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

RU 486, a new antiprogestational compound, was given to 37 women seeking termination of pregnancy and with amenorrhea of 42 days or less. 1 patient was found at the 2nd follow-up visit to have an extrauterine pregnancy. The patients received either 25 mg, 50 mg, or 100 mg RU 486 twice daily for 4 days. All patients attended 3 follow-up visits, 1, 2, and 5-6 weeks after the start of therapy. The start, duration, and amount of bleeding as well as plasma progesterone, beta-human chorionic gonadotropin (hCG) and cortisol concentrations were determined for each treatment day and at follow-up visits. All but 3 patients started to bleed during treatment. Frequency of complete abortion was 61% (22 of 36 patients). In only 3 patients was the pregnancy unaffected by treatment. The clinical efficacy of the treatment was not dose-dependent. Most of the patients experienced only minor dise effects in terms of mild uterine pain, nausea, and vomiting. However, 2 patients suffered from heavy bleeding requiring blood transfusion and curettage. In patients with complete abortion, beta-hCG values decreased significantly but not until the 1ft follow-up visit. The plasma progesterone also decreased. This decrease appeared earlier with the higher daily dose of RU 486. Cortisol concentrations increased during treatment with all 3 dosage regimens but the levels remained within the normal range. It is concluded the treatment with RU 486 may provide a novel therapy for menstrual regulation but the efficacy of it needs to be improved to compete with such alternatives as vacuum aspiration.
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PMID:Termination of very early pregnancy by RU 486--an antiprogestational compound. 674 60

Existing evidence suggests that preoperative psychological preparation that is designed to reduce anxiety may sensitize cortisol and adrenaline responses to surgery. In a controlled trial of abdominal surgery patients, we therefore tested the effects of a preoperative preparation that used guided imagery, not to reduce anxiety, but to increase patients' feelings of being able to cope with surgical stress; 26 imagery patients were compared with 25 controls who received, instead, background information about the hospital. State-anxiety was similar in each group, but imagery patients experienced less postoperative pain than did the controls, were less distressed by it, felt that they coped with it better, and requested less analgesia. Hormone levels measured in peripheral venous blood did not differ on the afternoon of admission, before preparation. Cortisol levels were, however, lower in imagery patients than in controls immediately before and after surgery. Noradrenaline levels were greater on these occasions in imagery patients than controls. The results are interpreted in relation to two theories. One states that preoperative "worry" reduces surgical stress. The other concerns the influence of active and passive coping on endocrine responses to stress.
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PMID:Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. 779 76

The purpose of this study was to investigate whether the fetus mounts a hormonal stress response to a potentially painful procedure, intrauterine needling. Cortisol and beta-endorphin concentrations in fetal plasma obtained during uncomplicated fetal blood sampling or intrauterine transfusions by needling the fetal intra-abdominal portion of the umbilical vein (intrahepatic vein) were compared to hormone concentrations in fetal plasma obtained by the conventional technique of needling the placental cord insertion, which is not innervated. Cortisol and beta-endorphin concentrations did not increase within 10 minutes of fetal abdominal needling (n = 15). However, more prolonged needling during transfusion at the intrahepatic vein was associated with an increase in fetal plasma cortisol (median increase 48 nmol/L; 95% Cl, 23-86) and beta-endorphin (207 pg/mL; 113-307) concentrations compared to transfusion at the placental cord insertion (p < 0.005 for both hormones). The magnitude of rise in hormone increased linearly with the duration of needling (cortisol, r = 0.80; beta-endorphin, r = 0.88, p < 0.05 for both). These data suggest that the fetus mounts a hormonal stress response to invasive procedures. They raise the possibility that the human fetus feels pain in utero, and may benefit from anaesthesia or analgesia for invasive procedures.
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PMID:Fetal plasma cortisol and beta-endorphin response to intrauterine needling. 791 81

