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

The purpose of this study was to assess the efficacy and side effects of morphine sulfate controlled-release (MSCR) in patients with cancer pain who had previously required narcotic analgesia. The study design included an attempt at conversion of 30 patients from the previously required narcotic analgesic to around the clock (ATC) 4-h dosing of morphine sulfate immediate-release (MSIR) that would provide satisfactory analgesia. All patients controlled on MSIR at 4-h ATC were then successfully converted to MSCR and had an appropriate dosage regimen established. The patients were subsequently maintained for 4 weeks on MSCR, with the majority of patients adhering to a 12-h schedule at two-thirds the total daily morphine dose of the q 4 h regimen. Twenty-four patients completed this dosage range study. Five dropouts were not related to use of MSCR, while one patient was discontinued because of nausea following administration of both MSIR and MSCR. Patients preferred the analgesic relief of MSCR over their previous narcotic regimen. Half the patients manifested fewer side-effects compared with their prestudy narcotics. No patients had greater side-effects with MSCR. These findings support the efficacy and safety of MSCR at appropriate dosage for the prolonged relief of cancer pain.
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PMID:Dosage range study of morphine sulfate controlled-release. 243 Apr 48

Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology and developed a system in which patients with severe pain received a continuous narcotic infusion, along with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95% received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection and respiratory depression. Progressive pain due to either advancing disease or development of drug tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients with pain related to malignancy can be managed well with this system; and (3) pain control programs can be designed, implemented, and evaluated in the private practice setting.
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PMID:Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117 patients. 247 20

In order to assess the respective contribution of opioid receptors to the behavioral and physiological characteristics of lactating animals, we challenged mice with morphine at different phases of the lactation period. Sensitivity to morphine's effects on aggressive behavior, pup care, pain response and body temperature were measured. Lactating mice were assigned to 1 of the 3 weeks of lactation and to 1 of 5 doses of morphine sulfate (0, 1, 3, 6, 10 mg/kg IP). After morphine administration, rectal temperature and tail flick were assessed. Behavior towards three pups was observed for 5 min, followed by an aggression test with a female intruder. Morphine significantly increased the latency to retrieve pups and decreased aggressive behavior at doses that do not decrease motoric activity. Compared to virgin mice, lactating females are less sensitive to the analgesic actions of morphine but similarly sensitive to its hypothermic properties. The fact that virgin and lactating females can be distinguished on the basis of their sensitivity to morphine-induced analgesia suggests that lactating animals undergo functionally relevant changes in opioid regulation of pain sensitivity. Furthermore, morphine's specific and potent inhibition of pup retrieval supports the hypothesis that decreased opioid peptide activity is important for the expression of certain postpartum behaviors.
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PMID:Morphine effects on maternal aggression, pup care and analgesia in mice. 249 61

Microinjection of morphine sulfate into dorsal raphe, ventrolateral central gray and dorsolateral central gray inhibits spinal nociceptive reflexes. The effects of the blockade of spinal opioid, adrenergic, and serotonergic receptors by intrathecal injection of naloxone, yohimbine and methysergide, respectively, on inhibition of the tail-flick response induced by morphine microinjected into dorsal raphe, ventrolateral central gray and dorsolateral central gray were studied. Naloxone (20 micrograms) given intrathecally effectively antagonized inhibition of the tail-flick response induced by morphine (4 micrograms) given into dorsal raphe and ventrolateral central gray, but not dorsolateral central gray. On the other hand, intrathecal injection of yohimbine (30 micrograms) antagonized inhibition of the tail-flick response induced by morphine given into ventrolateral central gray and dorsolateral central gray, but not dorsal raphe. Intrathecal injection of prazosin (30 micrograms) did not antagonize inhibition of the tail-flick response induced by morphine given into dorsal raphe or lateral central gray. Intrathecal injection of methysergide (30 micrograms) only partially antagonized inhibition of the tail-flick response induced by morphine given into dorsal raphe, but not ventrolateral central gray and dorsolateral central gray. It is concluded that the analgesia induced by morphine injected into dorsal raphe is mediated by spinal opioid receptors but not by spinal alpha 2-adrenergic receptors while the analgesia produced by morphine given into dorsolateral central gray is mediated by spinal alpha 2-adrenergic receptors. The analgesia induced by morphine given into ventrolateral central gray is mediated in part by both spinal alpha 2-adrenergic and opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Differential actions of the blockade of spinal opioid, adrenergic and serotonergic receptors on the tail-flick inhibition induced by morphine microinjected into dorsal raphe and central gray in rats. 255 62

