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Background: Periarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery. Methods: Sixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates. Results: In the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications. Conclusions: The present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days. Trial registration: Chinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023. [ABSTRACT FROM AUTHOR]

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Introduction: Various analgesics are used to control intense headaches in patients following subarachnoid hemorrhage. In addition to pain control, it has been shown that some analgesics can affect various pathophysiological cascades. Therefore, we devised a study to assess whether the use of metamizole has a significant impact on the development of ischemic complications, hydrocephalus, and the overall outcome in patients following aneurysmal subarachnoid hemorrhage in the context of the other non-opioids and opioids effects. Methods: In our retrospective, single-center cohort study, we enrolled 192 patients diagnosed with subarachnoid hemorrhage. We recorded their initial clinical status, comorbidities, and the daily dosage of analgesics over 14 days of hospitalization after the onset of subarachnoid hemorrhage. Using univariate and subsequent multivariate logistic regression analysis, we assessed the influence of various factors, including analgesics, on the development of delayed cerebral ischemia and hydrocephalus, as well as on 2-week and 6-month outcomes. Results: Although the administration of non-opioids, in general, had no effect on the development of delayed cerebral ischemia or hydrocephalus, the use of metamizole as the main analgesic was associated with a significantly lower chance of poor outcome at both 2-weeks and 6-months, as well as the development of delayed cerebral ischemia. As opioids were indicated primarily for analgosedation in mechanically ventilated patients with poor clinical status, their usage was associated with a significantly higher chance of poor outcome, delayed cerebral ischemia, and hydrocephalus. Conclusion: Our results suggest that the prescription of metamizole may be associated with better outcomes and a lower chance of delayed cerebral ischemia development in patients after subarachnoid hemorrhage. Considering the retrospective nature of our study and the limited worldwide availability of metamizole due to its prohibition in some countries, our results do not demonstrate a clear benefit but rather justify the need for subsequent prospective studies. [ABSTRACT FROM AUTHOR]

Abstract An experimental design and response surface methodologies using Plackett–Burman and Box-Behnken designs were applied for selecting and optimizing the most appropriate parameters which significantly affect the separation and quantitative estimation of five skeletal muscle relaxants and four analgesic drugs (baclofen, methocarbamol, dantrolene sodium, orphenadrine citrate, cyclobenzaprine hydrochloride, ketoprofen, etoricoxib, ibuprofen, and mefenamic acid) with a relatively short duration of analysis in a single run. For the separation of the nine drugs, an INERTSIL ODS-V3-5 µm C18 column (250 × 4.6 mm I.D.) was used with the optimum mobile phase conditions (45.15 mM ammonium acetate buffer pH 5.56 adjusted with acetic acid, acetonitrile, and methanol in a ratio of 30.5:29.5:40, v/v/v with a flow rate of 1.5 mL/min) and UV-detection at 220 nm. The optimized method was successfully subjected to the validation steps as described in ICH guidelines for linearity, precision, accuracy, robustness, and sensitivity. The optimized and validated method was effectively applied to determine the content of the studied drugs in their pharmaceutical preparations and to expand its applicability to the counterfeit estimation of etoricoxib in different brands of tablet dosage forms.

As one of the leading causes of death in childhood, cancer also causes discomfort to pediatric patients. Even with guidelines for pain management, more than half of hospitalized children have intense and unrelieved pain. The present work aims to describe the intensity of pain and its pharmacological management in a pediatric oncology population. Patients aged 0 to 17 years old, diagnosed with cancer, who were admitted to a children’s oncology hospital and had well-documented data on pain management in their medical records were included. A total of 333 patients were included, mostly male (55.8%) with a mean age of 7.9 years. A substantial portion of the patient cohort (51.4%) initially reported experiencing pain of moderate intensity during the first assessment. Subsequently, following the pharmacological intervention, a significant proportion of patients (90.1%) reported complete alleviation of pain. The predominant pharmaceutical agents utilized for pain management encompassed metamizole (76.6%) and morphine (10.2%). All pharmacological interventions used were able to significantly reduce patients’ pain. This study underscores the utilization of different pharmacological classes to achieve notable reductions in pain intensity among patients grappling with severe pain.

Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug–device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug–device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies. [ABSTRACT FROM AUTHOR]

As one of the leading causes of death in childhood, cancer also causes discomfort to pediatric patients. Even with guidelines for pain management, more than half of hospitalized children have intense and unrelieved pain. The present work aims to describe the intensity of pain and its pharmacological management in a pediatric oncology population. Patients aged 0 to 17 years old, diagnosed with cancer, who were admitted to a children's oncology hospital and had well-documented data on pain management in their medical records were included. A total of 333 patients were included, mostly male (55.8%) with a mean age of 7.9 years. A substantial portion of the patient cohort (51.4%) initially reported experiencing pain of moderate intensity during the first assessment. Subsequently, following the pharmacological intervention, a significant proportion of patients (90.1%) reported complete alleviation of pain. The predominant pharmaceutical agents utilized for pain management encompassed metamizole (76.6%) and morphine (10.2%). All pharmacological interventions used were able to significantly reduce patients' pain. This study underscores the utilization of different pharmacological classes to achieve notable reductions in pain intensity among patients grappling with severe pain. [ABSTRACT FROM AUTHOR]

Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports. [ABSTRACT FROM AUTHOR]

Copyright of Jurnal Locus: Penelitian dan Pengabdian is the property of Riviera Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation. [ABSTRACT FROM AUTHOR]

There has been a substantial increase in the use of extracorporeal membrane oxygenation (ECMO) support in critically ill adults. Understanding the complex changes that could affect drugs' pharmacokinetics (PK) and pharmacodynamics (PD) is of suitable need. Therefore, critically ill patients on ECMO represent a challenging clinical situation to manage pharmacotherapy. Thus, clinicians' ability to predict PK and PD alterations within this complex clinical context is fundamental to ensure further optimal and, sometimes, individualized therapeutic plans that balance clinical outcomes with the minimum drug adverse events. Although ECMO remains an irreplaceable extracorporeal technology, and despite the resurgence in its use for respiratory and cardiac failures, especially in the era of the COVID-19 pandemic, scarce data exist on both its effect on the most commonly used drugs and their relative management to achieve the best therapeutic outcomes. The goal of this review is to provide key information about some evidence-based PK alterations of the drugs used in an ECMO setting and their monitoring. [ABSTRACT FROM AUTHOR]

Copyright of Farmacie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The United States and many other developed nations are in the midst of an opioid crisis, with consequent pressure on prescribers to limit opioid prescribing and reduce prescription opioid misuse. This review addresses prescription opioid misuse for older adult surgical populations. We outline the epidemiology and risk factors for persistent opioid use and misuse in older adults undergoing surgery. We also address screening tools and prescription opioid misuse prevention among vulnerable older adult surgical patients (e.g., older adults with a history of an opioid use disorder), followed by clinical management and patient education recommendations. A significant plurality of older adults engaged in prescription opioid misuse obtain opioid medication for misuse from health providers. Thus, nurses can play a critical role in identifying those older adults at a higher risk for misuse and deliver quality care while balancing the need for adequate pain management against the risk for prescription opioidmisuse. [ABSTRACT FROM AUTHOR]

Copyright of Pediatrie pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite various advantages, opioid peptides have been limited in their therapeutic uses due to the main drawbacks in metabolic stability, blood-brain barrier permeability, and bioavailability. Therefore, extensive studies have focused on overcoming the problems and optimizing the therapeutic potential. Currently, numerous peptide-based drugs are being marketed thanks to new synthetic strategies for optimizing metabolism and alternative routes of administration. This tutorial review briefly introduces the history and role of natural opioid peptides and highlights the key findings on their structure-activity relationships for the opioid receptors. It discusses details on opioid peptidomimetics applied to develop therapeutic candidates for the treatment of pain from the pharmacological and structural points of view. The main focus is the current status of various mimetic tools and the successful applications summarized in tables and figures. [ABSTRACT FROM AUTHOR]

Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient’s life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports.

