鞘内注射丹参酮ⅡA对神经病理性疼痛大鼠的镇痛作用

目的:研究丹参酮ⅡA对坐骨神经慢性压迫大鼠的的镇痛效果及大鼠脊髓背角内半胱氨酸天冬氨酸蛋白酶3(caspase-3)和胶质纤维酸性蛋白(GFAP)表达的影响.方法:检测大鼠在手术前及术后14d的机械痛阈和热痛阈;PCR及免疫组织化学分别检测大鼠脊髓背角内caspase-3和GFAP基因及蛋白的表达,TUNEL法检测脊髓背角内的细胞凋亡.结果:与假手术组比较,模型组大鼠的机械痛阈和热痛阈明显降低,caspase3和GFAP的表达均增多,凋亡染色阳性细胞数目也增多;与模型组比较,丹参酮ⅡA处理组大鼠的机械痛阈和热痛阈明显升高,脊髓背角内caspase-3和GFAP的表达均下降,凋亡染色阳性细胞数目也减少,差异均有统计学意义.结论:鞘内注射丹参酮ⅡA对坐骨神经慢性压迫模型大鼠有镇痛作用,其机制可能与降低脊髓背角内caspase-3和GFAP的表达有关.     

神经干细胞移植治疗坐骨神经半切断神经病理性疼痛的最佳剂量

背景：有研究表明神经干细胞移植治疗神经病理性疼痛有一定效果,但神经干细胞移植数量对神经病理性疼痛的疗效并不确切。 目的：观察不同数量神经干细胞鞘内注射对坐骨神经半切断大鼠神经病理性疼痛及脊髓背角、背根神经节胶质源性神经营养因子表达的影响。 方法：选取1只孕14-16 d SD大鼠制备神经干细胞悬液,分别以细胞数1×103,1×104,1×105,1×106,1×107经坐骨神经半切断伤模型大鼠鞘内注入30 μL,并设置模型组和假手术组作对照。记录术前1 d,术后1,3,7,14,21 d 机械痛及热痛阈;术后7,21 d免疫组织化学与RT-PCR检测同侧脊髓背角及背根神经节胶质源性神经营养因子的表达。 结果与结论：与假手术组比较,其他各组术后1 d 痛阈下降,术后7,14 d最低(P < 0.05);与模型组比较,术后7 d,随着移植神经干细胞的浓度不断增加,神经干细胞1×104,1×105,1×106,1×107组痛阈逐渐升高,脊髓背角及背根神经节胶质源性神经营养因子表达逐渐上调(P < 0.05);术后21 d,神经干细胞1×105,1×106,1×107组痛阈均与术前差异无显著性意义,但其胶质源性神经营养因子表达在神经干细胞1×105组最高(P < 0.05)。说明鞘内注射神经干细胞能缓解大鼠的神经病理性疼痛,注射剂量以1×105神经干细胞效果最佳。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

纳米二氧化锰对大鼠腹侧中脑的损伤作用

目的:探讨纳米二氧化锰(nano-MnO2)对大鼠腹侧中脑的损伤作用。方法:大鼠在脑立体定位下,实验组脑内注射nano-MnO2,对照组脑内注射生理盐水(NS),各组分别于注射1周后用免疫组织化学方法检测酪氨酸羟化酶(tyrosine hydroxylase,TH)、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)及诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)的表达变化。结果:免疫组织化学染色结果显示,实验组大鼠注射1周后,腹侧中脑损毁侧与对侧相比,TH阳性细胞明显减少(P<0.05),GFAP及iNOS阳性细胞明显增多(P<0.05);对照组大鼠注射1周后,腹侧中脑损毁侧与对侧相比,TH、GFAP和iNOS免疫反应阳性细胞均无明显变化(P>0.05)。结论:脑内注射nano-MnO2能引起大鼠中脑多巴胺能神经元的破坏,GFAP和iNOS的表达增加。     

