-
Journal of Vascular Surgery Sep 2018Pain in chronic venous ulcers (CVUs) notably increases with the usual cleaning of the wound. Chronic pain is usually poorly controlled even with the multiple analgesic...
OBJECTIVE
Pain in chronic venous ulcers (CVUs) notably increases with the usual cleaning of the wound. Chronic pain is usually poorly controlled even with the multiple analgesic treatments available. Analgesics can have different serious adverse effects and medical interactions in old patients with several comorbidities. This study reports the efficacy and safety of topical sevoflurane for treatment of pain in CVUs.
METHODS
We report a descriptive and retrospective study of 30 patients older than 65 years with painful CVUs refractory to conventional analgesic treatments. Patients received topical sevoflurane treatment before the usual cleaning of the ulcer. Cleaning visits with sevoflurane every 2 days for a period of 1 month were scheduled. We compared the visual analog scale results and analgesic drugs for cleaning with and without topical sevoflurane. The systemic pharmacokinetics of sevoflurane after topical application has not been determined.
RESULTS
Pain related to CVUs decreased with topical sevoflurane. Sevoflurane had an analgesic effect with latency time between 2 and 7 minutes. The duration of analgesia ranged between 8 and 18 hours. The time needed to take an analgesic treatment increased after application of sevoflurane. The use of other conventional analgesic drugs, including paracetamol, metamizole, nonsteroidal anti-inflammatory drugs, tramadol, and major opioids, was progressively reduced. The main local adverse effects were mild and transient, including heat, pruritus, and erythema. There were no systemic adverse effects.
CONCLUSIONS
Topical sevoflurane has an intense, fast, and long-lasting local analgesic effect with an adequate safety profile. It also diminishes the taking of other conventional analgesic drugs. Topical sevoflurane is an efficient and safe therapeutic alternative for refractory painful CVUs.
Topics: Administration, Topical; Aged; Analgesics; Female; Humans; Male; Methyl Ethers; Pain Management; Pain Measurement; Platelet Aggregation Inhibitors; Retrospective Studies; Sevoflurane; Time Factors; Varicose Ulcer
PubMed: 29452834
DOI: 10.1016/j.jvs.2017.11.071 -
Oncology (Williston Park, N.Y.) Oct 2004The management of cancer pain requires familiarity with a range of therapeutic strategies, including antineoplastic therapies, analgesic pharmacotherapy, and anesthetic,... (Review)
Review
The management of cancer pain requires familiarity with a range of therapeutic strategies, including antineoplastic therapies, analgesic pharmacotherapy, and anesthetic, neurosurgical, psychological, and rehabilitation techniques. Successful pain management is characterized by implementation of the techniques with the most favorable therapeutic index for the prevailing circumstances, along with provision for repeated evaluations, so that a favorable balance between pain relief and adverse effects is maintained. For most patients, pain management involves the administration of specific analgesic approaches. In all cases, these analgesic treatments must be skillfully integrated with the management of other symptoms.
Topics: Analgesics; Analgesics, Opioid; Drug Administration Routes; Drug Administration Schedule; Drug Tolerance; Humans; Narcotics; Neoplasms; Pain; Pain Management; Pain Measurement; Palliative Care; Receptors, Opioid
PubMed: 15609474
DOI: No ID Found -
Biomedicine & Pharmacotherapy =... Jun 2020Medicinal plants from traditional chinese medicine are used increasingly worldwide for their benefits to health and quality of life for the relevant clinical symptoms...
