Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The transplantation of cells that secrete neuroactive substances with analgesic properties into the CNS is a novel method that challenges current approaches in treating chronic pain. This review covers pre-clinical and clinical studies from both allogeneic and xenogeneic sources. One cell source that has been utilized successfully is the adrenal chromaffin cell, since such cells constitutively release catecholamines, opioid peptides, and neurotrophic factors; release can be augmented with nicotine. Other graft sources include AtT-20 and B-16 cell lines which release enkephalins and catecholamines, respectively. For grafting in rodents, adrenal medullary tissue pieces are transplanted to the subarachnoid space. Chromaffin cell transplants can decrease pain sensitivity in normal rats using standard acute pain tests (paw-pinch, hot-plate, and tail-flick). In addition, transplants can restore normal pain thresholds in rodent models of chronic pain (formalin, adjuvant-induced arthritis, and sciatic-nerve tie) which closely similate the pathologies of human chronic pain conditions. Xenografts have been studied due to concerns that future application for human pain may be limited by donor availability. Despite immune privileges of the CNS, xenografts require at least short-term immunosuppression to obtain a viable graft. Cell encapsulation is one method of sustaining a xenograft (in rat and human hosts) while circumventing the need for immunosuppression. Clinical studies have been initiated for terminal cancer patients with promising results as assessed by markedly reduced narcotic intake, visual analog scale ratings, and increased CSF levels of catecholamines and met-enkephalin.
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PMID:Update on cellular transplantation into the CNS as a novel therapy for chronic pain. 853 50

Eight patients undergoing major maxillary surgery were given sustained-release morphine (100 mg MST Continus) rectally, immediately after induction of general anaesthesia. Blood samples for assay were taken just prior to morphine administration, together with a further 11 samples over the following 24 h. Assay of the plasma for morphine, morphine-3-glucuronide and morphine-6-glucuronide was carried out using a validated high-performance liquid chromatography technique. Morphine Tmax ranged from 3 h to 12 h (median 6 h), Cmax 8.0-40.0 ng/ml and AUC0-24 90.1-429.7 ng/h/ml in subjects offering blood samples over the 24-h period. Likewise, morphine-3-glucuronide Tmax ranged from 3 h to 24 h (median 9 h), Cmax 153-370 ng/ml and AUC0-24 2776-4390 ng/h/ml. Morphine-6-glucuronide Tmax ranged from 8 h to 12 h (median 10 h), Cmax 24-59 ng/ml and AUC0-24 137-803 ng/h/ml. Morphine and morphine metabolite AUC0-24 ratios were calculated, but they did not correlate with analgesic needs. The AUC0-24 ratios were similar to those following oral and rectal dosing in other studies involving cancer patients. The wide variation of individual morphine and metabolite plasma levels, and their AUC ratios indicates considerable interpatient variability in the absorption and metabolism of rectal sustained-release morphine. This large interpatient variation may indicate that it is not suitable for acute pain, because analgesic requirements change much more rapidly than in the chronic pain situation where individual patient titration can take place.
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PMID:Rectal controlled-release morphine: plasma levels of morphine and its metabolites following the rectal administration of MST Continus 100 mg. 880 41

The term 'opioid' is a generic term for naturally occurring, semisynthetic and synthetic drugs which combine with opioid receptors to produce physiological effects and which are stereospecifically antagonised by naloxone. For clinical purposes, opioids can be classified according to their receptor interactions (agonist, partial agonist, agonist-antagonist and antagonist), the pain intensity for which they are conventionally used (moderate or severe), and their half-life (short or long). Pure agonists conventionally used for moderate pain, short and long half-life pure agonists conventionally used for severe pain, mixed agonist-antagonists and partial agonist opioids are described in detail. The effective clinical use of opioid drugs requires familiarity with drug selection, routes of administration, dosage guidelines and potential adverse effects. Opioids are unequivocally indicated in the management of severe acute pain and moderate to severe pain associated with cancer. There is increasing acceptance of the role of opioids in the management of recurring acute pain, chronic nonmalignant pain of organic origin and severe neuropathic pain. The selection of opioids is influenced by pain intensity, pharmacokinetic and formulary considerations, previous adverse effects and the presence of coexisting disease. Some patients will require sequential trials of several different opioids before a drug which is effective and well tolerated is identified. Opioid agents should be administered by the most comfortable and convenient route that meets the specific needs of the patient. The regimen for opioid medications should generally provide around-the-clock analgesia with provision for rescue doses for the management of exacerbations of the pain not covered by the regular dosage. At all times, uncontrolled pain should be addressed by gradual increase in the opioid dose until either pain control is achieved or intolerable and unmanageable adverse effects supervene. The management of pain with opioid analgesics demands frequent patient assessment and a readiness to re-evaluate the therapeutic plan in the setting of either inadequate relief or adverse effects.
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PMID:Opioid analgesics: comparative features and prescribing guidelines. 886 43

