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1.
Int J Mol Sci ; 22(13)2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34206850

RESUMO

Treating postoperative (PO) pain is a clinical challenge. Inadequate PO pain management can lead to worse outcomes, for example chronic post-surgical pain. Therefore, acquiring new information on the PO pain mechanism would increase the therapeutic options available. In this paper, we evaluated the role of a natural substance, epigallocatechin-3-gallate (EGCG), on pain and neuroinflammation induced by a surgical procedure in an animal model of PO pain. We performed an incision of the hind paw and EGCG was administered for five days. Mechanical allodynia, thermal hyperalgesia, and motor dysfunction were assessed 24 h, and three and five days after surgery. At the same time points, animals were sacrificed, and sera and lumbar spinal cord tissues were harvested for molecular analysis. EGCG administration significantly alleviated hyperalgesia and allodynia, and reduced motor disfunction. From the molecular point of view, EGCG reduced the activation of the WNT pathway, reducing WNT3a, cysteine-rich domain frizzled (FZ)1 and FZ8 expressions, and both cytosolic and nuclear ß-catenin expression, and the noncanonical ß-catenin-independent signaling pathways, reducing the activation of the NMDA receptor subtype NR2B (pNR2B), pPKC and cAMP response element-binding protein (pCREB) expressions at all time points. Additionally, EGCG reduced spinal astrocytes and microglia activation, cytokines overexpression and nuclear factor kappa-light-chain-enhancer of activated B cells (NFkB) pathway, downregulating inducible nitric oxide synthase (iNOS) activation, cyclooxygenase 2 (COX-2) expression, and prostaglandin E2 (PGE2) levels. Thus, EGCG administration managing the WNT/ß-catenin signaling pathways modulates PO pain related neurochemical and inflammatory alterations.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Catequina/análogos & derivados , Dor Pós-Operatória/tratamento farmacológico , Analgésicos/farmacologia , Animais , Anti-Inflamatórios/farmacologia , Catequina/farmacologia , Catequina/uso terapêutico , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/genética , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/metabolismo , Ciclo-Oxigenase 2/genética , Ciclo-Oxigenase 2/metabolismo , Receptores Frizzled/genética , Receptores Frizzled/metabolismo , Masculino , NF-kappa B/genética , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Proteína Quinase C/genética , Proteína Quinase C/metabolismo , Ratos , Ratos Sprague-Dawley , Receptores de N-Metil-D-Aspartato/genética , Receptores de N-Metil-D-Aspartato/metabolismo , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Proteínas Wnt/genética , Proteínas Wnt/metabolismo , Via de Sinalização Wnt , beta Catenina/genética , beta Catenina/metabolismo
2.
Int J Mol Sci ; 22(12)2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34203675

RESUMO

Recently, we found that the deletion of TRPC5 leads to increased inflammation and pain-related behaviour in two animal models of arthritis. (-)-Englerin A (EA), an extract from the East African plant Phyllanthus engleri has been identified as a TRPC4/5 agonist. Here, we studied whether or not EA has any anti-inflammatory and analgesic properties via TRPC4/5 in the carrageenan model of inflammation. We found that EA treatment in CD1 mice inhibited thermal hyperalgesia and mechanical allodynia in a dose-dependent manner. Furthermore, EA significantly reduced the volume of carrageenan-induced paw oedema and the mass of the treated paws. Additionally, in dorsal root ganglion (DRG) neurons cultured from WT 129S1/SvIm mice, EA induced a dose-dependent cobalt uptake that was surprisingly preserved in cultured DRG neurons from 129S1/SvIm TRPC5 KO mice. Likewise, EA-induced anti-inflammatory and analgesic effects were preserved in the carrageenan model in animals lacking TRPC5 expression or in mice treated with TRPC4/5 antagonist ML204.This study demonstrates that while EA activates a sub-population of DRG neurons, it induces a novel TRPC4/5-independent analgesic and anti-inflammatory effect in vivo. Future studies are needed to elucidate the molecular and cellular mechanisms underlying EA's anti-inflammatory and analgesic effects.


