Therapie
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Letter Case Reports
[Pharmacologic dependence on nefopam (Acupan): a case report].
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Recent research has revealed the presence of opioid receptors in inflamed peripheral tissues. This gives rise to the possibility of treating the pain caused by wounds with the advantage of reducing the secondary effects related to the use of opioids and at the same time rendering their use more efficacious. ⋯ In addition, the analgesic effect of opioids has been tested by cutaneous application for various conditions but on only a limited number of patients. On the basis of these case reports, we cannot conclude that the peripheral use of opioids is efficacious and the topical use of opioids cannot be recommended unless done within the framework of a controlled clinical trial.
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To evaluate the frequency and severity of accidental poisoning in children by narcotics or buprenorphine, a retrospective study was carried out: 75 cases were collected by the Marseille Poison Centre between 1993 and 1999. Most of the patients were between 1 and 3 years old and the drugs involved were cannabis and, more recently, Subutex (buprenorphine). These two drugs were responsible for the most severe cases of poisoning, most of which occurred at home.
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Long-term administration of morphine for chronic non-malignant pain continues to be controversial, mainly because of the fear of opioid addiction and abuse. It is important to distinguish three phenomena: tolerance of the analgesic and side-effects of the drug, physical dependence (which is a pure pharmacological event) and addiction (defined as a compulsive drug-related behaviour). Animal studies suggest that similar mechanisms underlie tolerance and physical dependence. ⋯ By contrast, the occurrence of an addictive behaviour depends on both different endogenous mechanisms and environmental factors. Clinical data suggest that the use of stable doses of morphine (or other opiates) is common in patients suffering from chronic non-malignant pain. However, drug addiction might develop in 'at-risk patients' and therefore the decision to start long-term treatment with an opiate should be undertaken very cautiously, and ongoing assessment of aberrant drug-related behaviours should be undertaken repeatedly.
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In 1998, 77 cases of accidental ingestion of paracetamol paediatric syrup (Efferalgan) in children were notified to the Marseille Poison Centre. In a quarter of them, the alleged dose taken was greater than the toxic dose. ⋯ The proximate marketing of a product with a child-proof top, which should allow the number of accidents to be reduced. Doctors and pharmacists should be informed rapidly, so that they can warn the families who still have the old type of bottle.