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PubMed2001

Successful withdrawal from analgesic abuse in a group of youngsters with chronic daily headache.

Abuse of ergotamine and analgesics is common in adults. It coexists with headache and can also induce headaches. Ten to 15% of patients attending headache clinics and 1% of the general population suffer from chronic daily headache due to medication misuse. Indeed, this phenomenon was recently regarded as an epidemic. Nonetheless, analgesic-induced headache in children and adolescents was first reported in 1998. We report on our experience with children and adolescents with daily or almost-daily headache concomitant with daily or almost-daily analgesic intake. Over a period of 3 years, we evaluated 26 children (19 girls and 7 boys) with chronic daily or near-daily headache related to daily analgesic intake. The mean age of the group was 14.2 years (range, 12-18), and the mean headache history duration was 1.6 years (range, 3 months to 4 1/2 years). The mean number of headache days per month was 28.1 (range, 19-31). All patients had no history of migraine prior to the chronic headache phase according to the International Headache Society criteria. They were using at least one dose of analgesic drug for each headache, whereas 16 were using analgesic drugs daily. The weekly analgesic intake averaged 28.1 tablets (range, 19-41). The majority abused simple analgesics. Twenty-one took acetaminophen alone. Five took a combination; four took a compound containing acetaminophen, caffeine, and codeine; and the fifth patient took a compound containing aspirin, caffeine, and codeine. All patients were informed about the phenomenon of medication-induced headache and were encouraged to achieve drug withdrawal. Withdrawal led to complete cessation of all headaches in 20 patients. In 5 patients, the daily headache resolved; however, they suffered from intermittent episodic migraine attacks, which were frequent enough in 3 to initiate prophylactic medication. One adolescent continued to have daily headache. Analgesic-induced headache does occur in adolescents. Successful withdrawal from the offending analgesics was achieved without hospitalization or significant interference with daily life and with complete disappearance of the induced chronic daily headache in 25 of 26 patients.

Adolescent↗
PubMed1997

Clinical consequences of nonnarcotic analgesic use.

The accuracy of the economic analysis of the selected adverse events evaluated by McGoldrick and Bailie is questionable. The quantitative perspective on the economics of the adverse events associated with nonnarcotic analgesic use proposed by these authors is limited by the fact that they have combined data on over 30 different NSAIDs into a single value for comparison with two single-entity agents: acetaminophen and aspirin. The relative prevalence of major organ system toxicities varies markedly among the NSAIDs, and this variance invalidates the use of a class conclusion approach. Their conservative incidence estimates, the lack of data in some areas (i.e., hepatic injury), and the exclusion of combination analgesics further limit the utility of their conclusions. However, it is difficult to argue authoritatively that the relative costs of toxicities associated with the three analgesic classes they reviewed are not representative. The ultimate question is, "What is the optimal analgesic for a given patient?" This question can be addressed only if one considers the underlying cause of pain, its chronicity/acuity, the patient's concurrent disease states, if any, and the potential for drug interactions with the patient's concomitant medications. McGoldrick and Bailie concluded on an economic basis that acetaminophen is the analgesic of choice for most patients, including those with impaired renal function. This recommendation is in agreement with those of the Analgesics and the Kidney Ad Hoc Committee of the National Kidney Foundation. It also would seem prudent to use acetaminophen as the first-line agent for those patients in whom aspirin and NSAID use should be avoided or used only with caution along with frequent monitoring of renal function, blood pressure, electrolytes, and/or coagulation status. Thus, there is little to no controversy in their recommendation to initiate treatment with acetaminophen. The authors, however, also suggested that switching patients from an NSAID to acetaminophen would result in significantly decreased costs and morbidity. These authors, however, did not address one key issue that impacts their economic analysis: the relative efficacy of acetaminophen and NSAIDs. If efficacy is similar, then the risk/benefit ratio and economic consequences would favor the use of acetaminophen. However, if many patients are receiving NSAIDs because they did not obtain pain relief with the use of acetaminophen, there would be neither rationale or likely benefit with a change in therapy to acetaminophen. Finally, McGoldrick and Bailie did not evaluate an issue that has perhaps the most far-reaching consequence. Many OTC analgesics are currently marketed as combinations of aspirin, acetaminophen, salicylamide, or caffeine (Table 2). Although the intent of these combinations was [Table: see text] to enhance efficacy while minimizing adverse events, it is now apparent that at least concerning adverse events, the goal was not achieved. Therefore, in light of the markedly higher risk for renal injury with combination analgesics, these agents should be withdrawn from the marketplace. While some might argue that patient education is the key and that addition of an explicit warning on the label of OTC combination products should be an adequate intervention, this agreement is not supported by the Belgium experience. The removal of combination analgesics from the OTC marketplace could be accomplished by governmental action, such as the ban on phenacetin over 10 years ago. Alternatively, pharmacists could no longer sell these products and counsel patients on the rational use of OTC analgesics. The choice among single-entity agents could then be individualized on the basis of patient's current medical status and the adverse event profile of the available agents.