The TRPA1 channel is involved in a variety of physiological processes and its activation leads to pain perception and the development of inflammation. Peptide Ms 9a-1 from sea anemone Metridium senile is a positive modulator of TRPA1 and causes significant analgesic and anti-inflammatory effects by desensitization of TRPA1-expressing sensory neurons. For structural and functional analysis of Ms 9a-1, we produced four peptides—Ms 9a-1 without C-terminal domain (abbreviated as N-Ms), short C-terminal domain Ms 9a-1 alone (C-Ms), and two homologous peptides (Ms 9a-2 and Ms 9a-3). All tested peptides possessed a reduced potentiating effect on TRPA1 compared to Ms 9a-1 in vitro. None of the peptides reproduced analgesic and anti-inflammatory properties of Ms 9a-1 in vivo. Peptides N-Ms and C-Ms were able to reduce pain induced by AITC (selective TRPA1 agonist) but did not decrease AITC-induced paw edema development. Fragments of Ms 9a-1 did not effectively reverse CFA-induced thermal hyperalgesia and paw edema. Ms 9a-2 and Ms 9a-3 possessed significant effects and anti-inflammatory properties in some doses, but their unexpected efficacy and bell-shape dose–responses support the hypothesis of other targets involved in their effects in vivo. Therefore, activity comparison of Ms 9a-1 fragments and homologues peptides revealed structural determinants important for TRPA1 modulation, as well as analgesic and anti-inflammatory properties of Ms9a-1. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the characteristics of drug-related problems ( DRP ) in postoperative analgesia treatment of orthopaedic patients, so as to provide basis for pharmacists to intervene postoperative analgesia treatment and promote the rational use of analgesics. METHODS: Medical orders of postoperative patients in orthopaedics of the hospital from Apr. to Jun. 2021 were collected. Retrospective review of postoperative analgesic drugs was carried out by pre-prescription review system combined with manual review. DRP were summarized and analyzed by using the Pharmaceutical Care Network Europe (PCNE) classification system. RESULTS: A total of 272 patients with orthopaedic surgery were enrolled, of which 186 DRP were found in 124 patients (45. 59%). The main problem types of DRP were possible adverse drug events (90 cases, 48. 39%) and poor treatment effect (76 cases, 40. 86%). The main causes of DRP were interaction (35 cases, 18. 82%), long course of treatment ( 35 cases, 18. 82%), repeated drug use ( 28 cases, 15. 05%) and improper drug selection ( 27 cases, 14. 52%). CONCLUSIONS: There are still many DRP in postoperative analgesia treatment of orthopaedic patients. Pharmacists can effectively find problems and analyze causes by using PCNE classification system, which provides basis for standardized clinical rational drug use, and helps to improve postoperative pain and accelerate postoperative recovery. [ABSTRACT FROM AUTHOR]

Chronic pain, a common symptom of people with rheumatoid arthritis, usually behaves as persistent polyarthralgia pain and causes serious damage to patients' physical and mental health. Opioid analgesics can lead to a series of side effects like drug tolerance and addiction. Thus, seeking an alternative therapy and screening out the corresponding analgesic drugs is the key to solving the current dilemma. Traditional Chinese Medicine (TCM) therapy has been recognized internationally for its unique guiding theory and definite curative effect. In this study, we used the Apriori Algorithm to screen out potential analgesics from 311 cases that were treated with compounded medication prescription and collected from “Second Affiliated Hospital of Zhejiang Chinese Medical University” in Hangzhou, China. Data on 18 kinds of clinical symptoms and 16 kinds of Chinese herbs were extracted based on this data mining. We also found 17 association rules and screened out four potential analgesic drugs—“Jinyinhua,” “Wugong,” “Yiyiren,” and “Qingfengteng,” which were promised to help in the clinical treatment. Besides, combined with System Cluster Analysis, we provided several different herbal combinations for clinical references.

Abstract Background Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication. Methods A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves. Results The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839–0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain). Conclusions During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication.

