Use Of Analgesic Drugs Research Articles

A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis

Objective: To evaluate the short- and long-term effectiveness of exercise training in relation to pain, function and direct costs to health care systems attributable to hip osteoarthritis. Design: Prospective, two-year randomized controlled trial. Setting: An outpatient primary health care setting. Subjects: One hundred and twenty men and women aged from 55 to 80, with radiologically diagnosed hip osteoarthritis with associated clinical symptoms. Interventions: The combined exercise and general practitioner (GP) care group received 12 supervised (once per week) exercise sessions at the baseline and four additional booster sessions one year later. Both groups received standard GP care. Main measures: The WOMAC Osteoarthritis Index, physical functioning score of RAND-36 (SF-36), the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis, number of total hip replacements, the use of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs), performance-based outcome scores and body mass index (BMI). Results: There were no differences between the groups with respect to WOMAC hip pain, physical functioning score of RAND-36, performance-based outcome scores or BMI. The effect of the exercise intervention on WOMAC function was statistically significant at 6 months (mean = −7.5; 95% confidence interval (CI) −13.9 to −1.0; P = 0.02) and 18 months (mean = −7.9; 95% CI −15.3 to −0.4; P = 0.04). There were no statistically significant differences in the total health care system costs between the groups. Conclusion: The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period.

Effect of aromatherapymassage on pain easing after cesarean section

：Objective To discuss theeffect of aromatherapy massage on pain easing after cesarean section.Methods 456primiparas without chronic body disease,mental disorder,postoperative analgesia orunhealthy neonates were selected and randomly divided into control group(228 cases)andexperimental group(228 cases).The control group received routine care,and the experimentalgroup received plant essence aromatherapy massage besides routine care. Postpartumincision pain,uterine contraction pain and other body discomfort,as well as analgesic druguse after cesarean section were compared between the two groups. Results The degree of thepain at different stages in the experimental group was significantly lower than thecontrol group(P ＜0. 05). Analgesic drug was not needed 24 hours after cesarean section in theexperimental group. Conclusions Aromatherapy massage effectively eases pain after cesareansection and reduces analgesic drug use. Key words: Aromatherapy massage; Cesarean section; Pain; Effect

The use of sedatives, analgesic and anaesthetic drugs in the horse: An electronic survey of members of the American Association of Equine Practitioners (AAEP)

To determine the sedative, analgesic and anaesthetic drugs and techniques that are used by equine veterinarians. HYPOTHESIS OR OBJECTIVES: To provide equine veterinarians with information concerning veterinary use of anaesthetic techniques, a reflection of the collective experiences of the profession. A survey was conducted of those members of the American Association of Equine Practitioners (AAEP) with an electronic mail address on file with the organisation using proprietary, web-based software. The survey was comprised of 30 questions divided into 8 sections: nonsteroidal anti-inflammatory drugs; local anaesthesia; alternative techniques; standing chemical restraint; epidural anaesthesia; short-term anaesthesia; long-term anaesthesia; and a place for the respondent to make comments. The response rate was 13.8% (952/6911) AAEP member veterinarians primarily use phenylbutazone and flunixin as anti-inflammatory drugs, and lidocaine and mepivacaine for local anaesthesia. Combinations of drugs are preferred for standing chemical restraint. While many veterinarians frequently utilise short-term anaesthesia, longer anaesthesia is less frequently performed. Most AAEP member veterinarians use sedatives in combination to provide standing chemical restraint. Extra-label use of drugs is a core component of current equine sedation and anaesthetic practice. Equine veterinarians can compare their choices of anaesthetic drugs with others practising equine medicine and surgery and may be stimulated to investigate alternative methods of providing comfort to horses.

A prospective randomized study for postoperative pain relief of lower extremity fractures: efficacy of intrathecal morphine administration.

