Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2002
Cyclooxygenase-2 inhibition potentiates morphine antinociception at the spinal level in a postoperative pain model.
After peripheral inflammatory stimuli, spinal cord cyclooyxgenase-2 (COX-2) mRNA and protein levels increase, whereas COX-1 is unchanged. In animal models of inflammatory pain, intrathecal COX-2 selective inhibitors suppress hyperalgesia. However, the role of spinal COX-2 inhibition in postoperative pain is not well elucidated. This study investigates whether a water-soluble COX-2 selective inhibitor, L-745337, can modify allodynic responses in a rat model of postoperative pain. ⋯ These results suggest a spinal interaction of COX-2 inhibition with opiate analgesia may allow a reduction of postoperative pain with lower doses of opiate.
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Reg Anesth Pain Med · Sep 2002
Changes in regional cerebral blood flow in the thalamus after electroconvulsive therapy for patients with complex regional pain syndrome type 1 (preliminary case series).
The aim of the present case series was to examine whether changes in regional cerebral blood flow (rCBF) induced by electroconvulsive therapy (ECT) in the thalamus are related to the efficacy of ECT. Four chronic pain patients with complex regional pain syndrome (CRPS) type-1 (age, 33 to 58 years) who had failed to respond to standard pain treatments received a course of ECT. To investigate the possible mechanisms of the analgesic effect of ECT on chronic CRPS type-1, we measured significant changes in the rCBF of the thalamus using technetium-99m ethyl cysteinate dimer single photon emission computed tomography (99mTc ECD SPECT), before and after ECT and compared these values between responders and nonresponders. ⋯ The results from the SPECT suggest that normalization of the balance of rCBF in the thalamus may be related to the analgesic efficacy of the ECT on CRPS Type-1.