草乌甲素脂质体的皮肤渗透性及抗炎镇痛作用

目的：考察草乌甲素脂质体的皮肤渗透性及抗炎镇痛效果。方法：采用正交设计详细考察了处方中各因素对透皮速率的影响；比较了脂质体与饱和水溶液的经皮渗透性；研究了脂质体对二甲苯所致急性炎症以及醋酸所致扭体反应的影响。结果：处方中磷脂、油酸、油酸钠对透皮速率有极显著性影响。脂质体可以明显加快草乌甲素的透皮吸收，缩短时滞。本品对炎症和疼痛均有明显的抑制作用，优于双氯芬酸钠乳胶剂对照组。结论：脂质体是草乌甲素透皮吸收的优良载体，有利于充分发挥药物的疗效。     

草乌甲素的研究进展

草乌甲素是一种现代植物药,具有良好的抗炎镇痛及免疫调节作用,安全性好.本文围绕草乌甲素的药理学、安全性和临床应用,综述其在风湿免疫病及其他慢性疼痛性疾病中的应用.     

针灸镇痛的临床疗效观察

目的了解使用针灸法治疗多种疼痛的疗效，并探讨其镇痛作用机制。方法将390例患者随机分为针灸镇痛组（260例）和药物镇痛组（130例），针灸镇痛组采用循经取穴、辨证取穴以及对症取穴法进行取穴针灸治疗，每周2次，10次为1个疗程，观察疗效。结果多种疼痛经过针灸治疗后症状明显改善，差异有统计学意义（P〈0．01）。结论针灸疗法是治疗多种疼痛的有效方法之一。     

701跌打镇痛膏镇痛作用研究

<正>临床上治疗跌打损伤、风湿痹痛的药物很多,如非甾体类抗炎镇痛药吲哚美辛等、传统中医药中的各种跌打损伤膏药等,在临床上发挥了一定的疗效,但化学药物大都存在副作用大,停药后疼痛反复发作等问题;传统中药大都也存在镇痛作用弱,镇痛作用机制不清晰等问题。上述问题在一定的程度上都限制了相应药物的应用。701跌打镇痛膏在国内外上市销售多年,临床疗效确切。然而其对何种类型的疼痛疗效更敏感,以及其镇痛作用是通过外周或者是通过中枢发挥的至今未见相关报道。为进一步明确701跌打镇痛膏     

术后急性疼痛治疗的新进展

围术期疼痛,特别是术后急性疼痛的治疗,是临床麻醉的重要组成部分,完善的术后疼痛治疗对于提高术后患者生活质量具有重要的意义。研究发现,术后急性疼痛的发生和发展受多种因素影响,新型的多模式镇痛应用不同作用机制的镇痛药物,通过不同的给药途径,阻断疼痛传导的不同环节位点,提高镇痛效果,减轻药物不良反应,维持机体内环境的相对稳定,已取代了传统的单模式的镇痛方法。同时,疼痛的管理理念已经从疼痛控制转为疼痛管理,将在术后急性疼痛治疗中发挥着重要的作用。     

吗啡超前镇痛用于术后疼痛治疗的研究进展

目的:为进一步促进吗啡超前镇痛在术后疼痛治疗中的合理应用提供科学依据。方法:以"吗啡""超前镇痛""Morphine""Preemptive analgesia"等为检索词,通过检索中国知网、万方、维普、Pub Med等数据库中收录的2005-2017年发表的相关文献,就吗啡超前镇痛用于术后疼痛治疗的研究进展进行归纳和综述。结果与结论:共纳入有效文献25篇。吗啡的镇痛作用一方面体现为抑制疼痛反射,另一方面体现为是阻断传导神经,使机体无疼痛感。药理学机制方面比较明确的为后者。吗啡超前镇痛在临床上可有效缓解和改善多种不同手术的术后疼痛症状,对患者的康复具有积极意义;同时吗啡与其他麻醉药物联用进行超前镇痛时也表现出良好的镇痛疗效。但吗啡相关的安全性、耐药性等问题还需进一步关注。今后随着吗啡相关机制研究的深入,将逐步明确吗啡用于超前镇痛领域的安全性及个体差异,进一步推动吗啡超前镇痛在术后疼痛治疗中的应用;并且,未来预防性镇痛及多模式镇痛理念的发展必将进一步拓展吗啡的临床应用空间。     