Systemic opioids are known to be effective for controlling postoperative pain. Intrathecal morphine administration can be performed in a simple manner concurrently with spinal anesthesia. The purpose of this study was to investigate the efficacy of intrathecal morphine administration for the postoperative analgesia of lower extremity fractures. A prospective randomized study for postoperative pain relief was conducted. Fifty consecutive patients with a lower extremity fracture who underwent osteosynthesis under spinal anesthesia were enrolled. The patients were divided into two groups for comparative results. No baseline variable differences between the groups were observed. Twenty-two patients were assigned to a morphine group and were administered intrathecal bupivacaine combined with a single intrathecal injection of morphine. The other 28 patients were assigned to a control group and administered intrathecal bupivacaine alone. Pain intensity was assessed using the Visual Analog Scale (VAS). The use of supplemental analgesics, time of first request for supplemental analgesics, and side effects were investigated. During the initial 12 h after surgery, the VAS score was significantly lower in the morphine group (p < 0.05). The use of supplemental analgesic drugs was significantly less in the morphine group (p < 0.05). The time of first request of the control group was shorter than that of the morphine group (p < 0.001). Side effects were seen more frequently in the morphine group though there was no significant difference. Although the use of morphine requires appropriate postoperative care, an intrathecal morphine injection can be an attractive analgesic for the postoperative pain of lower extremity fractures.

A Case-control Study of Preemptive Analgesia for Postoperative Pain in Patients Undergoing Posterior Lumbar Interbody Fusion

A case-control clinical study of preemptive analgesia for postoperative pain was conducted. To compare the efficacy of 2 preemptive analgesics: continuous subcutaneous morphine alone (SC) and continuous subcutaneous morphine combined with single intrathecal injection of morphine (SI). Systemic opioids are known to be effective for controlling the postoperative pain. Only a few studies have investigated the efficacy of preemptive analgesia using morphine. In a previous study, continuous subcutaneous morphine brought some analgesic effects with a low rate of complications. However, the analgesic effect was not sufficient. Forty-four patients were enrolled in this study. SC and SI procedures for preemptive analgesia were conducted for the 22 patients. All the patients underwent posterior lumbar interbody fusion with instrumentation. Pain management was assessed using the Visual Analog Scale (VAS). Moreover, use of supplemental analgesics, time of first request for supplemental analgesics, and side effects were investigated. No baseline variable differences between the groups were observed. From immediately after surgery (at 0 h) to 24 hours after surgery, the VAS of the SI group was significantly lower than that of the SC group. The average VAS of the SI group was always less than 30 at any time point. No significant difference was observed in the use of supplemental analgesic drugs between the 2 groups, but the time of first request of the SC group was shorter than that of the SI group. Minor side effects were observed in 3 cases of the SC group and in 6 cases of the SI group. In 1 case of the SI group, a nasal airway was used for a few hours owing to mild respiratory depression. SI provided a favorable analgesic effect at any time point. The VAS score was always below 30. Major complications were not observed in either group, but more careful observation for respiratory status was required after the SI procedure. SI can be an attractive method for postoperative analgesia and accomplished with technical ease.

A population-based case-control study of risk factors for neural tube defects in Shenyang, China

To explore the risk factors for neural tube defects (NTD) in Shenyang, we carried out a population-based case-control study. We used chi-square test or Fisher's exact test to evaluate variations in the prevalence by selected covariates. Adjusted odds ratios and 95% confidence intervals were derived from univariate and multivariable conditional logistic models. A history of maternal previous birth defect-affected pregnancy was a risk factor for NTDs (adjusted OR = 4.00, 95%CI = 1.29-12.45). Risks for NTDs were significantly associated with exposure to maternal factors during the periconceptional period such as a history of fever or cold (adjusted OR = 6.36, 95%CI = 3.24-12.52), use of analgesic and antipyretic drugs (adjusted OR = 4.94, 95%CI = 1.79-13.63), oral contraceptive use (adjusted OR 2.06, 95%CI 1.16, 3.68), and passive smoking (adjusted OR = 2.24, 95%CI = 1.04-4.81). Folic acid tablets use and fresh vegetable or fruit consumption ≥6 meals a week in periconception appeared to be protective factors (adjusted OR 0.33, 0.55, and 0.40, and 95%CI 0.13-0.44, 0.30-1.01, and 0.21-0.74, respectively). Differences in risk were found between the two most common phenotypes of NTD, anencephaly, and spina bifida. This study suggests that a history of previous birth defect-affected pregnancy, a history of maternal fever or cold, use of analgesics, antipyretics, and oral contraceptives, exposure to passive smoking, folic acid use, and consumption of fresh vegetable and fruit may be associated with NTD risk.

