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

According to modern pain concepts, "pain" is the result of multifactorial influences. Planning of therapy therefore requires the diagnostic evaluation of a number of factors including delineation of an organic lesion, evaluation of the influence of pain on the individual's psychological development, situational anxiety, psychological coping style etc. The understanding and management of psychological factors is crucial in every pain syndrome as the idea the pain is either psychogenic or organic is outdated. For the treatment of mild pain salicylic acid is still unsurpassed. The rationale of its combination with a tranquillizer, and with codeine or benzomorphane for moderately severe pain, can be understood on the basis of modern pain concepts. Before strong narcotics are used a trial with combination of a phenothiazine with a tricyclic antidepressant drug is warranted. Methadone seems to have advantages over morphine for very distressing pain treated with narcotics. Biofeedback for pain due to muscle spasms, electrical stimulation of the dorsal column for intense chronic pain due to a well-delineated organic lesion, and operant conditioning applied by a well-trained team of physicians and staff are promising new treatments for pain. The place of acupuncture in future pain therapy cannot yet be judged. It must first be freed of cult-type opinions and evaluated further by studies meeting modern western standards of pain research.
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PMID:Practical problems in the treatment of pain. 23 21

The respiratory and pupillary effects of oral l-, d-, and d,l-methadone were studied in healthy male volunteers 21 to 35 yr of age. The mean half-life of drug in blood was 22 hr for racemic methadone, 24 hr for l-methadone, and 25 hr for d-methadone. The effects of d-methadone were not significantly different from the placebo response at a 7.5 mg dose, whereas a 50 and 100 mg dose slightly depressed respiration in one subject each. Both 7.5 mg of l-methadone and 15 mg of d,l-methadone induced intense and sustained respiratory depression and miosis. The changes induced by l-methadone were of longer duration than those of d,l-methadone, lasting more than 72 hr in some subjects. Whole blood drug concentration correlated well with respiratory depression and miosis for l- and d,,l-methadone. The potency ratio of l-methadone to d,l-methdone, calculated from blood drug concentration data, was found to be 3.0 for respiratory depression and 2.7 for miosis. The antiduretic effect of 15 mg of d,l-methadone was investigated in three subjects and was found to persist for as long as measurements were taken, namely 11 and 12 hr in two subjects. d,l-Methadone administered frequently for pain may have cumulative effects on respiratory control and ability to excrete a water load.
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PMID:Clinical effects and pharmacokinetics of racemic methadone and its optical isomers. 83 34

rac-Methadone is used clinically for the chronic maintenance treatment of heroin addiction and for the relief of pain. As the pharmacological activity of methadone is due primarily to the (-)-(R)-enantiomer, stereospecific measurements of methadone serum concentrations in methadone-treated patients are expected to be more relevant for clinical studies than earlier described total drug measurements. This study describes a stereospecific gas chromatographic (GC) method for the determination of methadone in serum. The extracted methadone was derivatizised with (-)-menthyl chloroformate. The diastereometric derivatives were analysed by GC on a capillary column and detected with a nitrogen-phosphorus detector. The resolution factor obtained for the methadone enantiomers was 1.1 with a relatively short time of analysis (30 min). By analysing the pure (-)-(R)-enantiomer, no racemization was seen during the analysis. The lower limit of quantitation was 75 nmol/l for each enantiomer. Measurements of the ratio between (-)-(R)- and (+)-(S)-methadone concentrations in serum from five methadone-treated patients showed interindividual differences (range 0.5-1.1). The patient results correlated well with those from another GC method measuring total methadone.
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PMID:Stereospecific gas chromatographic method for determination of methadone in serum. 138 63

This double-blind randomised study compared postoperative analgesia after a loading regimen of methadone or morphine in thirty women undergoing abdominal hysterectomy. Methadone or morphine, 0.25 mg.kg-1, was given intravenously at induction of anaesthesia with further increments in the recovery room for analgesia if required. The mean (SD) total doses of methadone and morphine required were 0.43 (0.13) mg.kg-1 and 0.45 (0.15) mg.kg-1 respectively. Patients in the methadone group had lower pain scores in the subsequent 48 hours (P less than 0.001) and required less supplementary intramuscular opioids (P less than 0.001). Ten patients in the methadone group did not request any further opioid analgesics while all patients in the morphine group made at least two requests for opioids. The overall postoperative course was remembered as less painful by patients in the methadone group (P less than 0.001). There was no significant respiratory depression or excessive sedation in either group.
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PMID:A double-blind randomised trial comparing postoperative analgesia after perioperative loading doses of methadone or morphine. 160 41