蛛网膜下腔注射pcDNA3．1（＋）-hPPE对大鼠神经病理性痛的镇痛效应

目的:观察蛛网膜下腔注射重组质粒pcDNA3.1(+)-hPPE对大鼠神经痛的镇痛作用.方法:SD大鼠随机分为坐骨神经慢性压迫(CCI)组、CCI假手术组、实验组和空质粒组.CCI组和CCI假手术组,用于观察疼痛持续时间;实验组和空质粒组分别于CCI术后第15天蛛网膜下腔注射重组质粒pcDNA3.1(+)-hPPE和空质粒pcDNA3.1(+).测定各组注射质粒前后CCI模型鼠双后肢热痛阈(PWTL),观察纳洛酮对镇痛效应的影响,用放射免疫法检测脑脊液灌流液中脑啡肽(L-ENK)的含量,同时采用免疫组织化学方法测定两组大鼠脊髓背角N-甲基-D-天冬氨酸(NMDA)受体2B亚基(NR2B)表达的变化.结果:CEI术后7～33 d,术侧PWTL明显低于对照侧.空质粒组注射前后热痛阈未见明显变化;与空质粒组相比,实验组大鼠蛛网膜下腔注射重组质粒pcDNA3.1(+)-hPPE后的第3天产生明显的抗伤害效应(FTWL升高),持续镇痛长达18d,且镇痛效应能被纳洛酮翻转.实验组脑脊液灌流液L-ENK含量显著高于空质粒组.与空质粒组比较,实验组大鼠脊髓背角NR2B阳性蛋白表达明显受到抑制.结论:蛛网膜下腔注射重组质粒pcDNA3.1(+)-hPPE能够减轻大鼠神经病理性疼痛的热痛敏行为.     

鞘内给予氯胺酮通过抑制星形胶质细胞内STAT3的磷酸化改善大鼠神经病理性痛的研究

目的:观察神经病理性痛大鼠鞘内给予氯胺酮对于脊髓背角星形胶质细胞内信号转导和转录活化因子3(STAT3)磷酸化水平的影响。方法:采用L5脊神经结扎(SNL)方法制作慢性神经病理性痛模型,利用机械刺激法和热板法连续观察造模后大鼠的痛行为变化;应用免疫组织化学染色和Western Blot方法观察大鼠腰膨大节段胶质纤维酸性蛋白(GFAP)和磷酸化STAT3(pSTAT3)的表达水平。结果:SNL模型大鼠机械性痛阈和热痛阈均明显降低,且术后一周内均保持在较低的水平(P0.01),从术后第3 d起鞘内连续给予氯胺酮至第7 d能够明显缓解大鼠患侧后爪的机械性痛敏和热痛敏。免疫荧光组织化学染色显示:pSTAT3在星形胶质细胞上有表达,且SNL后pSTAT3与GFAP在脊髓背角的表达均升高。Western Blot结果显示:与对照组相比,SNL后第7 d脊髓背角的pSTAT3的表达明显上调(P0.05),从术后第3 d鞘内连续给予氯胺酮至第7 d能够明显下调STAT3的磷酸化水平。结论:鞘内给予氯胺酮能够明显下调脊髓背角星形胶质细胞内STAT3的磷酸化水平从而达到缓解疼痛的目的。     

鞘内注射丹参酮ⅡA对坐骨神经慢性压迫性痛大鼠脊髓背角内磷酸化p38MAPK的影响

目的:研究丹参酮ⅡA(TSA)对坐骨神经慢性压迫性痛大鼠脊髓背角内磷酸化p38丝裂原活化蛋白激酶(p-p38MAPK)表达的影响,探讨丹参酮ⅡA的镇痛机制。方法:SD雄性大鼠随机分为假手术组(sham组)和模型组。模型组又分为生理盐水组(NS组)和处理组(TSA组)。模型组在手术当日及术后每日鞘内注射生理盐水0.1 ml和丹参酮ⅡA20 mg/kg,连续注射10 d。检测各组大鼠在手术前及术后10 d的机械痛阈和热痛阈;术后第10天,免疫组织化学和免疫蛋白印迹检测大鼠脊髓背角内p-p38MAPK的表达。结果:与假手术组比较,生理盐水组大鼠的机械痛阈和热痛阈明显降低,p-p38MAPK的表达增多;与生理盐水组比较,处理组的机械痛阈和热痛阈明显升高,脊髓背角内p-p38MAPK的表达下降,差异均有统计学意义。结论:鞘内注射丹参酮ⅡA对坐骨神经慢性压迫性痛模型大鼠的镇痛作用可能与降低脊髓背角内p-p38MAPK的表达有关。     

