A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma
Child; Female; Humans; Male; Pain Measurement; Analgesics; Treatment Outcome; Patient Satisfaction; Acute Disease; adolescent; Administration; Oral; Non-Narcotic/therapeutic use; Dose-Response Relationship; Drug; Opioid/therapeutic use; Pain/diagnosis/drug therapy/etiology; Codeine/therapeutic use; Acetaminophen/therapeutic use; Ibuprofen/therapeutic use; Wounds and Injuries/complications
OBJECTIVE: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries. PATIENTS AND METHODS: Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. RESULTS: A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale <30 mm) than the other 2 groups. There was no significant difference between patients in the codeine and acetaminophen groups in the change in pain score at any time period or in the number of patients achieving adequate analgesia. CONCLUSIONS: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.
2007
Clark E; Plint AC; Correll R; Gaboury I; Passi B
Pediatrics
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2006-1347" target="_blank" rel="noreferrer">10.1542/peds.2006-1347</a>
The use of methadone for cancer pain
Child; Humans; Analgesics; Attitude of Health Personnel; Treatment Outcome; Information Dissemination; Patient Selection; Drug Interactions; Clinical Protocols; Drug Administration Schedule; Practice; Attitudes; Health Knowledge; Palliative Care/methods; Dose-Response Relationship; Drug; Neoplasms/complications; Pain/diagnosis/drug therapy/etiology; Biological Availability; Drug Costs; Drug Industry/economics; Drug Information Services; Metabolic Clearance Rate; Methadone/chemistry/economics/pharmacology/therapeutic use; Morphine/pharmacology/therapeutic use; Opioid/chemistry/economics/pharmacology/therapeutic use
Methadone is not a new analgesic drug [69]. Several studies have demonstrated that methadone is a valid alternative to morphine, hydromorphone, and fentanyl for the treatment of cancer-related pain, and extensive reviews on the subject have been published in recent years [10,23,25,64,70,71]. Most people involved in pain therapy, however, are not well informed about the properties of methadone. The authors believe that the low cost of methadone paradoxically contributes to the limited knowledge of its characteristics and to the restricted therapeutic use of this drug. The low cost of methadone means there is little financial incentive for pharmaceutical companies to invest in research or to disseminate scientific information. Unfortunately, the lack of scientific information from pharmaceutical companies frequently results in a lack of knowledge on the part of physicians. Unless the existing approach changes, both culturally and politically, ignorance about methadone will persist among medical experts. The low cost of methadone, rather than being an advantage, will result in the limited exploitation of an effective drug.
2002
Ripamonti C; Bianchi M
Hematology/oncology Clinics Of North America
2002
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Journal Article
<a href="http://doi.org/10.1016/s0889-8588(02)00017-5" target="_blank" rel="noreferrer">10.1016/s0889-8588(02)00017-5</a>
A double-blind, crossover trial of intravenous clodronate in metastatic bone pain
Female; Humans; Male; Pain Measurement; Adult; Aged; Middle Aged; Double-Blind Method; 80 and over; Infusions; Intravenous; Clodronate; Clodronic Acid/administration & dosage/therapeutic use; Bone Neoplasms/physiopathology/secondary; Pain/diagnosis/drug therapy/etiology
After a baseline symptom and laboratory assessment, 24 patients with metastatic bone disease and pain were randomized to receive either a 4-hr intravenous infusion of 2-dichloromethylene bisphosphonate (Cl2MDP), 600 mg in 500 mL of normal saline, or a 4-hr placebo infusion, 500 mL of normal saline. The administration was double blind. After 1 wk, the assessment was repeated and the patients were crossed over to the alternate treatment. After 1 more wk, a final assessment and blinded choice by the patient and investigator took place. Of the 21 evaluable patients, 12 (57%) chose the Cl2MDP and 4 (19%) chose the placebo; 5 (24%) patients did not have a specific preference (p = NS). The investigator chose the Cl2MDP in 14 (67%) cases, placebo in 6 (29%) cases and was unable to discern a difference in 1 (5%) case (p less than 0.05). The patients and investigator made similar selections in 16 (76%) instances. On the visual analogue scale assessments, a significant decrease in pain scores was observed following the Cl2MDP infusion (p less than 0.01) and an increase in activity scores was also demonstrated (p less than 0.01). No significant difference in the daily oral morphine equivalent analgesic requirement was demonstrated for either arm. No difference in clinical and laboratory parameters of toxicity was evident between the placebo and Cl2MDP arms of the trial. Our preliminary findings suggest that Cl2MDP is safe, and has analgesic properties that may prove to be useful in the management of metastatic bone pain.
