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Query: UMLS:C0278080 (physical dependence)
 1,658 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The route of alcohol administration used in the experimental study of the role of alcohol in carcinogenesis should mimic the human condition: the p.o. route should, therefore, have major attention. This route appears in concord with epidemiological evidence of alcohol involvement in cancers of the upper digestive tract. The relative advantages of schedule-induced polydipsia, an alcohol solution as the sole fluid source, and an alcohol-containing fluid diet are assessed, as well as the intake of alcohol via the respired air. These routes allow a wide range of daily alcohol doses to be ingested, the largest resulting in continuous intoxication and the development of physical dependence. The equivocal resulta from various already published typical experiments are discussed, indicating the necessity of using a variety of appropriate dosages, dosage routes, and dosage forms in appropriate controls, as well as indicating the necessity of investigating the role of concentration and kind of alcoholic beverage in a variety of strains and species in both sexes and at various ages.
Cancer Res 1979 Jul
PMID:Modes of alcohol administration appropriate for the study of the role of alcohol in carcinogenesis. 57 61

This article examines misperceptions and barriers to adequate pain relief in cancer patients. Healthcare professionals have gaps in their knowledge of opioid drugs as well as misconceptions concerning tolerance, physical dependence, and addiction that often lead to the underprescribing of these agents. The pervasiveness of the "say no to drugs" message in our society and the fear of addiction on the part of patients and their families creates yet another barrier to the legitimate use of opioids to treat cancer pain. Legal and regulatory documents filled with arbitrary and ill-defined labels meant to promote the legitimate use of these drugs and curtail their misuse may instead intimidate healthcare professionals and negatively influence prescribing habits. Increased educational efforts for pharmacists and other healthcare professionals as well as the development of clinical role models and state cancer pain initiatives are cited as means to break down these barriers in order to achieve adequate pain relief for all cancer patients.
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PMID:Misperceptions and inadequate pain management in cancer patients. 172 70

Clinical studies of the injectable nonsteroidal anti-inflammatory agent (NSAIA) ketorolac tromethamine are reviewed, and the chemistry, pharmacology, pharmacokinetics, drug interactions, and adverse effects of ketorolac are described. Ketorolac exhibits anti-inflammatory, analgesic, and antipyretic activity. Although the exact mechanisms of action have not been determined, its effects appear to be associated principally with the inhibition of prostaglandin synthesis. After oral, i.m., or i.v. administration, ketorolac and its metabolites are excreted mainly in urine. Ketorolac tromethamine has been used for the symptomatic relief of moderate to severe postoperative pain, including that associated with abdominal, gynecologic, oral, orthopedic, or urologic surgery. Ketorolac has also been used for the relief of acute renal colic, pain associated with trauma, and visceral pain associated with cancer. When administered i.m., ketorolac produced analgesia comparable to that of i.m. doses of meperidine, pentazocine, or morphine. The most common adverse effects associated with short-term administration are nervous system and gastrointestinal effects; these are usually mild and occur in about 39% of patients. Unlike opiate analgesics, ketorolac does not appear to cause tolerance or physical dependence in patients receiving long-term therapy. Ketorolac tromethamine has been administered concomitantly with morphine or meperidine without apparent adverse interaction. For short-term pain management, an initial i.m. ketorolac tromethamine loading dose of 30 or 60 mg is recommended. Ketorolac tromethamine appears to be as effective as morphine or meperidine for short-term management of moderate to severe postoperative pain. It lacks the respiratory depressant effects of opiate analgesics but shares the toxic potentials of other NSAIAs.
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PMID:Ketorolac, an injectable nonnarcotic analgesic. 229 76

The clinical pharmacology of the narcotic-type analgesics is discussed in depth. Relative analgesic potency, peak and duration of analgesia, oral potency, and adverse effects are reviewed, With an emphasis on the clinical application of this knowledge. The differences among psychologic dependence, physical dependence, and tolerance are carefully delineated. Guidelines are provided for using narcotic-type analgesics in the management of patients with cancer.
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PMID:Role of opioid analgesics. 648 29

Despite widespread knowledge about many aspects of pain relief and the availability of appropriate opioid analgesics, inadequate pain management of cancer patients remains pervasive. The reasons can be classified into three categories: (1) societal barriers: (some health care providers still classify patients requiring "atypical" pain control as actual or potential drug abusers and continue to be affected by the deep-rooted negative image of opium and its misuse throughout history), (2) knowledge deficits (care givers often do not recognize the need for individualized treatment in accordance with the specific pain syndrome, the profile of the patient, the appropriate analgesic regimen, or the route of dosing; in addition, physical dependence, addiction, and tolerance are often regarded as synonymous and not clearly distinguished from one another), and (3) influence of governmental regulations (because drug regulatory guidelines concerning opioids are often vague and ambiguous, physicians are uncertain about what constitutes legitimate opioid use and fear regulatory and legal sanctions when prescribing opioid analgesics in higher than "normal" amounts; as a result, pain is often undertreated). It is imperative that we strive to overcome these barriers and correct societal biases and misinformation in order to create a more rational plan for effective cancer pain management in which opioid analgesics are utilized appropriately.
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PMID:The barriers to adequate pain management with opioid analgesics. 809 39

