Articles: opioid-analgesics.
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Ugeskrift for laeger · Jan 1994
Review[Opioid analgesics in the treatment of non-malignant chronic pain].
Opioid sensitivity, residual pain, development of tolerance, physical and psychological dependence are described and discussed in relation to long-term opioid therapy. Based on this, guidelines for long-term opioid administration are established for chronic pain conditions of non-cancer origin. The indication must be well-considered--a life-long treatment may be instituted. ⋯ The single dosages should be identical and administered with identical time intervals, which are determined by the duration of action of the drug in use. P.r.n.-administration should not be allowed. Only one physician should be responsible for the treatment and for the prescription of the opioid analgesic drugs.
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For tolerance development studies, computer modelling and statistical tests suggested that the equation which best described the decrement of analgesic effect was best served by an exponential decay function. Further analysis of the time course data led to the tentative conclusion that all groups of animals became tolerant at the same rate, regardless of drug or dose. A literature search revealed then, as it does now, that although there are many statements regarding the rate of opioid tolerance, there has been little systematic investigation of this. ⋯ The possibility of probe administration to the same region of CNS that was rendered tolerant, as in the Y-catheter method, further enhances the focus on the pharmacodynamic mechanisms of tolerance without the ancillary and literally peripheral concerns of a dispositional nature. A posological approach to these studies cannot be overemphasized, as it is only through such time consuming and costly experiments that rigorous, quantitative data can be obtained. Such data may help to guide the hand of the physician towards rational therapeutic intervention in the treatment of patients with chronic pain and opioid tolerance.
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Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. ⋯ Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.
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It is reported that intrathecal (it) injection of low dose of dynorphin (Dyn) induces no analgesia while high dose of Dyn induces analgesia and might lead to hindlimb paralysis and loss of reflex via NMDA receptor. We hypothesized that NMDA receptor antagonists may reveal kappa analgesic-potential of subliminal dose of Dyn. ⋯ Combination of Dyn A- (1-13) 5 nmol or U50488H 100 nmol, a kappa receptor agonist with either DL-2-amino-5-phosphonovaleric acid (5 and 10 nmol) or kynurenic acid (25 and 50 nmol) it induced synergistic analgesia, which was reversed by nor-binaltorphimine 15 nmol, a kappa receptor antagonist. It is concluded that kappa opioid receptor agonists and NMDA receptor antagonists synergistically induce analgesia via interaction with their receptors.