奇迈特治疗骨科术后疼痛疗效观察

目的评价盐酸曲马多缓释片(奇迈特)治疗骨科术后疼痛的临床疗效与耐受性。方法在骨科病房选择术后疼痛的成人病例共31例,服用奇迈特,根据疼痛控制程度和副反应调整剂量。观察镇痛起效时间、止痛持续时间,以及有无不良反应。结果全部病例均完成试验,无失访和因不能耐受而退出者。结果起效时间10～60分钟,平均21.5分钟,止痛持续时间0.5～12小时,平均5.1小时。完全缓解(CR)5例,明显缓解(PR)12例,无效(NR)0例。结论奇迈特作为盐酸曲马多的缓释片,是一种长效中枢性镇痛剂,使用方便。在治疗肌肉骨骼系统的术后疼痛方面具有优良的镇痛效果,副反应程度轻,有良好的耐受性,为骨科急、慢性疼痛的药物治疗提供了一种新的选择。     

盐酸曲马多缓释片引起皮肤瘙痒

盐酸曲马多缓释片(奇曼丁)临床多用于治疗中、重度疼痛.盐酸曲马多缓释片的不良反应有恶心、呕吐,出汗,口干,眩晕,嗜睡等,而皮肤反应较少见,现报道盐酸曲马多缓释片引起皮肤瘙痒1例.     

口服氨酚羟考酮和盐酸曲马多治疗妇科腹腔镜手术后早期疼痛的研究

目的 :观察妇科腹腔镜手术病人术后早期单次口服氨酚羟考酮 (泰勒宁 )和盐酸曲马多 (奇曼丁 )进行镇痛的有效性和安全性。方法 :12 0例VAS评分 >3分的妇科腹腔镜手术病人 ,随机分 3组 ,分别口服泰勒宁、奇曼丁或安慰剂 1片 ,3组病人均给予吗啡静脉自控止痛泵作为补救镇痛用药。观察并记录服药即刻、服药后 0 .2 5、0 .5、0 .75、1、2、4、6、8、12、2 4h的VAS评分、PCA用量以及不良反应 ,根据VAS评分计算疼痛缓解度 ,2 4h进行总体镇痛满意度评估。结果 :泰勒宁组和奇曼丁组VAS评分低于安慰剂组 (P <0 .0 5 ) ,泰勒宁组和奇曼丁组之间VAS评分相近 (P >0 .0 5 )。泰勒宁组和奇曼丁组补救PCA吗啡用量明显低于安慰剂组 (P <0 .0 5 ) ,泰勒宁组和奇曼丁组补救PCA吗啡用量相当 (P >0 .0 5 )。泰勒宁组和奇曼丁组总体镇痛满意度评估优于安慰剂组 (P <0 .0 5 )。 2 4h恶心呕吐率方面 ,奇曼丁组明显高于其他两组 (P <0 .0 5 )。结论 :口服泰勒宁和奇曼丁能有效地缓解妇科腹腔镜病人手术后的中至重度疼痛 ,早期口服给药镇痛的方式安全、有效。与奇曼丁组相比 ,泰勒宁组的不良反应发生率更低。     

盐酸曲马多缓释片投产

国家四类新药盐酸曲马多缓释片已在山东新华制药股份有限公司投产。该药为非吗啡类中枢性镇痛药物,其耐受性和依赖性很低,多用于中度和严重急慢性疼痛的治疗和外科手术。该药在制造工艺上采用骨架型缓释片盐酸曲马多缓释片投产     

盐酸曲马多缓释片治疗癌痛30例疗效观察

目的　探讨盐酸曲马多缓释片 (奇曼丁 )治疗癌痛的临床效果。方法　奇曼丁常规起始剂量 2 0 0 mg·d-1,每天总剂量不超过 6 0 0 mg。当每日总量达 6 0 0 mg无效时 ,剔除出组。结果　 3 0例癌痛患者的总有效率为76 .7% ,其中轻中度有效率 87% ,重度有效率 43 %。副作用主要是便秘和恶心。结论　奇曼丁安全镇痛效果好 ,副作用少 ,适宜作为二阶梯止痛药     