The management of pain has been much developing for the last ten years in French medicine, particularly in O.R.L. It is a well-known fact that all pains are not identical and it is essential to differentiate them well. According to the kind of pain (acute pain, pain induced by a cancer, chronic pain), the attitude to be adopted may be quite different. Therefore, it is essential to master the pharmacology of these analgesic drugs. The aim of this paper is to review the current and everlasting knowledge of these drugs. We shall tackle the latest data concerning the mechanisms of action of analgesics and specify the practical use of morphinic compounds in 1996 and quote the means used in the pain treatment by deafferentation. In conclusion, it seems important to us to bring to mind the consequences of a misuse of analgesics.
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PMID:[Analgesics: their role in current therapeutics]. 895 25

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity. The analgesic efficacy of ketorolac has been extensively evaluated in the postoperative setting, in both hospital inpatients and outpatients, and in patients with various other acute pain states. After major abdominal, orthopaedic or gynaecological surgery or ambulatory laparoscopic or gynaecological procedures, ketorolac provides relief from mild to severe pain in the majority of patients and has similar analgesic efficacy to that of standard dosages of morphine and pethidine (meperidine) as well as less frequently used opioids and other NSAIDs. The analgesic effect of ketorolac may be slightly delayed but often persists for longer than that of opioids. Combined therapy with ketorolac and an opioid results in a 25 to 50% reduction in opioid requirements, and in some patients this is accompanied by a concomitant decrease in opioid-induced adverse events, more rapid return to normal gastrointestinal function and shorter stay in hospital. In children undergoing myringotomy, hernia repair, tonsillectomy, or other surgery associated with mild to moderate pain, ketorolac provides comparable analgesia to morphine, pethidine or paracetamol (acetaminophen). In the emergency department, ketorolac attenuates moderate to severe pain in patients with renal colic, migraine headache, musculoskeletal pain or sickle cell crisis and is usually as effective as frequently used opioids, such as morphine and pethidine, and other NSAIDs and analgesics. Subcutaneous administration of ketorolac reduces pain in patients with cancer and seems particularly beneficial in pain resulting from bone metastases. The acquisition cost of ketorolac is greater than that of morphine or pethidine; however, in a small number of studies, the higher cost of ketorolac was offset when treatment with ketorolac resulted in a reduced hospital stay compared with alternative opioid therapy. The tolerability profile of ketorolac parallels that of other NSAIDs; most clinically important adverse events affect the gastrointestinal tract and/or renal or haematological function. The incidence of serious or fatal adverse events reported with ketorolac has decreased since revision of dosage guidelines. Results from a large retrospective postmarketing surveillance study in more than 20,000 patients demonstrated that the overall risk of gastrointestinal or operative site bleeding related to parenteral ketorolac therapy was only slightly higher than with opioids. However, the risk increased markedly when high dosages were used for more than 5 days, especially in the elderly. Acute renal failure may occur after treatment with ketorolac but is usually reversible on drug discontinuation. In common with other NSAIDs, ketorolac has also been implicated in allergic or hypersensitivity reactions. In summary, ketorolac is a strong analgesic with a tolerability profile which resembles that of other NSAIDs. When used in accordance with current dosage guidelines, this drug provides a useful alternative, or adjuvant, to opioids in patients with moderate to severe pain.
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PMID:Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetic properties and therapeutic use in pain management. 901 Jun 53

With the release of Acute Pain and Cancer Pain Guidelines from the federal government, many healthcare agencies will be instituting programs to improve pain management. The authors describe a pilot project in acute pain management that did not yield desired results. On the basis of this experience and through a review of the literature, information is provided to staff development educators about problems and issues in planning and executing a program in pain management using structure, process, and outcome as a framework.
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PMID:Lessons learned in implementing a staff education program in pain management in the acute care setting. 911 Jul 14

