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

We conducted an open-label randomized clinical trial comparing the efficacy and tolerability of diflunisal and dextropropoxyphene napsylate with acetaminophen (DPN-A) in the management of mild to moderate pain following arthroscopic surgery of the knee. Patients used a self-rating pain scale to evaluate the analgesia provided by each medication. Twenty-six patients completed the study; 12 received diflunisal and 14 received DPN-A. The physicians found no significant differences between the two groups in their preoperative or postoperative assessment of pain, tenderness, swelling, and active range of motion. There were no statistically significant differences between the two groups' mean pain scores or assessment of the overall efficacy of their respective drugs. No patient in either treatment group reported any adverse effects.
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PMID:A comparison of the efficacy and tolerability of diflunisal and dextropropoxyphene napsylate with acetaminophen in the management of mild to moderate pain after arthroscopy of the knee. 257 53

A double-blind study of 43 patients undergoing excision of haemorrhoids under spinal anaesthesia was carried out to compare the analgesic effects of diflunisal (DFL, 21 patients) and dextropropoxyphene napsylate (DPN, 22 patients) on post-operative pain. Eleven patients (25%) reported no significant pain during the study indicating that they had needed no analgesic medication (4 in the DFL group and 7 in the DPN group). Thus 17 patients in the DFL group and 15 patients in the DPN group contributed to the analysis data. Seven patients in the DFL group and 9 patients in the DPN group needed additional analgesic therapy on the day of surgery. After the day of surgery the analgesic effect of both of the test medications was sufficient but DFL proved to provide slightly better pain relief than DPN. Two patients in each study group had mild adverse reactions including vomiting and epigastric pain, which were probably drug related. It is concluded that both DFL and DPN are safe and sufficiently effective treatments for pain after haemorrhoidectomy but not until one day after surgery.
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PMID:Comparison of diflunisal and dextropropoxyphene napsylate in the treatment of post-operative pain. 286 31

Neurophysiological study of all links of afferent somatosensory systems in neuropathies of different genesis was conducted. Patients with alcoholic (APN) and diabetic (DNP) polyneuropathies have been examined and selected as follows: 19 patients with intensive spontaneous pain syndrome (scoring over 6 on VAS); 20--without pain; 22 patients with allodiny caused by neuropathic pain and 38--without allodiny. Control group included 20 healthy subjects. Symptom complex of pain syndrome encompassed pronounced disorders of cutaneous sensitivity, minus symptoms in deep sensory sphere and high depression level. Neurophisiological appearances of spontaneous pain syndrome in APN and DPN are characterized by generalized mixed damage of peripheral sensible nerves and of 1 beta-afferents of H-reflex arch. Insufficiency of function of pain control system was mainly of deafferent character. Allodiny and spontaneous pain syndrome are reciprocally combined, the former being distinguished by involvement in pathology of 1-[symbol: see text] fibers (motor nerves and efferent links of H-reflex).
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PMID:[Neuropathic pain syndrome: clinico-neurophysiological analysis]. 1462 81

This article describes the development of micro-opioid receptor (MOR) binding and GTPgammaS functional SPAs as improved screening tools for the identification of MOR antagonists. Opioid receptors are members of the seven-transmembrane G protein-coupled receptor (GPCR) family and are involved in the control of various aspects of human physiology, including pain, stress, reward, addiction, respiration, gastric motility, and pituitary hormone secretion. Activation of the MOR initiates intracellular signaling pathways leading to a reduction in intracellular cyclic AMP levels, inhibition of calcium channels, and activation of potassium channels resulting in a reduction of the excitability of neurons. Characterization of opioid receptor ligand binding has traditionally been accomplished through the use of low throughput filtration-based binding assays, whereas functional activity has been based upon cyclic AMP measurements or filtration-based GTPgammaS functional assays. This report describes the development of a MOR displacement binding SPA using the radiolabeled antagonist [(3)H]diprenorphine ((3)H-DPN). The assay was optimized using statistical experimental design and demonstrates the stability and robustness necessary for HTS. The assay was biased toward the identification of MOR antagonists through the addition of Na(+). Our assay conditions also minimized the phenomenon of ligand depletion, a problem commonly observed in low-volume assays using high receptor-expressing cell lines. The optimized procedure revealed (3)H-DPN affinity constants at the MOR that were consistent with results obtained using filtration methods (K(D) (SPA) = 1.89 +/- 0.24 nM, K(D) (filtration) = 1.88 +/- 0.35 nM). The binding SPA identified known opioid receptor modulators contained within the Library of Pharmacological Active Compounds (LOPAC) cassette, and the GTPgammaS scintillation proximity assay (SPA) was used to confirm the functional activity of the LOPAC antagonists acting at the MOR. Conversion of the ligand binding and GTPgammaS functional assays to a homogeneous SPA generated a simple assay with dramatically increased throughput. Data from the development and implementation of the displacement binding and GTPgammaS functional SPAs are presented.
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PMID:Development of displacement binding and GTPgammaS scintillation proximity assays for the identification of antagonists of the micro-opioid receptor. 1509 Feb 35