1992
Ernst DS; MacDonald RN; Paterson AH; Jensen J; Brasher P; Bruera E
Journal Of Pain And Symptom Management
1992
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Journal Article
<a href="http://doi.org/10.1016/0885-3924(92)90101-m" target="_blank" rel="noreferrer">10.1016/0885-3924(92)90101-m</a>
Recurrent pain attacks in a 3-year-old patient with myoclonus epilepsy associated with ragged-red fibers (MERRF): a single-photon emission computed tomographic (SPECT) and electrophysiological study
Child; Female; Humans; Magnetic Resonance Imaging; Preschool; Q3 Literature Search; Emission-Computed; Tomography; Evoked Potentials; Epilepsies; Recurrence; Pain/diagnosis/drug therapy/etiology; Single-Photon; Somatosensory/physiology; Cytochrome c Group/pharmacology; Flavin Mononucleotide/pharmacology; MERRF Syndrome/complications/diagnosis/physiopathology; Myoclonic/complications/physiopathology/radionuclide imaging; Thalamus/blood supply; Thiamine/pharmacology
We reported a 3-year-old girl with myoclonus epilepsy associated with ragged-red fibers (MERRF) who was afflicted with recurrent pain attacks and allodynia on the right side of the body. Although magnetic resonance imaging showed normal intensity in the thalamus, single-photon emission computed tomography (SPECT) revealed hypoperfusion in the thalamus. Somatosensory evoked potentials showed delayed early cortical responses, particularly on right median nerve stimulation. The parenteral administration of cytochrome c with flavin mononucleotide and thiamine diphosphate abolished the intolerable pain. This clinical improvement was objectively supported by the results of SPECT and neurophysiological findings. These observations suggested that a dysfunction of the thalamus was responsible for her pain and that cytochrome c therapy was of benefit for this symptom.
1997
Tanaka S; Osari S; Ozawa M; Yamanouchi H; Goto Y; Matsuda H; Nonaka I
Brain & Development
1997
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Journal Article
<a href="http://doi.org/10.1016/s0387-7604(96)00558-x" target="_blank" rel="noreferrer">10.1016/s0387-7604(96)00558-x</a>
Ketamine-fentanyl-midazolam infusion for the control of symptoms in terminal life care
Female; Humans; Male; Pain Measurement; Aged; Middle Aged; Treatment Outcome; Drug Therapy; 80 and over; Biomarkers of Pain; retrospective studies; Infusions; Intravenous; Neoplasms/complications; Receptors; Pain/diagnosis/drug therapy/etiology; Terminal Care/methods; Combination; N-Methyl-D-Aspartate/antagonists & inhibitors; Analgesics/pharmacology/therapeutic use; Cognition Disorders/drug therapy/etiology; Fentanyl/pharmacology/therapeutic use; Hypnotics and Sedatives/pharmacology/therapeutic use; Ketamine/pharmacology/therapeutic use; Midazolam/pharmacology/therapeutic use; Psychomotor Agitation/drug therapy/etiology
In this report, we describe nine terminally ill patients with metastatic cancer who were treated with an intravenous infusion consisting of ketamine (2 mg/ml)/fentanyl (5 micrograms/ml)/midazolam (0.1 mg/ml) (K/F/M) to control pain after traditional analgesic therapies were unsuccessful. In addition to pain, all patients exhibited some symptoms of cognitive compromise and agitation. After initiation of the K/F/M infusion, all patients exhibited some degree of qualitative improvement in these symptoms as well as in overall pain control. We feel that these observations warrant reporting of the efficacy of this infusion for the treatment of uncontrolled pain and agitation in terminally ill patients when the traditional methods of pain control are inadequate.
