PubMed · 4793283
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S G Matts. 1973. Analgesics.. https://pubmed.ncbi.nlm.nih.gov/4793283/
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Intramuscular injections are still part of routine care in the treatment of children. Vaccines, premedications and analgesics are administered by this route. The pain associated with an intramuscular injection is severe, the risk of complications is increased, and pharmacodynamics and pharmacokinetics are unpredictable. In many cases, equivalent alternatives of rectal, oral or intranasal routes of administering pharmacologic agents exist. Intramuscular injection of analgesics and premedications to children are-except in case of emergencies-obsolete. This demand corresponds to the guidelines of the World Health Organization (WHO) and the International Association for the Study of Pain (IASP).
We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. Apart from the opiate effect of the morphine the decisive factor was the NMDA-antagonism of the s-ketamine. The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.
Pain during labor is common and severe, as is menstrual pain, and this pain originates from the uterine cervix and is transmitted via the hypogastric nerve to the spinal cord. Prostaglandins play an important role in nociceptive transmission in the spinal cord. Pharmacologically, targeting a specific cyclooxygenase (COX) enzyme isoform has as its goal to effectively treat pain while avoiding side effects. Both COX-1 and COX-2 inhibitors have been shown to effectively treat a variety of pain conditions in animals and in humans; however, their efficacy in treatment of acute visceral pain has not been explored. The purpose of this study is to evaluate the pharmacologic effects of specific spinal COX inhibitors on uterine cervical distention induced nociception. The results indicate that intrathecal (i.t.) administration of the COX-2 inhibitor, SC58238, and the nonspecific COX inhibitor, indomethacin, effectively inhibited the electromyographic activity induced by UCD. None of the inhibitors altered hemodynamic response to uterine cervical distension. The study suggests that targeting spinal COX-2 could be useful to treat transient and acute visceral pain from the uterine cervix.