Articles: pain.
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Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. ⋯ Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.
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The present study examined the influence of spinally administered fentanyl on the spontaneous and noxiously evoked activity of wide dynamic range (WDR) neurons in the dorsal horn of decerebrate, spinal cord-transected cats. This work was performed in order to evaluate the dose-response relationship, time course, and naloxone reversibility of fentanyl suppression of neurons that are involved with the transmission of information about pain. Extracellular single neuron recordings were obtained from 18 WDR neurons in the lumbar enlargement. ⋯ Such results support the concept that fentanyl is acting through a specific drug-receptor interaction. The onset of neuronal suppression occurred more rapidly, and the duration of the suppression was longer following fentanyl than that seen following spinal morphine. The onset and duration of this suppression correlates well with human clinical data, providing further evidence that alterations of WDR neuronal activity may be important in the production of spinal opioid analgesia.
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In the light of hypotheses related to the evolution of pain-carrying systems in mammals, terminal projection fields in brainstem and diencephalon of efferents of nucleus caudalis (NC) of the spinal trigeminal complex and spinal cord were determined in hedgehog by using Nauta-Gygax and Fink-Heimer silver techniques for degeneration. Unilateral NC lesions resulted in medullary degeneration in the ventral portion of NC contralaterally and bilaterally in cuneate nucleus (CU) and reticular formation. Pontine degeneration was noted ipsilaterally in medial (PBM) and lateral (PBL) parabrachial, facial motor (VII), and interpolar, oral, and main sensory trigeminal nuclei; degeneration in reticular formation was bilateral. ⋯ These results are consistent with the thesis that specific sensory thalamic nuclei evolved from a diffuse sensory region. Response properties of neurons in the dorsomedial portion of the ventral nuclear field, an area which are also received NC efferents, are not known. Last, NC projections to MD and LH implicate the role of "limbic" aspects of nociception.
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Randomized Controlled Trial Clinical Trial
Analgesic effect of graded doses of flurbiprofen in post-episiotomy pain.
Our purpose was to evaluate the analgesic efficacy and safety of single oral doses of flurbiprofen 25, 50 and 100 mg, aspirin 600 mg, and placebo in the relief of moderate to severe post-episiotomy pain. One hundred and fifty-two evaluable patients completed a randomized, double-blind, stratified, parallel groups study. They were observed over a six hour period by one nurse-observer. ⋯ Flurbiprofen 25 mg appeared to be slightly less effective than aspirin 600 mg, but the differences were not statistically significant. Flurbiprofen 50 and 100 mg were quite similar and were significantly more effective than aspirin 600 mg and flurbiprofen 25 mg. There were no observed or reported adverse effects.