Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.186
Filtrar
1.
Rev Bras Ter Intensiva ; 33(1): 48-67, 2021.
Artículo en Español, Inglés | MEDLINE | ID: mdl-33886853

RESUMEN

OBJECTIVE: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. METHODS: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. RESULTS: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. DISCUSSION: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


Asunto(s)
Analgesia/normas , Consenso , Delirio/terapia , Manejo del Dolor/normas , /terapia , Analgesia/métodos , Analgésicos/administración & dosificación , Lista de Verificación , Delirio/diagnóstico , Ambulación Precoz , Familia , Humanos , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Bloqueo Neuromuscular/métodos , Bloqueo Neuromuscular/normas , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Agitación Psicomotora/terapia
2.
Ann Agric Environ Med ; 28(1): 179-182, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33775085

RESUMEN

INTRODUCTION: Back pain is now a very common phenomenon. It is caused by various pathologies in the area of the motor unit of the spine. These changes can cause pressure on the nerve structures within the spinal canal, resulting in various ailments. Pain is the most common symptom. In most cases, patients are qualified for conservative management. In the case of neurological deficits, the patient is qualified for spinal surgery. Unfortunately, surgical treatment is not always 100% effective therapy method. Moreover, many external factors, such as smoking for instance, can affect the process of tissue healing and decide on the time of recovery. OBJECTIVE: The aim of the study was to assess the impact of smoking on back pain intensity in rehabilitated patients with discopathy treated conservatively and surgically. MATERIAL AND METHODS: The study included 41 patients after surgical treatment (9 smokers) and 96 patients (20 smokers) undergoing conservative therapy for back pain due to discopathy. All patients underwent a multidirectional rehabilitation programme at the Department of Rehabilitation and Physical Medicine of the Medical University in Lódz. RESULTS: The Laitinen scale was used to assess the patients' pain. Rehabilitation of patients with back pain due to discopathy had a significant analgesic effect (p <0.0001). Furthermore, there was observed a statistically significant effect of smoking on the level of pain intensity on the Laitinen scale in the group of patients who underwent surgery (p <0.0469). The smokers operated on had significantly worse results. CONCLUSIONS: 1) Complex rehabilitation of patients with back syndrome pain due to discopathy demonstrated significant analgesic effectiveness. 2) Smoking significantly worsens the results of the therapy in patients who underwent surgery.


Asunto(s)
Analgésicos/administración & dosificación , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/cirugía , Fumar/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Dolor de Espalda/fisiopatología , Dolor de Espalda/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Cicatrización de Heridas , Adulto Joven
3.
Br J Anaesth ; 126(5): 1029-1037, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33678402

RESUMEN

BACKGROUND: Sample size determination is essential for reliable hypothesis testing in clinical trials and should rely on adequate sample size calculations with alpha, beta, variance, and an effect size being the minimal clinically important difference (MCID). This facilitates interpretation of the clinical relevance of statistically significant results. No gold standard for MCIDs exists in postoperative pain research. METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for English language articles on randomised trials investigating analgesic interventions after total hip or knee arthroplasty. Primary outcomes were the reported MCIDs for pain score and cumulated rescue opioid consumption. Secondary outcomes included reported sample size calculations and propensity to report statistical significance without reaching MCID. Trend analyses were conducted using statistical process control. RESULTS: We included 570 trials. Median MCID for 0-24 h opioid consumption was 10 mg i.v. morphine equivalents for absolute reductions (interquartile range [IQR]: 6.8-14.5) and relative 40% (IQR: 30-50%). Median MCIDs for pain scores were absolute 15 mm at rest (IQR: 10-20) and 18 mm during movement (IQR: 10-20) on a 0-100 mm VAS and relative 30% (IQR: 20-30%). No trends were demonstrated for MCIDs. Adequate sample size calculations were reported in 34% of trials. In 46% of trials with statistically significant primary outcomes, the differences did not reach the predetermined MCID. CONCLUSIONS: We provide clinician-perceived MCID estimates for rescue opioid consumption and pain scores that can be used for sample size calculations until reliable evidence-based patient-rated MCIDs emerge. Nearly half of the trials with significant findings did not reach the predetermined MCID.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Analgésicos/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Humanos , Diferencia Mínima Clínicamente Importante , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto
4.
Nat Commun ; 12(1): 1367, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33649338

RESUMEN

Effective control of pain management has the potential to significantly decrease the need for prescription opioids following a surgical procedure. While extended release products for pain management are available commercially, the implementation of a device that safely and reliably provides extended analgesia and is sufficiently flexible to facilitate a diverse array of release profiles would serve to advance patient comfort, quality of care and compliance following surgical procedures. Herein, we review current polymeric systems that could be utilized in new, controlled post-operative pain management devices and highlight where opportunities for improvement exist.