Neuropathic pain is the focus of current clinical research, clinical identification, and treatment. It is unique from nociceptive pain and requires evaluation of the relevance and utility of common pain measures created for other painful conditions. This study evaluated the psychometric properties of a modified Brief Pain Inventory (BPI) for patients with painful diabetic peripheral neuropathy (BPI-DPN). Participants were patients with painful DPN (n=255) enrolled in a DPN Burden of Illness survey referred through 17 outpatient settings (primary care physicians, endocrinologists, neurologists, and anesthesiologists). Patients completed the BPI-DPN, and self-report measures of health-related quality of life, mood sleep, and healthcare utilization. Construct, criterion and discriminant validity, and internal consistency reliability were evaluated. Principal axis factoring with oblimin rotation revealed two interpretable factors (eigenvalues>1.0), consistent with most published BPI validation studies; a severity scale comprising the four BPI Severity items and an interference scale comprising the seven Interference items, which satisfied criteria for interpretability and model fit. Cronbach's alpha was high (0.94) for both scales. Mean pain Severity was highly correlated with Bodily Pain from the Medical Outcomes Study Short Form-12, version 2 (rs=0.63, P < 0.001), the Pain/Discomfort item in the Euro-QoL (rs=0.58, P < 0.001), and a verbal rating scale measure of pain severity (rs=0.74, P < 0.001). Individual BPI-DPN Interference domains were moderately correlated (rs's >0.5, P < 0.001) with analogous measures, and the Sleep Interference item had a high, significant association with the three primary Medical Outcome Study-Sleep scale subscales (rs's=0.66-71, P < 0.001). Worst Pain and Interference ratings were significantly associated with hospital utilization and outpatient visits due to DPN. These results replicate, in a pure peripheral neuropathic pain condition, the BPI psychometric characteristics documented in populations with nociceptive or mixed pain conditions. The BPI-DPN is a promising instrument in the evaluation of painful DPN.
J Pain Symptom Manage 2005 Apr
PMID:Validation of a modified version of the brief pain inventory for painful diabetic peripheral neuropathy. 1585 44

The article reviewed clinical studies on painful diabetic peripheral neuropathy (PDPN) treated by integrative medicine. PDPN, a common complication of diabetes mellitus, which could severely influence patients' quality of life. The keystone and difficulty of PDPN treatment is to relieve pain. Tricyclic anti-depressants are the firstline agents for neuropathic pain but with obvious adverse reactions. Antiepileptic drugs and capsicin can relieve PDPN with less adverse reactions. In recent years, lots of report of clinical studies on DPN treated by TCM or integrative medicine were issued, but those pertinent to PDPN were seldom. Only the papers with independent statistical analysis on effect of pain relieving were selected to review in this article, and the authors presumed that it is feasible to treat PDPN with integrative medicine.
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PMID:[Progress on painful diabetic peripheral neuropathy treated by integrative medicine]. 1589 90

Neuropathic pain is the focus of current clinical research, clinical identification, and treatment. It is unique from nociceptive pain and requires evaluation of the relevance and utility of common pain measures created for other painful conditions. This study evaluated the psychometric properties of a modified Brief Pain Inventory (BPI) for patients with painful diabetic peripheral neuropathy (BPI-DPN). Participants were patients with painful DPN (n = 255) enrolled in a DPN Burden of Illness survey referred through 17 outpatient settings (primary care physicians, endocrinologists, neurologists, and anesthesiologists). Patients completed the BPI-DPN and self-report measures of health-related quality of life, mood sleep, and health care use. Construct, criterion and discriminant validity, and internal consistency reliability were evaluated. Principal axis factoring with oblimin rotation revealed two interpretable factors (eigenvalues > 1.0), consistent with most published BPI validation studies: a severity scale comprising the four BPI Severity items and an interference scale comprising the seven Interference items, which satisfied criteria for interpretability and model fit. Cronbach's alpha was high (0.94) for both scales. Mean pain Severity was highly correlated with Bodily Pain from the Medical Outcomes Study Short Form-12, version 2 (r(s) = 0.63, P < .001), the Pain/Discomfort item in the Euro-QoL (r(s) = 0.58, P < .001), and a verbal rating scale measure of pain severity (r(s) = 0.74, P < .001). Individual BPI-DPN Interference domains were moderately correlated (r(s)'s > 0.5, P < .001) with analogous measures, and the Sleep Interference item had a high, significant association with the three primary Medical Outcome Study-Sleep scale subscales (r(s)'s = 0.66-71, P < .001). Worst Pain and Interference ratings were significantly associated with hospital use and outpatient visits because of DPN. These results replicate, in a pure peripheral neuropathic pain condition, the BPI psychometric characteristics documented in populations with nociceptive or mixed pain conditions. The BPI-DPN is a promising instrument in the evaluation of painful DPN.
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PMID:Validation of a modified version of the Brief Pain Inventory for painful diabetic peripheral neuropathy. 1612 33

