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PubMed1995

Case report: analgesic nephropathy: a soda and a powder.

Analgesic nephropathy has long been considered a potentially preventable cause of renal disease. Early reports were described in patients who consumed analgesics containing phenacetin. In recent data, the removal of phenacetin from analgesic preparations resulted in a reduction in analgesic-induced end stage renal disease in Europe and Australia. However, a reduction in the incidence of analgesic nephropathy has not occurred uniformly, suggesting that phenacetin is not the sole cause. Current data raise concerns regarding adverse renal effects of acetaminophen and nonsteroidal antiinflammatory drugs. Aspirin taken alone may be of least concern. The diagnosis of analgesic nephropathy is suggested in subjects with chronic renal failure, a history of daily consumption of analgesic preparations, small bumpy kidneys, and renal papillary necrosis or chronic interstitial nephritis. However, the spectrum of disease may be changing, because these agents also may increase the risk of cardiovascular disease and chronic renal disease due to nephrosclerosis, glomerulonephritis, and diabetes mellitus. Potential pathogenetic mechanisms in analgesic nephropathy include direct cellular injury induced by analgesics, prostaglandin inhibition with reduction or redistribution of renal blood flow, and interesting new concepts regarding the role of caffeine in increasing oxygen demand and reducing oxygen supply in the medulla. The primary goal of therapy is discontinuation of analgesic consumption. Because of the association between analgesic intake and uroepithelial tumors, surveillance of patients for neoplasm is suggested.

Analgesics↗
PubMed1992

A 1-year follow-up of prescribing patterns of analgesics in primary health care.

The prescription of analgesics and anti-inflammatory drugs (analgesics) was studied using computerized patient records from a Finnish health centre with a population base of some 27,000 inhabitants. A random sample of every fifth patient visiting the health centre in 1986 was chosen. This study sample consisted of 4,577 patients with 17,021 physician contacts and altogether 14,035 prescriptions during the 1-year follow-up: of these analgesics comprised 14.8%. The proportion of the study population who received at least one analgesic prescription was 23 +/- 1.2% (95% CI). The use of physician contacts as a base revealed 10.7 +/- 0.5% (95% CI) of the contacts with an analgesic prescription. The exposure to analgesics among males increased with age from 17% for those aged 15-34 years to 34% for those aged 75 years or more. Among women, exposure to analgesics increased from 17% (15-34 years) to 41% (75 years or more). Most of patients who received analgesic prescriptions were incidental users (one or two analgesic prescriptions per year). Only 4% of women and 3% of men were categorized as heavy users of analgesics (seven or more analgesic prescriptions per year). The proportion of heavy users increased with age and was highest in the oldest age-group (75 years or more). In order to make informed policy judgements about drug use in society, we need routine sales statistics and patient-specific drug-use data such as those presented in this paper.

Adolescent↗
PubMed1999

Factors determining analgesic and sedative drug requirements during extracorporeal shock wave lithotripsy.

PURPOSE: The aim of this study was to determine what factors influence the analgesic and sedative requirements during extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A retrospective study was carried out on 2,103 lithotripsy treatments performed over a 7-year period using an electromagnetic lithotriptor. Treatment with analgesics and anxiolytic drugs administered during ESWL was evaluated, and two new variables to determine the analgesic and sedative requirements were defined. A multivariant analysis model was established to determine which variables are related to or could predict the analgesic and/or sedative drug requirements. RESULTS: The most frequently used sedative drug was potassium chlorazepate which was used in 2,059 patients at a mean total dose of 25.6 mg. Pethidine was used in 2, 006 patients at a mean total dose of 56.3 mg, and fentanyl in 995 patients at a dose of 93.3 microg. In 52.4% of patients analgesic requirements were low, and in 76.6% sedative requirements were low. In 21.1% of patients analgesic drug requirements were high, and in 1. 8% of patients sedative drug requirements were high. The multivariant analysis showed that those requiring most analgesics were, the younger patients (p = 0.003), those who received a higher number of shock waves (p < 0.001) and those who needed more sedation (p < 0.001). Those who received the greatest amount of sedatives were women (p = 0.0026); younger patients (p < 0.001); those treated with higher voltages (p = 0.032), and patients with the highest analgesic requirements (p < 0.001). CONCLUSIONS: Predicting the analgesic drug requirements prior to ESWL is very difficult. The present study shows that young age, a greater discharge of shock waves and a high sedative drug requirement are factors clearly related to greater analgesic drug requirements. Higher sedative drug requirements are needed by women, younger patients, those receiving high discharge voltages and those with higher analgesic requirements.