Asunto(s)
Sistemas de Liberación de Medicamentos , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Polímeros/química , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Animales , Humanos , Control Social Formal
5.
Medicine (Baltimore) ; 100(12): e24997, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761655

RESUMEN

BACKGROUND: Knee osteoarthritis is a common chronic progressive disease, which seriously affects the quality of life of the middle-aged and elderly, and even leads to disability. More and more evidence shows that acupoint injection is beneficial to the clinical treatment of knee osteoarthritis, but there are differences in the efficacy of different acupoints and injection drugs, and there is no systematic review to assess this therapy at present. The purpose of this study is to systematically evaluate the efficacy and safety of acupoint injection in improving pain and joint function in patients with knee osteoathrosis. METHODS: According to the retrieval strategy, we will search from CNKI, Wanfang, VIP, Chinese Biomedical Science, PubMed, Embase, Web of Science and the Cochrane Library for randomized controlled trials of acupoint injection in the treatment of knee osteoarthritis from the establishment of the database to February 2021. The study will be screened according to the inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the study. Revman 5.4 software is used for meta-analysis. RESULTS: This study will evaluate the efficacy of acupoint injection in the treatment of knee osteoarthritis by evaluating the total effective rate, the degree of pain relief, joint function score, adverse reactions, and so on. CONCLUSION: This study will provide reliable evidence-based basis for the clinical application of acupoint injection in the treatment of knee osteoarthritis. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number-doi: 10.17605/OSF.IO/M5FTK.


Asunto(s)
Puntos de Acupuntura , Analgésicos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Metaanálisis como Asunto , Osteoartritis de la Rodilla/tratamiento farmacológico , Manejo del Dolor/métodos , Revisiones Sistemáticas como Asunto , Humanos , Osteoartritis de la Rodilla/fisiopatología
6.
Medicine (Baltimore) ; 100(6): e24605, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578565

RESUMEN

ABSTRACT: Preoperative anxiety is a major problem in children leading to a poor outcome. Preanesthetic oral ketamine is generally used in children but has less bioavailability due to the first-pass effect. Even ketamine has an unpleasant taste. Preanesthetic inhaled ketamine is also reported effective and safe in children. The objectives of the study were to compare the effectiveness and safety of preanesthetic nebulized ketamine against preanesthetic oral ketamine for sedation and postoperative pain management in children.Children received 10 mg/kg oral ketamine (children received preanesthetic oral ketamine [OK cohort], n = 142), or nebulized with 3 mg/kg ketamine (children were preanesthetic nebulized with ketamine [NK cohort], n = 115), or received apple juice (children suspectable to preoperative ketamine and received apple juice only [OA cohort], n = 126) before anesthesia for elective surgery. Data regarding preoperative hemodynamic parameters, sedation score measurements, postoperative pain management, postoperative nausea and vomiting management, and postoperative complications were collected and analyzed.Preoperative hemodynamic parameters for oral and nebulized ketamine administration were stable. Nebulized ketamine was provided higher sedation than apple juice (P = .002, q = 4.859) and oral ketamine (P = .002, q = 3.526). Children of NK cohort had required fewer fentanyl consumption until discharge than those of OA (55.45 ±â€Š7.19 µG/ child vs 65.15 ±â€Š15.24 µG/ child, P < .0001, q = 9.859) and OK (55.45 ±â€Š7.19 µG/child vs 60.19 ±â€Š8.12 µG/child, P < .0001, q = 4.953) cohorts. Children of the NK cohort had consumed higher ondansetron syrup than those of the OA cohort but fewer than those of the OK cohort until discharge. Gastrointestinal side effects were reported in the OK cohort, and nose irritation and drowsiness were reported in the NK cohort.Like preanesthetic oral ketamine, preanesthetic inhaled ketamine also has safety for children. Preanesthetic inhaled ketamine can provide effective sedation in low doses during operation than preanesthetic oral ketamine.Level of evidence: III.


Asunto(s)
Analgésicos/administración & dosificación , Ketamina/administración & dosificación , Dolor Postoperatorio/prevención & control , Medicación Preanestésica , Analgésicos/efectos adversos , Antieméticos/administración & dosificación , Niño , Preescolar , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Ketamina/efectos adversos , Masculino , Ondansetrón/administración & dosificación , Náusea y Vómito Posoperatorios/inducido químicamente , Náusea y Vómito Posoperatorios/prevención & control , Estudios Retrospectivos
7.
Value Health ; 24(2): 196-205, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518026

RESUMEN

OBJECTIVES: Little is known about relationships between opioid- and gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients' opioid and gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. METHODS: This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or gabapentinoids. Using group-based multitrajectory modeling, this study identified patients' distinct opioid and gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. RESULTS: Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose gabapentinoid users, and consistent high-dose opioid and moderate-dose gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). CONCLUSIONS: Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Analgésicos/uso terapéutico , Gabapentina/uso terapéutico , Medicare/economía , Dolor/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Analgésicos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Estudios Transversales , Utilización de Medicamentos , Planes de Aranceles por Servicios/economía , Femenino , Gabapentina/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
8.
Medicine (Baltimore) ; 100(3): e23895, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545958

