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)

Given the difficulty of obtaining traditionally illicit drugs, consumption is turning towards less restricted products. We report the case of an 18-year-old man, who after inhaling xylazine (a non-narcotic sedative used in veterinary medicine for analgesia, hypnosis and muscle relaxation) presented with an episode of chills and dizziness followed by sweating, gait instability, palpitations and two episodes of syncope with bradycardia and hypotension. Ten cases of toxicity caused by xylazine consumption by oral and parenteral administration (intramuscular, subcutaneous, and intravenous) have been documented in humans. In these cases, consumption was either involuntary or for suicidal or homicidal purposes, or used as an agent of drug abuse, occasionally resulting in death. We present the second documented case of toxic effects of drug abuse with inhalated xylazine.
 ...
PMID:Drug abuse with inhalated xylazine. 1297 9

Adverse and analgesic effects of acupuncture during the second and third trimesters of pregnancy were studied retrospectively in an observational study including 167 consecutive patients with lower back pain, pelvic pain, or both. In each patient acupuncture was given on at least two different occasions by three manual stimulations of two or more acupuncture or tender points, mainly LR-3 and LI-4 together with local tender points, at 15-min intervals. Possible adverse and analgesic effects were assessed by the midwife responsible for the acupuncture given in each patient. There were no abortions and no influence on the delivery course of the infants, but transient premature labor was observed during the fourth stimulation carried out in the 15th gestational week in one woman. Other possible adverse effects, like transient dizziness or tiredness, were reported in 35 patients (21%). Analgesia, as assessed by midwives involved, was good or excellent in 72% of patients. Acupuncture seems to be safe and effective for pain relief in lower back pain, pelvic pain, or both during the second and third trimesters of pregnancy. Nevertheless, prospective randomized studies are needed to confirm these findings.
 ...
PMID:Acupuncture for lower back and pelvic pain in late pregnancy: a retrospective report on 167 consecutive cases. 1510 52

Studies addressing pain management after pediatric spinal fusion surgery have focused on the use of patient-controlled or epidural analgesia during the immediate postoperative period. Controlled-release (CR) analgesics have been found to be safe and effective in adults. The purpose of this study was to describe the use of oxycodone-CR in pediatric patients after the immediate postoperative period. A retrospective chart review of 62 postoperative spinal fusion patients (10-19 years) was conducted. The mean initial oxycodone-CR dose was 1.24 mg/kg/day. The mean ratio of conversion from parenteral morphine equivalents to oxycodone-CR was 1:1. Mean pain scores decreased from 4.2/10 to 3.7/10 with the transition to oxycodone-CR. Common side effects included dizziness, constipation, and nausea. Oxycodone-CR was used for an average of 13.3 days, which included an average wean time of 6 days. Results of this study demonstrate safe and effective use of oxycodone-CR in the pediatric spinal fusion population.
 ...
PMID:Controlled-release oxycodone for the management of pediatric postoperative pain. 1511 83

Women undergoing general anesthesia for breast surgery are at particular risk of postoperative nausea and vomiting. In a randomized, double-blinded, placebo-controlled trial, 90 patients scheduled for breast surgery, aged 33-63 years, received intravenously placebo, 3 mg granisetron, or 0.3 mg ramosetron (n = 30 of each) at the end of surgical procedure. A standard general anesthetic technique and postoperative analgesia were used. Emetic episodes and safety assessment were performed during 0-24 hours and 24-48 hours after anesthesia. The rate of patients experiencing emetic symptoms (nausea, retching, vomiting) 0-24 hours after anesthesia was 17% with granisetron (P = 0.013) and 10% with ramosetron (P = 0.002) compared with placebo (47%); the corresponding rate 24-48 hours after anesthesia was 27% (P = 0.032) and 7% (P = 0.001), compared with placebo (53%). In the 24-48 hours after anesthesia, there were fewer emetic episodes in patients who had received ramosetron than in those who had received granisetron (P = 0.039). The severity of nausea was less in patients receiving ramosetron than in those receiving granisetron (P = 0.044). Zero to 24 hours after anesthesia, no difference in the rate of patients having emetic symptoms and the severity of nausea was observed between the granisetron and ramosetron groups. The most common reported adverse events were headache and dizziness, and there were no difference in the incidence of adverse events due to the study drug among the 3 groups. In conclusion, prophylactic therapy with ramosetron is more effective than that with granisetron for the long-term prevention of postoperative nausea and vomiting in women undergoing general anesthesia for breast surgery.
 ...
PMID:Benefits and risks of granisetron versus ramosetron for nausea and vomiting after breast surgery: a randomized, double-blinded, placebo-controlled trial. 1526 19

