Articles: pain.
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Clinical neurosurgery · Jan 1983
Treatment of chronic pain of malignant origin with intrathecal opiates.
The acute administration of intrathecal morphine in man results in analgesia mediated by an opiate receptor. Chronically infused intraspinal opiates have an analgetic action mediated by opiate receptors. ⋯ There appear to be at least two classes of opiate receptors in the human and animal spinal cords which mediate analgesia. Our preliminary data suggest that, as in the animal model, DADL, a delta-ligand, shows significant activity in a morphine-tolerant spinal cord.
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A review of conditions producing shoulder pain in the adult indicates the diverse nature of the various processes. Particularly important are diseases leading to articular abnormalities of the glenohumeral, acromioclavicular, and sternoclavicular articulations as well as surrounding structures such as the rotator cuff. Accurate diagnosis of the conditions requires careful radiographic examination supplemented with specialized techniques, including fluoroscopy, arthrography, and conventional or computed tomography.
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Cancer investigation · Jan 1983
Comparative StudyAnalgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination.
As part of a study to evaluate the analgesic efficacy of meperidine and hydroxyzine, alone and in combination, a double-blind complete crossover study of meperidine (50 mg IM), hydroxyzine (100 mg IM), meperidine (50 mg IM) plus hydroxyzine (100 mg IM), and saline placebo was conducted. Thirty patients with chronic moderate to severe pain due to metastatic cancer were evaluated as to pain relief following administration of all four study medications. All of the treatment groups showed statistically significant analgesic activity as compared to placebo. ⋯ The pharmacokinetics of meperidine and hydroxyzine were compared to observed analgesia. Significant correlation between serum drug levels of meperidine and hydroxyzine and pain relief resulted and the serum levels of meperidine and hydroxyzine necessary for analgesia were calculated to be 0.10-0.15 mg/ml and 60-70 ng/ml; respectively. The observed analgesia of the meperidine/hydroxyzine combination was correlated with the analgesia of the individual agents and the limited additive analgesia observed with the addition of meperidine to hydroxyzine does not justify the added toxicity of the narcotic.