RESUMEN

BACKGROUND: Several previous trials have attempted to compare the efficacy of femoral nerve block (FNB) and local infiltrative analgesia (LIA) for patients received anterior cruciate ligament (ACL) reconstruction, but reached inconsistent conclusions. The primary purpose of this present research was to compare the FNB and LIA in the reconstruction of ACL. METHODS: This investigation was conducted and then reported on the basis of Strengthening the Reporting of Observational studies in the Epidemiology checklist. From our registry database, we retrospectively determined 688 patients who received the primary reconstruction of ACL from 2016 to 2019 at our academic institutions. This current retrospective cohort study was approved through the institutional review committee at our hospital. Inclusion criteria contained the primary or autograft bone-patellar tendine-bone reconstruction of ACL in the patients over 16 years of age. Patients in the LIA group underwent intraoperative infiltration at the harvested site after tendon harvest, with use of 2 mg/mL of ropivacaine 20 mL and 5 mg/mL of epinephrine, respectively. After the reconstruction of ACL, 5 Lg/mL of epinephrine, and 20 mL of ropivacaine (2 mg/mL) were injected at the site of surgical trauma. The patient in FNB group was given 40 mL of ropivacaine (2 mg/mL), and the ropivacaine was injected into femoral nerve sheath at femoral triangle level. The primary outcome was the consumption of morphine 24 h after the operation. And the secondary results involved the complications, functional results, and the scores of pain. RESULTS: It is assumed that the efficacy of LIA in the early postoperative pain is no less than that of FNB. For our study, the major limitation is the lack of randomization. Nevertheless, these data were prospectively harvested, with high response rate of patient. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6277).


Asunto(s)
Analgésicos/uso terapéutico , Reconstrucción del Ligamento Cruzado Anterior , Bloqueo Nervioso , Dolor Postoperatorio/prevención & control , Analgésicos/administración & dosificación , Nervio Femoral , Humanos , Dimensión del Dolor , Estudios Retrospectivos , Resultado del Tratamiento
9.
J Zoo Wildl Med ; 51(4): 848-855, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33480565

RESUMEN

Evaluation of sex ratios is a critical component of chelonian captive breeding programs and may become increasingly useful to assess the demographics of free-living populations. In many reptile species, the sex of immature animals cannot be determined based on external features. Endoscopic sex identification is an accurate and safe method to identify the sex of immature individuals of some chelonian species. A number of studies describe this technique in controlled, hospital settings and report significant interspecies variations in gonad morphology; however, there are few reports describing this technique in field conditions. In the current study, the gonadal morphology of 40 immature Western Santa Cruz tortoises (Chelonoidis porteri) on Santa Cruz Island in Galapagos, Ecuador, was assessed. A previously described endoscopic protocol was used to perform sex identification under field conditions. Tortoises were anesthetized using an intramuscular injection of ketamine (10 mg/kg) and medetomidine (0.1 mg/kg), which provided an adequate plane of anesthesia. The medetomidine was reversed with atipamezole (0.5 mg/kg). Field conditions presented challenges such as limited control over lighting, suboptimal patient positioning, and restricted power supply for endoscopy equipment. The immature testicle in Western Santa Cruz tortoises was oval, reddish pink, and tightly adhered to the coelomic membrane ventral to the kidney. The surface of the gonads resembled other species with the notable exception that the ovaries lacked a significant number of primordial follicles. These gonadal characteristics were consistent, with only one individual identified as undetermined sex of the 40 samples. This field-based endoscopic gonadal evaluation was a safe and sensitive technique for determining the sex of free-living immature Western Santa Cruz Galapagos tortoises.


Asunto(s)
Anestesia/veterinaria , Ovario/anatomía & histología , Maduración Sexual , Testículo/anatomía & histología , Analgésicos/administración & dosificación , Analgésicos/farmacología , Animales , Femenino , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/farmacología , Ketamina/administración & dosificación , Ketamina/farmacología , Masculino , Medetomidina/administración & dosificación , Medetomidina/farmacología , Ovario/crecimiento & desarrollo , Testículo/crecimiento & desarrollo , Tortugas/fisiología
10.
Trials ; 22(1): 95, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499921