We have compared the efficacy of 0.9% NaCl 20 ml (n = 15), 0.25% bupivacaine 20 ml (n = 15) and 0.5% lignocaine 20 ml (n = 15), administered i.p., in reducing postoperative pain and opioid requirements, and modifying the metabolic response to surgery and postoperative lung function after laparoscopic cholecystectomy. There were no differences in postoperative pain scores (visual analogue scale and verbal rating scale) between the three groups in the first 4 h after operation and in analgesic requirements during the first 24 h. In all groups, forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s decreased 2 h after surgery (P < 0.001). Ventilatory values recovered only partially in the first 2 days after operation (P < 0.05), with no significant differences between groups. Plasma concentrations of glucose and cortisol increased after surgery (P < 0.05). Cortisol concentrations returned to baseline 48 h after operation. There were no significant differences between the groups in any measured variable. These data suggest that the administration of 20 ml of local anaesthetics i.p. is not effective in reducing postoperative pain, improving lung function, or attenuating the metabolic endocrine response after laparoscopic cholecystectomy.
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PMID:Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung function. 813 42

Pain and endocrine-metabolic response to surgical stress, during surgery and in the early postoperative period, was compared in two groups of patients affected by gallstones and randomly assigned to Laparoscopic Cholecystectomy or Open Cholecystectomy. Pain was assessed by the VAS method also taking into account the need of analgesic administration in the postoperative period. The so called "stress hormones" (Prolactin (PRL), Cortisol (CORT), Human Growth Hormone (HGH)) and glycaemia were monitored during surgery and in the first postoperative 24 hours. The minimal invasive technique of laparoscopic cholecystectomy accounted for a very limited analgesic administration. In the intraoperative period laparoscopic cholecystectomy plasma hormone levels overlapped the open cholecystectomy ones, while in the postoperative period a constant increase in PRL and CORT levels was registered in the open cholecystectomy group demonstrating a prolonged stressful condition. The end results of this study show that laparoscopic cholecystectomy has major advantages than open cholecystectomy in the treatment of gallstones as far as pain and endocrine-metabolic response are concerned.
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PMID:[Perioperative pain and stress: a comparison between video laparoscopic cholecystectomy and "open" cholecystectomy]. 828 76

Eighteen dogs undergoing lateral thoracotomy at the left fifth intercostal space were randomly assigned to 1 of 3 postoperative analgesic treatment groups of 6 dogs each as follows: group A, morphine, 1.0 mg/kg of body weight, IM; group B, 0.5% bupivacaine, 1.5 mg/kg given interpleurally; and group C, morphine, 1.0 mg/kg given interpleurally. Heart rate, respiratory rate, arterial blood pressure, arterial blood gas tensions, alveolar-arterial oxygen differences, rectal temperature, pain score, and pulmonary mechanics were recorded hourly for the first 8 hours after surgery, and at postoperative hours 12, 24, and 48. These values were compared with preoperative (control) values for each dog. Serum morphine and cortisol concentrations were measured at 10, 20, and 30 minutes, hours 1 to 8, and 12 hours after treatment administration. All dogs had significant decreases in pHa, PaO2, and oxygen saturation of hemoglobin, and significant increases in PaCO2 and alveolar-arterial oxygen differences in the postoperative period, but these changes were less severe in group-B dogs. Decreases of 50% in lung compliance, and increases of 100 to 200% in work of breathing and of 185 to 383% in pulmonary resistance were observed in all dogs after surgery. Increases in work of breathing were lower, and returned to preoperative values earlier in group-B dogs. The inspiratory time-to-total respiratory time ratio was significantly higher in group-B dogs during postoperative hours 5 to 8, suggesting improved analgesia. Blood pressure was significantly lower in group-A dogs for the postoperative hour. Significant decreases in rectal temperature were observed in all dogs after surgery, and hypothermia was prolonged in dogs of groups A and C. Significant differences in pain score were not observed between treatment groups. Cortisol concentration was high in all dogs after anesthesia and surgery, and was significantly increased in group-B dogs at hours 4 and 8. Significant differences in serum morphine concentration between groups A and C were only observed 10 minutes after treatment administration. In general, significant differences in physiologic variables between groups A and C were not observed. Results of the study indicate that the anesthesia and thoracotomy are associated with significant alterations in pulmonary function and lung mechanics. Interpleurally administered bupivacaine appears to be associated with fewer blood gas alterations and earlier return to normal of certain pulmonary function values. Interpleural administration of morphine does not appear to provide any advantages, in terms of analgesia or pulmonary function, compared with its IM administration.
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PMID:Evaluation of pulmonary function and analgesia in dogs after intercostal thoracotomy and use of morphine administered intramuscularly or intrapleurally and bupivacaine administered intrapleurally. 853 84

