Analgesia by Christoph Stein, Christoph Stein

By Christoph Stein, Christoph Stein

This quantity makes an attempt to summarize the present nation of data on mechanisms underlying some of the results of analgesics, their facet influence profiles, and their symptoms and contraindications in medical use. It additionally provides insights into present efforts to find novel mechanisms underlying the new release of other sorts of soreness and the ensuing improvement of latest modulating compounds.

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Example text

3 Clinical Applications . . Acute Pain . . . . . Chronic Pain . . . . Pharmacokinetics . . . Absorption . . . . . Distribution . . . . Metabolism and Excretion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Functional deletion of the arrestin-3 gene resulted in remarkable potentiation and prolongation of the analgesic effect of morphine (Bohn et al. 2000; Bohn et al. 2002) but had no effect on the acute antinociceptive potency of etorphine, fentanyl, or methadone (Bohn et al. 2004). However, to date the majority of studies on opioid tolerance have been performed in the absence of painful tissue injury. This may explain some of the discrepancies between experimental (Smith et al. 2003) and clinical studies (Stein et al.

1996). No significant improvements in any of the latter parameters were detected, and there was a lack of overall patient preference for the opioid. Most authors concluded that morphine may confer analgesic benefit with a low risk of addiction, but that it is unlikely to yield psychological or functional improvement (Watson and Babul 1998). Adverse opioid side effects were reported in all of these investigations and led to the drop-out of large numbers (up to 60%) of patients. Thus, there is a lack of prospective controlled studies examining the long-term (at least several months) administration of opioids.

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