RESUMEN

BACKGROUND: Epidemiological studies have shown that young women often suffer from primary dysmenorrhea (PD) which is a common cause that affects their routine work and quality of life. Chinese herbal medicine has been widely used for PD in China. A systematic review found that Xuefu Zhuyu (XFZY) has a promising effect on PD management, yet there is a dearth of high-quality evidence in support of this claim. We want to conduct a randomized controlled trial to evaluate the efficacy and safety of XFZY for PD patients. METHODS: This is a protocol for a multicenter, randomized, placebo-controlled trial. A total of 248 participants with PD will be recruited at 6 centers and randomized into two groups-a herbal treatment group and a placebo group. The participants will receive either XFZY or placebo, three times per day, for 3 menstrual cycles, with a 12-week follow-up. The primary outcome will be the mean change in pain intensity as measured by VAS, while the change in menstrual pain duration, the change in peak pain intensity as measured by VAS, the Cox Menstrual Symptom Scale (CMSS), quality of life EQ-5D-5L, cumulative painkiller consumption, and health economics will be included as secondary outcomes. Adverse events will also be reported. DISCUSSION: This protocol describes a multicenter, double-blind, randomized, placebo-controlled trial that investigates the efficacy and safety of XFZY for primary dysmenorrhea. Validated evaluation tools will assess dysmenorrhea severity. We believe that this research will provide important evidence regarding the use of XFZY to treat dysmenorrhea. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900026819 . Registered on 23 October 2019.


Asunto(s)
Medicamentos Herbarios Chinos/administración & dosificación , Dismenorrea/tratamiento farmacológico , Adolescente , Adulto , Analgésicos/administración & dosificación , China , Ensayos Clínicos Fase IV como Asunto , Método Doble Ciego , Esquema de Medicación , Medicamentos Herbarios Chinos/efectos adversos , Dismenorrea/complicaciones , Dismenorrea/diagnóstico , Dismenorrea/psicología , Femenino , Humanos , Estudios Multicéntricos como Asunto , Dimensión del Dolor/estadística & datos numéricos , Placebos/administración & dosificación , Placebos/efectos adversos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
11.
Br J Anaesth ; 126(2): 445-457, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33461725

RESUMEN

Electroencephalographic (EEG) activity is used to monitor the neurophysiology of the brain, which is a target organ of general anaesthesia. Besides its use in evaluating hypnotic states, neurophysiologic reactions to noxious stimulation can also be observed in the EEG. Recognising and understanding these responses could help optimise intraoperative analgesic management. This review describes three types of changes in the EEG induced by noxious stimulation when the patient is under general anaesthesia: (1) beta arousal, (2) (paradoxical) delta arousal, and (3) alpha dropout. Beta arousal is an increase in EEG power in the beta-frequency band (12-25 Hz) in response to noxious stimulation, especially at lower doses of anaesthesia drugs in the absence of opioids. It is usually indicative of a cortical depolarisation and increased cortical activity. At higher concentrations of anaesthetic drug, and with insufficient opioids, delta arousal (increased power in the delta band [0.5-4 Hz]) and alpha dropout (decreased alpha power [8-12 Hz]) are associated with noxious stimuli. The mechanisms of delta arousal are not well understood, but the midbrain reticular formation seems to play a role. Alpha dropout may indicate a return of thalamocortical communication, from an idling mode to an operational mode. Each of these EEG changes reflect an incomplete modulation of pain signals and can be mitigated by administration of opioid or the use of regional anaesthesia techniques. Future studies should evaluate whether titrating analgesic drugs in response to these EEG signals reduces postoperative pain and influences other postoperative outcomes, including the potential development of chronic pain.


Asunto(s)
Analgésicos/administración & dosificación , Anestesia General , Anestésicos Generales/administración & dosificación , Ondas Encefálicas/efectos de los fármacos , Encéfalo/efectos de los fármacos , Electroencefalografía , Monitorización Neurofisiológica Intraoperatoria , Nocicepción/efectos de los fármacos , Umbral del Dolor/efectos de los fármacos , Dolor Postoperatorio/prevención & control , Encéfalo/fisiopatología , Relación Dosis-Respuesta a Droga , Humanos , Dolor Postoperatorio/fisiopatología , Estimulación Física , Valor Predictivo de las Pruebas , Factores de Tiempo , Resultado del Tratamiento
12.
Psychopharmacology (Berl) ; 238(3): 877-886, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33404738

