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

Classification, epidemiology, pathophysiology, and therapy of migraine, cluster, and muscle-contraction (tension) headaches are reviewed. Migraine headache is related to vasomotor changes and is often preceded or accompanied by neurologic symptoms, nausea, and vomiting. Ergot alkaloids are used in acute migraine episodes; products containing caffeine are sometimes used for synergy. Other agents including antiemetic and sedative drugs and a combination product containing isometheptene mucate , dichloralphenazone , and acetaminophen have been used. Methysergide is the drug of choice for migraine prophylaxis. Of all patients with cluster headache, 90% experience episodes that occur in series separated by intervals as short as one week or as long as 25 years, and the remaining 10% have chronic headache. Pain is unilateral, nausea and vomiting are rare, and there is no aura. Pathophysiology is thought to be similar to that of migraine. Supportive treatment includes drug therapy to improve sleep and avoidance of alcohol and vasodilating agents. Aerosol ergot preparations may be effective for treatment of acute episodes . Prednisone has been used both as an abortive agent and for prophylaxis, while ergotamine, methysergide, and lithium have been tried prophylactically. Chronic tension headache is a constant, tight, pressing, or bandlike sensation in the frontal, temporal, or occipital area that occurs daily. The deep, steady ache differs from the throbbing sensation of vascular headache. Constant overcontraction of scalp muscles may be a cause. Heat, massage, and stretching are used to alleviate excess muscle contraction. Tension headache has been treated with analgesics, nonsteroidal anti-inflammatory agents, muscle relaxants, and amitriptyline. Drug treatment of headache must be based on headache type and tailored to individual response. Bio-feedback may be useful in some patients when combined with drugs.
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PMID:Classification, mechanisms, and management of headache. 637

In this multicenter study a nonnarcotic analgesic available for moderate pain, naproxen sodium, 550 mg, was compared to a combination that is used extensively for moderate to severe pain, aspirin, phenacetin, caffeine and codeine phosphate (APC/C) (60 mg of codeine phosphate). Women with pain after major gynecologic surgery reported a similar pattern in pain reduction with the two medications except for a relatively sharper increase in pain intensity between four and six hours after administration of APC/C. A smaller number of patient complaints suggested that naproxen sodium was better tolerated than APC/C.
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PMID:Naproxen sodium vs. a combination of aspirin, phenacetin, caffeine and codeine phosphate for pain after major gynecologic surgery. A multicenter comparison. 637 36

The efficacy and acceptability of meptazinol and dextropropoxyphene plus paracetamol were compared in 32 elderly patients with various types of musculoskeletal pain. A double-blind crossover technique was used. After at least 1 week in hospital, the previous analgesic treatment was stopped and single-blind placebo was given for 1 day. Patients then received, at random, 5-days' treatment with either 200 mg meptazinol 4-times daily or 65 mg dextropropoxyphene plus 650 mg paracetamol 4-times daily before being crossed over to the alternative medication for a further 5 days. If necessary, up to 4 tablets a day were allowed of 500 mg aspirin plus 50 mg caffeine as a 'rescue' analgesic. Assessments were made before (on placebo) and at the end of each treatment period of pain severity and effect on patients' sleep, and details recorded of 'rescue' analgesic consumption and any side-effects. At the end of the trial, an overall assessment was made of the effectiveness and tolerance of each treatment and patients were asked which they preferred. The results showed that both treatments reduced pain severity significantly for all the parameters measured; however, most patients needed additional pain relief. Few side-effects were reported during either treatment period.
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PMID:A comparison between meptazinol and dextropropoxyphene plus paracetamol in elderly patients with musculoskeletal pains. 639 29

Conflicting reports have appeared in the recent literature on a presumed association between coffee intake and "fibrocystic breast disease." The hypothesis suggesting that abstention from coffee and caffeine consumption eliminates breast pain and resolves breast nodules was based on an uncontrolled clinical study. For a condition with a notorious reputation for "waxing and waning," it is essential to document the stability versus instability of clinical findings, keeping the methyl xanthine consumption constant. Seventy-two women, all with palpable breast nodules, were followed over a 6-month period with monthly examinations and questionnaires on intake of coffee, tea, soft drinks, chocolate, candies, and caffeine-containing drugs. The methyl xanthine consumption remained remarkably constant throughout the observation time. The examiner was uninformed as to previous examination findings and pain reports of each woman. In 21 (15%) breasts with nodularity, the nodules had completely disappeared by the termination of the study. A total of 125 (87%) breasts of the sample manifested a change in the number of nodules or a change in position. Forty-eight of the 72 women were menopausal. For a chronic condition with so much variety of subjective sensitivity and great variability of objective clinical palpation, it is difficult to relate the amount of methyl xanthine consumption to "fibrocystic breast disease."
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PMID:Prospective study of "fibrocystic breast disease" and caffeine consumption. 647 53

