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)

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of diclofenac sodium are reviewed. Diclofenac, the first nonsteroidal anti-inflammatory agent (NSAID) to be approved that is a phenylacetic acid derivative, competes with arachidonic acid for binding to cyclo-oxygenase, resulting in decreased formation of prostaglandins. The drug has both analgesic and antipyretic activities. Diclofenac is efficiently absorbed from the gastrointestinal tract; peak plasma concentrations occur 1.5 to 2.0 hours after ingestion in fasting subjects. Even though diclofenac has a relatively short elimination half-life in plasma (1.5 hours), it persists in synovial fluid. The drug is metabolized in the liver and is eliminated by urinary and biliary excretion. In clinical trials, diclofenac was as effective as aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, and naproxen in improving function and reducing pain in patients with rheumatoid arthritis. For treatment of osteoarthritis, diclofenac was equivalent in efficacy to aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, naproxen, flurbiprofen, mefenamic acid, and piroxicam. Diclofenac was as effective as indomethacin or sulindac in treating ankylosing spondylitis. The most frequent adverse effects reported for diclofenac were gastrointestinal, but these effects were fewer and less serious than occurred with aspirin or indomethacin; in addition, diclofenac caused fewer central nervous system reactions than indomethacin. Diclofenac is administered in divided doses with meals. The recommended total daily dosage is 100 to 150 mg (osteoarthritis and ankylosing spondylitis) or 150 to 200 mg (rheumatoid arthritis). Diclofenac is effective, but no more so than other NSAIDs. It is structurally distinct and offers another choice in the treatment of rheumatological conditions.
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PMID:Diclofenac sodium. 267 Mar 97

The ability of two nonsteroidal anti-inflammatory agents--piroxicam and diclofenac--to control endodontic pain was compared with that of a placebo control in a double-blind study of 267 patients requiring endodontic therapy. Endodontic treatment was carried out over three visits with an interval of 5 to 7 days between each two consecutive visits. All patients were clearly instructed to take the medication only if they experienced pain, between the visits or postoperatively, for 3 consecutive days. The patients subjectively rated their pain on a scale of 1 to 4 as none, mild, moderate, or severe. The ratings were done preoperatively and at 2, 4 and 8 hours after the initial dose of medication was taken, as well as on the second and third days. Statistical analysis of the data revealed that both piroxicam and diclofenac significantly reduced the mean pain score at the end of all observations and were significantly superior to the placebo until the end of the study. More than 90% of the patients treated with piroxicam and more than 80% of the patients treated with diclofenac showed complete relief of pain. Overall, piroxicam was clearly more effective than diclofenac or the placebo. It provided more consistent relief of pain, beginning 2 hours after the initial dose, and it continued to do so at every interval thereafter. Diclofenac required longer time to reach maximum effectiveness. Piroxicam's superiority was greater at the first and second days after the initial dose of medication was taken. With respect to side effects, piroxicam was better tolerated by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of endodontic pain with nonsteroidal anti-inflammatory agents: a double-blind, placebo-controlled study. 291 50

The pain relief provided by regular intramuscular diclofenac and on demand intramuscular papaveretum was compared over a 48 h postoperative period in 114 patients undergoing total hip replacement. The study was of a randomised, single-blind, between-group design. Patients were assessed by a surgeon, physiotherapist and nursing staff. Diclofenac was more effective than papaveretum in pain control (P less than 0.001), wound tenderness (P less than 0.01), awareness (P less than 0.001) and mobilisation (P less than 0.01). Wound drainage (P greater than 0.05) and wound oedema (P greater than 0.05) were not significantly different in the two treatments. Gastrointestinal complications were encountered in both groups; two patients on diclofenac had to be withdrawn because of them. The use of diclofenac given as a postoperative analgesic is rewarding, particularly in patients undergoing musculoskeletal procedures. Patients will be more comfortable and will mobilise better during their whole postoperative course.
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PMID:Postoperative pain relief; a new approach: narcotics compared with non-steroidal anti-inflammatory drugs. 213 19

Combined Therapy of Transcutaneous Electrical Nerve Stimulation and Iontophoresis with Benzydamine and Diclofenac. The combination of transcutaneous electrical nerve stimulation (TENS) and the iontophoresis of benzydamine and diclofenac in a counter-current field is a new method in the treatment of chronical pain of the head and neck region. Prior to a clinical study this method was tested in a preliminary examination in 15 healthy volunteers. Clinical and physical data were investigated from which a theoretical maximum value of the quantity of iontophorised non-steroidal antiphlogistics (NSAI) could be calculated. The actual achievable absorption is discussed. Based on these data it is concluded that a good effective tissue concentration of benzydamine and diclofenac can be achieved with iontophoresis by means of TENS.
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PMID:[Combination therapy of transcutaneous electric nerve stimulation and iontophoresis with benzydamine and diclofenac]. 326 35