It is estimated that there are between 50,000 and 90,000 drug abusers in the former West Germany. IV drug users are the second largest group of AIDS victims after homosexual and bisexual men. From 1989 to 1990, IV drug users up 16.1% of 1425 reported AIDS cases. 52% of 124 female AIDS cases were drug abusers. 4-12 weeks pass from the time of HIV infections to the appearance of HIV antibodies, thus testing is not foolproof. Heroin abuse often leads to oligo- or amenorrhea. yet 593 female IV drug users in New York City had 2289 pregnancies (often detecting their pregnancy too late for abortion), averaging 2.5 live births and 1.3 abortions. Fetal HIV transmission occurs in 20-40% of cases. The effectiveness of azidothymidine (AZT) prophylaxis is not clear. Only 29% of 50 HIV-infected women had complication-free pregnancies: 34% had premature pain and contractions, and 11 of 49 children were born prematurely before the 35th week. Drugs used include opiates, barbiturates, cocaine, cannabis, amphetamine, LSD, and mescaline. The daily cost of addiction leads to illegal activities. 80% of addicted women turn to prostitution. Methadone has been used for substitution in the US. In Germany, levomethadone (L-Polamidon) is approved and has a half time of 29 hours which is much longer than that of heroin. The heroin substitution regime consists of 4-5 ml of levomethadone and later 1-3 drops/day. Asphyxia of the fetus could occur in unmedicated withdrawal, necessitating the use of levomethadone even during pregnancy. The reduction of .2 ml of this drug every 2 days was well tolerated. Outpatient drug treatment is risky, it should be carried out only in maternal-child care facilities.
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PMID:[Drug abuse, pregnancy and HIV infection]. 177 78

The analgesic and adverse effects of intrathecal methadone 5 mg, 10 mg and 20 mg were assessed and compared with intrathecal morphine 0.5 mg. The study was conducted on 38 patients who underwent total knee or hip replacement surgery. The intrathecal opioid was administered at the end of surgery and assessments began 1 h thereafter and continued for 24 h. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine 0.5 mg provided effective and prolonged analgesia. Intrathecal methadone 5 mg, 10 mg, and 20 mg produced good analgesia of 4 h duration. Thereafter the median pain scores with intrathecal methadone were consistently higher (worse) than those with intrathecal morphine (P less than 0.05). The time to the onset of discomfort severe enough to require supplemental morphine was longer after intrathecal morphine than following methadone (15 h with morphine 0.5 mg; 6.25 h, 6.5 h and 6 h with methadone 5 mg, 10 mg, and 20 mg respectively: P less than 0.05). Central nervous system depression manifesting as respiratory depression, hypotension, and excessive drowsiness occurred in 3 of 8 patients injected with methadone 20 mg intrathecally. Generalized pruritus, nausea, vomiting, and urinary retention were common and equally distributed among the treatment groups. We conclude that both intrathecal morphine 0.5 mg and methadone 5, 10, and 20 mg provide excellent analgesia but that morphine has a more prolonged effect. Methadone 20 mg produced unacceptable side effects. Clinical evidence for rostral spread of methadone within the CSF, as indicated by facial itching and excessive drowsiness, was less apparent with 5 mg than with 10 and 20 mg. Various explanations for the observed differences between the drugs are discussed.
Pain 1990 Nov
PMID:Intrathecal methadone: a dose-response study and comparison with intrathecal morphine 0.5 mg. 208 26

