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)

Subhypnotic doses of thiopentone are considered to have a hyperalgesic effect, while propofol has a hypoalgesic effect. We investigated the effect of these drugs on the nociceptive system by measuring the pain threshold to laser stimulation and the pain evoked potential (power and latency). Nineteen patients (ASA group I) participated. Twelve patients received thiopentone 0.5 mg kg-1 and propofol 0.25 mg kg-1 in random order separated by an interval of 14 h, and seven patients received saline. Immediately after the injection of both agents, the pain threshold was increased significantly (P less than 0.001) and the amplitude of the evoked potential was reduced significantly (P less than 0.05), while the latency of the evoked potential remained constant. It is concluded that, in subhypnotic doses, both thiopentone and propofol decrease the acute pain evoked by argon laser stimulation.
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PMID:Subhypnotic doses of thiopentone and propofol cause analgesia to experimentally induced acute pain. 188 13

The power and nociceptive intensity of shock waves generated by the Dornier HM3 extracorporeal shock wave lithotripter (ESWL) are voltage dependent and suited to algesimetry in a controllable voltage range of 8-30 kV. Fidelity of the HM3 as an algesimeter was tested by: (1) In vitro measurements of shock pressure at voltages between 14 and 30 kV were recorded by a force transducer at the point of clinical focus. (2) Unanaesthetized volunteer (n = 5) assessment and VAS pain scores of shocks in the range of 10-24 kV, yielding highly significant correlations between blinded randomized shock voltage (r = 0.88), and VAS scores (r = 0.84). (3) Voltage-tolerance curves generated from 33 ASA class 1 or 2 patients undergoing ESWL treatment under epidural analgesia with 0.125% bupivacaine, fortified with a bolus epidural dose of 100 micrograms fentanyl if pain arose during treatment. Voltage tolerance was increased by 50% after an epidural bolus of 100 micrograms fentanyl (P less than 0.001). The respiratory consequences of epidural fentanyl were assessed by changes of respiratory rate and rhythm recorded from capnographic tracings of expired carbon dioxide. This study indicates that the Dornier HM3 system provides a valuable opportunity to conduct precise, quantitative measurements of induced deep truncal pain, as well as the effectiveness and respiratory cost of analgesic interventions directly applicable to the safe management of acute pain.
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PMID:Critique of the Dornier HM3 lithotripter as a clinical algesimeter. 232 92

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (20 each having undergone abdominal or orthopedic operations). Whenever the patients required pain relief, piritramid demand doses of 2.0 mg were given via the hand-button of a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 15 mg with a pump refractory time of 1 minute between valid demands. A continuous low-dose piritramid infusion (0.24 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 19.7 +/- 6.5 hours (mean +/- SD). During this time, 17.1 +/- 13.8 demands per patient were recorded resulting in mean individual piritramid consumptions of 30.4 +/- 28.1 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. Following abdominal surgery, slightly more piritramid was needed compared with orthopedic patients, although less pain relief was achieved in the former group. The same proved to be true for a comparison between the sexes, males requiring significantly more piritramide for less pain relief than females (p = 0.05). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 73% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (sweating, nausea, emesis) occurred in about 20% but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and for clinical pain research.
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PMID:Patient-controlled analgesia with piritramid for the treatment of postoperative pain. 288 42

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) has been studied during the early postoperative period in 40 ASA I-III patients recovering from elective major and minor surgery (20 abdominal and 20 orthopaedic operations). Doses of 3.7 mg of the new agonist-antagonist opioid analgesic nalbuphine were available on demand, whenever the patients felt that pain relief was necessary, delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC) in response to use of a patient-controlled manual switch. The maximum dose/h was set at 28.2 mg, with a refractory time of 1 minute between successful demands. A continuous nalbuphine infusion (0.44 mg X h-1) was administered in addition in order to prevent obstruction of the catheter. The duration of the PCA period was 17.9 (0.4-28.0) h (median, range). During that time, 13.3 (1-45) demands per patient were recorded, resulting in median individual nalbuphine consumptions of 51.3 (8.1-1050.5) micrograms X kg-1 X h-1. Self-administration was characterized by considerable intra- and inter-individual variability. Following abdominal surgery significantly more nalbuphine was needed compared to orthopaedic patients, but it resulted in poorer pain relief. There were no statistically significant differences in drug requirements or pain scores between the sexes. Overall efficacy and patient acceptance proved to be good. When compared with previous conventional postoperative analgesia, the effectiveness of PCA was judged superior by about 57% of patients. Side effects (nausea, sweating) occurred in about 10% of patients but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the period of PCA. Patient-controlled analgesia is a promising technique for the treatment of acute pain and for clinical pain research.
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PMID:Patient-controlled analgesia with nalbuphine, a new narcotic agonist-antagonist, for the treatment of postoperative pain. 379 24