It is clear that the majority of the evidence for symptomatic management of DPN is for either TCAs or anticonvulsants. The Canadian Diabetes Association recommends agents from these classes as first-line therapy. Though these agents appear to be effective, the management of neuropathic pain is still quite difficult and many patients only achieve partial relief from therapy while others find no relief. It is important to focus on the prevention of onset and progression of diabetic neuropathy by dealing with the root of the problem, glycemic control. Patients should be educated on the importance of intensive glycemic control for the prevention of all diabetes complications, including peripheral neuropathy (Bril & Perkins, 2003).
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PMID:An update on the treatment and management of diabetic peripheral neuropathy. 1725 99

The aim of this study was to evaluate the causes, prevalences, clinical manifestations of hospital-referred polyneuropathies, and evaluate neurophysiological findings in idiopathic polyneuropathy. From 2000 to 2005, 226 patients with polyneuropathy were examined. Polyneuropathy was diagnosed when symptoms, clinical- and neurophysiological findings were compatible with affection of at least two peripheral nerves. They were classified in symptomatic and idiopathic polyneuropathy after investigation. Clinical manifestations were evaluated for diabetes- (DPN), inflammatory- (INPN), hereditary- (HPN) and idiopathic polyneuropathy (IDPN). Neurophysiological findings were investigated in IDPN. 72% had a symptomatic polyneuropathy. Most frequent causes were diabetes mellitus (18%), inflammation, (16%) and hereditary (14%). Most common prevalences per 100,000 were as follows: IDPN, 21; DPN, 13 and HPN, 11. Predominating clinical manifestations were: sensory and motor in INPN, HPN and IPN; sensory in DPN. Pain was more present in IDPN and DPN than in others. In IDPN axonal demyelinating affection was present in 20%. Symptomatic polyneuropathy was common and diabetes mellitus, inflammation and hereditary were frequent causes. In IDPN, DPN, HPN and INPN different clinical patterns were found. Additionally, in IDPN axonal demyelinating affection was more frequent than previously reported.
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PMID:Hospital-referred polyneuropathies--causes, prevalences, clinical- and neurophysiological findings. 1753 35

Seven published, randomized, placebo-controlled clinical trials with pregabalin have shown robust efficacy for relief of neuropathic pain from DPN and PHN. An investigation of the efficacy and safety of twice daily pregabalin enrolled 395 adults with painful DPN for > or = 1 year in a 12-week, double-blind, placebo-controlled trial. Patients were randomized to placebo, 150, 300, or 600 mg/day pregabalin (n = 96, 99, 99, and 101). Primary efficacy measure was change from baseline in endpoint mean pain score from patients' daily pain diaries. Secondary efficacy measures included pain-related sleep-interference scores, Patient and Clinical Global Impressions of Change (PGIC, CGIC), and the EuroQOL Health Utilities Index (EQ-5D). Statistically significant reduction in pain was observed in patients receiving pregabalin 600 mg/day, and 46% of patients treated with 600 mg/day pregabalin reported > or = 50% improvement in mean pain scores from baseline (vs 30% of placebo patients, p = 0.036). Number needed to treat to achieve such response was 6.3. Pregabalin 600 mg/day was significantly superior to placebo in improving pain-related sleep-interference scores (p = 0.003), PGIC (p = 0.021), and CGIC (p = 0.009). (Neither pregabalin 150 nor 300 mg/day separated from placebo on these measures, largely because of an atypically large placebo response in one country representing 42% of patients.) All pregabalin dosages were superior to placebo in improving EQ-5D utility scores (all p > or = 0.0263 vs placebo). Pregabalin was well tolerated at all dosages; adverse events were generally mild to moderate. Number needed to harm (discontinuation because of adverse events) was 10.3 for pregabalin 600 mg/day.
Eur J Pain 2008 Feb
PMID:Pregabalin for relief of neuropathic pain associated with diabetic neuropathy: a randomized, double-blind study. 1763


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