RESUMEN

BACKGROUND: Memory deficit is a common cognitive comorbid in patients with neuropathic pain that need better treatment. Recent research revealed that nanocurcumin has an antinociceptive action and a protective effect against memory disorders, suggesting its possible effectiveness for the treatment of neuropathic pain and its comorbidity. METHODS: Adult male albino Wistar rats (n = 32) were randomly divided into four experimental groups: CCI+ nanocurcumin, CCI + vehicle, sham + nanocurcumin, and sham + vehicle. Neuropathic pain induced by a chronic constriction injury of the sciatic nerve. Nanocurcumin or vehicle was injected intraperitoneally for 10 days. Behavioral assessment achieved to evaluate pain threshold in the von Frey test and radiant heat test, also spatial learning and memory examined by the Morris water maze (MWM) test. To explore the possible relation, IL-1ß, and TNF-α levels of the hippocampus measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Our data showed that CCI caused neuropathic pain-related behaviors and spatial learning and memory disorders in rats. Chronic treatment with nanocurcumin significantly increased pain threshold (P < 0.001; F = 27.63, F = 20.58), improved spatial memory (P < 0.01; F = 47.37), and decreased the hippocampal levels of IL-1ß (P < 0.001; F = 33.57) and TNF-α (P < 0.01; F = 7.25) in CCI rats. CONCLUSION: Chronic nanocurcumin can ameliorate pain-related behavior, improve spatial learning and memory deficits, and is associated with the reduction of IL-1ß and TNF-α levels in the hippocampus in CCI rats. Nanocurcumin may be potentially providing a therapeutic alternative for the treatment of neuropathic pain and its memory impairment comorbidity.


Asunto(s)
Analgésicos/uso terapéutico , Curcumina/uso terapéutico , Hipocampo/efectos de los fármacos , Interleucina-1beta/metabolismo , Neuralgia/tratamiento farmacológico , Memoria Espacial/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismo , Analgésicos/administración & dosificación , Analgésicos/química , Animales , Conducta Animal/efectos de los fármacos , Constricción , Curcumina/administración & dosificación , Curcumina/química , Modelos Animales de Enfermedad , Hipocampo/metabolismo , Masculino , Trastornos de la Memoria/complicaciones , Trastornos de la Memoria/tratamiento farmacológico , Trastornos de la Memoria/metabolismo , Nanopartículas/administración & dosificación , Nanopartículas/química , Neuralgia/complicaciones , Neuralgia/metabolismo , Umbral del Dolor/efectos de los fármacos , Ratas , Ratas Wistar , Nervio Ciático/efectos de los fármacos , Nervio Ciático/lesiones
13.
Neurosci Lett ; 745: 135647, 2021 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-33444673

RESUMEN

Experimental studies have indicated that prolonged ketamine exposure in neonates at anesthetic doses causes neuronal apoptosis, which contributes to long-term impairments of learning and memory later in life. The neuronal excitotoxicity mediated by compensatory upregulation of N-methyl-d-aspartate receptors (NMDARs) is proposed to be the underlying mechanism. However, this view does not convincingly explain why excitotoxicity-related apoptotic injury develops selectively in immature neurons. We proposed that the GABAA receptors (GABAARs)-mediated excitatory synaptic signaling due to high expression of the Na+-K+-2Cl- co-transporter (NKCC1), occurring during the early neuronal development period, plays a distinct role in the susceptibility of immature neurons to ketamine-induced injury. Using whole-cell patch-clamp recordings from the forebrain slices containing the anterior cingulate cortex, we found that in vivo repeated ketamine administration significantly induced neuronal hyperexcitability in neonatal, but not adolescent, rats. Such hyperexcitability was accompanied by the increase both in GABAAR- and NMDAR-mediated synaptic transmissions. An interference with the NKCC1 by bumetanide treatment completely reversed these enhanced effects of ketamine exposure and blocked GABAAR-mediated postsynaptic current activity. Thus, these findings were significant as they showed, for the first time, that GABAAR-mediated excitatory action may contribute distinctly to neuronal excitotoxic effects of ketamine on immature neurons in the developing brain.


Asunto(s)
Potenciales Postsinápticos Excitadores/efectos de los fármacos , Neuronas GABAérgicas/efectos de los fármacos , Giro del Cíngulo/efectos de los fármacos , Giro del Cíngulo/crecimiento & desarrollo , Ketamina/administración & dosificación , Sinapsis/efectos de los fármacos , Analgésicos/administración & dosificación , Animales , Animales Recién Nacidos , Potenciales Postsinápticos Excitadores/fisiología , Femenino , Neuronas GABAérgicas/fisiología , Masculino , Ratas , Ratas Sprague-Dawley , Sinapsis/fisiología
14.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33408103

RESUMEN

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Asunto(s)
Dolor Abdominal/etiología , Colecistectomía Laparoscópica , Colecistitis Aguda/diagnóstico , Vesícula Biliar/patología , Anomalía Torsional/diagnóstico , Administración Intravenosa , Anciano , Analgésicos/administración & dosificación , Antibacterianos/administración & dosificación , Colecistitis Aguda/tratamiento farmacológico , Colecistitis Aguda/etiología , Tratamiento Conservador , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/cirugía , Humanos , Necrosis/diagnóstico , Necrosis/cirugía , Periodo Posprandial , Tomografía Computarizada por Rayos X , Anomalía Torsional/complicaciones , Anomalía Torsional/cirugía , Ultrasonografía
15.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431538

RESUMEN

Stiff-Person syndrome (SPS) is a rare autoimmune neurological disorder characterised by episodic painful muscle rigidity and violent spasms. A significant trigger for the painful spasms experienced by patients is pain itself, making optimal pain management and avoidance a necessity. While first-line and second-line therapies for spasm prevention and termination are known, there is a paucity of evidence to guide pain management. We report the case of a 26-year-old woman with SPS referred for excruciating muscle cramping and rigidity with pain lasting beyond the episodes themselves. We report the novel use of ketamine and intravenous magnesium sulfate which may provide analgesia, spasm avoidance and early termination of exacerbations in SPS.


