DOCSLIB.ORG

Treatment for Acute Pain: an Evidence Map Technical Brief Number 33

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment for Acute Pain: an Evidence Map Technical Brief Number 33 Technical Brief Number 33 R Treatment for Acute Pain: An Evidence Map Technical Brief Number 33 Treatment for Acute Pain: An Evidence Map Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0000-81 Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Victoria A. Nelson, M.Sc. Shellina Scheiner, PharmD, B.C.G.P. Mary L. Forte, Ph.D., D.C. Mary Butler, Ph.D., M.B.A. Sanket Nagarkar, D.D.S., M.P.H. Jayati Saha, Ph.D. Timothy J. Wilt, M.D., M.P.H. AHRQ Publication No. 19(20)-EHC022-EF October 2019 Key Messages Purpose of review The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acute pain. We map the evidence for several acute pain conditions including postoperative pain, dental pain, neck pain, back pain, renal colic, acute migraine, and sickle cell crisis. Improved understanding of the interventions studied for each of these acute pain conditions will provide insight on which topics are ready for comprehensive comparative effectiveness review. Key messages • Few systematic reviews provide a comprehensive rigorous assessment of all potential interventions, including nondrug interventions, to treat pain attributable to each acute pain condition. Acute pain conditions that may need a comprehensive systematic review or overview of systematic reviews include postoperative postdischarge pain, acute back pain, acute neck pain, renal colic, and acute migraine. • Certain acute pain conditions have many published systematic reviews: postoperative pain, pain associated with dental procedures and oral surgery, low back pain, acute migraine. Several acute pain conditions have sufficient new data to warrant a new systematic review: pain associated with dental procedures and oral surgery, low back pain, renal colic, acute migraine. • Few systematic reviews of acute pain treatments examine outcomes other than very short- term outcomes. Pain during the week or month following the inciting event and persistent opioid use were rarely reported. • Most systematic reviews report pain outcomes using scales that measure only pain intensity, while few assess function or other pain characteristics. • Few reviews focused on specific settings or populations other than general adults or children and adolescents. • Future research using ACTTION-APS-AAPM Pain Taxonomy dimensions to characterize acute pain would be valuable. • Additional original research and up-do-date comprehensive systematic reviews would help inform treatment decisions for a wide variety of acute pain conditions. ii This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00008-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help health care decision-makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program website at www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. Suggested citation: Brasure M, Nelson VA, Scheiner S, Forte ML, Butler M, Nagarkar S, Saha J, Wilt TJ. Treatment for Acute Pain: An Evidence Map. (Prepared by the Minnesota Evidence- based Practice Center under Contract No. 290-2015-0000-81) AHRQ Publication No.19(20)- EHC022-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2019. Posted final reports are located on the Effective Healthcare Program search page. DOI: https://doi.org/10.23970/AHRQEPCTB33. iii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. This EPC evidence report is a Technical Brief. A Technical Brief is a rapid report, typically on an emerging medical technology, strategy or intervention. It provides an overview of key issues related to the intervention—for example, current indications, relevant patient populations and subgroups of interest, outcomes measured, and contextual factors that may affect decisions regarding the intervention. Although Technical Briefs generally focus on interventions for which there are limited published data and too few completed protocol-driven studies to support definitive conclusions, the decision to request a Technical Brief is not solely based on the availability of clinical studies. The goals of the Technical Brief are to provide an early objective description of the state of the science, a potential framework for assessing the applications and implications of the intervention, a summary of ongoing research, and information on future research needs. In particular, through the Technical Brief, AHRQ hopes to gain insight on the appropriate conceptual framework and critical issues that will inform future research. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. If you have comments on this Technical Brief, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to [email protected]. Gopal Khanna, M.B.A. Arlene Bierman, M.D., M.S. Director Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Suchitra Iyer, Ph.D. Director Task Order Officer Evidence-based Practice Center Program Center for Evidence and Practice Center for Evidence and Practice Improvement Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iv Acknowledgments We thank Cheryl Cole-Hill, Shivani Rao, and Jeannine Ouellette for their research, administrative, and editorial help bringing the report to completion. Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report follows: Roger Chou, M.D. Christina
Load more