Prevalence of parafunctional habits and temporomandibular dysfunction symptoms in patients attending a tertiary headache clinic

To investigate the most prevalent forms of headache in a tertiary outpatient service, and to assess the frequency of associated parafunctional habits and temporomandibular dysfunction symptoms (TMD). All new patients referred to the Headache Outpatient Service in UNIMES during 2008 were prospectively assessed by the neurologist and the dental surgeon. Eighty new patients were assessed; chronic migraine and episodic migraine without aura were the most prevalent conditions, accounting for 66.3% of all cases. There was significantly higher use of analgesics/days for the chronic migraine patients. The prevalence of parafunctional habits was 47.5% and the prevalence of TMD symptoms was 35%. The high prevalence of primary headaches, parafunctional habits and TMD symptoms and the inadequate use of analgesic drugs suggest that primary healthcare units need further training in the field of headache and orofacial pain.

Aspirin, Non-Aspirin Analgesics and the Risk of Hypertension in the SUN Cohort

The use of aspirin and non-aspirin analgesics has been associated with changes in blood pressure. The aim of this study was to investigate prospectively the association between the regular use of aspirin and non-aspirin analgesics and the incidence of hypertension. The SUN project is an ongoing, continuously expanding, prospective cohort of Spanish university graduates initially free of hypertension, cardiovascular disease, diabetes and cancer; 9986 (mean age 36 years) were recruited during 1999-2005 and followed up for a mean of 51 months. Regular aspirin and non-aspirin analgesic use and the presence of other risk factors for hypertension were assessed by questionnaire at baseline, and the incidence of hypertension was assessed using biennial follow-up questionnaires. In total, 543 new cases of hypertension were identified during follow-up. Regular aspirin use (i.e. 2 or more days/week) was associated with a higher risk of hypertension (hazard ratio=1.45; 95% confidence interval, 1.02-2.04) after adjustment for various confounding factors. Regular use of non-aspirin analgesic drugs was also associated with a higher risk of hypertension (hazard ratio=1.69; 95% confidence interval, 1.28-2.23). The regular use of aspirin and non-aspirin analgesics were both associated with an increased risk of developing hypertension, independently of other risk factors.

Stapled haemorrhoidopexy: extent of tissue excision and clinical implications in the early postoperative period

This study quantified prospectively the amount of rectal wall removed during stapled haemorrhoidopexy and assessed its effect on ano-rectal function and health-related quality of life. Thirty-three consecutive patients who underwent stapled haemorrhoidopexy for second- or third- degree haemorrhoids, or for failed medical treatment, in the Department of Surgery and Gastroenterological Sciences at the University of Padova were included. All patients were assessed preoperatively and postoperatively using a structured questionnaire to determine the number of defecations per week, incomplete defecations, time taken to defecate any difficulty in defecating, soiling, the use of drugs and continence. All patients were reassessed at 1 and 2 weeks and at 30 days after the procedure using the Cleveland Global Quality of Life (CGQL) questionnaire. All patients underwent preoperative and postoperative ano-rectal manometry at least 30 days after stapled haemorrhoidopexy. The median surface area of the resected rectal wall was 10.5 (range, 9-15) mm(2) and the median thickness was 3 (range, 2-4) mm. Muscle tissue was included in all specimens. The median thickness of the resected rectal wall correlated inversely with the rectal volume when the recto-anal inhibitory reflex (RAIR) was initiated during postoperative manometry (ρ = -0.50, P = 0.07). A significant, direct correlation was found between the surface area of the resected rectal wall and the rectal volume during postoperative manometry (ρ = 0.53, P = 0.08) and the use of analgesic drugs after 2 weeks (ρ = 0.63, P = 0.04). Significant correlations were found between being female and postoperative resting pressure (ρ = -0.74, P < 0.01), squeeze pressure (ρ = -0.64, P = 0.01) and maximum tolerated volume (ρ = -0.78, P < 0.01). Stapled haemorrhoidopexy is safe and effective. The thicker the resected rectal wall, the lower the volume of initiation of the RAIR.