Objectives: To determine the effect of using abdominal binder after cesarean delivery on postoperative wound pain, physical function and analgesic drugs use.Materials and Methods: A randomized controlled trial was conducted between January and April 2018 at KhonKaen Hospital. Fifty women who underwent elective cesarean delivery were randomly allocated to either the abdominal binder group or routine standard care. The primary outcome was postoperative wound pain as measured by a visual analog scale (VAS) scores at 6, 24, and 48 hours after using the binder. The secondary outcomes included physical function as measured by distance 6-minute walk test (6MWT), time to first ambulation, analgesic drugs use and adverse effects.Results: Postoperative wound pain was indicated by a significantly lower VAS score in the binder group with the repeated measures ANOVA (F= 30.78, p < 0.005). The respective postoperative VAS score at 6, 24, and 48 hours was also significantly lower in the binder group (mean ± SD at 6, 24, and 48 hr. = 4.77 ± 1.97, 3.73 ± 1.48, and 2.51 ± 1.63 vs. standard care 6.85 ± 2.26, 5.49 ± 2.34, and 4.66 ± 2.21; p < 0.05). Postoperative opioid drugs use in the binder group was significantly less than in the standard care (5.22 ± 1.20 mg vs. 7.63 ± 2.43 mg; p < 0.01). There were no significant differences in the 6MWT and time to first ambulation between the two groups. No serious adverse effects were reported.Conclusion: Using abdominal binder can reduced pain and analgesic drugs used in postoperative cesarean delivery.

Despite various advantages, opioid peptides have been limited in their therapeutic uses due to the main drawbacks in metabolic stability, blood-brain barrier permeability, and bioavailability. Therefore, extensive studies have focused on overcoming the problems and optimizing the therapeutic potential. Currently, numerous peptide-based drugs are being marketed thanks to new synthetic strategies for optimizing metabolism and alternative routes of administration. This tutorial review briefly introduces the history and role of natural opioid peptides and highlights the key findings on their structure-activity relationships for the opioid receptors. It discusses details on opioid peptidomimetics applied to develop therapeutic candidates for the treatment of pain from the pharmacological and structural points of view. The main focus is the current status of various mimetic tools and the successful applications summarized in tables and figures.

We aimed to characterize the in‐hospital analgesic use among total hip or knee arthroplasty (THA or TKA) patients, and to identify possible drug‐related challenges. We identified 15 263 patients operated with a THA or TKA between 1 January 2012 and 30 April 2016. The prevalence of analgesic users and patients with potential clinically relevant drug‐drug interactions (DDIs), along with the prevalence of readmission among patients with vs. without a DDI, were calculated. A DDI was defined as the combination of (A) a diuretic, an angiotensin‐converting enzyme inhibitor or an angiotensin II receptor blocker, and an non‐steroidal anti‐inflammatory Drug (NSAID); (B) warfarin and an NSAID; and (C) a benzodiazepine or a benzodiazepine‐related drug and an opioid. The prevalence of analgesics administered in THA and TKA patients was 99.3% and 99.1% for paracetamol and 93.8% and 98.8% for opioids, respectively. The prevalence of patients who received interaction A, B or C was 8.4%, 2.5% and 40.7%, respectively. Patients with vs. without a DDI had a higher prevalence of 30‐day readmission. In conclusion, most THA and TKA patients were administered paracetamol or opioids. The prevalence of 30‐day readmission was higher in patients with than in patients without a potential clinically relevant DDI. [ABSTRACT FROM AUTHOR]

Background: Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication. Methods: A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves. Results: The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839–0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain). Conclusions: During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication. [ABSTRACT FROM AUTHOR]

This study reports the chemo‐ and regioselective synthesis, at good yields, of (E)‐4‐(amino)‐1,1,1‐trifluoro‐5‐(4,5‐alkyl‐3‐(trifluoromethyl)‐1H‐pyrazol‐1‐yl)pent‐3‐en‐2‐ones (pyrazole‐enaminones), from the of N‐alkylation reaction of trifluoromethyl pyrazoles with 5‐bromo enaminones. The obtained compounds were tested as potential analgesics in a screening test involving mice. Three of these compounds significantly reduced the spontaneous nociception induced by the application of capsaicin, which is an algogenic substance. Compound 5 g presented satisfactory antinociceptive activity compared to celecoxib, a drug used as a positive control, without promoting locomotor changes in the mice. Moreover, molecular modeling simulations showed that compound 5 g interacts with the cyclooxygenase enzyme at the same binding site as celecoxib. Together, our data suggest that compound 5 g is a promising prototype for the development of new analgesic drugs. [ABSTRACT FROM AUTHOR]