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Pentazocine bolusses of each 8 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 60 mg with a pump refractory time of 1 min between valid demands. A continuous low-dose pentazocine infusion (1 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 20.3 +/- 5.9 h (mean, standard deviation). During this time, 20.0 +/- 12.7 demands per patient were recorded resulting in mean pentazocine consumption of 135.6 +/- 81.4 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. There were no statistically significant differences with regard of pentazocine consumption or pain relief between abdominal and orthopaedic patients, nor could any be demonstrated between the sexes. Similarly, no clear differences were found after various anaesthetic techniques (neuroleptanalgesia, halothane or spinal anaesthesia). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 68% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (nausea, emesis, sweating) occurred in about 10-18% but were usually of minor intensity. Circulatory or respiratory problems were not observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and clinical pain research.
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PMID:[Postoperative on-demand analgesia with pentazocine (Fortral)]. 409 11

There must be a differentiation between acute and chronic pain. While acute pain should be treated causally, this is usually no longer possible when pain has become chronic. It may even become so intense that a chronic pain patient can no longer live a productive life. The pain threshold is decreased by endogenous substances like prostaglandin E, but also kallekrein and bradykinin. Hyperadrenergic stimuli can advance pain; for example, the so-called phantom-limb pain. Also important within the biorhythm is the time of day, the physical state of activity and the psychological constitution. The pain patient often uses his disease to focus the attention of the physician on him. There are central and peripheral acting analgesics available for treatment of pain. The effect of peripheral acting analgesics can be explained by inhibition of the prostaglandin synthesis, by ASS (ASA) and its descendants, the antirheumatic agents. These acidic substances are mainly concentrated in the inflammatory tissue. They act as antiphlogistics, analgetics, and antipyretics. Descendants of phenacetin act as analgetics and antipyretics. Efficacy usually lasts 3 hours. Therefore these substances should be administered regularly and in sufficient doses, according to a fixed daily schedule. This reduces unnecessary pain and avoids overdosages. To reduce side effects and tachyphylaxis, a change of analgesics in intervals of approx. 6 weeks proved satisfactory. If peripheral analgesics are no longer sufficient, for example in the final phase of a carcinoma disease, morphine and its derivatives will then be applied. To reduce the dosage, additionally a neuroleptic drug and eventually a thymoleptic drug may be administered.
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PMID:[Pain and its management with drugs]. 716 35

Oral transmucosal fentanyl citrate (OTFC) has been used in a variety of clinical situations. This study was designed to determine if OTFC could provide analgesia to patients with acute pain after major surgery. Following written informed consent, 38 ASA Physical Status I-III patients undergoing either a total hip replacement or total knee arthroplasty were studied prospectively. The patients were randomly allocated to receive either OTFC (7-10 micrograms/kg) or a placebo identical in appearance to an OTFC unit. General anesthesia was administered for surgery, and patient-controlled analgesia (PCA) with morphine was initiated in all patients. The PCA interval dose was adjusted to provide adequate analgesia as determined by the patient and physician; the PCA lock-out time was not changed. On the morning after surgery, the most recent 12 h of PCA data (milligrams per hour of morphine and PCA attempts per hour) were recorded. OTFC or placebo units were administered at times 0, 4, and 8 h during a 12-h study, resulting in three identical units being completely consumed. PCA data, as well as incidence and severity of any adverse side effects, were recorded during the study and for the next 12 h. Treatment groups were compared for similarity, and study variables were analyzed. Twenty-eight patients completed the study, 13 in the control group and 15 in the OTFC group. There were no significant differences between the study groups as to patients' age, gender, ASA classification, or surgical procedure. In addition, there were no differences between the groups in the number of PCA attempts or delivered dose of morphine during the prestudy or poststudy periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain. 842 19

