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PubMed2000

Trends in medical use and abuse of opioid analgesics.

CONTEXT: Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although international and national expert groups have determined that opioid analgesics are essential for the relief of pain, little information has been available about the health consequences of the abuse of these drugs. OBJECTIVE: To evaluate the proportion of drug abuse related to opioid analgesics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxycodone. DESIGN AND SETTING: Retrospective survey of medical records from 1990 to 1996 stored in the databases of the Drug Abuse Warning Network (source of abuse data) and the Automation of Reports and Consolidated Orders System (source of medical use data). PATIENTS: Nationally representative sample of hospital emergency department admissions resulting from drug abuse. MAIN OUTCOME MEASURES: Medical use in grams and grams per 100,000 population and mentions of drug abuse by number and percentage of the population. RESULTS: From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41,371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118,455 to 141,325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32,430 to 34,563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidine (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 838 to 865). CONCLUSIONS: The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.

Analgesics, Opioid↗
PubMed1991

Irreversible damage to the medullary interstitium in experimental analgesic nephropathy in F344 rats.

Renal papillary necrosis (RPN) and a decreased urinary concentrating ability developed during continuous long-term treatment with aspirin and paracetamol in female Fischer 344 rats. Renal structure and concentrating ability were examined after a recovery period of up to 18 weeks, when no analgesics were given, to investigate whether the analgesic-induced changes were reversible. There was no evidence of repair to the damaged medullary interstitial matrix, or proliferation of remaining undamaged type 1 medullary interstitial cells after the recovery period following analgesic treatment. The recovery of urinary concentrating ability was related to the length of analgesic treatment and the extent of the resulting inner medullary structural damage. During the early stages of analgesic treatment, the changes in urinary concentrating ability were reversible, but after prolonged analgesic treatment, maximum urinary concentrating ability failed to recover. This study shows that prolonged analgesic treatment in Fischer 344 rats causes progressive and irreversible damage to the interstitial matrix and type 1 interstitial cells leading to RPN. The associated urinary concentrating defect is reversible only during the early stages of structural damage to the inner medulla.

Acetaminophen↗
PubMed2006

Increasing deaths from opioid analgesics in the United States.

PURPOSE: Since 1990, numerous jurisdictions in the United States (US) have reported increases in drug poisoning mortality. During the same time period, the use of opioid analgesics has increased markedly as part of more aggressive pain management. This study documented a dramatic increase in poisoning mortality rates and compared it to sales of opioid analgesics nationwide. METHODS: Trend analysis of drug poisoning deaths using underlying cause of death and multiple cause of death mortality data from the Centers for Disease Control and Prevention and opioid analgesic sales data from the US Drug Enforcement Administration. RESULTS: Unintentional drug poisoning mortality rates increased on average 5.3% per year from 1979 to 1990 and 18.1% per year from 1990 to 2002. The rapid increase during the 1990s reflects the rising number of deaths attributed to narcotics and unspecified drugs. Between 1999 and 2002, the number of opioid analgesic poisonings on death certificates increased 91.2%, while heroin and cocaine poisonings increased 12.4% and 22.8%, respectively. By 2002, opioid analgesic poisoning was listed in 5528 deaths-more than either heroin or cocaine. The increase in deaths generally matched the increase in sales for each type of opioid. The increase in deaths involving methadone tracked the increase in methadone used as an analgesic rather than methadone used in narcotics treatment programs. CONCLUSIONS: A national epidemic of drug poisoning deaths began in the 1990s. Prescriptions for opioid analgesics also increased in this time frame and may have inadvertently contributed to the increases in drug poisoning deaths.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Analgesic use for postoperative pain: differences arise when comparing departments of surgery.

