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

The management of patients with chronic pain is a common clinical challenge. Indeed, chronic pain is often inadequately controlled in patients with cancer and in those with non-cancer chronic pain. Because of the complex nature of chronic pain, successful long-term treatment is more difficult than for acute pain. Most often acute pain is nociceptive, whereas chronic pain can be nociceptive (i.e., in response to noxious stimuli), neuropathic (i.e., initiated by a primary lesion or dysfunction in the nervous system) or mixed in origin. Opioids are the current standard of care for the treatment of moderate or severe nociceptive pain. Opioids mediate their actions by binding and activating receptors both in the peripheral nervous system and those that are found in inhibitory pain circuits that descend from the midbrain to the spinal cord dorsal horn. Opioid agonists exert a number of physiological responses including analgesia, which increases with increasing doses. The use of opioids to manage pain in patients with cancer is well accepted. The WHO step-wise algorithm for analgesic therapy based on pain severity reserves the use of opioid therapy for moderate and severe pain. The WHO algorithm has proven to be highly effective for the management of cancer pain. However, the use of opioids to treat patients with chronic non-cancer pain is controversial because of concerns about efficacy and safety, and the possibility of addiction or abuse. The results of clinical surveys and retrospective case series involving patients with non-cancer chronic pain have been inconsistent in regard to resolving these controversial issues. The oral route of drug administration is most appropriate for patients receiving opioids; although rectal, transdermal and parenteral routes of administration are used in specific situations. For continuous chronic pain, opioids should be administered around-the-clock and several long-acting formulations are available that require administration only once or twice daily. Opioid doses should be titrated according to agent-specific schedules to maximise pain relief and maintain tolerability. Adverse effects include constipation, nausea and vomiting, sedation, cognitive impairment and respiratory depression. Tolerance to the analgesic and adverse effects as well as physical dependence, which causes withdrawal symptoms upon discontinuance, may occur with opioid use. Estimates of addiction rates among patients with chronic non-cancer pain range from 3.2 to 18.9%. Successful pain treatment and symptom management is an attainable goal for the majority of patients with chronic pain. Further controlled clinical trials are needed to define the role of opioid therapy in chronic non-cancer pain, and to establish criteria for patient selection and specific treatment algorithms.
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PMID:Responsible prescribing of opioids for the management of chronic pain. 1248 20

Acupuncture is an ancient method of healing coming from the Chinese traditional medicine. In Western medical science it is accepted and proven method of healing based on neurophysiological, neurobiochemical and neuroendocrinological research. Acupuncture as a method of healing has been accepted also by the World Health Organisation with strongly defined indications and contraindications. Indications for acupuncture included: acute and chronic pain syndrome, allergic disorders, addiction, psychosomatic and psychosexual illness and acupuncture analgesia/anaesthesia. It is very important that there are no harms of acupuncture treatment, although mild side effects are possible. Acupuncture is based on characteristics of meridian points, afferent nerve information evoked by acupuncture stimulation, inhibitory mechanisms in the central nervous system, endogenous antinociceptive substances concerned with acupuncture analgesia and descending mechanisms of antinociceptive control.
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PMID:[New findings in acupuncture therapy]. 1261 44

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Addiction among cancer patients on strong analgesics is a rare but difficult management challenge. The case is presented of a 28-year-old woman with breast cancer and painful bone metastases, suffering with dysfunctional social chaos and addicted to Percocet (oxycodone and acetaminophen). Having broken the trust of her health care team, trust was rebuilt by incorporating the substance abuse clinic and enforcing a contractual agreement. With open and honest support, the team was able to both care for and empower the patient. Issues of trust, liability, opioid tolerance, and barriers to optimal analgesia for cancer pain are discussed.
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PMID:Trust violated: analgesics for addicts. 1269 44

Although opioids provide effective analgesia, largely unsubstantiated concerns about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use. As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments, and that instituting an appropriate dosing regimen can minimise withdrawal symptoms. Early studies had suggested that addiction might result from chronic opioid therapy, though more recent data indicate a low risk in patients with no history of drug abuse. New treatment regimens may also reduce the risk of tolerance, physical dependence and addiction. Long-acting preparations, such as transdermal fentanyl and possibly some forms of other slow release opioids, which maintain constant opioid concentrations in the plasma, minimise the occurrence of the 'between-dose' symptoms such as withdrawal and opioid-induced euphoria. This review discusses the development of tolerance, physical dependence and addiction during opioid therapy, and the influence of these factors on the choice of treatment.
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PMID:Opioid tolerance and dependence: an inevitable consequence of chronic treatment? 1270 45

The use of opioid medications for analgesia is associated with concerns about adverse side effects and the potential for development of physical dependence, tolerance, or addiction. Pain often is undertreated, which may provoke drug-seeking behavior by patients. Physicians must assess requests for more pain medication as stemming from either undertreatment of pain, development of physical tolerance, or addiction. Important tools for addiction screening include the use of questionnaires, patient interviews, and lab tests. In this study, the physiological and behavioral consequences of chronic pain and its treatment with opioids, along with guidelines for prescribing opioid pain medication, are presented.
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PMID:Addiction and pain. 1285 61

