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PubMed2001

Analgesic use and renal function in men.

CONTEXT: Several case-control studies suggest an association between analgesic use and increased risk of chronic renal disease, but few cohort studies have examined this association. OBJECTIVE: To determine whether analgesic use is associated with risk of renal dysfunction. DESIGN AND SETTING: Cohort study of analgesic use data from the Physicians' Health Study, which lasted 14 years from September 1982 to December 1995 with annual follow-up. PARTICIPANTS: A total of 11 032 initially healthy men who provided blood samples and self-report of analgesic use. MAIN OUTCOME MEASURES: Elevated creatinine level defined as 1.5 mg/dL (133 micromol/L) or higher and a reduced creatinine clearance defined as 55 mL/min (0.9 mL/s) or less, and self-reported use of acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs (never [<12 pills]; 12-1499 pills; 1500-2499 pills; and >/=2500 pills). RESULTS: A total of 460 men had elevated creatinine levels (4.2%) and 1258 had reduced creatinine clearance (11.4%). Mean creatinine levels and creatinine clearances were similar among men who did not use analgesics and those who did, even at total intakes of 2500 or more pills. In multivariable analyses adjusted for age; body mass index; history of hypertension, elevated cholesterol, and diabetes; occurrence of cardiovascular disease; physical activity; and use of other analgesics, the relative risks of elevated creatinine level associated with intake of 2500 or more pills were 0.83 (95% confidence interval [CI], 0.50-1.39; P for trend =.05) for acetaminophen, 0.98 (95% CI, 0.53-1.81; P for trend =.96) for aspirin, and 1.07 (95% CI, 0.71-1.64; P for trend =.86) for other nonsteroidal anti-inflammatory drugs. No association was observed between analgesic use and reduced creatinine clearance. CONCLUSIONS: Moderate analgesic use in this cohort study of initially healthy men was not associated with increased risk of renal dysfunction.

Acetaminophen↗
PubMed1999

Morphologic evidence that analgesic-induced kidney pathology contributes to the progression of tumors of the renal pelvis.

BACKGROUND: Whether phenacetin-containing analgesics cause renal pelvic tumors by virtue of the weak mutagenicity of phenacetin, or indirectly through local effects of analgesic-induced renal papillary scarring, is debated. Because phenacetin consumption ceased in New South Wales, Australia in 1975, cases of renal pelvic carcinoma seen 14-15 years later (many of which were associated with long-standing analgesic-induced renal papillary pathology) provided an opportunity to examine the temporal relation between phenacetin exposure and those histologic characteristics of the tumors and adjacent renal tissue that may implicate analgesics in their etiology. METHODS: The authors conducted a "blinded" histopathologic review of tumors of the renal pelvis and adjacent noncancerous renal tissue from 100 cases for which epidemiologic data regarding risk factor exposure (specifically phenacetin-containing analgesics, tobacco, infection, and kidney stones) had been obtained in a population-based case-control study from New South Wales in 1989 and 1990. RESULTS: A history of consumption of phenacetin-containing analgesics was associated strongly with the presence and severity of diffuse renal papillary scarring, and less strongly with papillary calcification. The histologic grade of the renal pelvic tumors tended to rise significantly with consumption of phenacetin-containing analgesics in a dose-dependent fashion and with the degree of papillary scarring, but was not related to smoking. In multivariate analysis it was the degree of papillary scarring (to a greater extent than the amount of phenacetin consumption) that was associated significantly and strongly with a higher histologic grade. Only diffuse papillary calcification was associated significantly with squamous change in the renal pelvic tumors. CONCLUSIONS: Based on the results of the current study, the authors conclude that 1) in phenacetin-related tumors of the renal pelvis, the presence and severity of analgesic-induced renal papillary scarring correlates with tumor progression and 2) papillary calcification is a risk factor for squamous change in renal pelvic urothelioma.

Age Factors↗
PubMed1997

Analgesic efficacy of a hydrocodone with ibuprofen combination compared with ibuprofen alone for the treatment of acute postoperative pain.

