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P Sjøgren

Publications and source records attributed to P Sjøgren.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Treatment of cancer pain in Denmark. A questionnaire survey].

A questionnaire survey was carried out with the aim of evaluating knowledge about and practice of cancer pain treatment in Denmark. A questionnaire was sent to a 10% random sample of Danish physicians. Of these 1411 physicians, 1068 (76%) returned the questionnaires and after the exclusion of those doctors who never treated cancer patients, 577 (54%) were analyzed. Their knowledge of the principles and practice of cancer pain treatment was evaluated by means of 14 multiple-choice and open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of three simulated patient cases. Ninety-seven percent of the physicians recognized difficulties in cancer pain treatment, the most frequent being side effects of drugs and inadequate pain relief. It appeared from the proposals for pain treatment of the patient cases that the majority of the physicians could treat both pain from bone metastasis (75%) and visceral pain (78%) satisfactorily, while very few suggested coanalgesics for neuropathic pain (20%). Older physicians performed less satisfactorily than did their younger colleagues. Basic pain treatment skills have been acquired by the Danish physicians. However, in the future emphasis should be placed on the treatment of neuropathic pain with coanalgesics and the management of opioid side-effects.

Analgesia↗
PubMed1997

Psychomotor and cognitive functioning in cancer patients.

Psychomotor and cognitive dysfunction in cancer patients can be classified into two main categories according to etiology: disease-induced factors (metabolic disturbances, brain metastasis, pain, etc.) and treatment-related factors (drugs, antineoplastic therapy, etc.). In particular, the effects of chronic opioid administration in cancer patients have been subjected to investigations, and most studies have been engaged in assessment and treatment of the cerebral dysfunction. Early studies found that cancer patients in chronic oral opioid therapy had prolonged continuous reaction times, and that the opioids seemed to be mainly responsible for the prolongation. Significant dose escalations of opioids (> or = 30%) caused transiently impaired psychomotor and cognitive functions in cancer patients. Cancer patients in chronic oral opioid therapy did not achieve any advantages changing to epidural opioid therapy with regard to faster continuous reaction times and less pain. Large doses of opioids are often required to control severe pain in cancer patients. As increased sedation and impaired psychomotor and cognitive functions often occur, a number of studies have investigated the use of amphetamine derivatives to counteract the sedative side-effects of opioid. These drugs seem promising during high-dose opioid therapy and their use may be particularly rewarding in poor opioid-responsive pain conditions such as incident and neuropathic pain.

Analgesics, Opioid↗
PubMed1996

Identification of steroid receptors in human adipose tissue.

Steroids have the ability to alter adipose tissue distribution. Controversy exists as to whether these effects of sex hormones (oestrogen, progesterone and testosterone) on human adipose tissue are indirect or direct, as only very few studies have focused on steroid receptor status in human adipose tissue. In the present study, we reinvestigated steroid receptor status in human mature adipose tissue and human preadipocytes. Oestrogen, glucocorticoid and androgen receptors were found in human mature adipocytes from both women and men. The receptors were detected by ligand binding. Furthermore, the existence of the receptors was confirmed by demonstrating that adipocytes contained mRNA encoding the receptors. cDNA was generated using reverse transcriptase (RT) followed by polymerase chain reaction (PCR) amplification using specific primers (RT-PCR) for the specific steroid receptors. Adipocytes did not contain mRNA encoding the progesterone receptor (PR), and no progesterone binding was detectable in human adipocytes. Human preadipocytes contained glucocorticoid receptor (GR) mRNA and androgen receptor (AR) mRNA, whereas we were unable to detect oestrogen receptor (ER) mRNA and progesterone mRNA in human preadipocytes. In conclusion, oestrogen glucocorticoid and androgen receptors are present in mature adipocytes from subjects of both sexes, whereas adipocytes do not contain progesterone receptors. In preadipocytes, only glucocorticoid receptors and androgen receptors are present, whereas oestrogen receptors and progesterone receptors are not present.

Adipose Tissue↗
PubMed1996

Stereoselective pharmacokinetics of methadone in chronic pain patients.

Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported. The analgesically active R-methadone has a significantly longer mean elimination half-life than the optical antipode S-methadone (t1/2 = 37.5 and 28.6 h, respectively). The mean total volume of distribution is 496.6 L for R-methadone and 289.1 L for S-methadone. Significant differences in the mean clearance between R- and S-methadone are seen (0.158 and 0.129 L/min, respectively). However, the lagtime after oral administration and the bioavailability did not show differences between the isomers. The data suggest that both enantiomers of methadone should be measured if correlations between pharmacodynamics and kinetics are made due to the stereoselective differences in half-life, total volume of distribution, and clearance.