Since both anesthesia and sleep depress consciousness, bidirectional relationship between them has been further studied. Earlier findings have shown that they share electroencephalographic features and brain regions that are activated in both state of unconsciousness. Despite these similarities, medication-induced sedation provokes different outcome from natural sleep. Enlisting commonly used analgesic drugs, such as benzodiazepines, intravenous agents, benzodiazepine antagonists, opioids, and other adjuvants, the study is comprised of assorted case studies that are clinically applicable or comparable. Acknowledging potential of analgesic drugs on sleep disorders including sleep deprivation, narcolepsy, circadian rhythm disorder, periodic limb movement disorder, and obstructive sleep apnea, the study underscores the clinical importance of studying both fields, sleep and anesthesia. In conclusion, the aim of this review is explaining the consequences of analgesic agents or sedatives on sleep and sleep disorders.

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Today, the widespread use of opioid and analgesic drugs (OAs) has caused global concern due to their addictive properties and side effects. Therefore, in this study, polyvinyl alcohol (PVA)/poly acrylic acid (PAA)/MOF NiCoZn-LDH@graphene oxide (GO) electrospun nanofiber was synthesized and employed as an effective and novel sorbent at thin-film microextraction (TF-μSPE) method for the fast and simultaneous extraction of seven opioid and analgesic drugs in human biological fluids (plasma, urine) before performing quantitative analysis by high-pressure liquid chromatography (HPLC-UV) device. This new nano-absorbent was characterized by energy dispersive X-ray spectrometer (EDX), X-ray photoelectron spectroscope (XPS), Fourier transforms infrared spectrometer (FT-IR), field emission scanning electron microscopy (FE-SEM), X-ray diffraction analysis (XRD), and nitrogen absorption-desorption analysis (BET). The combination of MOF NiCoZn-LDH@GO with a highly porous structure and rich functional groups in the PVA/PAA substrate casing significantly improves the absorption properties of the nanofibers. In other words, the existence, of MOF NiCoZn-LDH@GO composite in the polymer network PVA/PAA causes an increase in the extraction efficiency of the electrospinning adsorbent due to the creation of hydrogen bonds and π-π interactions with the intended analytes. Various effective factors in the extraction efficiency of the desired analytes were optimized using a one-variable-at-a-time method. Under the optimum conditions, the linearity dynamic range was achieved in the range of 0.3–1000.0 for caffeine, naloxone, noscapine, and celecoxib, and 0.5–1000.0 μg L−1 for tramadol, codeine, and hydrocodone with correlation coefficients ≥0.999. The lowest detection limit (LODs) and the lowest quantitative limit (LOQs) of the TF-μSPE method were obtained in the range of (0.1–0.15) and (0.3–0.5), respectively. Incorporation of the synthesized MOF NiCoZn-LDH@GO/carbon clothe into the polymer network of PVA/PAA and the production of a novel, porous, and rich in functional groups adsorbent by the electrospun system for the extraction of seven analgesic drugs in biological fluids before identification by the HPLC-UV system. [Display omitted] • MOF NiCoZn-LDH@GO with a flower-like array on carbon cloth was synthesized. • MOF NiCoZn-LDH@GO has functional groups and high absorption capacity and porosity. • TF-μSPE-HPLC-UV method was used for identification and extraction of analgesic drugs. • Detection of trace amounts of analgesic drugs in biological fluid. [ABSTRACT FROM AUTHOR]