Asunto(s)
Espasticidad Muscular/tratamiento farmacológico , Manejo del Dolor/métodos , Dolor Intratable/tratamiento farmacológico , Síndrome de la Persona Rígida/complicaciones , Adulto , Analgesia Controlada por el Paciente/métodos , Analgésicos/administración & dosificación , Anticonvulsivantes/administración & dosificación , Femenino , Humanos , Sulfato de Magnesio/administración & dosificación , Relajantes Musculares Centrales/administración & dosificación , Espasticidad Muscular/diagnóstico , Espasticidad Muscular/etiología , Espasticidad Muscular/rehabilitación , Dimensión del Dolor , Dolor Intratable/diagnóstico , Dolor Intratable/etiología , Dolor Intratable/rehabilitación , Índice de Severidad de la Enfermedad , Síndrome de la Persona Rígida/diagnóstico
16.
Postgrad Med ; 133(1): 1-9, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33423590

RESUMEN

Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a 'low and slow' dosing approach to limit common side effects and optimize tolerability alongside patients' expectations. When requiring titration to higher doses, we recommend initiating 'asymmetric dosing,' with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The 'low and slow' approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.


Asunto(s)
Analgésicos/administración & dosificación , Neuralgia/tratamiento farmacológico , Pregabalina/administración & dosificación , Pregabalina/efectos adversos , Factores de Edad , Analgésicos/uso terapéutico , Conducción de Automóvil , Comorbilidad , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Quimioterapia Combinada , Humanos , Cumplimiento de la Medicación , Dimensión del Dolor , Educación del Paciente como Asunto , Pregabalina/uso terapéutico , Factores Sexuales , Trastornos Relacionados con Sustancias/prevención & control
17.
J Dairy Sci ; 104(2): 2040-2055, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33309349

RESUMEN

Both the economic loss and welfare implications of lameness affect the dairy industry. Currently no analgesic drugs are approved to alleviate lameness-associated pain in lactating dairy cattle in the United States. In this randomized controlled trial, 48 lactating Holsteins were enrolled to evaluate the effect of oral meloxicam and i.v. flunixin meglumine on induced lameness. Cows were allocated to 1 of 4 treatment groups (n = 12 per group): lameness and flunixin meglumine (LAME + FLU); lameness and meloxicam (LAME + MEL); lameness and placebo (LAME + PLBO); or sham induction and placebo (SHAM + PLBO). Six hours before treatment, arthritis-synovitis was induced in the distal interphalangeal joint with 20 mg of amphotericin B, whereas SHAM cows were given an intra-articular injection of an equal volume (4 mL) of isotonic saline. Cows in LAME + FLU received 2.2 mg/kg flunixin meglumine i.v. and whey protein placebo orally; LAME + MEL were administered 1 mg/kg meloxicam orally and 2 mL/45 kg sterile saline placebo i.v.; LAME + PLBO were administered 2 mL/45 kg sterile saline placebo i.v. and whey protein placebo orally; and SHAM + PLBO received 2 mL/45 kg sterile saline placebo i.v. and whey protein placebo orally. The initial treatment of MEL, FLU, or PLBO was identified as time 0 h and followed by a second dose 24 h later with data collection for 120 h. The methods used to assess analgesic efficacy were electronic pressure mat, visual lameness assessment, visual analog score, plasma cortisol concentration, plasma substance P concentration, mechanical nociception threshold, and infrared thermography imaging. Linear mixed effect modeling was the primary method of statistical analysis. Visual lameness scoring indicated a lower proportion of the FLU + LAME group was lame at the T2 h and T8 h time points in comparison to the positive controls, whereas MEL therapy resulted in a lower proportion of lame cows at the T8 h time point. Cortisol area under the effect curve was lower following FLU therapy compared with LAME + PBLO for the 0-2 h (LSM difference = 35.1 ng·h/mL, 95% CI: 6.8, 63.3 ng·h/mL), 2-8 h (LSM difference = 120.6 ng·h/mL, 95% CI: 77.2, 164.0 ng·h/mL), and 0-24 h (LSM difference = 226.0 ng·h/mL, 95% CI: 103.3, 348.8 ng·h/mL) time intervals. Following MEL therapy, cortisol area under the effect curve was lower than LAME + PLBO for both the 2 to 8 h (LSM difference = 93.6 ng·h/mL, 95% CI: 50.2, 137.0 ng·h/mL) and 0 to 24 h time intervals (LSM difference = 187.6 ng·h/mL, 95% CI: 64.9, 310.4 ng·h/mL). Analysis of data from other assessment modalities failed to discern biologically relevant differences between treatment groups. We conclude that meaningful differences were evident for visual lameness assessment and cortisol from MEL and FLU treatment versus the positive control. Further clinical research is needed toward development of a model that will create reproducible events that are more pronounced in severity and duration of lameness which can be validated as a substitute for naturally occurring lameness cases.