Acetaminophen↗
PubMed2003

Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study.

OBJECTIVE: To examine the relation between analgesic use at baseline and the subsequent risk of chronic pain (> or =15 days/month) and the risk of analgesic overuse. METHODS: In total, 32, 067 adults reported the use of analgesics in 1984 to 1986 and at follow-up 11 years later (1995 to 1997). The risk ratios (RR) of chronic pain and RR of analgesic overuse in the different diagnostic groups (i.e., migraine, nonmigrainous headache, neck pain, and low-back pain) were estimated in relation to analgesic consumption at baseline. RESULTS: Individuals who reported use of analgesics daily or weekly at baseline showed significant increased risk for having chronic pain at follow-up. The risk was most evident for chronic migraine (RR = 13.3, 95% CI: 9.3 to 19.1), intermediate for chronic nonmigrainous headaches (RR = 6.2, 95% CI: 5.0 to 7.7), and lowest for chronic neck (RR = 2.4, 95% CI: 2.0 to 2.8) or chronic low-back (RR = 2.3, 95% CI: 2.0 to 2.8) pain. Among subjects with chronic pain associated with analgesic overuse, the RR was 37.6 (95% CI: 21.3 to 66.4) for chronic migraine, 14.4 (95% CI: 10.4 to 19.9) for chronic nonmigrainous headaches, 7.1 for chronic neck pain (95% CI: 5.5 to 9.2), and 6.4 for chronic low-back pain (95% CI: 4.9 to 8.4). The RR for chronic headache (migraine and nonmigrainous headache combined) associated with analgesic overuse was 19.6 (95% CI: 14.8 to 25.9) compared with 3.1 (95% CI: 2.4 to 4.2) for those without overuse. CONCLUSION: Overuse of analgesics strongly predicts chronic pain and chronic pain associated with analgesic overuse 11 years later, especially among those with chronic migraine.

Adult↗
PubMed2004

Analgesic overuse among subjects with headache, neck, and low-back pain.

OBJECTIVES: To examine the prevalence of chronic headache (> or =15 days/month) associated with analgesic overuse in relation to age and gender and the association between analgesic overuse and chronic pain (i.e., migraine, nonmigrainous headache, neck and low-back pain). METHODS: In the Nord-Trøndelag Health Study 1995 to 1997 (HUNT-2), a total of 51,383 subjects responded to headache questions (Head-HUNT), of which 51,050 completed questions related to musculoskeletal symptoms and 49,064 questions regarding the use of analgesics. RESULTS: The prevalence of chronic headache associated with analgesic use daily or almost daily for > or =1 month was 1% (1.3% for women and 0.7% for men) and for analgesic overuse duration of > or =3 months 0.9% (1.2% for women and 0.6% for men). Chronic headache was more than seven times more likely among those with analgesic overuse (> or =1 month) than those without (odds ratio [OR] = 7.5, 95% CI: 6.6 to 8.5). Upon analysis of the different chronic pain subgroups separately, the association with analgesic overuse was strongest for chronic migraine (OR = 10.3, 95% CI: 8.1 to 13.0), intermediate for chronic nonmigrainous headache (OR = 6.2, 95% CI: 5.3 to 7.2), and weakest for chronic neck (OR = 2.6, 95% CI: 2.3 to 2.9) and chronic low-back (OR = 3.0, 95% CI: 2.7 to 3.3) pain. The association became stronger with increasing duration of analgesic use for all groups and was most evident among those with headache, especially those with migraine. CONCLUSIONS: Chronic headache associated with analgesic overuse is prevalent and especially chronic migraine is more strongly associated with frequent intake of analgesics than other common pain conditions like chronic neck and chronic low-back pain.

