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[Distinct structural bases of the immunoregulatory and central analgesic effects of IFNalpha].

Interferon-alpha (IFNalpha), a cytokine, is also an analgesic molecule. There is significant cross reactivity between IFNalpha and anti-opioid sera, suggesting a strong antigenic relatedness between human IFNalpha molecules and opioid peptides. Different structural basis of the immunoactivity and analgesic effect of IFNalpha can be demonstrated by different reactivities of the two reactions towards different mutants of IFNalpha obtained by using the site-directed mutagenesis. When the 129th Tyr residue of human IFNalpha was mutated to Ser, the immunoactivity of the mutant almost disappeared, while the strong analgesic activity still persisted, which could be blocked by naloxone. These results indicate that there exist distinct domains in the IFNalpha molecule, which mediate immune and analgesic effects differentially, and that the receptor mechanism underlying immune and analgesic effects of IFNalpha may be different.

Adjuvants, Immunologic↗

[Survey on the utilization of narcotic analgesics].

UNLABELLED: To evaluate the prescription of narcotic analgesics by the medical staff of Nanfang Hospital. METHODS: Drug utilization index (DUI) was used to analyze the prescriptions of narcotic analgesics to both in- and out-patients in the year of 2000. RESULTS: Six kinds of narcotic analgesics were prescribed mostly to relieve renal biliary colic, cancer pain and cough in the year 2000 in Nanfang Hospital. DUI shows no abuses of narcotic analgesics. CONCLUSION: The utilization of narcotic analgesics in Nanfang Hospital is basically well justified.

Adolescent↗

[Treatment of pain with opioid analgesics and the role of TTS-fentanyl (Durogesic)].

Current opinions in chronic pain treatment with opioid analgesics are presented in this review. Justified use of opioid analgesics in treatment of chronic non-malignant pain in inflammatory and degenerative processes is emphasised. Advantages of opioid analgesics compared with non-opiod analgesics are stressed. New form of opioid--a patch, Durogesic TTS, recently registered in Croatia, is described. After brief review of pharmacodynamics and pharmacokinetics of Durogesic, authors experiences in both chronic malignant pain and chronic non-malignant pain treatment with this analgesic are described. Trial was performed in Pain clinic of Karlovac General Hospital as a part of international multicentric clinical trial. Regarding efficacy, compared to the previous therapy, TTS fentanyl was evaluated positively by patients, both in pain control and ease of use, and by the author, for around the clock, non-invasive administration. Slow dose adjustment in rapid illness progression was recognised as disadvantage.

Administration, Cutaneous↗

Utilizing brain imaging for analgesic drug development.

Analgesia is defined as loss of pain sensation without loss of consciousness; pain may be acute or chronic. Acute pain is well understood and can be controlled with currently available analgesics. Chronic pain, however, is not effectively controlled with current analgesics and side effect profiles often limit the use of these agents. Currently there are: (i) no objective methods for defining pain or analgesia in humans; (ii) no objective methods for correlating efficacy of analgesics in animal testing with human testing; and (iii) no objective method of evaluating the efficacy of analgesics in painful conditions, including neuropathic pain in which adaptive or maladaptive changes evolve with time. A technological revolution in functional brain imaging in humans and animals offers new approaches to objective evaluation of analgesics and of clinical pain states. These approaches hold great promise for revolutionizing drug development at preclinical and clinical stages.

Analgesics↗

Structure-activity relationship studies: study of the analgesic properties of a series of synthesized esters of 3- (4-benzyl-1-piperazinyl) 1-phenylpropanols.

