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

A few effects of carbon dioxide on pain threshold and acid-base balance are known. The purpose of this study was to investigate specifically the variations of analgesia in relation to hypercapnia during general anaesthesia and the respective roles played by carbon dioxide and [H+]. The nociceptive jaw opening reflex was studied on five beagle dogs anaesthetized with alfathesin administered at constant rate under acute hypercapnic conditions and acute metabolic acidosis. Acute hypercapnia did not decrease the jaw opening reflex significantly until a level was reached where PaCO2 values modified blood [H+] (pH) significantly (10 +/- 1.04 kPa corresponding to [H+] 91.5 +/- 13.24 nmol/l (pH 7.04 +/- 0.06) p less than 0.05)). At [H+] 176.2 +/- 42.77 nmol/l (pH 6.7 +/- 0.13) (p less than 0.01) the reflex was only 9.3 +/- 3.9 per cent (p less than 0.001) of its initial value. The infusion of decinormal solution of HCl during constant capnia caused an abrupt drop of the reflex. There was a correlation between reflex and metabolic acidosis (p less than 0.05). The authors conclude that modification of the jaw opening reflex occurs with extreme values of arterial [H+] incompatible with safe anaesthesia and they discuss the mechanisms involved.
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PMID:[Comparison of the effects of acute respiratory acidosis and acute metabolic acidosis on the jaw-opening reflex in the anesthetized dog]. 723 18

Alkaline reflex gastritis is a disabling clinical syndrome, occurring most often after gastric surgery. It is characterized by abdominal pain and bilious vomiting, and, presumably, is due to gastric irritation by regurgitated duodenal contents. The only known effective treatment is by surgical diversion to prevent the duodenal reflux. Unfortunately, the clinical diagnosis is difficult to prove, and the results of surgery are too often disappointing because of inaccurate patient selection. This is a report of a new test for distinguishing patients with symptomatic bile reflux gastritis. The test consists of blind sequential infusion into the stomach, via nasogastric tube, of 20 ml of 0.1 N HCl, normal saline, 0.1 N NaOH, and the patient's own gastric contents. Each solution is given twice. A positive test is defined as reproduction of the patient's usual pain by NaOH, and/or gastric contents, but not by acid or saline. Fifteen of 21 patients with clinical symptoms and endoscopic findings suggesting bile gastritis had a positive alkali infusion test, while only one of 18 normal controls and none of 17 controls with other causes of abdominal pain had a positive test (p less than 0.001). Of the 21 patients with clinical-endoscopic bile gastritis, 15 have had surgical treatment by Roux-en-Y gastrojejunostomy. Nine of ten patients with positive test had excellent symptomatic relief after surgery. Zero of five patients with a negative test were relieved of pain after the operation. Tis simple test appears to be a sensitive, specific, and accurate means for selecting patients for surgical treatment of alkaline reflux gastritis.
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PMID:Intragastric alkali infusion: a simple, accurate provocative test for diagnosis of symptomatic alkaline reflux gastritis. 727 47

Effective analgesia resulted from the injection of peridural meperidine in two groups of cancer patients, eight with postoperative pain and eight with intractable pain. Peridural meperidine HCl, 100 mg (n = 8), in 10 ml saline administered to patients following surgery was followed by a median duration of analgesia of 6 hours (range 4-20 hours) over periods ranging from 1-4 days. Peridural meperidine HCl, 30-100 mg (n = 8), in 10 ml saline administered to patients with intractable pain gave a median duration of analgesia of 8 hours (range 4-20 hours) over periods ranging from 1-9 days. There was no obvious tendency towards tolerance. In all patients, the onset of analgesia was within 5 min and was complete within 30 min. This analgesia paralleled the rise in CSF meperidine concentrations following peridural administration. Systemic absorption of peridurally administered meperidine occurred with a half-life of 15-30 min and produced blood concentrations high enough to contribute to analgesia after approximately 20 min in the majority of patients. There was no objective evidence in any neurological change nor sympathetic blockade after peridural meperidine. From this evidence the dorsal horn of the spinal cord may be the major site of action as distinct from the axonal blockade produced by local anesthetics, indicating 'selective' spinal analgesia.
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PMID:Peridural meperidine in humans: analgesic response, pharmacokinetics, and transmission into CSF. 729 5

