Journal of pain and symptom management
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J Pain Symptom Manage · Oct 1998
Randomized Controlled Trial Clinical TrialProlonged treatment with transdermal fentanyl in neuropathic pain.
Forty-eight patients with noncancer neuropathic pain who had participated in a randomized controlled trial with intravenous fentanyl (FENiv) infusions received prolonged transdermal fentanyl (FENtd) in an open prospective study. Pain relief, side effects, tolerance, psychological dependence, mood changes, and quality of life were evaluated. The value of clinical baseline characteristics and the response to FENiv also was evaluated in terms of the outcome with long-term FENtd. ⋯ In only one patient did tolerance emerge. There was a significant positive correlation between the pain relief obtained with FENiv and that with prolonged FENtd (r = 0.59, P < 0.0001). We conclude that (1) long-term transdermal fentanyl may be effective in noncancer neuropathic pain without clinically significant management problems and (2) A FENiv-test may assist in selecting neuropathic pain patients who might benefit from prolonged treatment with FENtd.
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J Pain Symptom Manage · Jul 1998
Randomized Controlled Trial Clinical TrialThe human capsaicin model of allodynia and hyperalgesia: sources of variability and methods for reduction.
Intradermal and topical application of capsaicin have been used to study mechanisms of mechanical allodynia (MA) and pinprick hyperalgesia (PPH) and the efficacy of drugs in relieving these symptoms. However, it is associated with significant inter- and intra-subject variability. In order to improve the model's sensitivity, we examined several potential sources of variability of capsaicin-evoked MA and PPH in healthy volunteers, including skin temperature fluctuations, method (intradermal vs. topical) and site (volar forearm vs. foot dorsum) of administration. ⋯ However, greater intra-subject consistency (MA: foot: r = 0.84; arm: r = 0.49; PPH: r = 0.87; r = 0.39) and significantly larger areas of MA (15.8 +/- 4.2 vs 9.1 +/- 2.5, p < 0.05) were seen with the foot. (PPH: foot: 28.9 +/- 6.7; arm: 21.6 +/- 4.2, NS). Large variability exists among subjects receiving CAP, with some developing minimal MA. However, these subjects may be screened out prior to entry, increasing the sensitivity of the model, which may be further improved by clamping the skin temperature.
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J Pain Symptom Manage · May 1998
Randomized Controlled Trial Clinical TrialProglumide as a morphine adjunct in cancer pain management.
Proglumide, a cholecystokinin (CCK) antagonist, has been shown to have agonist effects at extremely low doses on both endogenous and exogenous opioid systems. To determine the effectiveness and the side effects of proglumide as an opioid agonist, a double-blind crossover study was conducted in 60 patients with cancer pain who were treated with opioid analgesics. Forty-three patients completed both treatment arms: (a) full analgesic dose plus placebo (the patient's usual analgesic dose, individualized to drug dose and route) and (b) one-half analgesic dose plus 50 mg of proglumide. ⋯ No differences in pain perception were detected between the study arms. The latter finding is consistent with an augmentation of morphine analgesia, but without additional controls, the equivalency of the two arms cannot be determined with certainty. Nonetheless, this study suggests that proglumide may have use as an opioid adjunct in patients with cancer pain.
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J Pain Symptom Manage · Apr 1998
Randomized Controlled Trial Clinical TrialSuggestion/placebo effects on pain: negative as well as positive.
This study explores the effect of positive and negative placebo suggestions on pain induced by hand exposures to ice water. Thirty-six participants were randomly assigned to one of the following interventions: (a) positive placebo suggestion, (b) negative placebo suggestion, and (c) control. The positive placebo-suggestion participants were given favorable messages about the beneficial effects of ice-water hand immersion. ⋯ Results indicate that both the positive and negative placebo-suggestion interventions significantly altered participants' pain threshold, pain tolerance, and pain endurance. Participants exposed to a positive placebo condition tolerated pain better than a neutral condition. Participants exposed to a negative placebo did not tolerate pain as well as participants with a neutral condition.
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J Pain Symptom Manage · Feb 1998
Randomized Controlled Trial Comparative Study Clinical TrialDextropropoxyphene versus morphine in opioid-naive cancer patients with pain.
The role of opioids for moderate pain (so-called "weak" opioids) in the second step of the World Health Organization's analgesic ladder has been investigated in a prospective randomized study. Sixteen patients were administered dextropropoxyphene (DPP) in a dosage ranging from 120 mg to 240 mg daily (group 1), and 16 patients were administered the lowest doses (20 mg daily) of commercially available controlled-release morphine (group 2). ⋯ Intensity and frequency of nausea and vomiting, drowsiness, and dry mouth were higher in group 2 than in group 1 during the initial treatment. These results stress the role of "weak" opioids during the induction of opioid therapy in opioid-naive cancer patients.