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Biomedical subjects

S Reddy

Publications and source records attributed to S Reddy.

At least 163 records · Page 9Linked to original sources
PubMed1995

Phospholipase A2 activation in human neutrophils requires influx of extracellular Ca2+ and leukotriene B4.

We have demonstrated that phospolipase A2 (PLA2) activation in human neutrophils requires both the influx of extracellular Ca2+ and leukotriene B4 (LTB4). Surprisingly, the eicosanoids (LTB4 and its omega-oxidation products) formed were quantitatively very similar in both thapsigargin (Thap)- and A-23187-stimulated neutrophils. In contrast, Thap had very little effect on the activation of PLA2 when 5-lipoxygenase (5-LO) was blocked by BW755C or MK-886, whereas A-23187 caused a substantial activation. The lack of PLA2 activation in Thap-stimulated neutrophils results from the inhibition of LTB4 formation in the presence of 5-LO inhibitors. It appears that A-23187 activates both LTB4-dependent and -independent PLA2, whereas Thap activates LTB4-dependent PLA2. Experiments with ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid demonstrated that activation of Thap-sensitive PLA2 and 5-LO requires the influx of Ca2+. Neither the transient elevation of cytosolic Ca2+ from intracellular stores nor the sustained Ca2+ influx alone without LTB4 appears sufficient to cause the activation of LTB4-dependent PLA2. We suggest that the activation of LTB4-dependent PLA2 involves 1) a sustained elevation of cytosolic Ca2+ coupled to the influx of extracellular Ca2+ and 2) a coupling between LTB4 and its receptor. We conclude that LTB4-dependent PLA2 plays an important role in the poststimulatory formation of lipid mediators such as prostaglandins, leukotrienes, and platelet-activating factor.

Calcimycin↗
PubMed1995

Long-term effects of nicotinamide-induced inhibition of poly(adenosine diphosphate-ribose) polymerase activity in rat pancreatic islets exposed to interleukin-1 beta.

Nicotinamide (NIC) is presently extensively studied as a potential agent that might prevent the development of insulin-dependent diabetes mellitus. This study aimed to examine the consequence of exposing isolated rat pancreatic islets to various concentrations of NIC (0, 0.5, 1.0, 5.0, 10, and 25 mM) over a prolonged period (6 days) in tissue culture and also to assess the efficacy of NIC to counteract interleukin-1 beta (IL-1; 25 U/ml)-induced beta-cell dysfunction. Except for a 30-40% increase at 5.0 mM NIC, the insulin content of islets was not affected by NIC. Also, the islet DNA content remained essentially unchanged. The insulin accumulation in the culture medium declined at 5-25 mM NIC between days 4-6. The insulin release in response to 16.7 mM glucose on day 6 was enhanced after culture with the addition of 0.5 mM NIC, but 25 mM NIC caused a strong inhibition of insulin secretion. However, neither the (pro)insulin nor the total protein biosynthesis rate of the islets was affected by NIC. A significant inhibition of the islet poly(ADP-ribose) polymerase activity by 40-80% was observed at 5-25 mM NIC. IL-1 was then tested together with 1.0 and 10 mM NIC. The islet DNA content was markedly reduced in all groups treated with IL-1, as was the medium insulin accumulation. Moreover, NIC failed to prevent IL-1 induced impairment of islet insulin release on day 6. The cytokine induced a very pronounced and sustained increase in the medium nitrite accumulation, and NIC could not influence this elevation. Thus, these data show that prolonged exposure to elevated NIC levels impaired the function of rat beta-cells, and NIC failed to counteract IL-1 actions. Whether these events are mimicked in the ongoing clinical trials with NIC remain to be established.

Animals↗
PubMed1995

Age-dependent sensitivity to streptozotocin of pancreatic islets isolated from female NOD mice.