大鼠三叉神经尾侧亚核内星形胶质细胞对疼痛刺激的反应及与神经元的关系

目的 研究大鼠三叉神经尾侧亚核(Sp5C)星形胶质细胞对唇下注射福尔马林所致疼痛的反应及其与神经元的关系。方法 用免疫组织化学方法，显示注射后不同时间Sp5C星形胶质细胞与神经元内抗磷脂酶C(PLC)、抗Fos和抗胶质原纤维酸性蛋白(GFAP)免疫组织化学产物的表达和分布。结果 正常大鼠Sp5C无免疫组织化学阳性染色，唇下注射福尔马林后，Sp5C内的星形胶质细胞出现抗PLC、抗Fos和抗GFAP阳性染色，神经元出现抗PLC和抗Fos阳性染色，且有相同的亚核分布，关系密切。抗PLC和抗Fos免疫组织化学阳性先出现于星形胶质细胞，而后在神经元出现表达。结论 Sp5C内星形胶质细胞可能参与中枢神经系统对疼痛刺激的调节，并主动调节神经元的活动。     

大鼠延髓内脏带星形胶质细胞与神经元对选择性神经病理性痛的反应

目的 研究大鼠延髓内脏带(MVZ)内星形胶质细胞与神经元对选择性性神经病理性痛的反应.方法 25只成年 SD 大鼠,其中15只为接受左侧坐骨神经分支选择性损伤(SNI)组,5只作为假手术组,5只为对照组.在术前、术后10d、20d、30d(每时段5只)观察大鼠疼痛行为学并检测机械刺激缩足反射阈值(PWMT)的变化;应用抗Fos蛋白与抗胶质原纤维酸性蛋白(GFAP)或抗Fos蛋白与抗酪氨酸羟化酶(TH)的单一或双重免疫荧光法染色,Confocal显微镜下观察延髓MVZ内GFAP标记的星形胶质细胞的荧光强度,Fos/ GFAP双标记星形胶质细胞以及Fos/TH双标记神经元的平均数. 结果 SNI组大鼠与对照组或假手术组相比,术后10d其痛敏增高(PWMT值降低),20d痛敏达到高峰(PWMT值最低).免疫荧光染色显示:SNI术后MVZ内星形胶质细胞表现为激活型,GFAP免疫荧光强度明显增加;孤束核及腹外侧区的Fos/GFAP双标记星形胶质细胞及Fos/TH双标记神经元的平均值显著增高,SNI术后20d达到高峰. 结论 SNI术后MVZ内的星形胶质细胞和神经元均被激活.     

8-O-乙酰山栀子苷甲酸通过抑制脊髓背角JNK的磷酸化水平改善大鼠炎性痛的研究

目的:探究8-O-乙酰山栀子苷甲酸(8-O-acetyl-SM,8-Oa S)对于慢性炎性痛模型大鼠痛行为及脊髓背角星形胶质细胞内c-Jun氨基酸末端激酶(c-Jun N-terminal kinase,JNK)磷酸化水平的影响。方法:运用大鼠足底注射完全弗式佐剂(complete Freund’s adjuvant,CFA)的方法建立慢性炎性痛模型;通过腹膜腔注射8-Oa S进行干预;采用von Frey丝测定大鼠足底50%机械性缩足反射阈值;应用免疫荧光组织化学染色法观察大鼠腰膨大节段脊髓背角胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)及磷酸化的JNK(phosphorylatedc-Jun N-terminal kinase,p JNK)表达;应用Western Blot方法对大鼠脊髓背角内GFAP、JNK以及p-JNK的表达水平进行定量分析。结果:(1)行为学结果显示:与对照组相比,CFA模型大鼠机械性痛阈明显降低(P0.01),腹膜腔注射8-Oa S可有效提高CFA诱导的机械性痛阈值(P0.05);(2)免疫荧光染色结果显示:CFA模型脊髓背角内GFAP的表达量明显高于正常组,且p JNK基本表达于星形胶质细胞内;(3)Western Blot结果显示:与对照组相比,CFA造模后7 d脊髓背角内GFAP和p JNK表达明显上调,腹膜腔给予8-Oa S可以显著下调CFA诱导的脊髓背角内GFAP和p JNK的水平(P0.01)。结论:腹膜腔内给予8-Oa S可有效提高炎性痛大鼠的机械性痛阈,其机制是通过下调脊髓背角星形胶质细胞内JNK信号通路的磷酸化水平进而抑制星形胶质细胞的激活。     

