Florella Magora

EPIDURAL MORPHINE IN TREATMENT OF PAIN

Epidural injections of a 2 mg morphine were given to 10 patients with severe acute or chronic pain. All cases had considerable amelioration of pain, which commenced within 2-3 min, reached a peak in 10-15 min, and was effective for 6-24 h. It is suggested that the morphine reached the subarachnoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior-horn cells of the spinal cord.

Electronic pressure algometry of deep pain in healthy volunteers

Deep pressure pain threshold (PPT) and pressure pain tolerance (PPtol) were measured by pressure algometry at the mastoid processes, external malleoli, and sternum in 24 healthy volunteers. The algometer consisted of a force displacement transducer with a 0.25 cm2 pressure tip linked to a recorder. The rate of force application was approximately 1kg/sec/0.25cm2. High intersubject variation was noted at all sites for both PPT and PPtol. Mean PPT and PPtol values at the sternum were 5.2kg +/- 2.1 and 8.1kg +/- 2.4, respectively, and significantly higher than at the other sites. PTT did not differ significantly between the sexes or between dominant and nondominant sides. PPtol, on the other hand, was lower in the women, but significantly so only at the malleoli. On repeat examination, comparison between the mean values at each site showed no statistical differences in any instance. Pressure algometry, as used in this study in healthy subjects, proved a reliable technique for the estimation of deep PPT and PPtol values. It may possibly serve for screening the response to experimental pain in various groups of pain patients.

Urinary function during epidural analgesia with methadone and morphine in post-cesarean section patients

&NA; Urinary function was assessed in 120 women after cesarean section under epidural anesthesia. Postoperative analgesia was obtained by means of epidurally administered methadone (40 patients) or morphine (40 patients). In the remaining 40 women, no narcotic drugs were given and postoperative pain was treated with intramuscular or oral non‐opiate analgesics and sedatives. Both methadone and morphine provided potent postoperative pain relief. Following epidural methadone, mean urine volumes of the first two postoperative voidings were increased (543 ± 38n ml and 571 ± 31 ml) as compared with those after epidural morphine (219 ± 25 ml and 218 ± 18 ml) and with those of patients receiving non‐opiate analgesics (319 ± 28ml and 414 ± 30 ml). The mean time interval between the end of surgery and first voiding following methadone analgesia was shorter (336 ± 27 min) than after morphine (582 ± 18 min) or after non‐opiate (448 ± 28 min) analgesic drugs. Difficulty in micturition and the need for bladder catheterization were also decreased in the group with epidural methadone (2.5%) in comparison with the groups receiving morphine (57.5%) or non‐opiate analgesic medicaments (12.5%). The use of epidural methadone for postoperative pain relief is advocated, both in view of its analgesic potency and of the low incidence of urinary disturbances.

Effect of oral contraceptives on blood viscosity

Abstract Blood viscosity and hematocrit were examined in 47 young healthy women before and during the administration of two different oral contraceptives. In 8 (17 per cent) of the patients, increases in blood viscosity and in hematocrit were noted within 3 months and were more marked after 6 months of therapy. Cessation of these agents resulted in a rapid return to pretreatment values. Clinical signs of thrombophlebitis developed in one patient who had shown the sharpest and highest rise both in blood viscosity and hematocrit. It is suggested that an increase in blood viscosity and/or hematocrit might be an indication to stop the administration of oral contraceptives.

Effects of virtual reality immersion and audiovisual distraction techniques for patients with pruritus

BACKGROUND Virtual reality immersion (VRI), an advanced computer-generated technique, decreased subjective reports of pain in experimental and procedural medical therapies. Furthermore, VRI significantly reduced pain-related brain activity as measured by functional magnetic resonance imaging. Resemblance between anatomical and neuroendocrine pathways of pain and pruritus may prove VRI to be a suitable adjunct for basic and clinical studies of the complex aspects of pruritus. OBJECTIVES To compare effects of VRI with audiovisual distraction (AVD) techniques for attenuation of pruritus in patients with atopic dermatitis and psoriasis vulgaris. METHODS Twenty-four patients suffering from chronic pruritus - 16 due to atopic dermatitis and eight due to psoriasis vulgaris - were randomly assigned to play an interactive computer game using a special visor or a computer screen. Pruritus intensity was self-rated before, during and 10 min after exposure using a visual analogue scale ranging from 0 to 10. The interviewer rated observed scratching on a three-point scale during each distraction program. RESULTS Students t tests were significant for reduction of pruritus intensity before and during VRI and AVD (P=0.0002 and P=0.01, respectively) and were significant only between ratings before and after VRI (P=0.017). Scratching was mostly absent or mild during both programs. CONCLUSIONS VRI and AVD techniques demonstrated the ability to diminish itching sensations temporarily. Further studies on the immediate and late effects of interactive computer distraction techniques to interrupt itching episodes will open potential paths for future pruritus research.

The action of intrathecal morphine and methadone on the lower urinary tract in the dog.

