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

Because of discrepancies in the estimates of the relative analgesic potencies of hydromorphone and morphine, the drugs were compared in two four-point, double-blind bioassays. In the first study, hydromorphone, 1 and 2 mg, was compared with morphine, 5 and 10 mg, in 31 postoperative patients; in the second, hydromorphone, 0.5 and 1 mg, was compared with morphine, 5 and 10 mg, in 112 postoperative patients. Subjective responses to nurse-observer questions were used to quantitate analgesia for postoperative pain. Hydromorphone is more potent than commonly believed: approximately 0.9 to 1.2 mg is equianalgesic with 10 mg of morphine, with a similar incidence of side effects.
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PMID:Relative analgesic potencies of morphine and hydromorphone in postoperative pain. 4 47

Seventy unselected subjects were anaesthetized for major surgical operations with intravenous hydromorphone, nitrous oxide and muscle relaxants as required. The results were compared with earlier observations made with morphine under similar conditions on 44 other subjects from the same hospital population. Hydromorphone was found to be 8.5 times as potent as morphine in terms of the median surgical loading dose, and its median therapeutic half-life was 4.07 hours against morphine's 5.28 hours. It proved to be superior to morphine in its greater consistency of action. The mid-90 per cent variance of its loading dose was 30% less and the same variance of its therapeutic half-life was 65% less than that of morphine. All the differences were statistically significant or highly significant. Observations concerning the fraction of the surgical loading dose of hydromorphone required by the patients to prevent post-operative discomfort also revealed great consistency. This is taken to indicate that psychological factors play only a subordinate role in modulating the intensity of postoperative pain.
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PMID:Anaesthesia time/dose curves IX: the use of hydromorphone in surgical anaesthesia and postoperative pain relief in comparison to morphine. 79 62

A direct comparison of the analgesic activities of heroin and hydromorphone was carried out in cancer patients with postsurgical pain. Intramuscular doses of 5 and 10 mg of heroin were compared with 1 and 2 mg of hydromorphone in a randomized, double-blind, 4-point parallel group assay. Design innovations in the study provided that about half the patients would receive prior repeated doses of the same drug as the test medication, and half would receive the alternate medication. Both test drugs were found to be potent, relatively short acting analgesics with similar profiles of action. Hydromorphone was about 5 times as potent as heroin on a milligram basis. The comparison of those patients who had repeated doses of the same treatment prior to the test dose and those who had repeated doses of the alternate drug demonstrated no significant effect on the relative potency estimates. Side effect occurrence was similar for both drugs, with sleepiness the most prominent effect. The study supports the view that hydromorphone and heroin produce similar clinical effects, and that either drug may adequately substitute for the other. Covariate analysis indicated that time since last analgesic was positively related to analgesia, and amount of prior opioid had a negative relationship. To a lesser extent, increase in patient age was associated with an increase in analgesic scores. Taking these covariates into account served to increase the sensitivity of the analysis.
Pain 1990 Apr
PMID:Clinical analgesic assay of repeated and single doses of heroin and hydromorphone. 169 62

Continuous subcutaneous infusions offer a safe, simple, effective alternative to intravenous or intramuscular injections when oral medications cannot be used. They are extremely useful for cancer patients suffering from pain, vomiting, seizures, and other symptoms. Hydromorphone or morphine may be combined with metoclopramide, methotrimeprazine, or haloperidol (in D5W only), in the same pump to control both pain and nausea. Seizures can be controlled by subcutaneous infusion of phenobarbital or midazolam. If proper doses are prescribed and skin irritation is watched for, they can be used safely in the patient's home.
J Pain Symptom Manage 1990 Feb
PMID:Subcutaneous infusions for control of cancer symptoms. 196 87

The use of hydromorphone and clonidine, delivered intrathecally by an implanted infusion pump, is described in a patient with intractable cancer pain. The patient was a 48-year-old woman with uterine cervical cancer-related pain that was poorly responsive to conventional oral narcotics. Hydromorphone was used because of the patient's history of morphine intolerance. When progressive intrathecal hydromorphone dosages were required, intrathecal clonidine (an alpha 2 adrenergic agonist) was infused concomitantly. Intrathecal hydromorphone and clonidine successfully controlled this patient's pain without the necessity to resort to destructive neurosurgery.
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PMID:Continuous intrathecal hydromorphone and clonidine for intractable cancer pain. 242 32

A 43-year-old male with a Pancoast syndrome suffered severe unrelieved pain for approximately 10 months after diagnosis. The results of administration and cessation of lidocaine and carbamazepine strongly suggest that a neurogenic component contributed to the severity of this patient's pain. This was also supported by a long period of previous sensory and motor loss in the upper limb and upper chest wall. Initially pain relief was attainable with a combination of oral carbamazepine and oral hydromorphone. However, as the patient's condition worsened, this combination produced only partial pain relief. Complete relief of the patient's pain was then attained only with a combination of epidural hydromorphone and oral carbamazepine. Hydromorphone was administered via an implanted, externalized silastic epidural catheter and infused by a miniaturized battery-operated pump which permitted a background infusion and the administration of patient and family-delivered boli. With this combination of oral carbamazepine and epidural hydromorphone, the patient was able to obtain complete pain relief for a period of 3 months until the time of death.
Pain 1989 Jan
PMID:Combined neurogenic and nociceptive pain in a patient with Pancoast tumor managed by epidural hydromorphone and oral carbamazepine. 246 31