鞘内注射丹参酮ⅡA对坐骨神经慢性压迫性痛大鼠脊髓背角N-甲基-D-天冬氨酸受体表达的影响

目的:研究丹参酮ⅡA对坐骨神经慢性压迫性痛大鼠脊髓背角内N-甲基-D-天冬氨酸受体2B亚基(NR2B)表达的影响,探讨丹参酮ⅡA的镇痛机制。方法:SD雄性大鼠随机分为假手术组和模型组。模型组又分为生理盐水组和处理组。模型组在手术当日及术后每日在大鼠鞘内注射生理盐水0.1 ml和丹参酮ⅡA 20 mg/kg,连续注射14 d。检测各组大鼠在手术前及术后14 d的机械痛阈和热痛阈;术后第14天,免疫组织化学检测大鼠脊髓背角内NR2B的表达。结果:与假手术组比较,生理盐水组大鼠的机械痛阈和热痛阈明显降低,NR2B的表达增多;与生理盐水组比较,处理组的机械痛阈和热痛阈明显升高,脊髓背角内NR2B的表达下降,差异均有统计学意义。结论:鞘内注射丹参酮ⅡA对坐骨神经慢性压迫性痛模型大鼠的镇痛作用可能与降低脊髓背角内NR2B的表达有关。     

The Prevalence of Severe Pain,its Etiopathological Characteristics and Treatment Profile of Patients Referred to A Tertiary Cancer Care Pain Clinic

Pain is the most feared symptom in cancer. About 52–77% patients suffer pain despite World Health Organization (WHO) recommendations. Out of total, one-third patients suffer moderate to severe pain. This study was undertaken to determine the prevalence, etiopathogenesis and characteristics of severe pain and treatment response among pain clinic referrals in a busy tertiary care cancer center. This study found a high prevalence (31.5%) of severe pain. A total of 251 patients who had complete pain data were analyzed for etiopathological characteristics and treatment response. Head and neck cancer contributed the highest prevalence among all regions. Oncologists prescribed non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol with or without mild opioids to 14% patients and pain clinic physicians prescribed opioids and overall 63.7% patients had a better response after pain clinic referral, even then, morphine was not prescribed to many deserving patients. Doctors need pain education about opioids to remove any fear of prescribing opioids in presence of severe pain.     

Genetic predictors for acute experimental cold and heat pain sensitivity in humans

Background

The genetic contribution to pain sensitivity underlies a complex composite of parallel pain pathways, multiple mechanisms, and diverse inter‐individual pain experiences and expectations.

Methods

Variations for genes encoding receptors related to cold and heat sensation, such as transient receptor potential A subtype 1 (TRPA1), M subtype 8 (TRPM8), V subtype 1 (TRPV1), δ opioid receptor subtype 1 (OPRD1), catechol O‐methyltransferase (COMT), and fatty acid amide hydrolyase (FAAH), were investigated in four major ethnic populations.

Results

We defined 13 haplotype blocks in European Americans, seven blocks in African Americans, seven blocks in Hispanic subjects, and 11 blocks in Asian Americans. Further study in European American subjects found significant associations between short duration cold pain sensitivity and variations in TRPA1, COMT, and FAAH in a gender dependent manner. Our observations demonstrate that genetic variations in TRPA1, COMT, and FAAH contribute gender specifically to individual variations in short duration cold pain sensitivity in a European American cohort.

Conclusions

The effects of TRPA1 variations on experimental short duration heat pain sensitivity may contribute to inter‐individual variation in pain sensitivity in humans.     