In a double-blind, randomized controlled trial among 500 post-partum patients experiencing moderate to severe pain, a single oral dose of an aspirin/caffeine combination (800 mg aspirin, 65 mg caffeine) provided significantly more pain relief at 2 hours than did a higher dose of an acetaminophen/aspirin combination (648 mg acetaminophen, 648 mg aspirin) and a higher dose of acetaminophen alone (1000 mg acetaminophen). At 3 and 4 hours, the acetaminophen/aspirin combination as well as the aspirin/caffeine combination were significantly superior to acetaminophen alone. At all times, all three drugs were significantly superior to placebo. There were no clinically significant adverse reactions. These results provide evidence of a potentiating effect of caffeine on aspirin's analgesic potency.
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PMID:A double-blind randomized study of an aspirin/caffeine combination versus acetaminophen/aspirin combination versus acetaminophen versus placebo in patients with moderate to severe post-partum pain. 651 49

Psychotropic substances combined with simple analgesics are a common pharmacologic denominator in the dependency complex. More than 95 percent of patients studied took preparations containing barbiturates; the remaining few subjects used analgesics combined with caffeine. Dependence on compound analgesic preparations usually develops in patients with headaches--migraine, tension headaches, and other complex forms--since ergotamine-containing preparations are generally effective only at the onset of an attack, and prophylactic administration is, therefore, common. Once dependence has developed, reduction or discontinuation of the medication is typically followed after one or two days by an increase in the intensity of the pain. This may cause the patient to revert to these preparations in an attempt to reduce pain and may lead to an unfortunate vicious cycle. Therefore, cessation of psychotropic analgesic combinations is essential in the treatment of chronic pain.
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PMID:Effects and risks of psychotropic and analgesic combinations. 665 May 31

Our objective was to determine the value of caffeine in combination with acetaminophen in the relief of pain from uterine cramping, episiotomy, and third molar extraction. In the dental study, 173 patients received two or four tablets of 500 mg acetaminophen or the combination of 500 mg acetaminophen and 65 mg caffeine. In the three postpartum studies, 1345 patients received one, two, or three tablets of acetaminophen, the combination, or a placebo. The mean scores for the summary variable percent sum of the pain intensity differences (% SPID) were higher in all for the combination than for acetaminophen alone, and in two studies the null hypothesis of no differences was rejected. The relative potency estimates for % SPID were 1.9, 1.8, and 1.3 for the three studies in which bioassays could be performed and the pooled relative potency was 1.7 with a 95% confidence interval of 1.1 to 3.1. The results were essentially the same among pain models and among patient groups with similar habitual caffeine consumption. Onset of analgesia was also faster with the combination. We conclude that caffeine enhances the analgesic efficacy of acetaminophen.
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PMID:Effect of caffeine on acetaminophen analgesia. 683 29

The analgesic efficacy of a hydrocodone-acetaminophen combination, a codeine-acetaminophen combination, a codeine-APC (aspirin, phenacetin, and caffeine) combination, and a placebo was evaluated in outpatients who had moderate or severe pain after the surgical removal of impacted third molars. Each of the active medications had a significant effect on essentially all measures of total and peak analgesia; they did not differ significantly on any measure of analgesia. Adverse effects were transitory and, in general, appear to have been related to the centrally acting component of each combination analgesic.
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PMID:An evaluation of the analgesic efficacy of three opioid-analgesic combinations in postoperative oral surgery pain. 693 24

The value of ibuprofen (Motrin) as an analgesic was assessed in two consecutive studies in 425 patients with postherniorrhaphy pain. In the first study, 400 mg ibuprofen proved superior to placebo and as effective as one tablet of a compound containing 375 mg of acetylsalicylic acid, 30 mg caffeine and 8 mg codeine (ACC-8). In the second study, the analgesic effectiveness of 400 mg of ibuprofen was intermediate between that of two tablets of ACC-8 and one tablet of ACC-30 (a compound containing 375 mg ASA, 30 mg caffeine and 30 mg codeine). The side effects of all drugs were negligible. Ibuprofen should be a suitable alternative analgesic in postoperative pain of this type.
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PMID:Relief of postoperative pain by ibuprofen: a report of two studies. 699 Oct 89

A method for the evaluation of the efficacy of mild analgesic drugs in outpatients with nonmigrainous headache is described. During the 3-hour drug evaluation period, patients were required to record at hourly intervals their pain intensity using both a verbal rating and a visual analog scale, their pain relief, and the occurrance of side effects. The results obtained in six studies consisted of comparisons of reference compounds aspirin (1000 mg) and two analgesic combinations (containing aminophenazone, caffeine, and butalbital); test medications aspirin (500 mg), codeine (30 mg), proquazone (300 mg), and new formulations of the two analgesic combinations (aminophenazone replaced by propyphenazone); and, in every study, placebo. In a seventh study, the analgesic effects of three doses aspirin (250, 500, and 1000 mg) were compared with that of placebo. Every study was conducted under double-blind, complete crossover conditions, and between 24 and 36 patients were used in each study. Using parametric and nonparametric statistical analyses, the reference compounds and the majority of the test medications exhibited significant analgesic properties. Also, a highly significant dose--response effect was demonstrated for aspirin. It is concluded that the headache model is a practicable, reliable, and sensisive method for the evaluation of the effectiveness of mild analgesic drugs.
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PMID:Headache as a model for assessing mild analgesic drugs. 699 34


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