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

The clinical use of neuroleptics, benzodiazepines, narcotic analgesics, barbiturates, and neuromuscular blockers to manage delirium and agitation in the intensive-care setting is reviewed. Delirium is the most commonly encountered mental disturbance in critically ill patients and may be precipitated by factors such as physical illness, medications, pain, and emotional stress. If agitation cannot be controlled through nonpharmacologic means, pharmacologic intervention may be necessary. Haloperidol is the neuroleptic of choice for rapid control of delirium and agitation in the critically ill patient. It has few adverse effects in most patients, even at high doses, although it can cause extrapyramidal symptoms. Among the benzodiazepines, lorazepam should be considered a first-line agent. It may be used alone or in combination with haloperidol (or another neuroleptic). Midazolam is suitable for administration by continuous i.v. infusion in the intensive-care setting because of its water solubility, short half-life, and short duration of action. The sedative effects of narcotics may be advantageous in patients with both agitation and pain. Barbiturates are not recommended for routine use in the treatment of delirium and agitation. The use of neuromuscular blocking agents such as pancuronium bromide and metocurine iodide may be necessary when other therapies have failed. Haloperidol and the benzodiazepines, alone or in combination, are the drugs of choice for treatment of acute agitation and delirium in critically ill patients.
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PMID:Treatment of delirium in the critically ill patient. 167 22

Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otilonium bromide (OB) (40 mg tid or placebo). In our patients we performed, before and after the treatment, a clinical evaluation (symptom variations) and functional studies (sigmoid manometry during bowel distension). As regards clinical parameters, otilonium bromide significantly reduced abdominal pain and bloating and significantly increased (p less than 0.02) the pain threshold. However the comparison with the placebo group did not show any difference between the two groups. Sigmoid motility during distension was significantly reduced (p less than 0.05) in OB group, whereas it did not change in the placebo group. We can conclude that, in irritable bowel syndrome (IBS) patients, OB is able to improve symptoms and to reduce stimulated motor activity of the sigmoid.
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PMID:Clinical and functional evaluation of the efficacy of otilonium bromide: a multicenter study in Italy. 175 85

We studied 40 patients with irritable bowel syndrome (IBS) which received in a simple-blind fashion otilonium and pinaverium bromide (15 days each drug). During each 15-day period we evaluated: number of pain episodes, intensity of pain, number of bowel movements, side effects. Otilonium bromide, (OB), compared with pinaverium bromide was able to significantly (p less than 0.05) reduce the number of pain attacks, whereas no significant differences were found between the 2 groups as regards the other parameters. The occurrence of side effects was similar in the two treatment courses. We can conclude that the two types of treatment were similarly useful in IBS, although OB seems more effective than pinaverium bromide.
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PMID:A comparison of the action of otilonium bromide and pinaverium bromide: study conducted under clinical control. 175 86

Treatment of different types of pain Type A: 1. Diflunisal 500 mg b.i.d./naproxen 500 mg b.i.d. or another NSAID. Satisfactory effect: Continue Partial effect: Continue, but add step 2 No effect: Proceed to step 2 2. Morphine. Conventional tablets/mixture or slow release morphine. Dosage as described above. Nausea is treated with haloperidol 1-5 mg at night. Some patients do better t.i.d. 3. Glucocorticosteroid, as described above 4. Epidural morphine/local anaesthetic Type B: 1. Amitriptyline. Starting dose: 10 mg at night. Increase by 10 mg every other night until the patient has pain relief or experiences unacceptable side effects 2. Nerve blocks, if possible 3. Glucocorticosteroids 4. Strong opioids 5. Epidural opioids/local anaesthetics Type C: 1. Carbamazepine in increasing doses to 200-400 mg t.i.d. 2. Proceed as described for type B Type D: 1. Urinary colic: flavoxolate (Urispadol) 200-400 mg t.i.d. or emepronium bromide (Cetiprin) 200-400 mg t.i.d. 2. Opioids perorally 3. Epidural local anaesthetic (sympathetic block)/opioids.
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PMID:Carcinoma of the prostate. Treatment of pain. 176 76

The Authors evaluated clinical efficacy of nifedipine versus cymetropio bromide in relieving acute ureteral colic in 40 patients. Rapidity, efficacy and time of these drugs' activity in relieving pain of ureteral colic has been evaluated. The investigation shows as nifedipine relieves acute ureteral pain more quickly than cymetropio bromide (respectively 5 minutes in 95% of patients, 20 minutes in 65% of patients), but for a brief time (pain recurrence respectively in 70% and 25% of patients).
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PMID:[Emergency treatment of ureteral colic with nifedipine]. 181 72