Recommended publications
  • The Femoral Nerve Block Characteristics Using Ropivacaine 0.2% Alone, with Epinephrine, Or with Lidocaine and Epinephrine
    SCIENTIFIC ARTICLES THE FEMORAL NERVE BLOCK CHARACTERISTICS USING ROPIVACAINE 0.2% ALONE, WITH EPINEPHRINE, OR WITH LIDOCAINE AND EPINEPHRINE A.M. TAHA1,2 AND A.M. ABD-ELmaKSOUD31* Keywords: anesthetic techniques, regional, femoral; anaesthetics local, ropivacaine; equipment, ultrasound machines. Abstract Background: The objective of this study was to evaluate the femoral nerve block characteristics (onset, success rate and duration) using ropivacaine 0.2% alone; with epinephrine, or with lidocaine and epinephrine compared with that using ropivacaine 0.5%. Methods: Ninety six patients were included in this prospective controlled double blind study and were randomly allocated into four equal groups (n=24). All the patients received ultrasound guided femoral nerve block using 15 ml of either ropivacaine 0.5% (group 1), ropivacaine 0.2% (group 2), ropivacaine 0.2% with epinephrine (group 3) and ropivacaine 0.2% with lidocaine and epinephrine (group 4). The block onset, success rate and duration were recorded. Results: The motor onset was significantly delayed in group 2 (compared with the other three groups) and in group 3 (compared with group 4). However, the block success rate and duration were comparable in the four groups. Conclusion: In femoral nerve block, ropivacaine 0.2% may have a comparable success rate and duration to ropivacaine 0.5% but with a remarkably delayed motor onset that may be improved by adding epinephrine. Addition of lidocaine may further accelerate the motor onset. Introduction The femoral nerve block (FNB) is a commonly indicated block, and ropivacaine is a widely used long acting local anesthetic (LA)1,2. Peripheral nerve blocks can provide excellent anesthesia and postoperative analgesia 3,4.
    [Show full text]
  • Medical Review(S) Clinical Review
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 200327 MEDICAL REVIEW(S) CLINICAL REVIEW Application Type NDA Application Number(s) 200327 Priority or Standard Standard Submit Date(s) December 29, 2009 Received Date(s) December 30, 2009 PDUFA Goal Date October 30, 2010 Division / Office Division of Anti-Infective and Ophthalmology Products Office of Antimicrobial Products Reviewer Name(s) Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD Review Completion October 29, 2010 Date Established Name Ceftaroline fosamil for injection (Proposed) Trade Name Teflaro Therapeutic Class Cephalosporin; ß-lactams Applicant Cerexa, Inc. Forest Laboratories, Inc. Formulation(s) 400 mg/vial and 600 mg/vial Intravenous Dosing Regimen 600 mg every 12 hours by IV infusion Indication(s) Acute Bacterial Skin and Skin Structure Infection (ABSSSI); Community-acquired Bacterial Pneumonia (CABP) Intended Population(s) Adults ≥ 18 years of age Template Version: March 6, 2009 Reference ID: 2857265 Clinical Review Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD NDA 200327: Teflaro (ceftaroline fosamil) Table of Contents 1 RECOMMENDATIONS/RISK BENEFIT ASSESSMENT ......................................... 9 1.1 Recommendation on Regulatory Action ........................................................... 10 1.2 Risk Benefit Assessment.................................................................................. 10 1.3 Recommendations for Postmarketing Risk Evaluation and Mitigation Strategies ........................................................................................................................
    [Show full text]
  • Nitrate Prodrugs Able to Release Nitric Oxide in a Controlled and Selective
    Europäisches Patentamt *EP001336602A1* (19) European Patent Office Office européen des brevets (11) EP 1 336 602 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.7: C07C 205/00, A61K 31/00 20.08.2003 Bulletin 2003/34 (21) Application number: 02425075.5 (22) Date of filing: 13.02.2002 (84) Designated Contracting States: (71) Applicant: Scaramuzzino, Giovanni AT BE CH CY DE DK ES FI FR GB GR IE IT LI LU 20052 Monza (Milano) (IT) MC NL PT SE TR Designated Extension States: (72) Inventor: Scaramuzzino, Giovanni AL LT LV MK RO SI 20052 Monza (Milano) (IT) (54) Nitrate prodrugs able to release nitric oxide in a controlled and selective way and their use for prevention and treatment of inflammatory, ischemic and proliferative diseases (57) New pharmaceutical compounds of general effects and for this reason they are useful for the prep- formula (I): F-(X)q where q is an integer from 1 to 5, pref- aration of medicines for prevention and treatment of in- erably 1; -F is chosen among drugs described in the text, flammatory, ischemic, degenerative and proliferative -X is chosen among 4 groups -M, -T, -V and -Y as de- diseases of musculoskeletal, tegumental, respiratory, scribed in the text. gastrointestinal, genito-urinary and central nervous sys- The compounds of general formula (I) are nitrate tems. prodrugs which can release nitric oxide in vivo in a con- trolled and selective way and without hypotensive side EP 1 336 602 A1 Printed by Jouve, 75001 PARIS (FR) EP 1 336 602 A1 Description [0001] The present invention relates to new nitrate prodrugs which can release nitric oxide in vivo in a controlled and selective way and without the side effects typical of nitrate vasodilators drugs.
