Chronic Pain - Challenge and Response

Budd, Keith

doi:10.2165/00003495-199400471-00006

Cited by 39 publications

(22 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unlike other opioid agonists, respiratory depression is seldom, if ever, reported using recommended doses orally (184,185). However, a case report revealed that tramadol may result in respiratory depression in patients with renal failure (187).…”

Section: Dual or Multimechanism Opioidsmentioning

confidence: 99%

See 1 more Smart Citation

The Pharmacotherapy of Chronic Pain: A Review

Lynch

Watson

2006

Pain Research and Management

103

View full text Add to dashboard Cite

The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date.Key Words: Anticonvulsants; Antidepressants; Cannabinoids; Chronic pain; Opioids; Pharmacotherapy; Topical analgesics La pharmacothérapie de la douleur chronique : Une analyse Les deux dernières décennies ont contribué à un vaste ensemble de travaux précliniques qui nous ont permis de mieux comprendre les mécanismes physiopathologiques sous-jacents responsables de la douleur chronique. Dans ce contexte, il est admis que le traitement efficace de la douleur est une priorité et qu'il exige souvent le recours à un agent ou à une association d'agents ayant une action analgésique. La présente analyse présente une démarche probante de la pharmacothérapie de la douleur chronique. Des recherches dans Medline ont été effectuées sur tous les agents utilisés pour le traitement classique de la douleur chronique. Les articles publiés jusqu'en juin 2005 ont été inclus. La stratégie de recherche incluait les essais aléatoires et contrôlés et, si elles étaient disponibles, les analyses systématiques et les méta-analyses. D'autres références ont été obtenues dans la partie des références des articles trouvés à l'aide de la stratégie de recherche précédente. Les agents dont aucun essai contrôlé n'étayait l'efficacité pour le traitement de la douleur chronique étaient exclus de la présente analyse, sauf si les données scientifiques précliniques étaient convaincantes, si les travaux humains initiaux étaient positifs ou si on pensait que les données scientifiques colligées jusque-là étaient intéressantes pour le lecteur.

show abstract

Section: Dual or Multimechanism Opioidsmentioning

confidence: 99%

“…Urinary retention and constipation are very infrequent (186). In addition, minimal tolerance has been reported and the addiction potential is low (184,185). Because tramadol inhibits the reuptake of monoamines, it should not be used with monoamine oxidase inhibiters.…”

Section: Dual or Multimechanism Opioidsmentioning

confidence: 99%

The Pharmacotherapy of Chronic Pain: A Review

Lynch

Watson

2006

Pain Research and Management

103

View full text Add to dashboard Cite

show abstract

“…These findings suggest the possibility that pain could lead to physiological changes at supraspinal levels associated with the suppression of opioid dependence. It has been reported that tramadol has a potential for physical and psychological dependence (Yanagita 1978;Liu et al 1999;Sprague et al 2002;Tzschentke et al 2002), but may possess considerably less abuse potential than morphine (Budd 1994). Recent clinical evidence has suggested that tramadol abuse has been suggested in humans (Cicero et al 1999;Yates et al 2001;Zacny 2005;Epstein et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Changes in the rewarding effects induced by tramadol and its active metabolite M1 after sciatic nerve injury in mice

et al. 2008

View full text Add to dashboard Cite

Our present data support the notion that the rewarding effect induced by tramadol is mediated mainly through metabolism to its active metabolite M1 via MOR. Furthermore, the suppression of the M1-induced G protein activation in the lower midbrain area caused by sciatic nerve ligation may be responsible for inhibiting the rewarding effects induced by s.c. injection of tramadol and M1 under a neuropathic pain-like state.

show abstract

“…They are effective in those painful situations 17 , but are not considered the drugs of choice due to the risk of dependency, reduced cognitive capacity, tolerance, and possible hormonal dysfunctions, especially with chronic use 18 . Tramadol has two mechanisms of action; it is a mu opioid receptor agonist and it inhibits the reuptake of noradrenaline and serotonin in the synaptic cleft 19 . Corticosteroids are anti-inflammatory agents that, among other properties, stabilize the membrane of the lisosomes and reduce the production of inflammatory substances by those organelles, decrease capillary permeability, which prevents loss of plasma to the tissues, and reduce leukocyte migration to the area of inflammation 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Eles são eficazes nesses quadros álgicos 17 , mas não são todos como de primeira escolha por causa do risco de dependência, prejuízo cognitivo, tolerância e possíveis distúrbios hormonais, sobretudo quando administrados cronicamente 18 . O tramadol apresenta dois mecanismos de ação, agonista dos receptores opióides mu e inibição da recaptação de noradrenalina e serotonina na fenda sináptica 19 . Os corticóides são agentes que apresentam efeitos antiinflamatórios, dentre outros, por estabilizarem as membranas dos lisossomos e reduzirem a produção de substâncias inflamatórias produzidas por essas organelas, diminuírem a permeabilidade capilar, prevenindo a perda de plasma tecidual e reduzindo a migração de leucócitos para a área inflamada 20 .…”

Section: Introductionunclassified

Dor neuropática após trauma com agulha de peridural

Ramos¹,

Gomes²

2008

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES:Neurologic complications secondary to epidural block are uncommon. Direct mechanical trauma to nerve roots may cause neuropathic pain that, usually, has a favorable evolution; however, it is a potentially severe complication that can evolve into a chronic disorder. The objective of this study was to discuss acute traumatic neuropathic pain and, especially, its treatment. CASE REPORT:A male patient was admitted for surgical treatment of gastroesophageal reflux via laparoscopy and scheduled to be discharged on the first postoperative (PO) day. He underwent epidural block associated with general anesthesia. During the localization of the epidural space, the patient complained of severe pain in the left lower limb. The needle was repositioned and the epidural space was located. In the PO, the patient developed allodynia and hyperesthesia. Neuropathic pain was diagnosed. Treatment included antidepressant, anticonvulsant, corticosteroids, tramadol, and vitamin B complex. On the 28 th PO the patient was asymptomatic and presented a normal physical exam, being discharged from the hospital. CONCLUSIONS:The patient presented a favorable evolution with the treatment instituted. Early diagnosis and treatment can avoid irreversible lesions, change the prognosis, and avoid social and medical-legal consequences.

show abstract

Chronic Pain - Challenge and Response

Cited by 39 publications

References 12 publications

The Pharmacotherapy of Chronic Pain: A Review

The Pharmacotherapy of Chronic Pain: A Review

Changes in the rewarding effects induced by tramadol and its active metabolite M1 after sciatic nerve injury in mice

Dor neuropática após trauma com agulha de peridural

Contact Info

Product

Resources

About