Articles: pain-clinics.
-
Animal experiments have unequivocally demonstrated peripheral antinociceptive effects of opioids in inflamed tissue. Exogenous mu-, delta- und kappa-agonists can produce such effects. Opioid receptors are present on peripheral terminals of primary afferent neurons and their endogenous ligands are produced and contained in resident immune cells within the inflamed tissue. ⋯ A small number of clinical studies has examined the peripheral analgesic effects of opioids. Their results are equivocal so far. In view of the predominant role of the inflammatory process in the manifestation of peripheral opioid effects, the postoperative situation seems to be particularly worthwhile to study.
-
In the pain treatment of patients with incurable head and neck tumors it may be difficult to provide adequate oral drug therapy in the advanced stages. In these cases continuous subcutaneous application of morphine by means of external infusors is an alternative. An example of the method of continuous subcutaneous application of analgesics in pain therapy is shown in a patient suffering from a chondrosarcoma of the maxilla. ⋯ Because of growing tumor infiltration, we progressively increased the morphine dosage. Nevertheless, continous subcutaneous application of droperidol, dexamethasone and clonidine was also needed to achieve much better analgesia. The technical simplicity of this safe and effective treatment make it suitable for outpatient care in tumor clinics.
-
Although the greatest part of the human body is composed of muscle, diseases of the muscle, such as muscular dystrophies and inflamatory or metabolic myopathies, occur invery few patients. On the other hand, myalgia is one of the most common symptoms in routine clinical medicine. This is problematic, because muscular pain can be caused by many different physical and psychiatric diseases. In order to avoid unecessary and expensive laboratory tests a careful examination of clinical symptoms and signs is necessary.
-
Thirty patients suffering from reflex sympathetic dystrophy accompanied by continuous spontaneous pain of the affected distal limb were investigated. The aim of the study was to determine whether a suprasystolic compression (cuff) fixed at the distal part of the affected limb and interrupting the distal circulation would influence the pain. In most cases, this so-called ischaemia-test led to a substantial suppression of pain, which occurred during the first or second minute after the cuff had been applied. Therefore, this test can be used as a new diagnostic tool to support the clinical diagnosis of reflex sympathetic dystrophy.
-
alpha(2)-Adrenozeptoragonisten agonists have shown antinociceptive and analgesic effects, which are not antagonized by naloxone. Therefore, the mechanism of action should be independent of opioid receptors. Most studies on this topic have been performed using clonidine. Experimentally the analgesic effect of clonidine can be suppressed by the inhibition of central adrenergic receptors. Furthermore, clonidine has analgesic effects at the spinal level. During recent years numerous studies have shown the analgesic effect of spinally or epidurally administered clonidine in humans. However, only very few studies have investigated the analgesic effect of parenterally administered clonidine in humans. ⋯ In our study the analgesic effect of 150 mug clonidine i.v. was equivalent to that of 5 mg morphine i.v. and 50 mg tramadol. Our results in humans confirm the dosage relationship of 1ratio30 found by Eisenach in sheep. Further studies on the use of parenteral clonidine for postoperative analgesia seem to be warranted.