    [Show full text]
  • The National Drugs List
    ^ ^ ^ ^ ^[ ^ The National Drugs List Of Syrian Arab Republic Sexth Edition 2006 ! " # "$ % &'() " # * +$, -. / & 0 /+12 3 4" 5 "$ . "$ 67"5,) 0 " /! !2 4? @ % 88 9 3: " # "$ ;+<=2 – G# H H2 I) – 6( – 65 : A B C "5 : , D )* . J!* HK"3 H"$ T ) 4 B K<) +$ LMA N O 3 4P<B &Q / RS ) H< C4VH /430 / 1988 V W* < C A GQ ") 4V / 1000 / C4VH /820 / 2001 V XX K<# C ,V /500 / 1992 V "!X V /946 / 2004 V Z < C V /914 / 2003 V ) < ] +$, [2 / ,) @# @ S%Q2 J"= [ &<\ @ +$ LMA 1 O \ . S X '( ^ & M_ `AB @ &' 3 4" + @ V= 4 )\ " : N " # "$ 6 ) G" 3Q + a C G /<"B d3: C K7 e , fM 4 Q b"$ " < $\ c"7: 5) G . HHH3Q J # Hg ' V"h 6< G* H5 !" # $%" & $' ,* ( )* + 2 ا اوا ادو +% 5 j 2 i1 6 B J' 6<X " 6"[ i2 "$ "< * i3 10 6 i4 11 6! ^ i5 13 6<X "!# * i6 15 7 G!, 6 - k 24"$d dl ?K V *4V h 63[46 ' i8 19 Adl 20 "( 2 i9 20 G Q) 6 i10 20 a 6 m[, 6 i11 21 ?K V $n i12 21 "% * i13 23 b+ 6 i14 23 oe C * i15 24 !, 2 6\ i16 25 C V pq * i17 26 ( S 6) 1, ++ &"r i19 3 +% 27 G 6 ""% i19 28 ^ Ks 2 i20 31 % Ks 2 i21 32 s * i22 35 " " * i23 37 "$ * i24 38 6" i25 39 V t h Gu* v!* 2 i26 39 ( 2 i27 40 B w< Ks 2 i28 40 d C &"r i29 42 "' 6 i30 42 " * i31 42 ":< * i32 5 ./ 0" -33 4 : ANAESTHETICS $ 1 2 -1 :GENERAL ANAESTHETICS AND OXYGEN 4 $1 2 2- ATRACURIUM BESYLATE DROPERIDOL ETHER FENTANYL HALOTHANE ISOFLURANE KETAMINE HCL NITROUS OXIDE OXYGEN PROPOFOL REMIFENTANIL SEVOFLURANE SUFENTANIL THIOPENTAL :LOCAL ANAESTHETICS !67$1 2 -5 AMYLEINE HCL=AMYLOCAINE ARTICAINE BENZOCAINE BUPIVACAINE CINCHOCAINE LIDOCAINE MEPIVACAINE OXETHAZAINE PRAMOXINE PRILOCAINE PREOPERATIVE MEDICATION & SEDATION FOR 9*: ;< " 2 -8 : : SHORT -TERM PROCEDURES ATROPINE DIAZEPAM INJ.