Asunto(s)
Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedades de los Bovinos/tratamiento farmacológico , Clonixina/análogos & derivados , Cojera Animal/tratamiento farmacológico , Meloxicam/uso terapéutico , Dolor/veterinaria , Administración Oral , Analgésicos/administración & dosificación , Animales , Antiinflamatorios no Esteroideos/administración & dosificación , Bovinos , Clonixina/administración & dosificación , Clonixina/uso terapéutico , Industria Lechera , Femenino , Inyecciones Intravenosas/veterinaria , Lactancia/efectos de los fármacos , Cojera Animal/etiología , Meloxicam/administración & dosificación , Dolor/tratamiento farmacológico
18.
Brain ; 144(2): 665-681, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33367648

RESUMEN

Opioids such as morphine are mainstay treatments for clinical pain conditions. Itch is a common side effect of opioids, particularly as a result of epidural or intrathecal administration. Recent progress has advanced our understanding of itch circuits in the spinal cord. However, the mechanisms underlying opioid-induced itch are not fully understood, although an interaction between µ-opioid receptor (MOR) and gastrin-releasing peptide receptor (GRPR) in spinal GRPR-expressing neurons has been implicated. In this study we investigated the cellular mechanisms of intrathecal opioid-induced itch by conditional deletion of MOR-encoding Oprm1 in distinct populations of interneurons and sensory neurons. We found that intrathecal injection of the MOR agonists morphine or DAMGO elicited dose-dependent scratching as well as licking and biting, but this pruritus was totally abolished in mice with a specific Oprm1 deletion in Vgat+ neurons [Oprm1-Vgat (Slc32a1)]. Loss of MOR in somatostatin+ interneurons and TRPV1+ sensory neurons did not affect morphine-induced itch but impaired morphine-induced antinociception. In situ hybridization revealed Oprm1 expression in 30% of inhibitory and 20% of excitatory interneurons in the spinal dorsal horn. Whole-cell recordings from spinal cord slices showed that DAMGO induced outward currents in 9 of 19 Vgat+ interneurons examined. Morphine also inhibited action potentials in Vgat+ interneurons. Furthermore, morphine suppressed evoked inhibitory postsynaptic currents in postsynaptic Vgat- excitatory neurons, suggesting a mechanism of disinhibition by MOR agonists. Notably, morphine-elicited itch was suppressed by intrathecal administration of NPY and abolished by spinal ablation of GRPR+ neurons with intrathecal injection of bombesin-saporin, whereas intrathecal GRP-induced itch response remained intact in mice lacking Oprm1-Vgat. Intrathecal bombesin-saporin treatment reduced the number of GRPR+ neurons by 97% in the lumber spinal cord and 91% in the cervical spinal cord, without changing the number of Oprm1+ neurons. Additionally, chronic itch from DNFB-induced allergic contact dermatitis was decreased by Oprm1-Vgat deletion. Finally, naloxone, but not peripherally restricted naloxone methiodide, inhibited chronic itch in the DNFB model and the CTCL model, indicating a contribution of central MOR signalling to chronic itch. Our findings demonstrate that intrathecal morphine elicits itch via acting on MOR on spinal inhibitory interneurons, leading to disinhibition of the spinal itch circuit. Our data also provide mechanistic insights into the current treatment of chronic itch with opioid receptor antagonist such as naloxone.


Asunto(s)
Analgésicos/administración & dosificación , Morfina/administración & dosificación , Prurito/inducido químicamente , Prurito/fisiopatología , Receptores Opioides mu/fisiología , Médula Espinal/efectos de los fármacos , Médula Espinal/fisiopatología , Animales , Dermatitis/fisiopatología , Femenino , Inyecciones Espinales , Interneuronas/efectos de los fármacos , Interneuronas/fisiología , Masculino , Potenciales de la Membrana/efectos de los fármacos , Ratones Endogámicos C57BL , Receptores de Bombesina/fisiología , Células Receptoras Sensoriales/efectos de los fármacos , Células Receptoras Sensoriales/fisiología , Canales Catiónicos TRPV/fisiología , Proteínas del Transporte Vesicular de Aminoácidos Inhibidores/fisiología
19.
J Ethnopharmacol ; 266: 113408, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32979409