PURPOSE: The goal of the study is to analyse whether the analgesic therapy of postoperative pain during the first 2 days after surgery differs among the different surgical departments. METHODS: Patients were randomly chosen from among all those who underwent elective surgery. Characteristics of analgesic treatment (drug, dosage, schedule) and pain intensity were determined at the postoperative anaesthetic care unit and in the first and second postoperative days on the ward. All comparisons were carried out by surgical departments. RESULTS: Six hundred and twenty-three patients from six surgical departments were studied. Analgesic treatment orders varied greatly among the different departments, and these differences were statistically significant regarding number of drugs, type of drugs, analgesic schedule, and completeness of medical orders. Some differences were also observed regarding drug dosage. Patients from gynaecology and obstetrics, traumatology and orthopaedics and general surgery reported the most severe pain. CONCLUSIONS: The treatment of postoperative pain differs among the surgical departments, especially regarding analgesic schedules and completeness of analgesic orders. Analgesic therapy may often be based more on customary habits than on the patients' pain intensity.

Adolescent↗
PubMed1990

[Chronic use of analgesics].

Quantitative aspects of longterm analgesic intake are presented, based on a case-control-study on the relation between regular analgesic intake and endstage renal failure in the area of West Berlin (1984-86). Lifetime analgesic consumption of more than 1000 persons were investigated. A total of 285 longterm analgesic users (185 cases = 35.8%; 100 controls = 19.3%) were detected. An odd ratio of 2.44 (95% CI: 1.77-3.39) was computed. Regular analgesic intake was defined as an intake of at least 15 analgesic doses per month continuously over a period of at least 12 months. 90% of the regular users preferred mixed analgesics compounds, in most cases with the psychotropic additive caffeine.

Adult↗
PubMed2006

Clinical research on nourishing yin and unblocking meridians recipe combined with opioid analgesics in cancer pain management.

OBJECTIVE: To investigate the analgesic effects of Nourishing yin and Unblocking meridians Receipe (NUR) combined with opioid analgesics in managing cancer pain. METHODS: All the patients enrolled were differentiated as of yin deficiency and meridian blocked syndrome type of TCM. Forty-one of them in the treated group were treated with NUR combined with opioid analgesics, while 43 of them in the control group were given opioid analgesics alone with successive 14 days as one treatment course for both groups. RESULTS: The indexes of the treated group were superior to those in the control group as to the degree of pain-relieving, the therapeutic effect of analgesia, the occurrence frequency of cancer pain every day and its duration each time, the analgesic initial time, and the quality of life. CONCLUSION: NUR combined with opioid analgesics in cancer pain management was more effective than opioid analgesics alone.

Adult↗
PubMed1975

A new method for the evaluation of analgesic activity using adjuvant-induced arthritis in the rat.

A bioassay was developed for the assessment of analgesic activity by using pain resulting from a reproducible pathological condition. The vocalization displayed by rats with adjuvant-induced polyarthritis was defined as an expression of pain, and a decrease of this response was established as specifically demonstrating analgesic activity. This method was capable of detecting the analgesic activity of morphine-like and narcotic antagonist-type analgesics, as well as the activity of the antipyretic analgesics. The relative potencies of known analgesic agents determined with this technique closely approximated the potencies of these analgesics in man. The instrumentation for recording and measuring the vocal response of arthritic rats is described.

Analgesics↗
PubMed1990

Clonidine, administered intracerebroventricularly in mice, produces an anti-analgesic effect which may be mediated spinally by dynorphin A (1-17).

Clonidine, administered intracerebroventricularly, was shown to have two actions in the tail-flick test in mice: an overt anti-analgesic and a latent analgesic effect. The anti-analgesic effect was demonstrated by antagonism of the antinociceptive response to morphine, administered intrathecally. This anti-analgesic effect was attenuated by naloxone and nor-binaltorphimine, given intrathecally. Given intracerebroventricularly by itself, clonidine had no antinociceptive effect; however, the administration of naloxone and nor-binaltorphimine intrathecally uncovered the latent antinociceptive action of clonidine given intracerebroventricularly. This sensitivity to the opioid antagonists, given intrathecally, indicated that an endogenous anti-analgesic opioid might mediate the actions of clonidine at the spinal level. The putative opioid was postulated to be dynorphin A (1-17). Analgesia induced by intrathecally administered morphine was attenuated by the intrathecal administration of dynorphin A (1-17) at doses of less than 10 pg (5 fmol). This action of dynorphin was blocked by naloxone (5 fg, 0.014 fmol) and nor-binaltorphimine (10 ng, 12.3 pmol) at doses which did not block mu and kappa receptors in the spinal cord. The authors propose that clonidine, given intracerebroventricularly, activates an anti-analgesic system which descends spinally and is mediated by dynorphin A (1-17) in the spinal cord. This anti-analgesic effect of dynorphin A (1-17) appears to be a new function for dynorphin A (1-17).