Hydrocodone is a semisynthetic opioid with analgesic and antitussive properties qualitatively similar to other opioid agonists. Ibuprofen is a nonsteroidal antiinflammatory agent with analgesic and antipyretic activity and is an effective, primarily peripheral-acting antiinflammatory analgesic. The objective of this clinical trial was to determine the additive analgesic effect of the combination of 15 mg hydrocodone bitartrate with 400 mg ibuprofen, relative to 400 mg ibuprofen alone and placebo, in the treatment of postoperative pain. The single-dose analgesic efficacy of the combination of hydrocodone bitartrate with ibuprofen was compared with ibuprofen alone and placebo in 120 patients with moderate or severe postoperative pain after abdominal surgery. Analgesia was measured during the 6-hour period after dosing based on onset of relief, hourly and summary variables, and duration of effect. A significantly greater proportion of patients treated with the hydrocodone/ibuprofen combination reported onset of relief compared with ibuprofen or placebo; however, the distribution functions for time to onset of relief did not differ among treatments. Hydrocodone with ibuprofen and ibuprofen alone were significantly more effective than placebo for all measures of analgesia. The combination of hydrocodone with ibuprofen was significantly superior to ibuprofen for all hourly analgesic evaluations, weighted sum of pain intensity differences (SPID), total pain relief (TOTPAR), and global rating of study medication. No patients in the hydrocodone with ibuprofen group required analgesic remedication during the 6-hour study period, compared with 25% and 82% in the ibuprofen and placebo groups, respectively. The analgesic superiority of 15 mg hydrocodone bitartrate combined with 400 mg ibuprofen compared with 400 mg ibuprofen alone was demonstrated across many efficacy variables.

Adolescent↗
PubMed2003

Analgesic properties of some ethiopian medicinal plants in different models of nociception in mice.

Many people use analgesic plants to relieve pain and inflammation though most of them have not yet been proved to possess such properties. The objective of the present study was to screen the aqueous and ethanol extracts of four Ethiopian traditionally used medicinal plants for analgesic properties. Aqueous and ethanol extracts of the plant materials were screened for their analgesic properties in mice using tail-flick, hot-plate and tail-pinch tests at three dose levels. Normal saline and standard analgesics were employed as negative and positive controls, respectively. The plants subject for the present screening were Ocimum suave, Ocimum lamiifolium, Lippia adoensis, and Ajuga remota. All extracts were observed to possess analgesic properties with varying potencies in tail-flick and hot-plate tests. Analgesic activity, however was not observed with tail-pinch test. The analgesic potencies also varied with concentrations and time after administration. From the present findings, it can be concluded that the extracts of all the plant materials have got analgesic properties with fast onset of action whose mechanisms need to be investigated further.

Administration, Oral↗
PubMed2000

Intrathecal polymer-encapsulated bovine adrenal chromaffin cells fail to produce analgesic effects in the hotplate and formalin test.

Numerous publications have reported that adrenal chromaffin cells implanted in the lumbar intrathecal space produce analgesic effects in rodent models of pain. The present study was intended to replicate and extend on the results of those previous publications. This study was conducted to determine: (1) if analgesic effects of polymer-encapsulated intrathecal adrenal chromaffin cells could be detected in the more sensitive low temperature hot-plate test without using nicotine to stimulate chromaffin cell output, (2) if a dose-response curve can be produced in the hot-plate and formalin tests with different numbers of adrenal chromaffin cells (0K, 120K, or 330K), (3) if cell viability and/or the magnitude of analgesic effects are affected by differences in implant site (i.e. thoracic versus lumbar implant site), and (4) the magnitude of the analgesic effects of adrenal chromaffin cells relative to doses of systemic morphine. No analgesic effects related to chromaffin cells were detected in the present study in the formalin test or in the hot-plate test, even with nicotine stimulation, regardless of the number of cells implanted or the intrathecal implant site. The reliability and sensitivity of the behavioral measures to the effects of mild analgesics are supported by the fact that consistent differences in performance between individual rats could be detected, the effects of fairly modest doses of nicotine and morphine were detectable, and consistent dose-response curves were evident with respect to both nicotine and morphine. Device performance appeared to be within the range of previous studies that reported analgesic effects of encapsulated adrenal chromaffin cells. It is unclear why analgesic effects of adrenal chromaffin cells were not detected in the present study.

