Articles: analgesics.
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Pain, the most frequent subjective symptom in cancer patients, can and must be treated. Satisfactory pain relief helps whatever patients achieve their remaining potential. This transforms his experience and the memories of his family. ⋯ In patients with moderate pain, if non-opioids do not provide adequate relief, codeine or an alternative weak opioid should be prescribed. In patients with severe pain, morphine, a strong opioid, is the drug of choice. A series of principles established on the basis of considerable clinical experience and of controlled studies of analgesics indicate that the dose of an analgesic should be determined on an individual basis, and administered on a regular basis by the clock.
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Flupirtine is a novel analgesic recently introduced with therapy. The present study assessed the role of opioid mechanisms in flupirtine-induced antinociception, localized its site of action along the neuraxis and evaluated its relative potency. Analgesic and general behavioral effects of flupirtine (0.3-10 mg/kg i.v.) were compared to those of the opioid analgesic pentazocine (0.3-5 mg/kg i.v.) in chronic spinal dogs. ⋯ Both drugs constricted pupils and lowered body temperature. In drug interaction studies, a relatively high dose (1 mg/kg i.v.) of the opioid antagonist naltrexone antagonized the effects of pentazocine but not those of flupirtine. It is concluded that flupirtine-induced antinociception is not opiate-receptor mediated, that its antinociceptive actions occur primarily at supraspinal sites and that its potency is less than that of pentazocine in the dog.
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During the 1960s, it was observed that the tricyclic antidepressant imipramine was effective in the treatment of neuralgia, myalgia, and pain in carcinoma. Similarly, in other studies, clomipramine was also found to have an analgesic effect. The sedative antidepressant amitriptyline has proved effective in migraine prophylaxis, chronic tension headache, and psychogenic musculoskeletal and neuralgic facial pain. ⋯ The remaining tricyclic and the tetracyclic antidepressants have not been sufficiently well evaluated. This is also true of monoamine oxidase inhibitors, of which individual reports to date suggest are probably also effective as analgesics. A scientific investigation into the possible differences in the effectiveness of various antidepressants in specific chronic pain conditions is an important task for the future.