Analgesics↗
PubMed1988

Depression by morphine and the non-opioid analgesic agents, metamizol (dipyrone), lysine acetylsalicylate, and paracetamol, of activity in rat thalamus neurones evoked by electrical stimulation of nociceptive afferents.

Pyrazolone and salicylic acid derivatives and the aniline derivative, paracetamol, are often classified as peripherally acting analgesic agents, while morphine is a centrally acting analgesic agent. Since indications exist that the non-opioid analgesic agents can also produce central effects, experiments were carried out on rats under urethane anaesthesia in which activity was recorded from single neurones in the dorsomedial part of the ventral nucleus (VDM) of the thalamus that was elicited by supramaximal electrical stimulation of nociceptive afferents in the sural nerve. In addition, activity was recorded in ascending axons of the spinal cord which was evoked by electrical stimulation of nociceptive afferents in the sural nerve. The substances studied were morphine, the pyrazolone derivatives, metamizol (dipyrone) and aminophenazone ('Pyramidon'), lysine acetylsalicylate, and paracetamol. All drugs were found to depress dose-dependently evoked activity in VDM neurones after intravenous (i.v.) injection. The ED50 of morphine in depressing evoked activity in VDM neurones is 0.05 mg/kg. Morphine also dose-dependently reduced activity in ascending axons of the spinal cord, the ED50 being 1.7 mg/kg. The ED50 of metamizol in depressing evoked activity in VDM neurones is 120 mg/kg, and that of aminophenazone is 22.7 mg/kg. The 2 ED50 values differ significantly. It has been found previously that metamizol increased nociceptive activity in some ascending axons and aminophenazone increased this activity in all ascending axons tested. The ED50 of lysine acetylsalicylate in depressing evoked activity in VDM neurones is 74 mg/kg. The drug did not reduce nociceptive activity in ascending axons of the spinal cord. The ED50 of paracetamol in depressing evoked activity in VDM neurones is 19.0 mg/kg. Paracetamol did not depress nociceptive activity in ascending axons of the spinal cord at a dose as high as 150 mg/kg administered by intraperitoneal injection. Naloxone (0.2 mg/kg i.v.) abolished the depressant effects of morphine but failed to reduce those of the non-opioid analgesic agents even at a high dose (1 mg/kg i.v.). Unlike morphine, the non-opioid analgesic agents did not completely block evoked activity in VDM neurones but only partially blocked their activation. The results suggest that the non-opioid analgesic agents tested can produce a central analgesic effect which, however, is weaker than that of morphine.

Acetaminophen↗
PubMedDate not supplied

The analgesic efficacy of ketorolac for acute pain.

Ketorolac is a nonsteroidal anti-inflammatory drug, available in both oral and parenteral forms, that possesses significant analgesic potency. Its analgesic efficacy has been studied extensively for the treatment of moderate-to-severe pain in many clinical settings. Although ketorolac possesses significant analgesic potency, it has limited utility as an analgesic for the acute treatment of moderate-to-severe pain in the emergency department. Oral ketorolac has been shown to provide analgesia that is the same or better than aspirin, acetaminophen, and dextropropoxyphene with acetaminophen, and equal analgesia to most other commonly available oral analgesics, including ibuprofen and acetaminophen with codeine. Intramuscular ketorolac provides analgesia equivalent to commonly used doses of meperidine and morphine. However, its utility in acute pain, when rapid relief is necessary, is limited due to a prolonged onset to analgesic action (30-60 min) and a significant number of patients who exhibit little or no response, more than 25% in most studies. The use of intravenous ketorolac has been less well studied. It has analgesic potency but its utility in patients with moderate-to-severe pain is also limited because there is a significant percentage of patients who fail to obtain adequate relief. Ketorolac may be most useful in supplementing parenteral opiates.

