Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An open prospective observational study was performed, aiming to measure symptom severity following operative gynaecological laparoscopy and explore any associated factors. Women having concomitant procedures were excluded. Each woman had standardized analgesia, completed a symptom diary for 7 days postoperation, and had a standardized form completed by the surgeon detailing the operation. Back pain, nausea and vaginal pain were found to not be of clinical significance. Cutting major vessels, ligaments, vagina or ovary had major impacts on postoperative symptoms. In the presence of a standardized analgesic regimen, symptoms did not resolve for at least 5 days.
 ...
PMID:Factors associated with pain following operative laparoscopy: a prospective observational study. 952 98

To assess the efficacy of nortriptyline, a tricyclic antidepressant, as an analgesic in chronic back pain without depression, we conducted a randomized, double-blind, placebo-controlled, 8-week trial in 78 men recruited from primary care and general orthopedic settings, who had chronic low back pain (pain at T-6 or below on a daily basis for 6 months or longer). Of these 57 completed the trial; of the 21 who did not complete, four were withdrawn because of adverse effects. The intervention consisted of inert placebo or nortriptyline titrated to within the therapeutic range for treating major depression (50-150 ng/ml). The main outcome endpoints were pain (Descriptor Differential Scale), disability (Sickness Impact Profile), health-related quality of life (Quality of Well-Being Scale), mood (Beck Depression Inventory, Spielberger State Anxiety Inventory, Hamilton Anxiety/Depression Rating Scales), and physician rated outcome (Clinical Global Impression). Reduction in pain intensity scores was significantly greater for participants randomized to nortriptyline (difference in mean change 1.68, 95%-0.001, CI -3.36, P = 0.050), with a reduction of pain by 22% compared to 9% on placebo. Reduction in disability marginally favored nortriptyline (P = 0.055), but health-related quality of life, mood, and physician ratings of overall outcome did not differ significantly between treatments. Subgroup analyses of study completers supported the intent-to-treat analysis. Also, completers with radicular pain on nortriptyline (n = 5) had significantly (P < 0.05) better analgesia and overall outcome than did those on placebo (n = 6). The results suggest noradrenergic mechanisms are relevant to analgesia in back pain. This modest reduction in pain intensity suggests that physicians should carefully weigh the risks and benefits of nortriptyline in chronic back pain without depression.
 ...
PMID:A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain. 971 47

Women frequently use a mixture of analgesics to gain relief from the distress of childbirth and antenatally require information on their effectiveness and side-effects. One such example would be the reported long-term neonatal behavioural changes following systemic opioids such as pethidine. The most frequently reported maternal effects of epidural or spinal analgesia are prolonged symptoms of headache, backache and neurological sequelae. Large retrospective studies of postpartum symptomatology have focused on correlations with regional nerve blockade rather than on other more commonly used analgesics. Post-dural puncture headache is a recognized long-term complication of epidural nerve blockade. However, prospective studies have not confirmed any causal relationship between epidural analgesia and backache and neurological complications are five times more common after childbirth itself than after regional nerve blockade. Postpartum symptomatology describes significant morbidity in the community but its relationship to analgesia in labour is still to be proved.
 ...
PMID:The long-term effects of analgesia in labour. 1002 34

We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0-20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a time lag of 2-4 days between the first symptoms and institution of the appropriate treatment.
 ...
PMID:Paraplegia, a severe complication to epidural analgesia. 1002 36

Though uncommon, osteoporosis can occur in pregnancy or shortly after delivery. The most common feature is back pain, often severely disabling. Suspect osteoporosis if pain of sudden onset in the upper lumbar or thoracic spine is not relieved by simple analgesia, or if there is a noticeable loss of height. X-rays reveal low bone density and fractures of the vertebrae. 70% of cases occur in first pregnancies. Recurrence is unusual. Most cases resolve spontaneously; a minority cause disability lasting months or years. If osteoporosis is diagnosed, breast feeding should be discouraged because of its effect on bone mineral density. Anyone who has had osteoporosis of pregnancy is at risk of postmenopausal osteoporosis and should take medical advice.
 ...
PMID:Osteoporosis in pregnancy: more than postural backache. 1019 21