Triple therapy has been recommended as the most effective treatment for Helicobacter pylori eradication. Despite achieving a comparatively high eradication result, however, around 10% of patients still fail to be cured. Omeprazole can enhance efficacy of single and double antibiotic protocols and is particularly effective when combined with clarithromycin and a nitroimidazole. This study examined the effect of combining triple therapy with omeprazole. A prospective, randomised, unblinded, single centre trial was carried out on consecutive patients with symptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment. Patients were given a five times/day, 12 day course of colloidal bismuth subcitrate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronidazole (200 mg) with either 20 mg omeprazole twice daily (triple therapy+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night. Compliance and side effects were determined using a standard questionnaire form. One hundred and twenty five of 165 triple therapy+omeprazole patients and 124 of 171 triple therapy+famotidine patients returned for rebiopsy four weeks after completion of treatment. Significantly more triple therapy+omeprazole patients achieved eradication 122 of 125 (97.6%) as assessed by negative urease test, culture, and histological assessment, when compared with 110 of 124 (89%) triple therapy+famotidine patients (p = 0.006; chi 2). There were 30 triple therapy+omeprazole (24%) and 26 triple therapy+famotidine (21%) patients with de novo metronidazole resistant H pylori included in the study. Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant.
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PMID:Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori. 748 31

Additive analgesic effects of long-term application of a combination of the vitamins B1, B6, B12 (thiamine diphosphate 100 mg, pyridoxsine-HCl 200 mg, cyanocobalamin 20 micrograms, p.o.) on a single dose of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac (diclofenac-Na, 50 mg, p.o.) were investigated with a noninflammatory experimental pain model in 38 healthy volunteers. B-vitamins were given with 3 dosages/day for 1 week. Then experimental sessions of 3 h followed to test the analgesic efficacy of the NSAID. In these sessions, phasic pain was induced by intracutaneously applied brief electrical pulses (20 ms). Measured were the pain ratings, the cerebral potentials and the EEG delta power in responses to the stimuli as target variables for the analgesic test. Unspecific effects upon the vigilance system were evaluated by spontaneous EEG, auditory-evoked potentials and reaction times. The investigation was performed as a placebo-controlled, double-blind cross-over study. Blood samples were taken to monitor the plasma concentrations of the active agents. Whereas in the first block of stimuli (40-60 min after diclofenac medication) no analgesic effects of diclofenac could be observed, either given alone or after pretreatment with the B-vitamins, in the second stimulus block (100-120 min after medication) significant effects appeared in all target variables describing analgesia. Pain ratings were decreased by about 5%, late cerebral potentials by about 9% and stimulus-induced delta power of the EEG by about 14%. These effects were significant (p < 0.05, p < 0.01) against those under placebo, but came out to be independent of the B-vitamin pretreatment. No B-vitamin effects of the B-vitamins could be detected, either additive analgesic effects on diclofenac analgesia or on the concomitant variables describing unspecific sedative effects. Clearly the B-vitamin pretreatment for 1 week enlarged the plasma levels for vitamin B6 by 700%, for vitamin B1 by 70% and for vitamin B12 by 50%. All B-vitamin concentrations were independent of each other.
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PMID:Do the B-vitamins exhibit antinociceptive efficacy in men? Results of a placebo-controlled repeated-measures double-blind study. 760 64

We performed iontophoresis with Ca channel blockers for healthy adult volunteers. In this clinical study, we used iontophoresis with Ca channel blockers. Ten out patients with PHN treated at our pain clinic were treated with iontophoresis. They were randomly assigned to one of the following four treatments: (1) 5 ml of 4% lidocaine HCl, (2) 2 mg of nicardipine HCl + 5 ml of distilled water, (3) 2 mg of verapamil HCl + 5 ml of distilled water, and (4) 2 mg of diltiazem HCl + 5 ml distilled water. Iontophoresis was performed using the above four drugs on the positive pole. Using a VAS, each patient was evaluated concerning the analgesic effect. The pain before treatment (10 points) was used as the base line. Compared with the scores before treatment, VAS scores decreased significantly after iontophoresis in all four groups. In the lidocaine group, a significant decrease in VAS scores occurred immediately after iontophoresis and lasted up to 24 hours, reaching the nadir at 2 hours. In the nicardipine group, the decrease occurred immediately after iontophoresis and lasted up to one day, reaching the nadir at four hours. In the verapamil group, the decrease started 1 hour after iontophoresis and lasted up to 48 hours, reaching the nadir at 8 hours. In diltiazem group, the decrease started 1 hour after iontophoresis and lasted up to 48 hours, reaching the nadir at 4 hours. Iontophoresis with Ca channel blockers produced a prolonged analgesic effect in PHN patients. Previously we had observed the same effect in adult volunteers. Therefore, we believe that this therapy will be clinically useful.
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PMID:[The effect of iontophoresis with several Ca channel blockers for PHN patients]. 774