Adult↗
PubMedDate not supplied

Factors associated with suboptimal analgesic use in community-dwelling elderly.

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred in 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk in consistently increased in those who are depressed or have impaired physical functional status.

Aged↗
PubMed2000

[Evaluation of the relationship between the occurrence of headache, use of analgesics and realizing a therapeutic effect among patients with hypertension].

The aim of the study was to assess the prevalence of headaches and analgesic use in hypertensive patients and to evaluate the relationship between taking analgesic drugs and adherence to antihypertensive therapy. 754 consecutive hypertensive patients (446 women and 308 men, aged 18-89 years, median age--58 years) from 7 out-patient centres participated in the study. Anonymous questionnaires consisted of 13 simple questions concerning demographic parameters (age, gender), clinical data (the duration of hypertension and antihypertensive therapy), the history of headache and use of analgesics were distributed among the participants. Among the hypertensives participating in the study, 82.9% (625) reported headaches. Analgesics were used by 65.3% (408) of hypertensive patients with headaches. There was significant, positive linear correlation between the history of headaches and the duration of analgesic use in hypertensive patients. The rate of non-compliance was significantly higher among patients with headaches who reported regular use of analgesics when compared to non-users of analgesics. There were statistically more non-compliants among patients taking more than 1 type of analgesics than in hypertensives reporting use of only 1 analgesic drug. The prevalence of headaches and the rate of analgesic use is considerably significant among hypertensive patients. Analgesic consumption seems to be a risk factor for non-adherence to antihypertensive medication.

Adult↗
PubMed2005

[Long-term prognosis of analgesics abuse headache].

OBJECTIVE: To evaluate the long-term prognosis of analgesics abuse headache. METHODS: Ninety-five consecutive patients with analgesics abuse headache were treated in Toyonaka Municipal Hospital. Seventy-three patients (76.8%) had migraine, eighteen (19.0%) had tension-type headache and four (4.2%) new daily persistent headache. Seventy-seven (81.1%) were females and eighteen (18.9%) males. All patients were treated for six years from November 1997 to October 2003 and a total of sixty-nine patients were available for interview as of October 2004 at a mean time interval of 41.5 months after drug withdrawal therapy. Twenty-two patients were admitted to our inpatient withdrawal unit, twenty-five patients were treated by outpatient withdrawal therapy. Tapering analgesics gradually in conjunction with instituting preventive therapy treated twenty-two patients. RESULTS: Inpatient-Nine cases (41%) reported intake of analgesics on < or = 8 days/month, five cases (23%) on 9-15 days/month and eight cases (36%) > 15 days/month. Three cases (14%) developed recurrent analgesic abuse. Outpatient (abrupt discontinuation)--Twelve cases (48%) reported intake of analgesics on < or = 8 days/month, five cases (20%) on 9-15 days/month and eight cases (32%) >15 days/month. One case (4%) reported on recurrent analgesic abuse. Outpatient (tapering analgesics gradually)--One case (5%) reported intake of analgesics on < or = 8 days/month and twenty-one cases (95%) reported daily intake. Fifteen cases (68%) reported continuous analgesic abuse. Comparison between migraine and tension-type headache suggested that patients with migraine showed a tendency towards a better prognosis than patients with tension-type headache. CONCLUSIONS: These results demonstrate the efficacy of withdrawal treatment in difficult cases suffering from analgesics abuse headache. If patients cannot be safely or adequately treated as outpatients, inpatient treatment may be needed.

Adult↗
PubMed1982

Epidemiology of analgesic nephropathy in Belgium.

