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)

Soon available in Europe, fentanyl transdermal system (Transdermal Therapeutic System: TTS fentanyl) is a new, easy and non invasive way for delivery of a strong opioid. Skin is not only a transit site for transdermal administered drugs, but is an active barrier and acts as a reservoir after removal of the delivery system. Use of transdermal fentanyl has first been studied for the treatment of postoperative pain. But the great latency of the kinetics of fentanyl by this way certainly moderates this indication. Latency is a much less important problem for chronic administration in cancer pain. This could be an interesting indication for TTS fentanyl. But there are still troubles in converting previous opioid therapy doses when initiating transdermal administration, and in controlling breakthrough pain, so common in cancer patients. Further clinical studies are needed to determine optimal conversion rules and elaborate guidelines for control of acute pain episodes with "rescue doses".
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PMID:[Transcutaneous fentanyl]. 808 37

Effective management of chronic pain has become an increasingly critical issue in health care. Opioid agonists are among the most effective analgesics available for reducing pain perception; however, their chronic use is controversial. This is primarily due to regulatory barriers, misunderstandings about pain management among primary caregivers, fear of adverse side effects, and misconceptions about the potential risks of addiction. Short-acting opioids provide effective analgesia for acute pain but should be avoided as primary analgesics for chronic pain management. Long-acting opioids have greater utility than short-acting opioids in treating chronic pain in patients with consistent pain levels. Results of studies show that improved quality of life is directly related to the use of long-acting opioids in patients with chronic pain of both cancer and noncancer etiology. Short-acting opioids may be used during the initial dose titration period of long-acting formulations and as rescue medication for episodes of breakthrough pain. Clinical experience reveals that selection of an effective pain regimen for the patient with chronic pain, combined with aggressive management of side effects, leads to improved overall functioning and quality of life.
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PMID:Long-acting opioids for chronic pain: pharmacotherapeutic opportunities to enhance compliance, quality of life, and analgesia. 1134 85

Cancer patients experience pain in multiple sites and from several pathophysiologies of the symptom complex. The fluctuating nature of cancer pain intensity is a relevant clinical feature and depends on disease patterns and pain mechanisms. Breakthrough pain is defined as episodes of pain that "break through" the control of an otherwise effective analgesic therapy. Traditional ways of classifying pain in the cancer population include distinguishing pain associated with the treatments, the tumor, or unrelated to both and between chronic and acute pain. In focusing on the care of the cancer patient with pain, it is useful to be familiar with the characteristics of the typical syndrome found in association with different tumor types and anatomic locations. An understanding of the etiology of pain in relation to the cancer is useful in recognizing these complications and in treating them. This article reviews the methods presently applied to the classification of cancer pain and highlights the need for more research in this area.
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PMID:Classification of cancer pain syndromes. 1178 Jul 4

The purpose of this study was to validate the changes in acute pain measurement scales that are most strongly associated with a patient-determined indicator of clinical importance. Measures of pain intensity and pain relief are commonly used outcomes in therapeutic clinical trials. Recent studies of the properties of acute pain measures have provided data defining the cut-off points that are best associated with clinically important differences. Validation of these findings in another clinical trial data set is important. Data were obtained from the titration phase of a recently conducted randomized controlled clinical trial of oral transmucosal fentanyl citrate (OTFC), which compared OTFC to immediate release morphine sulfate (MSIR) for the treatment of cancer-related acute breakthrough pain. Changes in pain intensity and pain relief were recorded every 15 minutes for 60 minutes and global medication performance recorded at the end of each study pain episode. At any titration step, if the patient felt that the first dose of the study medication did not provide adequate relief within 30 minutes, an additional rescue medication could be taken. To find the level of each pain scale best associated with this measure of the adequacy of pain relief, the calculated sensitivity, specificity, and accuracy for different cut-off points of the measured pain scales were compared to whether or not the patient needed rescue medication. The overall ability of the pain measures to discriminate episodes for which a rescue was not needed was calculated using area under the receiver operating characteristics (ROC) curves. Data were analyzed from 134 OTFC-naive patients who collected data on 1307 episodes of breakthrough pain. Using the criteria of a balanced sensitivity and specificity, the best cut-off points were determined to be: 33% for the percent pain intensity difference; > or =2 for the raw pain intensity difference on a 0-10 numeric rating scale; > or =2 (i.e., moderate or better) for pain relief; > or =33% for the percent maximum total pain relief; and > or =2 (good or better) for global medication performance. ROC area under the curve ranged from 0.839 to 0.862 for each of the pain measures listed above, calculated at 60 minutes. These data indicate that the pain scale cut-off points that are best associated with a patient-derived measure of a clinically important difference closely approximate those found in an earlier study. ROC analysis provided evidence that the overall pain measures were strongly associated with not requiring an "additional dose of rescue medication." Thus, the cut-off points determined for these pain scales provide a good surrogate measure of a patient-determined clinically important response. This provides support for the usefulness of these values in future clinical trials of pain therapy.
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PMID:Clinically important changes in acute pain outcome measures: a validation study. 1272 31

Chronic post-thoracotomy pain (CPP) is associated with surgical intercostal nerve injury. Like other forms of neuropathic pain, there is no ideal treatment. Nitroglycerin (NTG) has been found efficacious in acute pain, but has not been tested for chronic pain with neuropathic characteristics. The present study investigated the efficacy of NTG combined with the nonsteroidal anti-inflammatory drug etodolac for the treatment of CPP. Thirty of 129 patients who underwent thoracotomy within an 18-month period had moderate to severe pain that did not respond to etodolac. NTG, 5 mg/day, was added to the treatment. A significant reduction in VAS was observed on day 14 of treatment (from 66.7 +/- 11 to 42.1 +/- 5, P< 0.05). Similar changes were noted in breakthrough pain intensity and and sleep efficiency. The only side effect was mild headache, which was self-limited to the first few days of NTG administration. We conclude that NTG added to etodolac appears to be effective for the treatment of CPP, with minimal side effects. Further randomized blinded studies are required.
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PMID:Efficacy of transdermal nitroglycerin combined with etodolac for the treatment of chronic post-thoracotomy pain: an open-label prospective clinical trial. 1503 39