Streptozotocin (STZ), a selective beta-cell cytotoxin, given in multiple low doses to susceptible mouse strains causes insulin-dependent diabetes mellitus (IDDM) with an autoimmune pathology. Studies in the human suggest that environmental factors such as viruses and certain toxins may modulate the expression of the disease in genetically-prone individuals and the effect may also be age-dependent. Here we have examined the effects of graded, low doses of STZ on beta-cell function and insulin and DNA contents in vitro in cultured islets isolated from female IDDM-prone NOD mice at 4 weeks and at 8 weeks. Results were compared with islets from age and sex-matched non-diabetes prone C57BL/Ks mice. No changes in islet DNA or insulin contents were observed after an acute 30 min exposure to STZ (0, 1.1, 2.2 and 4.4 mM) in the two strains at each of the age groups. However, the DNA content in the NOD mouse islets tended to be lower at 8 weeks, being significant at 1.1 mM STZ. At 4 weeks, islets from NOD mice had a higher insulin content than the control mice but this declined at 8 weeks when it became comparable to the control strain. STZ caused a dose-dependent inhibition of islet glucose oxidation rates in all groups. However, at 4 weeks, exposure to 2.2 mM STZ resulted in a significantly greater inhibition in NOD mice than in age-matched control mice. This was reversed at 8 weeks when the islets from NOD mice showed a greater resistance to oxidative impairment than from C57BL/Ks mice. In the presence of 16.7 mM glucose, an inhibitory pattern, similar to the glucose oxidation rate, was also observed for insulin release. In the control mice the relative inhibition of insulin release and glucose oxidation rate was similar at 4 and 8 weeks. These results suggest that islets from the NOD mouse at 4 weeks and prior to insulitis are more sensitive to STZ-induced functional impairment. This enhanced sensitivity suggests that cumulative exposure of diabetes-prone islets to low doses of selective beta cell toxins may be a determinant for later development of IDDM.

Aging↗
PubMed1995

Low dose streptozotocin causes diabetes in severe combined immunodeficient (SCID) mice without immune cell infiltration of the pancreatic islets.

Streptozotocin (stz) given in low doses (40 mg/kg body weight) on 5 consecutive days to susceptible strains of mice causes diabetes. Previous studies have shown that the induction of diabetes is associated with inflammatory infiltrates within the pancreatic islets. However, it is unclear whether stz causes limited beta cell destruction followed by insulitis or whether the diabetogen promotes immune cell influx into the pancreatic islets, followed by immune-mediated beta-cell destruction. It is also unclear whether stz given in sub-diabetogenic doses is capable of causing diabetes independent of cell-mediated processes. Here we have examined these possibilities in CB.17 Scid mice which lack functional T and B cells but have immunocompetent macrophages and NK cells. Low dose stz given to Scid mice caused diabetes in approximately 50% of mice of both sexes by 21 days (14/24 males; 10/18 females). Sections of pancreas were examined immunohistochemically for the presence of MAC-1 positive cells (macrophages and natural killer cells) in the exocrine, peri- and intra-islet regions at different time points following the administration of stz. There were no statistically significant differences in the number of immunoreactive cells in the three locations between tissues obtained from stz-injected mice (3, 7, 14 and 21 days after stz injection and at onset of diabetes) and buffer-injected Scid mice. Although diabetic Scid mice showed a reduced number of insulin immunoreactive cells and peri- and intra-islet distributed glucagon cells, no insulitis was seen histochemically. In parallel studies, normal Swiss male mice given stz at a similar dose developed diabetes (10/10) associated with insulitis which consisted predominantly of CD4, CD8 and MAC-1 cells. Balb/c mice given stz similarly, also developed diabetes (5/8) without showing insulitis, although a moderate increase in the number of macrophages were observed within several islets. These studies demonstrate that stz administered in multiple low doses to Scid mice can cause beta cell destruction and diabetes in the absence of immune cell infiltrate within the pancreatic islets.

Animals↗
PubMed1995

3-Methylcholanthrene and pyridine effects on CYP1A1 and CYP1A2 expression in rat renal tissue.