This review highlights the advantages of regional anaesthesia techniques, especially of epidural analgesia, for the management of postoperative and posttraumatic pain: excellent pain relief and a high degree of patient satisfaction, even compared to the gold standard of acute pain therapy, i.v. PCA with opioids. Further advantages of epidural analgesia (EA) are discussed, such as early recovery of gastrointestinal function, reduction of postoperative respiratory complications, lower incidence of myocardial ischema, better mobilisation, reduced risk of thromboembolism, lower incidence of chronic pain problems (such as phantom limb pain) etc. Nevertheless, many studies failed to show significant effects on outcome (e.g. mortality). Weighing the risks, costs and benefits of EA, this technique is indicated in case of significant postoperative pain, especially in case of painful mobilisation, in patients with significant pulmonary risk factors (ASA 3 or IV), in patients where an improved perfusion or gastrointestinal motility is deemed essential, and if chronic pain syndromes are common problems that should be prevented (e.g., amputation). For the praxis of epidural analgesia it is emphasised to place the catheter in an appropriate segment to obtain sufficient analgesia without side effects. Organisational structures (such as an acute pain service) and appropriate monitoring allow to continue EA with local anaesthetics and/or opioids on surgical wards. Recommendations are given for the monitoring of EA on surgical wards. Clear cut agreements should define the role of anaesthesiologists, surgeons and nurses in the management of patients treated with postoperative EA on surgical wards.
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PMID:[Epidural analgesia in postoperative pain therapy. A review]. 967 10

There is a lack of valid epidemiological data on malignancy-associated pain in modern pediatric oncology. Pediatric oncology patients (self-assessment) and their parents from 28 hospitals were questioned using age-adapted, structured interviews and validated pain assessment tools. Pain intensity was measured by the NRS and Bieri faces scale. We conducted 363 interviews with patients and their parents, and 46 with the parents alone (if patients <2.5 years). Pain was reported at the time of the interview or within the last 24 h, 7 d, or 4 weeks in 15%, 28%, 50% and 58% of cases, respectively. The proportion of patients suffering severe to maximal pain (NRS>3; Bieri>2) increased significantly (p=0.001, chi2 test). The median pain intensity for the most severe pain episode within the last 4 weeks was 6.7 (NRS 0-10). Adverse effects of anti-tumor therapy were the most frequent cause of pain. Multivariate analyses depicted general physical condition either "severely reduced" (ASA status 3) (OR 4.0, 95% CI 1.1-14.7, p=0.037) or "moderately reduced" (ASA status 2) (OR 1.8, 95% CI 1.1-2.9, p=0.018), "in-patient status" (OR 1.8, 95% CI 1.2-2.9, p=0.010), and "co-morbidity present" (OR 3.5, 95% CI 1.1-10.7, p=0.030) as risk factors for severe to maximal pain. General anesthesia was the only factor significantly (OR 0.14, 95% CI 0.05-0.39, p<0.01) associated with a reduction in the proportion of patients suffering severe to maximal pain during bone marrow aspiration. Our data emphasize both the importance of in-house acute pain control and the need for general anesthesia during painful procedures in pediatric oncology.
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PMID:Pain in pediatric oncology--children's and parents' perspectives. 1597 20

The aim of these recommendations is the revision of data published in 2002 in the "SIAARTI Recommendations for acute postoperative pain treatment". In this version, the SIAARTI Study Group for acute and chronic pain decided to grade evidence based on the "modified Delphi" method with 5 levels of recommendation strength. Analgesia is a fundamental right of the patient. The appropriate management of postoperative pain (POP) is known to significantly reduce perioperative morbidity, including the incidence of postoperative complications, hospital stay and costs, especially in high-risk patients (ASA III-V), those undergoing major surgery and those hospitalized in a critical unit (Level A). Therefore, the treatment of POP represents a high-priority institutional objective, as well as an integral part of the treatment plan for "perioperative disease", which includes analgesia, early mobilization, early enteral nutrition and active physiokinesitherapy (Level A). In order to improve an ACUTE PAIN SERVICE organization, we recommend: --a plan for pain management that includes adequate preoperative evaluation, pain measurement, organization of existing resources, identification and training of involved personnel in order to assure multimodal analgesia, early mobilization, early enteral nutrition and active physiokinesitherapy (Level A); --the implementation of an Acute Pain Service, a multidisciplinary structure which includes an anesthetist (team coordinator), surgeons, nurses, physiotherapists and eventually other specialists; --referring to high-quality indicators in establishing an APS and considering the following key points in its organization (Level C): --service adoption; --identifying a referring anesthetist who is on call 24 hours a day; --patient care during the night and weekend; --sharing, drafting and updating written therapeutic protocols; --continuous medical education; --systematic pain assessment; --data collection regarding the efficacy and safety of the implemented protocols; --at least one audit per year. --a preoperative evaluation, including all the necessary information for the management of postoperative analgesia (Level C); --to adequately inform the patient about the risks and benefits of drugs and procedures used to obtain the maximum efficacy from the administered treatments (Level D). We describe pharmacological and loco-regional techniques with special attention to day surgery and difficult populations. Risk management pathways must be the reference for early identification and treatment of adverse events and chronic pain development.
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PMID:Postoperative pain treatment SIAARTI Recommendations 2010. Short version. 2136 30


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