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)

Intraperitoneal erythropoietin was given to three children on chronic peritoneal dialysis. Doses between 100 and 150 units/kg were given undiluted into a dry cavity twice weekly and left for 10-12 h before resuming dialysis. Satisfactory haemoglobin levels were seen over a 6-month period and there were no complications. Intraperitoneal administration of erythropoietin is cost-effective and avoids the local pain of subcutaneous injections.
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PMID:Intraperitoneal erythropoietin treatment of children with chronic renal failure. 763 34

New information on the treatment of juvenile rheumatoid arthritis emphasizes more aggressive control of arthritis, particularly the use of methotrexate, both in low- and higher-dose regimens. Information concerning drug toxicity, including that of the nonsteroidal anti-inflammatory drugs, second-line agents, and methotrexate, suggests that these drugs are well tolerated in children. A new corticosteroid, deflazacort, minimizes bone demineralization and growth retardation. Adjunctive measures, including erythropoietin, pain management techniques, conditioning programs, and nutrition, have demonstrated advantages in some children with juvenile rheumatoid arthritis.
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PMID:Treatment of juvenile rheumatoid arthritis. 769 Nov 40

Recombinant human erythropoietin (rHuEpo) is used to correct anaemia in dialysis patients. Subcutaneous administration of rHuEpo may be associated with pain at the injection site. This study assessed the pain of subcutaneous infiltration of two different preparations of rHuEpo, alpha and beta, and the value of a local anaesthetic (Emla) cream, in reducing the pain of infiltration. Forty-eight haemodialysis patients were enrolled into a double-blind, placebo-controlled, paired-comparison study. Pain was assessed using a visual analogue scale, a verbal descriptive scale and a direct comparison between paired treatments. Subcutaneous injection of rHuEpo alpha was more painful than rHuEpo beta (P < 0.001); using placebo cream 42% of patients described the pain of rHuEpo alpha as severe or very severe, whereas none of the patients found rHuEpo beta so painful. Application of Emla for at least 2 h prior to injection resulted in a significant reduction in the pain of both preparations, but was unable to reduce the pain of rHuEpo alpha to that of rHuEpo beta. Subcutaneous injection of rHuEpo alpha is more painful than rHuEpo beta, even after application of Emla. Although the discomfort of rHuEpo beta is graded as very mild by most adult patients the use of Emla is associated with a significant reduction in discomfort, which may be of benefit to paediatric patients.
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PMID:Pain after subcutaneous injection of recombinant human erythropoietin: does Emla cream help? 955 Jun 87

Subcutaneous injections of recombinant human erythropoietin (rHuEPO) produce considerable pain which can result in noncompliance. As a prelude to an investigation of the possible use of local anesthetics as additives to subcutaneous rHuEPO, we examined the effect of the addition of lidocaine on the erythropoietic properties of rHuEPO. Two weeks after 5/6 nephrectomy, 22 rats were randomly assigned to the following groups: normal saline, rHuEPO, lidocaine, and rHuEPO plus lidocaine. Injections were given three times a week for 2 weeks. No change in hematocrit was observed in the saline and lidocaine groups. The hematocrit of the rHuEPO rats increased from 44.5 +/- 1.4% (mean +/- SD) to 61.6 +/- 2.1% (P < 0.0005), and that of the rHuEPO plus lidocaine group from 42.8 +/- 4.3% to 63.9 +/- 3.0% (P < 0.005), with no difference between the groups. We conclude that the combination of rHuEPO plus lidocaine is as effective as rHuEPO alone in increasing the hematocrit of rats with chronic renal failure.
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PMID:Effect of lidocaine on the hematopoietic properties of recombinant human erythropoietin in the uremic rat. 794 41