Children who undergo cardiac catheterization present pain management challenges to nurses. In this experimental study, the investigator examined the effect of imagery on children's pain and anxiety during cardiac catheterization. Twenty-four children, aged 9 to 17 years were randomly assigned to a control, presence, or imagery condition. Physiological, psychological, and behavioral data were used to rate children's pain and anxiety during cardiac catheterization. Children in the imagery condition displayed fewer distress behaviors during cardiac catheterization. Children in the presence condition reported the lowest levels of pain. Cortisol elevation over baseline was lowest in the control group, a result consistent with findings in previous studies. Several correlations of interest are reported. Implications for nursing practice and research are discussed.
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PMID:Effect of imagery on children's pain and anxiety during cardiac catheterization. 854 13

We have previously shown that there is deficient hypothalamic-pituitary-adrenal (HPA) responsiveness in rheumatoid arthritis (RA) patients. The basis for this deficient response is not known. The purpose of the project was to investigate whether the defective HPA response in RA patients is the result of increased endogenous opioid tone secondary to chronic pain which can suppress corticotrophin-releasing hormone (CRH) production. We conducted a double-blind placebo-controlled cross-over trial to study the effect of the opiate antagonist, naloxone, on psychometric function together with plasma adrenocorticotrophic hormone (ACTH), cortisol and prolactin. Seven RA patients with active and established disease and eight healthy controls were studied. Each received either a bolus i.v. infusion of 20 mg naloxone or normal saline. After at least 72 h, they received naloxone if they had previously received normal saline or vice versa. The pain score was statistically significantly higher at baseline in the RA group compared with controls (5.7 +/- 3.25 vs 0.35 +/- 0.21, P < 0.001). No difference was found in the other psychometric assessments throughout the study. Patients receiving normal saline did not show any significant change in cortisol or ACTH. Cortisol and ACTH showed a sharp and significant rise after naloxone treatment in both RA and normal subjects (P < 0.001 and P < 0.01), but no difference was observed between the two groups. The mean prolactin level showed no significant change in both groups after any treatment. We conclude that endogenous opioid tone does not appear to be a major contributor to the HPA defect in RA. However, the number of patients studied was small and this result will require confirmation from larger trials.
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PMID:Endogenous opioid tone in patients with rheumatoid arthritis. 864 33

This exploratory, prospective study was set up to determine the relationship between cortisol and catecholamine levels and labor experience and postpartum maternal mood. It was performed at the Coronation Hospital, which serves a low-income urban population in Johannesburg. Blood samples were taken from 189 low-risk primiparous women in active first stage of labor and analyzed for cortisol, norepinephrine, epinephrine and dopamine. The stress hormone levels were then correlated with maternal anxiety, depression and self-esteem scores, and changes associated with mothers' labor experience and pain. Patients who were distressed and required analgesia had higher cortisol levels. Those who described a more positive labor experience at 24 hours also had higher cortisol levels. There were no significant correlations between psychological test scores and stress hormone levels. Both labor pain at the time and a more positive recollected labor experience were associated with high cortisol levels. Cortisol and catecholamine levels in labor did not correlate with postpartum psychological test scores.
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PMID:Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women. 874 92

The behaviour of 101 calves was evaluated during (n = 73) and after (n = 28) thermical dehorning without anaesthesia. Cortisol in saliva (n = 68) was measured in 68 calves. A simulation of dehorning was carried out as a control in most of the animals. The area around the horn bud was examined histologically in 20 calves of different ages (newborn until 3-4 months old). Additionally, the influence of dehorning cows with a wire-saw under anaesthesia on behaviour (n = 16), cortisol in saliva (n = 23), and the milk yield was examined. Independent of the calves' age, the horn bud and the surrounding hairy area were well innervated. For all calves dehorning without anaesthesia was a painful experience. During dehorning calves showed distinct pain and defense reactions. Most reactions were observed more often when the calves were dehorned as when dehorning was simulated. The cortisol in saliva was significantly increased after dehorning. In summary, we have to conclude that calves have a well developed nociceptive system from birth on. Therefore calves should only be dehorned using anaesthesia. Despite the anaesthesia, dehorning was stressful for the cows, as measured by a significant increase of cortisol in saliva. Moreover, cows showed pain reactions when the effects of the anaesthesia diminished. Dehorning had only a short effect on the milk yield of the cows.
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PMID:[Ethological, physiological and histological aspects of pain and stress in cattle when being dehorned]. 915 26


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