Acute Disease↗
PubMed2004

COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgery.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, the COX-2 selective inhibitors (CSIs or Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties. OBJECTIVE: This is a narrative review of the literature aimed to discuss analgesic efficacy, clinical safety and cost-benefit ratio of CSIs in the treatment of post-oral surgery pain. METHODS: Relevant drug and clinical studies of analgesic efficacy and safety of CSIs in the management of postoperative dental pain were identified through searches of MEDLINE/PubMed, in peer-reviewed journals of medicine and dentistry. The Food and Drug Administration Web site was searched for data of tolerability. Hand-searching included several dental journals and bibliographies of relevant studies. The last electronic search was conducted in April 2003. RESULTS: Data from well-designed, randomized, controlled trials of CSIs on the management of post-oral surgery pain indicate that these drugs are as well-effective analgesic agents as traditional NSAIDs and offer clinical advantages in terms of GI safety and unimpaired platelet function. CSIs do not offer advantages of renal safety over traditional NSAIDs. CONCLUSION: Although CSIs display analgesic efficacy similar to that of traditional NSAIDs in the treatment of acute, post-oral surgery pain, there is reasonable evidence that these new drugs are preferable in patients who are at an increased risk of developing serious upper-GI complications, in patients who take aspirin for cardiovascular comorbid conditions, and in those allergic to aspirin. Furthermore, CSIs may be given more safely than NSAIDs in perioperative settings, because of their lack of impairment of the blood-clotting. However, the high costs of CSIs available at present limit their routine use in the short period of postoperative dental pain-in most cases 2 to 4 days after surgery-because there is not an increased risk of developing serious GI complications with the use of cost-saving NSAIDs. The GI safety advantages of CSIs may improve the tolerability of long-duration analgesic therapies, such as cases of painful temporomandibular joint disorders and chronic orofacial pain. Further studies are needed to determine the cost-benefit ratio of using CSIs for the management of acute pain.

Analgesics↗
PubMed2004

A prospective randomized crossover study of the preemptive analgesic effect of nitrous oxide in oral surgery.

OBJECTIVE: Preliminary animal data has shown that nitrous oxide has a preemptive analgesic effect on postoperative pain. Whether a similar effect occurs in humans is not established. In this prospective randomized crossover study, we investigated the effect of preincisional versus postincisional nitrous oxide on postoperative oral surgical pain.Study design The trial was a crossover study where 36 patients had each of their symmetrical impacted mandibular third molars randomly scheduled for removal in 2 sessions. Each of the 36 patients acted as his or her own control; one side of the jaw was allocated randomly to receive nitrous oxide preoperatively (pretreated side) and the other side postoperatively (posttreated side). The pretreated side received 50% nitrous oxide preoperatively for 20 minutes and 100% oxygen postoperatively for 20 minutes as placebo. The posttreated side received 100% oxygen preoperatively for 20 minutes and 50% nitrous oxide postoperatively for 20 minutes. The difference in postoperative pain between the pretreated and posttreated sides was assessed by 4 primary end-points: pain intensity as measured by a 100-mm visual analog scale (VAS) hourly for 8 hours, time to first analgesic, total analgesic consumption during the first 48 hours, and a 5-point categorical patient global assessment scale (0=poor, 1=fair, 2=good, 3=very good, and 4=excellent). RESULTS: The VAS scores did not differ between the 2 sides at any time (P=.50): neither did the time to first analgesic (P=.8), amount of total analgesic consumption (P=.77), and patient's global assessment differ (P=.63). CONCLUSION: Our results do not support the preliminary animal data that nitrous oxide has a preemptive analgesic effect for postoperative pain. 50% nitrous oxide administered preoperatively for 20 minutes has no preemptive analgesic effect on postextraction pain.