Health care professionals face numerous challenges in assessing and treating chronic pain patients with a substance abuse history. Societal perspectives on morality and criminality, imprecise addiction terminology, litigation fears, and genuine concern for a patient's relapse into or escalation of substance abuse result in unrelieved and under-relieved pain in precisely the population that--as increasing evidence indicates--is generally intolerant of pain. Before adequate pain relief can occur in chronic pain patients with current or past substance abuse issues, it is imperative that the clinician recognize addiction as a disease with known symptoms and treatments. Further, the clinician must realize the difference between true addiction and similar conditions, so the patient's condition can be monitored and regulated properly. Although clinicians are often reluctant to medicate with opioids, it is always best to err on the side of adequate pain relief. Withholding opioids from chronic pain patients in order to avoid the onset or relapse of addiction is contrary to the growing body of evidence and results only in unnecessary pain for the patient. Chronic pain in patients with a history of addictive disease can be treated successfully with opiate analgesia; it just requires caution and careful monitoring of medication use. If addiction is treated as a known risk when providing opioid analgesia to a recovering addict, its development can be minimized while pain relief is provided.
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PMID:Chronic pain, substance abuse and addiction. 1456 7

Regulators of G protein signaling (RGS) are a family of proteins known to accelerate termination of effector stimulation after G protein receptor activation. RGS9-2, a brain-specific splice variant of the RGS9 gene, is highly enriched in striatum and also expressed at much lower levels in periaqueductal gray and spinal cord, structures known to mediate various actions of morphine and other opiates. Morphine exerts its acute rewarding and analgesic effects by activation of inhibitory guanine nucleotide-binding regulatory protein-coupled opioid receptors, whereas chronic morphine causes addiction, tolerance to its acute analgesic effects, and profound physical dependence by sustained activation of these receptors. We show here that acute morphine administration increases expression of RGS9-2 in NAc and the other CNS regions, whereas chronic exposure decreases RGS9-2 levels. Mice lacking RGS9 show enhanced behavioral responses to acute and chronic morphine, including a dramatic increase in morphine reward, increased morphine analgesia with delayed tolerance, and exacerbated morphine physical dependence and withdrawal. These findings establish RGS9 as a potent negative modulator of opiate action in vivo, and suggest that opiate-induced changes in RGS9 levels contribute to the behavioral and neural plasticity associated with chronic opiate administration.
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PMID:Essential role for RGS9 in opiate action. 1459 21

A variety of analgesics are used for the treatment of acute and chronic pain in different disease states. A narcotic or a non-narcotic analgesic that does not cause respiratory depression and addiction is needed. In Ayurveda a large number of indigenous drugs have been mentioned possessing analgesic properties (e.g. Guggul, Erand, Rasna, Bhringaraj, Methika, Palandu and Prasikayavani). The present experimental research work was undertaken to determine the analgesic activity of the total ethanol extract of Eclipta alba, and also the isolated alkaloids of Eclipta alba in albino mice by using standard experimental models such as the tail clip method, the tail flick method and the acetic acid induced writhing response. The results from this study show that both the ethanol extract as well as the total alkaloids produce good analgesic activity in all the different models of analgesia used. The total alkaloidal fraction was the most efficacious in all models tested.
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PMID:Analgesic studies on total alkaloids and alcohol extracts of Eclipta alba (Linn.) Hassk. 1502 60

We examined whether pre-operative information benefited patients receiving patient-controlled analgesia (PCA) after major surgery. We investigated whether patients felt better informed about PCA and also whether pre-operative information altered the use of PCA, the adequacy of pain relief, worries about addiction and safety, and knowledge of side-effects. We investigated the effectiveness of information provided in two ways, namely by a patient-determined leaflet or an interview by a trained nurse from the pain team, compared with routine pre-operative information. We studied 225 patients, 75 in each group. Patients in the leaflet group were better informed about PCA, became familiar with using PCA more quickly and were less confused about PCA than the control group. However, there were no effects on pain relief, worries about addiction and safety, and knowledge of side effects. The pre-operative interview resulted in no benefits. Our findings indicate that the detailed provision of pre-operative information failed to improve patients' experiences of PCA.
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PMID:Pre-operative information and patient-controlled analgesia: much ado about nothing. 1502 6

G protein-coupled receptors (GPCRs) have proven to be the most highly favorable class of drug targets in modern pharmacology. Over 90% of nonsensory GPCRs are expressed in the brain, where they play important roles in numerous neuronal functions. GPCRs can be desensitized following activation by agonists by becoming phosphorylated by members of the family of G protein-coupled receptor kinases (GRKs). Phosphorylated receptors are then bound by arrestins, which prevent further stimulation of G proteins and downstream signaling pathways. Discussed in this review are recent progress in understanding basics of GPCR desensitization, novel functional roles, patterns of brain expression, and receptor specificity of GRKs and beta arrestins in major brain functions. In particular, screening of genetically modified mice lacking individual GRKs or beta arrestins for alterations in behavioral and biochemical responses to cocaine and morphine has revealed a functional specificity in dopamine and mu-opioid receptor regulation of locomotion and analgesia. An important and specific role of GRKs and beta arrestins in regulating physiological responsiveness to psychostimulants and morphine suggests potential involvement of these molecules in certain brain disorders, such as addiction, Parkinson's disease, mood disorders, and schizophrenia. Furthermore, the utility of a pharmacological strategy aimed at targeting this GPCR desensitization machinery to regulate brain functions can be envisaged.
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PMID:Desensitization of G protein-coupled receptors and neuronal functions. 1521 28


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