The aim of this study was to investigate the effects of recombinant human erythropoietin (rh-EPO) in patients with cancer-related anaemia. Thirty-six ambulatory patients who had malignant neoplasms and haemoglobin (Hb) values of < 11 g/dl (Pretoria is 1,310 m above sea level) entered the study. Patients with renal insufficiency or anaemia caused by bleeding or haemolysis, and patients with iron deficiency or megaloblastic anaemia, were not entered in the study. 22 IU/kg rh-EPO was given subcutaneously 3 times/week. The dose was escalated if Hb values did not rise after 4 weeks. All 36 patients were evaluable for toxicity. Side effects ascribed to rh-EPO were pain or discomfort at the site of injection (12 patients), heart palpitations (3 patients), skin rash (2 patients) and hypertension, deep vein thrombosis, and myalgia in 1 patient each. Thirty of the 36 patients who entered the study were evaluable for response. There were 16 females and 14 males among the evaluable patients. Median age was 64.5 years. Response, defined as an increase of Hb of at least 2 g/dl or to 12.5 g/dl, for at least 1 month, was documented in 12 patients. This was accompanied by an improvement in performance status and occurred within 1 month in 5 of the 12 patients who responded. rh-EPO has a limited but measurable therapeutic value for patients with cancer-associated anaemia.
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PMID:Recombinant human erythropoietin in the treatment of cancer-related anaemia. 797 Apr 93

Recombinant human erythropoietin (rHuEpo) can be administered to continuous ambulatory peritoneal dialysis (CAPD) patients subcutaneously (SC), intravenously (IV), and intraperitoneally (IP). Subcutaneous rHuEpo is preferred in CAPD patients because of its ease of administration and favorable pharmacokinetics. The longer half-life of SC rHuEpo allows for one or two doses per week. Since SC rHuEpo can cause pain and local irritation at the injection site, the efficacy and safety of intramuscular (IM) rHuEpo were compared to SC rHuEpo in 6 random stable CAPD patients. The protocol in each subject consisted of a single weekly injection of IM rHuEpo for 3-6 months (period 1), crossover to SC rHuEpo for 3-6 months (period 2), and crossover to IM rHuEpo for 3-6 months (period 3). The rHuEpo dose was adjusted by protocol to achieve a target hematocrit of 30%-33%. Pain at the injection site was graded on a scale of 0-3. All patients preferred IM rHuEpo to SC rHuEpo because of less pain at the injection site. One patient tolerated IM rHuEpo for six months (period 1), then left the study after one month of SC rHuEpo because of ecchymoses and pain at the SC injection sites. In all patients, there was no significant difference in the dose of rHuEpo (U/kg/wk) during the three study periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of intramuscular versus subcutaneous erythropoietin for the treatment of anemia in CAPD patients. 799 9

Twenty-two patients in haemodialysis were treated with erythropoietin subcutaneously in a double-blinded cross-over study with erythropoietin prepared either as a lyophilisate or an albumin-solution. The aim was to compare local reactions and pain. Both preparations were tolerated well. No major adverse reactions were seen. Erythropoietin albumin-solution was associated with significantly more burning pain than erythropoietin lyophilisate. Allergy does not seem to be involved. Albumin could be the irritative agent.
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PMID:[Adverse effects of subcutaneous administration of erythropoietin solution versus lyophilisate in patients receiving hemodialysis]. 829 8

We review data concerning site and regulation of erythropoietin (EPO) production, its effects on target tissue, routes of administration and clinical applications. In the anaemia of chronic renal failure (ACRF) treatment with recombinant human erythropoietin (r-Hu-EPO) has been shown to be effective in both improvement of the anaemia and increase in quality of life. In the anaemia of chronic disease (ACD), associated with various malignant, infectious and inflammatory disorders, many investigators have demonstrated an inappropriately low EPO response to anaemia. Therapeutic trials in patients with ACD mostly lacked sufficient numbers of patients for evaluation of the effects. The results obtained from some studies in AIDS and rheumatoid arthritis and the effect on the number of units of autologous blood obtained from patients planned for elective surgery are encouraging, however. Adverse reactions of r-Hu-EPO treatment are mainly confined to the ACRF population and include hypertension, shunt thrombosis and pain at the injection site. The exact mechanism of action of EPO is not yet fully understood. Large scale clinical trials are required to establish its effects on both the anaemia and quality of life in anaemias other than ACRF.
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PMID:Erythropoietin: mechanisms of action and indications for treatment. 837 77