草乌甲素注射液对蛙离体坐骨神经干动作电位的影响

目的:探讨应用电生理方法比较草乌甲素注射液和普鲁卡因注射液对蛙离体坐骨神经干动作电位的影响及草乌甲素发挥局部麻醉作用的机制.方法:制备牛蛙离体的坐骨神经一腓神经标本,分为草乌甲素注射液组、普鲁卡因注射液组,以及草乌甲素注射液浓度组(10%,20%,50%,100%).用BL-420生物机能实验系统引导神经干动作电位,分别测定神经干动作电位的幅度、持续时间.结果:草乌甲素注射液和普鲁卡因注射液均可降低神经干动作电位的幅度,草乌甲素的作用大于普鲁卡因;但两者对神经干动作电位的持续时间无影响.结论:草乌甲素注射液对蛙离体坐骨神经干动作电位的产生有一定的抑制作用.     

氯诺昔康复合小剂量芬太尼用于术后静脉镇痛

芬太尼静脉术后镇痛已广泛应用于临床，但常因可导致恶心、呕吐、皮肤瘙痒、注射部位疼痛、甚至嗜睡、呼吸抑制等而限制其临床应用。氯诺昔康是非甾体抗炎镇痛药，它对各种疼痛的镇痛作用显著。本文比较观察了各种不同的静脉镇痛配方用于术后静脉镇痛治疗中的镇痛效果和不良反应。     

疼痛水平及镇痛治疗在急诊四肢创伤患者中的调查研究

目的 调查急诊科四肢创伤患者的疼痛程度及镇痛治疗情况.方法 共调查了126例四肢创伤患者,采用数字分级评分法对患者的疼痛程度进行评估；调查四肢创伤患者的镇痛情况及疼痛缓解时间.结果 急诊科创伤患者均存在不同程度的疼痛,患者的疾病状况（P=0.000）、性别（P=0.003）、年龄（P=0.005）对疼痛程度均有影响；66.67％接受疼痛治疗的患者在接受镇痛治疗后40 ～ 50 min内疼痛得到缓解.结论 急诊科护士在创伤患者疼痛状况评估、提供完善的镇痛治疗方面存在不足,急诊科创伤患者镇痛治疗指引有待完善.     

草乌甲素胶丸治疗肩周炎的疗效观察

肩周炎是门诊常见、多发的疼痛疾病之一,起病比较缓慢,主要表现为:肩关节周围的疼痛及关节僵直、活动受限,肩部疼痛难忍,尤其夜间疼痛剧烈,严重影响患者的睡眠及日常生活。我院麻醉科疼痛门诊采取草乌甲素胶丸治疗肩周炎,取得了良好效果,现报道如下。1资料与方法1.1一般资料选取肩周炎患者80例,均符合中华人民共和     

草乌甲素片治疗骨关节炎效果和安全性评价

目的 观察草乌甲素片治疗骨关节炎的临床疗效和安全性.方法 本研究采用开放式对照法,将114例骨关节炎患者分为2组：试验组57例,口服草乌甲素片0.4 mg,3次/d;对照组57例,口服双氯芬酸钠片25 mg,3次/d.2组疗程均为2周.疗效判断指标为服药前后患者对自己的总体评价变化、医生对患者总体情况的评价变化、患者关节压痛数变化、关节肿胀数变化以及美国西部安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分变化,同时观察不良反应发生情况.结果 用药后2周,对照组自评视觉模拟评分（VAS）试验前为（66±13）,试验后为（33±13）,差异有统计学意义（P＜0.01）;试验组患者自评VAS评分试验前为（67±15）,试验后为（39 ± 13）,差异有统计学意义（P＜0.01）;医生VAS评分均有明显改善[对照组试验前为（66±12）,试验后为（33±12）,试验组试验前为（67±15）,试验后为（39±12）]（P＜0.01）;且试验组不劣于对照组.对照组关节压痛数试验前为2.0（1.0,4.0）,试验后为0.0（0.0,1.0）;试验组关节压痛数试验前为2.0（0.0,3.0）,试验后为0.0（0.0,1.0）;对照组关节肿胀数试验前为8.0（5.0,10.0）,试验后为2.0（1.0,3.0）;试验组关节肿胀数试验前为7.0（5.0,10.0）,试验后为2.0（1.0,4.0）;对照组WOMAC评分试验前为（31±13）,试验后为（14±7）;试验组WOMAC评分试验前为（33±17）,试验后为（14±8）.2组患者关节压痛数、关节肿胀数以及WOMAC评分均有明显改善（P＜0.01）,2组间差异无统计学意义（P＞0.05）.结论 草乌甲素片治疗骨关节炎疗效确切,不劣于双氯芬酸钠片.     