Adult↗
PubMed2005

Evaluation of compliance among nursing staff in administration of prescribed analgesic drugs to critically ill dogs and cats.

OBJECTIVE: To investigate the prescription of analgesic drugs to hospitalized critically ill dogs and cats and determine compliance of nursing staff in administering the prescribed analgesics. DESIGN: Cross-sectional study. ANIMALS: 272 dogs and 79 cats hospitalized in an intensive care unit during a 2-month period. PROCEDURE: Patient treatment orders were examined daily for details regarding prescribed and administered analgesic drugs. RESULTS: A mean of 39% of cats and dogs in the intensive care unit were prescribed analgesic drugs each day, the most common of which were opioids. Local anesthetic drugs, nonsteroidal anti-inflammatory drugs, and ketamine were prescribed less frequently. Cats were less likely than dogs to receive analgesics after traumatic injury, but the difference was not significant. There was no difference between species in frequency of prescription of analgesic drugs after surgery. Most patients were prescribed a single class of analgesic drug; only 13% had orders for multiple analgesics. Of the patients for which analgesics were prescribed, 64% received them exactly as prescribed, 23% had at least 1 reduction in dosing, and 13% had at least 1 increase in dosing. When a decrease in dosing occurred, the drugs were opioids in each instance, whereas when drug dosing was increased, the drugs were of various types. CONCLUSIONS AND CLINICAL RELEVANCE: Discrepancies sometimes existed between the dose of analgesic prescribed and that administered. This appeared to occur primarily because of concerns about adverse effects of opioid drugs. Strategies to reduce these effects may improve pain management in critically ill dogs and cats.

Analgesics↗
PubMedDate not supplied

[Analgesic abuse and psychiatric comorbidity in headache patients].

Headache patients frequently overuse analgesic medications: 20% of the patients from headache centers is concerned by this problem, which has been estimated to occur in four percent of the community migrainers. Frequent use of various types of headache medication may paradoxically cause an increase in headache attack frequency as well as their chronicisation due to potentially complex mechanisms of sensitization. Patients will enter into a self- perpetuating cycle of daily headaches and use of symptomatic medications which can lead to addiction and to social and occupational impairement. Indeed, many patients will experience pharmacological tolerance and dependence but also by some kind of craving. International Headache Society qualify these patients as abusers referring mostly to the amount of substance ingested. Hence patients are labelled analgesic abusers . However, as many of these analgesic medications contained psychotropic substances (i.e. caffeine, codeine.), these patients may fulfill DSM IV criteria of dependance. Nevertheless, the dependance criteria should be adapted to chronic pain patients. Indeed, if pharmacological dependence and tolerance criteria are easy to apply in such patients, it is not the case for the criteria a great deal of time spent to obtain substances, to use substances or to recover from substances effects . As analgesic medications are legally obtained from medical practitioners, drug seeking behaviours are mostly: obtaining medications from multiple providers, repeating episodes of prescription loss and multiplying requests for early refills. Moreover the detrimental effects of analgesic abuse on psychosocial functioning is likely to be related to pain rather than to medication overuse. Finally the best indicator of addictive behaviors in such patients, is the loss of control over the use of analgesic medication despite the adverse consequences over pain. Comorbidity with addiction to other substances has never been specifically scrutinized in this population, but it is well documented that chronic pain patients have high rates of addiction with various types of substances. Moreover, it is well documented that these patients are at higher risk for anxious (panic disorders and phobic disorders) and depressive disorders than non abusing headache patients. Anxiety and depressive scores are related to both the chronicity of headaches, and the amount of analgesic intake. Therefore, this comorbidity is possibly related to psychoactive substance use but there is no prospective study concerning chronological link between the anxious and depressive disorders and analgesic abuse. The presence of personality disorders in these patients is poorly documented, with the exception of neuroticism, which probably reflects the anxious and depressive comorbidity. Clinical findings show that a subgroup of patients needs an hospitalisation to succeed in withdrawal. They appears likely to be dependant on several types of drugs, to present with fear of pain itself, and to present with cluster B personality disorders, whereas another subgroup is specifically dependant on one type of drug, present with fear of pain induced impairement, and present with cluster C personality disorders. Those patients, when becoming aware of dependance, succeed in withdrawal at home, without the need of an hospitalization. The analgesic medication overuse and dependance can also be considered as a maladjusted strategy to manage pain (with prevalent passive and avoidant coping strategies). More research is required focusing on psychopathological aspects of analgesic overuse and dependance, to improve withdrawal modalities and to reduce the rate of relapses.