Analgesics, Opioid↗
PubMed1984

Differential analgesic cross-tolerance to morphine between lipophilic and hydrophilic narcotic agonists.

Mice were rendered tolerant to morphine by the subcutaneous implantation of one 75 mg morphine pellet. Seventy-two hours post-pellet implantation, the animals were evaluated in the tail-flick assay for analgesic tolerance and cross-tolerance to subcutaneously administered morphine, normorphine, methadone, etorphine and intracerebroventricularly administered morphine. With the pellet remaining in situ during testing, there was the expected analgesic tolerance to peripherally administered morphine and analgesic cross-tolerance to normorphine. However, with the pellet in situ during testing, there was a surprising lack of analgesic tolerance to intracerebroventricular administered morphine and no analgesic cross tolerance to peripherally administered etorphine or methadone. In contrast, removal of the morphine pellet 3 hours prior to the analgesic evaluation apparently unmasked the expression of tolerance and cross-tolerance as evidenced by a three fold, parallel shift to the right of the analgesic dose-response curve for subcutaneously administered etorphine and methadone and a seven fold shift to intracerebroventricularly administered morphine. These data emphasize that a more rigorous evaluation of tolerance development methodologies need be explored and support the suggestion that removal of the morphine-inducing pellet prior to analgesic determinations results in a distinct state of "tolerance" quite different from that observed with the pellet remaining in situ during testing.

Analgesics, Opioid↗
PubMed1980

Bladder urothelium in nephropathy associated with analgesics.

A history of ingestion of large quantities of analgesics in patients having clinical and radiographic features of chronic interstitial nephritis leads to the diagnosis of analgesic nephropathy. In analgesic nephropathy the renal damage possibly occurs from a high concentration of analgesics and/or their metabolites. Since urinary concentrations of analgesics and their metabolites are also high, urinary bladder wall may be similarly damaged. Bladder urothelium was examined in 20 patients. Ten control patients with uremia, hypertension, or bladder neck obstruction showed normal histology. Two of the 5 patients with analgesic nephropathy had brownish pigmentation of bladder. All 5 analgesic nephropathy patients showed chronic inflammation similar to that found in 5 patients with bacterial infections. It is suggested that pigmentation of bladder wall and/or chronic inflammation of bladder mucosa of unknown etiology when found in a patient with chronic interstitial nephritis, would support the diagnosis of analgesic nephropathy.

Analgesics↗
PubMed2004

Analgesic safety and efficacy of diclofenac sodium softgels on postoperative third molar extraction pain.

PURPOSE: The purpose of this single-blind, placebo-controlled, 3-arm parallel, randomized study was to compare the analgesic efficacy and tolerability of a single dose of 100 mg diclofenac potassium (Cataflam; Novartis, Stein, Switzerland), 100 mg diclofenac sodium softgel, and placebo in patients experiencing moderate to severe postoperative pain after third molar extraction. PATIENTS AND METHODS: Seventy-five patients (67% female with a mean age of 23, age range 18 to 34.5 years) participated in the study following removal of at least 1 impacted mandibular third molar. Patients received a single dose of study medication when their postoperative pain reached a moderate or severe intensity. Analgesic efficacy measures included the time to meaningful pain relief measured using a stopwatch and time to rescue medication. Pain relief (PR) and Pain intensity (PI) ratings were recorded at 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5, 6, 8, and 24 hours postdosing. Summary analgesic measures, including Summed Pain Relief Score (TOTPAR) and Summed Pain Intensity Differences (SPID), were calculated from the 0.25- to 6-hour responses. The time between pain relief and rescue and a global evaluation for the effectiveness of the study medications were recorded at the end of the study. Seven scheduled blood samples were collected from each patient for determining plasma concentrations of diclofenac anion. RESULTS: Both diclofenac sodium softgel and Cataflam were significantly more effective than placebo (P <.0001) for all summary analgesic measures. The average overall pain relief was substantially better from diclofenac sodium softgel than from Cataflam, but the difference was not statistically significant (P =.14). In patients taking diclofenac sodium softgel, 50% of the patients experienced a time to onset of analgesic activity within 18 minutes and the median analgesic duration was 5 hours (302 minutes). Fifty percent of the patients taking Cataflam had a time to onset of action within 38 minutes, and the median duration of analgesia was 4.5 hours (272 minutes). At the time of rescue drug administration or 6 hours, whichever was earlier, 72% of the patients given diclofenac sodium softgel rated the medication as a very good or excellent pain reliever, whereas only 45% of the patients taking Cataflam gave these ratings. No serious adverse events were observed in this study. The mean concentrations of diclofenac from the diclofenac sodium softgel formulation were significantly different from the Cataflam formulation. The mean C(max) for the softgel was almost twice that of Cataflam and C(max) was reached an hour earlier, on average. CONCLUSIONS: More diclofenac anion was absorbed at a quicker rate using the formulation diclofenac sodium softgel 100 mg than Cataflam. The softgel provided a very rapid onset of analgesic activity, a prolonged analgesic duration, and an acceptable side-effect profile in the postoperative third molar surgery pain model. In an acute pain situation, the rapid absorption of nonsteroidal anti-inflammatory drugs from a formulation like the Softgel may positively affect the time of onset and duration of inflammatory pain compared with other commercially available nonsteroidal anti-inflammatory drug formulations.