地尔硫缓释片治疗轻、中度原发性高血压30例

目的 :观察地尔硫缓释片治疗轻、中度原发性高血压临床疗效及不良反应。方法 :选择门诊及住院轻、中度高血压病人 30例 ,用地尔硫缓释片 90～ 180mg·d- 1。 12例病人作动态血压观察 ,整个疗程为 12wk。结果 :30例病人 11例 (37% )显效 ,13例 (4 3% )有效 ,总有效率 80 %。 2 4h平均收缩压和舒张压分别从 (18.8± 0 .9)kPa和 (11.7±0 .4 )kPa降至 (15 .8± 0 .5 )kPa和 (10 .0± 0 .4 )kPa。结论 :地尔硫能持续、平稳、有效地降压 ,其耐受性良好。     

盐酸吗啡缓释片治疗癌症疼痛的临床疗效分析

本文探讨癌症疼痛病人接受盐酸吗啡缓释片治疗的效果及其安全性。全国 13个省市 2 5家医院参加此项多中心开放性临床试验 ,共 5 6 7例癌症疼痛病人接受盐酸吗啡缓释片镇痛治疗 ,平均年龄 5 7.8岁 (16～ 91岁 )。结果显示镇痛疗效 :治疗前病人疼痛程度 (NRS)为 7.0± 1.8,其中重度疼痛 382例 (6 7.4 % ) ,中度疼痛 16 0例 (2 8.2 % ) ,轻度疼痛 2 5例 (4 .4 % )。治疗 1、5、10、15、2 0、2 5、30 d疼痛程度分别降至 4 .6± 2 .4 ,2 .8± 1.8,2 .7± 1.8,2 .6± 1.7,2 .5± 1.6 ,2 .3± 1.4 ,2 .2± 1.4。与治疗前疼痛程度比较差异有显著意…     

盐酸曲马多微球缓释片的制备及药动学研究

目的 探讨盐酸曲马多微球缓释片的制备方法,并对微球缓释片在家犬体内药动学进行研究。方法 以乙基纤维素作为包裹材料,运用喷雾干燥法制备盐酸曲马多缓释微球,直接压片得到盐酸曲马多微球缓释片。对微球缓释片和市售缓释片进行家犬体内单剂量给药实验,建立高效液相分析方法。结果 HPLC显示方法精密度、回收率、专属性都符合要求。市售缓释片和微球缓释片的药动学参数C_max分别为(322±16)ng·mL^-1和(346±11)ng·mL^-1;T_max分别为(2.5±0.3)h和(1.5±0.4)h;t_1/2分别为(4.31±0.84)h和(4.95±0.79)h,AUC_0→t分别为(2 940.8±32.1)ng·h·mL^-1和(3 560.9±18.6)ng·h·mL^-1,相对生物利用度为121.09%,不同释放时间点,盐酸曲马多微球缓释片的体内吸收与体外释放都具有良好的相关性。结论 盐酸曲马多微球缓释片具有缓释效果。     

琥珀酸美托洛尔缓释片治疗轻、中度高血压临床疗效观察

目的观察琥珀酸美托洛尔缓释片(以下简称美托洛尔缓释片)对原发性高血压的临床疗效和耐受性。方法采用自身对照开放试验方法,选择符合中国高血压防治指南诊断标准的40例轻、中度原发性高血压患者,经2周观察期后,口服美托洛尔缓释片(1次/d,47.5 mg/次),服药8周。对治疗前、后各项相关指标进行对照检查。结果40例患者的显效率为60%(24/40),总有效率为85%(34/40)。患者SBP/DBP下降[(21±11)mmHg/(12±7)mmHg],与治疗前血压比较,有显著性差异(P<0.01)。不良反应少,仅2例有轻度窦性心动过缓。结论美托洛尔缓释片治疗轻、中度高血压疗效确切,耐受性好。     

