PubMed HealthSearch

Biomedical subjects

J Linford

Publications and source records attributed to J Linford.

7 recordsLinked to original sources

Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double-blind pilot study.

A double-blind pilot study was undertaken to test the administration of low doses of the long-acting benzodiazepine drug clonazepam in the management of chronic intractable temporomandibular disorder/myofascial pain patients who were not responsive to occlusal splint, behavioral, and physical therapy. Clonazepam was selected for its long duration and its cholinergic/GABA-ergic/serotonergic, anxiolytic, muscle relaxant, and sedative properties. Clonazepam appears to be effective when compared to a placebo. However, caution must be observed with long-term administration of clonazepam because of potential side effects such as depression and liver dysfunction. Indiscriminate administration of clonazepam may be harmful to the patient.

Adolescent

Transdermal fentanyl: pharmacokinetics and preliminary clinical evaluation.

A new transdermal drug-delivery system that administers the synthetic opioid fentanyl through intact skin was evaluated for 24 hours postoperatively in eight patients who had undergone orthopedic surgery. Plasma samples were obtained over a 72-hour period for pharmacokinetic analysis in five patients. The patients were also evaluated intensively for adequacy of analgesia, frequency of nausea and sedation, and occurrence of ventilatory depression. A median lag time of 2.25 hours after application of the transdermal system was observed before the appearance of fentanyl in the blood. Median peak concentration and time to peak were 1.0 ng/ml and 22 hours, respectively. The apparent elimination of fentanyl after transdermal administration is prolonged relative to previously reported values. Absorption analysis indicates zero-order fentanyl administration, and in addition, suggests deposition of drug in an epidermal site, with the resultant prolonged absorption process giving the appearance of slow elimination. No significant toxicities were observed. Four patients required no additional analgesia. No consistent correlations among fentanyl concentration and any clinical values were observed. Transdermal administration of fentanyl appears to be a viable alternative to conventional routes of narcotic administration and warrants further study.

Absorption

Intraspinal opiates for treatment of intractable pain in the terminally ill cancer patient.

The discovery of opiate receptors and then their endogenous ligands in 1974 (Snyder et al., 1974) has elucidated a vast pharmacology of opiates providing a basis for their diverse clinical applications. With the awareness of quality of life as a primary goal in terminal cancer patients, widespread attention has been drawn to the direct delivery of long-term intraspinal analgesics to cancer patients for who all medical pain control regimens have failed (Coombs & Saunders, 1974). Intraspinal administration of opiates and nonopiate analgesics is not only appealing on theoretical grounds but provides a minimally invasive method to insure otherwise unobtainable pain relief while eliminating obtundation and systemic side-effects associated with conventional therapy (Cobb et al., 1984; Harbaugh et al., 1982; Leavens et al., 1982; Malone et al., 1985; Onofrie et al., 1981; Poletti et al., 1981). Although intraspinal opiates have been used in the treatment of postoperative and benign-pain syndromes (Asari et al., 1981; Cousins & Mather, 1984), in our discussion we review the basic science, current techniques and possible future improvements in spinal analgesia in the control of chronic cancer pain.

Humans

Baclofen in the treatment of post-amputation autonomous stump movements.

Baclofen at 20-40 mg/day was used to successfully treat two post-amputation patients who developed continuous complex involuntary movements of the proximal extremity. These autonomous movements were otherwise recalcitrant to therapy and were felt to arise from neural generators intrinsic to the spinal cord. Baclofen is known to be useful for spasticity of spinal etiology and now appears to be indicated for treatment of involuntary autonomous movements in post-amputation patients.

Amputation, Surgical

Pain management after lower extremity amputation.

Phantom pain may occur in up to 85% of patients after limb amputation. Although the pathophysiology of postamputation phantom pain is not well understood, it seems to be produced by a complex multifactorial interaction between the peripheral, sympathetic, and central nervous systems. The theoretical aspects of this are reviewed. Management of phantom limb pain may be both medical and surgical. Among the pharmacological agents proved effective against phantom pain are beta-blockers, tricyclic antidepressants, and anticonvulsants. Surgical management includes peripheral nerve stimulation, thermocontrolled coagulation of the spinal cord, spinal cord stimulation, transcutaneous nerve stimulation, and stereotactic deep brain stimulation.

Adrenergic beta-Antagonists

Development of a tissue-equivalent phantom for diaphanography.

A phantom is proposed for quality control and calibration of instruments used for transillumination of the breast for early detection of cancer. A container is filled with a material having optical properties very similar to those of breast tissue, and internal objects are viewed by transmitted light. The phantom can be used to optimize operating conditions for the visualization of small or deep-seated lesions.

Breast Neoplasms