All patients with cancer invariably experience pain during the course of their disease. Treatment- and diagnosis-related acute pain and persistent pain caused by the disease itself or treatment sequellae are involved. Pain should be suspected, diagnosed and evaluated as a first line symptom. The physician should recognized its different components and pathophysiological mechanisms. Treatment should be prescribed according to the needs of each patient and regularly verified to obtain maximal efficacity with the least side effects. Opiate drugs are frequently used for nocipeptive pain. Neurogenic pain requires selective use of psychotropes.
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PMID:[Pain in cancer patients. Practical attitude]. 929 92

A limited number of studies have examined relationships between temperament and children's/adolescents' responses to painful procedures and have identified several different dimensions of temperament that are related to children's pain response. The focus of these studies was one-time, acute pain experiences, such as immunization and postoperative pain. In this study, children and adolescents' responses to a moderately painful procedure, lumbar puncture, were examined as they related to temperament. Nineteen children and adolescents, ages 4 to 18 years, who were receiving treatment for cancer, were participants in this study. Parents completed one of three age-appropriate temperament questionnaires at the beginning of the study and prior to the parent and child learning cognitive-behavioral techniques. Behavior during the procedure was videotaped at baseline, and for up to four visits after baseline and coded using the Observation Scale of Behavioral Distress (OSBD). Pain reports were collected after the procedure using the Oucher pain self-report scale. Improvement in the level of behavioral distress was determined by examining the differences between pre- and post-treatment OSBD scores and self-reported pain ratings. There was a significant improvement in pain reports over the 5-month period, but behavioral distress did not change significantly. At the baseline visit, the temperament dimensions of more positive mood, lower activity, less persistence, and lower distractibility were related to higher pain reports, but not behavioral distress. However, after 5 months, only the dimension of positive mood was significantly correlated with improvement in pain reports. The amount of time parents and children practiced the techniques, their comfort with the techniques and their perceived effectiveness also were correlated with positive mood.
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PMID:Relationships between cognitive behavioral techniques, temperament, observed distress, and pain reports in children and adolescents during lumbar puncture. 950 66

The purposes of this study were to (a) test the feasibility of the Cancer Total Quality Pain Management (TQPM) Patient Assessment Tool in a population of oncology inpatient and outpatients; and (b) identify factors associated with poor pain relief. The Cancer TQPM Tool was adapted from the American Pain Society's Quality Assurance Standards on Acute Pain and Cancer Pain and was tested in a convenience sample of 200 patients. The majority of patients reported that the TQPM Tool was easy to understand and to use, providing evidence for the feasibility of the tool. Factors associated with higher pain intensity included the inpatient setting, the presence of metastatic disease, hesitancy in bothering the nurse, and concerns regarding tolerance and addiction. Although there was a strong relationship between concern about addiction and concern about tolerance, fear of tolerance appeared to have a greater effect on pain intensity scores than did fear of addiction. The findings from this study suggest that the Cancer TQPM Patient Assessment Tool can be used effectively in both inpatients and outpatients to determine outcomes and the quality of cancer pain management, as well identify factors associated with poor pain control. Clinical implications include more effective education of patients and caregivers, including equivalent emphasis on tolerance and addiction.
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PMID:Barriers to cancer pain relief: fear of tolerance and addiction. 970 52

Postanaesthesia care units used to echo with cries of patients in pain after general anaesthesia. Each as-needed dose of analgesia was given only after permission of the surgeon or anaesthesiologist. Once conscious, patients were required to request each subsequent analgesic dose until hospital discharge. Not surprisingly, nearly half the patients who have an operation experience moderate to severe pain after surgery. Acute pain control has advanced dramatically and is now a field with dedicated texts, journals, and research. Despite improved surgical techniques that have transformed many operations into same-day procedures, inadequately controlled pain may still extend the length of hospital stay and predispose to expensive, time-consuming complications such as pneumonia. Recognition of economic and humanitarian benefits of pain control has prompted worldwide attention from professional groups, insurers, and governments. This paper describes the process of acute pain and measures to control it with drugs or non-pharmacological interventions. Even brief intervals of acute pain can induce long-term neuronal remodelling and sensitisation ("plasticity"), chronic pain, and lasting psychologial distress. Hence, acute pain and other types of pain (cancer-related or chronic) that are classified as distinct actually have many similarities.
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PMID:Acute pain. 1037 32


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