1. Although it is well known that morphine induces significant immunosuppression, the potential immunosuppressive activity of morphine derived drugs commonly used in the treatment of pain (codeine, hydromorphone, oxycodone) has never been evaluated. 2. We evaluated in the mouse the effect of the natural opiates (morphine and codeine) and synthetic derivatives (hydromorphone, oxycodone, nalorphine, naloxone and naltrexone) on antinociceptive thresholds and immune parameters (splenocyte proliferation, Natural Killer (NK) cell activity and interleukin-2 (IL-2) production). 3. Morphine displayed a potent immunosuppressive effect that was not dose-related to the antinociceptive effect, codeine possessed a weak antinociceptive effect and limited immunosuppressive activity; nalorphine, a mu-antagonist and kappa-agonist, exerted a potent immunosuppressive effect, but had very weak antinociceptive activity. The pure kappa-antagonist nor-BNI antagonized the antinociceptive, but not the immunosuppressive effect of nalorphine. 4. Hydromorphone and oxycodone, potent antinociceptive drugs, were devoid of immunosuppressive effects. 5. The pure antagonists naloxone and naltrexone potentiated immune responses. 6. Our data indicate that the C6 carbonyl substitution, together with the presence of a C7-8 single bond potentiates the antinociceptive effect, but abolishes immunosuppression (hydromorphone and oxycodone). 7. The single substitution of an allyl on the piperidinic ring resulted in a molecule that antagonized the antinociceptive effect but maintained the immunosuppressive effect. 8. Molecules that carry modifications of C6, the C7-8 bond and C14, together with an allyl or caboxymethyl group on the piperidinic ring antagonized both the antinociceptive and the immunosuppressive effect of opiates and were themselves immunostimulants.
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PMID:Antinociceptive and immunosuppressive effects of opiate drugs: a structure-related activity study. 920 56

Intramuscular (i.m.) injection with meperidine is the most common analgesic approach to treat postoperative pain in Taiwan. Hydromorphone (Dilaudid) can provide very potent and rapid analgesic effect through subcutaneous (s.c.) injection. Although hydromorphone is widely used in North America, no study has compared the analgesic efficacy, side effect profiles and patients' satisfaction with the method of injection of hydromorphone s.c. and meperidine i.m. for the immediate post-operative analgesia. In this randomized and double-blind study, 60 female patients scheduled for abdominal total hysterectomy were treated either with 1 mg hydromorphone s.c. (n = 30) or 50 mg meperidine i.m. (n = 30) when they regained consciousness and asked for analgesic treatment in the recovery room. Visual analogue score (VAS) of wound pain was obtained at 0, 10 and 30 min after injection by a blinded observer. The occurrence and severity of nausea, vomiting, dizziness, drowsiness, flatus passage and respiratory depression were recorded. Post-operative analgesia in the ward was maintained by patient-controlled analgesia (PCA) with intravenous morphine. Time to first PCA demand, the number of demands, delivery, delivery/demand ratio and 24 h morphine consumption were documented. We found that VAS was reduced at 10 min and, to a greater extent, at 30 min postinjection in both groups but with no significant difference between the two groups. The occurrence and severity of side effect profiles were similar in both groups except that dizziness was more frequently observed after meperidine injection. Delivery, demand, delivery/demand ratio and 24 hr morphine consumption by PCA were not significantly different between the two groups. Time to first PCA trigger was also similar. Patients receiving hydromorphone s.c. injection exhibited higher satisfactory score than those receiving meperidine i.m. injection. Hydromorphone 1 mg, injected subcutaneously, was as effective as intramuscular meperidine 50 mg while permitting more favorable injection technique and fewer side effects. We suggest that subcutaneous hydromorphone is a good alternative to intramuscular meperidine for postoperative analgesia in the recovery room.
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PMID:Comparison of subcutaneous hydromorphone with intramuscular meperidine for immediate postoperative analgesia. 1046 24

Hydromorphone is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low. The kidney excretes hydromorphone and its metabolites. Some metabolites may have greater analgesic activity than hydromorphone itself but are unlikely to contribute to the pharmacological activity of hydromorphone. With the exception of pruritus, sedation and nausea and vomiting, which may occur less after hydromorphone than after morphine, the side-effects of these drugs are similar. On a milligram basis hydromorphone is five times as potent as morphine when given by the oral route, and 8.5 times as potent as morphine when given intravenously.
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PMID:Hydromorphone: pharmacology and clinical applications in cancer patients. 1130 75

With the exception of morphine, hydromorphone is the most commonly used intrathecal opioid for the treatment of intractable pain. The purpose of this study was to evaluate the stability and compatibility of hydromorphone in the implantable infusion system that is most commonly used in these patients. Hydromorphone solution was incubated at 37 degrees C in infusion system reservoirs and with individual materials which comprise the fluid pathway of the infusion system. Stability was analyzed using high performance liquid chromatography; mechanical integrity of device materials was evaluated after drug exposure. After 4 months of exposure to device materials or intact devices, hydromorphone concentration remained greater than 95% of starting material. All device materials retained acceptable mechanical performance. These results demonstrate that hydromorphone is stable at physiological temperatures for at least 4 months in an implantable infusion system and that current clinical practice of refilling the pump every 3 months is appropriate.
J Pain Symptom Manage 2001 Dec
PMID:Stability and compatibility of hydromorphone hydrochloride in an implantable infusion system. 1173 67


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