Aged↗
PubMed1995

[Continuous subcutaneous infusion of opioids in cancer patients].

This review article describes pharmacokinetics, pharmaco-dynamics, side effects and the practical use of continuous subcutaneous infusion of opioids in cancer patients with pain. Clinical studies have shown that the analgesic effects of continuous subcutaneous infusion of morphine are comparable to continuous intravenous morphine, and that the treatment modality is associated with a low frequency of side-effects and complications. Continuous subcutaneous infusions of morphine are therefore recommended as the treatment of choice for cancer patients with pain, when oral analgesic treatment is no longer possible.

Humans↗
PubMed1995

[Morphine-induced hyperalgesia, allodynia and myoclonus--new side-effects of morphine?].

During the last ten years hyperalgesia (H), allodynia (A) and myoclonia (M) has been reported at an increased frequency in human beings treated with morphine. The side effects are most common in cancer patients treated with high dose morphine, and has been reported for all routes of administration. The mechanisms are unknown, but human cases and experimental works have resulted in the following theories: 1) Morphine and morphine metabolites change the postsynaptic pain-transmission in dorsal horn neurones via non opioid-receptors (glycine and/or N-methyl-D-aspartate). 2) Morphine and morphine metabolites activate other opioid receptor populations. 3) Supplemental drugs in cancer management. 4) An abnormal metabolism of morphine or morphine metabolites. 5) A combination of one or more of the above-mentioned theories. The first mentioned theory is the most likely. The treatment of morphine induced H, A, and M seems to be to discontinue morphine administration and to initiate therapy with other opioids (fentanyl, sufentanyl, methadone or ketobemidone).

Humans↗
PubMed1995

Irradiation of bone metastases in breast cancer patients: a randomized study with 1 year follow-up.

The results from a prospective randomized trial comparing two different radiation schedules for treatment of painful bone metastases in women with recurrent breast cancer are presented. A total of 217 patients with painful bone metastases were randomized to either 30 Grey (Gy) in ten fractions, five fractions a week (5F/W) or 15 Gy in three fractions 2F/W. The effect of treatment was evaluated by pain assessment, the radiological response and the degree of side-effects. The patients were rated at start of treatment and after 1, 3, 6 and 12 months. No difference between the two radiation regimes was found, neither in achieved pain relief, improvement in level of activity and medication, nor was there any difference in radiological response and side-effects from treatment. Both regimes resulted in a significant improvement in both pain score and level of activity 1 month after treatment, an improvement which persisted during the follow-up period. We conclude that 15 Gy given in three fractions 2F/W is as effective as 30 Gy in ten fractions 5F/W, but more convenient to the patient and of less cost to society.

Adult↗
PubMed1994

Continuous reaction time after single dose, long-term oral and epidural opioid administration.

Auditory continuous reaction time was studied in three treatment groups. Twenty opioid naive patients received intramuscular morphine 0.15 mg kg-1 bodyweight for premedication. Thirty-one cancer patients were treated with oral opioids, 180 mg morphine per 24 h (median). Twenty-two cancer patients were treated with epidural morphine, 79 mg morphine per 24 h (median). The treatment groups were compared to a control group of 44 healthy persons taking no analgesics. The reaction time was measured using 152 auditory signals and summarized as 10%, 50% and 90% percentiles. Analysing reaction time distributions, the opioid naive patients showed the greatest difference to the control group in the shortest reaction times while chronic opioid users showed the greatest difference for the longest reaction times. There seems to be a qualitative difference in reaction time distribution, between opioid naive individuals treated with single dose morphine and cancer patients in long-term treatment.

Acoustic Stimulation↗
PubMed1993

[Cerebral dysfunction after prolonged use of opioids].

Cerebral dysfunction due to long-term treatment with opioids is a problem of increasing relevance because of the rapidly growing use of opioids. A review of psychomotor and cognitive test methods is given, including their application in patients on long-term opioid treatment. The findings of the most valid studies on cancer patients in long-term treatment with opioids are an increase in continuous reaction time and subjective sedation score regardless of the routes of administration. Studies of drug addicts in long-term treatment with opioids seem to reflect a lowering of the general level of activity. According to recent studies, patients with chronic non-malignant pain conditions are responsible for the major part of the total opioid consumption. So far, no studies of cerebral dysfunction have been performed on this group of patients. Further research should concentrate on the use of few valid psychomotor and cognitive tests and should include patients with chronic non-malignant pain conditions.