Analgesics↗
PubMed1979

[Asthma caused by analgesics].

Asthma, caused by analgesics, a relatively frequent phenomenon in bronchial asthma conditioned by infection, often remains unrecognized and is then sometimes a danger of high degree for these patients. Pathogenetically, the asthma caused by analgesics perhaps does not underlie an immunological mechanism, but an induced by analgesics prostaglandin-E-synthesis inhibition. For this speak the results of skin tests, of the LTT with analgesics and of IgE concentration measurements. Concomitant phenomena of the asthma caused by analgesics are: initial rhinirrhoe, alcohol intolerance, polyposis nasi and NNH affections. Among the evoking noxae the pyrazolones (regard: pyrazolone containing asthma mixed preparations!) are of greatest importance. Since already the smallest doses of analgesics may evoke considerable asthmatic reactions the indication to the exposition test should be made cautiously. In an anamnestic suspicion on asthma caused by analgesics a strict avoidance of analgesics, antirheumatic drugs and antipyretic drugs is necessary. Salicyl amide does not cause in vitro a prostaglandin synthesis inhibition. Still further clinical examinations are necessary, whether it amy generally be recommended as a possible alternative of analgesics in asthma caused by analgesics.

Analgesics↗
PubMed1981

Nephropathy as a hazard of analgesic abuse.

Analgesic nephropathy is discussed. It has been estimated that 5-7% of all patients with chronic renal failure have a history of excessive analgesic use. Chronic analgesic abusers are predominantly women (3:1), and the peak incidence is between the ages of 40-60. Most analgesic abusers have some psychoneurosis with a history of headaches, backaches, arthritis, or ulcers. Several mechanisms for this nephrotoxicity have been proposed. It is thought that the ingestion of aspirin with phenacetin modifies the metabolism or alters the renal tissue response to one of these two drugs in such a manner as to increase toxicity. It has been proposed that the oxidative metabolites of phenacetin act in conjunction with aspirin to cause papillary necrosis. Chronic renal failure, a history of excessive analgesic use, radiological evidence of papillary necrosis, and clinical evidence of hematuria and mild proteinuria may confirm the diagnosis of analgesic nephropathy. Pharmacists should be aware of the indicence of analgesic nephropathy, and the general profile of patients who abuse analgesics. Early detection and cessation of analgesic use may avert progressive renal failure. Pharmacists should advise patients on the long-term complications of chronic analgesic use.

Adult↗
PubMed1997

Pharmacokinetic-pharmacodynamic relationships for analgesics.