Tapentadol immediate release for the relief of moderate-to-severe acute pain

Tapentadol is a novel, centrally acting analgesic with two mechanisms of action: µ-opioid receptor agonism and norepinephrine reuptake inhibition. It has demonstrated broad analgesic efficacy across multiple pain models. This article reviews the clinical development of tapentadol immediate release (IR), including results from Phase II and III clinical trials that evaluated the efficacy and safety of tapentadol IR in patients with moderate-to-severe acute pain. In clinical studies in patients with moderate-to-severe acute postoperative pain, osteoarthritis pain and/or low back pain, tapentadol IR 50, 75 or 100 mg every 4 – 6 h has demonstrated analgesic efficacy similar to that observed with the µ-opioid receptor agonist oxycodone HCl IR 10 or 15 mg every 4 – 6 h. However, at doses providing comparable analgesic efficacy, tapentadol IR has been associated with significantly lower incidences of nausea and/or vomiting and constipation, and a significantly lower rate of treatment discontinuation compared with oxycodone IR. The observed efficacy across different pain models and favorable gastrointestinal tolerability profile associated with tapentadol IR indicate that this novel analgesic is an attractive treatment option for the relief of moderate-to-severe acute pain.     

葛根素对神经病理性痛模型小鼠的镇痛作用

目的探讨葛根素对神经病理性痛模型小鼠的镇痛作用,为临床开发新的镇痛药物奠定基础。方法结扎雌性C57BL/6小鼠单侧胫神经和腓总神经,建立坐骨神经分支选择损伤(spared nerve injury,SNI)神经病理性痛模型,利用机械刺激法和冷盘法分别观察腹腔注射不同剂量葛根素(100,75和25mg·kg-1)对SNI模型小鼠患侧脚掌痛阈的影响。结果 SNI模型小鼠腹腔注射75mg·kg-1葛根素可显著提高患侧脚掌的50%缩足阈值(P<0.01)和降低5min抬足次数(P<0.01),产生明显的镇痛作用,镇痛时间可维持60～70min;100mg·kg-1葛根素腹腔注射后虽然也可产生明显的镇痛作用,但作用时间较短,仅维持10～20min;25mg·kg-1葛根素腹腔注射后没有明显的镇痛作用。结论适当剂量的葛根素对神经病理性痛具有明显的镇痛作用。     

Etodolac in the management of pain: A clinical review of a multipurpose analgesic

Etodolac is a non-steroidal anti-inflammatory drug with analgesic properties. Its primary anti-inflammatory mechanism of action is through a selective effect on cyclo-oxygenase-2 (COX-2). It is rapidly absorbed after oral administration, and maximum plasma concentration (C_max) is reached in 1-2 h, with an elimination half-life (t1/2 ) of 6-8 h. Etodolac has been widely applied in the treatment of inflammatory arthritides such as rheumatoid arthritis, ankylosing spondylitis and gout and in osteoarthritis and has been shown to be efficacious and well tolerated. However, etodolac has other applications which rely primarily on its efficacy as an analgesic. In particular, etodolac has been evaluated in the treatment of a variety of different pain states. Etodolac has been observed to be efficacious in the treatment of acute pain following dental extraction, orthopaedic and urological surgery, and episiotomy, as well as in the treatment of pain due to acute sports injuries, primary dysmenorrhoea, tendonitis, bursitis, periarthritis, radiculalgia and low back pain. These studies indicate that etodolac is a multipurpose analgesic with many clinical applications in addition to its use in the treatment of inflammatory and degenerative forms of arthritis.     

The problem of pain: Additive analgesic effect of tramadol and buprenorphine in a patient with opioid use disorder