In the present review the role and regulation of foetal haemoglobin (HbF) in sickle-cell disease as well as the clinical results of therapy aimed at augmenting HbF synthesis are briefly discussed. Enhanced levels of HbF have an inhibitory effect on sickling and ameliorate the clinical course of sickle-cell disease. This knowledge has incited a search for pharmacological agents capable of stimulating HbF production. Cytostatic drugs, in particular hydroxyurea, but also other agents such as erythropoietin, butyrate and its analogues have been shown to induce HbF production. The mechanisms of action and the clinical effects of these agents are summarized. Only hydroxyurea has shown significant clinical effects in terms of reduction of pain-crises, chest syndrome and transfusions in sickle-cell patients. However, not all patients experience clinical amelioration and it appears difficult to predict which patient will gain from hydroxyurea therapy. Further studies need to expand the clinical experience with hydroxyurea, other HbF-inducing agents and combinations of these drugs. Moreover, they will hopefully provide criteria to enable appropriate selection of those patients with sickle-cell anaemia who will benefit clinically from HbF stimulation, also taking into account the risks and costs of long-term pharmacological therapy.
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PMID:Pharmacological induction of foetal haemoglobin synthesis in sickle-cell disease. 945 96

Patients may complain of pain at the injection site after subcutaneous (s.c.) administration of erythropoietin (EPO). Local pain due to s.c. EPO into the thigh was evaluated in 60 hemodialysis patients in a double-blind, placebo-controlled study. Identical volumes and concentrations (2000 IU in 0.5 ml) of phosphate-buffered epoetin-alpha (EPO-alpha ph), citrate-buffered epoetin-alpha (EPO-alpha ci) and epoetin-beta (EPO-beta) were compared to 0.5 ml of 0.9% saline (SAL), used as placebo. The patients received the 4 injections at the same occasion. For pain evaluation, a verbal scale ranging from no pain (0) to extremely painful (5) and a 10 cm ungraduated visual analogue score (VAS) (0 = no pain, 10 = maximal pain) were used. Treatment acceptance was assessed (yes/no) and expressed as a percentage of the population. Ranking of the preparations from 1 to 4 according to increasing local discomfort was performed. Median verbal pain scores and interquartile ranges were 1.0 (0-2) for SAL, 0.0 (0-2) for EPO-beta, 1.5 (0-3) for EPO-alpha ph (p < or = 0.05 vs SAL and EPO-beta) and 3.0 (2-4) for EPO-alpha ci (p < or = 0.001 vs EPO-alpha ph). VAS was 0.9 (0.5-2.5) for SAL, 0.9 (0.4-2.4) for EPO-beta, 2.7 (0.8-5.7) for EPO-alpha ph (p < or = 0.001 vs SAL and EPO-beta) and 4.2 (1.7-6.4) for EPO-alpha ci (p < or = 0.001 vs EPO-alpha ph). Treatment acceptance was 73% for SAL, 78% for EPO-beta, 60% for EPO-alpha ph (p < or = 0.05 vs EPO-beta) and 32% for EPO-alpha ci (p < or = 0.05 vs EPO-alpha ph). Ranking was 2 (1-3) for SAL, 2 (1-2) for EPO-beta, 3 (1-4) for EPO-alpha ph (p < or = 0.05 vs SAL and EPO-beta) and 4 (3-4) for EPO-alpha ci (p < or = 0.05 vs SAL and EPO-beta) and 4 (3-4) for EPO-alpha ci (p < or = 0.001 vs EPO-alpha ph). In conclusion, s.c. EPO-alpha ph is better accepted than s.c. EPO-alpha ci. However, s.c. EPO-beta is less painful.
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PMID:Pain at the injection site of subcutaneously administered erythropoietin: phosphate-buffered epoetin alpha compared to citrate-buffered epoetin alpha and epoetin beta. 949 Dec 85


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