Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy and safety of tramadol enantiomers in comparison with the racemate: a randomised, double-blind study with gynaecological patients using intravenous patient-controlled analgesia.
The opioid analgesic tramadol is a racemate and consists of 50% (+)- and 50% (-)-enantiomer. This study investigated analgesic efficacy and safety of both enantiomers after intravenous (i.v.) injection in comparison with the racemate. Ninety-eight patients recovering from major gynaecological surgery under opioid-free halothane anaesthesia were treated in a randomised, double-blind study with (+)-tramadol, (-)-tramadol or the racemate. ⋯ Assessment of laboratory screening, adverse events, vital signs and blood gas monitoring showed no serious drug-related events. Nausea and vomiting were the most frequently reported non-serious side effects and were most often seen with (+)-tramadol. Taking into account both efficacy and safety aspects, the racemate seems to be superior to either enantiomer alone.
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Clinical Trial Controlled Clinical Trial
Effects of regional intravenous guanethidine in patients with neuralgia in the hand; a follow-up study over a decade.
A study on the effect of regional intravenous (i.v.) guanethidine blockade (RGB) was done over a 10 years period in patients with post-traumatic neuralgia. Seven patients, investigated with quantitative sensory testing (QST) before and after RGB between 1979 and 1982, were reinvestigated in the period 1990-1992. In addition to the RGB, 6 patients were subjected to a placebo procedure with tourniquet inflation and i.v. injection of saline at follow-up. ⋯ RGB, whereas others consistently had no such effect. None obtained long-lasting pain relief from placebo. This supports the notion that different pathophysiological mechanisms are involved in post-traumatic neuralgia.
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Clinical Trial
A pharmacokinetic approach to resolving spinal and systemic contributions to epidural alfentanil analgesia and side-effects.
A pilot study was conducted in 7 normal volunteers to demonstrate the feasibility of employing pharmacokinetic tailoring to achieve matching plasma opioid concentration-time curves after epidural (e.p.) and intravenous (i.v.) alfentanil administration. Each subject participated in 1 pretest and 2 test sessions. Our pain model was cutaneous electrical stimulation of the finger and toe, adjusted to produce a baseline pain report of 5 (strong pain on a 0-5 scale). ⋯ Onset of pain relief was rapid, and duration was approximately 1.5 h with e.p. and 1 h with i.v. alfentanil. There were no differences in pupil size, ETCO2, or subjective side effects between e.p. versus i.v. administration. We conclude that systemic redistribution from the epidural space appears to account for most, but not all, of the analgesia.
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Comparative Study
Psychosocial factors discriminate multidimensional clinical groups of chronic low back pain patients.
Previous studies have empirically defined clinical subgroups of chronic low back pain (CLBP) patients, based on differing patterns of pain, disability and emotional distress. Because these identified groups generally are comparable in terms of physical and demographic variables, variation in functional status cannot be adequately explained by medical or social factors. In the present study we evaluated whether other psychosocial factors (stress, coping attempts, and satisfaction with social supports) might differentiate the observed groups. ⋯ Finally, a mixed picture of less life adversity, but more reliance on passive/avoidant coping strategies and more satisfactory social support networks was reported by patients categorized in the positive adaptation to pain group (i.e., high levels of pain, but relatively low levels of disability and depression). These findings suggest that psychosocial factors may be important and complex correlates of multidimensional clinical presentations of CLBP. Psychosocial factors may also offer an avenue for intervention across 3 key dimensions of CLBP.
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Supraspinally mediated antinociception has been clearly established for agonists acting via both micro- and delta-opioid receptors. The present experiments were undertaken to further characterize the role of supraspinal opioid delta receptors in the mediation of antinociception in rats and to examine the possible role of putative delta1- and delta2-opioid receptors in the antinociceptive effect. Cannulae directed at the right lateral ventricle, the periaqueductal gray (PAG), or the medullary reticular formation (MRF) were implanted in adult male, Sprague-Dawley rats for the microinjection of [D-Ala2,Glu4]deltorphin (delta2 agonist), [D-Pen2,D-Pen5]enkephalin (DPDPE, delta1 agonist), [D-Ser2,Leu5,Thr6]enkephalin (DSLET, mixed delta/micro agonist) or morphine (reference micro-opioid). ⋯ Morphine anticociception was not antagonized by either DALCE or Cys-DELT. These data demonstrate that supraspinal delta-opioid receptors can be activated to elicit antinociception in the rat and that opioid delta2 receptors predominate in this effect. Further, these effects may occur predominately via inhibition of supraspinally organized behavior without activation of descending systems such as those mediating the TF response in the rat.