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

Ciramadol, an agonist-antagonist analgesic (in intramuscular doses of 30 and 60 mg) was compared with 10 mg of morphine and placebo in a double-blind, parallel study in 160 patients with postoperative pain. The patients were assigned randomly to one of the four treatment groups and could receive a dose of the medication every 3 hr as needed for 48 hr; a maximum of six doses was allowed in a 24-hr period. Formal efficacy assessments using standard pain intensity and pain relief scales were restricted to the initial dose period. The three active therapy groups had significantly (P less than 0.05) higher analgesia scores than the placebo group on all efficacy scales. The mean cumulative efficacy scores for the initial dose evaluation were highest for 60 mg of ciramadol; however, patients' overall evaluations of therapy were highest in the morphine group. Nausea and vomiting were the most frequent adverse experiences (15-25% incidence); however, there were no statistically significant differences between groups in their occurrence. A greater percentage (P less than 0.05) of patients reported skin reactions in the 60 mg ciramadol group (15%) than in the 30 mg ciramadol (0%) and placebo (0%) groups. Sedation was slightly higher with the active therapies than with placebo. Changes in vital signs were minimal. It is concluded that 60 mg of ciramadol compares favorably with 10 mg of morphine as a postoperative analgesic.
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PMID:A double-blind comparison of multiple intramuscular doses of ciramadol, morphine, and placebo for the treatment of postoperative pain. 390 21

Important demographic realities may have an impact on a woman's end-of-life options. The vast majority of Americans age 85 and older are women, and they are much more likely than their male counterparts to be widowed, live alone, live below the poverty line, or die in a nursing home. Although pain is not inevitable among the terminally ill, it is vastly undertreated, and elderly women are at heightened risk for undertreatment. Pain and other physical and psychological symptoms should be treated aggressively, according to well-delineated principles of palliative care, including avoiding painful, unwanted treatments that only serve to prolong the dying process. Patients have the right to refuse unwanted treatment, even if this would result in death, and patients who lack decisional capacity can refuse these treatments through an authorized surrogate decision maker. Formal, written advance directives are particularly important for older women, who may be the group least likely to desire life-sustaining treatment. Dying patients also have the right to receive adequate analgesia or sedation for intractable symptoms, even if it might hasten death. Societal and legal consensus has been reached that forgoing treatment and receiving adequate symptom control are permissible, while significant moral and legal debate over the permissibility of euthanasia and assisted suicide continues.
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PMID:End-of-life issues for very elderly women: incurable and terminal illness. 924 5

Peripheral nerve blockade is gaining popularity as an analgesic option for both upper or lower limb surgery. Published evidence supports the improved efficacy of regional techniques when compared to conventional opioid analgesia. The incidence of neurological deficit after surgery associated with peripheral nerve block is unclear. This paper reports on neurological outcomes occurring after 1065 consecutive peripheral nerve blocks over a one-year period from a single institution. All patients receiving peripheral nerve blocks for surgery were prospectively followed for up to 12 months to determine the incidence and probable cause of any persistent neurological deficit. Formal independent neurological review and testing was undertaken as indicated. Thirteen patients reported symptoms that warranted further investigation. A variety of probable causes were identified, with peripheral nerve block being implicated in two cases (one resolved at nine months and one remaining persistent). Overall incidence of block-related neuropathy was 0.22%. Persistent postoperative neuropathy is a rare but serious complication of surgery associated with peripheral nerve block. Formal follow-up of all such blocks is recommended to assess causality and allow for early intervention.
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PMID:Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks. 1802 86

Publication bias and scientific fraud are major threats to valid guidelines, especially guideline recommendations. Both topics have so far not been investigated systematically. It is assumed that guideline authors underestimate the potential influences on the validity of their recommendations. On the basis of questions and the example of depression guidelines the potential influence of publication bias will be outlined and discussed. Formal consensus processes which are used to phrase and grade recommendations might protect guideline recommendations against the influence of publication bias and might thereby imply one major difference to systematic reviews. Based on the examples of Werner Bezwoda and Scott S. Reuben, who fabricated studies in breast cancer and analgesia, it can be estimated that scientific fraud has no or only minimal effect on the recommendations given in clinical guidelines. Either the fraudulent work is in line with other (true) studies, which consequently leads only to an overestimation of the quantity of evidence in the guideline. Or the faked study is the only piece of evidence available, which guideline authors would then regard as an insufficient basis for a clinical recommendation. Although publication bias and scientific fraud had no influence on the example guidelines, guideline authors should be aware of this possibility and control this problem by systematically reviewing the evidence, critically appraising primary studies, and formulating prudent recommendations.
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PMID:[Fraudulent studies, unpublished data and their effect on the development of guidelines and evidence-based recommendations]. 2070 Nov 7