The incidence of analgesic nephropathy in patients with terminal renal failure (AN-TRF) was evaluated by questioning all the dialysis units in Belgium. The results were analyzed with respect to the distribution of the analgesic market in Belgium. Replies were received from 46 of the 49 dialysis units for adults. Of the 1,400 patients treated in these units, 258 (18.4%) have AN. Furthermore, AN was more frequent in the neighbourhood of Antwerp than in the other Belgian provinces (100 AN-TRF/million adults vs 19; 36% of TRF vs 14%, P less than 0.001). The number of patients treated by hemodialysis per million adults was correlated well with the number of AN-TRF/million adults in the various areas of Belgium (r = 0.73, P less than 0.05). 265 tons of analgesics (35 g/adult/year), including 55 tons of phenacetin (7 g/adult/year) are sold each year in Belgium. Among the five most popular drugs in Belgium, three are analgesics containing acetylsalicylate-phenacetin or phenazone or paracetamol-caffeine. These three analgesics are made in the neighbourhood of Antwerp, no such analgesics are made in other areas of Belgium. No correlation exists between the geographic distribution of AN-TRF and the distribution of other widely-used over-the-counter drugs such as laxatives, non-phenacetin-containing analgesics and even analgesics which contain phenacetin but which are not made in Belgium. Conversely, the distribution of AN-TRF was well correlated with that of the sale of an analgesics made in the neighbourhood of Antwerp (r = 0.79, P less than 0.001). Belgium thus has, after Australia, the second highest incidence of analgesic nephropathy in the world. The geographic distribution of AN-TRF inside Belgium correlates with the existence of analgesic factories in the neighbourhood of Antwerp.

Acetaminophen↗
PubMed1993

Prescription and use of analgesics in dogs and cats in a veterinary teaching hospital: 258 cases (1983-1989)

The frequency of prescribing analgesics and administering them for the treatment of apparent postoperative pain in 243 dogs and 15 cats was evaluated. Surgeries performed on the animals evaluated included limb amputations, limb-sparing bone cancer resection, thoracotomy, cervical vertebral instability repair, and humeral fracture repair. Only 1 cat was treated once with an analgesic after surgery, and cats were not evaluated statistically. Dogs undergoing amputation, limb salvage procedure, or thoracotomy were more likely to be treated than dogs undergoing the other surgeries. Ninety-six (40%) of the 243 dogs were under the influence of an analgesic at any time during their postoperative hospital stay, and 69 dogs (28%) received 1 or more doses of an analgesic after recovery from general anesthesia. One hundred thirty-three dogs were cared for in the intensive care unit (ICU) immediately after surgery. Written instructions for treatment with an analgesic were given for 61 of those dogs, and 50 were given at least 1 dose of the prescribed analgesic. Dogs cared for in the ICU were twice as likely to be given an analgesic as dogs cared for in the surgery ward. The estimated duration of analgesic effect exceeded 8 hours in 46 (19%) of 243 dogs. Small and juvenile dogs were least likely to be treated. Interns and residents were twice as likely as faculty to administer analgesics. Most written interpretations of pain behavior observed in the ICU were made on the basis of vocalizations. Half of the dogs for which medical record comments suggested moderate to severe pain were not given an analgesic. The most frequently administered analgesic immediately following surgery was oxymorphone, followed by butorphanol and morphine. Aspirin was never administered to dogs in the ICU, but was used in 10 dogs that were in the surgery ward for > 74 hours.

Amputation, Surgical↗
PubMed1985

[The pharmacologic effect of flupirtine, a structurally new analgesic].