颈肩痛患者颈肩部肌肉的表面肌电图特征

背景：颈肩痛是由颈肩部软组织(主要是肌肉)的慢性劳损所引起的常见临床症状。表面肌电图是一种新型、无创的肌肉活动检查手段,能测量肌肉的活动和功能。 目的：评价颈肩疼痛患者颈肩部肌肉功能,为表面肌电图的应用和颈肩疼痛患者合理防治与康复提供理论依据。 方法：应用表面肌电图对32例单侧颈肩疼痛的办公室工作人员在站立下,进行低头、头后伸、双手上举时颈竖脊肌、斜方肌上支的表面肌电测试。在测试前,对患者的颈肩疼痛进行目测类比评分。然后根据收集的数据,比较受试者颈肩部疼痛侧与非疼痛侧测试肌肉的肌电活动。 结果与结论：测试前,受试者颈肩疼痛目测类比评分(平均分)为5.03分;受试者在低头、头后伸、双手上举过程中,其疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号较非疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号弱;疼痛侧颈竖脊肌、斜方肌上支肌电的平均振幅值与非疼痛侧相比差异有显著性意义(P < 0.05);疼痛侧颈竖脊肌、斜方肌上支肌电的平均频率斜率值与非疼痛侧相比差异无显著性意义(P > 0.05)。提示颈肩疼痛患者疼痛侧的颈肩肌肉的活动能力下降,长期坐位作业的办公室人员要定时进行颈肩部肌肉锻炼。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

The pain behavior check list (PBCL): Factor structure and psychometric properties

The construct of pain behaviors as observable and measurable manifestations of pain occupies a central role in Fordyce's operant model of pain. The present study was designed to evaluate the multidimensional nature of the construct and to explore the psychometric properties of a newly developed self-report instrument called the Pain Behavior Check List (PBCL). Subjects were 126 chronic pain patients who completed an initial version of the PBCL and other standardized questionnaires as part of their evaluation by the West Haven VAMC. Factor analysis identified four factors labeled Distorted Ambulation, Affective Distress, Facial/Audible Expressions, and Seeking Help. Substantial reliability and stability estimates for the total PBCL and the subscales support the potential clinical and theoretical utility of the instrument.This research was supported by Department of Veterans Affairs Merit Review funds awarded to the first author.     

An empirical examination of the “pain-behavior” construct

Observable means of communicating pain and suffering, pain behaviors, have been postulated to comprise an important construct relevant in both the development and the maintenance of chronic pain [Fordyce, W. E. (1976). Behavioral Methods for Chronic Pain and Illness, C V. Mosby, St. Louis, Mo.]. Two groups of professionals who have direct contact with chronicpain patients (i.e., physicians and psychologists) participated in a study designed (a) to identify the latent or underlying characteristics of pain behaviors and (b) to assess the degree of agreement of these characteristics between health professionals with very different training. Multidimensional scaling and hierarchical clustering statistical techniques were employed to identify the latent structure of pain behaviors. Two primary pain behavior dimensions were identified, namely, audible-visible and affective-behavioral. Four clusters of pain behaviors were identified and labeled distorted ambulation or posture, negative affect, facial/audible expressions of distress, and avoidance of activity. The two samples of health-care providers identified virtually equivalent latent characteristics of pain behaviors. The data suggest that there is consistency in the pain-behavior construct and that the latent structure is generally congruent with Fordyce's original conceptualization. The results provide an empirically derived basis for the assessment of pain behaviors.     