    [Show full text]
  • Study Protocol and Statistical Analysis Plan
    The University of Texas Southwestern Medical Center at Dallas Institutional Review Board PROJECT SUMMARY Study Title: Ultrasound-guided fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial Principal Investigator: Irina Gasanova, MD Sponsor/Funding Source: Department of Anesthesiology and Pain Management, UT Southwestern Medical School IRB Number: STU 122015-022 NCT Number: NCT02658240 Date of Document: 01 April 2016 Page 1 of 7 Purpose: In this randomized, controlled, observer-blinded study we plan to evaluate ultrasound-guided fascia iliaca compartment block with ropivacaine and periarticular infiltration with ropivacaine for postoperative pain management after total hip arthroplasty (THA). Background: Despite substantial advances in our understanding of the pathophysiology of pain and availability of newer analgesic techniques, postoperative pain is not always effectively treated (1). Optimal pain management technique balances pain relief with concerns about safety and adverse effects associated with analgesic techniques. Currently, postoperative pain is commonly treated with systemic opioids, which are associated with numerous adverse effects including nausea and vomiting, dizziness, drowsiness, pruritus, urinary retention, and respiratory depression (2). Use of regional and local anesthesia has been shown to reduce opioid requirements and opioid-related side effects. Therefore, their use has been emphasized (3, 4, 5, 6). Fascia Iliaca compartment block (FICB) is a field block that blocks the nerves from the lumbar plexus supplying the thigh (i.e., lateral femoral cutaneous femoral and obturator nerves). The obturator nerve is sometimes involved in the FICB but probably plays little role in postoperative pain relief for most surgeries of the hip and proximal femur.
    [Show full text]
  • Ultrasound Guided Femoral Nerve Block
    Ultrasound Guided Femoral Nerve Block Michael Blaivas, MD, FACEP, FAIUM Clinical Professor of Medicine University of South Carolina School of Medicine AIUM, Third Vice President President, Society for Ultrasound Medical Education Past President, WINFOCUS Editor, Critical Ultrasound Journal Sub-specialty Editor, Journal of Ultrasound in Medicine Emergency Medicine Atlanta, Georgia [email protected] Disclosures • No relevant disclosures to lecture Objectives • Discuss anatomy of femoral nerve • Discuss uses of femoral nerve block classically and 3-in-1 variant • Discuss technique of femoral nerve blockade under ultrasound • Discuss pitfalls and potential errors Femoral Nerve Block Advantages • Many uses of regional nerve blocks • Avoid narcotics and their complications • Allow for longer term pain control • Can be used in patients unfit for sedation – Poor lung health – Hypotensive – Narcotic dependence or sensitivity Femoral Nerve Blocks • Wide variety of potential indications for a femoral nerve block – Hip fracture – Knee dislocation – Femoral fracture – Laceration repair – Burn – Etc. Nerve Blocks in Community vs. Academic Setting • Weekend stays • Night time admissions • Time to get consult and clear • Referral and admission patters • All of these factors can lead to patients spending considerable time prior to OR • Procedural sedation vs. block Femoral Nerve Blocks • Several basic principles with US also • Specialized needles +/- • No nerve stimulator • Can see nerve directly and inject directly around target nerve or nerves • Only
    [Show full text]
  • Hygroscopicity of Pharmaceutical Crystals
    HYGROSCOPICITY OF PHARMACEUTICAL CRYSTALS A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY DABING CHEN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY RAJ SURYANARAYANAN (ADVISER) JANUARY, 2009 © Dabing Chen, January / 2009 ACKNOWLEDGEMENTS I am very grateful to my thesis advisor, Prof. Raj Suryanarayanan, for his constant guidance, support, and encouragement throughout my research. Without his help, the completion of this thesis would be impossible. His friendship and advices are precious to my professional and personal growth and will help me overcome many difficulties in my future career. I would like to take the opportunity to thank Prof. David J.W. Grant, who was my advisor during the first three years in graduate school and led me into the research area of physical pharmacy. It was my great honor to have worked for him, and he will always live as a role model in my life. Many thanks to Dr. Zheng Jane Li at Boehringer Ingelheim Pharmaceuticals (BI) for her invaluable advice as an industrial mentor and also for agreeing to serve on my committee. I sincerely appreciate her helpful discussions, revision of the manuscripts, and supervision of my research. I also want to thank her for providing me the internship opportunity at BI. I thank Dr. Timothy S. Wiedmann and Dr. Theodore P. Labuza for serving on my committee and for critically reviewing my thesis. I also want to thank Dr. Timothy S. Wiedmann for allowing me the use of the HPLC instruments in his lab and also for his advice as the Director of Graduate Studies.