Assuntos
Analgésicos/farmacologia , Anti-Inflamatórios/farmacologia , Sesquiterpenos de Guaiano/farmacologia , Canais de Cátion TRPC/metabolismo , Analgésicos/uso terapêutico , Animais , Anti-Inflamatórios/uso terapêutico , Comportamento Animal/efeitos dos fármacos , Carragenina , Células Cultivadas , Cobalto/metabolismo , Modelos Animais de Doenças , Edema/patologia , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/metabolismo , Hiperalgesia/tratamento farmacológico , Inflamação/complicações , Inflamação/tratamento farmacológico , Inflamação/patologia , Masculino , Camundongos Knockout , Dor/complicações , Dor/tratamento farmacológico , Dor/patologia , Fenótipo , Células Receptoras Sensoriais/efeitos dos fármacos , Células Receptoras Sensoriais/metabolismo , Sesquiterpenos de Guaiano/uso terapêutico
3.
J Laryngol Otol ; 135(7): 634-639, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34254581

RESUMO

OBJECTIVES: Tonsillectomy has generated extensive comment on the internet, but this content has not been examined in a scientific manner. This study aimed to determine what the blogosphere has to say about adult tonsillectomy and to report whether this information can be used to improve post-surgical care. METHODS: The internet was searched to find personal blogs relating to tonsillectomy. A retrospective review of data collected on these blogs was carried out and the blogs were conceptually analysed by the authors. RESULTS: Fifty blogs were included. Seventy per cent of patients had read blogs prior to their procedure. The average pain score where available was 7.2. Complications occurred in 10 per cent of patients. Only 1 patient (2 per cent) regretted having a tonsillectomy. CONCLUSION: It is important for otolaryngologists to stay in tune with the blogosphere as this unregulated and easily accessible source of information is both friend and foe but will ultimately help in pre-operative counselling and post-operative management.


Assuntos
Analgésicos/uso terapêutico , Blogging , Dor Pós-Operatória/tratamento farmacológico , Satisfação do Paciente , Complicações Pós-Operatórias , Tonsilectomia , Tonsilite/cirurgia , Adulto , Feminino , Humanos , Internet , Masculino , Medição da Dor
5.
Medicine (Baltimore) ; 100(23): e26225, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115008

RESUMO

BACKGROUND: Lung cancer (LC) is the malignant tumor with the highest incidence in the world, and treatment methods include surgery, radiotherapy, chemotherapy, and immunotherapy. Cancer pain is a common symptom in patients with LC, and the clinical treatment is to relieve it with analgesics. Acupuncture can relieve cancer pain. This study aims to systematically study the efficacy and safety of acupuncture combined with analgesics on cancer pain in patients with LC. METHODS: From the beginning to April 2021, search Medline, Embase, Cochrane Central Controlled Trials Register (Central), China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM), and Chinese Science Journal Database (VIP database). Search the international clinical trial registration platform and the Chinese clinical trial registration platform to find ongoing or unpublished trials. The main outcome indicator is the total effective rate of analgesia, and the secondary outcome indicator is pain intensity score and adverse reactions. The RevMan 5.4 software will be used for statistical analysis. RESULTS: This study will provide the latest evidence for acupuncture combined with analgesics to relieve LC pain. CONCLUSION: The conclusion of this study is to evaluate the effectiveness and safety of acupuncture combined with analgesics in alleviating LC pain. INPLASY REGISTRATION NUMBER: INPLASY202150051.


