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

The analgesic effects of acupuncture were compared with those of codeine in the treatment of postoperative dental pain in 40 healthy male volunteers 18 to 30 years old. Upon the patient's recovery from local anesthesia (lidocaine), he was asked by a trained observer to classify the intensity of his pain as none, mild, moderate, or severe. He then received one of the following treatments: 1. Placebo: lactose, plus acupuncture placebo 2. Codeine: codeine, plus acupuncture placebo 3. Acupuncture (Ho-Ku): lactose, plus 2 Ho-Ku points 4. Codeine-acupuncture: codeine, plus 2 Ho-Ku points. The pain intensity score was recorded by the observer at half-hour intervals for 3 hours. Patients in treatment groups 2, 3 and 4 showed significantly greater pain relief than those in treatment group 1. For the 1st half hour, there was more pain relief with Ho-Ku alone than with codeine plus Ho-Ko (p less than 0.01). However, for the 2, 2 1/2, and 3-hour periods, codeine plus Ho-Ku produced more pain relief than any of the other treatments.
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PMID:Comparison of the effects of acupuncture and codeine on postoperative dental pain. 32 53

A model was developed to evaluate mild analgesics in an oral surgery outpatient clinic population. On a report form, patients recorded starting pain and then pain intensities, relief responses, and side effects hourly for 3 hr after drug administration. The treatments were randomly allocated to patients on a single-dose-only basis, and the double-blind technique was used. The first of two studies compared codeine 30 mg, aspirin 650 mg, codeine 30 mg with aspirin 650 mg, and placebo in 128 subjects. The second study compared codeine 60 mg, acetaminophen 600 mg, and codeine 60 mg with acetaminophen 600 mg and placebo in 160 subjects. Time-effect curves were generated for both pain relief and pain relief and pain intensity difference (PID). First-hour scores, peak scores, and total scores were statistically analyzed by parametric and nonparametric factorial analysis. Both aspirin 650 mg and acetaminophen 600 mg proved superior to placebo (p less than 0.01) for all measures of effect with both parametric or nonparametric analyses, while codeine 30 mg was not significantly superior to placebo in any analysis. Codeine 60 mg proved significantly superior to placebo for certain measures of effect when analyzed with the nonparametric model. There was no significant interaction between either aspirin or acetaminophen and codeine.
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PMID:A model to evaluate mild analgesics in oral surgery outpatients. 78 41

Aspirin and codeine, standard reference analgesics, are frequently used as positive controls in clinical trials of new oral analgesics. In randomized parallel double-blind studies, single doses of aspirin and codeine were compared with placebo in episiotomy pain (99 patients) and in postpartum uterine pain (130 patients), common models in analgesic trials. With aspirin, 600 and 1,200 mg, in episiotomy pain, analgesia as measured by pain intensity difference (PID) scores began within 1 hr, peaked at the second hour (p less than 0.01), and continued to the fifth hour (p less than 0.01). In uterine pain, responses with aspirin, 650 mg, were observed to be equally good. With codeine, 60 mg, in episiotomy pain measurable analgesia was present by the second hour and was significant at the fourth hour (p less than 0.05); in uterine pain, responses were indistinguishable from placebo throughout an 8-hr time-course. Codeine seemed ineffective and therefore umacceptable as a positive control in uterine pain. These data imply that the two postpartum pain models are qualitatively different: episiotomy pain seems sensitive to both aspirin and codeine, while uterine pain appears sensitive to aspirin but not to codeine.
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PMID:Asprin and codeine in two postpartum pain models. 78 93

To assess the problem of night pain and the use of hypnotic drugs in patients with rheumatic diseases 165 consecutive patients (mean age 58.5 years) were assessed and questioned about night pain and the use of drugs including night sedation. Most of the patients (106 (64%)) were women. A total of 32 (19%) patients were receiving night sedation for a mean duration of 43.9 months. Fourteen patients (13 women) were using these drugs to treat insomnia related to pain. The mean visual analogue pain score for night pain showed a significant difference between those receiving night sedation (5.2) and those who were not (3.7). Of the 70 patients who answered the Stanford Health Assessment Questionnaire (HAQ), those receiving night sedation also had a significantly higher mean score (1.91) than those who were not (1.2), suggesting that patients receiving night sedation were more clinically disabled. Codeine was used by more (34%) patients receiving night sedation than those who were not (18%) suggesting that those receiving night sedation had more pain. These results highlight the need for better pain management in patients with rheumatic diseases to minimise the risk of prescribing addictive drugs such as hypnotic drugs and codeine.
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PMID:Night pain in arthritis: patients at risk from prescribed night sedation. 141 23

A double-blind randomized parallel group trial was undertaken to compare the acceptability and efficacy of 2 forms of analgesic treatment, DI-Antalvic (Houde Laboratories, Puteaux, France) (30 mg dextropropoxyphene and 400 mg paracetamol per capsule) and Efferalgan-Codeine (UPSA Laboratories, Rueil Malmaison, France) (30 mg codeine and 500 mg paracetamol per tablet) prescribed for 1 week at doses of 6 capsules/day and 6 tablets/day, respectively, in 141 outpatients with active osteoarthritis of the knee or hip. The principal aim of the trial was concerned with acceptability, with efficacy as its secondary aim. The principal trial criterion was defined as overall assessment of acceptability by the patient at the end of the trial (success or failure) or by treatment dropouts because of an adverse effect (failure). Comparability of the groups was confirmed before any treatment regarding the physical characteristics of the patients, characteristics of osteoarthritis, and the initial level of pain and functional consequences of pain. Results show that the analgesic efficacy of the treatment was similar, but that the acceptability of Efferalgan-Codeine was significantly worse than that of DI-Antalvic: 53% failure with Efferalgan-Codeine versus 29% failure with DI-Antalvic (P = .005). Other trials of the same type would seem necessary (comparison of lower doses, other types of pain) before being able to generally extrapolate such findings.
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PMID:Acceptability and efficacy of two associations of paracetamol with a central analgesic (dextropropoxyphene or codeine): comparison in osteoarthritis. 147 72