Medicinal plants from traditional chinese medicine are used increasingly worldwide for their benefits to health and quality of life for the relevant clinical symptoms related to pain. Among them, Salvia miltiorrhiza Bunge is traditionally used in asian countries as antioxidant, anticancer, anti-inflammatory and analgesic agent. In this context, several evidences support the hypothesis that some tanshinones, in particular cryptotanshinone (CRY), extracted from the roots (Danshen) of this plant exhibit analgesic actions. However, it is surprisingly noted that no pharmacological studies have been carried out to explore the possible analgesic action of this compound in terms of modulation of peripheral and/or central pain. Therefore, in the present study, by using peripheral and central pain models of nociception, such as tail flick and hot plate test, the analgesic effect of CRY in mice was evaluated. Successively, by the aim of a computational approach, we have evaluated the interaction mode of this diterpenoid on opioid and cannabinoid system. Finally, CRY was dosed in mice serum by an HPLC method validated according to European Medicines Agency guidelines validation rules. Here, we report that CRY displayed anti-nociceptive activity on both hot plate and tail flick test, with a prominent long-lasting peripheral analgesic effect. These evidences were indirectly confirmed after the daily administration of the tanshinone for 7 and 14 days. In addition, the analgesic effect of CRY was reverted by naloxone and cannabinoid antagonists and amplified by arginine administration. These findings were finally supported by HPLC and docking studies, that revealed a noteworthy presence of CRY on mice serum 1 h after its intraperitoneal administration and a possible interaction of tested compound on μ and k receptors. Taken together, these results provide a new line of evidences showing that CRY can produce analgesia against various phenotypes of nociception with a mechanism that seems to be related to an agonistic activity on opioid system.
Topics: Analgesics; Animals; Humans; Male; Mice; Models, Molecular; Molecular Docking Simulation; Molecular Structure; Pain Measurement; Phenanthrenes; Protein Conformation; Receptors, Opioid
PubMed: 32203893
DOI: 10.1016/j.biopha.2020.110042 -
Journal of Psychiatry & Neuroscience :... Jan 1998Pain and discomfort in everyday life are often treated with over-the-counter (OTC) analgesic medications. These drugs are remarkably safe, but serious side effects can... (Review)
Review
Pain and discomfort in everyday life are often treated with over-the-counter (OTC) analgesic medications. These drugs are remarkably safe, but serious side effects can occur. Up to 70% of the population in Western countries uses analgesics regularly, primarily for headaches, other specific pains and febrile illness. It is not known whether the patterns of use are consistent with good pain management practices. OTC analgesics are also widely used to treat dysphoric mood states and sleep disturbances, and high levels of OTC analgesic medication use are associated with psychiatric illness, particularly depressive symptoms, and the use of alcohol, nicotine and caffeine. More than 4 g per day of acetylsalicylic acid (ASA) or acetaminophen over long periods is considered abuse. People using excessive amounts of OTC analgesics may need more effective treatments for chronic pain, depression or dysthymia. The possibility that these drugs have subtle reinforcing properties needs to be investigated. Certainly phenacetin, which was taken off the market in the 1970s, had intoxicating effects. A better understanding of patterns of use is needed to determine the extent of problem use of OTC analgesics, and whether health could be improved by educating people about the appropriate use of these drugs.
Topics: Analgesics; Humans; Nonprescription Drugs; Substance-Related Disorders
PubMed: 9505057
DOI: No ID Found -
Drugs Nov 2018Tapentadol prolonged release (tapentadol PR) [Palexia SR in EU] is a long-acting tablet formulation of the strong central analgesic tapentadol, which acts as both a... (Review)
Review
Tapentadol prolonged release (tapentadol PR) [Palexia SR in EU] is a long-acting tablet formulation of the strong central analgesic tapentadol, which acts as both a μ-opioid receptor (MOR) agonist and a noradrenaline reuptake inhibitor. Tapentadol PR is approved for chronic pain in various countries, with its EU indication (severe chronic pain manageable only with opioid analgesics) being the focus here. Well-designed trials and clinical practice data support tapentadol PR use in this setting. Short term, tapentadol PR was an effective and generally well tolerated analgesic for moderate to severe pain of varying aetiologies, including neuropathic pain. It provided analgesia at least as good as that of conventional strong opioids and appeared more favourable in terms of gastrointestinal tolerability, likely due to less potent MOR binding. Severe back pain with a neuropathic component responded well to moderate-dose tapentadol PR in some patients, while for others, an increase to the maximum recommended tapentadol PR dosage provided analgesia at least as good as that of moderate-dose tapentadol PR plus pregabalin and appeared to have some CNS tolerability benefits. Data also support the use of tapentadol PR in opioid rotation, including when conventional opioids are intolerable. Longer-term data in musculoskeletal pain conditions indicate continued benefit over up to 2 years' treatment with tapentadol PR with no evidence of tolerance. Thus, tapentadol PR is a useful option for the management of severe chronic pain.
