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)

Narcotics have been shown to act selectively upon nociceptive synaptic junctions in laminae 1 and 2 of the dorsal horn of the spinal cord. Subarachnoid or epidural injection of narcotics can produce selective segmental analgesia of great intensity and prolonged duration that is free of motor or sympathetic blockade. However, poorly lipid-soluble drugs, such as morphine, that tend to linger in the water phase of the CSF may spread rostrally to involve opiate receptors in brain stem nuclei. Delayed respiratory depression and lifethreatening apnoea is therefore the greatest danger. Other undesirable side effects include itching, nausea and vomiting and urinary retention. All side-effects are antagonized by naloxone. Intraspinal narcotic analgesia has many useful applications for the relief of acute or chronic pain. Obstetrical pain is less amenable to this approach. Effective and safe management of acute pain requires that the patients be under adequate surveillance to avoid the danger of insidious respiratory depression. Chronic malignant pain is well controlled by relatively small doses of narcotic, and these patients can be managed at home on a long-term basis.
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PMID:Spinal opiate analgesia: its present role and future in pain relief. 614 23

An adolescent girl with chronic myelogenous leukemia was treated with hypnosis for several disease- and treatment-related problems during the last 4 months of her life. Data were collected before and after hypnosis on the nature and intensity of the patient's acute pain and anxiety during bone marrow aspirations, chronic headache and backache, nausea and vomiting during chemotherapy, anorexia, and the discomfort associated with spiking temperatures. Comparisons of baseline and posthypnosis reports suggest that hypnosis was successfully used for acute and chronic pain, anxiety, unpleasant body sensations and, possibly, nausea and vomiting. The hypnotic techniques used, the limitations of hypnosis and clinical issues in this case are presented and discussed.
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PMID:Use of hypnosis for multiple symptoms in an adolescent girl with leukemia. 645 20

An Acute Pain Service (APS) was started in University Hospital, Kuala Lumpur by the Department of Anaesthesiology in October 1992 for more effective control of postoperative pain. The main modalities of treatment included patient controlled analgesia (PCA) using morphine or pethidine with PCA devises, epidural opiate analgesia (EOA) using tramadol or fentanyl/bupivacaine mixture and subcutaneous administration of morphine or pethidine. Five hundred and fifty-one patients were managed in the first year, with an overall patient satisfaction score of 83%. The majority (98.5%) of them were after abdominal or major orthopaedic surgery. Eighty per cent of patients scored < 3 on the verbal numeric pain scale, where 0 is no pain and 10 is the worst imaginable pain, on the first postoperative day. Nausea and vomiting was an unpleasant side effect in 20% of patients.
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PMID:First year's experience with an acute pain service--University Hospital Kuala Lumpur. 754 79

Propiram is an orally administered opioid analgesic with partial morphine-like agonist and weak antagonist properties. Analgesic efficacy of propiram, usually 50 or 100mg, appears comparable to that of standard dosages of other oral opioid drugs [i.e. pentazocine, pethidine (meperidine)] in patients with acute pain of moderate to severe intensity arising from various gynaecological and surgical procedures, and may be superior to codeine in gynaecological and postoperative dental pain. Some evidence of a more rapid onset of action for propiram than for these opioid agents, and a longer duration of action for propiram than for codeine, is encouraging but remains to be substantiated in more extensive clinical use. The tolerability profile of propiram resembles those of others in its class, with drowsiness, nausea and vomiting, and dizziness experienced most frequently in controlled trials. The apparently low propensity of propiram for development of physical dependence and psychotomimetic effects requires confirmation with wider clinical experience. Available data thus indicate that propiram is an effective, orally administered opioid analgesic suitable for providing relief of acute moderate to severe pain arising from various surgical or gynaecological procedures, and that the drug is likely to become a useful alternative in such conditions where opioid analgesia is appropriate.
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PMID:Propiram. A review of its pharmacodynamic and pharmacokinetic properties, and clinical use as an analgesic. 769 33