Effect of palmitoylethanolamide–polydatin combination on chronic pelvic pain associated with endometriosis: Preliminary observations

Objective Endometriosis is a chronic oestrogen-dependent gynaecological disorder, the most common symptom of which is pain. Inflammation can be considered one of the major causes of pain in endometriosis. In particular, degranulating mast cells have been found in significantly greater quantities in endometriotic lesions than in unaffected tissues. The increase in activated and degranulating mast cells is closely associated with nerve structures in painful endometriotic lesions. These observations indicate that inflammation due to mast cells may contribute to the development of pain and hyperalgesia in endometriosis. Controlling mast-cell activation may therefore relieve the pain associated with endometriotic lesions. Study design Four patients presenting an endometriosis-related pain intensity ≥5 (visual analogue scale for pain, or VAS) were enrolled and monitored during 3 months of the following treatment: oral palmitoylethanolamide 400 mg and polydatin 40 mg, twice daily for 90 days. Deep dyspareunia, dyschezia, dysuria, dysmenorrhoea and analgesic drug use during the 3-month follow-up period were also monitored, with the aim of demonstrating a reliable reduction in chronic pelvic pain. Results The preliminary results indicate that all patients enrolled experienced pain relief as early as 1 month after starting treatment. Furthermore, a reduction in the analgesic drugs usually employed for pain control was observed in all subjects treated. Additionally, some improvements in endometriotic lesions seemed to be demonstrated by imaging. Conclusions The palmitoylethanolamide–polydatin combination seems to be very useful in controlling chronic pelvic pain associated with endometriosis. As a result of these findings we have initiated a multi-centre pilot study to verify the effectiveness of this treatment in controlling the chronic pelvic pain associated with endometriosis.

Use of Analgesic and Sedative Drugs in the NICU: Integrating Clinical Trials and Laboratory Data

Recent advances in neonatal intensive care include and are partly attributable to growing attention for comfort and pain control in the term and preterm infant requiring intensive care.Limitation of painful procedures is certainly possible, but most critically ill infants require unavoidable painful or stressful procedures such as intubation, mechanical ventilation, or catheterization.Many analgesics (opioids and nonsteroidal anti-inflammatory drugs)and sedatives (benzodiazepines and other anesthetic agents) are available but their use varies considerably among units. This review summarizes current experimental knowledge on the effects of sedative and analgesic drugs on brain development and reviews clinical evidence that speaks for or against the use of common analgesic and sedative drugs in the NICU but avoids any discussion of anesthesia during surgery. Risk/benefit ratios of intermittent boluses or continuous infusions for the commonly used sedative and analgesic agents are discussed in the light of clinical and experimental studies. The limitations of extrapolating experimental results from animals to humans must be considered while making practical recommendations based on the currently available evidence.

What Do We Really Know About the Drugs We Use to Treat Chronic Pain?

Chronic pain can be extremely hard to treat in both humans and animals, and effective pain relief often requires the use of novel analgesic drugs. Little true scientific data actually exist for some of the drugs that we use to alleviate chronic pain, yet dosing protocols and expected results are available. The scientific data (pharmacokinetic/pharmacodynamic data) available for drugs used to treat chronic pain in veterinary patients will be presented along with published dosages and dosing guidelines.