地尔硫缓释片治疗高血压37例

探讨地尔硫缓释片对轻、中度高血压患者疗效和耐受性。方法 :采用地尔硫缓释片 90～ 180mg ,qd。结果 :37例患者经 8周治疗 ,血压较治疗前下降了 (3 .0 7± 1.6 6 ) (2 .0 2± 0 .94)kPa(P <0 .0 1) ,显效率 81.1% ,总有效率 97.3 %。 16例病人接受了动态血压监测 ,结果显示 2 4h平均血压较治疗前分别下降了 2 .71 1.5 7kPa(P <0 .0 1) ,收缩压与舒张压的谷峰比值分别为 6 6 .6 % ,76 .0 %。结论 :地尔硫缓释片是有效且易于耐受的抗高血压药物。     

Animal models of pain for drug discovery

One of the greatest challenges to discovering more efficacious medications for pain control has been the heterogeneity of the chronic pain condition in humans. It is now appreciated that distinct mechanisms contribute to normal physiological pain, pain arising from tissue damage and pain arising from injury to the nervous system. To study pain transmission, identify new pain targets and characterise the potential analgesic profile of novel compounds, an array of experimental animal pain models has been developed (mainly in rodents) attempting to replicate the many human pain conditions, including inflammatory, neuropathic, visceral and cancer pain states. The authors review commonly used rodent models of acute and chronic pain that have been used in an attempt to identify novel analgesic drugs. Although these animal models have helped to better understand pain physio–pharmacology mechanisms, one should remember that even for patients labelled under the same ‘pain condition’, the pain experience is unique, increasing the difficulty of modelling such painful states in animals. Looking back at decades of pain research, it is clear that the transition from preclinical findings to clinical applications in the treatment of pain has been difficult and that more predictive models need to be developed to facilitate the discovery and development of novel pain medications. For these reasons, particular attention has been given in this review to the more recently developed models of visceral, osteoarthritic and bone cancer pain.     

Current understanding of the mixed pain concept: a brief narrative review

Despite having been referenced in the literature for over a decade, the term “mixed pain” has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of “nociplastic pain” in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term “mixed pain” is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group’s discussions, a Medline search for the Medical Subject Heading “mixed pain” was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group’s consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain.     

Pharmacoeconomics of opioid therapy for chronic non-malignant pain

Chronic non-malignant pain (CNMP) is widely prevalent and associated with significant costs. Costs related to chronic pain include medical services and medications, treatment of medication-related toxicity and work absenteeism. The use of non-narcotic analgesics is associated with inadequate pain-relief for many patients, as well as significant and costly organ toxicity. When used appropriately and judiciously, opioid medications can be a useful addition to the treatment plan for patients with CNMP. Opioids can provide long-term, safe and cost-effective pain relief.     

Pregabalin for the treatment of postsurgical pain

Importance of the field: Multimodal postoperative pain management targeted at diminishing harmful outcomes should include pregabalin in cases that need opioid reduction and when the risk of developing chronic neuropathic postsurgical pain is present. Gabapentanoids have grown in importance due to their opioid-sparing effects. They may also contribute to the prevention of chronic postsurgical pain.

Areas covered in this review: We reviewed the literature regarding the use of gabapentanoids and their role in treatment modalities in acute postsurgical pain. Dosing, therapeutic efficacy, side effects, and their role within a multimodal regimen are discussed. Particular emphasis is placed on their ability to provide an opioid-sparing effect, as well as on their potential for inhibiting chronic neuropathic pain. A Pubmed search of pregabalin, gabapentin, acute pain, multimodal analgesia, chronic postsurgical pain, and neuropathic pain between 2000 and 2010 was done. Relevant articles – including randomized controlled trials, retrospective trials, case series, case reports, and review articles – were filtered to include those that relate to postsurgical pain.

What the reader will gain: Readers will gain an increased appreciation of the role of pregabalin in postsurgical pain in patients at risk of developing chronic pain.