Assuntos
Terapia por Acupuntura/normas , Analgésicos/normas , Dor do Câncer/terapia , Protocolos Clínicos , Manejo da Dor/normas , Terapia por Acupuntura/métodos , Analgésicos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Terapia Combinada/métodos , Terapia Combinada/normas , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Manejo da Dor/métodos , Segurança do Paciente/normas , Resultado do Tratamento
6.
Molecules ; 26(10)2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34069033

RESUMO

Nonsteroidal anti-inflammatory drugs (NSAIDs) are very commonly used, but their adverse effects warrant investigating new therapeutic alternatives. Polyalthic acid, a labdane-type diterpenoid, is known to produce gastroprotection, tracheal smooth muscle relaxation, and antitumoral, antiparasitic and antibacterial activity. This study aimed to evaluate the antinociceptive, antiallodynic, antihyperalgesic and anti-inflammatory effect of polyalthic acid on rats. Moreover, the effectiveness of treating hyperalgesia with a combination of polyalthic acid and naproxen was analyzed, as well as the type of drug-drug interaction involved. Nociception was examined by injecting 1% formalin into the right hind paw and thermal hyperalgesia and inflammation by injecting a 1% carrageenan solution into the left hind paw of rats. Allodynia was assessed on an L5/L6 spinal nerve ligation model. Polyalthic acid generated significant antinociceptive (56-320 mg/kg), antiallodynic (100-562 mg/kg), and antihyperalgesic and anti-inflammatory (10-178 mg/kg) effects. Antinociception mechanisms were explored by pretreating the rats with naltrexone, ODQ and methiothepin, finding the effect blocked by the former two compounds, which indicates the participation of opioid receptors and guanylate cyclase. An isobolographic analysis suggests synergism between polyalthic acid and naproxen in the combined treatment of hyperalgesia.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Diterpenos/uso terapêutico , Hiperalgesia/tratamento farmacológico , Administração Oral , Analgésicos/farmacologia , Animais , Anti-Inflamatórios/farmacologia , Diterpenos/administração & dosagem , Diterpenos/química , Diterpenos/farmacologia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Feminino , Ligadura , Naproxeno/farmacologia , Naproxeno/uso terapêutico , Ratos Wistar , Nervos Espinhais/efeitos dos fármacos , Fatores de Tempo
7.
Sci Rep ; 11(1): 12414, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127740

RESUMO

Primary aim was to assess prevalence and severity of potential and real drug-drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) ('potential interactions') and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02-1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12-1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.


Assuntos
COVID-19/tratamento farmacológico , Interações Medicamentosas , Hidroxicloroquina/química , Lopinavir/química , Ritonavir/química , Idoso , Analgésicos/química , Analgésicos/uso terapêutico , COVID-19/patologia , COVID-19/virologia , Doenças Cardiovasculares/tratamento farmacológico , Estudos de Coortes , Diuréticos/química , Diuréticos/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/tratamento farmacológico , Polimedicação , Fatores de Risco , Ritonavir/uso terapêutico , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Espanha
8.
J Wound Care ; 30(Sup6): S23-S32, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34120467

RESUMO

OBJECTIVE: To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. METHOD: This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. RESULTS: The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. CONCLUSION: To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.


Assuntos
Analgésicos/uso terapêutico , Dor/tratamento farmacológico , Encaminhamento e Consulta/normas , Telemedicina , Úlcera/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Resultado do Tratamento , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-34064096

RESUMO

Recently, there has been an increase in the use of over-the-counter (OTC) drugs. The consumption of these medicines can be unsafe, as incorrect self-diagnosis or the ingestion of inappropriate doses can lead to side effects and the occurrence of adverse reactions and drug-drug interactions. A cross-sectional descriptive observational study was carried out, targeting the entire Spanish population by using an online questionnaire. The results showed that 78.9% of the subjects had previously taken or were currently taking OTC drugs. This consumption decreased as the age of the subjects increased, with a prevalence of 36.4% of subjects aged ≥ 71 taking OTC drugs. Analgesics were the most consumed OTC drugs (49.1%) especially in women, youngsters with non-formal educational qualifications, and individuals of a low-medium socioeconomic level residing in urban areas. Measures should be implemented to optimize the safe use of OTC drugs in order to avoid the occurrence of secondary events associated with the lack of knowledge related to their the usage.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Medicamentos sem Prescrição , Analgésicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Prevalência , Automedicação
10.
Rev Bras Enferm ; 74(3): e20201303, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34161508