The analgesic potency of ethyl-N-[2-amino-6-(4-fluorophenylmethylamino)pyridin-3-yl]carb ama te (flupirtine, D 9998) in mice and rats in Haffner's test, electro-pain test and Randall-Selitto test (inflammation induced pain) lies between the more potent dextromoramide and methadone and the more weakly active pethidine, dextropropoxyphene, codeine, phenacetin and paracetamol. In comparison to codeine flupirtine is up to 4 times more potent, up to 2 times more active than pethidine and 4 times more potent than dextropropoxyphene in the above-mentioned methods. With one exception of inflammation induced pain, where flupirtine shows an activity of about 1 1/2 times that of phenacetin and paracetamol, both analgesics are about 10 to nearly 30 times less active than flupirtine in other above-mentioned tests. In the hot plate test flupirtine is twice as active as codeine and approximately 10 times more active than phenacetin and paracetamol. The weakest analgesic activity of flupirtine is seen in acetic acid test where it is about half as active as codein and approximately as active as dextropropoxyphene. Nevertheless, flupirtine is up to 10 times more potent than phenacetin and paracetamol. The acetic acid test is claimed to be non-specific according to our own experience and to other authors. Flupirtine is enterally absorbed at a higher degree than the other tested centrally acting analgesics. In regard to the results of various analgesic investigations in mice and rats flupirtine can be classified as a medium to strong acting analgesic. The duration of action of flupirtine is comparable to that of codeine. Experiments with flupirtine suggest that there are some convincing criteria for a pronounced central acting component of its analgesic activity. These criteria are the strong efficacy in the hot-plate and Haffner's test, in which only centrally acting analgesics show distinct effects, and the finding that flupirtine increases the pain threshold for vocalisation in rats and mice excluding a pure reflex of the spinal cord. In current experiments concerning the mode of action flupirtine exhibits a distinct central analgesic component of action. In spite of its relatively high analgesic potency which corresponds to that of opiates flupirtine does not show any other signs of opiate properties and other potent analgesics. Thus, flupirtine does not develop tolerance in mice and rats after 19 or 17 days of daily administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Aminopyridines↗
PubMed1993

[Analgesic efficacy and the tolerance for piroxicam-beta-cyclodextrin compared to piroxicam, paracetamol and placebo in the treatment of postextraction dental pain].

INTRODUCTION: Acute postoperative pain is a common experience in oral surgery practice. Non-steroidal anti-inflammatory drugs (NSAIDs) are quite effective against mild to moderate pain and they are generally better suited in ambulatory outpatients than narcotic analgesics. The analgesic activity of piroxicam, a well known NSAID has been documented in many pain states. Piroxicam can be administered once daily because of its long half-life, but its absorption in the gastrointestinal tract is slow as it is its onset of action. Piroxicam-beta-cyclodextrin (PBCD) is a new formulation of piroxicam which is the product of supermolecular encapsulation of piroxicam with the cyclic oligosaccharide beta-cyclodextrin. PBCD is absorbed much faster than standard piroxicam, and its action as an analgesic is consequently more rapid. The purpose of this study was to assess the efficacy and the rapidity of action of piroxicam-beta-cyclodextrin in comparison with standard piroxicam, paracetamol and placebo following surgical extraction of impacted third molars. MATERIALS AND METHODS: The study population was composed of 32 patients of both sexes and in good health. To be included into the study, patients must have had third molar removal resulting in acute post-surgical pain of at least moderate intensity. The patients were then randomly assigned to one of four treatment groups. PBCD 20 mg tablets; piroxicam 20 mg capsules; paracetamol 500 mg tablets, or placebo. The study was conducted according to a double-blind, double-dummy design. Pain intensity and pain relief were recorded at 0.5, 1, 1.5, 2, 3, 4 hours after a single dose of the study drugs, by means of a Keele-type rating scale. Rescue analgesics were not allowed before one and a half hour after taking the study drugs. A global evaluation of study drugs was expressed by patients at the end of the observation period. RESULTS: Treatment groups were homogeneous for demographic characteristics of the patients and for pain intensity at the time of medication with study drugs. All patients who received placebo requested supplemental analgesics, while none of the patients treated with the active drugs needed rescue analgesics. PBCD and paracetamol were comparable for their analgesic effect, while the time lag before a significant reduction of pain intensity with piroxicam was longer. Piroxicam and PBCD were superior to paracetamol because they showed a substantial analgesic effect through the 4-hour study duration, while paracetamol did not induce a complete relief from pain. DISCUSSION: One of the most commonly utilized model for the evaluation of analgesics is the third molar extraction pain. Our study clearly differentiated between active drugs and placebo. Furthermore, while PBCD and paracetamol showed a rapid effect, piroxicam was slow in inducing pain relief. The analgesic and anti-inflammatory activity of PBCD and piroxicam brought about the resolution of pain and inflammation consequent to the dental extraction. Paracetamol, a pure analgesic, was not equally active and pain persisted, even if at a low grade, throughout the observation period; probably this was due to local inflammation and edema. The results of our study appear to confirm the pharmacokinetic data on PBCD, which showed that therapeutic blood levels are reached faster with PBCD than with the standard piroxicam formulation. This results should be confirmed in studies with an adequate number of patients.

