氨酚曲马多治疗骨科急慢性疼痛的疗效

目的探讨氨酚曲马多治疗骨科急慢性疼痛的疗效。方法对骨科门诊124例疼痛患者（111例急性疼痛,13例慢性疼痛）其疼痛的程度用视觉模拟评分法（VAS）进行评分后,给予氨酚曲马多治疗5d,然后再次对疼痛进行评分并对疗效进行评价,并记录不良反应。结果急性疼痛患者治疗前平均疼痛的VAS评分为（5.38±1.43）,治疗后平均疼痛的VAS评分为（3.50±1.69）,二者有统计学意义;慢性疼痛患者治疗前平均疼痛的VAS评分为（4.83±1.30）,治疗后平均疼痛的VAS评分为（4.00±1.47）,二者有统计学意义。急性疼痛患者的不良反应主要为头晕14%、恶心4.5%、呕吐8.1%;慢性疼痛患者没有不良反应的发生。结论氨酚曲马多对于治疗骨科急慢性疼痛安全性较好,总体效果满意。     

Double-blind,placebo controlled comparison of paracetamol and paracetamol plus codeine — a quantitative evaluation by laser induced pain

Summary The aim of the present double-blind, placebo controlled, three-way cross over study was to evaluate the analgesic efficacy of single oral doses of paracetamol 1.0 g and paracetamol 1.0 g plus codeine 60 mg. Pain threshold and brain evoked potentials to laser stimulation were determined hourly for 6 h in 12 healthy volunteers. Pain threshold was significantly elevated compared to placebo 1 and 2 h after paracetamol ingestion. Paracetamol 1.0 g plus codeine 60 mg was superior to placebo 1 to 6 h after medication. Only at 1 and 2 h after ingestion the combined drug was better than paracetamol. The evoked potentials were significantly depressed compared to placebo 2 and 4 h after paracetamol. The combination of paracetamol and codeine was superior to placebo 1 to 6 h after ingestion. The potentials showed no difference between the two active drugs. The total analgesic effect (approximation of area under the time-efficacy curve), showed that the combined drug was superior to plain paracetamol. A higher incidence of adverse effects in 10 of the 12 subjects was observed after ingestion of the combined drug compared to plain paracetamol (1 of 12). Paracetamol appears to exert part of its action by a cental effect. There was at least 1 h between the peak plasma concentration of paracetamol and the peak hypoalgesia.     

Extended-release tramadol/paracetamol in moderate-to-severe pain: a randomized,placebo-controlled study in patients with acute low back pain

Abstract

Objective:

Combinations of oral analgesics may offer several potential benefits compared with an individual agent. The objective of this study was to investigate the efficacy and safety of an extended-release, twice-daily fixed combination of 75?mg tramadol/650?mg paracetamol (DDS-06C) in the treatment of moderate-to-severe pain, using acute low back pain as a model.     

Efficacy and tolerability of orally administered tramadol/dexketoprofen fixed-dose combination compared to diclofenac/thiocolchicoside in acute low back pain: experience from an Italian,single-centre,observational study

Abstract

Objectives

To compare the analgesic efficacy and tolerability of tramadol/dexketoprofen 75/25?mg (TRAM/DKP) versus diclofenac/thiocolchicoside 75/4?mg (DIC/THIO) in patients with moderate-to-severe acute low back pain (LBP).     

Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: a prospective observational pilot study (MIPORT)

ABSTRACT

Objective: Chronic back pain is characterized by a combination of neuropathic and nociceptive mechanisms of pain generation. The prevalence of the neuropathic pain component is unknown. Thus, in the context of an explorative study, we aimed to determine the prevalence of signs and symptoms indicating neuropathic pain in adult patients treated by orthopaedists. We also aimed to assess the usefulness of handheld computers (PDAs) in data collection.

Methods: Prospective epidemiological study in 18 orthopaedic practices or centres throughout Germany. Physician and patient questionnaires (paper/pencil or on handheld computers, PDAs) for patients with back pain of at least 3 months in duration were applied, as well as the von Korff score to assess pain intensity (visual analogue scale, VAS; 0 = no pain, 10 = worst possible pain) and pain characteristics, the Hannover Functional Ability Questionnaire (FFbH-R), and if patients agreed to provide information, the short-form Patient Health Questionnaire (PHQ-D) for depression.

Results: For 717 patients, both patient and physician questionnaires were available. Mean patient age was 56 years; pain was predominantly located in the low back (87%). Median current pain intensity on the VAS was 5.0. Confirmed key signs and symptoms indicated neuropathic pain was frequent, e.g. radicular pain radiating beyond the knee towards the foot (40.0%), positive Lasegue sign (18.4%), or absent patellar reflex (17.3%). A third of all patients (33.5%) had ≥ 3 characteristic signs for neuropathic pain. Patient functionality was severely reduced (median 43.3%). There were no relevant differences in outcomes between patients using the paper/pencil method (47%) versus those preferring PDAs (53%).