Adolescent↗
PubMed1984

Peripherally acting analgesics.

The therapeutic effect of aspirin and the other nonsteroidal anti-inflammatory drugs derives from the peripheral inhibition of prostaglandin synthetase. Aspirin produces irreversible inhibition, whereas the inhibition triggered by the other nonsteroidal anti-inflammatory drugs is reversible. Despite proved analgesic efficacy, use of aspirin and the nonsteroidal anti-inflammatory drugs may be accompanied by a wide range of side effects of a potentially serious nature. For relief of pain, there appears to be no clear-cut superiority of one nonsteroidal anti-inflammatory drug over another, and patients who fail to respond to one class of nonsteroidal anti-inflammatory drugs may respond to a representative of another class. As with aspirin, it is difficult to demonstrate the superiority of higher doses of these agents over the lower doses. The side-effect profile of non-narcotic analgesics favors acetaminophen, presumably because its inhibition of prostaglandin synthetase occurs centrally. Acetaminophen does not appear to have the same potential for toxicity that is seen with aspirin and other nonsteroidal anti-inflammatory drugs. At dosages up to 4 g per day, acetaminophen compares favorably in analgesic potency to aspirin and other nonsteroidal anti-inflammatory drugs, and it should be considered the treatment of choice for mild-to-moderate pain. Safe conditions for the analgesic use of nonsteroidal anti-inflammatory drugs in children and pregnancy have not been established. Because it is virtually free of side effects, acetaminophen may be the mild analgesic of choice for the pregnant patient. It has been used safely for years in children. Only a limited number of analgesic studies have been conducted in children. The results of analgesic studies carried out in adults are generally recognized as applicable to pain relief in children.

Acetaminophen↗
PubMed2000

Distinct domains of IFNalpha mediate immune and analgesic effects respectively.

Interferon-alpha (IFNalpha) is not only an immunoregulatory factor, but is also an analgesic molecule. The analgesic effect of IFNalpha was mediated by mu opioid receptor. After the 129th Tyr residue of human IFNalpha was mutated to Ser, the antiviral activity almost disappeared, but there still remained a strong analgesic activity that could be blocked by naloxone. These results indicate that there exist distinct domains in the IFNalpha molecule, which mediate immune and analgesic effects respectively, and suggest that there are different receptor mechanisms inducing immune and analgesic effects of IFNalpha. However, although the antiviral activity of IFNalpha decreased to 34.1% of wild type IFNalpha after the 122nd Tyr residue was changed to Ser, the analgesic activity of this mutant was lost completely. There were significant cross reactivities between INFalpha and anti-opioid sera. These studies show strong structural and functional similarities between INFalpha and opioid peptides, and inferred that the analgesic domain locates around the 122nd Tyr residue of IFNalpha molecule in tertiary structure.

Amino Acid Substitution↗
PubMed1998

(-)-Norpseudoephedrine, a metabolite of cathinone with amphetamine-like stimulus properties, enhances the analgesic and rate decreasing effects of morphine, but inhibits its discriminative properties.