RESUMO

OBJECTIVES: to assess the implementation of a nurse-initiated pain management protocol for patients triaged as semi-urgent, and its impact in pain intensity, in the Emergency Department. METHODS: a prospective cohort study for adult patients with pain who had been triaged as semi-urgent and admitted to the hospital's Emergency Department. Patients who received the intervention (pain-management protocol with analgesic administration) were compared to those who were managed using the conventional approach (physician evaluation prior to analgesic administration). RESULTS: of the 185 patients included, 55 (30%) received the intervention, and 130 (70%) were managed conventionally. Patients in the intervention group were more likely to have taken pain medication in the 4 hours prior to admission, and reported higher levels of pain at admission and more significant reductions in pain level. CONCLUSIONS: despite low protocol adherence, the intervention resulted in higher reported pain relief.


Assuntos
Serviço Hospitalar de Emergência , Manejo da Dor , Adulto , Analgésicos/uso terapêutico , Humanos , Estudos Prospectivos , Triagem
11.
Molecules ; 26(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065427

RESUMO

Early plants began colonizing earth about 450 million years ago. During the process of coevolution, their metabolic cellular pathways produced a myriad of natural chemicals, many of which remain uncharacterized biologically. Popular preparations containing some of these molecules have been used medicinally for thousands of years. In Brazilian folk medicine, plant extracts from the bamboo plant Guadua paniculata Munro have been used for the treatment of infections and pain. However, the chemical basis of these therapeutic effects has not yet been identified. Here, we performed protein biochemistry and downstream pharmacological assays to determine the mechanisms underlying the anti-inflammatory and antinociceptive effects of an aqueous extract of the G. paniculata rhizome, which we termed AqGP. The anti-inflammatory and antinociceptive effects of AqGP were assessed in mice. We identified and purified a protein (AgGP), with an amino acid sequence similar to that of thaumatins (~20 kDa), capable of repressing inflammation through downregulation of neutrophil recruitment and of decreasing hyperalgesia in mice. In conclusion, we have identified the molecule and the molecular mechanism responsible for the anti-inflammatory and antinociceptive properties of a plant commonly used in Brazilian folk medicine.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Bambusa/química , Extratos Vegetais/uso terapêutico , Sequência de Aminoácidos , Analgésicos/administração & dosagem , Animais , Anti-Inflamatórios/administração & dosagem , Cromatografia de Afinidade , Cromatografia Líquida de Alta Pressão , Relação Dose-Resposta a Droga , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Hiperalgesia/tratamento farmacológico , Inflamação/tratamento farmacológico , Células MCF-7 , Masculino , Camundongos , Células NIH 3T3 , Extratos Vegetais/administração & dosagem , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
12.
Medicine (Baltimore) ; 100(26): e26519, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190186