Adolescent↗
PubMed2005

Systematic review on analgesics given for pain following tonsillectomy in children.

In this systematic review effectiveness of analgesics for pain after tonsillectomy in children was evaluated and trial methodology of the included studies explored. Databases were searched for randomised, controlled studies on systemic paracetamol, NSAIDs and opioids. Eighty-four studies were evaluated for inclusion. Thirty-six studies were included and 48 excluded. Only in two studies investigated analgesics were given postoperatively for pain. All other studies investigated prophylactic administration of analgesics. Only five studies were truly placebo controlled. Trial methodology of the included studies varied greatly in respect to analgesics and doses used, duration of follow-up periods, methods of pain measurement, rescue analgesics and criteria for administrating rescue analgesia used. Sensitivity of studies was often unclear. Only 16 out of 36 studies were considered to be sensitive. Because of highly variable methodology and lack of sensitivity only limited conclusions on clinical efficacy of analgesics investigated can be drawn. No analgesic in single prophylactic dose provided analgesia for day of operation. Further studies are needed to find the optimal analgesic(s) for pain after tonsillectomy in children.

Adolescent↗
PubMed2005

[Abuse pattern of analgesics in chronic daily headache: a study in the general population].

BACKGROUND AND OBJECTIVE: The abuse pattern of analgesics is not well known in persons with "chronic daily headache and analgesic abuse" (CHA) in the general population. The objective of this study was to know the type of analgesics used by pharmacological group and the active ingredient in subjects with CHA in a large sample of the general population. PATIENTS AND METHODS: A questionnaire was distributed that investigated the frequency of headache and analgesic consumption among persons over 14 years (9,984 inhabitants) of the semiurban population of Santoña (Cantabria). A total of 4,855 subjects filled out the questionnaire. Although the CHA criteria require headache > or = 15 days a month, those individuals (n = 332) that report subjective consumption of analgesics for headache > or = 10 days in this period filled out a headache diary for one month. A total of 72 individuals fulfilled CHA criteria (1.48% of the general population). The varieties of CHA were classified according to the Silberstein et al criteria. RESULTS: The greatest consumption corresponded to the simple analgesic group with 34.7% of all the subjects followed by those of combined analgesics and ergotaminics consumed by 27.8% and 22.2% respectively. A total of 12.5% took opioids alone or associated and triptans were in the fifth place. The latter were consumed by 2.8% of all the subjects. The active ingredients used most were: paracetamol (54%), caffeine (49%), ergotic derivatives (38%) and propyphenazone (35%). The subjects detected consumed a mean of 2.5 active ingredients simultaneously. The mean units consumed in their different presentation by the subjects with CHA was 50 units/month. CONCLUSIONS: This study shows that CHA is a significant health care problem. In our setting, 85% of the persons with CHA of the population used analgesics and/or ergotics. These medications were given without prescription so that their obtention should be regulated in the pharmacy offices.