    [Show full text]
  • Research Journal of Pharmaceutical, Biological and Chemical Sciences
    ISSN: 0975-8585 Research Journal of Pharmaceutical, Biological and Chemical Sciences Formulation and Evaluation of Floating Drotaverine Hydrochloride Tablets Using Factorial Design Om Prakash*, S Saraf, M Rahman, Neeraj Agnihotri, and Vinay Pathak Department of Industrial chemistry, Integral University, Lucknow. Uttar Pradesh, India. ABSTRACT The main aim of this study was to optimize and evaluate the floating tablets of Drotaverine HCl that prolong the gastric residence time, increasing drug bioavailability and control pain for longer duration by oral administration. A floating drug delivery system(FDDS) was developed using gas forming agent like sodium bicarbonate, citric acid polymers like hydroxypropyl methyl cellulose(HPMC), Sod CMC, Carbopol-934P, PVP K-30. In 32 factorial design amount of HPMC(X1) and gas generating agents(X2) were selected as independent variable and % drug release for 30min,1h, 2h,4h,6h, 8h,12h, 16h , 24h and floating lag time (FLT) were taken as dependent variable. The floating tablet formulations were evaluated for Bulk density (gm/cm3), Tapped density(gm/cm3), Hausner ratio(HR), Carr index, Angle of repose, flow property, assay, in-vitro drug release, hardness, friability,weight variation. The results of in vitro release studies showed that the optimized formulation (F9) could sustain drug release (98.74%) for 24h and remain buoyant for more than 24h. The combination of hydrophilic (HPMC) and hydrophobic (carbopol-934P) polymer provides a better option for 24h release action, bioavailability, stability of tablets at 400C/75%RH, of optimized formulation was carried for one month and no significant change was observed. Keywords: floating drug delivery system(FDDS), Drotaverine HCl, gas generating agents, floating lag time (FLT), hydrophilic (HPMC) and hydrophobic (carbopol-934P) polymer.
    [Show full text]
  • Intramuscular Tramadol Vs. Diclofenac Sodium for The
    J Headache Pain (2005) 6:143–148 DOI 10.1007/s10194-005-0169-y ORIGINAL Zulfi Engindeniz Intramuscular tramadol vs. diclofenac sodium Celaleddin Demircan Necdet Karli for the treatment of acute migraine attacks Erol Armagan in emergency department: a prospective, Mehtap Bulut Tayfun Aydin randomised, double-blind study Mehmet Zarifoglu Received: 6 February 2005 Abstract The aim of this prospec- injection in future visits. Any Accepted in revised form: 15 April 2005 tive, randomised, double-blind study adverse events, whether related to Published online: 13 May 2005 was to evaluate the efficacy of intra- the drug or not, were also recorded. muscular (IM) tramadol 100 mg in Patients were followed up by tele- emergency department treatment of phone 48 h later to check for any acute migraine attack and to com- headache recurrence. Two-hour pain pare it with that of IM diclofenac response rate, which was the prima- sodium 75 mg. Forty patients who ry endpoint, was 80% for both tra- were admitted to our emergency madol and diclofenac groups. There department with acute migraine were no statistically significant dif- attack according to the International ferences among groups in terms of Z. Engindeniz (౧) • E. Armagan • M. Bulut Headache Society criteria were 48-h pain response, rescue treat- T. Aydin Department of Emergency Medicine, included in the study. Patients were ment, associated symptoms’ Uludag University Medical Faculty, randomised to receive either tra- response, headache recurrence and Acil Tip ABD Gorukle, madol 100 mg (n=20) or diclofenac adverse event rates. Fifteen (75%) Bursa 16059, Turkey sodium 75 mg (n=20) intramuscular- patients in the tramadol group and e-mail: [email protected] ly.
    [Show full text]
  • The Serotonergic System in Migraine Andrea Rigamonti Domenico D’Amico Licia Grazzi Susanna Usai Gennaro Bussone
    J Headache Pain (2001) 2:S43–S46 © Springer-Verlag 2001 MIGRAINE AND PATHOPHYSIOLOGY Massimo Leone The serotonergic system in migraine Andrea Rigamonti Domenico D’Amico Licia Grazzi Susanna Usai Gennaro Bussone Abstract Serotonin (5-HT) and induce migraine attacks. Moreover serotonin receptors play an impor- different pharmacological preventive tant role in migraine pathophysiolo- therapies (pizotifen, cyproheptadine gy. Changes in platelet 5-HT content and methysergide) are antagonist of are not casually related, but they the same receptor class. On the other may reflect similar changes at a neu- side the activation of 5-HT1B-1D ronal level. Seven different classes receptors (triptans and ergotamines) of serotoninergic receptors are induce a vasocostriction, a block of known, nevertheless only 5-HT2B-2C neurogenic inflammation and pain M. Leone • A. Rigamonti • D. D’Amico and 5HT1B-1D are related to migraine transmission. L. Grazzi • S. Usai • G. Bussone (౧) syndrome. Pharmacological evi- C. Besta National Neurological Institute, Via Celoria 11, I-20133 Milan, Italy dences suggest that migraine is due Key words Serotonin • Migraine • e-mail: [email protected] to an hypersensitivity of 5-HT2B-2C Triptans • m-Chlorophenylpiperazine • Tel.: +39-02-2394264 receptors. m-Chlorophenylpiperazine Pathogenesis Fax: +39-02-70638067 (mCPP), a 5-HT2B-2C agonist, may The 5-HT receptor family is distinguished from all other 5- Introduction 1 HT receptors by the absence of introns in the genes; in addi- tion all are inhibitors of adenylate cyclase [1]. Serotonin (5-HT) and serotonin receptors play an important The 5-HT1A receptor has a high selective affinity for 8- role in migraine pathophysiology.