RESUMO

BACKGROUND: The catheter-through-needle (CTN) method involves the insertion of a catheter with an outer diameter smaller than the initial puncture hole. We investigated whether the catheter-over-needle (CON) method is more effective than the CTN method in local anesthetic leakage at the catheter insertion site and catheter dislodgement, and how it affects postoperative pain management. METHODS: Seventy patients scheduled to undergo continuous femoral nerve block for pain control following total knee arthroplasty were enrolled and randomized to receive a perineural catheterization with either the CTN method (group CTN) or CON method (group CON). After ultrasound-guided catheterization, the transparent securement dressing was attached. The study compared the CON and CTN methods in terms of leakage at the catheter insertion site, catheter dislodgement, and postoperative analgesic efficacy for 48 hours postoperatively. RESULTS: Leakage at the catheter insertion site was significantly lower in the group CON (P < .05), while catheter dislodgement was not significantly different between the groups. The other adverse events were not different between the groups. The procedure time was significantly shorter in group CON (P < .05). No significant intergroup differences were observed 48 hours postoperatively in the visual analog scales, the number of patients requiring additional analgesics, and the number of times a bolus dose was injected with an injection pump. CONCLUSION: The CON method was able to shorten the procedure time while reducing the incidence of leakage at the catheter insertion site than the CTN method, and showed similar effects in postoperative pain management.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cateterismo , Nervo Femoral , Bloqueio Nervoso , Dor Pós-Operatória , Ultrassonografia de Intervenção/métodos , Idoso , Analgésicos/uso terapêutico , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/métodos , Cateterismo/instrumentação , Cateterismo/métodos , Feminino , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/terapia , Ropivacaina/administração & dosagem , Escala Visual Analógica
13.
Medicine (Baltimore) ; 100(19): e25792, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106615

RESUMO

BACKGROUND: Pain in the tendons or ligaments is extremely common, accounting for 30% of the causes of visiting general practitioners. Polydeoxyribonucleotide (PDRN) is emerging as a new treatment for musculoskeletal pain. However, the effects of PDRN in patients with tendon or ligament pain are unclear. Therefore, this study aimed to determine the impact of PDRN in patients with tendon or ligament pain through a meta-analysis. METHODS: Electronic literature search of PubMed, Embase, SCOPUS, and Cochrane Library databases of all articles on PDRN treatment for patients with tendon or ligament pain published in the English language from inception until January 31, 2020. The search identified 262 citations. RESULTS: One randomized controlled trial and 3 retrospective observational studies were included. Pain due to tendon or ligament disorders showed significant improvement after PDRN injection (standardized mean difference [SMD] = -1.43, 95% confidence interval [CI] = -1.80 to -1.06, P < .00001). In the subanalysis of patients with rotator cuff tendinopathy, rotator cuff tendinopathy-induced pain significantly improved (SMD = -2.34, 95% CI = -3.61 to -1.07, P = .0003) after PDRN injection. However, there was no difference in shoulder pain and disability index score and strength of shoulder abduction in patients with rotator cuff tendinopathy (shoulder pain and disability index score, SMD = 1.16, 95% CI = -1.20 to 3.52, P = .34; strength of shoulder abduction, SMD = 0.42, 95% CI = -0.03 to 0.88, P = .07). CONCLUSION: Effective pain relief was achieved in patients with tendon or ligament disorders after PDRN injection. To more precisely determine this effect, a meta-analysis with a larger number of clinical trials is warranted.


Assuntos
Analgésicos/uso terapêutico , Ligamentos , Dor Musculoesquelética/tratamento farmacológico , Polidesoxirribonucleotídeos/uso terapêutico , Tendinopatia/tratamento farmacológico , Humanos , Injeções , Dor Musculoesquelética/diagnóstico , Medição da Dor , Tendinopatia/diagnóstico , Resultado do Tratamento
14.
N Z Med J ; 134(1536): 52-76, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34140713

RESUMO

AIM: To measure primary medication non-adherence to antibiotics, paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients discharged from Counties Manukau Health Emergency Department (CMH-ED). METHOD: A retrospective observational study based on 1,600 discharged patients' data collected between 28 April-6 May and 28 July-9 August 2014. Data were included for patients who were residents within the Auckland Regional Public Health Service boundaries, presented to CMH-ED and were discharged with a prescription. RESULTS: Of 992 patients, 48.5% did not have at least one medication on their discharge prescription filled. Patients were mostly born in New Zealand (66.5%), of Pacific Island descent (42.8%), living in the most socioeconomically deprived areas (78.1%) and under 10 years of age (32.6%). Filling rates significantly increased with >1 prescribed item (p≤0.01). NSAIDs were significantly more likely to be filled compared with paracetamol (59.9% vs 51.3%, p=0.034); antibiotics were significantly more likely to be filled than all other medicines (80.4%, p<0.001). The most significant predictors for non-adherence when accounting for number and types of medications were patients 10-44 years (p<0.05) and smokers (p<0.01). CONCLUSIONS: Age, smoking and number of prescribed medications were predictors of non-adherence to medication type. Further research is warranted to assess whether changes to prescription co-payments affect the rate of nonadherence.