Pain: The Magnitude of the Problem and Unmet Therapeutic Needs

In The Tragedy of Needless Pain, an article Ronald Melzack published in the Scientific American in 1990, the author points out that over 80% of patients with cancer pain can obtain good pain relief if the available knowledge of pain therapy is properly applied. He further states that, since the majority of cancer pain patients continue to suffer agonizing pain, their pain is needless. Ten years later the tragedy of the under treatment of pain continues to be a major health problem worldwide and a disgrace for the health care profession and society. Every year in the United States of America there is one person every 1,000 people who dies after weeks or months of severe under treated cancer pain. Of the 38.8 million Americans who suffer moderate to excruciating acute pain, 51% do not receive proper pain control, while of the 50 million with chronic intractable non cancer pain proper pain relieve is achieved in less than 30% of the patients. While most advances in medicine are dependent on new discoveries prompted by basic and clinical research, pain therapy is hindered by two major barriers: lack of education on the subject and limited research funding. Pathophysiology and therapy of pain is at best marginally taught in medical, nursing and pharmacy schools. Therefore, the great majority of health care professionals have very little or no knowledge, and often have misconceptions, on the subject. For this reason, while 80 to 90% of patients suffering intense pain associated with advanced cancer could obtain proper pain control, albeit with some side effects caused by the analgesic medications, only 30% of them report acceptable pain relief. The majority of physicians also fail to appreciate that poorly treated intense pain not only causes misery for the patient but, it can have serious deleterious effects caused by inactivity, lack of sleep, anorexia, anxiety, depression of the immune system, and reactive depression. Therefore pain should be treated not only for humanitarian, but also for medical reasons. This generalized lack of education on pain is also responsible for the limited research funding granted to this field since the people entrusted with funding pain research projects suffer from the same ignorance. For instance, in 1999 the National Cancer Institute funded research projects for a total of $3.065 billion; 0.8% of this funding, or $24 million, was designated for research in pain and symptom control. It must be underlined that of all patients who are now affected by cancer 48% will die because of it and that 75% of them will develop severe pain and other distressing symptoms. The very limited funding for research on pain is responsible for the significant deficiency that still exists in the knowledge regarding the pathophysiology and therapy of pain. The most effective medication to control intense pain is morphine, or some of its derivatives. Morphine was isolated from opium almost 200 years ago, and opium has been used for pain control for over 3,500 years. Despite the great advances made in medicine during the last hundred years, the control of intense pain still relies on one of the oldest plant extracts known to mankind with all the side effects associated with its use. If we wish to eradicate unnecessary pain, which is a scourge of humanity, more education, new discoveries, and more advocacy for the suffering pain patients are needed.     

Reactions to pain among subjects high and low in dental fear

Differential pain tolerance might account for the diversity of reactions commonly seen in response to stressful medical and dental procedures. College students reporting themselves either highly fearful or nonfearful of dental work were compared in several aspects of their reactions to dental and nondental pain. The two groups did not differ in pain threshold or pain tolerance assessed during tooth pulp stimulation or during electrical stimulation of the forearm. High-dental fear subjects, however, retrospectively rated tooth shock (but not arm shock) more painful than low-fear subjects. High-fear subjects also showed significantly greater affective reactions assessed via the Anxiety Differential during both tolerance tests, with the group differences greater in magnitude during tooth shock than arm shock.This research was supported by USPHS Grant DE-04976 from the National Institute of Dental Research awarded to the first author.     

Repeated administration of systemic gabapentin alleviates allodynia-like behaviors in spinally injured rats

The effect of systemic gabapentin, a novel antiepileptic and analgesic, was tested on allodynia-like behaviors in spinal cord injured rats. On the first day of treatment 30 mg/kg intraperitoneal gabapentin did not alleviate hyper-reactivity to mechanical and cold stimulation. The allodynia was significantly reduced by 100 mg/kg gabapentin, which however, produced sedation and motor impairments. Repeated administration of 30 mg/kg gabapentin once a day produced a gradually increasing anti-allodynic effect. Total alleviation of mechanical allodynia was observed in most rats after the third administration of gabapentin. Thus, build-up of the antiallodynic effect of gabapentin may develop through a time dependent mechanism or alternatively through a gradual accumulation of the effective central nervous system concentration of the drug.     

Opioid-prescribing Practices in Chronic Cancer Pain in a Tertiary Care Pain Clinic

Introduction:

Under treatment of pain is a recognized global issue. Opioid analgesic medication is the mainstay of treatment in cancer patients as per the World Health Organization (WHO) pain relief ladder, yet 50% of cancer patients worldwide do not receive adequate pain relief or are undertreated.

Aim:

The aim of this study was to audit the ongoing opioid-prescribing practices in our tertiary cancer pain clinic during January–June 2010.

Materials & Methods:

The prescribed type of opioid, dose, dosing interval, and laxatives details were analyzed.

Results:

Five hundred pain files were reviewed and 435 were found complete for audit. Three hundred forty-eight (80%) patients were prescribed opioids. Two hundred fifty-nine (74.4%) received weak opioids while 118 (33.9%) received strong opioids. A total of 195 (45%) patients had moderate and 184 (42%) had severe pain. Ninety-three (26.7%) patients received morphine; however, only 31.5% (58 of 184) in severe pain received morphine as per the WHO pain ladder. Only 73 of 93 (78.4%) patients received an adequate dose of morphine with an adequate dosing interval and only 27 (29%) were prescribed laxatives with morphine.

Conclusion:

This study shows that the under treatment of pain and under dosing of opioids coupled with improper side effect management are major issues.