    [Show full text]
  • Development and Validation of an Ultra Performance Liquid
    DOI: 10.4274/tjps.76588 Turk J Pharm Sci 2017;14(1):1-8 ORIGINAL ARTICLE Development and Validation of an Ultra Performance Liquid Chromatography Method for the Determination of Dexketoprofen Trometamol, Salicylic Acid and Diclofenac Sodium Deksketoprofen Trometamol, Salisilik Asit ve Diklofenak Sodyum Etkin Maddeleri için Ultra Performanslı Sıvı Kromatografisi Yönteminin Geliştirilmesi ve Validasyonu Sibel İLBASMIŞ TAMER Gazi University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey ABSTRACT Objectives: A simple, fast, accurate and precise method has been developed for the determination of dexketoprofen trometamol (DKP), salicylic acid (SA) and diclofenac sodium (DIC) in the drug solutions using ultra high performance liquid chromatography (UPLC). Materials and Methods: UPLC method is highly reliable and sensitive method to quantify the amount of the active ingredient and the method is validated according to ICH guidelines. Results: The developed method is found to be precise, accurate, specific and selective. The method was also found to be linear and reproducible. The value of limit of dedection (LOD) of DKP, SA, DIC were found 0.00325 µg/mL, 0.0027 µg/mL and 0.0304 µg/mL, respectively. The limit of quantitation (LOQ) of DKP, SA and DIC were found 0.00985 µg/mL, 0.0081 µg/mL and 0.0920 µg/mL, respectively. Conclusion: Proposed methods can be successfully applicable to the pharmaceutical preparation containing the above mentioned drugs (dexketoprofen trometamol, salicylic acid and diclofenac sodium). Even very small amounts of active substance can be analyzed and validations can be performed easily. Key words: Dexketoprofen trometamol, salicylic acid, diclofenac sodium, UPLC, validation ÖZ Amaç: Deksketoprofen trometamol (DKP), salisilik asit (SA) ve diklofenak sodyumun (DIC) ilaç çözeltisindeki analizi için ultra yüksek basınçlı sıvı kromatografisi (UPLC) kullanılarak basit, hızlı, doğru ve kesin bir yöntem geliştirilmiştir.
    [Show full text]
  • Ataxia Caused by a Single Dose of Dexketoprofen Trometamol
    Acta Biomed 2014; Vol. 85, N. 3: 269-270 © Mattioli 1885 Case report Ataxia caused by a single dose of dexketoprofen trometamol Sema Avcı, Selim Genç, Macit Aydın, Fatih Büyükcam, Seda Özkan Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey Summary. Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Toxic effects to kidney and liver of amatoxin are common but cardiotoxic effects are unusual. In this case, we reported the cardiotoxic effect of amatoxin with the elevated troponin-I without any additional finding in electrocardiography, echo- cardiography and angiography Key words: cardiac enzyme, mushroom, poisoning, toxicity, troponin Introduction ture: 37.1ºC, hearth rate:75 beats/min. On physical examination, the patient was oriented, alert and con- Dexketoprofen trometamol is one of the non- scious. Neurological examination was normal except steroid anti-inflamatory drugs (NSAID) used as an- ataxia and dysarthria. She has no previous chronic dis- algesic (1). It is a water-soluable molecule and it is an eases. Laboratory results were as follows; glucose:102 active enantiomer of racemic ketoprofen (1). Peroral mg/dL, creatinine:0.61 mg/dl, alanine aminotransfer- dexketoprofen has considerable analgesic potency and ase (ALT): 8 U/L , aspartate aminotransferase (AST): well-tolerated adverse effects in patients who suffer 12 U/L, calcium:9.7 mg/dL, sodium:143 mEq/L, from acute and chronic pain (1).
    [Show full text]