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB. The analgesic requirement differed significantly between groups 1 (0.33 mg fentanyl) and 2 (0.15 mg fentanyl) and groups 3 (63.5 mg pentazocine) and 4 (31.5 mg pentazocine). There were also significant differences in circulatory responses. The maximum deviation from the initial value at the beginning of the operation in group 1 compared to group 2 was pulse rate + 28.7% vs + 2.4%, mean arterial pressure (Part) + 24.6% vs + 3.1%, and systolic pressure (Psyst) + 33% vs +/- 0%; group 3 compared to group 4: pulse rate + 16.4% vs + 3.2%, Part + 24.5% vs 0.0%, and Psyst + 26.5% vs + 196. The times of action of ICB extended from 7.54 h to 11.33 h for partial analgeisa, time to the first dose of analgesic from 12.3 h to 16.9 h (etidocaine 0.5% and 1% respectively without and with epinephrine). The mean blood levels after 100 mg bupivacaine-CO2 rose to 1.16 micrograms/ml after 5 min and reached a maximum after 15 min (1.29 micrograms/ml) as compared to 0.98 micrograms/ml after addition of ornithine-vasopressin. These values are very much higher than those after the use of bupivacaine-HCl solution. Etidocaine and bupivacaine-HCl have comparable durations of analgesia. Toxicologically, both substances can be applied safely with consideration of all pharmacological data for ICB. Of a total of 3,485 intercostal blockades, 2,775 were applied perioperatively (pre- and postoperatively); 265 were carried out for trauma patients (rib fractures) and 445 for therapeutic indications (herpes zoster neuralgia, tumor pain, costovertebral pain). In 8 blocks 10% ammonium sulfate, in 4 blocks absolute alcohol, and in 19 blocks 5% phenol were used for neurolysis. In 2 cases a marginal pneumothorax was seen, which was resorbed spontaneously (0.06%). Altogether 16,270 single intercostal nerves were blocked. Single-session intercostal blockade can be combined as unilateral analgesia with general anesthesia. This combination is characterized by stable circulatory conditions with avoidance of hypertensive reactions. The long-lasting analgesia allows early mobilization and physiotherapy both postoperatively and posttraumatically in patients with unilateral thoracic and abdominal pain.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The single intercostal block--surgical and therapeutic indications]. 264 21

Oral morphine is increasingly recognized as the pharmacologic standard for cancer pain management. Yet for the primary care physician and oncologist alike, misconceptions of the safety and efficacy of oral morphine along with lack of recognized guidelines for use have often resulted in inadequate cancer pain therapy. Use of controlled-release oral morphine sulfate (MSC) requires additional guidelines for optimum analgesia. Proposed are ten principles of dosing oral morphine, especially MSC, which were followed in a clinical trial involving cancer patients. MSC dosed at 8-, 10-, and 12-hour intervals was compared with immediate-release morphine (IRMS) dosed every four hours, and with prestudy analgesics. Patients achieved satisfactory analgesia at daily doses (mean +/- SE) of 118.0 +/- 8.6 mg and 111.4 +/- 12.6 mg (P greater than .05) for IRMS and MSC, respectively. Dosing endpoints were determined by titration with IRMS and MSC to a minimal and equivalent amount of supplemental short-acting analgesic. Side effects were typical for opioids and tolerated except for one dropout on IRMS (nausea and constipation). The ten principles have been incorporated into a dosing scheme as a practical guide for MSC therapy.
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PMID:Principles of cancer pain management. Use of long-acting oral morphine. 264 96

A double-blind, double-dummy, crossover study compared oral controlled-release morphine sulfate (MS Contin tablets [MSC], Purdue Frederick, Norwalk, CT) every 12 hours, and immediate-release morphine sulfate (IRMS) tablets, every 4 hours, in 14 evaluable patients with chronic cancer pain. The test model described showed assay sensitivity for steady-state analgesia, requiring relatively few subjects to yield statistical significance in pharmacologic potency estimates. Initial doses were the calculated equivalents of about one third the previous opioid requirements or at least 30 mg MSC every 12 hours or 15 mg IRMS every 4 hours. This was generally subtherapeutic; hence, additional IRMS was available for break-through pain. Doses of MSC and IRMS were titrated upwards until the requirement for rescue IRMS was less than 20% of the total daily amount of morphine. In both study phases, the total dose of morphine increased significantly from the first day to the last, on which it was significantly (34%) higher for IRMS than MSC. Pain was significantly less intense and frequent in the last 24 hours of each treatment arm than in the first, and equally well controlled by both regimens. The two treatments were equipotent in a pharmacologic assay using dosages and pain scores. The requirement for rescue analgesia was similarly comparable for both treatments, decreasing significantly with upward dose titration. The few side effects experienced (one with MSC and three with IRMS) did not include serious reactions such as respiratory depression. It is concluded that MSC, 12-hourly, controls cancer pain as effectively and safely as IRMS on a 4-hour schedule. MS Contin exhibits a 12-hour duration of action as previously shown in other well-controlled trials. A problem of pain exacerbation at the start of each study phase was found to be associated with the design of this study. It may be resolved with a higher initial study dose and/or use of a patient-controlled analgesia device for parenteral rescue doses.
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PMID:Evaluation of a cancer pain model for the testing of long-acting analgesics. The effect of MS Contin in a double-blind, randomized crossover design. 272 May 81