The efficacy of morphine by either lumbar extradural route or caudal extradural route and their adverse effects for postoperative analgesia were studied by comparing with the control group without morphine administration. 105 patients, 79 males and 26 females, aged 18 to 70 years, scheduled for hemorrhoidectomy surgery were selected. They were randomly assigned into three groups, i.e group I: without morphine use as control group (n = 35), group II: lumbar extradural morphine group (n = 35) and group III: caudal extradural morphine group (n = 35). Patients in group I received general anesthesia by face mask after induction by intravenous anesthetics and maintained with potent halogenated inhalation agents (isoflurane) through face mask. Patients in group II received lumbar extradural blockade through the L4-L5 intervertebral space, and those in group III received caudal extradural blockade through the sacrococcygeal junction (sacral hiatus) for intraoperative anesthesia and analgesia. Drugs included 0.5% bupivacaine 10ml + 2% xylocaine 10ml + 2mg morphine HCl + 0.1mg epinephrine were given either into the lumbar extradural space or into the caudal extradural space. No more narcotic has been given throughout the whole intraoperative course. All of these patients were followed up 24 hours later after the end of anesthesia. There were 11 patients (31.4%) in the control group, 26 patients (74.3%) in the lumbar extradural morphine group, and 25 patients (71.4%) in the caudal extradural morphine group who did not need additional narcotic for pain relief for more than 24 hours postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Lumbar extradural morphine and caudal extradural morphine for postoperative analgesia and their adverse effects. 796 25

Polyanhydride polymer matrices have been used successfully for sustained release of a number of drugs in vitro and in vivo. Dibucaine free base, dibucaine HCl, and bupivacaine HCl were incorporated into polymer matrices with copolymer 1,3-bis(p-carboxyphenoxy)propane-sebacic acid anhydride (1:4). Drug release was measured in vitro following incubation of the drug-polymer matrices in phosphate buffered solution, pH 7.4, at 37 degrees C, to approximate in vivo conditions. Local anesthetics were released in a sustained manner yielding 90% cumulative drug release over periods ranging from 3 to 14 days. The kinetics of release varied with both the choice of local anesthetic and the method of drug incorporation into the matrix (hot melt versus compression molding). Polymer local anesthetic matrix devices (PLAM), loaded by hot melt incorporation with 20% bupivacaine, were implanted in vivo adjacent to the sciatic nerve in three rats. Reversible neural blockade was observed for 4 days in all animals. Polymer implants without local anesthetic showed no neural blockade. This technology could lead to methods of prolonged blockade of peripheral nerves or of sympathetic ganglia, which may be utilized for the management of postoperative pain, sympathetically maintained pain, or certain forms of chronic pain.
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PMID:Sustained local anesthetic release from bioerodible polymer matrices: a potential method for prolonged regional anesthesia. 827 18

Mice selectively bred for high (HA) and for low analgesia (LA) induced by 3-min swimming at 20 degrees C and unselected controls (C) were injected three times daily for 3 days with 20 mg/kg morphine HCl. The analgesic effect of 10 mg/kg morphine in nontolerant mice differed between the lines in the rank order of HA > C > LA and significantly decreased after repeated treatment with morphine, as revealed by the hotplate test (56 degrees C). The tolerance to morphine analgesia was more pronounced in HA than in C mice but did not develop at all in LA mice. Similarly, the magnitude of swim-induced analgesia in morphine tolerant mice decreased to a greater degree in the HA than the C line but did not change in LA mice. Naloxone HCl (1 and 10 mg/kg) attenuated swim analgesia more in nontolerant HA than C mice but had no effect in morphine-tolerant HA and C and in all LA mice. The differential degree of morphine tolerance and cross-tolerance with swim analgesia suggests that the strategy of selective breeding toward divergent magnitudes of stress-induced analgesia has differentiated opioid involvement in endogenous pain inhibition in the selected lines.
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PMID:Cross-tolerance between morphine and swim analgesia in mice selectively bred for high and low stress-induced analgesia. 833 12

A randomized, placebo-controlled, double-blind study was conducted on 66 healthy patients aged 10-61 years undergoing elective ear, nose and throat surgery to assess the incidence and severity of pain associated with intravenous (i.v.) injection of diluted nalbuphine HCl given during induction of general anaesthesia, and to determine the efficacy of adding lignocaine (2 mg mL-1) to nalbuphine to reduce this pain. Injection of saline produced pain of low intensity in 15% of patients and a withdrawal response in 3% of patients. Injection of nalbuphine mixed with lignocaine produced a significantly higher incidence (36%; P < 0.025) and severity (P < 0.025) of pain than saline, but a similar number of responses (6%) to pain. The diluted nalbuphine alone produced the highest incidence (61%) of pain (P < 0.01 vs. saline, P = NS vs. nalbuphine with lignocaine), which was most severe (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine), and caused the highest number (27%) of withdrawal responses (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine). We conclude that diluted nalbuphine 2 mg mL-1 produces pain on i.v. injection into peripheral veins, and that this can be significantly reduced by adding lignocaine 2 mg mL-1 to the solution.
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PMID:The use of lignocaine to reduce pain on i.v. injection of diluted nalbuphine. 854 61


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