Adult↗
PubMed2002

Low-dose tizanidine with nonsteroidal anti-inflammatory drugs for detoxification from analgesic rebound headache.

OBJECTIVE: To describe an outpatient regimen for analgesic detoxification and resolution of analgesic rebound headache. BACKGROUND: Frequent analgesic use is believed to promote the transformation of episodic migraine into a chronic, pervasive headache syndrome. Management of pain precipitated by analgesic withdrawal is crucial to treatment success. Outpatient treatment protocols designed to achieve successful withdrawal will reduce costs and potentially lead to more widespread implementation of therapy. METHODS: Patients with appropriate histories were managed on an outpatient basis for detoxification by discontinuation of the offending analgesic and initiation of treatment with tizanidine and a long-acting nonsteroidal anti-inflammatory drug. Patients kept diaries of pain and medication use. Results were evaluated at 6 and 12 weeks. Patients able to tolerate no or trivial analgesic use (ie, 4 or fewer doses in each 2-week period) were considered responders. RESULTS: At 6 weeks, 36 patients (65%) were responders. At 12 weeks, 38 patients (69%) were responders. The chronic daily headache pattern had resolved at 12 weeks in 34 patients (62%). CONCLUSIONS: This treatment protocol was well tolerated and yielded a high degree of efficacy, demonstrating that outpatient management can be effective for achieving analgesic withdrawal and resolution of analgesic rebound headache.

Adult↗
PubMed2003

Analgesic effects of adrenal chromaffin allografts: contingent on special procedures or due to experimenter bias?

Many articles have reported that adrenal chromaffin cell transplants produce analgesic effects. Surprisingly, studies conducted in our laboratory failed to detect analgesic effects of adrenal chromaffin cell transplants. Although we have attempted to replicate the procedures reported to produce analgesic effects with adrenal chromaffin transplants, many of the different cell preparation procedures we have examined are fairly complex, and it is possible that our transplants were not sufficiently viable because of some subtle difference in our cell preparation procedures. In the present study we attempted to replicate as precisely as possible, and with very large groups to maximize statistical power, the simplest and most straightforward procedures previously reported to produce analgesic effects, adrenal allografts in the formalin test. The first experiment, conducted in our laboratories, failed to detect analgesic effects of intrathecal adrenal allografts in the formalin test. Another study conducted at a different research facility confirmed the absence of analgesic effects in the formalin test but verified that analgesic effects of morphine were detectable under the same blinded conditions. In addition, graft viability was verified histologically, but there was no correlation in either experiment between adrenal chromaffin cell number and pain behaviors. These results demonstrate more clearly than any of our previous reports that the analgesic effects of intrathecal adrenal transplants are not reliable and should not be accepted as valid until they can be produced reliably under rigorously blinded conditions.

Analgesia↗
PubMed2001

[Ten-year trend of analgesic drug use (1984 to 1995): results of three MONICA-based surveys in Augsburg)].

BACKGROUND AND OBJECTIVE: Use of drugs, especially analgesics, is thought to be responsible for the rising cost of the health system in Germany, but there are no published population data for analgesic intake in Germany. Data derived from the three MONICA surveys (Monitoring of Trends and Determinants of Cardiovascular Diseases) in Augsburg and its adjacent districts were analysed for the prevalence of analgesic usage between 1984 and 1995 (the first such survey for Germany). PATIENTS AND METHODS: A total of 5,899 males and 6,005 females (aged 25-64 years), representative of the population, were selected and examined in 1984/85, 1989/90 and 1994/95 (participation rate of those selected, 75-79%). Using a standardized protocol, all analgesic drugs taken during the previous 7 days were recorded and classified. The analysis was standardized for age and classified according to sex. RESULTS: Strong analgesics were not significantly used under the ambulatory conditions of this survey and were therefore excluded from the analysis. Intake prevalence of mild to moderately strong analgesics varied from 5.9-8.9% in males and 9.9-13.4% in females. Prevalence was significantly at its lowest in 1989/90, but similar at the beginning and end of the 10-year period. Changes in prevalence of analgesic usage were similar to those of on-demand medication. Salicylic acid preparations containing higher dosages of the active ingredient were the drugs most commonly used, followed by aniline preparations, heteroaryl- as well as aryl-acetate and propionic acid derivates, pyrazole derivates, oxicam and anthranylic acid derivates. CONCLUSION: The prevalence of taking mild of moderately strong analgesics was at a similar low level at the beginning and end of the 10-year period.