Background: There is a paucity of published literature on the optimal treatment of pain in patients on buprenorphine treatment (BT) for opioid use disorder. Using this case report, we hope to demonstrate that tramadol may represent an effective treatment option for pain in patients on BT while encouraging future clinical trials. Case: The patient is a 56-year-old Caucasian male with a history of opiate use disorder on treatment with buprenorphine/naloxone 8/2?mg 2 times a day (BID) who was followed in an outpatient general psychiatry clinic that specializes in patients with co-occurring substance use disorders. Although maintaining sobriety from opioids, the patient continued to struggle with acute on chronic pain secondary to osteoarthritis that had left him walking with a cane. The patient was started on tramadol 50?mg 3 times a day (TID) for acute pain by his primary care physician (PCP) while he awaited surgical intervention. He reported analgesic effect with buprenorphine/naloxone but noted that it did not last the full period between his doses. He reported further improvement in his pain along with greater daily functioning with the additional use of tramadol, without side effects or withdrawal symptoms. Discussion: Current recommendations for pain management in patients on BT include discontinuation of BT therapy and/or addition of an adjunctive opioid analgesic (including additional buprenorphine/naloxone) while continuing agonist medication for treatment of opioid use disorder. However, determining which medication to use can be difficult, as there has been no literature examining this issue. In this case, the combination of buprenorphine and tramadol demonstrated an additive analgesic effect. Randomized control studies need to be performed to further understand the changes in pain measurement in patients on BT with tramadol compared with other adjunctive analgesic medications.     

Effect of minoxidil on sympathetic nervous activity in clonidine-treated hypertensive patients

Summary The efficacy and safety of oral ciramadol, a synthetic partial agonist-antagonist analgesic, in rapid control of postoperative pain was compared with oral pentazocine in a double blind study in 46 patients. Ciramadol 20 mg and 60 mg and pentazocine 50 mg had a rapid analgesic effect, peaking within one hour. Although a similar pattern of activity was observed for ciramadol 20 mg and pentazocine 50 mg, ciramadol 60 mg provided significantly better and longer lasting pain relief (P<0.02). Side effects included sedation and sweating, which occurred with a similar frequency in the various treatment groups. Oral ciramadol appears to be a safe and highly effective analgesic.     

经皮下输注装置鞘内吗啡镇痛的疗效及经济学评价

目的：评估经皮下输注装置鞘内输注吗啡治疗癌性疼痛的有效性和经济性。方法：收集2017年4月至2018年4月采用经皮下输注装置鞘内吗啡输注治疗的32例晚期癌痛病例,统计患者的疼痛程度、住院时长和住院费用等一般信息,评价鞘内镇痛对癌痛患者疼痛程度、日常生活能力和镇痛药物用量的影响,分析患者鞘内镇痛前后每日镇痛所需费用的变化,以及鞘内镇痛前后每日镇痛费用的差额与住院费用平衡所需时长。结果：行鞘内镇痛术的癌痛患者平均疼痛持续时间为（10.6±9.7）月,平均住院时长和住院费用分别为（13.0±5.8）d和（48 237.0±11 137.0）元。鞘内镇痛能够显著降低癌痛患者的疼痛程度（VAS评分：6.81±0.16 vs.2.69±0.22）、镇痛药物用量[（105.94±23.04）mg vs.（1.62±0.44）mg]和每日镇痛费用[（211.71±99.31）元vs.（5.62±0.15）元],但对患者的日常生活能力没有显著的改善作用（68.75±25.84）vs.（65.47±25.09）。鞘内镇痛前后每日镇痛费用的差额与住院费用抵消所需要的平衡时间为（515.87±325.56）d。结论：经皮下输注装置鞘内吗啡镇痛能够有效治疗晚期癌痛,减少镇痛药物用量和每日镇痛费用,但不能改善患者的生活质量和降低癌痛患者的总镇痛费用。     

A data science approach to the selection of most informative readouts of the human intradermal capsaicin pain model to assess pregabalin effects

Persistent and, in particular, neuropathic pain is a major healthcare problem with still insufficient pharmacological treatment options. This triggered research activities aimed at finding analgesics with a novel mechanism of action. Results of these efforts will need to pass through the phases of drug development, in which experimental human pain models are established components e.g. implemented as chemical hyperalgesia induced by capsaicin. We aimed at ranking the various readouts of a human capsaicin–based pain model with respect to the most relevant information about the effects of a potential reference analgesic. In a placebo‐controlled, randomized cross‐over study, seven different pain‐related readouts were acquired in 16 healthy individuals before and after oral administration of 300 mg pregabalin. The sizes of the effect on pain induced by intradermal injection of capsaicin were quantified by calculating Cohen's d. While in four of the seven pain‐related parameters, pregabalin provided a small effect judged by values of Cohen's d exceeding 0.2, an item categorization technique implemented as computed ABC analysis identified the pain intensities in the area of secondary hyperalgesia and of allodynia as the most suitable parameters to quantify the analgesic effects of pregabalin. Results of this study provide further support for the ability of the intradermal capsaicin pain model to show analgesic effects of pregabalin. Results can serve as a basis for the designs of studies where the inclusion of this particular pain model and pregabalin is planned.