Journal of pain and symptom management
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J Pain Symptom Manage · Sep 1996
Randomized Controlled Trial Clinical TrialResponse to intravenous lidocaine infusion predicts subsequent response to oral mexiletine: a prospective study.
The local anesthetic sodium-channel blockers lidocaine and mexiletine reduce spontaneous and evoked activity in experimental neuroma models and have been reported to relieve a variety of clinical neuropathic pain conditions. The predictive value of relief from an intravenous lidocaine infusion (IVL) for subsequent relief from a 4-week trial of oral mexiletine was assessed in a prospective study of nine subjects with chronic neuropathic pain of peripheral origin. Subjects received IVL, 2 mg/kg and 5 mg/kg, over 45 min during separate sessions in random order under double-blind conditions. ⋯ Subsequent response to oral mexiletine was significantly correlated with the average response to the two IVL. Mexiletine dose and blood levels were not correlated with pain relief. The results suggest that IVL may be a valuable tool in selecting patients for oral therapy with analogous drugs.
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J Pain Symptom Manage · Jul 1996
Randomized Controlled Trial Clinical TrialUsing pressure to decrease the pain of intramuscular injections.
The purpose of this study was to determine if applying pressure to the site for 10 sec prior to an intramuscular injection would reduce injection pain, an approach suggested by anecdotal observation and the gate control theory. The subjects were 93 patients who had dorsogluteal intramuscular injections of immune globulin at a county health department. ⋯ Mean pain intensity on a 100-mm visual analogue scale, adjusted for differences in injection volume, was 13.6 mm for the experimental group and 21.5 mm for the control group (P = 0.03). The findings suggest that simple manual pressure applied to the site is a useful technique to decrease injection pain.
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J Pain Symptom Manage · Mar 1996
Randomized Controlled Trial Clinical TrialDay-to-day titration to initiate transdermal fentanyl in patients with cancer pain: short- and long-term experiences in a prospective study of 39 patients.
Initial dose finding in patients with cancer pain who are started on TTS fentanyl (Duragesic, TTS-F) is often unsatisfactory with currently recommended doses and intervals. Acknowledging that studies reveal a "psuedo steady state" 15 to 20 hr after application of TTS-F, we prospectively investigated an increased initial dose and day-to-day titration of TTS-F in 39 (evaluable) patients with uncontrolled cancer pain. Significant pain reduction (P = 0.001) was seen after 24 hr, and satisfactory analgesia was achieved within 48 h and maintained for the rest of the study. ⋯ Other side effects seemed to be less common compared with usual morphine treatment. TTS-F can be titrated effectively and safely on a day-to-day basis with an increased initial dose and adequate patient monitoring, thus avoiding more complicated approaches. TTS-F seemed to induce less constipation than might be expected.
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J Pain Symptom Manage · Mar 1996
Randomized Controlled Trial Clinical TrialIntrathecal morphine for analgesia in children undergoing selective dorsal rhizotomy.
Selective dorsal root rhizotomy is performed for relief of spasticity in children with cerebral palsy. Postoperative pain relief can be provided by intrathecal morphine administered at the time of the procedure. We sought to define an optimal dose of intrathecal morphine in children undergoing selective rhizotomy, through a randomized, double-blinded prospective trial. ⋯ By 24 hr, there was no difference in cumulative dose among groups. Postoperative pain scores and the incidence of respiratory events, nausea, vomiting and pruritus were comparable among groups. These data suggest that intrathecal morphine at 30 micrograms.kg-1 provides the most intense analgesia at 6 hr following selective dorsal root rhizotomy, but was otherwise comparable to the 10 micrograms.kg-1 dose.
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J Pain Symptom Manage · Nov 1995
Randomized Controlled Trial Clinical TrialRandomized evaluation of controlled-release codeine and placebo in chronic cancer pain.
Codeine is widely used in combination with acetaminophen and aspirin for the management of mild to moderate pain. However, there are few controlled clinical trials of single-entity codeine in chronic cancer pain. The purpose of this study was to evaluate the clinical efficacy and safety of controlled-release codeine given every 12 hr in patients with cancer pain. ⋯ Both patients and investigators preferred CR codeine to placebo (80% versus 3%, P = 0.0014 and 73% versus 7%, P = 0.0160, respectively). These data indicate that CR codeine, given every 12 hr results in significant reductions in pain intensity and the use of "rescue" acetaminophen-plus-codeine in patients with cancer pain. CR codeine provides the benefits of a flexible single entity codeine formulation and the convenience of 12-hr duration of action, which allows patients uninterrupted sleep and improved compliance.