Like psychomotor stimulants, a weak amphetamine-like agent, such as phenylpropanolamine, enhances the analgesic effects of morphine (MOR). Thus, it is possible that full psychomotor stimulant potency is not required to increase the analgesic action of opiates. The validity of this assumption is here tested by studying the ability of (-)-norpseudoephedrine (NPE), an enantiomer of phenylpropanolamine and a metabolite of cathinone, to influence both the analgesic effects of MOR and its discriminative stimulus properties. In mice NPE (5.6-10.0-17.0 mg/kg i.p.) did not prolong the latency to lick or to remove paws from a plate warmed at 54 degrees C. However, it significantly potentiated the analgesic effect of 3.2 mg/kg of MOR. These results were replicated in rats by use of the formalin test, which measures the numbers of hind paw flinches produced by injecting 50 microl of formalin into the dorsal surface of the paw. The higher dose of NPE (17 mg/kg) increased the effect of sub-analgesic doses of MOR (0.56 and 1.0 mg/kg). In rats trained to discriminate between 0.5 mg/kg of amphetamine and solvent in a two-lever operant behavior reinforced by water access. NPE induced a dose-dependent increment of drug lever responding from 0% at 1.0 mg/kg to 100% at 32.0 mg/kg. In contrast, NPE did not generalize for the MOR cue up to the dose of 56.0 mg/kg, which produced a substantial reduction of the response rate. However, when given in combination, NPE attenuated the discriminative effects of MOR and potentiated its inhibitory action on the response rate. These results exclude a direct action of NPE on the mu opiate system. In conclusion, NPE preserves amphetamine-like properties and these properties are probably responsible for the interaction of the drug with the analgesic and discriminative effects of MOR. Therefore, this study contradicts the assumption that the analgesic effects of MOR can be enhanced by a sympathomimetic drug that lacks significant psychostimulant actions.

Alkaloids↗
PubMed2000

Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers.

The purposes of this study were as follows: (1) to compare the attitudes which were considered to be barriers to cancer pain management held by Taiwanese cancer patients and their family caregivers; (2) to determine if these barriers were related to patient hesitancy to take analgesics and/or family caregiver hesitancy to administer analgesics: and (3) to determine if attitudinal barriers by patients and/or family caregivers predicted the adequacy of analgesics that patients used. A total of 159 dyads of oncology outpatients and their primary family caregivers (n = 318) participated in this study. The instruments completed by patients consisted of the Barriers Questionnaire-Taiwan form, the Brief Pain Inventory-Chinese version, the ECOG performance status scale, and a demographic and medication questionnaire. Family caregivers completed the Barriers Questionnaire-Taiwan form and a demographic questionnaire. The data in this study revealed that patients and family caregivers had attitudinal barriers to pain management and these concerns were positively correlated between patients and caregivers. Patient concerns were related to their hesitancy to take analgesics and, similarly, caregiver concerns were related to their hesitancy to administer analgesics. Most importantly, patient and caregiver concerns had an impact on how the patients' pain was managed: (1) patients and their family caregivers with higher levels of concerns used inadequate analgesics as compared to patients using adequate analgesics; (2) family caregiver barriers (concerns) were a significant predictor of inadequate management of cancer pain (after controlling for demographic and disease variables). Therefore, educational interventions for overcoming these barriers for both patients and their family caregivers may have potential for improving the management of cancer pain in Taiwan.

Adult↗
PubMed2002

Relationship between pain-specific beliefs and adherence to analgesic regimens in Taiwanese cancer patients: a preliminary study.

This pilot cross-sectional study aimed to 1) explore pain beliefs and adherence to prescribed analgesics in Taiwanese cancer patients, and 2) examine how selected pain beliefs, pain sensory characteristics, and demographic factors predict analgesic adherence. Pain beliefs were measured by the Chinese version of Pain and Opioid Analgesic Beliefs Scale-Cancer (POABS-CA) and the Survey of Pain Attitudes (SOPA). Analgesic adherence was measured by patient self-report of all prescribed pain medicine taken during the previous 7 days. Only 66.5% of hospitalized cancer patients with pain (n = 194) adhered to their analgesic regimen. Overall, patients had relatively high mean scores in beliefs about disability, medications, negative effects, and pain endurance, and low scores in control and emotion beliefs. Medication and control beliefs significantly predicted analgesic adherence. Patients with higher medication beliefs and lower control beliefs were more likely to be adherent. Findings support the importance of selected pain beliefs in patients' adherence to analgesics, suggesting that pain beliefs be assessed and integrated into pain management and patient education to enhance adherence.

Analgesics↗
PubMed1995

High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure.

Recently, well performing diagnostic criteria for analgesic nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 analgesic abusers (defined as daily use of analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of analgesic nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of analgesic nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of analgesic nephropathy.

Aged↗