Thirty-two patients (14 women and 18 men) whose age ranged between 15 and 76 were admitted on an emergency and anesthetized with propofol in view of various surgical interventions (9 appendectomies, 9 fractures, 5 wound healing, 6 abscess incisions, 2 corneal grafts and one complex trauma surgery) undergone 24 hours after their admission. Premedication included hydroxyzine 1.5 mg.kg-1, atropine sulfate 0.5 to 0.75 mg and pethidine 1 mg.kg-1 according to pain intensity and initial pathology. Narcosis was induced by 2.5 mg.kg-1 propofol injected intravenously. Propofol was then administered continuously at a dose of 9 mg.kg-1 in the first hour and of 4.5 mg.kg-1.h-1 in the following hours for 28 of the patients. Four patients undergoing short operations were given additional injections of one third of the initial dose. Analgesia and myorelaxation were obtained with fentanyl (0.16 +/- 0.06 mg) and vecuronium (9.3 +/- 4 mg). Narcosis proved to be very efficient. The side effects observed (13% myoclonia, 6% rash, 6% bradycardia, 0.3% pains at the time of injection) were similar to those quoted in the literature. Blood pressure stabilized after a short slight depression (13% to 18% of the standard values). Pulse remained regular. We can thus say that propofol is a good hypnotic drug for emergency anesthesia provided that its contra-indications especially shocks of cardiac or septic origin and hypovolemia, are carefully respected.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Propofol in emergency anesthesia]. 278 40

We studied the effects of two ovarian steroid treatments that induce proestrous-like surges in LH secretion on responsiveness to morphine sulfate (MS), as measured by induced hypothermic, antinociceptive, behavioral, and LH secretory changes. Ovariectomized rats received no steroids (OVX), 7.5 micrograms estradiol benzoate 2 days before the experiment (EB), or EB and then 5 mg progesterone 48 h later (EBP). MS administration coincided with the steroid-induced LH hypersecretion that occurs in the EB and EBP rats at 1530-1630 h. Serum LH concentrations were determined 30 min after administration of MS. In OVX and EB rats, MS caused a dose-dependent decrease in serum LH, but even 20 mg/kg MS did not alter serum LH during the EBP-induced LH surge. Brain-mediated morphine-induced analgesia was evaluated in the three steroid treatment groups from measurement of latency to pawlick on a hot plate. EB and EBP rats were less responsive than OVX rats to MS-induced antinociception. EB and EBP rats were also less responsive than OVX animals to the spinal cord-mediated analgesia due to MS, as calculated by tail-flick latency. MS-induced hypothermia revealed a responsiveness order of OVX greater than EB greater than EBP. Whereas MS caused a dose-dependent reduction in locomotor activity in OVX and EB rats, EBP rats showed marked hyperactivity at low MS doses and were less responsive to the suppression of locomotor activity at higher doses. These marked steroid-induced changes in MS responsiveness could not be explained by altered pharmacokinetic disposition of morphine. These data indicate that treatment with EBP, which stimulates a preovulatory-like LH surge, decreases the ability of MS to induce hypothermic, antinociceptive, and behavioral responses and abolishes its capacity to suppress LH release. These effects of gonadal steroids were not observed before the LH surge, which suggests that this surge is linked to the decline in MS sensitivity. Further, the diminished response to MS appears to be a function of the magnitude of the LH surge.
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PMID:Desensitization of brain opiate receptor mechanisms by gonadal steroid treatments that stimulate luteinizing hormone secretion. 283 73

The authors hypothesized that the analgesia provided by intraspinal opiates would decrease anesthetic requirement. To test this hypothesis, 20 women undergoing major gynecologic surgery were divided randomly into two groups. One group received 0.75 mg morphine sulfate intrathecally, and the other, the same dose intramuscularly (control), prior to the induction of anesthesia with halothane. MAC for halothane was 0.81% in the control group and 0.46% in the intrathecal morphine group (P = 0.024). The reduction in anesthetic requirement due to intrathecal morphine is greater than that produced by low to moderate doses of systemically administered opiates.
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PMID:Intrathecal morphine reduces the minimum alveolar concentration of halothane in humans. 284 66


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