Lowback pain and sciatica related with premenstruel period in patients with lumbar disc herniation

We examined the clinical progress of low back pain and radicular pain during the premenstrual period in patients with lumbar disc protrusion and discussed the probable effective physiopathological mechanisms and laboratory results reported in the literature. Fifty female patients with complaints of low back and leg pain, and with lumbar disc protrusion in their MRI investigations were included in the study. The pain was assessed using the modified "Low Back Outcome Scale of Greenough and Fraser" in the premenstrual and the normal postmenstrual periods. There was an increase in the use of analgesic drugs and the need for rest during the premenstrual period (p < 0.05). The severity of pain was significantly different between the two periods and it was more severe at the premenstrual period (p < 0.05). All the criteria that we chose from the modified "Low Back Outcome Scale of Greenough and Fraser" to assess the pain showed a significant difference between the premenstrual period and the normal period in our patients. This difference should be considered in the treatment strategies in the clinical setting. Patients should be re-evaluated for surgical decisions after the premenstrual period if possible.

일 도서지역 퇴행성관절염 환자의 삶의 질, 지각된 건강상태, 통증 및 일상생활동작 장애

본 연구는 도서지역 퇴행성관절염 환자들을 대상으로 삶의 질, 지각된 건강상태, 통증 및 일상생활동작 장애 정도와 각 변수 들 간의 상관관계를 규명하기 위하여 2008년 6월 23일부터 2008년 10월 8일까지 층화비율 표집에 의해 전라남도 신안군 14개면에 거주하는 40세 이상 관절염 환자 601명을 자료 수집을 하여, 서술적 통계, 평균과 표준편차, <TEX>$x^2$</TEX>- test, Pearson Correlation Coefficients로 분석하였다. 본 연구의 결과는 다음과 같다. 대상자의 삶의 질 평균은 115.87<TEX>${\pm}$</TEX>17.76, 지각된 건강상태는 4.40<TEX>${\pm}$</TEX>1.63, 통증은 6.31<TEX>${\pm}$</TEX>1.87, 일상생활동작 장애는 77.62<TEX>${\pm}$</TEX>12.13이었다. 대상자의 일반적 특성에 따른 삶의 질은 연령, 동거형태, 경제수준에서, 지각된 건강상태는 성별, 연령, 경제수준에서 유의한 차이가 있었다. 통증은 성별, 연령, 일 노동시간에서, 일상생활동작 장애는 성별, 연령, 학력에 따라 유의한 차이가 있었다. 질병관련 특성에서는 삶의 질과 지각된 건강상태, 통증, 일상생활동작 장애 모두 유병기간과 진통제 복용에서 유의한 차이가 있었다. 대상자들의 삶의 질, 지각된 건강상태, 통증, 일상생활동작 장애간의 상관관계는 삶의 질은 지각된 건강상태와는 통계적으로 유의한 양 상관관계를, 통증과 일상생활동작 장애와는 음 상관관계를 나타냈다. 이상의 결과를 통하여 도서지역 관절염 환자는 경제수준이 낮은 독거노인과 오래된 유병기간, 현재 진통제를 복용중인 대상자에서 삶의 질과 지각된 건강상태는 낮고 통증과 일상생활동작 장애는 높았다. 따라서 도서지역 관절염환자들의 건강증진을 위해서는 지각된 건강상태가 나쁜 독거노인을 대상으로 통증과 일상생활동작 장애를 줄이고 삶의 질을 높일 수 있는 적극적인 간호중재방안이 마련되어야 한다고 본다. Objectives: The purpose of this study was to identify and relationships among quality of life, perceived health status, pain and difficulty of daily activity with degenerative arthritis living in island residents. Methods: The participants were 601 degenerative arthritis patients. Data were collected using structured questionnaires from June 23th to Oct. 08th, 2008 and analyzed using the SPSS 12.0 program. and it included descriptive statistics, t-test, <TEX>$x^2$</TEX>-test, Pearson correlation coefficient. Results: The mean quality of life score was 115.87, perceived health status was 4.40, pain was 6.31 and difficulty of daily activity was 77.62. On the demographic variables, age, living arrangement, level of economics showed significant difference for the quality of life and sex and age showed significant difference for the perceived health status, pain, difficulty of daily activity. On the disease-related variables, duration of disease, use of analgesic drug showed significant difference for the dependent variables. There was a significant positive correlation among the quality of life, perceived health status, significant negative correlation pain and difficulty of daily activity. Conclusions: These results suggested that nursing intervention program including pain reduction, enhancing the perceived health status, ADL abilities and quality of life were necessary for the osteoarthritis patients in island residents.