Abstract Pain is an important and complex protective phenomenon. Good postoperative pain relief is important as it alleviates patient suffering and aids a rapid, uncomplicated recovery. Narcotic analgesic drugs are a support in pediatric operation in this circumstance when a patient has "nothing per oral" status. A novel reliable electrochemical sensor is fabricated for direct and sensitive determination of nalbuphine (NB) and tramadol (TR) analgesic drugs based on cobalt oxide/ionic liquid crystal/carbon nanotubes modified carbon paste electrode in presence of sodium dodecyl sulfate (CNTILCCoCP-SDS). The effect of type of metal oxide on the catalytic activity of the sensor towards NB determination was evaluated. Nano‑cobalt oxide showed highest electro-catalytic activity, excellent conductivity, antifouling ability and charge transfer enhancement compared to other studied metal oxides. Under the optimized conditions, simultaneous determination of NB and TR in human urine using the proposed sensor was successfully achieved with sub-nano detection limits of 0.58 nM and 0.62 nM respectively. The practical analytical performance of the sensor was attained for determination of NB and TR in their pharmaceutical samples with satisfied recovery results. This sensor has great ability to be extended for electrochemical applications in assaying of many drugs. Graphical abstract Unlabelled Image Highlights • Good postoperative pain relief is important as it alleviates patient suffering and aids rapid, uncomplicated recovery • Narcotic analgesic drugs are a support in pediatric operation in this circumstance when a patient has nothing per oral status • Novel electrochemical sensor is fabricated for direct and sensitive determination of NB and TR analgesic drugs in human urine • The sensor was fabricated upon modification of CP electrode with Co 3 O 4 -nanoparticles, ILC and CNTs in presence of SDS • Analytical performance of sensor was achieved for detection of NB and TR in pharmaceutical samples with good recovery results [ABSTRACT FROM AUTHOR]

Summary: Background: Rapid maxillary expansion (RME) is an orthopaedic procedure indicated for a wide variety of clinical conditions. Aim: The aim of the study was to compare the effects of ketoprofen lysine salt (KLS) vs paracetamol/acetaminophen (P) on pain perception during RME. Design: One hundred and fifty‐one subjects (mean age 8.6 year) were enrolled in this prospective controlled clinical trial according to inclusion criteria: prepuberal stage of development, negative posterior transverse interarch discrepancy, non‐concurrent use of other drugs. First phase: n.40 allocated to Group 1 used 40 mg of KLS, n.40 to Group 2 used 250 mg of P, n.36 to Group 3 as control group. Second phase: n.35 allocated to Group 4 used 40 mg ketoprofen lysine salt once a day for the first 3 days of activation. Pain experience was reported on a numeric rating scale (0‐4) and a 100‐mm visual analogue scale. Pain perception was tested with the Mann‐Whitney test (P < 0.05). Results: Pain perception was higher during the first 3 days of activation and it was described as mild to moderate. Group 1 experienced significantly less pain during the fourth, fifth, and sixth day (P < 0.05) compared with Group 2. Patients of the Group 4 reported significantly lower pain during the whole period of RME activation (P < 0.05). Conclusions: The perceived higher pain was reported during the second and third day of expansion. The analgesic effect of KLS is more effective than P during the fourth, fifth, and sixth day. The use of KLS during the first 3 days of activation seems to be able reducing pain during the whole active phase. [ABSTRACT FROM AUTHOR]

The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments.

Purpose: Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.Methods: Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.Results: The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.Conclusions: There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case. [ABSTRACT FROM AUTHOR]

An important goal of modern medicinal chemistry is to study the mechanisms of pain and analgesia in order to design effective analgesic drugs. Opioid analgesics are the gold standard for the treatment of severe pain; however, the use of opiates is associated with the development of side effects which are, in particular, related to the activation of the anti-opioid system. Mammalians synthesize a number of endogenous peptides, such as orphanin FGGFTGARKSARKLANQ, neuropeptide FF (FLFQPQRF-NH2), tripeptide melanostatin (MIF) PLG-NH2, as well as related compounds. These anti-opioid peptides are to one extent or another involved in homeostatic control of transmission of pain impulses. The present review includes the data published to date in domestic and foreign literature on the involvement of these peptides in such undesirable phenomena as inhibition of opioid analgesia, development of opioid tolerance and dependence, and hyperalgesia. Cell-cell and molecular ligand-receptor and receptor-receptor interactions of the opioid and anti-opioid systems are considered. These data can be useful for the design of new pharmaceuticals for pain relief. The generalization and study of these mechanisms are reflected in various approaches to treatment of pain syndromes and require analysis and further investigation. [ABSTRACT FROM AUTHOR]

