Comments on Fitzgibbon and Galer, PAIN, 58 (1994) 429-431.
Explore the source record for details and available documents.
Analgesics, Opioid↗
Biomedical subjects
Arthur G Lipman
Publications and source records attributed to Arthur G Lipman.
Low-dose amitriptyline as an adjunct to opioids for postoperative orthopedic pain: a placebo-controlled trial.
Tricyclic antidepressants (TCAs) have been found to be useful in the management of a variety of chronic pain conditions, although there is little published regarding the potential efficacy of this class of drug as an adjunct for the control of acute postoperative pain and related symptoms. Twenty-eight patients undergoing total hip or knee arthroplasty completed a randomized, placebo-controlled, double-blinded trial of 50 mg of amitriptyline p.o. HS on postoperative days 1, 2 and 3 while using patient-controlled morphine or meperidine analgesia (PCA). Visual analog (VAS) and numerical verbal (NVS) pain ratings, sedation scores, sleep quantity/quality scores, and sense of well-being scores were assessed twice daily on each of the days succeeding amitriptyline/placebo use. Hourly opioid use was recorded and transcribed from the memory of the PCA devices in use. Mean scores in the amitriptyline group for pain NVS were greater (P < 0.05) (higher score = greater pain) on day 1 and greater on day 2 for the pain VAS. Mean scores for sense of well-being were greater (P < 0.05) (higher score = better sense of well-being) for the placebo group on days 1 and 2. On days 2 and 3, sleep scale variable mean scores were worse in the placebo group (P < 0.025). There were no other statistically significant differences between the control and active drug groups for any of the outcome variables measured. We conclude that amitriptyline at the dose prescribed is no different than placebo in altering the majority of postoperative symptom variables studied in the sample study population but caused no significant adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Recent advances in pharmacotherapy for cancer pain management.
PURPOSE: This review provides an outline of several recent advances in drug treatment options and strategies for managing cancer pain. OVERVIEW: The development of cyclooxygenase-2-selective nonsteroidal anti-inflammatory drugs (NSAIDs) and transmucosal fentanyl citrate provide new pharmacologic options for the treatment of cancer pain. Combinations of opioid agonists and antagonists have provided data on new strategies to balance effective analgesia with analgesic-related adverse effects. In addition, the spectrum of adjuvant agents for the treatment of neuropathic pain has been extended to various antidepressants and topical analgesics. There is continued research on the role of the N-methyl-d-aspartate (NMDA) receptor and, specifically, on NMDA receptor antagonists that may augment analgesia and combat opioid resistance. Finally, a more potent generation of bisphosphonates may lead to improved pain relief for patients with bone metastases. CLINICAL IMPLICATIONS: With a combination of emerging new clinical research and professional practice experience of the cancer care team, new strategies will continue to be developed and implemented, resulting in the continued improved care of patients with cancer.
Analgesics, Opioid↗
Older and younger adults in pain management programs in the United States: differences and similarities.
OBJECTIVES: 1) To investigate health status of older (>or=60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. DESIGN: We performed a cross-sectional analysis. PATIENTS: Initial assessments of 6,147 patients dating from January 1998 to January 2003 were used. OUTCOMES MEASURES: We used the Treatment Outcomes of Pain Survey (TOPS), a disease-specific instrument that includes the Short Form-36. RESULTS: The health status of the older pain patients in terms of their actual scores was comparable with that of younger pain patients across the three sites. Health status is impaired to a lesser degree in older than in younger adults with chronic pain as compared with normative adults. Statistically significant differences were found in a number of domains of the TOPS. Older adults with chronic pain present with pain intensity similar to that of younger patients with chronic pain, but report better mental health (P < 0.002), less fear-avoidance (P < 0.05), less passive coping (P < 0.0001), more life control (P < 0.05), and more lower body physical limitations (P < 0.005) than younger patients with chronic pain. CONCLUSIONS: Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment.
Adaptation, Psychological↗