The drug management of severe alcohol withdrawal syndrome

We describe the various phases of the alcohol withdrawal syndrome with special reference to the pitfalls of using neuroleptics. We outline the importance of adequate sedation using either benzodiazepines or chlormethiazole. We provide a critical appraisal of the currently employed anti-epileptic medication in the alcohol withdrawal syndrome. We also indicate the usefulness of analgesic nitrous oxide as a screening test in differentiating the cases of alcohol withdrawal syndrome needing further intensive therapy to prevent progression to delirium tremens.     

Enlarged double-blind randomised trial of benzodiazepines against psychotropic analgesic nitrous oxide for alcohol withdrawal

We report a randomised double-blind controlled study with an enlarged cohort of participants (N = 51) using psychotropic analgesic nitrous oxide (PAN) versus benzodiazepines (BZs) for treating acute alcoholic withdrawal states. An additional 28 participants having received a BZ the night previous to the study were pooled with the previously analysed 23 (with no additional BZ). These pooled results showed that PAN is superior to a BZ regimen at P = .05 level, despite additional BZs. Our work provides further support for previous findings that show that PAN is a safe, rapid, and effective therapy for acute mild to moderately severe withdrawal states.     

The dual-system hypothesis of pain perception

We describe a dual-system hypothesis relating the seemingly contradictory findings reported in clinical and experimental investigations of pain. This incorporates a model in which two neuronal systems are related, involving Substance P (SP) and Enkephalin (E). This model uses feedback loops holding the systems in balance. The analogy to a control system is also made.