Prolonged delivery of analgesic drugs at target sites remains a critical issue for efficient pain management. The use of nano-carriers has been reported to facilitate applicable delivery of these agents to target sites with a reduced level of systemic toxicity. Different analgesics have been loaded onto various nano carriers, including those that are natural, synthetic and copolymer, for various medical applications. In this review, we will discuss the concept of nano-formulated carriers for analgesic drugs and their impacts on the field of pain management. [ABSTRACT FROM AUTHOR]

Objectives: Errors in drug dosing lead to poor patient outcomes and are common in patients with chronic kidney disease (CKD). Because the majority of patients with CKD are being treated by physicians specializing in internal medicine, we studied the awareness and knowledge that internal medicine resident trainees (IMRTs) have regarding the correct dosage of commonly used analgesic and neuropsychotropic medications for patients with CKD.Methods: We surveyed 353 IMRTs about their awareness of whether a medication needs dose adjustment in patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate.Results: There were high percentages for lack of awareness and knowledge. For analgesics, this lack of awareness/knowledge was highest for acetaminophen (awareness 83.0%, knowledge 90.9%). For neuropsychotropics, this was highest for paroxetine (awareness 74.5%, knowledge 91.5%). Analyses for postgraduate year (PGY) -1 trainees and PGY-2 trainees for analgesics showed higher odds for lack of awareness for tramadol (PGY-1 odds ratio [OR] 2.37, 95% confidence interval [CI] 1.2-4.62, P < 0.05; PGY-2 OR 2.34, 95% CI 1.16-4.72, P < 0.05) and for lack of knowledge for meperedine (PGY-1 OR 4.01, 95% CI 1.81-8.89, P < 0.05; PGY-2 OR 3.30, 95% CI 1.44-7.59, P < 0.05). Nephrology residency rotation for the neuropsychotropic medication of gabapentin showed lower odds for both lack of awareness (OR 0.56, 95% CI 0.32-0.97, P < 0.05) and knowledge (OR 0.52, 95% CI 0.27-0.997, P < 0.05).Conclusions: Awareness and knowledge are poor among IMRTs for dose adjustments of analgesics and neuropsychotropic medication classes in patients with CKD. There should be a renewed focus during IMRTs' residency on additional nephrology exposure and formal didactic educational training to help them better manage complex treatment regimens to prevent medication dosing errors. [ABSTRACT FROM AUTHOR]

The article clarifies that pain in obesity is not obesity and pain. The authors reviewed the literature and surveyed the clinical data about pain in people with abnormal body weight. The conclusion was made that pain in obese patients needs adequate management. Data for pharmacokinetic and pharmacodynamics characteristics of frequently used analgesic drugs are summarized. The authors include useful schemas of pharmacotherapy with non-opioid as well as opioid analgesics and practical guidelines for pain management in clinical ward or outpatient departments.

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Problem setting. Conducted a comparison of the systems of pharmaceutical provision with pharmaceutical care – providing medical products inUkraine and abroad through the introduction of health insurance and reimbursement of medicines from the state budget. Recent research and publications analysis. Quantitative analysis of the incidence of malignant neoplasms and mortality, the number of pharmacies inUkraine and Kharkiv region; the level of public spending on the program to combat cancer. Noted that the market of voluntary medical insurance inUkraine is underdeveloped (covering only 3% of the population) for a complete provision of population with necessary medicines and medical services. The basic conditions for the successful treatment of cancer. Analyzed legislative framework regulating the circulation of medicines for cancer patients inUkraine. Paper objective. The review violation circulation of medicines, pharmacy made by specialists in providing cancer. Determined that prescription drugs helps minimize forensic pharmaceutical risks (side effects, abuse, etc.). Processed work of scientists ofUkraine and other countries to ensure the cancer drugs of different pharmacological clinical, legal nomenclature and classification of legal groups. Conclusions of the research. Proposed standard-setting initiatives to improve the legal system "doctor-patient-pharmacist" and narcotic drugs for pharmaceutical providing for patients with cancer at discounted prescription from pharmacies in Ukraine and Kharkov region: expanding the definition of "pharmacy"; promoting the opening of pharmacies in rural areas and increase the number of pharmacies that carry out activities related to narcotic drugs