Articles: acute-pain.
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J. Pharmacol. Exp. Ther. · Nov 2011
Differential effects of nociceptin/orphanin FQ (NOP) receptor agonists in acute versus chronic pain: studies with bifunctional NOP/μ receptor agonists in the sciatic nerve ligation chronic pain model in mice.
1-(1-Cyclooctylpiperidin-4-yl)-indolin-2-one (SR14150) and 1-(1-(2,3,3a,4,5,6-hexahydro-1H-phenalen-1-yl)piperidinl-4-yl)-indolin-2-one (SR16835) are moderately selective nociceptin/orphanin FQ (NOP) receptor agonists. In the [(35)S]guanosine 5'-O-(3-thiotriphosphate) assay in vitro, SR14150 is a partial agonist at both the NOP and μ-opioid receptors, whereas SR16835 is a full agonist at the NOP receptor and has low efficacy at μ receptors. These compounds were tested for antinociceptive and antiallodynic activity, using mice in chronic pain, subsequent to spinal nerve ligation (SNL) surgery. ⋯ It is possible that during a chronic pain state, an up-regulated NOP system in the spinal cord leads to NOP receptor-mediated antiallodynia, which is blocked by NOP antagonists. However, supraspinal up-regulation could lead to an attenuation of morphine antinociception and antiallodynia, which can be alleviated by an NOP receptor antagonist. Thus, although neither NOP agonists nor antagonists are effective as analgesics in acute pain, they may have efficacy as analgesics, either alone or in combination with morphine, for treatment of chronic pain.
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Trauma, surgery, and burns are three common clinical scenarios that are associated with significant acute pain. This review describes the pathophysiology of acute pain utilizing three preclinical models: surgery, burn, and fracture. ⋯ Peripheral mediators of acute pain can vary depending upon the type of injury. Treatment aimed toward those mediators specific to the injury may improve acute pain management in the future. It will be important to translate these findings into clinical trials in the future.
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Tramadol hydrochloride/acetaminophen is a combination drug containing tramadol hydrochloride 37.5 mg and acetaminophen 325 mg. The use of 25% less tramadol in the combination product reduces the incidence of tramadol-related adverse events, while the addition of acetaminophen reduces the onset time of analgesia and improves the degree of analgesia. However, there was no clinically significant difference in the pharmacokinetic parameters of tramadol or acetaminophen when the fixed-dose combination was compared with the individual agents after multiple-dose administration. ⋯ It improves pain relief and provides a faster onset and longer duration of action with fewer adverse events than either component separately. It also reduces the severity of pain, photophobia and phonophobia associated with migraine headache. Tramadol hydrochloride/acetaminophen has been shown to be most effective in patients with mild to moderate pain and has a lower risk of serious adverse events.
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Pain is one of the main symptoms reported by patients who have had heart surgery. ⋯ Postoperative pain after heart surgery show significant individual variability. In our study, age, bypass grafting with internal mammary artery and preoperatory anxiety were shown as predictive variables of postoperative pain in patients undergoing heart surgery.
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Comparative Study
Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain.
Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the experience or anticipation of pain. The Child Pain Anxiety Symptoms Scale (CPASS) has recently been developed and validated in a pediatric community sample. The goal of the present study was to examine the psychometric properties of the CPASS in a sample of children and adolescents with acute postsurgical pain. ⋯ Pain anxiety was significantly associated with pain intensity (r = 0.44) and unpleasantness (r = 0.32) 48–72 hours after surgery (concurrent validity) and with pain unpleasantness (r = 0.29) and functional disability (r = 0.50; but not pain intensity, r = 0.20) 2 weeks later (predictive validity). The CPASS showed adequate sensitivity to change over time (mean change = 9.52; effect size = 0.49) and good sensitivity and specificity. The results of the present study provide initial validity and reliability of the CPASS in a clinical sample of children and adolescents after major surgery.