The aim of this study was to compare the clinical efficacy of electro-acupuncture (EA) with the combination of tramadol+midazolam (TM) for pain relief during outpatient extracorporeal shockwave lithotripsy (ESWL). A total of 35 patients (20 men, 15 women) with stones located in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with a third generation lithotriptor (Stone Lith, smart PCK) after receiving either EA (n=17) or TM (n=18) for sedation and analgesia. EA treatment was applied to patients by the same licensed acupuncturist 30 min prior to ESWL in group EA. Tramadol (1.5 mg/kg) 30 min before the start of lithotripsy and midazolam (0.06 mg/kg) 5 min prior to ESWL were given as a sedo-analgesic intravenously to group TM. During ESWL, blood pressure, heart rate, pain and sedation levels were measured at baseline and every 15 min thereafter. The pain intensity perceived during lithotripsy was evaluated using a visual analog scale (VAS). There was no statistical differences in the diameters of the stones and age of the patients between groups (P=0.590; P=0.568, respectively). In the EA group, the median of maximum energy level achieved was 16.0 kV (range 10-23 kV), while it was 18.0 kV (range 10-20 kV) in the TM group. There was no statistically significant difference between the maximum energy levels applied to the patients during ESWL (P=0.613). The median numbers of shockwaves were 2,114 (range 1,100-3,800) and 2,200 (range 1,500-3,200) in the EA and TM groups, respectively. In the TM group, the numbers of shockwaves used were higher than in group EA during ESWL. However, this difference was not significant (P=0.732). VAS scores were consistently lower in the EA group compared with the TM group throughout the ESWL procedure. The median VAS score was 5.0 (range 1-10) in the EA group while it was 8.0 (range 2-10) in the TM group. The patients who underwent EA had lower median scores of VAS than patients who took only conservative treatment, but this difference was not significant (P=0.245). When both groups were compared for stone-free rates, no significant difference was found [82.3% (14/17) for group EA, 88.8% (16/18) for group TM] (P=0.658). Durations of ESWL procedures were similar in both groups [median 27.4 min (range 15.7-34.3) in group EA vs 27.1 min (range 16.1-33.6) in group TM] (P=0.517). No side effects was seen in any patient who received EA. Side effects such as mild orthostatic hypotension and dizziness occurred in patients given sedo-analgesia, but these were not severe enough to require any patient to be excluded from the study. Our study shows that EA is an effective method for inducing sedation with analgesia without any demonstrable side effects.
 ...
PMID:Effectiveness of electro-acupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy. 1597 Oct 87

Opiates are the primary treatment for pain management in cancer patients reporting moderate to severe pain, and are being increasingly used for non-cancer chronic pain. However, prolonged administration of opiates is associated with significant problems including the development of antinociceptive tolerance, wherein higher doses of the drug are required over time to elicit the same amount of analgesia. High doses of opiates result in serious side effects such as constipation, nausea, vomiting, dizziness, somnolence, and impairment of mental alertness. In addition, sustained exposure to morphine has been shown to result in paradoxical pain in regions unaffected by the initial pain complaint, and which may also result in dose escalation, i.e. 'analgesic tolerance'. A concept that has been gaining considerable experimental validation is that prolonged use of opioids elicits paradoxical, abnormal pain. This enhanced pain state requires additional opioids to maintain a constant level of antinociception, and consequently may be interpreted as antinociceptive tolerance. Many substances have been shown to block or reverse antinociceptive tolerance. A non-inclusive list of examples of substances reported to block or reverse opioid antinociceptive tolerance include: substance P receptor (NK-1) antagonists, calcitonin gene-related peptide (CGRP) receptor antagonists, nitric oxide (NO) synthase inhibitors, calcium channel blockers, cyclooxygenase (COX) inhibitors, protein kinase C inhibitors, competitive and non-competitive antagonists of the NMDA (N-methyl-D-aspartate) receptor, AMPA (alpha-amino-3-hydroxy-5-methyl-4 isoxazolepropionic acid) antagonists, anti-dynorphin antiserum, and cholecystokinin (CCK) receptor antagonists. Without exception, these substances are also antagonists of pain-enhancing agents. Prolonged opiate administration indeed induces upregulation of substance P (SP) and calcitonin gene-related peptide (CGRP) within sensory fibers in vivo, and this is accompanied by an enhanced release of excitatory neurotransmitters and neuropeptides from primary afferent fibers upon stimulation. The enhanced evoked release of neuropeptides is correlated with the onset of abnormal pain states and opioid antinociceptive tolerance. Importantly, the descending pain modulatory pathway from the brainstem rostral ventromedial medulla (RVM) via the dorsolateral funiculus (DLF) is critical for maintaining the changes observed in the spinal cord, abnormal pain states and antinociceptive tolerance, because animals with lesion of the DLF did not show enhanced evoked neuropeptide release, or develop abnormal pain or antinociceptive tolerance upon sustained exposure to opiates. Microinjection of either lidocaine or a CCK antagonist into the RVM blocked both thermal and touch hypersensitivity as well as antinociceptive tolerance. Thus, prolonged opioid exposure enhances a descending pain facilitatory pathway from the RVM that is mediated at least in part by CCK activity and is essential for the maintenance of antinociceptive tolerance.
 ...
PMID:Is paradoxical pain induced by sustained opioid exposure an underlying mechanism of opioid antinociceptive tolerance? 1621 2