Assuntos
Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
15.
JAMA ; 325(23): 2357-2369, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34128998

RESUMO

Importance: Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy. Objective: To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults. Data Sources: Multiple databases from database inception to February 24, 2021. Study Selection: Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks. Data Extraction and Synthesis: Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small. Main Outcomes and Measures: The main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Findings: Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham. Conclusions and Relevance: There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.


Assuntos
Analgésicos/uso terapêutico , Terapia por Estimulação Elétrica , Transtornos de Enxaqueca/tratamento farmacológico , Analgésicos/efeitos adversos , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antieméticos/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Terapia por Estimulação Elétrica/efeitos adversos , Alcaloides de Claviceps/uso terapêutico , Medicina Baseada em Evidências , Humanos , Transtornos de Enxaqueca/terapia , Medição da Dor , Agonistas do Receptor de Serotonina/uso terapêutico , Triptaminas/uso terapêutico
16.
Rev Infirm ; 70(271): 47-48, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-34024586

RESUMO

Some pains, especially in oncology, are refractory to standard analgesics. Epidural analgesia is an efficient way to manage them. It allows the patient to be relieved, to improve his quality of life and the conditions of his return home or in an institution. The nurse has a very important role in the therapeutic education of the patient, the follow-up of the management, the accompaniment of the family and the anticipation of these needs.


Assuntos
Analgesia Epidural , Qualidade de Vida , Analgésicos/uso terapêutico , Analgésicos Opioides , Humanos , Dor/tratamento farmacológico
18.
BMC Musculoskelet Disord ; 22(1): 492, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049519

RESUMO

BACKGROUND: Previous studies have demonstrated the efficacy of duloxetine in reducing postoperative pain and opioid consumption. However, the effect of duloxetine on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of oral duloxetine in THA. METHODS: We enrolled 96 patients in this randomized controlled trial. These patients were randomized (1,1) to either the duloxetine group or the placebo group and received daily doses of 60 mg duloxetine or placebo, respectively, from 2 d pre-operation to 14 d after surgery. The primary outcome was pain severity upon movement measured by a visual analogue scale (VAS). The secondary outcomes included VAS scores for resting pain, morphine consumption, Harris Hip Score, patient satisfaction at discharge, length of postoperative hospital stay, and adverse events. RESULTS: Patients in the duloxetine group had significantly lower pain severity scores upon movement within 3 postoperative weeks (p < 0.05) while none of the differences met the minimum clinically important difference (MCID). Moreover, patients in the duloxetine group performed better in terms of resting pain (in 3 weeks after surgery), morphine requirements, and satisfaction level at discharge (all p < 0.05). There was no difference between groups in the prevalence of adverse events. CONCLUSIONS: Although it did not result in a clinically meaning reduction in pain after total hip arthroplasty, perioperative administration of 60 mg of duloxetine daily significantly alleviated pain in the postoperative 3 weeks and morphine requirements during the postoperative 48 h. Therefore, duloxetine still shows promise in optimizing the multimodal pain-management protocols in total hip arthroplasty. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000033606 , 06/06/2020.