Methadone, a potent long-acting opioid analgesic, is only seldom prescribed for postoperative pain relief in Germany. It was the aim of the present investigation to evaluate its efficacy and to establish an adequate dose range using intravenous patient-controlled analgesia (PCA), as well as to determine possible drug interactions with the antipyretic analgesic metamizol (dipyrone). 120 patients recovering from elective major abdominal, gynaecological or orthopaedic surgery under standardized balanced anaesthesia were randomly allocated to three groups to self-administer intravenous 1-methadone. Demand doses were 0.573 mg (group LD), 1.145 mg (group HD) or 0.573 mg to which 50 mg metamizol (dipyrone) were added (group LM). Infusion rate was set to 0.137 mg 1-methadone/h in every group, lockout time was 1 min. Hourly maximum dose was set to 5.95 mg 1-methadone/h. During an average PCA duration of 21 hours patients demanded mean dosages of 16.4 mg (LD), 18.7 mg (HD) or 13.4 mg (LM) 1-methadone. Although individual variation in drug consumption was high, effective pain relief was possible in all cases. Cardiovascular and respiratory status during the observation period was always normal. 88-93% of patients preferred PCA in comparison with earlier experienced conventional postoperative pain treatment. It is concluded that patients are able to control adequate drug consumption, i.e. to avoid overdosage, by adjusting demand frequency if variable demand dosages are offered. Thus 13-19 mg 1-methadone per day can be recommended as reasonable dose range for pain relief during the early postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative pain therapy with 1-methadone and metamizole. A randomized study within the scope of intravenous on-demand analgesia]. 219 55

The pharmacokinetics of methadone were studied in 14 patients with acute, severe burns and receiving an intravenous infusion of methadone to control their pain. Serum methadone concentrations were measured by gas chromatography on 5 mL arterial blood samples obtained at 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0 and 24 hours after the start of infusion. Albumin and Alpha-1-Acid glycoprotein (AAG) were measured by radial immunodiffusion. Serum methadone concentration-time data were fit with the appropriate sum of exponentials equation using iterative nonlinear regression analysis. All serum methadone concentration-time data were best described by a monoexponential equation. Estimates of Vd (180 +/- 62 L) were not significantly different from those predicted for Vc from body weight using literature values (156 +/- 41). Estimates of Vd were, however, significantly lower than those predicted for Vz using literature values (282 +/- 74) (P less than 0.001). In addition, CL values (53.0 +/- 19.3 L/h) were significantly higher than those predicted from body weight using literature values (9.2 +/- 2.3 L/h) (P less than 0.001). These changes resulted in estimates of the elimination half-life for methadone of 2.6 +/- 1.1 h. Methadone protein binding was independent of both albumin and AAG concentration. Multiple regression demonstrated that the significant predictors of CL in the early post burn injury period were serum albumin, days post injury and age. The coefficient of determination (r2) for this model was 0.8190. In summary, methadone CL is markedly elevated while the Vc is essentially unchanged during the early post burn injury period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacokinetics of continuous intravenous infusion of methadone in the early post-burn period. 230 84

Methadone is described in this review as a potent analgesic agent; in Germany it is seldom administered as a therapeutic agent. It has the following pharmacokinetic properties: high lipophilicity, large volume of distribution (initial and steady state), low clearance (hepatic capacity limited) with a long terminal elimination time, high bioavailability following oral administration, and a tendency to accumulate in the blood and tissues. The review also considers pharmacodynamic aspects of methadone, which in Germany is available only in the levo-rotatory form; all the effects are conditioned by this l-enantiomer. In other countries methadone is successfully used over the following range of indications: intra- and postoperative pain (intravenous and epidural administration), cancer pain, and non-malignant painful conditions. The concepts of minimal effective analgesic concentration in the blood plasma (MEAC) and concentration required for 50% relief on pain are discussed. The MEAC is lower for the l-isomer than for the racemate. Methadone alone is a good analgesic agent that has slight effects in the form of respiratory depression, to which partial tolerance builds up in the course of long-term use of the drug. The interaction between methadone with alcohol, benzodiazepines, and barbiturates can be dangerous.
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PMID:[Methadone--pharmacokinetics and pharmacodynamics of an opiate]. 256 28

The analgesic characteristics of 3 to 6 mg epidural methadone administered in two different concentrations for postoperative analgesia have been compared in two homogeneous groups of patients submitted to surgical procedures on trunk or legs. Methadone was given at a concentration of 0.1% in group I (70 patients) and diluted in 10 ml saline in group II (35 patients). Methadone doses were calculated on the basis of age and weight of the patient and the performed surgical procedure. Mean latency for analgesia was 25 +/- 11 min in group I and 28 +/- 13 min in group II. The duration of the analgesia was significantly longer (p less than 0.01) in group I (9.7 +/- 5.6 h) than in group II (5.7 +/- 2.4 h). Side effects were not frequent and without clinical significance in both groups. Epidural methadone is an effective method for postoperative pain relief. Drug concentration modifies the duration of the analgesia and concentration of 0.1% gives better results than more diluted preparations.
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PMID:[Effect of the peridural methadone concentration in postoperative analgesia]. 259 59


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