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Biomedical subjects

Gary McCleane

Publications and source records attributed to Gary McCleane.

9 recordsLinked to original sources
PubMed2007

Topical analgesics.

Our knowledge and understanding of the pathophysiology and treatment of pain is increasing; however, we should not lose sight of the simple opportunities that exist for intercepting pain at peripheral targets. Although systemic medication often has peripheral and central modes of action, the appeal for provision of medication close to where these peripheral targets exist should be high. If these sites can be attacked with relatively high concentrations of active drug while keeping systemic levels of that drug below the level at which systemic side effects become apparent, then this should lead to desirable outcomes. Even though the number of true topical agents with an indication for this use is small, a number of other topical agents are available that evidence suggests have the possibility of being effective. Given the increased understanding of pain, the likelihood of further topical agents becoming available is high.

Administration, Cutaneous↗
PubMed2005

Emerging trends in the management of neuropathic pain.

Despite significant improvements in our ability to treat neuropathic pain, we are far from the situation of being able to guarantee pain relief. The next few years promise to see the introduction of novel pharmacologic entities that show potential in the field of neuropathic pain treatment. Allied to this will be the realization that some drugs originally released for nonpain indications in fact have an analgesic effect in neuropathic pain. Our treatment armamentarium will be further enhanced by the release of currently available agents with proven efficacy but in new formulations. However, not every product of our improved knowledge will manifest as a new drug treatment for neuropathic pain. Despite evidence of efficacy, some drugs will fail to reach commercialization due to the lack of investment in their clinical development.

Analgesics↗
PubMed2004

Topical application of the tricyclic antidepressant doxepin can reduce dysuria and frequency.

The aim of this article is to highlight a novel treatment for the symptoms of chronic urethral and trigonal irritation. A patient with severe urethral hyperaesthesia who derived almost complete alleviation of symptoms with topical application of a tricyclic antidepressant cream is described. The possible modes of action of tricyclics when used via the topical route of administration are described. Topical application of a tricyclic antidepressant cream may alleviate the symptoms of urethral hyperaesthesia.

Administration, Topical↗
PubMed2004

Pharmacological strategies in relieving neuropathic pain.

The pharmacological treatment of neuropathic pain relies, to a large extent, on drugs belonging to a small number of defined classes. Opioids, tricyclic antidepressants, antiepileptic drugs and membrane stabilisers form the current basis of treatment. Varying levels of evidence support the use of individual members of these classes and overall show no indication that one class of drug, or individual drug has universal effectiveness. More refined knowledge of the modes of action of these agents used to treat neuropathic pain should lead to a more logical approach to the management of this difficult series of conditions. A number of drugs currently licensed for a different indication have recently had an analgesic effect in neuropathic pain attributed to them. In addition, a number of novel compounds are undergoing investigation and provide hope of dicovering more efficacious treatment options in the future.

Analgesics, Opioid↗
PubMed2004

Cholecystokinin antagonists a new way to improve the analgesia from old analgesics?

Cholecystokinin, originally thought to be confined only to the gastrointestinal tract, is now known to be co-localised in both the gastrointestinal tract and central nervous system. In animal models levels are increased after neural injury and with opioid administration. This peptide acts as an anti-opioid, and as levels increase, the extent of opioid derived antinociception decreases. Co-administration of a CCK antagonist along with an opioid is associated with an improved level of antinociception. Furthermore CCK antagonists may prevent antinociceptive tolerance with opioids and even reverse established tolerance. Human studies have now confirmed the pro-analgesic effect of some CCK antagonists. Human investigation of the effect of CCK antagonists on analgesic tolerance has yet to be performed. This review examines the available evidence that suggests a role for CCK antagonists in human pain management.

Analgesics↗
PubMed2003

Lignocaine gel: does it cause urethral pain rather than prevent it?

OBJECTIVES: To test the hypothesis that the chemical content of lignocaine gel is the cause of urethral pain during its instillation into the urethra. METHODS: A prospective, double blind study was designed to test whether plain aqueous gel caused less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel). 100 consecutive, consenting male patients attending for flexible cystoscopy were recruited and randomised to receive 11 ml of 2% lignocaine hydrochloride gel or 11 ml of plain aqueous gel. Upon receiving the gel into the urethra, the patient was asked to score any associated discomfort by using a horizontal, 100mm, non-graphical, visual analogue scale. Statistical comparison between the groups was made using the non-parametric Mann-Whitney U-test. RESULTS: Statistical analysis by Mann-Whitney U-test showed a significant reduction in urethral delivery discomfort in those patients receiving plain gel compared to those receiving 2% lignocaine hydrochloride gel (p=0.039). CONCLUSIONS: This current study has shown that plain aqueous gel causes significantly less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel).

Anesthetics, Local↗
PubMed2003

Pharmacological management of neuropathic pain.

In health, the nervous system exists in a balance between inhibitory and excitatory influences. This balance may be upset if neural tissue is damaged or irritated and may give rise to neuropathic pain. Such neuropathic pain does not respond consistently to opioid analgesics or NSAIDs and it may therefore be necessary to utilise other therapeutic agents with known activity on either the excitatory or inhibitory components of the pain pathway. These other agents are traditionally considered with reference to their original uses; we still refer to tricyclic antidepressants (TCAs) and anticonvulsant drugs when a consideration of their modes of action may allow more rational use. For example, carbamazepine is related to the TCAs by virtue of its chemical structure and proposed mode of action and yet is still classified as an anticonvulsant drug. With respect to the opioids, increasing evidence points to an analgesic effect in neuropathic pain, although concerns regarding tolerance and dependence still prevent more widespread use. The anticonvulsants comprise a group of compounds possessing anticonvulsant and analgesic properties, but each possesses differing modes of action and so several members of the class should be tried before a conclusion is reached that they, as a whole, are ineffective. TCAs may also have a role in the treatment of neuropathic pain. As with all drugs, if their use is not associated with pain relief in a defined period of time, their use should be terminated. Topical TCAs may also have a role where the area of neuropathic pain is small. Other options, such as SSRIs, membrane stabilisers, capsaicin, baclofen and clonidine may have potential in treating neuropathic pain. The available evidence regarding the efficacy of currently available agents for the treatment of neuropathic pain is sparse. With the knowledge of achieving analgesia, according to the modes of actions of various agents it is hoped that the treatment of this difficult condition may be more logical and successful.

Analgesics, Opioid↗