The effects of 3-methylcholanthrene (3-MC) and pyridine on rat renal cytochrome P450 (CYP) 1A1 and 1A2 mRNA expression have been examined by Northern-blot analysis and reverse transcriptase-polymerase chain reaction (RT-PCR), followed by Southern-blot analysis of the PCR products. Northern-blot hybridization and RT-PCR analyses of kidney poly(A)+ RNA revealed that 3-MC treatment produced a time-dependent increase in the renal CYP1A1 and 1A2 mRNA levels, with CYP1A1 and 1A2 mRNA levels maximally increased at 24 and 18 hr, respectively, after treatment. These data were confirmed via RT-PCR analysis using a subsaturating level of cDNA template and by Southern-blot analysis of the PCR products. This approach served as the foundation for examining the effects of pyridine on CYP1A1 and 1A2 expression in renal tissue. RT-PCR analysis of renal CYP1A1 and 1A2 poly(A)+ RNA levels after treatment with pyridine (200 mg/kg/day for 3 consecutive days) revealed that CYP1A1 mRNA levels were maximally elevated approximately 10-fold after pyridine treatment for 2 consecutive days, whereas CYP1A2 mRNA levels were maximally elevated approximately 3-fold at 24 hr after treatment. The mRNA levels of glyceraldehyde 3-phosphate dehydrogenase, which served as an internal control, remained constant after 3-MC or pyridine treatment. These results show that expression of CYP1A1 and 1A2 mRNAs is enhanced in renal tissue after exposure to 3-MC or pyridine, and that constitutive expression of CYP1A1 seems to be greater than that of CYP1A2 in renal tissue.

Animals↗
PubMed1995

An overview of the CERC ARTEMIS project.

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

Computer Communication Networks↗
PubMed1995

A distributed, scalable, community care network architecture for wide-area electronic patient records: modeling and simulation.

Principal systems issues relative to computerizing patient medical records that are yet to be addressed in the scientific literature include (1) the characteristics of networks, i.e. bandwidth and capacity, and their impact on the performance of the system, (2) the architecture and the underlying algorithm of the system, (3) the location and migration of medical records, (4) scalability of the system, and (5) the nature of the performance variation under heavy and light use of the network. Key parameters that affect performance include the number of patients, doctors, frequency of patient visits, and the number of electronic queries and record entries initiated during a patient-doctor interaction episode. This paper presents AMPReD, a Distributed, Scalable, Community Care Network Architecture that aims to provide Real-Time Access to Geographically-Dispersed Patient Medical Records. The AMPReD model includes stationary hospitals and medical clinics, mobile clinics, migrating doctors as well as patients, the communications network, and the patient medical record database. AMPReD's goals include (1) the accurate modeling of the propagation of medical records and (2) providing real-time access to patient medical records from anywhere in the system. To achieve these goals, an asynchronous, distributed algorithm must be developed that achieves concurrent access of multiple, autonomous databases. AMPReD is modeled and simulated for a representative community care network on a network of workstations configured as a loosely-coupled parallel processor, for different parametric combinations of number of doctors, patients, and number of queries or record entries generated corresponding to every patient-doctor interaction episode. AMPReD defines and obtains key performance measures including the idle times of the doctors, patient waiting times, the access times of queries as functions of their sizes, and the growth of the databases. In addition, AMPReD also measures the deviation of the actual time required for a patient-doctor interaction episode from the scheduled interaction interval, as a function of the network load. For the representative system selected, performance measures indicate that the network, utilizing 1/2T1 links, and the database system poses no bottleneck to the system even where the number of doctors and patients within a 30 minute interval are chosen at 192 and 200 respectively. A T1 is a standard, digital, transmission link that is rated at 1.44Mbits/sec.

Algorithms↗
PubMed1994

Proximal tubular cell electrolytes during volume expansion in the rat.

1. Proximal tubular intracellular elements were measured by electron microprobe X-ray analysis (a) in rats volume-expanded with albumin-saline in which peritubular oncotic pressure remained normal and (b) in rats in which the renal artery was snared before volume expansion (the early snare model). Glomerular filtration rate and urine Na+ excretion were measured in addition to intracellular Rb+ following a 30 s infusion of RbCl as a marker for K+ transport. 2. In albumin-saline volume-expanded rats, intracellular levels of Na+ ([Na+]i) at 21.5 +/- 0.6 mmol (kg wet wt)-1, Cl- ([Cl-]i) at 18.0 +/- 0.4 mmol (kg wet wt)-1 and Rb+ ([Rb+]i) at 9.4 +/- 0.4 mmol (kg wet wt)-1 were significantly higher (P < 0.0001) than the levels in non-expanded rats ([Na+]i, [Cl-]i and [Rb+]i at 17.7 +/- 0.4, 14.6 +/- 0.3 and 4.7 +/- 0.4 mmol (kg wet wt)-1, respectively; means +/- S.E.M.). The data are consistent with Na+ pump inhibition in the proximal tubule, although this cannot be directly derived from intracellular element measurements. 3. In an early snare model of volume expansion, [Na+]i, intracellular K+ ([K+]i) and [Rb+]i remained unchanged (16.1 +/- 0.4, 131.0 +/- 2.0 and 5.2 +/- 0.3 mmol (kg wet wt)-1, respectively) compared to non-expanded snared kidneys (15.9 +/- 0.6, 131.3 +/- 1.8 and 4.8 +/- 0.3 mmol (kg wet wt)-1, respectively). [Cl-]i at 18.3 +/- 0.5 mmol (kg wet wt)-1 increased (P < 0.0008) compared to controls at 15.8 +/- 0.5 mmol (kg wet wt)-1. Thus, in these rats, evidence for an inhibition of the Na+ pump was no longer observed. This points to a major intrinsic mechanism within the kidney for mediating natriuresis, since circulating factors were identical to those in the unsnared kidney, where significant natriuresis occurred.