Pain Assessment, Sedation, and Analgesic Administration in the Intensive Care Unit

Pain Assessment, Sedation, and Analgesic Administration in the Intensive Care Unit

Analysis of a population of patients who were referred to a second level pain center: Clinical and demographic characteristics

Pain is the symptom that leads most patients to ask for medical intervention; if not controlled, pain may become a very costly item in the Italian Health Care system. Proper referral to a second level specialist pain center can extensively decrease the duration of a painful condition, prevent the onset of more pain and of the so-called pain syndromes, and also reduce the improper use of analgesic drugs or pain surgery. Patients should be referred to a specialist pain center when their pain is uncontrolled. In this observational study we analyzed the clinical and demographic data of a population referred for the first time to a specialist pain center (Fondazione Salvatore Maugeri, Pavia) in the year 2008 to define patient characteristics and to understand who makes referrals and after which kind of pharmacological and interventional treatment. Our results indicate that in Italy patients are referred to a pain center very late, which increases the duration of pain syndromes and the cost of pain management.

Risk factors for oral clefts: a population‐based case‐control study in Shenyang, China

Shenyang in Northern China has one of the highest reported prevalence rates of oral clefts in the world. To explore the risk factors for oral clefts in Shenyang, we carried out a population-based case-control study. A total of 360 990 births in 2000 to 2007 were screened for oral clefts; the overall prevalence was 1.76 per 1000. The ratio of cleft lip with or without cleft palate (CL +/- P) : cleft palate only (CP) was 5.60:1. The overall male : female ratio was 2.02:1. CLP and CL were more common in males than in females with a sex ratio (SR) of 2.88:1 and 1.86:1 respectively, whereas CP was more common in females with an SR of 0.71:1. Using a multivariable conditional logistic regression model, 586 oral clefts cases were compared with 1172 control mothers. Maternal factors significantly associated with increased risk for oral clefts were history of a fever or cold (adjusted OR 2.34, 95% CI 1.06, 5.60); use of analgesic and antipyretic drugs (adjusted OR 3.10, 95% CI 1.41, 6.86); poor ventilation during heating (adjusted OR 2.25, 95% CI 1.10, 4.60); and consumption of pickled vegetables >6 per week (adjusted OR 3.86, 95% CI 1.11, 13.47) during pregnancy. Factors which appeared to be protective were meat consumption >or=4 times per week (adjusted OR 0.43, 95% CI 0.28, 0.67); and legume consumption >6 times per week (adjusted OR 0.60, 95% CI 0.41, 0.89). Differences in risk were found between the two most common phenotypes, CL +/- P and CP only. Most of the environmental factors had stronger associations with risk for CL +/- P rather than CP, whereas history of oral clefts, as well as legume consumption, were more strongly associated with the risk for CP than for CL +/- P. The findings suggest that aetiological heterogeneity may exist between CL +/- P and CP.