Conclusion: Screening for neuropathic pain in this setting is feasible with simple questionnaires and scales on PDAs. Neuropathic pain is a major contributor to chronic back pain and a frequent component in patients seen by orthopaedists. At least one third of all patients should undergo additional diagnostic measures to confirm the cause of neuropathic pain.     

Multimodal analgesia in moderate-to-severe pain: a role for a new fixed combination of dexketoprofen and tramadol

Background: Untreated and under-treated pain represent one of the most pervasive health problems, which is worsening as the population ages and accrues risk for pain. Multiple treatment options are available, most of which have one mechanism of action, and cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety concerns. Another limitation of single-agent analgesia is that, in general, pain is due to multiple causes. Combining drugs from different classes, with different and complementary mechanism(s) of action, provides a better opportunity for effective analgesia at reduced doses of individual agents. Therefore, there is a potential reduction of adverse events, often dose-related. Analgesic combinations are recommended by several organizations and are used in clinical practice. Provided the two agents are combined in a fixed-dose ratio, the resulting medication may offer advantages over extemporaneous combinations.

Conclusions: Dexketoprofen/tramadol (25?mg/75?mg) is a new oral fixed-dose combination offering a comprehensive multimodal approach to moderate-to-severe acute pain that encompasses central analgesic action, peripheral analgesic effect and anti-inflammatory activity, together with a good tolerability profile. The analgesic efficacy of dexketoprofen/tramadol combination is complemented by a favorable pharmacokinetic and pharmacodynamic profile, characterized by rapid onset and long duration of action. This has been well documented in both somatic- and visceral-pain human models. This review discusses the available clinical evidence and the future possible applications of dexketoprofen/tramadol fixed-dose combination that may play an important role in the management of moderate-to-severe acute pain.     

Reporting rate of adverse drug reactions to the French pharmacovigilance system with three step 2 analgesic drugs: dextropropoxyphene, tramadol and codeine (in combination with paracetamol)

AIMS

Three ‘weak’ opioid analgesics in association with paracetamol are marketed in France as step 2 analgesics: dextropropoxyphene, tramadol and codeine. These combinations are involved in several adverse drug reactions (ADRs), but no data are available about their comparative reporting rate. The aim was to compare the reporting rate of ADRs between tramadol/paracetamol (TRM+P), codeine/paracetamol (COD+P) and dextropropoxyphene/paracetamol (DXP+P).

METHODS

All spontaneous reports submitted to the French Pharmacovigilance Database from 1 January 1987 to 31 December 2006 suspected to be induced by one of the three step 2 analgesic combinations (DXP+P, TRM+P, COD+P) were extracted. Their consumption for the same period was obtained from the French Drug Agency. The number of ADRs, serious ADRs and different organ classes of ADRs were compared according to their consumption. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each variable using DXP+P as reference.

RESULTS

The reporting rate of ADRs was calculated as 24.9/100 000 person-years for DXP+P, 44.5/100 000 person-years for TRM+P and 12.5/100 000 person-years for COD+P. The reporting rate (OR 0.56, 95% CI 0.50, 0.63) and ‘seriousness»’ (OR 0.65, 95% CI 0.53, 0.80) of ADRs were significantly higher with TRM+P than with DXP+P. However, hepatobiliary ADRs were significantly more frequent with the DXP+P combination (OR 2.62, 95% CI 1.59, 4.37). In contrast, the reporting rate (OR 1.99, 95% CI 1.82, 2.18) and ‘seriousness’ (OR 2.64, 95% CI 2.24, 3.11) of ADRs were significantly higher with DXP+P than with COD+P.

CONCLUSIONS

Among the three step 2 analgesic combinations, reporting rate and ‘seriousness’ of ADRs are the highest with TRM+P and the lowest with COD+P. Our study suggests that the safety profile of DXP+P is worst than that of COD+P.     

Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach

Abstract

Background:

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management.     

Skeletal pain in postmenopausal women with osteoporosis: prevalence and course during raloxifene treatment in a prospective observational study of 6 months duration

ABSTRACT

Objective: To assess the prevalence of skeletal pain in postmenopausal women before the onset of raloxifene treatment and the further course of pain during treatment in a naturalistic setting.

Research design and methods: Prospective, uncontrolled, multicentre, 6‐month, observational study in Germany. Clinical, diagnostic and pain data were collected at baseline, 6 weeks and 6 months of raloxifene treatment from 3299 female outpatients with postmenopausal osteoporosis. Physicians assessed the presence or absence of back pain, joint pain and diffuse bone pain at each visit, perceived sleep quality and the use of analgesics. Patients assessed intensity and frequency of pain using a 100?mm visual analogue scale (VAS) and a 5‐point scale (from ‘rarely’ to ‘permanently’), respectively.