The effects of intrathecally administered morphine and methadone on lower urinary tract dynamics were investigated by cystometrograms and urethral pressure profiles in 16 anesthetized dogs. The examinations were performed before and 30, 60 and 90 minutes following intrathecal injection of 0.03 mg./kg. morphine or methadone. Intrathecal normal saline was used for control studies. Significant relaxation of the detrusor was noted after intrathecal morphine as expressed by a decrease in mean intravesical pressure (p less than 0.05) and by a rise in the calculated detrusor compliance. These effects were reversed by intravenously injected naloxone. As opposed to morphine, methadone caused an increase in detrusor tone. No appreciable effects were observed on the urethra after intrathecal morphine or methadone. Neither intravenous injection of the opiates nor intrathecal administration of saline caused alterations in bladder tone. The result may imply a spinal, albeit opposing, effect of the two opiates on bladder dynamics.

URODYNAMIC STUDIES AFTER INTRATHECAL FENTANYL AND BUPRENORPHINE IN THE DOG

Cystometrograms (CMC) and urethral pressure profiles (UPP) were used in six anesthetized dogs to study the Urodynamic effects of intrathecal (IT) injections of fentanyl and buprenorphine. The CMC and UPP were examined for each of the two drugs in all dogs (four experiments per animal). The measurements were performed before and 15, 30, 60, 90, and 120 min after IT injection of either 1.5 μg/kg fentanyl or 2 μg/kg buprenorphine. Fifteen minutes after IT injection of fentanyl, reduction in bladder tone was already noted, followed by decreases in mean peak vesical pressure of 48.3% ± 6.0 (SE) (P < 0.05) and mean peak urethral pressure of 38% ± 3.0 (P < 0.05) between 30 and 60 min after injection. These decreases, occurring in each experiment, gradually lessened at 90 and 120 min. The effects of IT buprenorphine, a partial opioid agonist, on bladder and urethral dynamics were inconsistent and non significant in all studies. Disturbances of micturition observed clinically after spinal opioid administration may be related to the decrease in intravesical pressure and the resulting highly compliant bladder. Relaxation of the urethral musculature seen 15 min after IT fentanyl may prevent overdistension of the bladder and its associated complications.

Willow Species and Aspirin: Different Mechanism of Actions

Many believe that willow is the natural source of aspirin. However, willow species contain only a low quantity of the prodrug salicin which is metabolized during absorption into various salicylate derivatives. If calculated as salicylic acid, the daily salicin dose is insufficient to produce analgesia. Salicylic acid concentrations following an analgesic dose of aspirin are an order of magnitude higher. Flavonoids and polyphenols contribute to the potent willow bark analgesic and anti‐inflammatory effect. The multi‐component active principle of willow bark provides a broader mechanism of action than aspirin and is devoid of serious adverse events. In contrast to synthetic aspirin, willow bark does not damage the gastrointestinal mucosa. An extract dose with 240 mg salicin had no major impact on blood clotting. In patients with known aspirin allergy willow bark products are contraindicated. Copyright

The effect of epidural morphine on ureteral colic and spasm of the bladder.

Twenty-one patients suffering from severe pain associated with ureteric stones and spasm of the bladder which did not respond to repeated systemic injections of pethidine and papaverine received continuous epidural morphine. The morphine, 3-4 mg per dose, was injected into the lumbar-epidural space, and 15-20 min later all patients were pain free for at least 24 h. Administration of morphine was continued for periods ranging from 2 days to 2 weeks according to need. Eleven of the patients with ureterolithiasis passed the stone spontaneously. Epidural morphine analgesia is indicated for persistent ureteral colic and for spasm of the bladder when conventional treatment fails or systemic drugs are contraindicated. It abolishes pain and spasm for prolonged periods of time and does not interfere with the spontaneous elimination of stone.

Rise and Fall of Oral Health Products with Canadian Bloodroot Extract

The rhizome of Sanguinaria canadensis (SC, bloodroot) contains an active principle with antimicrobial, antiinflammatory, antioxidative and immunomodulatory effects. For this reason SC extract has been added to toothpastes and mouthwashes in various concentrations. When tested separately, neither the toothpastes nor the mouthwashes with SC extract had any demonstrable clinical effectiveness against dental plaque and gingivitis. Although using them together twice a day seemed more effective than using placebo, more recent studies have shown conflicting results. Preclinical safety studies up to 2000, which did not include studies longer than 6 months, were thought not to indicate any appreciable potential for harm – to the oral mucosa in particular. In 2003, the FDA Subcommittee on Oral Health Care Drug Products for Over‐the‐Counter Human Use concluded from a review that using SC‐containing products is safe. However, for reasons unknown, the review failed to consider publications between 1999 and 2001 that suggested a possible link between the use of SC‐containing products and the pre‐neoplastic lesion, leukoplakia. As it happened, bloodroot had already been removed (in 2001) from the formula of one of the most widely used products in question and the brand has since then disappeared altogether from the worldwide market. Copyright