Clinical Factors Associated with Pain in Acute Myocardial Infarction

Karlson, Björn W.; Sjölin, Margareta; Herlitz, Johan

doi:10.1159/000175955

Cited by 4 publications

(7 citation statements)

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“…The pronounced variability in estimated severity of pain in AM1 patients has also been demonstrated in previous studies (Herlitz et al, 1986;Karlson et al, 1993). Earlier studies have also suggested that some subgroups of patients such as those with smaller infarcts (Herlitz et al, 1984;Nielsen et al, 1990) and elderly patients (Bayer, 1988) have less severe pain.…”

Section: Discussionsupporting

confidence: 68%

“…The evaluation of the intensity and duration of chest pain by analyses of morphine consumption is likely to give a fairly reliable estimate of the clinical pain course in hospital (Herlitz, 1990;Nielsen et al, 1990;Karlson et al, 1993). Such an estimate could of course be criticized, since it has been reported that some patients with severe chest pain do not ask for adequate pain relief (Bondestam et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

“…Chest pain in patients with AM1 is characterized by marked variability in intensity, frequency and duration as well as location (Karlson et al, 1993;Everts et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

“…In spite of long and extensive use, knowledge is still lacking regarding predictors of consumption, duration of pain relief, time between drug administration and pain relief, as well as optimal doses to patients with myocardial ischaemia or those developing AM1 (Herlitz, 1989). On the other hand, observational studies have provided information that various estimates of infarct size, male sex and initial degree of suspicion of infarction correlate to the degree of pain experienced, as well as the amount of morphine required during the initial hospital stay (Karlson et al, 1993). On the other hand, observational studies have provided information that various estimates of infarct size, male sex and initial degree of suspicion of infarction correlate to the degree of pain experienced, as well as the amount of morphine required during the initial hospital stay (Karlson et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

“…For obvious reasons, it is not possible to perform placebo-controlled intervention trials. On the other hand, observational studies have provided information that various estimates of infarct size, male sex and initial degree of suspicion of infarction correlate to the degree of pain experienced, as well as the amount of morphine required during the initial hospital stay (Karlson et al, 1993). The predictors of morphine use in unselected patients with chest pain due to suspected AMI are yet not established.…”

Section: Introductionmentioning

confidence: 99%

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Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction

Everts

Karlson

Herlitz

et al. 1998

European Journal of Pain

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The characteristics of chest pain due to suspected acute myocardial infarction and morphine use during the first 3 hospital days are described in a population of 2988 consecutive patients admitted to hospital. The duration of pain was usually less than 24 h (mean 20.9+/-0.55 h), and only 24.8% of patients experienced chest pain of longer duration. The majority of patients had only one attack of pain, but 34.4% experienced four or more attacks during hospitalization. A mean morphine dose of 6.7+/-0.2 mg was administered over the 3 hospitalization days, but surprisingly 52.4% of all patients required no morphine analgesia at all. Independent predictors of an increased morphine consumption were initial degree of suspicion of acute myocardial infarction, ST changes on admission ECG, male sex, a history of angina pectoris and a history of congestive heart failure. In a separate pharmacokinetic/pharmacodynamic study in 10 patients, plasma concentrations of morphine and its major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), were measured after intravenous administration of morphine. In this patient group, terminal half-life of unchanged morphine ranged from 0.77 to 3.22 h. M3G and M6G plasma concentrations increased gradually up to 60-90 min after the intravenous morphine injection. Initial pain intensity by numerical rating scale was 6.6+/-0.6 (arbitrary units), and after morphine administration, there was a rapid and significant decrease in pain intensity. After 20 min, pain relief was 69+/-11% and remained at this level during the following 8 h observation period. It is concluded that the need for morphine administration in patients with suspected or definite acute myocardial infarction, differs among subgroups of patients and, in particular, higher doses are needed in those with a strong suspicion of myocardial infarction at arrival. When intravenous morphine is given, it attains full effect 20 min after injection. Furthermore, the active morphine metabolites M3G and M6G appear rapidly in the circulation, which could influence the analgesic response to morphine treatment. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

“…Chest pain in patients with AM1 is characterized by marked variability in intensity, frequency and duration as well as location (Karlson et al, 1993;Everts et al, 1996).…”

Section: Discussionmentioning

confidence: 99%