Animals↗
PubMed1994

Combined modality treatment using BID radiation for locally advanced non-small cell lung carcinoma.

BACKGROUND: From February 1988 to August 1991, 82 patients were treated on Phase II trial of split-course multimodality treatment for locally advanced, non-small cell lung cancer (NSCLC). METHODS: Treatment consisted of twice-daily radiation (150 cGy/fraction) delivered with concomitant infusional cisplatin, etoposide, and fluorouracil for 1 week every third week. Patients were classified before initial treatment as either potentially resectable (eligible for surgery [ES]) or ineligible for surgery (IES). The ES group consisted of 38 Stage IIIA and 7 Stage IIIB patients. The IES group had 5 patients staged as IIIA and 32 staged as IIIB. Most patients were staged clinically. ES patients received three cycles of treatment (39 Gy) before resection. IES patients received four cycles (60 Gy) delivered with curative intent. RESULTS: Thirty-nine of 45 ES patients underwent resection. The pathologic response rate was 27%. Three-year actuarial local control was 86% for 41 evaluable ES patients. Three-year actuarial survival for the whole ES group was 39%, with a median follow-up for living patients of 32 months. The IES group faired less well, with an 18% 3-year actuarial survival. Treatment was well tolerated with a median weight loss of one-half pound, mild or moderate pneumonitis in 5%, mild esophagitis in 15%, and severe nausea and/or vomiting in 10% of patients. Treatment-related mortality was 5%. CONCLUSIONS: Patients treated with conventional radiation alone for Stage III NSCLC are rarely cured. This well tolerated Phase II study demonstrated encouraging results for such patients. Both local control and survival appeared promising, especially in patients rendered resectable after combined-modality treatment.

Adult↗
PubMed1994

Curcumin is a non-competitive and selective inhibitor of phosphorylase kinase.

Recently, we reported that curcumin (diferuloylmethane) inhibits the growth of several different kinds of tumor cells. In order to investigate the mechanism of this inhibition, we examined the effects of curcumin on different protein kinases: highly purified protein kinase A (PkA), protein kinase C (PkC), protamine kinase (cPK), phosphorylase kinase (PhK), autophosphorylation-activated protein kinase (AK) and pp60c-src tyrosine kinase. While all kinases tested were inhibited by curcumin, only PhK was completely inhibited at relatively lower concentrations. At around 0.1 mM curcumin, PhK, pp60c-src, PkC, PkA, AK, and cPK were inhibited by 98%, 40%, 15%, 10%, 1%, and 0.5%, respectively. Lineweaver-Burk plot analysis indicated that curcumin is a non-competitive inhibitor of PhK with a Ki of 0.075 mM. Overall, our results indicate that curcumin is a potent and selective inhibitor of phosphorylase kinase, a key regulatory enzyme involved in the metabolism of glycogen. This has important implications for the anti-proliferative effects of curcumin.

Binding, Competitive↗
PubMed1994

Potential radioprotective agents. 1. Homologs of melatonin.

Homologs of melatonin were prepared by acylation of 5-methoxytryptamine with the appropriate acid chloride or anhydride. The products were administered as solutions or suspensions in soybean oil by ip injection to mice 30 min prior to irradiation with 950 cGy of 6 mV photons. Protection was achieved with all compounds, survival rate being maximal for mice treated with the hexanoic amide 5 and the octanoic amide 6.

