Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie
-
At present, the opioids, anti-epileptic, membrane stabilising and anti-depressant drugs are the mainstay of treatment for alleviating neuropathic pain. This article summarises data on some new medications of these classes and also other groups of medications in development. Recent data on the use of combination medications and its implications will also be discussed.
-
Ketamine is a dissociative anaesthetic; its mechanism of action is primarily an antagonism of the N-methyl-D-aspartate (NMDA) receptor. The role of ketamine, in particular in lower sub-anaesthetic doses, has recently gained increasing interest in pain management. It has been studied in a considerable number of trials and analysed in meta-analyses and systematic reviews. ⋯ Low dose ketamine also has 'preventive analgesia' properties. Furthermore, in higher doses it provides effective and safe sedation and analgesia for painful procedures. The place of ketamine in the treatment of chronic pain and the effects of long-term medicinal use remain unclear.
-
For more than 100 years, the use of opioid analgesic agents has been linked with modulation of the immune system in man. More recently, it has become apparent that both exogenous and endogenous opioids exert some effect upon the immune system but that this can be beneficial or deleterious depending on numerous variables. ⋯ However, it still remains unclear whether this is clinically important in man although it would appear to be good practice to avoid such agents in patients already immunosuppressed by disease or pharmacotherapy. Powerful opioid analgesics without immunosuppressive properties can be selected and should be used in such situations and as these agents can offer additional benefits in addition to their non-immunosuppresive analgesia, it should be considered whether to use them at all times in preference to immunosuppressive opioids.
-
Biomed. Pharmacother. · Aug 2006
The impact of educational intervention programs on pain management in a pediatric emergency department.
Management of pain and anxiety is an important part of patient care in the pediatric emergency department (ED). Even though it has improved significantly over the past few years, it is still suboptimal. The objective of this study was to evaluate the effect of informal and formal education on pain and anxiety management in the pediatric ED. ⋯ Whereas, during period C, a significant increase in the use of ketamine and morphine was demonstrated (RR=24.56, CI 10.71-56.3 and RR=3.07, CI 2.12-4.44, respectively), while the use of meperidine (RR=0.68, CI 0.49-0.94) and N2O (RR=0.46, 95% CI 0.32-0.67) declined significantly. Educational interventions have a clear impact on pain and anxiety management demonstrated by the subsequent change in the use of sedatives and analgesics and should be provided to pediatric ED physicians. Informal teaching affected mainly the use of milder sedatives and analgesics, while formal structured training influenced the use of opioids and dissociative agents.
-
Biomed. Pharmacother. · Aug 2006
Pre-emptive analgesia and protective premedication. What is the difference?
The management of postoperative pain has been greatly informed by an increasing understanding of the basic science of pain transmission. The idea that analgesia given before the injury would be more effective than the same analgesia given after the injury was named pre-emptive analgesia. The evidence for this phenomenon in postoperative pain management has been very mixed. ⋯ A recent meta-analysis of the existing literature shows reduction of postoperative morphine consumption but little reduction in reporting of opiate side effects. Pregabalin, which has a better pharmacokinetic profile, may be a better alternative, and is currently under study. Neither gabapentin nor pregabalin are licensed for use in postoperative pain, and it is unlike that the manufacturers will seek such a licence.