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

Sclerotherapy with 3% sodium tetradecyl sulfate and 3.5% rolitetracycline on an outpatient basis was applied to 55 hydroceles. The over-all cure rate was 96% with an average followup of 13 months. Of the patients 64% were cured after only 1 sclerosant instillation. A post-sclerotherapy operation was necessary in 4% of the patients. Pain of a significant degree occurred after sclerotherapy in only 29% of the patients. Sclerotherapy appears to be an effective, economical and safe form of outpatient therapy for hydroceles.
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PMID:Sclerotherapy for hydroceles. 232 10

We have evaluated the efficaciousness and side effects of continuous administration of morphine by lumbar epidural route for relieving postoperative pain in major surgery of the abdomen and orthopedic surgery. Lumbar epidural catheters were placed to 25 patients (mean age, 52 years) before induction of general anesthesia. All patients received a 4 mg bolus dose of morphine sulfate 1 hour before finalization of general anesthesia and subsequently they were placed on a continuous infusion of morphine sulfate at 0.3-1 mg/h. All patients achieved analgesia which maintained then pain-free and allowed early ambulation and initiation of active respiratory physiotherapy. Duration of continuous analgesia varied from 3 to 5 days. No patient presented respiratory depression; four presented nausea and eight had urinary retention. We believe that continuous epidural infusion of morphine is efficacious and safe for the treatment of acute postoperative pain in patients undergoing abdomen major surgery and orthopedic surgery.
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PMID:[Continuous infusion of epidural morphine to relieve postoperative pain. Protocol and results]. 233 11

Intraperitoneal administration of gentamicin sulfate (5-800 micrograms/kg), but not gentamicin base (23-92 micrograms/kg) produced antinociception in rats and mice, as assessed by the tail-flick, carrageenan-induced articular incapacity tests, and hot-plate tests. The AD50 s in rats (tail-flick test) and mice (hot-plate test) were 11.48 and 147.9 micrograms/kg, respectively, but doses of 200-800 micrograms/kg were required to reduce the hyperalgesia induced in rats by carrageenan. In both species, bell-shaped dose-response curves were obtained, indicating that high doses of gentamicin had little or no effect. Non-effective doses of gentamicin failed to produce a significant increase in morphine antinociception in either rodent species. The possible involvement of N-type voltage-sensitive Ca2+ channels in the mechanism of antinociception induced by gentamicin is considered.
Pain 1990 Jun
PMID:Antinociception induced by intraperitoneal injection of gentamicin in rats and mice. 238 73

Ongoing interest in the improvement of pain management with opioid analgesics had led to the investigation of sublingual opioid absorption. The present report determined the percent absorption of selected opioid analgesics from the oral cavity of normal subjects under conditions of controlled pH and swallowing when a 1.0 ml aliquot of the test drug was placed under the tongue for a 10-minute period. Compared with morphine sulfate at pH 6.5 (18% absorption), buprenorphine (55%), fentanyl (51%), and methadone (34%) were absorbed to a significantly greater extent (p less than 0.05), whereas levorphanol, hydromorphone, oxycodone, heroin, and the opioid antagonist naloxone were not. Overall, lipophilic drugs were better absorbed than were hydrophilic drugs. Plasma morphine concentration-time profiles indicate that the apparent sublingual bioavailability of morphine is only 9.0% +/- 11.9% (SD) of that after intramuscular administration. In the same subjects the estimated sublingual absorption was 22.4% +/- 9.2% (SD), indicating that the sublingual absorption method may overestimate apparent bioavailability. When the oral cavity was buffered to pH 8.5, methadone absorption was increased to 75%. Thus, an alkaline pH microenvironment that favors the unionized fraction of opioids increased sublingual drug absorption. Although absorption was found to be independent of drug concentration, it was contact time dependent for methadone and fentanyl but not for buprenorphine. These results indicate that although the sublingual absorption and apparent sublingual bioavailability of morphine are poor, the sublingual absorption of methadone, fentanyl, and buprenorphine under controlled conditions is relatively high.
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PMID:Sublingual absorption of selected opioid analgesics. 245 8

Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology and developed a system in which patients with severe pain received a continuous narcotic infusion, along with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95% received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection and respiratory depression. Progressive pain due to either advancing disease or development of drug tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients with pain related to malignancy can be managed well with this system; and (3) pain control programs can be designed, implemented, and evaluated in the private practice setting.
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PMID:Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117 patients. 247 20

