Patient-Controlled Analgesia

Parker, Robert K.

doi:10.1001/jama.1991.03470140059024

Cited by 157 publications

(14 citation statements)

References 29 publications

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“…It is clear that opioids function as a negative reinforcer (i.e., decreasing pain) in non-drug abusing populations; both males and females reliably self-administer opioids after painful medical procedures (Berman et al, 1990; Parker et al, 1991). Pain also can alter the pharmacodynamic effects of opioids.…”

Section: Introductionmentioning

confidence: 99%

Effects of cold pressor pain on the abuse liability of intranasal oxycodone in male and female prescription opioid abusers

Lofwall¹,

Nuzzo²,

Walsh³

2012

Drug and Alcohol Dependence

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Background Approximately 1.9 million persons in the U.S. have prescription opioid use disorders often with concomitant bodily pain, but systematic data on the impact of pain on abuse liability of opioids is lacking. The purpose of this study was to determine whether pain alters the intranasal abuse liability of oxycodone, a commonly prescribed and abused analgesic, in males and females. Methods Sporadic prescription opioid abusers (10 females, 10 males) participated in this mixed (between and within-subject), randomized inpatient study. Experimental sessions (n=6) tested intranasal placebo, oxycodone 15 or 30 mg/70 kg during cold pressor testing (CPT) and a warm water control. Observer- and subject-rated drug effect measures, analgesia, physiologic and cognitive effects were assessed. Results The CPT significantly increased blood pressure, heart rate, pain, stress, and “opiate desire” compared to the no-pain control but did not alter opioid liking, high or street value. Intranasal oxycodone produced effects within 10 minutes, significantly decreasing pain and significantly increasing subjective measures of abuse liability (e.g., high). Females had higher ratings of street value, high, and liking for one or both active doses. Conclusions The CPT was a reliably painful and stressful stimulus that did not diminish the abuse liability of intranasal Oxycodone®. Females were more sensitive to oxycodone on several abuse liability measures that warrant further follow-up. Snorting oxycodone rapidly produced psychoactive effects indicative of substantial abuse liability.

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Section: Introductionmentioning

confidence: 99%

Effects of cold pressor pain on the abuse liability of intranasal oxycodone in male and female prescription opioid abusers

Lofwall¹,

Nuzzo²,

Walsh³

2012

Drug and Alcohol Dependence

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“…Human laboratory studies (Comer, Sullivan, Vosburg, Kowalczyk, & Houser, 2010; Zacny et al, 1996) and clinical studies reporting patient-controlled analgesia procedures (Gil, Ginsberg, Muir, Sykes, & Williams, 1990; Graves, Arrigo, Foster, Baumann, & Batenhorst, 1985; Parker, Holtmann, & White, 1991; Sidebotham, Dijkhuizen, & Schug, 1997) indicate that non drug-abusers self-administer prescription opioids only in the presence of experimentally-induced or current pain while recreational opioid users self-administer opioids (e.g., oxycodone) regardless of the presence or absence of pain (Comer, et al, 2010; Lofwall, Nuzzo, & Walsh, 2012). These findings suggest that the reinforcing effects of opioids in pain patients is most likely due to the ability of these drugs to relieve pain, yet the abuse liability of opioids appears not to vary as a function of pain among drug users and chronic pain patients with a long history of opioid use.…”

mentioning

confidence: 99%

Effects of paclitaxel on mechanical sensitivity and morphine reward in male and female C57Bl6 mice.

Neelakantan

Ward

Walker

2016

Experimental and Clinical Psychopharmacology

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This study evaluated the hypothesis that a paclitaxel treatment regimen sufficient to produce mechanical allodynia would alter sensitivities of male and female mice to the conditioned rewarding and reinforcing effects of morphine. Saline or paclitaxel were administered on days 1, 3, 5, and 7 in male and female C57Bl/6 mice to induce morphine-reversible mechanical allodynia as measured by the Von Frey filament test. Paclitaxel treatment did not change sensitivity to morphine conditioned place preference (CPP) relative to saline treatment in either male or female mice. Morphine produced peak self-administration under a fixed ratio-1 schedule of reinforcement for 0.03 mg/kg morphine per infusion in female mice and 0.1 mg/kg morphine per infusion in male mice. During the progressive ratio experiments, saline treatment in male mice decreased the number of morphine infusions for 12 days whereas the paclitaxel-treated male mice maintained responding for morphine similar to baseline levels during the same time period. However, paclitaxel did not have an overall effect on the reinforcing efficacy of morphine assessed over a limited dose range during the course of the repeated self-administration. These results suggest that the reward-related behavioral effects of morphine are overall not robustly altered by the presence of paclitaxel treatment under the current dosing regimen, with the exception of maintaining a small yet significant higher baseline than saline treatment during the development of allodynia in male mice.

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“…It was reported that continuous drug perfusion and PCA is superior to conventional intermittent doses of analgesics, 12) however, other researchers, 13) noted in their report that such a comment still needs further investigations. Some researchers compared epidural route and the above mentioned method and noted that there exists no diŠerence in e‹ciency, but former route is more advantageous for additional doses and that both methods are superior to intermittent dosing.…”

Section: Discussionmentioning

confidence: 90%

“…7,9,12,13) However, most of those reports were designed to compare diŠerent routes of administration of one or two agents.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

Öztekin

İşsever

et al. 2006

YAKUGAKU ZASSHI

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Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the eŠects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally intoˆve randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO 2 , pCO 2 , SaO 2 ), radial arterial blood pressures were measured in theˆrst 24 hrs postoperatively. Bolus requirements were determined by physicians and side eŠects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO 2 ( p＝0.002). Meperidine had the lowest number of bolus doses ( p＝0.001). There were no signiˆcant diŠerences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar eŠect with each other for pain relief except tramadol.

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Patient-Controlled Analgesia

Abstract: --The routine use of a continuous opioid infusion in combination with a standard PCA regimen does not improve pain management compared with PCA alone after abdominal hysterectomy.

Cited by 157 publications

References 29 publications

Effects of cold pressor pain on the abuse liability of intranasal oxycodone in male and female prescription opioid abusers

Effects of cold pressor pain on the abuse liability of intranasal oxycodone in male and female prescription opioid abusers

Effects of paclitaxel on mechanical sensitivity and morphine reward in male and female C57Bl6 mice.

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

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