Dextropropoxyphene withdrawal from a French university hospital: impact on analgesic drug consumption

Dextropropoxyphene is a weak opioid analgesic, widely used as a step 2 analgesic (according to WHO classification) in combination with peripheral analgesics, mainly paracetamol. Recent data have underlined its poor analgesic efficacy (in comparison with paracetamol), risks of serious adverse drug reactions (i.e. hepatic reactions, hallucinations, abuse, withdrawal symptoms, hypoglycaemia), possible lethality after overdose, its risk of accumulation in patients with renal failure or in elderly people and some pharmacokinetic insufficiencies (i.e. different half-lives for dextropropoxyphene and paracetamol). Taking into account these data, the drug committee of the Toulouse University Hospital (France) decided to withdraw dextropropoxyphene from the hospital formulary since 1 June 2005. The aim of our study was to investigate the consequences of this withdrawal by comparing use of analgesic drugs in Toulouse University Hospital before (2004) and after (2006) dextropropoxyphene withdrawal (using defined daily dose for 1000 hospitalization-days as the unit measure). Before withdrawal, dextropropoxyphene (in combination with paracetamol) was the second most used analgesic drug after paracetamol alone. After dextropropoxyphene withdrawal, total consumption of analgesic drugs decreased by 4.6% (2006 vs. 2004). There was a 28% decrease in consumption of step 2 analgesics [with an increase in oral tramadol and a slight decrease in codeine (in combination with paracetamol)]. During the same period, step 1 analgesic consumption increased by 11% (mainly paracetamol) and that of step 3 analgesics slightly decreased (-8%). These results show that dextropropoxyphene withdrawal was not associated with a marked switch in prescriptions towards other analgesic drugs. This paper underlines the interest of a hospital-based drug committee to promote rational drug use. Finally, the present data allow us to discuss putative misuse of dextropropoxyphene.

Lack of effect of naltrexone on the spinal synergism between morphine and non steroidal anti-inflammatory drugs

To enhance analgesia, the combinatorial use of analgesic drugs with proven efficacies is a widely-used strategy to reduce adverse side effects. The present study charcaterizes the antinociceptive interaction of intrathecal morphine co-administered with different NSAIDs using isobolographic analysis.Antinoceptive activity was evaluated using a model for acute visceral pain, the writhing test of mice. The possible involvement of opioid receptors in the mechanism of action of the intrathecal co-administration of morphine and NSAIDs was investigated using the non-selective receptor antagonist naltrexone. The study demonstrated a synergistic antinociception of intrathecal administered combinations of morphine with the following NSAIDs: diclofenac, ketoprofen, meloxicam, metamizol, naproxen, nimesulide, parecoxib and piroxicam. The supra additive effect was obtained with very low doses of each drug and it appeared to be independent of the COX-1 or COX-2 inhibition selectivity of each NSAID and was not significantly modified by intrathecal naltrexone. The findings of the present work suggest that the combination of opioids and NSAIDs has a direct action on spinal nociceptive processing, which may be achieved via mechanisms that are independent of the activation of opioid receptors. The ineffectiveness of naltrexone to reverse the analgesic activity of opioids + NSAIDs combinations indicates that other complex pain regulatory systems are involved in this effect.

The availability of prescription‐only analgesics purchased from the internet in the UK

Increasing numbers of people are accessing medicines from the internet. This online market is poorly regulated and represents a potential threat to the health of patients and members of the public. Prescription-only analgesics, including controlled opioids, are readily available to the UK public through internet pharmacies that are easily identified by popular search engines. The majority of websites do not require the customer to possess a valid prescription for the drug. Less than half provide an online health screen to assess suitability for supply. The majority have no registered geographical location. Analgesic medicines are usually purchased at prices significantly above British National Formulary prices and are often supplied in large quantities. These findings are of particular relevance to pain-management specialists who are trying to improve the rational use of analgesic drugs. To explore the availability to the UK population of prescription-only analgesics from the internet. Websites were identified by using several keywords in the most popular internet search engines. From 2000 websites, details of 96 were entered into a database. Forty-six (48%) websites sold prescription analgesics, including seven opioids, two non-opioids and 18 nonsteroidal anti-inflammatory drugs. Thirty-five (76%) of these did not require the customer to possess a valid prescription. Prescription-only analgesics, including controlled opioids, are readily available from internet websites, often without a valid prescription.