A major goal of current pain research is to develop scientifically-based guidelines to optimize selection of analgesic drug doses and control pain. Numerous clinical studies have shown that the drug dose required to effectively alleviate pain is often highly variable, both between patients and between pain episodes in individual patients. This high variability makes it difficult to predict appropriate dosing regimens that will adequately control pain in the individual patient. The result is a "trial and error" approach to analgesic therapy. Experimental tools that measure analgesic response and drug disposition after administration of analgesics can be used to better predict the therapeutic effects of analgesics in individual patients. The approach defines factors that contribute to variability in therapeutic response. Pharmacokinetic-pharmacodynamic (PK/PD) modeling involves analysis of drug disposition data and drug efficacy data. Modeling depends on sensitive and reliable methods to quantify both pain and plasma (or other body fluid) levels of analgesic agents. Two major approaches have been used to quantify pain. The first utilizes subjective reports from patients, while the second employs physiological correlates of pain, such as evoked potentials. Results from PK/PD analysis that successfully identify a relationship between drug dose, drug concentration, and effect can be used to predict the effects of drug dose on analgesic effect in individuals. The ultimate goal is to provide patients with better pain relief by understanding variables that affect the analgesic concentration/effect relationship. This review examines the available pharmacokinetic-pharmacodynamic (PK/PD) data for selected opioid and nonopioid analgesics. Even though most analgesics are used clinically in multiple doses, the majority of PK/PD studies conducted to date evaluate single dose effects. Further studies with multiple doses are required to evaluate the validity of PK/PD relationships defined from single dose studies.

Analgesics↗
PubMedDate not supplied

Dental therapeutic practice patterns in the U.S. II. Analgesics, corticosteroids, and antibiotics.

This article examines the prescribing practices for peripherally acting and centrally acting analgesics, corticosteroids, and antibiotics following third molar extraction. A nationwide survey involving the prescribing patterns of a random national sample of 850 practicing oral surgeons was performed in 2004. Ibuprofen was the peripherally acting analgesic respondents used most frequently in the previous month, selected by 73.5% of the respondents. The ibuprofen dose prescribed most frequently was 800 mg, followed by doses of 600 mg and 400 mg. The centrally acting analgesic prescribed most frequently was the combination formulation of hydrocodone with acetaminophen, selected by 64.0% of the respondents. Recommendations for oral analgesics to manage postoperative pain relied on the peripherally acting analgesic ibuprofen or the centrally acting analgesic combination formulation hydrocodone with acetaminophen. Routine instructions to use centrally acting analgesics "as needed for pain" suggest that centrally acting analgesics are offered to manage pain that postoperative peripherally acting analgesics and intraoperative long-acting local anesthetics do not control adequately. The frequency with which oral and maxillofacial surgeons administered antibiotics and corticosteroids varied widely based on perceived patient need and dentist expectations.

Acetaminophen↗
PubMed2004

Comparison of two different preparations of ibuprofen with regard to the time course of their analgesic effect. A randomised, placebo-controlled, double-blind cross-over study using laser somatosensory evoked potentials obtained from UW-irritated skin in healthy volunteers.