Results: At baseline, patients had mean (SD) age 67.6 (9.3) years, 89.4% were reported to have reduced bone mineral density, 39.8% had pre-existing fractures and 93.4% had skeletal pain (physician assessment): 85.1% had back pain, 41.8% joint pain and 32.5% diffuse bone pain. Median pain intensity on VAS was 66.0?mm. After 6 months of raloxifene treatment, the frequency and intensity of pain and use of analgesics for skeletal pain decreased consistently by approximately 50%. Pain frequency decreased in 58.2% and increased in 2.3% of patients. The median decrease in pain intensity from baseline to 6 months was 27.0?mm (46%). Patients’ subjective quality of sleep improved: the proportion of patients who were reported to sleep well increased from 21.3% at baseline to 46.7% at 6 months. The decrease in relative pain frequency was greatest with diffuse pain (67.6%) followed by joint pain (36.9%) and back pain (32.5%).

Conclusion: Raloxifene treatment in postmenopausal women with osteoporosis was associated with a marked reduction of skeletal pain and analgesic consumption and an improvement in subjective sleep quality. Further investigation in a randomised, placebo-controlled trial is warranted.     

Acute back pain: benefits and risks of current treatments

Abstract

Objective:

To review the efficacy and safety of current treatments for acute low back pain.     

Development and testing of a neuropathic pain screening questionnaire: ID Pain

ABSTRACT

Objective: To develop a patient-completed screening tool to help differentiate nociceptive and neuropathic pain.

Research design and methods: A multicenter study was performed for item reduction (initial 89-item questionnaire) and model building. Patients (N = 586) with non-headache chronic pain completed the questionnaire and were referred to pain specialists for diagnosis. Factor and regression analyses were used to derive a final, 6-item questionnaire – ID Pain. A second multicenter study evaluated reliability and validity. Patients (N = 308) treated by pain specialists completed ID Pain and validation measures.

Main outcome measures: Sensitivity and specificity were assessed using receiver operating characteristic curves and the concordance c index. Reliability was assessed using a κ statistic and intraclass correlation coefficient.

Results: Final 6 items were: did the pain feel: (1) like pins and needles? (2) hot/burning? (3) numb? (4) like electrical shocks? (5) is the pain made worse with the touch of clothing or bed sheets? (6) is the pain limited to your joints? ‘Yes’ answers to questions 1–5 were scored as 1, while a ‘yes’ answer to question 6 was scored as –1. ‘No’ answers were scored as 0. Higher scores (–1 to 5) suggested a neuropathic component. The questionnaire accurately predicted diagnoses of neuropathic pain made by pain specialists. The concordance c indices in the studies were 0.73 and 0.69. The ICC was 0.742; the κ statistic ranged from 0.742 to 0.527.

Conclusions: ID Pain appeared to accurately indicate the presence of a neuropathic component of pain. As a brief, self-administered screening tool, it could be useful in primary care settings.     

Innovative pain therapy with a fixed combination of prolonged-release oxycodone/naloxone: a large observational study under conditions of daily practice

Abstract

Background:

Chronic pain has a marked negative impact on quality of life. Opioid treatment is often effective in controlling this pain, but it has numerous side-effects, particularly affecting bowel function.     

Paper versus electronic rating scales for pain assessment: a prospective,randomised, cross-over validation study with 200 chronic pain patients

ABSTRACT

Objective: Following the recent introduction of hand-held computers to be used by patients instead of conventional pencil-and-paper questionnaires, a validation study under ’real-life? conditions was conducted, in order to compare these two clinical instruments when used by chronic pain patients to describe their pain using visual and numerical rating scales.

Method: Each of 200 chronic pain patients attending a single physician's practice was given two pain questionnaires to complete, one on paper and one on a hand-held computer; completion of these took place directly before and after consultation, in randomised order. The questions asked in the two questionnaires were identical: present pain, average pain, worst pain and those of the painDETECT questionnaire (the latter distinguishes characteristic symptoms of nociceptive pain). In accordance with standard practice, the paper questionnaire used numerical rating scales and the electronic one employed visual analogue scales, with or without a numerical indicator.

Results: Nearly all patients (99?%?) of the study population (58?%?female; aged 57?±?14 years) completed both questionnaires. In spite of the expected substantial intra-individual scatter, overall results from the two questionnaire types were highly consistent. Only a few differences of potential statistical significance (p?<?5?%?) were observed, and none were found that would have led to different interpretations. No difference was seen between results from the electronic visual analogue scales with and without a numerical indicator.

Conclusion: Under conditions of routine clinical practice, the hand-held computer questionnaire can give results equivalent to those obtained with the conventional paper questionnaire.