Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015-2018.

Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as defined daily dose for statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015-2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.

Understanding Opioid Actions, Pain and Analgesia: A Tribute to Dr. Gavril Pasternak.

This special issue is a tribute to our mentor, colleague and friend, Gavril W. Pasternak, MD, PhD. Homage to the breadth and depth of his work (~ 450 publications) over a 40 career in pharmacology and medicine cannot be captured fully in one special issue, but the 22 papers collected herein represent seven of the topics near and dear to Gav's heart, and the colleagues, friends and mentees who held him near to theirs. The seven themes include: (1) sites and mechanisms of opioid actions in vivo; (2) development of novel analgesic agents; (3) opioid tolerance, withdrawal and addiction: mechanisms and treatment; (4) opioid receptor splice variants; (5) novel research tools and approaches; (6) receptor signaling and crosstalk in vitro; and (7) mentorship. This introduction to the issue summarizes contributions and includes formal and personal remembrances of Gav that illustrate his personality, warmth, and dedication to making a difference in patient care and people's lives.

Why Would the Pope Have A Private Audience with Anesthesiologists? The Origin of the "Doctrine of Double Effect" and Its Application to Pain Control.

Sunday February 24, 1957 was a pivotal day in the history of anesthesiology and pain medicine. The leader of the Roman Catholic Church, Pope Pius XII met with anesthesiologists attending an international symposium sponsored by the Italian Society of Anesthesiologists entitled, "Anesthesia and the Human Personality". The purpose of this audience was to seek clarification about the use of opioids at the end of life to reduce suffering. Three questions had been formulated from the previous year's Italian Congress of Anesthesiologists and sent to the Holy See on this specific issue. The Pope responded during this audience remarking that there was no moral obligation to withhold pain medication that could elevate suffering. He further remarked that the suppression of consciousness that can occur with opioids was consistent with the spirit of the Christian gospels. Finally, he also stated that it was not morally objectionable to administer opioids even if it might shorten life. The moral philosophy behind these answers is the doctrine of double effect. In essence, administering medications to relieve pain, the primary effect, may also hasten death, the unintended secondary effect. In seeking answers to these questions, the Italian anesthesiologists were at the forefront of a larger and ongoing debate. As new therapies are developed that may have unintended consequences, when it is morally permissible to use them?

The Genesis of Pain Medicine as a Subspecialty in Anesthesiology.

Certification in pain medicine as a subspecialty in Anesthesiology was conceived in 1989 and first discussed by the American Board of Anesthesiology in 1990. Shortly thereafter, the ABA submitted an application to the American Board of Medical Specialties for recognition to certify in pain management. That was approved in 1991. The Accreditation Council of Graduate Medical Education approved an application from the Anesthesiology Residency Review Committee to accredit programs in pain management education and training in 1992. The first examination for Pain Management certification was given in 1993. The certificate was modified in 2002 to Pain Medicine rather than Pain Management. Five member boards of ABMS are now approved for certification in pain medicine and all use the ABA Pain Medicine examination.

An Evolution of Suffering: Anesthesiology's Contribution to Pain Management.

The modern human, and all progenitor species before it, evolved in a milieu of pain and suffering. Recent innovations in medicine have permitted the development of tools to mitigate these powerful experiences. Anesthesiologists have been on the vanguard of developing treatments and systems to face this challenge. Pain is a heterogeneous entity that requires precise categorization, and targeted, multimodal treatment to optimally manage. Anesthesiologists have developed a system whereby analgesia permits a myriad of life-saving surgeries, and have expanded their role beyond the perioperative setting. This includes unique contributions to how the concept of pain is experienced by infants, and appropriate interventions in this population. Contemporary anesthesiologists have extended their responsibilities to include harnessing robust technologies to manage pain in outpatient clinics, and serving as pain experts within hospital systems. This article serves as a primer to the history of anesthesiologists' contributions to pain management.

Who Controls the Power over Pain? A Comparative History of Nurse Anaesthesia.

From the advent of the use of anaesthesia during surgery through the Second World War, confusion and competition over who should administer the technology - doctors or nurses - dominated gendered discussions of professional boundaries. Using information about practice in the United States, the United Kingdom, and France in this period, we find vastly different outcomes for nurse-administered anaesthesia. Differences in perceptions regarding the gendered nature of this technology and its related level of prestige largely determined who could practice it. When administering anaesthesia carried low prestige and was viewed as non-technical, it fell under the purview of women's work in medicine, that is, nursing. When the same technology gained prestige and became perceived as a technical, medical skill, doctors associated it with their masculine professional identity and worked to exclude nurses from administering anaesthesia.

Perkins's patent metallic "Tractors": Development, adoption, and early dissemination of an eighteenth-century therapeutic fad.

The metallick Tractors were patented by Elisha Perkins, a Connecticut physician, in 1796, for the treatment of various ailments, particularly those associated with pain. They were subsequently rapidly and widely disseminated on the basis of testimonials and aggressive marketing tactics. Dissemination was facilitated by endorsements from prominent physicians, politicians, and clergy, by quasi-theoretical explanations of efficacy based on then-current experiments of Galvani and others, and by the apparent simplicity and safety of the procedure. Abandonment of this ineffective therapy was later prompted by the application of blinded placebo-controlled trials using sham devices.

The assessment of Perkins' patent metallic "tractors": Abandonment of an 18th-century therapeutic fad following trials using sham instruments.