In the treatment of painful conditions the time to onset of a drug's analgesic effect is of great relevance. Plain ibuprofen acid (Ibu, CAS 15687-27-1) is relatively slowly absorbed after oral administration (t(max) is about 90-120 min). If, however, ibuprofen is given in form of a lysine salt, absorption is much quicker. It has been shown in pharmacokinetic studies that the maximum plasma concentration after administration of an ibuprofen lysine tablet (IbuLys) is reached at about 35 min after oral administration. The aim of this study was to evaluate the onset and extent of the analgesic effect of 400 mg ibuprofen administered as marketed ibuprofen lysine tablets (two tablets of Dolormin as a single dose) in comparison with standard Ibu tablets (two tablets as a single dose) and placebo (Plc) utilising the objective, quantitative (high resolution) method of Laser algesimetry. The N1-P2 peak-to-peak amplitude of the Laser-induced somatosensory evoked potentials (LSEPs)--measured during the first two hours after administration of study drugs--was the main efficacy parameter for the onset of the analgesic effects. The values obtained during 5 h after administration of the study drugs were used to measure the extent of the analgesic effects. As a main result with respect to the onset of analgesic action, the reduction of the N1-P2 peak-to-peak amplitude was significantly and relevantly more pronounced during the first 2 h after administration of IbuLys than after Ibu (IbuLys vs. Plc: p < or = 0.0020, IbuLys vs. Ibu: p < or = 0.0366). During the same time the amplitudes of the single N1-components of the LSEPs were also significantly smaller after IbuLys than after Plc (p < or = 0.0031) whereas the difference between plain Ibu and Plc was not significant (p < or = 0.1027). As a measure of the extent of analgesic action, the N1-P2 peak-to-peak amplitudes recorded during 5 h after medication were more effectively reduced by IbuLys than by Ibu (IbuLys vs. Plc: p < or = 0.0001, IbuLys vs. Ibu: p < or = 0.0041, Ibu vs. Plc: p (0.383). The reduction of the amplitudes of the single N1-components by IbuLys was significant in comparison to Plc (p < or = 0.0031), but not in comparison to Ibu. During the time of 5 h after medication the attenuating (analgesic) effect of IbuLys on the amplitude of the P2 component of the LSEPs was stronger than that of Plc (p < or = 0.0053) and stronger than that of Ibu (p < or = 0.0058). In summary IbuLys was significantly superior to Ibu with respect to the onset and extent of the analgesic effect. drugs were used to measure the extent of the analgesic effects. superior to Ibu with respect to the onset and extent of the analgesic effect.

Adult↗
PubMed1985

Relationship between enkephalinase inhibition of thiorphan in vivo and its analgesic activity.

The relationship between enkephalinase inhibition by thiorphan in vivo and analgesic activity in nociceptive tests was studied. The analgesic activity of thiorphan in various nociceptive tests was compared with that of a narcotic analgesic, morphine and antipyretic analgesic, antipyrine. Tail-flick test revealed that thiorphan applied intracerebroventricularly (i.c.v.) or intraperitoneally (i.p.) in rats markedly potentiated the analgesic activity of [D-Ala2, Met5]-enkephalin administered i.c.v. The amount of thiorphan in the mouse brain and the fragments of Met-enkephalin degraded by brain homogenate were assayed after intraperitoneal administration of 300 mg/kg thiorphan. The concentration of thiorphan in the brain arised to 18.2 +/- 2.4 nmol/g brain 30 min after intraperitoneal administration of thiorphan and then it quickly disappeared from the brain. As to the fragments of Met-enkephalin degraded by brain homogenate after i.p. administration of thiorphan, the concentration of tyrosine and tyrosyl-glycine (Tyr-Gly) was the same as that of the vehicle control, whereas only the amount of tyrosyl-glycyl-glycine (Tyr-Gly-Gly) decreased to 21.5% of the control value after 30 min, and then it recovered to 75% after 180 min. Thus, thiorphan inhibited enkephalinase activity alone demonstrating selective activity. Thiorphan at doses of 30-300 mg/kg demonstrated analgesic activity in the nociceptive tests of acetic acid writhing, hot-plate and tail-flick, whereas it did not have any activity in the tail-pinch test. Morphine showed analgesic activity in the four nociceptive tests employed. Antipyrine showed analgesic activity in three nociceptive tests but not in the tail-flick test. The dose response curves for morphine and antipyrine were parallel. The slope of the dose response curve for thiorphan, however, was shallower than those for two reference analgesics used. The role of main enkephalin degrading enzymes in the brain was discussed with respect to the analgesic action of thiorphan and its concentration in the brain.

Amino Acids, Sulfur↗
PubMed2004

[Non-opioid analgesics for perioperative pain therapy. Risks and rational basis for use].