Four previously stynthesized derivatives of 3- (4-benzyl-1-piperazinyl)-1-phenylpropanol were screened for analgesic activity in albino mice using a variation of the Eddy and Lambach hot plate method. The result showed that the most significant analgesic effect was elicited by the parent secondary 3-piperazinylpropanol, namely 3-(4-benzyl-1-piperazinyl)-1-phenylpropanol. Its esterification products with propanoyl, benzoyl and phenylacetyl chlorides exhibited reduced analgesic properties. The percent maximum protection against thermal pain produced by Aspirin (71.43%) was twice as high as that produced by the most active of the four derivatives (43.65%). The analgesic effect of the compounds was dose dependent. From acute toxicity studies in mice, the LD50 values were estimated to be in range of moderate toxicity (89.74 to 243 mg/kg). The most active of the compounds studied, namely, 3-(4-benzyl-1-piperazinyl-1-phenylpropanols, was also found to be the most toxic. The margin between its safe doses and its LD50 (89.74 mg/kg) was found to be very narrow. Esterification of the 3-(4-benzyl-1-piperazinyl)-1-phenylpropanol led to decrease in its analgesic activity and also a decrease in its toxicity.

Analgesics↗

Analgesic, antiinflammatory and hypoglycemic effects of Sutherlandia frutescens R. BR. (variety Incana E. MEY.) [Fabaceae] shoot aqueous extract.

Previous studies on the pharmacology of South African medicinal plants in our laboratories and elsewhere have shown that some plants possess therapeutic attributes. One such ethnomedically useful plant is Sutherlandia frutescens R. BR. (family: Fabaceae). S. frutescens is widely used in South African traditional medicine for the management and/or control of a plethora of human ailments. In order to scientifically appraise some of the ethnomedical uses of S. frutescens, the present study was undertaken to investigate the analgesic, antiinflammatory and antidiabetic properties of the plant's shoot aqueous extract in experimental animal models. The analgesic effect of the herb's shoot extract was evaluated using the hot-plate and acetic acid test models of pain in mice, while the antiinflammatory and hypoglycemic effects of the plant's shoot aqueous extract were investigated in rats, using fresh egg albumin-induced pedal (paw) edema, and streptozotocin (STZ)-induced diabetes mellitus. Diclofenac (100 mg/kg) and chlorpropamide (250 mg/kg) were used, respectively, as reference drugs for comparison. S. frutescens shoot aqueous extract (50-800 mg/kg i.p.) produced significant (p < 0.05-0.001) analgesic effects against thermally- and chemically-induced nociceptive pain stimuli in mice. The plant extract (50-800 mg/kg p.o. or i.p.) also significantly (p < 0.05-0.001) inhibited fresh egg albumin-induced acute inflammation and caused significant (p < 0.05-0.001) hypoglycemia in rats. The various chemical constituents and secondary metabolites of the herb are speculated to account for the observed analgesic, antiinflammatory and hypoglycemic effects of the plant. The results of this experimental animal study suggest that S. frutescens shoot aqueous extract possesses analgesic, antiinflammatory, and hypoglycemic properties, and thus lend pharmacological credence to the suggested folkloric uses of the herb in the management and/or control of painful, arthritic and other inflammatory conditions, as well as for adult-onset, type-2 diabetes mellitus in some communities of South Africa.

Analgesics↗

[The role of triptans and analgesics for primary headache treatment].

Primary headache especially migraine is very common disorder. The mainstay in the acute treatment of migraine is triptans (sumatriptan, zolmitriptan, eletriptan, naratriptan) and analgesics or NSAIDs. However, it is still unclear the appropriate usage of triptans and analgesics or NSAIDs for migraine treatment. Mild attacks may be managed with analgesics or NSAIDs while severe disabling ones usually respond better to specific antimigraine drugs, triptans. Analgesics or NSAIDs administration is always plagued with the potential of subsequent drug induced headache phenomenon. Therefore usage of analgesics or NSAIDs should be restricted only for young and typical type patients with migraine. As triptan medication method corresponding to various life style, in addition to tablet formulation, there are subcutaneous injector and nasal spray formulation in sumatriptan, rapid melt tablet formulation in zolmitriptan (rapimelt) and naratriptan (rapidisk). These different type of formulation are valuable for patient's needs.

