries. Clinical impressions that either morphine or meperidine should be the preferred treatment for patients following gynecologic operations was not found by a 24-hour review of 500 patients for pain relief and side effects. Although mild itchiness occurred more frequently in the morphine PCA group, treatment was rarely necessary.
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PMID:Side effects of morphine patient-controlled analgesia and meperidine patient-controlled analgesia: a follow-up of 500 patients. 163 56


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