Acetaminophen↗
PubMed2004

Analgesic prescription patterns among hemodialysis patients in the DOPPS: potential for underprescription.

BACKGROUND: Dialysis patients require special consideration regarding analgesics, given their altered pharmacokinetic and pharmacodynamic profiles and increased potential for adverse reactions. METHODS: Analgesic prescription patterns were investigated using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), with 3749 patients in 142 United States facilities studied between May 1996 and September 2001. RESULTS: The proportion of patients prescribed any analgesic decreased from 30.2% to 24.3%; narcotic prescriptions decreased from 18.0% to 14.9%. The most commonly prescribed narcotics were propoxyphene/acetaminophen combinations (47.2%). Combinations containing acetaminophen were prescribed concurrently for 84.1% of patients on narcotics. About one half of prescriptions for narcotics, acetaminophen, and cyclooxygenase-2 (COX-2) agents were for 12 months or more; one half of prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) were for 8 months or more. The proportion of patients prescribed analgesics varied by facility (mean +/- SD = 27.9%+/- 18.9% for all analgesics, range 0% to 89.3%). Analgesic prescription was more likely among the elderly, women, and patients with cardiovascular disease (other than coronary artery disease or congestive heart failure), lung and psychiatric disease, cancer (other than skin), and recurrent cellulitis. Patients prescribed laxatives were almost twice as likely to be on a narcotic (odds ratio = 1.95, P < 0.0001). Analgesic prescription did not correlate with loss of residual renal function or hospitalization for a gastrointestinal disorder. Three-quarters of patients reporting moderate to very severe pain were not prescribed analgesics. Furthermore, 74% of patients with pain that interfered with work had no analgesic prescription. CONCLUSION: Dialysis patients and providers may benefit from both refinement of existing guidelines and a renewed understanding regarding appropriate prescription of analgesics.

Acetaminophen↗
PubMed1995

Determination of analgesic interaction between acetaminophen and d-propoxyphene obtained by means of the surface of synergistic interaction.

The analgesic effects of acetaminophen, p.o., (ACE) and d-propoxyphene, s.c., (PROP) administered either separately or in 24 different combinations were determined in a model of pain-induced functional impairment in the rat. This allowed us to detect the analgesic interaction profile of the combinations. Furthermore, we set out to determine the optimal degree of enhancement obtained with a specific combination of the above drugs by means of the surface of synergistic interaction (SSI) of the combinations. This parameter was calculated from the total analgesic effect produced by the combination after having subtracted the analgesic effect produced by each drug alone. The ED50s for ACE and PROP were 286.1 +/- 1.4 mg/kg and 66.3 +/- 1.2 mg/kg, respectively. Over the dose ranges used, the analgesic activities of both ACE and PROP tended to be smaller than those of their respective combinations. Furthermore, 11 combinations showed various degrees of enhancement (p<0.01), while the others (13) exhibited additive analgesic effects. The combination of ACE (562.3 mg/kg) and PROP (56.2 mg/kg) produced the maximum analgesic effect. However,5 combinations of ACE with PROP (177.8-56.2, 316.2-10.0, 316.2-17.8, 316.2-56.2 and 562.3-10.0 mg/kg) produced the highest enhancement. The SSI clearly showed which combination of these analgesic drugs produced the highest degree of enhancement in the rat. This study shows that a specific combination ratio of analgesic drugs can produce optimum enhancement of their analgesic effects.