Topics: Analgesics; Chronic Pain; Delayed-Action Preparations; Drug Therapy, Combination; Humans; Neuralgia; Pain Management; Pregabalin; Tapentadol
PubMed: 30471002
DOI: 10.1007/s40265-018-1007-2 -
Journal of Intensive Care Medicine Jun 2024Chronic opioid use represents a significant burden to global healthcare with adverse long-term outcomes. Elevated patient reported pain levels and analgesic... (Observational Study)
Observational Study
BACKGROUND
Chronic opioid use represents a significant burden to global healthcare with adverse long-term outcomes. Elevated patient reported pain levels and analgesic prescriptions have been reported following discharge from critical care. We describe analgesic requirements following discharge from hospital and identify if a critical care admission is a significant factor for stronger analgesic prescriptions.
METHODS
This retrospective observational cohort study identified patients in the UK Biobank with a registered admission to any UK hospital between January 1, 2010 and December 31, 2015 and information on prescriptions drawn both prior to and following hospital discharge. Two matched cohorts were created from the dataset: critical care patients and hospital patients admitted without a critical care encounter. Outcomes were analgesic requirements following hospital discharge and factors associated with increased analgesic prescriptions. Multivariable logistic regression was used to identify factors associated with prescriptions from higher steps on the World Health Organization (WHO) analgesic ladder.
RESULTS
In total, 660 formed the total study population. Strong opioid prescriptions following discharge were significantly higher in the critical care cohort ( value <.001). Critical care admission (OR = 1.45) and increasing Townsend deprivation (OR = 1.04) index were significantly associated with increasing strength of analgesic prescriptions following discharge.
CONCLUSIONS
Critical care patients require stronger analgesic prescriptions in the 12 months following hospital discharge. Patients from areas of high socioeconomic deprivation may also be associated with increased analgesic requirements. Multidisciplinary support is required for patients who may be at risk of chronic opioid use and could be delivered within critical care recovery programs.
Topics: Humans; Female; Male; Retrospective Studies; Critical Illness; Middle Aged; Analgesics, Opioid; Aged; Critical Care; United Kingdom; Patient Discharge; Analgesics; Adult; Drug Prescriptions; Logistic Models
PubMed: 38087427
DOI: 10.1177/08850666231219916 -
Molecules (Basel, Switzerland) Jul 2023species are native to South Africa, and they have a long history in medicinal use. This study aimed to extract essential oils from different parts of , determine the...
species are native to South Africa, and they have a long history in medicinal use. This study aimed to extract essential oils from different parts of , determine the chemical composition of the essential oils, and assess the essential oils' biological potential as analgesic and anti-inflammatory agents. The essential oils were obtained by hydro-distilling different parts of , and the essential profile was determined by GC-FID and GC-MS. The analgesic activity of the essential oil was determined by using a tail immersion in hot water method in rats, whereas the anti-inflammatory activity of the essential oils was assessed according to right hind paw oedema induced by egg albumin; the three doses selected for each experiment were 100, 200, and 400 mg/kg. According to the GC-FID and GC-MS analysis, camphene (3.6-33.4%), α-terpineol (4.8-19.1%), α-thujone (1.5-15.6%), piperitone (0.9-12.2%), linalool (1.6-11.7%), myrcene (5.2-10.7%), germacrene D (3.7-10.4%), β-caryophyllene (1.2-9.5%), β-cadinene (3.4-6.7%), and β-bourbonene (4.2-6.2%) were some of the major compounds identified in the oil. essential oils demonstrated analgesic activity by increasing pain latency in hot water; furthermore, in an inflammation test, the essential oil reduced the egg-albumin-induced paw oedema in both the first and second phases. Therefore, the current findings suggest that essential oils have analgesic and anti-inflammatory properties.
Topics: Rats; Animals; Pelargonium; South Africa; Plant Oils; Oils, Volatile; Anti-Inflammatory Agents; Analgesics; Edema
PubMed: 37513168
DOI: 10.3390/molecules28145294 -
Current Neuropharmacology Nov 2022Despite much research efforts being devoted to designing alternative pharmacological interventions, chronic pain remains to be an unresolved clinical problem. Quercetin,... (Review)
Review
Despite much research efforts being devoted to designing alternative pharmacological interventions, chronic pain remains to be an unresolved clinical problem. Quercetin, a compound that belongs to the flavonoids family, is abundantly found in fruits and vegetables. Emerging evidence indicates that quercetin possesses anti-nociceptive effects in different rodent models of chronic pain, including inflammatory pain, neuropathic pain and cancer pain. In this review, we summarize the mechanisms underlying the analgesic effect of quercetin in preclinical studies. These studies showed that quercetin exerts potent analgesic effects against chronic pain via suppressing neuroinflammation and oxidative stress as well as modulation of synaptic plasticity, GABAergic system, and opioidergic system. Considering that the safety of quercetin is well established, it has great potential for clinical use in pain treatment.
Topics: Humans; Quercetin; Chronic Pain; Flavonoids; Neuralgia; Analgesics
PubMed: 35959909
DOI: 10.2174/1570159X20666220812122437 -
The Journal of Pain Mar 2011Drugs without a strong evidence base and outside of recommendations are too often prescribed for older adults. Established guidelines such as Beers criteria have... (Review)
Review
Drugs without a strong evidence base and outside of recommendations are too often prescribed for older adults. Established guidelines such as Beers criteria have identified both specific medications and certain drug classes as inappropriate for older adults, primarily due to adverse effects. Age-related physiological changes in distribution, metabolism, and elimination often alter the effects of pharmacotherapies in older adults. When designing a therapeutic program, all elements contributing to the pathophysiology of painful conditions should be considered, as well as the mechanisms of action of analgesic drug classes. Both appropriate and inappropriate medications for older adults are detailed herein, as well as their contraindications and potential drug-drug or drug-disease interactions. The number needed to treat (NNT) can be useful in considering efficacy, while the safety of a pharmacotherapy is indicated by the calculated number needed to harm (NNH). The NNT is a measure describing the number of patients who require treatment for every 1 who reaches the therapeutic goal, and the NNH describes the number of participants who manifest side effects; these can further be segregated into numbers who withdraw from studies due to intolerable side effects. These parameters, along with a patient's comorbidities and concomitant medications, should be considered when selecting an analgesic and dose regimen. In addition, practitioners should avoid prescribing multiple-drug therapies that have overlapping pharmacodynamics or that may have an adverse pharmacokinetic interaction.
Topics: Aged; Aging; Analgesia; Analgesics; Humans; Pain, Intractable
PubMed: 21396598
DOI: 10.1016/j.jpain.2011.01.001 -
American Family Physician Jun 2013The approach to patients with acute pain begins by identifying the underlying cause and a disease-specific treatment. The first-line pharmacologic agent for the... (Review)
Review
The approach to patients with acute pain begins by identifying the underlying cause and a disease-specific treatment. The first-line pharmacologic agent for the symptomatic treatment of mild to moderate pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). The choice between these two medications depends on the type of pain and patient risk factors for NSAID-related adverse effects (e.g., gastrointestinal, renovascular, or cardiovascular effects). Different NSAIDs have similar analgesic effects. However, cyclooxygenase-2 selective NSAIDs (e.g., celecoxib) must be used with caution in patients with cardiovascular risk factors and are more expensive than nonselective NSAIDs. If these first-line agents are not sufficient for mild to moderate pain, medications that target separate pathways simultaneously, such as an acetaminophen/opioid combination, are reasonable choices. Severe acute pain is typically treated with potent opioids. At each step, adjuvant medications directed at the underlying condition can be used. Newer medications with dual actions (e.g., tapentadol) are also an option. There is little evidence that one opioid is superior for pain control, but there are some pharmacologic differences among opioids. Because of the growing misuse and diversion of controlled substances, caution should be used when prescribing opioids, even for short-term treatment. Patients should be advised to properly dispose of unused medications.
Topics: Acetaminophen; Acute Pain; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Humans; Pain Management
PubMed: 23939498
DOI: No ID Found