Analgesics, Opioid↗
PubMed1993

[Buprenorphine for postoperative analgesia after total hip alloplasty].

Three different post-operative pain relief schedules were investigated in a double blind study after total hip replacement. Group BS received a priming dose of buprenorphine i.m. at the time of wound closure and continued with sublingual buprenorphine every eight hours. Supplementary doses of buprenorphine i.m. could be demanded. Group B and M received a priming dose of buprenorphine and morphine respectively, and continued with sublingual placebo eight hourly. Supplementary doses of buprenorphine could be demanded by patients in Group B and supplementary doses of morphine by patients in Group M. On one occasion VAS scorings of groups BS and B were statistically significantly lower than group M, and on another occasion VAS scorings of group BS were statistically significantly lower than the other two groups. Furthermore, the number of on demand supplementary doses was statistically significantly higher in group M. It is concluded that buprenorphine administered at regular intervals as well as on demand provided better postoperative analgesia than morphine at present dose levels. In this context, only moderate advantages were obtained by administering buprenorphine at regular intervals.

Adult↗
PubMed1993

The protective effect of inhaled levomepromazine (Nozinan) on histamine-induced bronchial constriction.

The effect of inhaled levomepromazine (Nozinan, Veractil) on bronchial responsiveness to inhaled histamine was investigated in asthmatics. In a double blind, randomized controlled study, 12 asthmatics (FEV1% pred 52-96%, and PC20 histamine 1.01 mg/ml (geometric mean)) were challenged before and after inhalation of levomepromazine in three different doses. Before and after each inhalation of levomepromazine, PC20, FEV1, the continuous reaction time (CRT) and the subjective sedation score (VAS) were determined. A dose-dependent increase in PC20 was observed after inhalation of levomepromazine. PC20 was increased by up to 4.02 two-fold concentration differences (doubling), i.e. up to a 38-fold increase from the basic values. Inhalation of the two higher doses of levomepromazine had a small sedative effect evaluated from an increase in CRT and the VAS-score and corresponding to the plasma concentrations. We conclude that inhaled levomepromazine has a dose-dependent protective effect on histamine-induced bronchial hyperresponsiveness in asthmatics and that inhalation of levomepromazine was well tolerated. The mechanism by which levomepromazine acts on histamine-induced bronchial hyperresponsiveness is not known but it could be partly explained by the antihistaminic effect. In this respect levomepromazine bears comparison with the most potent second generation antihistamines. The plasma concentrations of levomepromazine measured corresponded to those seen after oral intake of 5-10 mg levomepromazine.

Administration, Inhalation↗
PubMed1993

Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure.

Myoclonic spasms occurred in a patient suffering from renal failure after high doses of continuous intravenous morphine (100 mg/h). The concentrations of morphine, morphine-6-glucuronide and morphine-3-glucuronide (mumol/l) in plasma were: 1.93, 52.06 and 381.8, and in cerebrospinal fluid were: 1.02, 5.86 and 61.82, respectively. The role of morphine and morphine glucuronides in myoclonic spasms is discussed.

Acute Kidney Injury↗
PubMed1992

[Causes of pain and treatment effect in patients with cancer referred to a multidisciplinary pain clinic].

The causes of pain were analysed in 200 patients referred to a multidisciplinary pain clinic for cancer patients. In 158 patients, pain caused directly by tumour growth was found, 116 patients had pain secondary to the cancer disease or treatment while 33 patients had pain caused by factors unrelated to the cancer disease. The patients had many different combinations of causes of pain and the majority had more than one cause of pain. At the first contact and after treatment for 1-2 weeks, the patients were asked whether they had pain on movement, at rest or pain which interrupted sleep. After treatment for 1-2 weeks and after treatment for more than two weeks, the patients assessed the relief of pain obtained (none, slight, moderate, considerable, complete). The majority of patients achieved relief of pain at rest and during sleep while movement was still accompanied by pain in a number of patients. The majority of patients considered that the relief of pain obtained was moderate or considerable. Treatment consisted of adjustment of medication, blockades and epidural opioids supplemented by psychological intervention and help from social workers in selected patients.

Analgesia↗
PubMed1992

Reaction time in cancer patients receiving peripherally acting analgesics alone or in combination with opioids.

Continuous Reaction Time (CRT) was measured in cancer patients receiving peripherally acting analgesics either alone (n = 16) or in combination with opioids (n = 16). Comparison was performed matching the patients from each group for age and performance status. Statistically significant prolongations of CRT and higher sedation scores were seen in the opioid group, while performance status did not have any influence on CRT.

Acetaminophen↗