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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Focused research on pain and pain control in children has developed primarily in the last 10 years and even now is woefully inadequate in relation to the magnitude of the problem. The available research, inferences from the adult literature, and anecdotal information all indicate the elusive nature of pain. Pain is not solely a fixed neurophysiologic response to a noxious stimulus but a product of the interaction of many variables such as age, cognitive set, personality, ethnic background, and emotional state. These factors exert a tremendous influence on the suffering which surrounds the pain message. Technology exists at present to eliminate or substantially reduce pain in almost all cases. There remains, however, a tendency, which is even more pronounced with respect to children, to underestimate or ignore pain. In an overall approach to pain in children, the following points should be considered: A high index of suspicion is necessary to determine if children are experiencing pain since they may have difficulty verbalizing their discomfort. In infants, physiologic variables should be considered (increased heart rate, palmar sweating, increased respiratory rate), and in preschoolers, time should be taken to ascertain that the child actually understands the word "pain" if it is used in questioning them. Some method of continuous monitoring, such as a visual analogue scan, should be considered as part of the treatment plan. Adequate analgesia should be provided. The appropriate dose should be administered at the appropriate pharmacokinetic time. Too little medication may cause obsessive attention to medication-related issues. Too much medication may cause sedation and lack of mental clarity, which is often anxiety-producing for both the parents and the child. The usefulness of p.r.n. medication has been seriously questioned and a time-contingent as opposed to pain-contingent strategy should be applied. Fears of addiction are generally unwarranted. Adjunctive medication may increase the value of offered narcotics and counteract some of their side effects. Although this monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance. The importance of distraction from pain by nursing, medical, or child life personnel using play techniques cannot be overestimated. Every attempt should be made to relax the child by using creative strategies. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Pain and pain control in children. 286 Oct 66

Iatrogenic, or medically induced, drug addiction is a problem affecting both patients and physicians. We describe the function of a new center devoted solely to managing iatrogenic addiction. The center accepts patients on physician referral only. The addiction usually arises as a complication of a medical disorder that is accompanied by pain and requires comprehensive and multidisciplinary evaluation and treatment. Detoxification from the offending medication, provision of chronic analgesia, and maintenance are managed with methadone. All appropriate modalities of treatment including psychotherapy, physical therapy, and relaxation techniques are employed.
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PMID:Medically induced drug addiction. 286 26

The acquisition of morphine analgesic tolerance was investigated in neonatal rats. Morphine was found to produce a potent analgesia, as measured by latency to retract a hindpaw from a 52 degree C hotplate, in rat pups as young as 1 day of age. Morphine analgesic tolerance, however, did not develop in rats until the third week of life. Rats given the same daily morphine regimen starting at 15 days of age or older showed rapid tolerance development. The data from four experiments indicate that experience with morphine prior to this age (Day 15) does not impact on the analgesic efficacy of the drug. Similarly, when morphine treatment was discontinued and the rats given a naloxone challenge, withdrawal symptoms were not observed in very young rats. Opiate withdrawal was first detected in rats that started their daily morphine treatment at 30 days of age and were then challenged with naloxone at 52 days of age. Therefore, two correlates of opiate addiction, tolerance and withdrawal, appear to be relatively late-developing phenomena in the rat.
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PMID:The ontogeny of opiate tolerance and withdrawal in infant rats. 324 19

The observation that the narcotic antagonist naloxone could inhibit analgesia produced by electrical stimulation of the brain indicated the involvement of an endogenous chemical in the relief of pain. Multiple endogenous opioid peptides have been identified that have similar pharmacological properties to known narcotic analgesics. The biosynthesis, release, and degradation of opioid peptides have been studied in order to better understand how the manipulation of endogenous opioid systems can be used to produce or augment analgesia. The results of our studies reveal that various conditions and manipulations, such as electrical brain stimulation, acupuncture, stress, and the administration of opioid analgesics, can cause the release of endogenous opioid peptides and possibly endogenous nonpeptide substances. It has also been discovered that nonopioid peptides, such as cholecystokinin, calcitonin, and angiotensin II, can alter the action of opioid analgesics by antagonizing or potentiating their effects. An understanding of the role of endogenous peptides in endogenous opioid mechanisms is necessary for the development of new ways to treat pain and such other disorders as sleep apnea in children (sudden infant death syndrome), head injury, and opioid addiction that involve the activation or alteration of endogenous opioid systems.
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PMID:The role of endogenous peptides in the action of opioid analgesics. 352 91