The profile of actions of dihydroetorphine (DHE) concerning antinociception, tolerance and dependence was compared with those of morphine in mice. DHE at 1, 5, 10 or 20 micrograms/kg produced an antinociceptive effect in a dose dependent manner and 10 micrograms/kg was nearly equipotent to that of 10 mg/kg of morphine. The antinociceptive effect of both drugs was completely suppressed by 1 mg/kg of naloxone, while neither 10 mg/kg of naltrindole nor 1 mg/kg of nor-binaltorphimine had any suppressive effect. Mice tolerant to morphine antinociception were tolerant to DHE and vice versa. The naloxone-sensitive, locomotor accelerating activity was progressively enhanced by daily administration of DHE and morphine and a cross reverse tolerance developed between these compounds, suggesting that common mechanisms, especially mediating opioid receptors, underlay the activity enhancement. The development of physical dependence as evidenced by naloxone precipitated withdrawal signs, however, was not observed with daily treatment with DHE, 10, 20 and 100 micrograms/kg for 6 d. Thus, we demonstrated that DHE produces the antinociceptive effect mediated through mu opioid receptors without causing development of a physical dependence, suggesting that it is safe to use in the clinical therapy of patients suffering severe pain such as that accompanying cancer.
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PMID:Antinociceptive effect of dihydroetorphine and its tolerance/dependence liability in mice. 822 Mar 23

Presents a clinician's viewpoint on the tolerance of and dependence on opiates and opioids in total anesthesia and management of acute (postoperative) and chronic (cancer) pain. Clinical observations are assessed with due consideration for the theoretical (pharmacological) studies. The author analyzes prolonged therapy with different opiates and opioids and the short-term use in massive doses at different stages of surgery. Tolerance to morphine rapidly forms during therapy of chronic pain, and the narcotic doses have to be progressively increased. Tolerance to opioids, such as tramal and buprenorphine, is less expressed. These agents are less hazardous as regards drug dependence, which was proven for tramal by the naloxone test. Clinical manifestations of physical dependence on opiates at different stages of surgical treatment are discussed for the first time. The main last-generation opiates are characterized (tramal, buprenorphine, nalbufin, butorphanol, prosidol) by their capacity to cause physical and mental dependence. The author emphasizes the importance of a proper selection of opiates, opioids, and combinations thereof with the optimal nonopiate components in general anesthesia, postoperative analgesia, and treatment of chronic pain in order to improve the efficacy and narcological safety of analgesia.
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PMID:[The problem of opioid tolerance and dependence during clinical use thereof]. 897 62

Opioids have been accepted as appropriate analgesic treatment for pain associated with cancer. However, controversy exists about their use for chronic noncancer pain. Reasons for reluctance are concerned about efficacy and potential adverse effects such as respiratory depression, addiction, physical dependence or intolerance. Many physicians worry about liability and legal restrictions. Nevertheless, pain management of chronic severe pain with opioids can be the only help when alternative methods are too risky of fail to be effective. This article briefly reviews the published literature on this topic and discusses some practical guidelines for the use of opioids in the treatment of non-cancer pain.
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PMID:[Opioids in treatment of chronic noncancer pain]. 954 32

Prolonged and excessive intake of alcoholic beverages can lead to addiction, increased tolerance and physical dependence as in the case of other drugs. It is the cause of many deaths due to cirrhosis, cancer and accidents. It favours numerous symptoms and disorders that can be reversible on withdrawal of alcohol. Alcohol is not toxic. Taken in regular and moderate fashion (20 to 30 g of alcohol per day), alcoholic beverages play a psychosocial role that gives a certain pleasure. In addition, many concordant epidemiologic studies support the notion that overall morbidity and mortality are significantly less than in those who abstain. The benefit is particularly evident in mortality due to cardiovascular events, but also in senile dementia and osteoporosis. However, there are no data confirming a cause and effect relationship. Despite this potentially favourable role, it cannot be recommended to suggest the use of alcohol to those who abstain, given the possibility that some might subsequently develop alcohol dependence.
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PMID:[Beneficial and deleterious effects of alcoholic beverages]. 1031 84

At a recent seminar on pain management in Atlanta, researchers reported that health care providers do poorly when it comes to recognizing and managing the pain suffered by patients with AIDS. This lack of adequate attention is reflected in the lack of relevant studies about pain management in the medical literature. As with cancer, AIDS pain increases with disease progression. However, patients with AIDS tend to be more depressed than cancer patients, and have a higher rate of suicidal thoughts. Experts at the seminar discussed the obstacles involved in treating pain in AIDS patients who have a history of substance abuse. According to one study, pain medication addiction is rare in patients. Providers must distinguish between tolerance and physical dependence. Guidelines for managing pain in substance abusers include respecting the patient's reports of pain, and setting clear goals and conditions for opioid therapy. Using a team approach that recognizes pharmacological and non-pharmacological interventions, and that pays attention to psychosocial issues will also lead to greater success in treating patients with pain. The most common painful illnesses are HIV-related headaches, herpes simplex, peripheral neuropathy, back pain, herpes zoster, and throat pain.
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PMID:Clinicians not providing necessary pain relief for AIDS patients. 1136 81


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