In order to assess the respective contribution of opioid receptors to the behavioral and physiological characteristics of lactating animals, we challenged mice with morphine at different phases of the lactation period. Sensitivity to morphine's effects on aggressive behavior, pup care, pain response and body temperature were measured. Lactating mice were assigned to 1 of the 3 weeks of lactation and to 1 of 5 doses of morphine sulfate (0, 1, 3, 6, 10 mg/kg IP). After morphine administration, rectal temperature and tail flick were assessed. Behavior towards three pups was observed for 5 min, followed by an aggression test with a female intruder. Morphine significantly increased the latency to retrieve pups and decreased aggressive behavior at doses that do not decrease motoric activity. Compared to virgin mice, lactating females are less sensitive to the analgesic actions of morphine but similarly sensitive to its hypothermic properties. The fact that virgin and lactating females can be distinguished on the basis of their sensitivity to morphine-induced analgesia suggests that lactating animals undergo functionally relevant changes in opioid regulation of pain sensitivity. Furthermore, morphine's specific and potent inhibition of pup retrieval supports the hypothesis that decreased opioid peptide activity is important for the expression of certain postpartum behaviors.
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PMID:Morphine effects on maternal aggression, pup care and analgesia in mice. 249 61

The development of tolerance to the antinociceptive effects of chronically administered delta (delta) and mu (mu) agonists was examined in vivo in rats using a protocol of alternated preferential activations of delta and mu receptors. This was accomplished by alternated chronic administrations of the relatively delta- and mu-selective agonists DADLE ([D-Ala2, D-Leu5]-enkephalin) and morphine sulfate (MSO4), respectively. Specifically, the agonists were given as 3 sequential 6 day cycles: (1) osmotic pump infusions of DADLE into the lumbar intrathecal space; (2) followed by intraperitoneal injections of MSO4; (3) followed again by intrathecal DADLE infusions. Following each cycle, the agonists' antinociceptive activities were measured using the tail-flick test of nociception. These were compared to their baseline (i.e., drug-naive) activities as a measure of tolerances. In a separate experiment the same total intrathecal dose of DADLE was infused chronically over twelve days without an interposed dose of MSO4. In the alternated agonist experiment, DADLE's antinociceptive ED50 value was increased by 10.4-fold, then reverted to only a 1.5-fold change from baseline and was subsequently shifted to a 13.7-fold increase over baseline. After cycle 2 with MSO4 a significant recovery from DADLE tolerance was noted as compared to that following cycle 1: 1.5- versus 10.4-fold, respectively. Furthermore, the interposition of a cycle of MSO4 between two cycles of DADLE resulted in a much lesser degree of tolerance for DADLE following cycle 3 (12 days of non-continuous DADLE infusion) than was noted after the 12 day continuous DADLE intrathecal infusion (13.7- versus 25.0-fold tolerance, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1989 Mar
PMID:Alternated delta and mu receptor activation: a stratagem for limiting opioid tolerance. 254 Apr 75

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB. The analgesic requirement differed significantly between groups 1 (0.33 mg fentanyl) and 2 (0.15 mg fentanyl) and groups 3 (63.5 mg pentazocine) and 4 (31.5 mg pentazocine). There were also significant differences in circulatory responses. The maximum deviation from the initial value at the beginning of the operation in group 1 compared to group 2 was pulse rate + 28.7% vs + 2.4%, mean arterial pressure (Part) + 24.6% vs + 3.1%, and systolic pressure (Psyst) + 33% vs +/- 0%; group 3 compared to group 4: pulse rate + 16.4% vs + 3.2%, Part + 24.5% vs 0.0%, and Psyst + 26.5% vs + 196. The times of action of ICB extended from 7.54 h to 11.33 h for partial analgeisa, time to the first dose of analgesic from 12.3 h to 16.9 h (etidocaine 0.5% and 1% respectively without and with epinephrine). The mean blood levels after 100 mg bupivacaine-CO2 rose to 1.16 micrograms/ml after 5 min and reached a maximum after 15 min (1.29 micrograms/ml) as compared to 0.98 micrograms/ml after addition of ornithine-vasopressin. These values are very much higher than those after the use of bupivacaine-HCl solution. Etidocaine and bupivacaine-HCl have comparable durations of analgesia. Toxicologically, both substances can be applied safely with consideration of all pharmacological data for ICB. Of a total of 3,485 intercostal blockades, 2,775 were applied perioperatively (pre- and postoperatively); 265 were carried out for trauma patients (rib fractures) and 445 for therapeutic indications (herpes zoster neuralgia, tumor pain, costovertebral pain). In 8 blocks 10% ammonium sulfate, in 4 blocks absolute alcohol, and in 19 blocks 5% phenol were used for neurolysis. In 2 cases a marginal pneumothorax was seen, which was resorbed spontaneously (0.06%). Altogether 16,270 single intercostal nerves were blocked. Single-session intercostal blockade can be combined as unilateral analgesia with general anesthesia. This combination is characterized by stable circulatory conditions with avoidance of hypertensive reactions. The long-lasting analgesia allows early mobilization and physiotherapy both postoperatively and posttraumatically in patients with unilateral thoracic and abdominal pain.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The single intercostal block--surgical and therapeutic indications]. 264 21

