Articles: opioid-analgesics.
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Ugeskrift for laeger · Jan 1994
Review[Opioid analgesics in the treatment of non-malignant chronic pain].
Opioid sensitivity, residual pain, development of tolerance, physical and psychological dependence are described and discussed in relation to long-term opioid therapy. Based on this, guidelines for long-term opioid administration are established for chronic pain conditions of non-cancer origin. The indication must be well-considered--a life-long treatment may be instituted. ⋯ The single dosages should be identical and administered with identical time intervals, which are determined by the duration of action of the drug in use. P.r.n.-administration should not be allowed. Only one physician should be responsible for the treatment and for the prescription of the opioid analgesic drugs.
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Intrathecal opioids and the combined spinal/epidural technique provide new tools for the obstetrical anesthesiologist. With intrathecal opioids, we can rapidly and safely relieve the pain of labor without maternal sedation or motor blockade. Intrathecal sufentanil 10 micrograms provides 1 to 2 hours of excellent analgesia during the first stage of labor. ⋯ Unless morphine is used, the side effects induced by intrathecal opioids are usually mild and easily treated. In our practice, combined spinal/epidural labor analgesia has rapidly gained wide acceptance by patients, nurses, obstetricians, and anesthesiologists. Continuous spinal analgesia, although theoretically appealing, requires further refinement.
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It is reported that intrathecal (it) injection of low dose of dynorphin (Dyn) induces no analgesia while high dose of Dyn induces analgesia and might lead to hindlimb paralysis and loss of reflex via NMDA receptor. We hypothesized that NMDA receptor antagonists may reveal kappa analgesic-potential of subliminal dose of Dyn. ⋯ Combination of Dyn A- (1-13) 5 nmol or U50488H 100 nmol, a kappa receptor agonist with either DL-2-amino-5-phosphonovaleric acid (5 and 10 nmol) or kynurenic acid (25 and 50 nmol) it induced synergistic analgesia, which was reversed by nor-binaltorphimine 15 nmol, a kappa receptor antagonist. It is concluded that kappa opioid receptor agonists and NMDA receptor antagonists synergistically induce analgesia via interaction with their receptors.
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Comparative Study Clinical Trial
The cognitive and psychomotor effects of opioid drugs in cancer pain management.
The time has come to evaluate critically our practice of cancer pain management and the assumptions on which it is based. We owe it to our patients to maximize the quality of their lives and to provide evidence for them that is based on a scientific approach rather than anecdotal experience. From the information available, opioids do have effects on cognitive and psychomotor function, and although many of these effects diminish once the patient is on a stable dose, the evidence suggests that baseline pretreatment levels are not achieved. ⋯ The management of the central adverse effects of opioids must be focused on accurate assessment and careful titration of opioids against pain. Adjuvant analgesic drugs and non-drug measures should be used whenever possible, and drugs should be chosen that will not contribute to existing difficulties. The appropriate use of psychostimulants has yet to be established as has the relative benefit of one opioid over another in cancer pain.