Total knee arthroplasty (TKA) is associated with significant postoperative pain. Adequate analgesics and techniques are required for early mobilization, continuous passive motion and intensified physical therapy as well as for high-quality postoperative analgesia.However, in the immediate postoperative setting the excessive nociceptive input can be blocked by using doses which are most frequently associated with adverse effects like dizziness, nausea and vomiting, sedation and risk of respiratory depression. The use of peripheral nerve blocks is recommended after orthopaedic surgery. After TKA, the continuous "3 in 1 nerve block" has been proven to be more effective than conventional patient controlled intravenous opioid therapy as well as than epidural analgesia accompanied by side effects. Postoperative analgesic techniques influence surgical outcome, duration of hospitalization and re-convalescence. The use of regional analgesia after TKA may initially lead to higher costs but it is counterbalanced by a reduction in morbidity and mortality, decrease in hospitalization, improved re-convalescence and a better functional outcome.
 ...
PMID:[Perioperative pain therapy for knee endoprosthetics]. 1636 38

Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.
 ...
PMID:The effect of preoperative ketorolac on WBC response and pain in laparoscopic surgery for endometriosis. 1638 58

Epidural analgesia remains the "gold standard" of pain relief after total knee replacement. However, peripheral nerve block is gaining popularity because the incidence of side effects may be reduced. Our study tests this postulate. Sixty patients were prospectively randomized to receive either epidural infusion or combined continuous femoral and sciatic nerve blocks. Ropivacaine 2 mg/mL plus sufentanil 1 mug/mL was given either epidurally or through the femoral nerve catheter, and ropivacaine 0.5 mg/mL was given through the sciatic nerve catheter using elastomeric infusers (delivering 5 mL/h for 55 h). The primary outcome measure was the total incidence of side effects (urinary retention and moderate to severe degrees of dizziness, pruritus, sedation, and nausea/vomiting on the first postoperative day). Intensity of motor blockade, pain at rest and on mobilization, and rehabilitation indices were also registered for 72 h. One or more side effects were present in 87% of patients in the epidural group whereas only 35% of patients in the femoral and sciatic block groups were affected on the first postoperative day (P = 0.0002). Motor blockade was more intense in the operated limb on the day of surgery and the first postoperative day in the peripheral nerve block group (P = 0.001), whereas the non-operated limb was more blocked in the epidural group on the day of surgery (P = 0.0003). Pain on mobilization was well controlled in both groups and there were no differences in the length of hospital stay. Rehabilitation indices were similar. The results demonstrate a reduced incidence of side effects in the femoral/sciatic nerve block group than in the epidural group on the first postoperative day.
 ...
PMID:A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. 1757 1

This is the first randomized controlled trial that tests the analgesic efficacy of transdermally delivered opioids in healthy volunteers and that assesses the sensitivity of different experimental pain tests to detect analgesia in this setting. Transdermal application of the full agonist fentanyl (TDF: 12.5 or 25 microg/h) and the partial agonist buprenorphine (TDB: 35 microg/h) was compared in three experimental models of acute pain (heat pain, painful electrical stimulation, cold pressor) in a double-blind, randomized, placebo-controlled, 4-arm crossover study with 20 healthy subjects (15 men, 5 women). Patches were administered for 72 h and pain levels measured at baseline and 24 and 72 h, with an 11-day wash-out. The cold pressor test was most sensitive to analgesic effects, with significant reductions in area under the pain intensity curve for all active compounds at 24 h (average reductions: 14% TDF 12.5 microg/h, 35% TDF 25 microg/h, 43% TDB 35 microg/h). There were significant increases in heat pain threshold for TDF 25 microg/h and TDB 35 microg/h. Painful electrical stimulation failed to demonstrate an analgesic effect. The magnitude of analgesia in the cold pressor model showed some correlation with TDF dosage and comparable effects for the full agonist fentanyl and the partial agonist buprenorphine. We conclude that the cold pressor test was most sensitive to analgesic effects in healthy subjects and that a transdermal dose of 12.5 microg/h fentanyl achieved significant pain reduction compared with placebo. Subjects experienced opioid-typical AEs including dizziness, nausea and vomiting. No serious AEs occurred.
 ...
PMID:Differential sensitivity of three experimental pain models in detecting the analgesic effects of transdermal fentanyl and buprenorphine. 1727 8


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