A comparative, multi-centre study, was conducted during June to December, 1996 to evaluate the efficacy and tolerance of Ketoprofen 100 mg Enteric Coated (EC) tablet and 100 mg intra-muscular injection; with that of Diclofenac Sodium 50 mg tablet and 75 mg intra-muscular injection in acute rheumatic and traumatic disorders. Total of 180 patients (90 per drug), were studied, 82 men and 98 women, between the ages of 18 and 75 years. The symptoms and the number of patients were backache 50, arthritis 64, frozen shoulder 32 and sprains 34. Pain was qualitatively assessed by visual analogue scale (VAS), XY pain index, pain at mobilization and the level of pain handicap. For pain (VAS 75-100) the treatment was initiated with an injectable bid, followed by tablets bid or tid. If the pain score on VAS was less than 75, tablets were given in a bid dosage. The duration of treatment was 15 days in each case. The overall complete relief of symptoms occurred in 25% (23/90) patients with Ketoprofen and in 10% (9/90) diclofenac sodium. Moderate to mild relief was found in 75% (67/90) cases with Ketoprofen and 87% (78/90) with diclofenac sodium. No pain relief was seen in 3% (3/90) with diclofenac sodium, as against no failure in pain relief in the ketoprofen group. Tolerance was found as excellent-good for ketoprofen in 72% (65/90) with diclofenac sodium in 50%, moderate to poor for ketoprofen in 28% (35/90) and with diclofenac sodium in 50% (45/90). Our results indicate that ketoprofen compared to diclofenac sodium is efficacious in acute rheumatic and traumatic injuries. Ketoprofen injection, compared to diclofenac sodium was found to be more effective in providing analgesia.
 ...
PMID:Study of efficacy and tolerance of ketoprofen and diclofenac sodium in the treatment of acute rheumatic and traumatic conditions. 1053 72

To understand the relative efficacy of noradrenergic and serotonergic antidepressants as analgesics in chronic back pain without depression, we conducted a randomized, double-blind, placebo-control head-to-head comparison of maprotiline (a norepinephrine reuptake blocker) and paroxetine (a serotonin reuptake blocker) in 103 patients with chronic low back pain. Of these 74 completed the trial; of the 29 who did not complete, 19 were withdrawn because of adverse effects. The intervention consisted of an 8-week course of maprotiline (up to 150 mg daily) or paroxetine (up to 30 mg daily) or an active placebo, diphenhydramine hydrochloride (up to 37.5 mg daily). Patients were excluded for current major depression. Reduction in pain intensity (Descriptor Differential Scale scores) was significantly greater for study completers randomized to maprotiline compared to placebo (P=0.023), and to paroxetine (P=0.013), with a reduction of pain by 45% compared to 27% on placebo and 26% on paroxetine. These results suggest that at standard dosages noradrenergic agents may provide more effective analgesia in back pain than do selective serotonergic reuptake inhibitors.
 ...
PMID:Effects of noradrenergic and serotonergic antidepressants on chronic low back pain intensity. 1120 64

Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anaesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthetic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).
 ...
PMID:[Indications for central versus peripheral regional anesthesia]. 1092 50

We report the case of a 19-year-old girl admitted to the hospital with a 2-month history of back pain and a 1-week history of severe weakness, who underwent a diagnostic lumbar puncture which was swiftly followed by acute neurologic deterioration requiring ventilation. She was subsequently shown to have an epidural abscess extending from the second cervical to the fifth lumbar vertebrae. She had received uneventful epidural analgesia for childbirth 14 months previously. The case is unusual in both the acute deterioration following lumbar puncture, and also in the length of time from epidural siting to abscess formation, if this were indeed the source of the infection.
 ...
PMID:Acute neurologic deterioration following lumbar puncture in an epidural abscess occurring 14 months after epidural catheter placement. 1114 86

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. The problem with spinal epidural abscesses is not treatment, but early diagnosis - before massive neurological symptoms occur" (Strohecker and Grobovschek 1986).
 ...
PMID:Spinal epidural abscess: a meta-analysis of 915 patients. 1115 48


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>