Acetaminophen↗
PubMedDate not supplied

Psychotropic adjuvant analgesics for pain in cancer and AIDS.

The 'WHO Analgesic Ladder' is a well validated approach for the selection of appropriate analgesic therapy for cancer pain as well as pain in AIDS. The mainstay of analgesic intervention for cancer and AIDS pain of moderate to severe intensity continues to be the appropriate use of opioid analgesics. There is, however, a growing appreciation for the role of adjuvant analgesics, such as antidepressants and other psychotropic medications, at each step of the WHO Analgesic Ladder, particularly in the treatment of neuropathic pain. Knowledge of the indications and usefulness of psychotropic analgesic drugs in cancer and AIDS pain populations will be most important to clinicians practicing in psycho-oncology/AIDS settings, particularly since these drugs are useful not only in the treatment of psychiatric complications of cancer and AIDS, but also as adjuvant analgesic agents in the management of pain. This paper reviews the literature on the use of antidepressants, psychostimulants, neuroleptics, anticonvulsants and other psychotropic analgesics in the management of cancer and AIDS pain. Mechanisms of analgesia, drug selection, and recommendations for clinical usage are discussed. The appropriate and timely use of psychotropic adjuvant analgesic drugs represents an opportunity for active psychiatric contribution to the multidisciplinary management of cancer and AIDS pain.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Epidemiology and mechanistic basis of analgesic-associated nephropathy.

End-stage renal failure (ESRF) due to analgesic nephropathy is still a common clinical condition in several countries, but the prevalence in dialysis patients shows large geographical differences. The frequency of ESRF of unknown aetiology is the inverse of that linked to analgesic abuse, and data suggest that the occurrence of analgesic nephropathy may be underestimated. The study of analgesic nephropathy is difficult because the earliest damage to the kidney is a renal papillary necrosis (RPN), which cannot easily be diagnosed. Continued analgesic abuse generally leads to a progressive secondary cortical degeneration which is easier to diagnose. If analgesic abuse is stopped at an early enough stage in nephropathy, clinical symptoms stabilize or improve, and ESRF may be averted. A high incidence of upper urothelial carcinoma (UUC) is also observed in individuals with a history of analgesic abuse, but it is still not clear if the two have a related pathogenesis. Study of the mechanism of RPN in animals administered analgesics and nonsteroidal antiinflammatory drugs (NSAID) has been difficult owing to their extrarenal toxicity. Several model compounds cause identical clinical changes and have as their selective target the renal medullary interstitial cells; subsequently, other changes (including cortical and glomerular degeneration) develop as a secondary cascade. A number of mechanisms have been proposed to explain RPN (e.g., counter-current concentrating mechanism, ischaemic injury, altered prostaglandin metabolism, immunological changes), but peroxidative metabolism of papillotoxic chemicals within the interstitial cells seems to be the most likely cause. Analgesic abuse is a costly socioeconomic condition for which there is currently no clinical treatment. If it is diagnosed early enough, severe renal degeneration can be prevented. Additional epidemiological information is needed to establish the causative role of analgesics and other chemicals, in order to determine the relative risk of each. Additional animal experiments are needed in order to clarify the molecular pathogenesis of RPN and UUC, to differentiate the stages in progression to ESRF and to develop more sensitive and selective diagnostic criteria.

Analgesics↗
PubMed1998

Analgesic use and chronic renal failure: a critical review of the epidemiologic literature.