Non-opioid analgesics play a central role in the management of postoperative pain. In this review, the pharmacology, the analgesic efficacy and the side-effects of non-opioid analgesics are summarized. First, the pharmacology of diclofenac, acetyl salicylic acid, dipyrone, acetaminophen and the COX-2 inhibitors is described. Second, the analgesic efficacy of non-opioid analgesics is analyzed for moderate pain (e.g. ambulatory surgery) and for moderate to severe pain (e.g. abdominal surgery-in combination with opioids). There is limited evidence for an additive analgesic effect of two non-opioid analgesics. Third, the major side-effects of non-opioid analgesics are discussed in relation to the pathophysiology, the frequency and the clinical relevance of these effects. In particular, side-effects on the gastrointestinal tract (ulcus formation), on coagulation (bleeding and thrombosis), on the renal (renal insufficiency), the pulmonary (bronchospasm) and the hematopoetic systems (agranulocytosis) are described. Recommendations for the clinical use of non-opioid analgesics for perioperative pain therapy are given.

Acute Kidney Injury↗
PubMed2005

Analgesic usage for low back pain: impact on health care costs and service use.

STUDY DESIGN: Cross-sectional analysis of analgesic use by patients with low back pain (LBP). OBJECTIVES: To describe patterns of analgesic use and their cost implications for the use of other care services among individuals with LBP enrolled in a health insurance plan during 2001. It was hypothesized that the use of analgesics would be most frequent among patients with LBP with neurologic findings. SUMMARY OF BACKGROUND DATA: National guidelines have recommended analgesics as the primary pharmacologic treatment of LBP. The choice of specific analgesics has major cost and service use implications. METHODS: The University of Pittsburgh Health System includes 18 affiliated hospitals, more than 5000 physicians, and a commercial health plan with 255,958 members in 2001. This study uses the System Health Plan's insurance claims database to identify members who had services provided for one of 66 International Classification of Diseases, Version 9, Clinical Modification codes that identify mechanical LBP (n = 17,148). RESULTS: In 2001, 7631 (43.5%) members with claims for LBP services had no analgesic pharmacy claims. The other 9517 (55.5%) had analgesics claims costing a total of $1.4 million; 68% of claimants were prescribed an opioid and 58% nonselective nonsteroidal antiinflammatory drugs (NSAID). The costs of opioids, NSAID, and cyclooxygenase-2 selective NSAID for patients with LBP represented 48%, 24%, and 28%, respectively, of total health plan expenditures for all uses of these drugs, including cancer. Opioid use was associated with the high volume usage of LBP care services. Patients with LBP with and without neurologic involvement and those with acquired lumbar spine structural disorders had similar patterns of analgesic use: those with congenital structural disorders were less likely to use analgesics; and those with psychogenic pain and LBP related to orthopedic devices were more likely to use opioids. CONCLUSIONS: With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services.

Adolescent↗
PubMed1988

Impact of non-narcotic oral analgesics on pain management.

Of the four categories of oral analgesics, three have been available since the 19th century. Although adequate doses of the more potent oral opioids such as morphine and methadone are effective even in severe pain, the commonly used "weak" narcotics such as codeine and propoxyphene are no more effective than usual doses of aspirin or acetaminophen. Furthermore, the opioids produce gastrointestinal and central nervous system adverse effects, and, during long-term administration, tolerance may develop and there is a risk of drug dependence. Aspirin and acetaminophen are the traditional agents of choice for oral analgesic therapy; until 10 years ago, there were no single-entity, oral analgesics--with the exception of large doses of oral narcotics--that were more effective than usual doses of aspirin or acetaminophen. However, there is a ceiling on the analgesic effect attainable with safe doses of these drugs, which may in part be overcome through the use of the third category of oral analgesics, combinations of aspirin or acetaminophen with oral opioids. The fourth category of oral analgesics constitutes the most important recent development in pain management with analgesic drugs: the newer peripherally acting, nonsteroidal anti-inflammatory analgesics, some of which are clearly more efficacious than aspirin or acetaminophen and compare favorably not only with full doses of narcotic combination products but even, in some cases, with strong injectable opioids. On repeated dosing, some nonsteroidal anti-inflammatory drugs are better tolerated than aspirin and some have a much longer duration of analgesic effect than aspirin or acetaminophen. Further study is needed to compare nonsteroidal anti-inflammatory drugs among themselves and to determine their value in chronic pain and in combination therapy.