It is essential that physicians and midlevel practitioners who care for residents in long-term care facilities be proficient in the recognition, assessment, and treatment of chronic pain. A holistic approach to the physical, emotional, social, and spiritual components of a resident's total pain and distress must be integrated into the palliative aspects of long-term care medicine. Furthermore, all practitioners must recognize and effectively manage, prevent, and/or minimize the occurrence of acute pain, breakthrough pain, incidental pain, and disturbance pain that frequently are superimposed on a resident's chronic pain.
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PMID:Effective pain management in the long-term care setting. 1535 93

The physiochemical characteristics of the potent synthetic opioid agonist fentanyl make it ideal for noninvasive transmucosal delivery. Studies of oral transmucosal fentanyl citrate (OTFC), a candied matrix formulation administered orally as a palatable lozenge on a stick, have investigated and determined this analgesic's pharmacokinetics and pharmacodynamics in a number of clinical settings, including premedication before surgery, acute analgesia for painful medical procedures, and, most recently, for the control of breakthrough cancer pain. The onset to meaningful pain relief in patients with acute pain from surgery or breakthrough pain from cancer is between 5 and 10 minutes after initiating OTFC use, equivalent to intravenous morphine. Analgesic dose equivalency studies suggest that OTFC is, on average, about 10 times more potent than morphine, although, in randomized, controlled, and blinded studies, many patients who were using relatively high doses of opioid anlagesics on an around the- clock schedule for control of cancer pain reported that even a low dose of OTFC (i.e., 200 microg) provided adequate relief from breakthrough pain. Side effects from OTFC are similar in character and frequency to other opioids, including sedation, nausea, and pruritus. These effects appear to wane rapidly with repeated use of this medication. To date there have been no reported serious adverse events in any of the population groups studied or treated with OTFC.
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PMID:A review of oral transmucosal fentanyl citrate: potent, rapid and noninvasive opioid analgesia. 1585 72

Pain remains a highly prevalent problem for patients with cancer and typically falls into one of 3 types: visceral, somatic, and neuropathic. A mechanistic, pathophysiologic approach to pain management involves a good assessment of the type of pain, followed by tailoring of the treatment based on the diagnosis. This pain management strategy can provide rapid pain control with a lower incidence of complications and side effects than other methods. Furthermore, pharmacogenetics may play an important role in individualizing therapies in the future, but for now this type of data offers explanations for phenomena commonly observed in clinical practice, such as (1) differences in individual analgesic and side-effect responses to various opioid agents, (2) incomplete cross-tolerance seen when switching between mu opioid analgesics, and (3) why opioid rotation can be beneficial for patients after an opioid therapy loses efficacy or becomes associated with intolerable side effects. Especially for difficult-to-manage pain patients, additions to the opioid analgesic armamentarium can potentially better individualize pain management, and provide another option to be used for opioid rotation. Among the most recent Food and Drug Administration-approved opioid analgesics for acute pain and persistent pain are oral immediate-release and extended-release formulations of oxymorphone, whereas for breakthrough pain, the ultrarapid-acting opioid, fentanyl effervescent buccal tablets, has newly been developed and indicated within the United States.
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PMID:Current developments in opioid therapy for management of cancer pain. 1841 25

Acute compartment syndrome can cause significant disability if not treated early, but the diagnosis is challenging. This systematic review examines whether modern acute pain management techniques contribute to delayed diagnosis. A total of 28 case reports and case series were identified which referred to the influence of analgesic technique on the diagnosis of compartment syndrome, of which 23 discussed epidural analgesia. In 32 of 35 patients, classic signs and symptoms of compartment syndrome were present in the presence of epidural analgesia, including 18 patients with documented breakthrough pain. There were no randomized controlled trials or outcome-based comparative trials available to include in the review. Pain is often described as the cardinal symptom of compartment syndrome, but many authors consider it unreliable. Physical examination is also unreliable for diagnosis. There is no convincing evidence that patient-controlled analgesia opioids or regional analgesia delay the diagnosis of compartment syndrome provided patients are adequately monitored. Regardless of the type of analgesia used, a high index of clinical suspicion, ongoing assessment of patients, and compartment pressure measurement are essential for early diagnosis.
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PMID:Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. 1902 95

In recent years, a growing interest in palliative care and in routes of administration other than oral have prompted more aggressive measures to improve the efficacy of analgesic interventions in patients with difficult pain conditions. This review provides an overview of the use of intravenous morphine to control pain in patients with cancer. Intravenous morphine has been increasingly used in different clinical situations--including breakthrough pain, poor pain control with escalating doses of oral opioids, retitrating patients with acute pain, treating patients with long-standing poor pain control and unpredictable needs, and optimising opioid therapy to prevent incident pain associated with bone metastases. Although intravenous administration requires supervision, it has considerable advantages, since direct administration into the circulation provides a rapid and predictable effect that is independent of absorption problems. I.v. morphine is advantageous in specific clinical situations and should be part of armamentarium of all physicians treating pain in patients with cancer.
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PMID:Intravenous morphine for management of cancer pain. 2043 17


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