Heavy use of analgesics, particularly over-the-counter (OTC) products, has long been associated with chronic renal failure. Most of the earlier reports implicated phenacetin-containing analgesics as the risk factor. Since the early 1980s. several case-control studies have reported associations between chronic renal failure and use of other forms of analgesics, including acetaminophen, aspirin, and other non-steroidal antiinflammatory drugs (NSAIDs). Findings from these studies, however. should be interpreted with caution because of a number of inherent limitations and potential biases in the study design and data collection procedures. These limitations include: failure to identify patients early enough in the natural history of their disease to collect reliable information on analgesic use at an etiologically relevant time period; selection bias due to incomplete identification of subjects or low response rates; selection of cases and controls from different population bases; failure to employ survey techniques to improve reliability of recall of analgesic use; failure to collect detailed information on analgesic use such as year started and ended and reasons for switching analgesics; lack of standardization in the definition of regular analgesic use; and failure to adjust for phenacetin use and other confounding factors when assessing associations with analgesics other than those containing phenacetin. It is our hope that this review of study design limitations will lead to improvements in future studies of chronic renal failure risk. Since use of analgesics is widespread and new OTC products are introduced frequently, the potential impact of these drugs on the development of chronic renal failure may be significant, thus warranting continued evaluation of these products for any renal toxicity.

Analgesics↗
PubMed2000

Renal and related cardiovascular effects of conventional and COX-2-specific NSAIDs and non-NSAID analgesics.

On a daily basis it appears that as many as one in five adults in the United States may consume an analgesic compound either on a prescription basis or by over-the-counter (OTC) purchase. This high profile of intermittent or repetitive analgesic use appears to be relatively similar throughout the developed world. Although analgesics generally have a good renal safety profile, the nonsteroidal anti-inflammatory drug (NSAID) analgesics may produce mild renal side effects, such as the generation of peripheral edema in up to 5% of the general population. Other more serious renal and related cardiovascular side effects tend to be more apparent in lesser numbers of clinically "at risk" NSAID analgesic users. In contrast, non-NSAID analgesics, such as paracetamol or tramadol, have essentially no renal or related cardiovascular side effects when used at recommended dosing schedules. This review characterizes the renal syndromes associated with the use of NSAID analgesics, identifies the risks inherent in the use of these compounds in treated patients with hypertension and congestive heart failure, summarizes the early comparable data available for the new COX-2-specific inhibitors, and profiles the scant acute and long-term clinical concerns attendant with the use of non-NSAID nonnarcotic analgesics. It is important that healthcare providers and practitioners are aware of the relative renal risks of different analgesics and that they use this knowledge to counsel the analgesic-consuming population appropriately.

Acetaminophen↗
PubMedDate not supplied

Analgesic addiction and pseudoaddiction in painful chronic illness.

OBJECTIVES: Research is needed to enable more effective assessment and treatment of analgesic addiction among patients with painful chronic illnesses and to improve our understanding of the staff-patient interactions that give rise to pseudoaddiction. This study tested predictions that certain drug-use behaviors and pain-coping strategies were associated with analgesic addiction, and that certain were associated with risk of pseudoaddiction. METHODS: Analgesic addiction and risk of pseudoaddiction among patients with sickle cell disease were measured by symptom counts, using an interview method for classifying symptoms as pain-related (pseudoaddiction) or non-pain-related (analgesic addiction). Concern-raising drug-use behaviors and treatment requirements for pain were also assessed, and participants completed the pain-coping strategies questionnaire. Qualitative case descriptions of patients meeting criteria for analgesic addiction and pseudoaddiction were examined to identify common and distinctive features of the two groups. RESULTS: Consistent with predictions, multiple regression analyses showed that disputes about analgesics were independently associated with risk of pseudoaddiction. Physiological dependence and illicit drug use were both associated with analgesic addiction, independently of other factors. The qualitative data showed that analgesic addiction was not an obvious, clear-cut phenomenon: addiction and pseudoaddiction were superficially similar, and even symptoms of genuine addiction originated in patients' experiences of pain and illness. CONCLUSIONS: These tentative findings were broadly consistent with what is known about analgesic addiction and pseudoaddiction in other painful conditions. They also suggested that current recommendations about addiction in pain patients could understate the potential importance of physiological dependence. The findings could inform staff training programs to improve pain management and reduce the incidence of pseudoaddiction. The classification of pain-related and non-pain-related symptoms could be used in further research on the development of analgesic addiction and the factors that influence staff attributions about addiction in patients with pain.

Adult↗
PubMed1994

Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia.

1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5. We conclude that nalbuphine (mean dose 0.13 mg kg-1) and pethidine (mean dose 1.35 mg kg-1), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.

Adolescent↗