From 1799 to 1801, with the instigation of John Haygarth, physicians in England evaluated the claims of Elisha and Benjamin Perkins that their patented "metallic tractors" could cure a wide variety of disorders. Previous therapies were typically judged based on experience and authority, whereas Perkinism was evaluated using a series of clinical trials of varying methodological sophistication, most employing sham instruments (all but those involving infants or horses), with a variety of trial designs, inconsistent use of contemporary controls, and different approaches to blinding subjects to the treatment administered. Haygarth and his colleagues collectively demonstrated that tractors and sham instruments produced equivalent effects in adults, and, by inference, that the tractors had no special therapeutic properties. Other trials using only genuine tractors demonstrated no effects in infants and horses, subjects who could not reasonably be influenced by suggestion and the imagination. These collective results provided strong support for the rival hypothesis that the observed effects were due to suggestion and the imagination of the subjects. Despite fallacy-laden counterattacks and counterarguments from Benjamin Perkins and his supporters, the trials eroded support for this therapy and led to abandonment of the "Metallic Practice" as a treatment in Britain and elsewhere.

Bearing the Pain: A Historic Review Exploring the Impact of Science and Culture on Pain Management for Childbirth in the United States.

Scientific advances over the past 150 years have influenced pain management practices during childbirth. Cultural attitudes about pain in childbirth have also affected these practices. The objective of this work is to examine the history of pain management in childbirth in the United States and explore the relationship between cultural attitudes and care practices. A historic review was chosen as the research method. Included were records that described pain management practices and records that explored the relationship between care practices and American cultural attitudes about pain in childbirth. The health science reference databases of CINAHL (EBSCO host), PubMed and the Cochrane Library were searched for English language articles. There were no limitations in years searched. Twenty-five primary records and 42 secondary records met inclusion criteria and were used in this work. Scientific developments as well as ever-changing cultural attitudes have greatly impacted pain management practices for childbirth in America. A highly complex and parallel, relationship exists between science and culture in regards to this history. To promote positive birth experiences for women, it is essential that obstetrical practices are congruent with cultural views regarding appropriate pain management in childbirth.

La práctica oftalmológica en México del siglo xviii / The practice of ophthalmology in Mexico in the 18th century

No disponible

Evidence-Based Pain Management: Building on the Foundations of Cochrane Systematic Reviews.

We discuss the history and current status of evidence-based medicine for the prevention and treatment of acute and chronic pain as it has developed in the Cochrane Collaboration's Pain, Palliative and Supportive Care Review Group.To date, the Pain, Palliative and Supportive Care Review Group has published 277 reviews and a further 11 reviews of systematic reviews summarizing the evidence for interventions. The Cochrane Library has readily available high-quality summaries of evidence of pharmacological interventions especially for postsurgical pain but also for chronic musculoskeletal and neuropathic pain. The library covers all forms of intervention, not only pharmacological.The world of evidence-based medicine is changing: most historical trials have been entered into reviews, but the evidence is still not well disseminated and needs to be better translated into decision support. Evidence should be at the heart of policymaking. Much has been achieved in the past 21 years, but there are no grounds for complacency.

Pinpricks: Needling, numbness, and temporalities of pain.

Acupuncture analgesia appeared relatively straightforward. A patient laid awake as the practitioner needled selected sites on the body to induce numbness for surgery. Numerous reports emerging from China in the 1970s featured men and women resting on operating tables, smiling into the camera, surrounded by doctors who attended to the excised region-the esophagus, brain, gut, heart, or lungs. In the course of a decade, hundreds of news articles proclaimed acupuncture analgesia as embodying the spirit of Communist politics. While "acupuncture analgesia" was a heterogeneous practice that addressed a variety of disorders, it cohered visually in photographs of patients indifferent to their vivisected bodies, and it cohered discursively as a means for eliminating sensitivity to pain. Across these domains of representation, I argue that reports of obliterating pain with a single needle across clinical encounters collapsed the multiple temporalities of pain. Drawing on sources from an imagined community of researchers and physicians in parts of China, Singapore, Macau, Hong Kong, Britain, and the United States, this chapter explores the epistemic and ontological implications of numbness-a distinct sensation defined by the lack of sensation-in the absence of the brain.

Publication-Based Academic Interest in Drugs and Techniques for Treatment of Postoperative Pain, 1975-2015.

PURPOSE: The aim of this study was to determine how drugs and their administration techniques, introduced over the past 40 years and still popular now, influenced publication-based academic interest in the treatment of postoperative pain. METHODS: Specific scientometric indices-popularity index (PI), top journal selectivity index (TJSI), and index of change (IC)-were used. Of the 61 terms searched, only those that had a PI value ≥1.0 during the 2011-2015 period were selected. They include eight drugs-bupivacaine, fentanyl, ropivacaine, acetaminophen, tramadol, remifentanil, and dexamethasone-and five techniques-patient-controlled analgesia, epidural opioids, ultrasound-guided nerve blocks, continuous nerve blocks, and transversus abdominis plane block (presented according to their decreasing PI value in each category). RESULTS: Four of these drugs or techniques with the highest PI in 2011-2015 also held top positions even 20 years earlier: in 1991-1995, the PI for bupivacaine was 9.1; fentanyl, 6.6; patient-controlled analgesia, 10.4; and epidural opioids, 6.8. Since that time, their PI values slowly decreased, for the first three items by approximately 50% and much more than that (85%) with epidural opioids. Nevertheless, to this day, they continue to hold the highest degree of publication-based academic interest. The TJSI can be regarded as an index of expectations at the time of articles publication. With bupivacaine, fentanyl, patient-controlled analgesia, and epidural opioids, the TJSI exceeded the specific high threshold of 10.0 for a very long time. The TJSIs of acetaminophen, ketamine, and dexamethasone were increased with the advent of new expectations regarding the treatment of postoperative pain using these old agents. CONCLUSIONS: Two important developments related to ultrasound-guided nerve block and continuous nerve block demonstrated only a moderate degree of academic interest. In conclusion, even today, the greatest publication-based academic interest related to postoperative pain is associated with drugs and techniques introduced 40-50 years ago.