Assuntos
Artroplastia de Quadril , Analgésicos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Método Duplo-Cego , Cloridrato de Duloxetina/efeitos adversos , Humanos , Estudos Prospectivos
19.
J Med Chem ; 64(10): 7033-7043, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-33949869

RESUMO

In a program to identify pain treatments with low addiction potential, we isolated five steroids, conosteroids A-E (1-5), from the hypobranchial gland of the mollusk Conus geographus. Compounds 1-5 were active in a mouse dorsal root ganglion (DRG) assay that suggested that they might be analgesic. A synthetic analogue 6 was used for a detailed pharmacological study. Compound 6 significantly increased the pain threshold in mice in the hot-plate test at 2 and 50 mg/kg. Compound 6 at 500 nM antagonizes type-A γ-aminobutyric acid receptors (GABAARs). In a patch-clamp experiment, out of the six subunit combinations tested, 6 exhibited subtype selectivity, most strongly antagonizing α1ß1γ2 and α4ß3γ2 receptors (IC50 1.5 and 1.0 µM, respectively). Although the structures of 1-6 differ from those of known neuroactive steroids, they are cell-type-selective modulators of GABAARs, expanding the known chemical space of neuroactive steroids.


Assuntos
Analgésicos/química , Caramujo Conus/química , Antagonistas GABAérgicos/química , Neuroesteroides/química , Receptores de GABA/química , Potenciais de Ação/efeitos dos fármacos , Analgésicos/síntese química , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Animais , Caramujo Conus/metabolismo , Modelos Animais de Doenças , Antagonistas GABAérgicos/isolamento & purificação , Antagonistas GABAérgicos/farmacologia , Antagonistas GABAérgicos/uso terapêutico , Gânglios Espinais/citologia , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Conformação Molecular , Neuroesteroides/isolamento & purificação , Neuroesteroides/farmacologia , Neuroesteroides/uso terapêutico , Dor/induzido quimicamente , Dor/tratamento farmacológico , Dor/patologia , Subunidades Proteicas/química , Subunidades Proteicas/metabolismo , Receptores de GABA/metabolismo
20.
Eur J Pharm Sci ; 163: 105865, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33979659

RESUMO

BACKGROUND: Mefenamic acid (MFA), a commonly prescribed non-steroidal anti-inflammatory drug (NSAID), possesses a greater risk of dose-related central nervous system (CNS) toxicity than other NSAIDs. In this study, α-tocopherol and α-tocopherol acetate were selected as prodrug moieties for MFA in an attempt to reduce the CNS toxicity and enhance the therapeutic efficacy. METHOD: α-tocopherol monoester of MFA (TMMA) and α-tocopherol di-ester of MFA (TDMA) were synthesized by esterification reaction and were subjected to various in vivo characterizations. RESULTS: Masking of the carboxylate group of MFA with the proposed pro-moieties significantly (p<0.05) delayed the onset of tonic-clonic seizure in mice. Besides, the intraperitoneal administration of TMMA and TDMA in mice produced significantly (p<0.05) stronger anti-inflammatory effects in the carrageenan-induced paw edema test and greater anti-nociceptive effect in the acetic acid-induced writhing test than MFA at an equimolar dose of 20 mg/kg. Treatment with TMMA and TDMA caused a significant (p<0.05) inhibition of pain at 1st and 2nd phases of formalin-induced licking test in mice, whereas treatment with MFA inhibited the 2nd phase only. Pretreatment with naloxone and flumazenil significantly (p<0.05) reversed the anti-nociceptive effect of MFA, TMMA and TDMA in the acetic acid-induced writhing test. In addition, treatment with TMMA and TDMA caused significantly (p<0.05) a higher inhibition of pain in the glutamate-induced licking response in mice than MFA. CONCLUSION: Masking the carboxylate moiety of MFA by α-tocopherol and α-tocopherol acetate has a great potential for reducing CNS toxicity, enhancing the therapeutic efficacy and altering the mode of anti-nociceptive action.


Assuntos
Analgésicos , Ácido Mefenâmico , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Animais , Anti-Inflamatórios/uso terapêutico , Edema/induzido quimicamente , Edema/tratamento farmacológico , Ésteres , Camundongos , Fitoterapia , Extratos Vegetais , Receptores de Glutamato , Ácido gama-Aminobutírico/uso terapêutico
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