Take home message: Pregabalin is a safe and effective medication that may decrease perioperative opioid use in patients with more acute neuropathic pain than acute inflammatory pain. When surgery involves more neuropathic-type acute pain there is growing evidence that pregabalin may decrease the incidence of chronic pain.     

Emerging concepts on the use of ketamine for chronic pain

ABSTRACT

Introduction: The use of ketamine infusions for chronic pain has surged, with utilization exceeding the proliferation of knowledge. A proposed mechanism for the long-term benefit in chronic pain is that ketamine may alter the affective-motivational component of pain.

Areas covered: In this review, we discuss the classification and various dimensions of pain, and explore the effects of ketamine on different pain categories and components. The relationship between ketamine’s action at the NMDA receptor, the development of chronic pain, and the its possible role in preventing the persistence of pain are examined. We also summarize animal models evaluating the antinociceptive effects of ketamine and risk mitigation strategies of ketamine-associated side effects.

Expert opinion: Although ketamine exerts most of its analgesic effects via the NMDA receptor, recent evidence suggests that other receptors such as AMPA, and active metabolites such as nor-ketamine, may also play a role in pain relief and alleviation of depression. Data from clinical studies performed in patients with chronic pain and depression, and the observation that ketamine’s analgesic benefits outlast its effects on quantitative sensory testing, suggest that the enduring effects on chronic pain may be predominantly due ketamine’s ability to modulate the affective-motivational dimension of pain.     

The pharmacological management of dental pain

ABSTRACT

Introduction

Dental pain is primarily treated by dentists and emergency medicine clinicians and may occur because of insult to the tooth or oral surgery. The dental impaction pain model (DIPM) has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain.     

Activation of Kv7 channels with the anticonvulsant retigabine alleviates neuropathic pain behaviour in the streptozotocin rat model of diabetic neuropathy

Abstract

Diabetic peripheral neuropathy (DPN) is the most incapacitating complication of diabetes mellitus. Up to 50% of patients with DPN develop peripheral neuropathic pain (PNP). The underlying ionic and molecular mechanisms of diabetic PNP (DPNP) are poorly understood. However, voltage gated potassium (K_v7) channels which have been implicated in the pathogenesis of other types of PNP are likely to be involved. Here we examined, in the streptozotocin (STZ) rat model of DPNP, whether activating the Kv7 channels with a potent activator retigabine (ezogabine) would reverse/attenuate behavioural signs of DPNP. STZ rats exhibited behavioural indices of mechanical and heat hypersensitivity, but not cold hypersensitivity or spontaneous pain, 35?days after STZ injection. Retigabine given at a dose of 15?mg/kg (but not at 7.5?mg/kg, i.p.) significantly attenuated mechanical, but not heat hypersensitivity in DPNP rats, and was as effective as the positive control gabapentin. This analgesic effect of retigabine was completely reversed by the K_v7/M channel blocker XE991 (3?mg/kg, i.p.) indicating that the anti-allodynic effects of retigabine were mediated by K_v7 channels. In conclusion, the findings suggest that Kv7 channels are involved in DPNP pathogenesis, and that strategies that target their activation may prove to be effective in treating DPNP.     

癌痛住院患者阿片类药物合理使用分析

目的对我院住院的癌痛患者治疗进行调查分析,为临床合理使用阿片类药物提供参考。方法检索我院2012年1月至12月癌痛住院患者的电子病历,对阿片类药物进行用药频度（DDDs）、药物利用指数（DUI）、癌痛分布、癌症患者出院疼痛评分和用药合理性进行评价。结果共计286例癌痛治疗患者,癌痛控制不佳有82例,占比28．7％;余204例疼痛强度≤3。阿片类长效制剂曲马多缓释片、芬太尼透皮贴剂、盐酸羟考酮缓释片、吗啡缓释片分别为DDDs前4位,在各型癌痛治疗中占主导地位。部分科室不合理使用哌替啶注射剂比例较高。结论阿片类药物的使用基本合理,还应更严格按照癌症疼痛诊疗规范使用阿片类药物,癌痛规范化治疗示范病房的创建还需要进一步深化。