Recently a sustained-release morphine sulfate tablet (MS Contin [MSC]) was introduced in Canada. In a randomized double-blind crossover trial we compared MSC given every 12 hours with a morphine sulfate solution (MSS) given every 4 hours to 17 patients suffering from chronic severe pain. After titration of the morphine dosage to optimize the analgesic effect, each patient received 10 days of therapy with either MSC or MSS, then 10 days of therapy with an equal daily dose of the other formulation. Both preparations provided effective pain control, with minimal side effects. There was no significant difference between MSC and MSS in pain scores on a visual analogue scale (VAS), severity scores for tiredness and nausea, amount of supplemental morphine needed for break-through pain or patient preference. The plasma morphine concentrations tended to be greater during treatment with MSC. The study had an 89% probability of detecting a clinically significant difference in VAS pain scores. We conclude that an individualized, twice-daily regimen of MSC is as effective as MSS given every 4 hours for control of severe pain. The twice-daily regimen has several advantages: it provides for an uninterrupted night's sleep, it is substantially more convenient than the six doses per day required with MSS, and it should help reduce both medication errors and noncompliance.
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PMID:Control of severe pain with sustained-release morphine tablets v. oral morphine solution. 264 88

In medicine and in cardiology one must be aware that there is no "standard" management for any condition. However, some guidelines can be offered for the management of myocardial infarction in the early stages. The following can be considered an aggressive but stepwise approach to therapy of patients with suspected myocardial infarction using conventional drugs with or without thrombolytic therapy or coronary angioplasty. Any patient presenting with prolonged chest pain occurring at rest should have an electrocardiogram. If the ECG is abnormal, an evolving myocardial infarction can be suspected. In this setting, oxygen should be administered if the patient is dyspneic, cyanotic, or has rales in the chest, intravenous nitroglycerin should be given, and the patient's response should be assessed. Caution should be observed at this point if the patient is sweating or hypotensive. Administration of a vasodilator in a dehydrated patient may drop the blood pressure further. If pain is relieved and the ECG returns to normal, the working diagnosis is severe angina. However, acute myocardial infarction should not be dismissed. A strong case for the use of intravenous heparin can be made to prevent the redevelopment of intracoronary clot inasmuch as thrombosis probably occurs in most patients presenting with unstable and severe angina, as it most surely does in patients with an evolving acute myocardial infarction. If nitrates and oxygen relieve chest pain but the ECG remains abnormal, for example, ST segment elevation, the diagnosis of acute evolving myocardial infarction must be considered and intravenous nitrates should be continued. If the patient has no relief of pain from nitrates and oxygen and the ECG remains abnormal, morphine sulfate should be administered intravenously in sufficient dosage to relieve the chest pain but not produce hypotension or hypoventilation. Once the diagnosis of myocardial infarction has been made, some would begin administering intravenous lidocaine as prophylaxis against the ventricular arrhythmias commonly encountered in the earlier stages of myocardial infarction. It has not been my practice to use prophylactic lidocaine, but I believe it is prudent to have a low threshold for the use of this drug in patients with frequent PVCs, especially if they are multifocal. If the patient exhibits symptomatic bradycardia or heart block, a trial with intravenous atropine is warranted. Additionally, while all of this is going on, one should contemplate using beta-blockers if there is good indication, and thrombolytic therapy if there are no contraindications to its use.
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PMID:Conventional drug therapy of patients with acute myocardial infarction. 265 36


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