Articles: acute-pain.
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The veterinary journal · Jul 2012
Randomized Controlled TrialPharmacokinetics of intravenous and intramuscular parecoxib in healthy Beagles.
Parecoxib is an inactive pro-drug that is rapidly converted to valdecoxib, a selective cyclooxygenase (COX)-2 inhibitor registered for the management of post-operative pain in humans. Recent studies have suggested that parecoxib has excellent clinical efficacy and safety in veterinary species. The aim of the current study was to assess the pharmacokinetics of parecoxib and valdecoxib after intravenous (i.v.) and intramuscular (i.m.) administration. ⋯ The half-life of valdecoxib was about 2 h, which was shorter than reported for humans, although the plasma concentrations following both routes of administration were likely to be effective for analgesia. The absolute bioavailability of parecoxib was 66%. The pharmacokinetic features of parecoxib make it suitable for treatment of acute pain in the canine species.
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Randomized Controlled Trial Multicenter Study
Novel p38α mitogen-activated protein kinase inhibitor shows analgesic efficacy in acute postsurgical dental pain.
SCIO-469 is a selective p38α mitogen-activated protein kinase (MAPK) inhibitor for preclinical models of acute pain. This prospective, double-blind, randomized clinical study compared efficacy and safety of oral SCIO-469, ibuprofen, and placebo in postsurgical dental pain. Subjects (n = 263) undergoing extraction of 1 or more impacted mandibular third molars received preoperative treatment with SCIO-469 (150, 210, or 300 mg), ibuprofen (400 mg), or placebo; the 210-mg group received 90 mg postoperatively. ⋯ Ibuprofen also increased time to rescue medication (6.6 hours) versus placebo (P = .04). Dizziness, headache, and nausea were the most frequently reported adverse events. This is the first clinical demonstration of antinociceptive effects in acute pain with preoperative administration of a p38α MAPK inhibitor.
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Randomized Controlled Trial Comparative Study
Acute experimental endotoxemia induces visceral hypersensitivity and altered pain evaluation in healthy humans.
Growing evidence suggests that systemic immune activation plays a role in the pathophysiology of pain in functional bowel disorders. By implementing a randomized crossover study with an injection of endotoxin or saline, we aimed to test the hypothesis that endotoxin-induced systemic inflammation increases visceral pain sensitivity in humans. Eleven healthy men (mean ± standard error of the mean age 26.6 ± 1.1 years) received an intravenous injection of either lipopolysaccharide (LPS; 0.4 ng/kg) or saline on 2 otherwise identical study days. ⋯ Pain thresholds correlated with interleukin 6 at +1h (r=0.60, P<.05) and +3h (r=0.67, P<.05) within the LPS condition. This report is novel in that it demonstrates that a transient systemic immune activation results in decreased visceral sensory and pain thresholds and altered subjective pain ratings. Our results support the relevance of inflammatory processes in the pathophysiology of visceral hyperalgesia and underscore the need for studies to further elucidate immune-to-brain communication pathways in gastrointestinal disorders.
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Randomized Controlled Trial
What do plasma beta-endorphin levels reveal about endogenous opioid analgesic function?
Plasma levels of beta-endorphin (BE), an endogenous opioid analgesic, are often reported as they relate to acute and chronic pain outcomes. However, little is known about what resting plasma BE levels might reveal about functioning of the endogenous opioid antinociceptive system. This study directly examined associations between resting plasma BE and subsequent endogenous opioid analgesic responses to acute pain in 39 healthy controls and 37 individuals with chronic low back pain (LBP). ⋯ For the ISC task, these links were significantly more prominent in LBP participants (BE × Participant Type Interactions, p's < 0.05). Results suggest that elevated resting plasma BE may be a potential biomarker for reduced endogenous opioid analgesic capacity, particularly among individuals with chronic pain. Potential clinical implications are discussed.
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Contemp Clin Trials · Mar 2012
Randomized Controlled Trial Multicenter Study Comparative StudyClinical trial implementation and recruitment: lessons learned from the early closure of a randomized clinical trial.
The NHLBI-sponsored Sickle Cell Disease Clinical Research Network (SCDCRN) conducted a multi-center, acute intervention randomized clinical trial of two methods of Patient Controlled Analgesia for acute pain. This trial was terminated early due to low enrollment. We analyzed the perceived barriers and recruitment difficulties as reported by the coordinators and principal investigators. ⋯ We identified multiple barriers to patient accrual including short duration of enrollment period, protocol design, complex dosing schedule, requirement for staff availability during week-end and after hours, multiple departments' involvement, protocol acceptance, eligibility criteria, competing protocols, and limited staff. Each of these areas should be targeted for intervention in order to plan and conduct successful future clinical trials.