Analgesics↗

[Prospective study of the analgesic action of clomipramine versus placebo in refractory lumbosciatica (68 cases)].

The authors sought to determine the analgesic activity of clomipramine (CMP) versus placebo, efficacy and side-effects according to the time of administration, long term clinical results and the relationship between plasma levels and analgesic effect. This double-blind randomised trial involved the infusion of 250 ml of glucose solution morning and evening versus placebo. CMP was administered at progressive doses for 8 days (maximum dosage 75 mg), either in the morning at 8 a.m. or in the evening at 6 p.m. Sixty eight patients accepted to be treated, all suffering from low back pain with or without sciatica. Maintenance treatment at the dose of 75 mg/day was then administered. CMP had a statistically significant analgesic action independent (rapidity of action) of its antidepressant activity. CMP was more effective and better tolerated (sedative and tranquilizer effect) in the evening. Long term results were poor (75% of cases). There was no link between plasma levels and clinical response. The authors noted that the analgesic activity of CMP was rapid, but for a duration limited to the short term and that this efficacy compared with the quite good results obtained with the placebo could be explained by a possible methodological bias (patients hospitalised and treated by intravenous infusions). The finding that CMP was better tolerated in the evening, without any loss of efficacy, is a positive feature (chronotherapeutic trial). Poor long term results could be partially explained by side-effects (66%). There was no relationship between analgesic effect and plasma levels.

Adult↗

Assessment of relative intrinsic activity of mu-opioid analgesics in vivo by using beta-funaltrexamine.

Morphine is the prototypic mu-opioid analgesic; however, in certain situations in vitro, morphine behaves as a partial agonist. To assess the relative intrinsic activity of morphine and three other mu-opioid analgesics in vivo, beta-funaltrexamine (beta-FNA), an irreversible antagonist selective for the mu receptor, was used to reduce the effective receptor reserve. By using a stereotaxic device, 1.25 to 20 micrograms of beta-FNA was infused into the lateral ventricle of rats. Twenty-four hours later, animals were tested in the tail-flick assay with cumulative doses of morphine, levorphanol, methadone or fentanyl. Pretreatment with 2.5 micrograms of beta-FNA induced parallel rightward shifts of both the morphine and levorphanol dose-effect curves and 5.0 micrograms of beta-FNA reduced the maximum analgesic effect of these agonists. Methadone surmounted the antagonism of 5.0 micrograms of beta-FNA; 10 micrograms was required to reduce the maximum analgesic effect of methadone. Fentanyl overcame the blockade induced by both 5.0 and 10 micrograms of beta-FNA. Only with a pretreatment dose of 20 micrograms of beta-FNA was the maximum analgesic effect of fentanyl reduced. Thus, when a certain proportion of mu receptors is inactivated, i.e., with 5.0 micrograms of beta-FNA, fentanyl and methadone have the capacity to surmount the blockade, whereas morphine and levorphanol do not. This suggests that fentanyl and methadone have higher intrinsic efficacies than do morphine and levorphanol. Thus, a strategy used widely in vitro was applied successfully in vivo to assess relative intrinsic activities of a series of mu-opioid agonists.

Analgesics↗

Pharmacology of pravadoline: a new analgesic agent.