5-Methoxytryptamine↗
PubMed1994

Potential radioprotective agents. 2. Substituted anilines.

A series of substituted anilines was examined for radioprotective activity by injecting them ip into mice subjected to a near-lethal dose of 6 mV photons. Electronegative groups such as Br, NO2, CN, and acyl in the meta or para position gave rise to highly active compounds (80-100% protection), while p-amino, methyl, amide, hydroxy, and fluoro groups decrease activity. No general correlations could be developed, however, between biological activity and a wide variety of calculated molecular parameters. The highest activity was found with p-aminobenzophenone (1), p-aminopropiophenone (2), its ethylene ketal (3), 2-amino-5-chloropyridine (35), and 5-amino-2-chloropyridine (36).

Aniline Compounds↗
PubMed1994

Differential effects of phorbol 12-myristate 13-acetate and diacylglycerols on thromboxane A2-independent phospholipase A2 activation in collage-stimulated human platelets.

We investigated the priming effects of protein kinase C (PKC) activators such as phorbol 12-myristate 13-acetate (PMA), 1,2-DiC8 and OAG, and 1,3-DiC8 (a poor activator of PKC) on thromboxane A2 (TxA2)-independent phospholipase A2 (PLA2) activation in human platelets using collagen and A23187 as agonists. We measured PLA2 activation in collagen-stimulated platelets in the presence of BW755C, which abolished TxA2 synthesis, rise in cytosolic Ca2+, and aggregation. In the presence of PMA (50 nM), the amount of arachidonic acid (AA) released in platelets stimulated with collagen and A23187 represented 300% (13.85 nmol versus 4.5 nmol) and 400% (28 nmol versus 7 nmol) of controls (without PMA), respectively, while 1,2-DiC8, OAG, and 1,3-DiC8 increased TxA2-independent AA release by 50% in A23187-stimulated platelets and had no effect on the release of AA in collagen-stimulated platelets. Interestingly, 1,3-DiC8, which is a poor activator of PKC, was as effective as the other two DAGs (OAG and 1,2-DiC8) in priming TxA2-independent PLA2 activation, but was less effective than PMA in platelets stimulated with A23187. These results suggest that the TXA2-dependent IP3-mediated rise in cytosolic Ca2+ may not be obligatory for priming PLA2 activation in the presence of PMA in collagen-stimulated platelets. In contrast, 1,2-DiC8, OAG, and 1,3-DiC8 likely enhanced PLA2 activation via intracellular Ca2+ as they selectively affect this enzyme only in A23187-stimulated platelets. We also observed a significant increase in both saturated (palmitic and stearic acids) and unsaturated fatty acids (oleic and linoleic acids) in platelets stimulated by collagen or A23187 in the presence of PMA (50 nM), but not in the presence of DAGs. These findings imply that PMA may also affect the activation of DAG/MAG lipases, PLA1, or nonspecific PLA2. Since both 1,2-DiC8 and OAG exert no significant effect on the release of these fatty acids, the effects observed with PMA on DAG lipase/PLA1 may not involve a PKC-dependent mechanism. We, therefore, conclude that the mechanisms by which PMA and DAGs prime PLA2 activation are different and that the priming mechanism by DAGs may not involve PKC, but may require a rise in intracellular Ca2+.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗
PubMed1994

1,3-Dioctanoylglycerol (1,3-DiC8) is as effective as 1,2-dioctanoylglycerol (1,2-DiC8) in priming phospholipase A2 activation in human platelets and neutrophils.

