摘要:

Analgesic drug development as currently undertaken is limited by a number of factors that contribute to the paucity of new analgesics introduced into clinical practice despite marked advances in delineating of the molecular-genetic mechanisms contributing to acute and chronic pain. The participants in this workshop explored the unmet need in analgesia and recommended strategies for enhancing analgesic drug development in the future. The workshop concluded that translating scientific advances into improved pain relief will require new thinking and a cooperative effort among the pharmaceutical industry, regulatory agencies, funding agencies, the biomedical research community, professional societies and clinicians. The workshop also recommended that a better understanding of the epidemiology of pain could contribute to improvement in clinical trial methodology and outcome measures.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe treatment of pain during pregnancy other than that of labor is a clinical issue that has not been addressed in a systematic manner.Materials and MethodsTo assess current knowledge, a review of the human and animal literatures was undertaken using MEDLINE. In addition, the dynamics of three pharmacological compartments, the mother, the placenta, and the fetus, and fate of drugs given in pregnancy, was reviewed.ResultsThe literature review yielded little information except for a few case studies in which opiates, nonsteroidal anti-inflammatory drugs, antidepressants, &mgr; agonists, and anticonvulsants were used in the treatment of pain in pregnancy. In contrast, there is extensive information in the addiction medicine literature concerning the use of opioids in recovering pregnant addicts. Methadone, buprenorphine, and morphine have been used to treat women seeking recovery from opioids, and neonatal outcomes have been closely monitored with no evidence of harm to the newborn.ConclusionsExperience in women seeking recovery from opioids and their newborns illustrates that opioids are an effective and safe pharmacological option for the treatment of pain during pregnancy. Controlled studies are needed to expand knowledge in this clinical area.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo assess the efficacy of a self-management group intervention in improving physical functioning, mood, and pain among elderly persons with chronic pain, and to identify factors that may be associated with improvement.Materials and MethodsForty-five residents of three retirement communities (86% women; mean age, 82.0 years) were assigned randomly to a 7-week pain self-management group or an educational booklet control condition. Participants completed self-report measures of pain, functioning, depression, and pain-related beliefs at baseline, 9 weeks later (after treatment), and 3 months after the post-treatment assessment.ResultsThe self-management group showed significantly greater pre- to post-treatment improvement in physical role function (P= 0.04) and characteristic pain intensity (P= 0.02). No significant differences were found between groups on measures of pain-related activity interference, depression, and pain-related beliefs. Improvement in characteristic pain and physical role function was not associated with baseline depression scores, pretreatment expectations, or changes in pain-related beliefs.DiscussionThis study provides preliminary support for the efficacy of a self-management group intervention for older adults with chronic pain and has implications for future studies of such approaches for this and similar populations.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundSex differences in the response threshold to painful stimuli and the higher number of chronic pain syndromes in women than in men have prompted a series of studies on lower animals and humans aimed at clarifying the role of gonadal hormones in pain.ObjectiveThis article examines the morphologic and functional aspects of gonadal hormone systems and the relations between gonadal hormones and pain circuits, to identify areas deserving of increased attention in elucidating the endocrine mechanisms that contribute to abnormal pain states.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundNumerous experimental studies, conducted primarily over the past 10 years, show that there are sex differences in opioid analgesia. This review summarizes the published literature on sex differences in analgesia produced by acute administration of drugs acting at &mgr;-, &kgr;-, and &dgr;-opioid receptors, in animals and humans. Additionally, methodological issues in research into opioid sex differences are discussed.ConclusionsProcedural variables that may influence the outcome of studies examining sex differences in opioid analgesia include modality and intensity of the noxious stimulus used in the pain test, opioid type (efficacy and selectivity), and experimental design and data analytic techniques. Subject variables that may be important to consider include subject genotype and gonadal steroid hormone state of the subject at the time of analgesia testing. Evidence is provided for multiple mechanisms underlying sex differences in opioid analgesia, including both pharmacokinetic and pharmacodynamic factors. Future research directions are suggested, such as examining sex differences in opioid tolerance development, sex differences in opioid analgesia using models of acute inflammatory pain and chronic pain, and sex differences in effects of opioids other than analgesia, which may limit their therapeutic use.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of acupuncture as an analgesic during labor.DesignA randomized, unblinded, controlled study.SettingA labor ward in a University Hospital.PatientsParturients at term.InterventionsOne group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the “no acupuncture” group by parity, but who had not been offered the opportunity to take part. Outcome measure “effectiveness of acupuncture” was measured by the requirement for use of meperidine.ResultsMeperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P< 0.0001), and 29% of the control group. The use of other analgesics was also lower in the acupuncture group. Patient satisfaction was high: 89 of 103 patients asked said they would want acupuncture during another labor.ConclusionsAcupuncture during labor reduced the requirement for other painkillers and has high patient satisfaction in this randomized, unblinded, controlled study.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThe aim of this study is to describe the incidence and characteristics of pain, sensory abnormalities, abnormal body sweating, and pathologic gustatory sweating in pain patients with persistent post-sympathectomy pain.MethodsA retrospective chart review of a series of consecutive pain patients with persistent post-sympathectomy pain was performed. Inclusion criteria were: (1) sympathectomy performed for the indication of neuropathic pain, and (2) persistent pain after the procedure. Demographic data, patterns of pain before and after sympathectomy, patients' pain drawings, and incidence of pain had been collected concurrently at the time of referral. Additional data regarding sensory findings, surgical details of the sympathectomy, sweat patterns, and incidence of abnormal body sweating and pathologic gustatory sweating were extracted from the patients' charts or obtained in follow-up appointments.ResultsSeventeen adults (13 females and 4 males) with a mean age of 37 years (range 25–52) at the time of sympathectomy met the inclusion criteria. Five of the 17 patients experienced temporary pain relief for an average of 4 months (range 2–12 months), 3/17 retained the same pain as before the surgery, 1 patient was cured of her original pain but experienced a new debilitating pain, and 8/17 patients continued to have the same or worse pain in addition to a new or expanded pain. Pathologic gustatory sweating was present in 7/11 patients asked, and abnormal sweating (known as compensatory hyperhidrosis) in 11/13 patients asked.DiscussionThe present study does not allow for conclusions about the effectiveness of surgical sympathectomy for neuropathic pain. However, our findings indicate that if the pain persists after the procedure, the complications may be quite serious and at times worse than the problem for which the surgery was originally performed.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

AimTo investigate the potential pro-analgesic effect of the non-specific CCK antagonist proglumide on the analgesia produced by dihydrocodeine.MethodA double-blind, placebo-controlled crossover study of 30 adult subjects.ResultsMean pain scores fell from a baseline of 8.12–7.89 during the placebo phase (N.S.) and to 6.82 during the proglumide phase (P< 0.05). Side effects were minor.ConclusionThe CCK antagonist proglumide enhances the analgesic effect of dihydrocodeine.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID