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Analgesic Therapy (analgesic + therapy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009
A. DABBAGH
Introduction: This study looks at the effect of supplementary intravenous magnesium sulfate on acute pain when administered in patients undergoing lower limb orthopedic surgery using spinal anesthesia with bupivacaine. Method and materials: In this double-blind, randomized, placebo-controlled clinical trial, 60 patients were selected and randomly divided into two groups. Efforts were made to place both groups under the same method of anesthesia. One group received 8 mg/kg intravenous magnesium sulfate, started before the incision and continued up to the end of the surgical procedure, using a 50 ml syringe, via a peripheral large bore catheter; the second group received the same volume of placebos using the same method. To present the results, mean (± SD) was used; a P value of <0.05 was considered significant. Results: There was no difference between the two groups in terms of the basic variables. Pain reported by the first group that received magnesium sulfate was significantly less at the first, third, sixth and 12th hours after the operation in comparison with the group that received placebo. Also, the intravenous morphine requirements in the first 24 h after the surgery were less in the magnesium group (4.2 ± 1.6 mg) than in the control group (9.8 ± 2.1 mg). Conclusion: Intravenous magnesium sulfate can serve as a supplementary analgesic therapy to suppress the acute post-operative pain, leading to less morphine requirements in the first 24 h. [source]

The Management of Pain From Collapse of Osteoporotic Vertebrae With Continuous Intrathecal Morphine Infusion

NEUROMODULATION, Issue 2 2007
Maria Rita Saltari MD
ABSTRACT Objectives., Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QoL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. Continuous intrathecal administration of morphine through an implantable pump might represent an alternative therapy to conventional oral or transdermal administration of opioids and has some advantages and disadvantages for pain relief and improvement in QoL when compared to conventional opioid delivery. It is our objective to report our experience using intrathecal delivery of analgesics in a population of patients with refractory pain due to vertebral fractures. Materials and Methods., In 24 patients, refractory to conventional delivery of opioids, we used intrathecal analgesic therapy. To test for efficacy and improvement in QoL, we administered the visual analog scale (VAS) for pain and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Before patients were selected for pump implantation, an intraspinal drug delivery trial was performed to monitor side-effects and responses to intrathecal therapy. Results., Significant pain relief was obtained in all implanted patients. Using the QUALEFFO, we observed significant improvement of all variables such as QDL (quality of daily life), DW (domestic work), ambulation, and PHS (perception of health status), before and after one year after pump implantation. With intrathecal morphine infusion, none of the 24 patients required additional systemic analgesic medication. The mean morphine dose during the spinal trial was 11.28 mg/day, 7.92 mg/day at pump implantation, and 16.32 mg/day at one-year follow-up. Conclusions., Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QoL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side-effects with systemic administration of analgesics. [source]

Evidence For and Against the Use of Opioid Analgesics for Chronic Nonmalignant Low Back Pain: A Review

PAIN MEDICINE, Issue 3 2002
J. D. Bartleson MD
Abstract Introduction., Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. Methods., A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. Results., There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. Conclusions., There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP. [source]

The management of cancer pain,

CA: A CANCER JOURNAL FOR CLINICIANS, Issue 2 2000
Dr. Nathan I. Cherny MBBS
Any therapeutic strategy developed for patients experiencing cancer pain depends on the goals of care, which can be broadly categorized as prolonging survival, optimizing comfort, and optimizing function. The relative priority of these goals for any individual should direct therapeutic decision-making. By combining primary treatments, systemic analgesic agents, and other techniques, most cancer patients can achieve satisfactory relief of pain. In cases where pain appears refractory to these interventions, invasive anesthetic or neurosurgical maneuvers may be necessary, and sedation may be offered to those with unrelieved pain at the end of life. The principles of analgesic therapy are presented, as well as the practical issues involved in drug administration, ranging from calculating dosage to adverse effects, and, when necessary, how to switch and/or combine therapies. Adjuvant analgesics, which are drugs indicated for purposes other than relief of pain but which may have analgesic effects, are also listed and discussed in some detail. Surgical and neurodestructive techniques, such as rhizotomy or cordotomy, although not frequently required or performed, represent yet other options for patients with unremitting pain and diminished hope of relief. Although cancer pain can be a complex medical problem arising from multiple sources, patients should be assured that suffering is not inevitable and that relief is attainable. [source]