Relationships between Measurement of Pain Using Visual Analog Score and Morphine Requirements during Postoperative Intravenous Morphine Titration

Aubrun, Frédéric; Langeron, Olivier; Quesnel, Christophe; Coriat, Pierre; Riou, Bruno

doi:10.1097/00000542-200306000-00017

Cited by 213 publications

(151 citation statements)

References 27 publications

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“…Consequently, lower opioid doses might be needed in these patients since they would risk side effects on normal dosages. While lower opioid consumption has indeed been found in the postoperative setting (n ϭ 152) in 3435TT genotyped individuals (31 ), this is not a uniform finding [see online Supplemental Table 3; ABCB1, references (1)(2)(3)(4)(5)]. Sample sizes in these mostly postoperative studies that failed to find a significant effect of the 3435CϾT variant were comparable with that of the previous positive study (32 ).…”

Section: Abcb1mentioning

confidence: 70%

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

et al. 2017

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BACKGROUND The use of opioids to alleviate pain is complicated by the risk of severe adverse events and the large variability in dose requirements. Pharmacogenetics (PGx) could possibly be used to tailor pain medication based on an individual's genetic background. Many potential genetic markers have been described, and the importance of genetic predisposition in opioid efficacy and toxicity has been demonstrated in knockout mouse models and human twin studies. Such predictors are especially of value for neonates and young children, in whom the assessment of efficacy or side effects is complicated by the inability of the patient to communicate this properly. The current problem is determining which of the many potential candidates to focus on for clinical implementation. CONTENT We systematically searched publications on PGx for opioids in 5 databases, aiming to identify PGx markers with sufficient robust data and high enough occurrence for potential clinical application. The initial search yielded 4257 unique citations, eventually resulting in 852 relevant articles covering 24 genes. From these genes, we evaluated the evidence and selected the most promising 10 markers: cytochrome P450 family 2 subfamily D member 6 (CYP2D6), cytochrome P450 family 3 subfamily A member 4 (CYP3A4), cytochrome P450 family 3 subfamily A member 5 (CYP3A5), UDP glucuronosyltransferase family 2 member B7 (UGT2B7), ATP binding cassette subfamily B member 1 (ABCB1), ATP binding cassette subfamily C member 3 (ABCC3), solute carrier family 22 member 1 (SLC22A1), opioid receptor kappa 1 (OPRM1), catechol-O-methyltransferase (COMT), and potassium voltage-gated channel subfamily J member 6 (KCNJ6). Treatment guidelines based on genotype are already available only for CYP2D6. SUMMARY The application of PGx in the management of pain with opioids has the potential to improve therapy. We provide a shortlist of 10 genes that are the most promising markers for clinical use in this context.

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Section: Abcb1mentioning

confidence: 70%

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

et al. 2017

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“…In the present study, dysmenorrhea was considered in terms of experiencing pain which makes activities of daily living difficult, and was defined as VAS ≥ 4, which has been used in several dysmenorrhea studies worldwide (Banikarim et al 2000;Ortiz et al 2009;Ozerdogan et al 2009). Severe dysmenorrhea was defined as VAS ≥ 7 (Aubrun et al 2003), which may require medical treatment (VAS 4-6 was considered moderate dysmenorrhea). In this paper, we use a term "moderate-severe dysmenorrhea" which means moderate or severe dysmenorrhea.…”

Section: Questionnairementioning

confidence: 99%

Prevalence of Dysmenorrhea and Its Correlating Lifestyle Factors in Japanese Female Junior High School Students

Kazama

Maruyama²,

Nakamura

2015

Tohoku J. Exp. Med.