Analgesia↗
PubMed2003

Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid.

BACKGROUND: In a previous study on the effect of electro-acupuncture (EA) in combination with a paracervical block (PCB) as an analgesic method during oocyte aspiration in IVF treatment, EA appeared to increase the pregnancy rate. This study was designed to test the hypothesis that EA as an analgesic during oocyte aspiration would result in: (i) a better IVF pregnancy rate than with alfentanil; (ii) peroperative analgesia that was as good as that produced by alfentanil; (iii) less postoperative abdominal pain, nausea and stress; and (iv) a reduction in the use of additional analgesics. Neuropeptide Y (NPY) concentrations in follicular fluid (FF) were analysed when possible. METHODS AND RESULTS: In this prospective, randomized, multicentre clinical trial, 286 women undergoing oocyte aspiration were randomly allocated to the EA group (EA plus a PCB) or to the alfentanil group (alfentanil plus a PCB). No significant differences were found between the EA and alfentanil groups in any of the IVF variables. NPY concentrations in FF were significantly higher in the EA group compared with the alfentanil group. No correlation between pregnancy rate and NPY concentrations was found in either analgesic group. Both EA plus a PCB and alfentanil plus a PCB induced adequate peroperative analgesia during oocyte aspiration evaluated using the visual analogue scale. After 2 h, the EA group reported significantly less abdominal pain, other pain, nausea and stress than the alfentanil group. In addition, the EA group received significantly lower amounts of additional alfentanil than the alfentanil group. CONCLUSION: EA does not improve pregnancy rate in the present clinical situation. The observation that NPY concentrations in FF were higher in the EA group may be important for human ovarian steroidogenesis. The analgesic effects produced by EA are as good as those produced by conventional analgesics, and the use of opiate analgesics with EA is lower than when conventional analgesics alone are used.

Acupuncture Analgesia↗
PubMed1978

'The analgesic abuse syndrome': an epidemiological perspective.

Mild analgesics are freely available, widely used, and generally safe. Nevertheless a proportion of the population takes excessive quantities, of whom some develop chronic renal failure in consequence. A syndrome of analgesic abuse has been proposed, definable by characteristics other than analgesic intake. To examine this concept, a population study of analgesic consumption was carried out; the distribution was clearly unimodal and no association could be found between the quantity of analgesics taken and social class, marital status, working or not working, tea or coffee consumption or the number of cigarettes smoked. The principal determinants appeared to be sex, with females reporting a higher intake, and the presence of painful conditions. It was concluded that analgesics abuse cannot be defined other than by the number of analgesics consumed, and that the concept of an analgesic abuse 'syndrome' is not helpful in the design of preventive programmes.

Adult↗
PubMed2005

Usage of paracetamol-containing combination analgesics remains high in primary care.

AIMS: Paracetamol-containing combination analgesics are widely prescribed but the use of paracetamol/dextropropoxyphene (co-proxamol) is particularly controversial. We aim to examine the prescribing patterns of the paracetamol-containing analgesics in Ireland. METHODS: A national primary care prescribing database was used to investigate patterns of usage. Twenty-six thousand three hundred and eighteen patients who were new to therapy with paracetamol and paracetamol-containing analgesics between January and June 2002 were identified as follows: no previous analgesic medication in the 6 months prior to enrolment into the study, and followed up for at least 12 months from the time of enrolment. Duration of therapy and the number of prescriptions received post enrolment were analyzed according to age. Odds ratios for receiving long-term (>1 month) compared with short-term (1 month) prescriptions for co-proxamol, paracetamol only or a paracetamol combination-type analgesic were calculated for women vs. men, and in those aged over 65 vs. those aged under 65 years. RESULTS: Co-proxamol was the most commonly prescribed analgesic, accounting for 42% of all prescriptions dispensed during 2003. Long-term use of paracetamol-containing analgesic preparations was uncommon, with 56.7% receiving only 1 month's prescription during the study period. However, women (OR = 1.18, 95% CI 1.07, 1.28, P < 0.0001) and those over 65 years (OR = 1.71, 95% CI 1.57, 1.86, P < 0.0001) were more likely to receive a follow-up prescription for co-proxamol, but also for paracetamol (women, OR = 1.28, 95% CI 1.16, 1.39; over 65 year olds, OR = 2.67, 95% CI 2.44, 2.93) and the paracetamol combinations (women, OR = 1.33, 95% CI 1.20, 1.47; over 65 year olds, OR = 1.69, 95% CI 1.53, 1.87). CONCLUSIONS: Co-proxamol was the most commonly prescribed paracetamol-containing analgesic preparation in Ireland. The results may indicate inappropriate use in primary care.