1. Prevent predictable pain, such as occurs postoperatively. Anticipatory pain management is particularly important in the elderly, who frequently attempt to "tough it out" without much analgesia. 2. Assume the patient is in pain if the situation is potentially painful, even without verbal complaints. Confused elders may be unable or unwilling to verbalize pain. For example, a confused 90-year-old woman with an acute hip fracture should be treated for pain, even if she does not complain of it. Elders, especially if demented, may not have the usual external "pain behaviors." 3. Do not routinely use antiemetics, especially phenothiazines. The incidence of postoperative nausea and vomiting is probably less in the elderly, and antiemetics are strongly anticholinergic and poorly tolerated in the frail elderly. 5. Do not use IM narcotics at all, except as "rescue analgesia" or when acute pain has subsided. Their high peak, low trough profile leads to a respiratory depression, excess pain cycle which is poorly tolerated in the elderly IV, or even oral, morphine is better tolerated. 6. Use multiple modalities for analgesia; for example, intercostal nerve block and epidural opioids, or IV-PCA and IV NSAIDs. This will enhance analgesia and reduce narcotic toxicity. This is especially important in frail elders, who often tolerate systemic narcotics poorly. 7. Use site-specific analgesia. Certain operative sites, such as the upper extremity, are especially amenable to local nerve blocks. Others, such as thoracotomy, are especially painful and need potent analgesia. For upper-extremity surgery, consider interscalene nerve block and NSAIDs. For thoracotomy, use extrapleural, intercostal nerve block and epidural narcotics. Local bupivacaine and NSAIDs work well after inguinal herniorrhaphy. For knee surgery, consider intra-articular morphine and NSAIDs. 8. Whenever possible, add a scheduled parenteral, rectal, or oral NSAID, in order to spare narcotics, enhance analgesia, and decrease inflammatory mediators. Unless the patient has a contraindication or there is a strong concern about hemostasis or peptic ulceration, NSAIDs should generally be administered. The major concern in frail elders is acute renal failure; therefore, ensure good hydration and avoid use of NSAIDs if renal function is diminished. NSAIDs should be used on a scheduled (not prn) basis.
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PMID:Postoperative pain management in the frail elderly. 885 47

We audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 micrograms.ml-1 infusion occurred in four patients (1.2%), all with a sensory block higher than T5. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.
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PMID:An audit of the safety of an acute pain service. 940 64

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy.
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PMID:The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services. 1021 22

Preemptive analgesia is based on administration of an analgesic before a painful stimulus generates, so as to prevent the subsequent rebound mechanism. Tissue injury results in disruption of the processing mechanisms of noxious stimuli afferent to the CNS (central nervous system) by way of an increase of inputs in the spinal cord. These reactions may be reduced by the administration of opioids. Few studies on preemptive analgesia with opioids in children are available, and none of them is concerned with pediatric neurosurgery. Tramadol and fentanyl are synthetic opioids which are relatively new and act through the activation of pain-inhibitory mechanisms. We conducted a randomized, prospective trial on the preemptive effects in children of these two analgesic drugs, administered according to three different protocols: tramadol as a bolus (1 mg/kg); tramadol by continuous infusion (150 microg/kg per h); fentanyl by continuous infusion (2 microg/kg per h). In all, 42 children undergoing major neurosurgical operations were enrolled in the study, 14 in each treatment group. Each treatment was started at the induction of general anesthesia and continued throughout the entire duration of the operation. The postoperative pain evaluation was conducted in the Pediatric Intensive Care Unit at the end of the surgical operations and involved comparison of any changes in behavioral (AFS scale and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic arterial pressure, oxygen saturation, O(2) and CO(2) partial pressure) parameters. Only 2 children, both in group A, needed further drug administration postoperatively. No significant side effects were noticed in any of the three groups, except that in group A there was a higher incidence of nausea and vomiting. Tramadol efficacy seems to be better when it is administered in continuous infusion; this treatment modality also leads to fewer adverse effects. Fentanyl, in contrast, proved to be superior to tramadol in the treatment of postoperative pain. In conclusion, preemptive analgesia is a valid technique for the treatment of acute pain in children undergoing major neurosurgical operations.
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PMID:Preemptive analgesia with tramadol and fentanyl in pediatric neurosurgery. 1066 14

(1) This codeine-based syrup is indicated for the treatment of pain in children. It is the first step 2 analgesic (WHO classification) to become available in France for oral treatment of children. (2) Efficacy and the optimal dose regimen are based mainly on lengthy experience with codeine in other countries. Only a few small trials on acute pain are available. (3) The safety profile is that of all opiates: adverse effects comprise mainly constipation, nausea and vomiting. (4) Accidental ingestion by a young child can lead to severe poisoning.
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PMID:Codeine for child pain: new preparation. Helpful in some cases. 1150 26

Following the establishment of an acute pain service in one UK acute NHS trust, including the introduction of patient-controlled analgesia (PCA), pain scoring, and a rationalization of the use of simple analgesics, attention was drawn to an apparent increase in postoperative nausea and vomiting (PONV) among women given PCA following abdominal hysterectomy. Audits were conducted into clinical practice and patient satisfaction and it was agreed that an evaluation of the evidence should be conducted to ensure that the correct direction for development in the management of PONV could be established. This article discusses the evidence surrounding the issues regarding the management of PONV in patients who have been given PCA. The possibility of adding antiemetics to the analgesic solution, and the choice of antiemetic drugs, are investigated. Other factors that can affect the incidence of PONV in patients with PCA are also discussed, and an auditable framework for the evaluation of clinically effective practice is suggested.
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PMID:Postoperative nausea management and patient-controlled analgesia. 1197 21


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