Pravadoline is a new chemical entity with analgesic activity in humans. This report describes the pharmacology of pravadoline and compares the activity of pravadoline with that of two major classes of analgesics, the opioids and the nonsteroidal anti-inflammatory drugs (NSAIDs). Like the NSAIDs, pravadoline inhibited the synthesis of prostaglandins (PGs) in mouse brain both in vitro (IC50, 4.9 microM) and ex vivo (ED50, 20 mg/kg p.o.) and displayed antinociceptive activity in rodents subjected to a variety of chemical, thermal and mechanical nociceptive stimuli. Administration of pravadoline prevented the writhing response induced by i.p. administration of acetylcholine (ED50, 41 mg/kg p.o.) or PGE2 (ED50, 24 mg/kg p.o.) and prolonged the response latency induced by tail immersion in hot water at a temperature of 55 degrees C (minimum effective dose, 100 mg/kg s.c.). In the rat, treatment with pravadoline prevented acetic acid-induced writhing (ED50, 15 mg/kg p.o.), brewer's yeast-induced hyperalgesia (Randall-Selitto test) (minimum effective dose, 1 mg/kg p.o.), the nociceptive response induced by paw flexion in the adjuvant-arthritic rat (ED50, 41 mg/kg p.o.) and bradykinin-induced head and forepaw flexion (ED50, 78 mg/kg, p.o.). The antinociceptive activity of pravadoline cannot be explained by an opioid mechanism, because pravadoline-induced antinociception was not antagonized by naloxone (1 mg/kg s.c.) and pravadoline did not bind to opioid receptors at concentrations up to 10 microM. However, like the opioid analgesics, pravadoline diminished the electrically induced twitch response of mouse vas deferens preparations, but, in contrast to opioids, this action of pravadoline was not attenuated by naloxone. The possibility is discussed that this effect of pravadoline upon isolated tissues may contribute to its antinociceptive activity. In contrast to NSAIDs, pravadoline was more potent ex vivo as an inhibitor of the formation of PGs in brain vs. stomach. In addition, pravadoline failed to produce gastrointestinal lesions when administered p.o. to rats or mice, and did not possess significant anti-inflammatory activity at antinociceptive doses. Also unlike NSAIDs, pravadoline inhibited rat gastrointestinal transit when administered at doses similar to those which were antinociceptive. The overall pharmacologic profile of pravadoline suggests that the compound may be capable of managing more diverse or more severe pain than is achieved by anti-inflammatory analgesics, without producing side effects commonly associated with either the opioid or the nonopioid analgesics.

Analgesics↗

Analgesic effects of phencyclidine-like drugs in rhesus monkeys.

Analgesic and discriminative stimulus effects of phencyclidine (PCP), ketamine, dextrorphan, (+)-N-allyl-normetazocine [(+)-SKF 10,047] and (+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d) cyclohepten-5,10-amine maleate (MK-801) were studied in rhesus monkeys. All five compounds increased in a dose-related manner the latency for monkeys to remove their tails from warm water with the order of potency being MK-801 greater than PCP greater than ketamine greater than (+)-SKF 10,047 greater than dextrorphan. Moreover, these effects were temperature-dependent with larger doses required to produce a maximum response when higher temperatures (i.e., 55 degrees C) were studied. The effects of PCP, ketamine, dextrorphan, (+)-SKF 10,047 and MK-801 were not attenuated by a dose (1.0 mg/kg) of the opioid antagonist quadazocine that antagonized the analgesic effects of the opioid mu agonist alfentanil and kappa agonist U-50,488. MK-801, PCP, (+)-SKF 10,047 and dextrorphan also substituted in a dose-related manner for the ketamine discriminative stimulus (1.78 mg/kg) and their relative potency as discriminative stimuli was the same as their relative potency in the tail withdrawal procedure. The apparent analgesic effects of PCP-like drugs occurred at doses 2- to 8-fold larger than doses required for discriminative stimulus effects and 3- to 10-fold smaller than doses required for anesthesia. These results support the notion that PCP-like drugs produce analgesic effects at subanesthetic doses. Moreover, the analgesic effects of PCP and related drugs in rhesus monkeys were not mediated by actions at the opioid receptors known to be associated with analgesia.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗

[Effects of central Ca2+ on analgesic action of lappaconitine].