Various kinins (dissolved in 50 microliters) were applied to the nasal mucosa of healthy human volunteers to test the algesic and proinflammatory effects of these peptides in an intact human tissue. [des-Arg9]-bradykinin (0.5 mumol) was found to be inactive, while bradykinin (0.05-0.5 mumol) and especially kallidin (0.005-0.5 mumol) induced: (a) a mild painful sensation described as burning and pricking (latency 30 s, duration 3-5 min), (b) perception of pulsatility and obstruction in the nasal cavity (onset 1 min, duration 6-8 min). Substance P (0.5 mumol) and neurokinin A (0.5 mumol) produced slight obstruction and weak pulsatile sensation but not pain. Capsaicin (0.05 nmol) produced pain and secretion of fluid, but not pulsatile sensation. The effects of kallidin were not affected by repeated (to induce desensitization) applications of capsaicin (0.5 mumol). Likewise, ipratropium bromide (80 mg in 100 microliters) did not affect responses to kallidin. In an intact human tissue, kallidin produces various effects, including an algesic response, that are apparently independent from activation of B1 receptors and from desensitization of capsaicin-sensitive primary afferents.
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PMID:Kallidin applied to the human nasal mucosa produces algesic response not blocked by capsaicin desensitization. 183 14

In 52 patients 0.5-3.0 ml of iohexol, 180 mg/ml, was injected using lateral injection technique and fluoroscopy control. A total of 146 lumbar discs using local anaesthesia was injected. Two types of premedication were used; either diazepam alone or diazepam in combination with pethidine and glycopyrronium bromide. There was no difference in the discography injection pain between the groups (X2 = 0.774, P greater than 0.05]. During discography, some patients had nausea (2%), convulsions (4%), back pain (6%) and hypotension (10%), but no allergic reactions were seen. This suggests that these immediate reactions are more related to the procedure itself than to the non-ionic ratio 3.0 iohexol contrast medium. More troublesome iatrogenic complications were seen the day after the discography in the form of severe headache (10%) probably related to liquor leakage, and increasing low back pain (81%). The latter may be caused by local haematoma or chemical irritation from iohexol. Patients with no pain during injection had a relatively slight need for analgesics (Somer's D = -0.196, P less than 0.05).
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PMID:Premedication and short term complications in iohexol discography. 183 70

Forty-nine patients with ureteral colic were included in this prospective double-blind study investigating the analgesic efficacy and side effects of a prostaglandin synthetase inhibitor Diclofenac sodium (Voltaren) versus a spasmolytic drug Tropenzilium bromide (Palerol). The analgesic efficacy and side effects of the calcium antagonist Nifedipine (Nidilat) applied sublingually in ureteral colic were also investigated. It was concluded that diclofenac sodium was more efficient for relieving pain due to acute ureteral obstruction and had fewer side effects than spasmolytic drugs. Nifedipine proved to have an analgesic effect equivalent to that of Tropenzilium bromide.
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PMID:Diclofenac sodium and spasmolytic drugs in the treatment of ureteral colic: a comparative study. 188 68

During her pregnancy (29 weeks) a 29-year-old woman complained of pain in the right upper quadrant of her abdomen. Gallbladder stones were demonstrated by ultrasonography. Because of recurrent pain attacks cholecystectomy was performed. Continuous intravenous tocolytic therapy, fenoterol bromide (Parusisten), was given during and following surgery. Two days after this first laparotomy she underwent a second laparotomy because of unexplained abdominal pain and blood loss. A subhepatic haematoma was found without a specific origin for the blood loss. Shortly after this second operation she developed clinical signs and abnormalities on the chest X-ray compatible with severe pulmonary oedema. She needed artificial ventilation for 15 days. There appears to be a pathophysiological relationship between the development of pulmonary oedema and tocolytic therapy. Probably, pulmonary oedema may develop during tocolytic therapy as a result of several factors such as increased hydrostatic pressure, decreased oncotic pressure and perhaps capillary leakage.
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PMID:[A patient with pulmonary edema following use of beta-sympathomimetics (tocolytic agents)]. 203 83

We treated 38 consecutive outpatients with ureter colic with a new anticholinergic spasmolytic agent, cimetropium bromide, in order to evaluate its efficacy in this condition. After assessing pain intensity by means of a visual analogic scale, we administered 5 mg i.v. Already after 30 minutes, 4 patients (11%) reported complete subsidence of pain. In 21 patients (55%) pain subsided almost completely within one hour. Eighteen patients required a second 5 mg i.v. injection after one hour; of these, 13 (72%) had complete regression or marked reduction of pain. Apart from dryness of the mouth which appeared in two cases after the second injection and was of moderate intensity, no side effects were observed.
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PMID:[Clinical experience with an anticholinergic spasmolytic cimetropium bromide in the treatment of patients with renal colic]. 215 32


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