One hundred unpremedicated patients scheduled for outpatient restorative dentistry and/or oral surgery were given either 75 mg diclofenac sodium (prostaglandin synthesis inhibitor) or a saline placebo i.v. in a double-blind random fashion before induction of anaesthesia with methohexitone (2 mg/kg). Intubation was facilitated with suxamethonium (1.2 mg/kg) and anaesthesia was maintained with isoflurane in 50% nitrous oxide and oxygen using spontaneous respiration. Cuff pressure was continuously monitored and maintained at 10-25 mmHg. The mean duration of anaesthesia was 141 +/- 75 min in the diclofenac group and 150 +/- 73 min in the saline group. Diclofenac inhibited prostaglandin synthesis, as evident from serum thromboxane B2 and urinary 6-keto-prostaglandin F1 alpha data. There was no difference in recovery as assessed from the orientation time (14.2 +/- 5.7 min and 14.5 +/- 6.3 min for diclofenac and saline patients, respectively), perceptual speed and ability to walk along a straight line 30 and 60 min after anaesthesia. Emetic symptoms were equally common in both groups: an overall incidence of 32.6% and 36.7% for the diclofenac and saline patients, respectively. In the whole patient series women became nauseated and vomited more than men (P less than 0.01). Diclofenac reduced the incidence of pain in the throat or oral region 1 h after anaesthesia (P less than 0.05) and other symptoms 1-24 h postoperatively (P less than 0.01). Thus, preoperative intravenous diclofenac appears useful in ambulatory patients undergoing restorative dentistry and oral surgery under isoflurane anaesthesia.
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PMID:Intravenous diclofenac sodium decreases prostaglandin synthesis and postoperative symptoms after general anaesthesia in outpatients undergoing dental surgery. 332 15

A controlled investigation was conducted to compare the effectiveness of diclofenac and papaveretum in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 3 and 13 years of age were randomly allocated to receive rectal diclofenac 2 mg/kg, intramuscular papaveretum 0.2 mg/kg or no medication immediately after induction of anaesthesia. Pain and appearance were assessed 1, 3 and 6 hours postoperatively, and the following morning. The assessments were double-blind and performed by the same observer. No significant differences in postoperative pain were found between the groups at any time. The use of diclofenac was associated with a significantly more rapid return to calm wakefulness and had significantly less effect upon respiratory rate. Consumption of paracetamol on the day of operation was significantly less in the diclofenac group. Diclofenac may offer advantages compared to papaveretum with regard to safety and convenience for use in the treatment of pain after tonsillectomy in children.
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PMID:A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy. 337 47

The effects of a prostaglandin synthesis inhibitor (diclofenac, Voltaren) and an opiate (oxycodone, Oxanest) on postoperative pain were compared. Included in the study were 85 candidates for various operations. Patients requesting an analgesic were given either 75 mg of diclofenac or 10 mg of oxycodone as an intramuscular injection. The onset of analgesic effect occurred within 13 +/- 4 min with oxycodone and within 16 +/- 8 min with diclofenac. The analgesic effect of diclofenac was slightly weaker than that of oxycodone (on a pain scale of 1-4, 1.6/2.1 after 0.5 h and 1.5/1.8 after 1 h). The patients again asked for an analgesic after an average of 4.6 h in the oxycodone group and after an average of 6.1 h in the diclofenac group. The average number of injections required until the first postoperative morning was 2.5 in the oxycodone group and 1.8 in the diclofenac group. Side-effects: 21 patients in the oxycodone group reported a total of 39 side-effects and eight patients in the diclofenac group a total of 10 side-effects. Diclofenac is an alternative to opiates in the management of postoperative pain. It is especially useful in patients in whom opiates cause side-effects.
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PMID:Diclofenac and oxycodone in treatment of postoperative pain: a double-blind trial. 354 48

An attempt is made to compile the pharmacological data on the leading non-steroidal anti-inflammatory drugs. They concern the pharmacodynamics, the pharmacokinetics and the unwanted effects of these compounds. From these data a few suggestions for rational use are made: Ibuprofen and diclofenac present as drugs with short and reliable elimination-halflife. The compound with the lower potency namely ibuprofen appears particularly suitable for use in patients suffering from mild inflammatory pain of probably short duration (hours, days). Diclofenac being more potent should be used in more serious painful conditions, the variable bioavailability and the sometimes delayed absorption of diclofenac should be kept in mind if success is not achieved. Ketoprofen may have similar characteristics as diclofenac. The quality of the available data is however limited. Indomethacin and piroxicam are highly potent and reliable in onset; the bioavailability amounts to 100%. Both compounds may owe their effectiveness and reliability to substantial enterohepatic recirculation which may also be responsible for the reported somewhat higher incidence of GI-tract problems in connection with their use. They should hence be used in serious conditions going along with intensive, long-lasting inflammatory pain. Naproxen being less potent than the later two may fall into the same category.
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PMID:[Pharmacologic characteristics as the basis for differential therapy using non-steroidal anti-inflammatory agents]. 359 Oct 20

A double-blind study was performed in 63 patients to compare diclofenac (a non-steroidal anti-inflammatory drug), pethidine and placebo with regard to efficacy and tolerability in the treatment of pain after abdominal hysterectomy. The compounds were injected post-operatively and the duration of pain relief was chosen as the parameter of efficacy. Pain intensity was measured on a visual analogue scale by the patient and according to a six-point scale by the investigator. Diclofenac gave significantly longer pain relief than pethidine or placebo. Few side-effects were reported after diclofenac and placebo, and post-operative bowel paralysis tended to be shorter with diclofenac.
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PMID:Diclofenac versus pethidine in the treatment of pain after hysterectomy. 365 83

In a prospective study, the influence of sole Diclofenac-Na therapy (3 X 25 mg Rewodina, Voltaren) on the calculus recurrence rate of eight frequently relapsing and therapy resistant calcium-oxalate stone patients is analysed. During a period of one year's treatment, the recurrence rate could be reduced by 73.2%, from 123 to 33 calculi. Serious side effects, changes in blood serological parameters and various urine components were not observed. The course of passages of calculi was improved by reduced pain and rapid passage. The paper summarizes all results of calcium-oxalate stone treatments with nonsteroidal antiphlogistics known so far. In the opinion of the authors, the present successful Diclofenac-Na treatment offers a novel possibility of influencing therapy resistant stone-formers over long periods.
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PMID:[Diclofenac-Na--an alternative treatment possibility in therapy-resistant calcium oxalate urolithiasis?]. 376 23


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