In a placebo-controlled, double-blind study we evaluated the ability of a single 50 mg oral dose of nalmefene to block the effects of intravenous opioid challenge (2 micrograms/kg fentanyl). Fentanyl-induced respiratory depression (CO2 responsiveness), analgesia (tourniquet ischemia), and subjective effects were totally blocked for 48 hours and showed only minimal breakthrough 72 hours after nalmefene. Plasma concentration-time data for nalmefene indicate good oral bioavailability and a prolonged terminal elimination phase (mean t1/2 11.1 hours). These findings suggest that nalmefene could provide prolonged effectiveness in limiting emergence of opioid effects during addiction therapy.
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PMID:Prolonged blockade of opioid effect with oral nalmefene. 353 70

The first symposium on endorphins and behavioural processes in Britain was held by the British Psychological Society in March 1985. Against a background of the explosive history of the discovery of endogenous opioids, problems of terminology, and basic mechanisms and concepts, five papers reflect the main fields in which outstanding progress has been made: analgesia, feeding, reward mechanisms, social behaviour and aggression, and addiction. A review of the literature on endorphins and exercise stresses both the value and limitations of trying to unravel a fashionable subject. Endorphin research is multi-disciplinary and highly complex, with tricky technical and conceptual problems and inevitable lack of consensus. Investigators should be more aware of the crucial role that outcomes of behaviour experiments play in the attribution of function to opioid systems.
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PMID:Introduction to symposium on endorphins and behavioural processes; review of literature on endorphins and exercise. 390 68

Electrical stimulation of the brainstem abolishes pain, while continued stimulation induces tolerance to the analgesic effect. Analgesic drugs producing tolerance also induce physical dependence, suggesting that the phenomenon of tolerance is associated with addiction. There is evidence that the neural mechanism for stimulation-produced analgesia is related to the release of opiate substances within the brain. We therefore propose that repeated or protracted brain stimulation elicits dependence upon the endorphins released by electrical stimulation of the neurons themselves. To investigate this possibility, rats were given repetitive bursts of analgesic electrical brain stimulation for two hours. Immediately thereafter, they were injected with the opiate antagonist, naloxone. Behaviors associated with low grade opiate withdrawal were observed. These data suggest that prolonged analgesic stimulation can result in naloxone-precipitated behaviors similar to the behaviors exhibited during opiate withdrawal.
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PMID:Opiate withdrawal behavior after focal brain stimulation. 654 76

A number of procedures are available to assess an opioid's capacity to be positively reinforcing, but each has limitations that could lead to the false conclusion of no addiction potential. The recently developed conditioned place preference (CPP)-test, however, overcomes some of these limitations. Diprenorphine can be used to establish a CPP indicating it has an unsuspected capacity to elicit positive affect. Since diprenorphine antagonizes opioid analgesia and elicits signs of positive affect, the conclusion is confirmed that opioid analgesia and opioid's capacity to be positively reinforcing are separable.
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PMID:Assaying addiction liability of opioids. 668 35

Despite the initial claims that propoxyphene (Darvon) provides analgesia without risk of dependence, there is growing international recognition of its addictive potential, with documentation of both psychological dependence and physical withdrawal symptoms. However, many physicians remain uninformed of the true nature of the drug and its potential for abuse and addiction. In terms of frequency of addiction among users, propoxyphene may be less dangerous than most narcotics, but it is more available by prescription and less expensive then illegal opiates, making it a prime target for both abuse and addiction. At present, increased caution by prescribing physicians is indicated. Patients now taking the drug should be carefully monitored for signs of abuse or dependence.
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PMID:Propoxyphene dependence: an update. 731 31

This study consisted of two interrelated parts. In the first part, the adequacy of pain relief in hospitalized post-surgical patients was assessed and described and in the second part ways in which nurses on the same units chose analgesic medications were examined and analyzed. Pain was considered a subjective experience. Patients were interviewed, and their charts reviewed on the third postoperative day. The sample included 109 patients in 5 central Illinois hospitals. After all patient interviews were completed, 121 nurses on the same units responded to a questionnaire which included clinical vignettes. Results of the patient interviews indicated that 75.2% of these patients were in moderate or marked pain distress and that a general question did not adequately assess pain. Chart review indicated that these patients were actually receiving less narcotic analgesics than they could receive. Nurses were overly concerned about the possibility of addiction; choices of analgesic medications seemed irrational; and knowledge of the drugs was inadequate. Moreover, these nurses indicated that complete pain relief after surgery was not their major goal. In 2 sets of identical vignettes where the only difference was the sex of the patient, nurses selected less medication for pain for female patients (P < 0.001 and P < 0.025 respectively). Factors that nurses consider in administering and choosing postoperative analgesia are described.
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PMID:Postsurgical pain relief: patients' status and nurses' medication choices. 745 88


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