Lappaconitine (LA), isolated from Aconitum sinomontanum Nakai, was characterized as analgesic principle by our laboratory. The analgesic effect of ip LA 6 mg/kg as measured in the rat tail-flick test was reduced by icv CaCl2 or MgCl2 0.1 or 1 mumol/rat. BaCl2 was inactive. The analgesic action induced by LA was potentiated by ethylene glycol tetraacetic acid (EGTA, 0.2 mumol/rat icv) but not by ethylenediamine tetraacetic acid (EDTA, 0.2 or 0.4 mumol/rat icv). The calcium antagonists nifedipine (5 mg/kg ip) and verapamil (1 mumol/rat icv) partially reversed the Ca2+ antagonistic effect on LA analgesia, although nifedipine did not enhance LA analgesic action and only at 15 min after medication did verapamil exhibit enhancement of LA analgesia. The analgesic activity of LA was reduced and augmented by microinjection of CaCl2 0.5 mumol and EGTA 50 nmol to periaqueductal gray (PAG) area, respectively. These results suggest that LA can produce analgesia, possibly through a decrease in cellular calcium availability and PAG may be involved in the Ca2+ antagonistic effect on LA analgesia.

Aconitine↗

[Mechanism of analgesic action of hyperin].

In previous works, we reported that Hyp (hyperin) showed strong analgesic effect, and inhibited discharges induced by multianalgesics, but without anesthetic action. In this study, the analgesic mechanism of Hyp was further investigated. In the tail-flick test in mice, EGTA was shown to markedly enhance the analgesic effect of Hyp and shift the dose-effect curve to the upper-left. CaCl2 significantly antagonized the effect of Hyp and shifted the dose-effect curve to the lower-right. In the afferent discharges induced by analgesics, EGTA markly elevated while cacl2 lowered the effect of Hyp. It was also found that A23187, which promote influx of Ca2+, could antagonize the effect of Hyp. In the frog sciatic nerves, we found that Hyp could significantly inhibit influx of Ca2+. This finding suggests that the analgesic effect of Hyp may have close relationship with the reduction of calcium in afferent nerve endings.

Analgesics↗

Maximum tolerated temperature in the rat tail: a broadly sensitive test of analgesic activity.

The methods most frequently employed for the study of analgesic activity of opiates are those based on thermal stimuli (hot-plate, tail-flick, TWR). These tests, however, are only sensitive for opiates which are pure agonists. In this work, we propose a modification of the TWR method capable of detecting analgesic activity in both agonist and agonist-antagonist opiates. In addition, non-opiate analgesics also show activity in this test. The ED50 (mg/kg, i.p.) of the substances studied, administered 30 min before commencement of the test, were as follows: buprenorphine: 0.02; methadone: 0.08; morphine: 1.9; pentazocine: 4.5; d-propoxyphene: 5.5; codeine: 7.6; pethidine: 9.2; zomepirac: 20.1; suprofen: 138.0; acetylsalicylic acid: 453.4. There was a statistically significant linear correlation between the results obtained by the proposed method (MTT) and those of some of the most frequently used methods for the study of analgesic agents (writhing induced by phenylbenzoquinone, acetic acid, acetylcholine bromide, hot-plate test and rat tail withdrawal test). The simplicity of the method makes it suitable for use in the battery of screening tests for analgesic activity of both narcotic and non-narcotic substances.

Acetates↗

The effect of withdrawal of phenacetin-containing analgesics on the incidence of kidney and urothelial cancer and renal failure.

Incidence data for cancers of the kidney and urinary tract (1973-83) and for end stage renal failure (ESRF) due to analgesic nephropathy (1973-86) were examined by loglinear regression to determine the effect of the withdrawal of phenacetin from analgesic preparations in New South Wales and the Australian Capital Territory. Allowing for the altered age and sex structure of the population, the incidence rate between 1973-83 for ESRF due to analgesic nephropathy, in persons aged between 5 and 54 years, decreased by 4.2% per year while that for ESRF excluding patients with analgesic nephropathy or diabetes increased annually by 1.3%. The incidence rates in persons over 14 years of age for cancer of the renal parenchyma (3.4% per year), renal pelvis (5.5%) and bladder (2.1%) increased significantly more than that for cancer at all sites (1.2%). Thus the decrease in ESRF due to analgesic nephropathy had not, by 1983, been paralleled by a decrease in renal parenchymal or urothelial cancer.

