Articles: acute-pain.
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Comparative Study Clinical Trial
Sensory responses to injection and punctate application of capsaicin and histamine to the skin.
A punctate, cutaneous application of capsaicin or histamine by means of a cowhage spicule elicits itch accompanied by pricking/stinging, burning, and typically, one or more areas of dysesthesia (alloknesis, hyperalgesia, hyperknesis). When applied over a wider and deeper area of skin by means of intradermal injection, histamine evokes the same sensory effects, but capsaicin evokes pain and hyperalgesia with allodynia instead of alloknesis. To examine the sensory effects of the spatial spread, depth, and amount of capsaicin and histamine, we applied different amounts of capsaicin or histamine by intradermal injection or by single vs multiple spicules within a circular cutaneous region of ~5 mm. ⋯ However, there was little or no itch; and allodynia replaced alloknesis. Yet, hyperalgesia was typically accompanied by hyperknesis. We conclude that the pruritic sensory responses produced by capsaicin/histamine spicules and histamine injections may be due to activation of common nerve fibers, possibly different from those mediating the flare, and that capsaicin injections may activate additional fibers whose effects mask the sensory effects of fibers mediating itch and alloknesis but not hyperknesis.
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To evaluate the effectiveness of NT in reducing pain and minimising use of analgesics in patients. ⋯ Neural therapy can be effective in reducing pain, as well as the use of analgesics. Further clinical trials would be needed to confirm this assertion.
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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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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.