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Dysmenorrhea is a common menstrual disorder experienced by adolescents, and its major symptoms, including pain, adversely affect daily life and school performance. However, little epidemiologic evidence on dysmenorrhea in Japanese adolescents exists. This cross-sectional study aimed to determine the prevalence of and identify factors associated with dysmenorrhea in Japanese female junior high school students. Among 1,167 girls aged between 12 and 15 years, 1,018 participants completed a questionnaire that solicited information on age at menarche, menstruation, and lifestyle, as well as demographic characteristics. Dysmenorrhea was defined based on menstrual pain using a Visual Analog Scale (VAS), with moderate or severe (moderate-severe) dysmenorrhea, which adversely affects daily life, defined as VAS ≥ 4, and severe dysmenorrhea defined as VAS ≥ 7. The prevalence of moderate-severe dysmenorrhea was 476/1,018 (46.8%), and that of severe dysmenorrhea was 180/1,018 (17.7%). Higher chronological and gynecological ages (years after menarche) were significantly associated with a higher prevalence of dysmenorrhea regardless of severity (P for trend < 0.001). In addition, short sleeping hours (< 6/day) were associated with moderate-severe dysmenorrhea (OR = 3.05, 95%CI: 1.06-8.77), and sports activity levels were associated with severe dysmenorrhea (P for trend = 0.045). Our findings suggest that dysmenorrhea that adversely affects daily activities is highly prevalent, and may be associated with certain lifestyle factors in junior high school students. Health education teachers should be made aware of these facts, and appropriately care for those suffering from dysmenorrhea symptoms, absentees, and those experiencing difficulties in school life due to dysmenorrhea symptoms.

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“…Pain at rest and pain during movement were evaluated at the time of the auditor's visit, using a numerical scale (NS) (0: no pain; 10 unbearable pain), with severe pain described as an NS pain intensity score 7, as previously suggested [5]. The maximal pain intensity reported by the patient was defined as the most intense pain between surgery and auditor's visit.…”

Section: Questionnairesmentioning

confidence: 99%

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Fletcher

Fermanian

Mardaye

et al. 2008

Pain

250

133

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(249 words)We carried out a national survey on postoperative pain (POP) management in a representative sample (public/private, teaching/non teaching, size) of 76 surgical centers in France. Based on medical records and questionnaires, we evaluated adult patients 24 hours after surgery, concerning information, pre and postoperative pain, evaluation, treatment and side effects. A local consultant provided information about POP management. Data were recorded for 1900 adult patients, 69.3% of whom remembered information on POP.Information was mainly delivered orally (90.3%) and rarely noted on the patient's chart (18.2%). Written evaluations of POP were frequent on the ward (93.7%) with appropriate intervals (4.1 (4.0) hours), but not frequently prescribed (32.7%). Pain evaluations were based on visual analog scale (21.1%), numerical scale (41.2%), verbal scale (13.8%) or non numerical tool (24%). Pain was rarely a criterion for recovery room discharge (19.8%).Reported POP was mild at rest (2.7 (1.3), moderate during movement (4.9 (1.9) and intense at its maximal level (6.4 (2.0). Incidence of side effects was similar according to patient (26.4%) or medical chart (25.1%) including mostly nausea and vomiting (83.3%). Analgesia was frequently initiated during anesthesia (63.6%). Patient-controlled analgesia (21.4%) was used less frequently than subcutaneous morphine (35.1%) whose prescription frequently did not follow guidelines. Non-opioid analgesics used included paracetamol (90.3%), ketoprofen (48.5%) and nefopam (21.4%). Epidural (1.5%) and peripheral (4.7%) nerve blocks were underused. Evaluation (63.4%) or treatment (74.1%) protocols were not available for all patients.This national, prospective, patient-based, survey reveals both progress and persistent challenges in POP management.

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Relationships between Measurement of Pain Using Visual Analog Score and Morphine Requirements during Postoperative Intravenous Morphine Titration

Abstract: A VAS score of 70 or greater should be considered indicative of severe pain. The relationship between the initial VAS score and morphine requirements is not linear, and the evolution of the VAS score during the pain relief process is described by a sigmoid curve.

Cited by 213 publications

References 27 publications

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

Prevalence of Dysmenorrhea and Its Correlating Lifestyle Factors in Japanese Female Junior High School Students

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

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