Acetaminophen↗
PubMed2005

Serotonergic activity contributes to analgesic overuse in chronic tension-type headache.

OBJECTIVE: To evaluate the possible existence of a genetically determined innate factor that could exert a profound influence on the development of analgesic overuse in chronic tension-type headache (CTTH). BACKGROUND: Many patients with CTTHs report the regular use of analgesics. Continuous use of analgesics results in the ultimate worsening of headaches. The factors related to development of analgesic overuse, however, remain poorly understood. The genetic factors for serotonin metabolism and the harm avoidance (HA) personality dimension are known to be associated with various substance abuse patterns. DESIGN: We performed serotonin transporter protein (5-HTT) gene-linked polymorphic region (5-HTTLPR) genotype polymorphism analyses, and investigated serotonin-related personality traits by assessing the HA dimension using tridimensional personality questionnaire, given to 48 patients with CTTHs and reported analgesic overuse (CTTH-AO), in 50 patients with CTTHs without analgesic overuse (CTTH-NO), and in 100 healthy controls. We compared their headache characteristics using standardized questionnaires. RESULTS: We discovered an excess frequency of 5-HTTLPR short allele and a different genotypic distribution in patients with CTTH-AO. The S/S genotype frequency was significantly higher in patients with CTTH-AO (83%) than in CTTH-NO (72%) and control (59%; P= .010) groups. Patients with CTTH-AO exhibited the highest HA scores (23.3 +/- 5.4), as compared to CTTH-NO (19.9 +/- 6.7) and control (16.3 +/- 6.1) groups. Individuals with the S/S genotype showed a greater tendency toward analgesic overuse (13.3 +/- 11.3 days per month) than did those with the non-S/S genotype (7.0 +/- 8.6 days per month: P= .02). CONCLUSIONS: Our data suggest that serotonergic activity may be involved in the development of analgesic overuse in CTTH and that 5-HTTLPR might be one of the genetically contributing factors.

Adult↗
PubMed1989

Regular analgesic intake and the risk of end-stage renal failure.

The strength of the association between regular analgesic intake (RAI) and end-stage renal failure (EF) has been insufficiently established until now. A case-control study was conducted to estimate the relative risks (RR) of EF after RAI (defined as consumption of 15 or more analgesic doses per month for a continuous period of at least 1 year) for cumulative drug intake, single-ingredient analgesics, combinations, and specific compounds. The case group included all patients with EF undergoing renal replacement therapy in the area of West Berlin (1984-1986, n = 921). Control subjects, matched to cases by sex, age, and nationality, were selected from a group of patients in outpatient clinics. Matching was possible for 517 cases. The RR of EF after RAI of any analgesic was 2.44 (95% confidence interval: 1.77-3.39) and after RAI of combination drugs 2.65 (95% confidence interval 1.91-3.67). No significant increase was found, however, after RAI of single-ingredient analgesics. The RR after RAI of combination drugs and for the most preferred analgesic ingredients (phenacetin, paracetamol, acetylsalicylic acid, phenazones, caffeine) increased with dose. Furthermore, a dose-time-related RR after RAI of the longest used preparation was found. Thus, the results clearly show an increased RR of EF after RAI related to both dose and exposure time of mixed analgesic compounds, but not for the use of only single-ingredient analgesics.

Adult↗