2000
Berger JM; Ryan A; Vadivelu N; Merriam P; Rever L; Harrison P
The American Journal Of Hospice & Palliative Care
2000
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Journal Article
<a href="http://doi.org/10.1177/104990910001700213" target="_blank" rel="noreferrer">10.1177/104990910001700213</a>
Methadone titration in opioid-resistant cancer pain
Female; Male; Pain Measurement; Adult; Analgesics; Aged; Therapeutic Equivalency; Drug Administration Schedule; 80 and over; Administration; Oral; Drug Tolerance; Human; Drug Resistance; Middle Age; Neoplasms/complications; Morphine/administration & dosage; Methadone/administration & dosage; Opioid/administration & dosage; Pain/diagnosis/drug therapy/etiology
AIM: To assess the use of methadone in patients with cancer pain who fail to respond to increasing doses of other opioids or experience intolerable side-effects from them. METHOD: Inpatients of a specialist palliative care unit were titrated onto oral methadone. The dose was calculated as 10% of the previous morphine equivalent dose, up to maximum of 40 mg, given every 3 h as required for analgesia. When daily requirements were stable it was divided into two regular doses. Pain was assessed on a five-point verbal rating score (VRS): a good response was defined as a fall in VRS of two points or more. Results are expressed as median (range). RESULTS: Thirty-three patients (13 men, 20 women, age 61 (34-91) years), 26 with inadequate analgesia and seven with intolerable opioid related side-effects, were converted to methadone from diamorphine (12), morphine (19) or fentanyl (two). Morphine equivalent dose was 480 (20-1200) mg/day prior to titration. Pain was neuropathic (11), nociceptive (three) or mixed (19). Stabilisation on methadone was complete in 3 (2-18) days in 29 (88%) patients at 80 (20-360) mg/day. Twenty-six (78%) had a good response. Four (12%) patients were withdrawn during titration (three entered terminal phase, one failed to respond). During follow-up 15 (45%) required alteration of methadone dose. Twenty-three (70%) patients were discharged home at 12 (4-26) days. In all cases the stable dose of methadone was less than the previous morphine equivalent, and there was a weak correlation between them. CONCLUSIONS: This method of methadone titration often results in improved pain control in patients with morphine resistance or intolerance. It requires careful titration in a specialist inpatient unit as there is no reliable formula for dose equivalence.
1999
Scholes CF; Gonty N; Trotman IF
European Journal Of Cancer Care
1999
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Journal Article
Pain and symptom control in terminally ill children
Child; Palliative Care; Pain Measurement; Adult; Analgesics; Antidepressive Agents; Preschool; infant; Comparative Study; Human; Opioid/therapeutic use; Tricyclic/therapeutic use; HIV Seropositivity/psychology; Anesthetics/therapeutic use; Depression/drug therapy/etiology; Gastrointestinal Diseases/therapy; Histamine H1 Antagonists/therapeutic use; Neoplasms/complications/psychology; Pain/diagnosis/drug therapy/etiology; Terminally Ill/psychology
The management of pain in terminally ill pediatric patients has incalculable benefits to patients, their families, and physicians and nurses. A therapeutic management plan is dependent on a thorough understanding of the causes of pain in these patients, on pain assessment, and on the myriad drugs and drug strategies that are essential in pain treatment. Aggressive symptom control of treatment- related side effects can ensure successful implementation of such a plan.
2000
Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
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Journal Article