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: The preparations of Phlomis aerial parts are used traditionally in Anatolia for wound healing and in inflammatory disorders. METHODS: For the identification of the active fraction, the air dried aerial parts of Phlomis rigida Labill. were extracted by methanol and fractionated successively by n-hexane, dichloromethane and ethyl acetate, respectively. The phenolic constituents were characterized by the Folin-Ciocaltheu method; the antioxidant activity was performed by ABTS and DPPH radical scavenging assays. In vitro anti-inflammatory activity was evaluated by LOX enzyme inhibition, spectrophotometrically as well as cell cultures. The wound healing properties of P. rigida extract gels were studied via in vitro cell culture methods and in vivo by excisional wound model using Balb-c mice. The P. rigida extract was analyzed and characterized by GC-FID, GC-MS, and LC-MS. RESULTS: The P. rigida methanol extract showed moderate LOX inhibitory at IC50 = 19.5 ± 2.8 µg/mL whereas the antioxidant activity was by DPPH• IC50 = 0.89 mg/mL, and by ABTS• IC50 = 0.99 mg/mL, respectively. In addition, a remarkable P. rigida extracts anti-inflammatory activity was observed in the cell culture assay, which was then confirmed by the in vitro wound healing activity applied at 0.125-0.5 mg/mL concentrations, resulting in a dose-dependent increase in wound closure at the final stage. The P. rigida gel formulation was prepared to evaluate the extract in vivo, whereas the experimental results of the new gel formulation supported the findings of the in vitro wound healing activity. CONCLUSION: The findings of this in vitro and in vivo study suggest that the wound healing and anti-inflammatory properties provide a scientific evidence of the ethnopharmacological application of Phlomis species.


Asunto(s)
Analgésicos/farmacología , Antiinflamatorios/farmacología , Phlomis/química , Extractos Vegetales/farmacología , Analgésicos/administración & dosificación , Analgésicos/aislamiento & purificación , Animales , Antiinflamatorios/administración & dosificación , Antiinflamatorios/aislamiento & purificación , Antioxidantes/aislamiento & purificación , Antioxidantes/farmacología , Depuradores de Radicales Libres/administración & dosificación , Depuradores de Radicales Libres/aislamiento & purificación , Depuradores de Radicales Libres/farmacología , Inflamación/tratamiento farmacológico , Inflamación/patología , Concentración 50 Inhibidora , Ratones , Ratones Endogámicos BALB C , Extractos Vegetales/administración & dosificación , Células RAW 264.7 , Cicatrización de Heridas/efectos de los fármacos
20.
J Ethnopharmacol ; 266: 113440, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33022341

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: In the State of Mato Grosso do Sul, the watery sap of Doliocarpus dentatus is used to alleviate thirst, and the leaves of this species are used to relieve pain and swelling associated with inflammatory processes. AIM OF THE STUDY: This study aimed to analyze the compounds of the leaves from the aqueous extract of D. dentatus (EADd) and evaluate its toxicogenetic and pain relief effects in animal models. MATERIALS AND METHODS: Compounds were identified in EADd by UHPLC-HRMS (Ultra high-performance liquid chromatography coupled to high resolution mass spectrometry). The oral dose of 17 mg/kg EADd, calculated according to ethnopharmacological uses, and doses between 30 and 300 mg/kg were used to test Swiss mice in formalin- and acetic acid-induced models of pain and behavior. EADd (100-2000 mg/kg) was assayed in mice by comet, micronucleus, and phagocytosis tests and by peripheral leukocyte counts. RESULTS: Phenolic compounds and flavonoids as well as trigonelline and isoquercetin were identified in EADd. All oral doses of EADd exhibited antinociceptive activity, as indicated by a decrease in pain in both phases, a decrease in cold hypersensitivity induced by formalin, and a decrease in abdominal contortions induced by acetic acid. EADd did not alter the exploratory, motor or motivational activities of the animals. The comet and micronucleus tests indicated that EADd was not genotoxic and did not change the phagocytic activity or peripheral leukocyte count. CONCLUSIONS: These results demonstrate that EADd could act as an antinociceptive agent that does not present genotoxicity. This study should contribute to justifying, in part, the popular use of D. dentatus in pain management, ensuring its safe use.


Asunto(s)
Analgésicos/farmacología , Dilleniaceae/química , Dolor/tratamiento farmacológico , Extractos Vegetales/farmacología , Analgésicos/administración & dosificación , Analgésicos/aislamiento & purificación , Animales , Cromatografía Líquida de Alta Presión , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Masculino , Espectrometría de Masas , Ratones , Pruebas de Mutagenicidad , Dolor/fisiopatología , Extractos Vegetales/administración & dosificación , Extractos Vegetales/toxicidad , Hojas de la Planta
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...