In the present study, we investigated the effects of different diacylglycerols in comparison with phorbol 12-myristate 13-acetate (PMA) on eicosanoid-independent phospholipase A2 (PLA2) activation in human platelets and neutrophils. Eicosanoid-independent PLA2 activation was measured under conditions where both cyclooxygenase and lipoxygenases were blocked by BW755C. In the presence of PMA (50 nM), the amount of mass arachidonic acid (AA) released represented 400 and 257% of control (without PMA) in A23187-stimulated platelets and neutrophils, respectively, while 1,2-dioctanoylglycerol (1,2-DiC8) and 1-oleoyl-2-acetyl-sn-glycerol (OAG) had increased the eicosanoid-independent AA release by 150 and 117-134% of control, in platelets and neutrophils, respectively. Our results further demonstrate that 1,3-dioctanoylglycerol (1,3-DiC8), a poor activator of protein kinase C (PKC), is nearly as effective as diacylglycerols, such as OAG and 1,2-DiC8 (activators of PKC) in priming PLA2 activation, but is less effective than PMA as a priming agent. However, all three diacylglycerols were less effective than PMA as priming agents. Furthermore, diacylglycerols including 1,3-DiC8 exerted a much greater effect on PLA2 activation in platelets than in neutrophils. Neither 1,3-DiC8 nor 1,2-DiC8 and OAG had any significant priming effect on the accumulation of palmitic and stearic acids, while PMA caused a substantial accumulation of these fatty acids in platelets, but not in neutrophils. We also found that exogenously added OAG underwent significant hydrolysis even in unstimulated platelets, but not in neutrophils, suggesting that exogenously added OAG may be readily accessible for diacylglycerol (DAG) lipase/PLA1 in platelets.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachidonic Acid↗
PubMed1994

Characterization of peripheral blood and ovarian cancer-infiltrating lymphocytes: effect of HIV infection on phenotypic expression and proliferative response.

A study that focused on the identification of the phenotype and proliferative responses of peripheral blood and ovarian cancer-infiltrating lymphocytes in a patient with stage III ovarian cancer who had human immunodeficiency virus infection is presented. Monoclonal antibodies and flow cytometry were used to determine the phenotypic expression, while thymidine incorporation response to stimulation by phytohemagglutinin and concanavalin A was used to determine the proliferative response. These immunologic characteristics were compared with the results of similar analyses performed in four HIV-seronegative patients with stage III ovarian cancer. The CD4:CD8 ratio in peripheral blood and ovarian tumor in the HIV-seropositive patient was 0.43:1 and 0.46:1, respectively, while in the four seronegative patients it was 1.83:1 and 0.64:1, respectively. The absolute and mean CD4 counts in the peripheral blood in the HIV-seropositive patient and HIV-seronegative patients was 260/mm3 and 707/mm3 (611-743), respectively, while in the ovarian tumor the percentage distribution of CD4 was 13 and 21% (9-44%), respectively. Despite there being intratumor immunosuppression in all five cases, the proliferative response was most markedly suppressed in the HIV-seropositive patient. Although surgery and chemotherapy were well tolerated, the HIV-seropositive patient died 6 months later with rapidly progressive disease. The remaining four HIV-seronegative patients are all alive, between 9 and 14 months postoperatively.

Aged↗
PubMed1994

The benzodiazepines as adjuvant analgesics.

There has been long-standing debate regarding whether benzodiazepines possess analgesic properties that are independent of their effects on mood and alertness. A careful review of the literature reveals insufficient evidence to support the contention that the benzodiazepines have meaningful analgesic properties in most clinical circumstances. Treatment with the benzodiazepines may reduce complaints of pain, but this seems to be an indirect effect related to their psychotropic properties, such as alleviation of anxiety and, in selected cases, depression. In the absence of definitive data, clinical experience suggests a potential role for treatment with benzodiazepines for acute muscle spasm, concomitant chronic pain and anxiety, and lancinating neropathic pain, in which case clonazepam and alprazolam may be the agents of choice. They should probably not be considered as first-line choices even for the above indications, since potential benefits must be considered in the context of potential for the development of cognitive impairment, physical and psychological dependence, worsening depression, overdose, and other side effects.

Adjuvants, Pharmaceutic↗
PubMed1994

The neuroleptics as adjuvant analgesics.

The role of neuroleptic drugs as adjuvant analgesics has been a subject of longstanding controversy. Despite frequent claims of efficacy, evidence from controlled trials supports neither claims of intrinsic analgesic properties nor the routine use of the neuroleptics as a means to reliably induce clinically useful analgesia. Methotrimeprazine is unique in that there is evidence for reliable dose-related analgesia that is comparable to opioid-mediated analgesia, although routine use is not recommended. Despite probable interaction with opioid receptors, there is insufficient evidence to support a role for the butyrophenone category of neuroleptics as adjuvant analgesics. Limited trials of the neuroleptics may be considered for pain that has been unresponsive to more conventional pharmacologic approaches, especially when associated with headache, nerve injury, or psychological distress. The neuroleptics have an important role in the symptomatic management of agitation, delirium, and nausea, particularly in patients with cancer.

Analgesics↗