Acetaminophen↗
PubMed1989

Pain development and consumption of analgesics after oral surgery in relation to personality characteristics.

In the present study a survey has been performed of the pain development and analgesic intake in 100 patients following elective oral surgery of impacted third molars in relation to preoperative assessment of personality characteristics. Our results show that no sex differences existed preoperatively concerning personality characteristics, concerning postoperative pain development or analgesic consumption. Fourteen patients reported no pain at all and 40 patients did not use any analgesics in the postoperative period. We also found a good correlation between total sum of pain scores and analgesic intake. Patients undergoing surgery in the morning reported a lower total sum of pain scores, reported pain at fewer occasions and tended to require less analgesics than patients being subjected to surgery in the afternoon. The patients who reported a total sum of pain scores in the upper percentile during the postoperative period rated their general health worse, as rated on the General Health (GH) questionnaire, and used more analgesics than did patients in the lower percentile. Also, patients not using any analgesics reported less symptoms of distress according to the GH scale as compared to patients using analgesics. In general, however, less than 10% of the variance in postoperative pain and consumption of analgesics could be explained by the preoperative factors studied.

Adolescent↗
PubMed1995

Analgesic effect of Irvingia gabonensis stem bark extract.

Irvingia gabonensis is used medicinally in most parts of tropical Africa for the treatment of a number of ailments. In West Africa the Mende tribe of Sierra Leone uses the stem bark to relieve pain. In order to establish a pharmacological rationale for the traditional use of this plant as a remedy for pain, the water and ethanol extracts of the powdered stem bark were screened for analgesic activity and compared with standard analgesic drugs. The water extract and morphine protected the mice from heat-induced pain. In contrast, the ethanol extract and metamizole sodium showed very low level of analgesic activity in this test. However, using tail pressure as a source of pain, the water and ethanol extracts, metamizole sodium and morphine offered protection to the mice against pain stimuli. Morphine and the water extract were more potent as analgesic agents in heat than non-heat pain test. The analgesic effects of the water extract and morphine were blocked by a non-selective opioid receptor antagonist, naloxone in both tests, whereas the analgesic effects of the ethanol extract and metamizole sodium were not antagonized by the same dose of the opioid antagonist. The data presented in this study suggest that the active principle(s) in the water extract has analgesic profile similar to that of the narcotic analgesic and the ethanol extract might contain compound(s) that behave like non-narcotic analgesic agent. These findings provide for the first time the pharmacological basis for the folkloric use of Irvingia gabonensis in the relief of pain.

Analgesics↗
PubMed1978

Analgesic nephropathy: etiology, clinical syndrome, and clinicopathologic correlations in Australia.

Analgesic abuse is a major public health hazard in Australia, and analgesic nephropathy with consequent terminal renal failure is the underlying cause in 20% of the patients requiring dialysis and transplantation. Analgesics are invariably taken in the form of compounds and mixtures. In the aspirin-phenacetin-caffeine (APC) mixture, aspirin appears to be the major nephrotoxic agent and phenacetin appears to play a secondary and synergistic role. The renal disease associated with abuse of analgesics is characteristic and is part of a much wider clinical syndrome, the analgesic syndrome, which includes peptic ulcer disease (35%), anemia (60 to 90%), hypertension (15 to 70%), ischemic heart disease (35%), psychological and psychiatric manifestations, pigmentation, and possible gonadal- and pregnancy-related effects. The primary lesion in analgesic nephropathy is renal papillary necrosis (RPN), and this is a nephrotoxic effect common to all nonsteroid antiinflammatory agents. The most important factor in the management of patients with analgesic nephropathy is the cessation of analgesic abuse, and this leads to improvement and stabilization of renal function. A small proportion of patients will, however, deteriorate in relation to accelerated hypertension, persistent proteinuria, ischemic heart disease, and complications leading to nephrectomy. Patients with analgesic nephropathy are poor risk patients and have a poor prognosis, even after dialysis and transplantation.

Adult↗