The oxidative metabolism of more than 20 drugs (e.g. sparteine, debrisoquine, dextromethorphan) is mediated by cytochrome P450IID6. Codeine O-demethylation to morphine was recently demonstrated to co-segregate with the polymorphic metabolism of debrisoquine and dextromethorphan. The female Dark-Agouti rat (DA) is an animal model for the poor metabolizer phenotype (PM) using debrisoquine or dextromethorphan as substrates. Studies were carried out to evaluate codeine metabolism in liver microsomes from female DA and Sprague-Dawley (SD) rats. The intrinsic clearance of codeine to morphine was 10-fold lower in DA rats due to a 5-fold higher Km (287 vs 49 microM) and a 2-fold lower Vmax (48 vs 94 nmol/mg/hr). Nineteen drugs were tested for inhibition of codeine O-demethylation. The four most potent competitive inhibitors were dextromethorphan (Ki = 2.53 microM), propafenone (Ki = 0.58 microM), racemic methadone (Ki = 0.3 microM) and quinine (Ki = 0.07 microM). The differences in morphine formation from codeine between SD and DA rats and the inhibition results show that this animal model appears to be a suitable model for the human EM and PM phenotypes, respectively. These strains could be used to study the pharmacodynamic consequences of the genetic polymorphism in codeine O-demethylation, and the effects of metabolic inhibitors. The outcome of these studies could impact on the therapy of pain control.
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PMID:Codeine O-demethylation: rat strain differences and the effects of inhibitors. 199 30

The effect that codeine has on the process of addiction and recovery is unclear. Confusion about definitions, study endpoints, and a lack of well-controlled clinical studies has led to this uncertainty. Codeine addiction is uncommon in people who do not have existing vulnerability to addiction, including alcoholism. Codeine use can sustain addiction or increase the risk of relapse in patients afflicted with addiction. The risk of relapse must be considered when treating conditions such as pain or cough in a person recovering from addiction. Codeine use may be circumvented with the appropriate use of alternative treatments for pain or cough. If codeine use becomes necessary, cautious prescribing and reliance on the patient's recovery support network become imperative.
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PMID:Safe use of codeine in the recovering alcoholic or addict. 200 86

The analgesic efficacy and kinetics of a single oral dose of 75 mg codeine was investigated in 12 extensive metabolizers and 12 poor metabolizers of sparteine in a double-blind, placebo-controlled crossover study. The cosegregation of the O-demethylation of codeine to morphine with the sparteine oxidation polymorphism was confirmed. Hence morphine could not be detected in the plasma of any of the poor metabolizers, whereas detectable morphine plasma levels were found in 10 of 12 extensive metabolizers. Pain thresholds to laser stimuli were determined before drug intake and 90, 150, and 210 minutes after drug intake. Codeine significantly increased the pricking pain thresholds in the extensive metabolizers (p less than 0.05), whereas there were no significant changes in the poor metabolizers. No change in pain thresholds occurred with placebo in any of the two phenotypes. In the extensive metabolizers there was a significant positive correlation between the increase in pain threshold and plasma concentration of codeine. The study supports the hypothesis that morphine formation is essential for achievement of analgesia during codeine treatment.
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PMID:Codeine increases pain thresholds to copper vapor laser stimuli in extensive but not poor metabolizers of sparteine. 224 79

Prescription habits, dose and form of application of analgesics were investigated in a retrospective study of postoperative pain alleviation involving 250 patients. On the basis of clinical and pharmacological criteria, a prescription regime is presented for Paracetamol as used singly and in combination with Codeine. The prescription regime has been tested in a prospective study involving 50 patients and found to be effective.
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PMID:[Postoperative analgesics consumption]. 225 1

Cigarette smoking-induced alterations in drug absorption, distribution, metabolism, excretion, and effectiveness are reviewed. Drug therapy can be affected pharmacokinetically by polyaromatic hydrocarbons and pharmacodynamically by nicotine. Pentazocine and phenylbutazone show increased metabolism in smokers and may have to be given in higher dosages. Smokers experience less pain relief with propoxyphene than do nonsmokers. Codeine, meperidine, and morphine are unaffected pharmacokinetically, and the effect on acetaminophen is probably not clinically important. Carbamazepine, phenytoin, and phenobarbital are not influenced. Heparin metabolism is elevated in smokers; this effect may necessitate modest increases in dosage. Warfarin clearance is increased, but this is not associated with a change in prothrombin time. Pindolol and propranolol are unaffected pharmacokinetically, but direct effects of nicotine may interfere with blood pressure control. Smoking transiently diminishes the diuretic effect of furosemide, inconsistently affects protein binding of lidocaine, and has no effect on prednisone, prednisolone, or dexamethasone. The metabolism of estrogens to less active metabolites is increased. Smoking is associated with decreased subcutaneous absorption of insulin and increased dosage requirements. Healing of GI ulcers with histamine H2-receptor antagonists may be compromised in smokers; sucralfate is probably more useful. Imipramine, benzodiazepines, chlorpromazine, and glutethimide may be influenced, and theophylline metabolism is accelerated. Cigarette smoking can affect the pharmacokinetic and pharmacodynamic properties of many drugs.
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PMID:Cigarettes and drug therapy: pharmacokinetic and pharmacodynamic considerations. 240 22


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