Analgesics↗

[Value of the intracutaneous skin test in analgesic intolerance in comparison with oral provocation].

A total of 24 patients showing predominantly urticarial and/or anaphylactic reactions to analgesics were exposed to the suspicious agents by means of skin testing and oral provocation. Only two patients, who had already shown mild anaphylactic symptoms during the skin test, were excluded from the oral provocation test. In 19 out of 24 cases, the presumed intolerance of analgesics could be confirmed by oral provocations, i.e., the rate of accuracy was 79%. Five patients tolerated the usual therapeutic single doses of previously suspicious agents, although 3 of them had shown positive skin tests. Two patients failed to show suspicious symptoms in both skin and oral provocation test. 14 patients reacted to propyphenazone, 6 patients to metamizole, and one patient each additionally to salicylamide or phenylbutazone. In the majority of the cases, parallel skin tests with all test agents were performed, using both aqueous suspension and the so-called serum linkage. Principally, both procedures proved equally good. In our patients, the skin tests (prick and intracutaneous test) were only reliable regarding the demonstration of propyphenazone allergy. 16 out of 19 patients showed the same reactions to both skin test and oral provocation (84%); in 3 cases, however, the skin tests to propyphenazone were false positive. The rate of accuracy in the metamizole skin test was 45%. With regard to the remaining suspicious agents, only 2 out of 6 positive skin tests were confirmed by oral provocation. In total, the numbers of true positive and false positive skin tests were almost equal. Thus, the demonstration of analgesic intolerance by history and skin test was only possible with a probability rate of 50%. By oral provocation, however, analgesic intolerance could be proved in almost 80% of the cases. Regarding the remaining 5 patients, we must assume that they were devoid of true analgesic allergy in spite of partly positive skin tests and apparently confirmative history.

Administration, Oral↗

Pharmacological studies of lappaconitine. Analgesic activities.

The analgesic activity of lappaconitine, which is contained in the root of Aconitum sinomantanum Nakai, was examined after oral and subcutaneous administration to mice or rats by using methods for screening of analgesics, i.e., hot plate, tail immersion, tail pinch, tail pressure, acetic acid-induced writhing, bradykinin-induced flexor reflex of hind limb and Randall-Selitto methods. The results were compared with those for morphine, indometacin and acetylsalicylic acid (ASA). Analgesic activities of lappaconitine were greater than those of indometacin and ASA, but generally about 2 to 5 times less than those of morphine. However, in the rat tail immersion test, orally administered lappaconitine exhibited more potent analgesic activity than morphine; in this test, lappaconitine was almost equipotent when given orally and subcutaneously, whereas the potency of orally administered morphine was only one-twentieth of that of subcutaneously administered morphine. Like morphine, lappaconitine increased the pain threshold of the normal paw as well as that of the inflamed paw when tested by the Randall-Selitto method. The results show that lappaconitine has strong analgesic activity, and further suggest that the central nervous system may be involved in the action on the pain threshold.

Aconitine↗

[The diagnosis of analgesic nephropathy].

Inspired by the large proportion of at least 17% of nephropathy due to analgesics as the basic disease among the patients undergoing chronic dialysis in Erfurt and under the impression of a greatly distributed "underdiagnosis" of this avoidable disease the actual diagnostic possibilities for recognition are demonstrated. Above all, in analgesic syndrome the thinking-of is of greatest importance, and the sensible making of the patient's analgesics history. The presumable diagnosis analgesic nephropathy is than made secure by means of imaging methods, with the help of which the almost pathognomonic papillary necroses can be demonstrated. Finally, the reasons are given for the importance of the exact diagnosis analgesic nephropathy, even in the stage of nephrocirrhosis.

Analgesics↗