Are analgesics stimulants

Psychostimulants as Adjuvant Analgesics (HTML)

May 14, 2014 – 06:34 am

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Abstract
Psychostimulants have multiple roles in the adjuvant treatment of pain. This article reviews the pharmacology of different agents in this class. Studies will be discussed that demonstrate the efficacy of these drugs in potentiating opioid analgesia, counteracting opioid-induced sedation and cognitive impairment, allowing dose escalation in difficult pain syndromes, and alleviating symptoms of depression. Practical guidelines will be suggested, and areas for future research indicated. Amphetamine derivatives have been found to potentiate opioid analgesia, as well as to counteract opioid-induced sedation and cognitive failure in patients with advanced cancer. These drugs have also been used for the management of depression. This article will outline some of the evidence relating to the role of these drugs in cancer patients.

Clinical Effects of Psychostimulants
Since the 1940s, researchers have been reporting that dextroamphetamine has analgesia-potentiating effects in combination with morphine. In the 1970s, a randomized, placebo-controlled, single-dose trial of 450 postoperative patients found that dextroamphetamine enhanced pain relief in a dose-dependent manner in a randomized, placebo-controlled, single-dose trial. Our group performed a randomized, double-blind, crossover trial comparing mazindol (a mild amphetamine derivative) with placebo in a similar population of 30 patients with advanced cancer and mild-to-moderate pain. While our patients experienced reduced pain intensity and decreased need for analgesics, they had increased anxiety and reduced appetite, and two patients developed acute delirium. Our findings suggested that these drugs did not appear to improve the general comfort of the patients, although we could reproduce the analgesic potentiation described by other authors.

In a second study, we chose methylphenidate, a shorter-acting amphetamine derivative with demonstrated safety in medically ill and geriatric patients. A total of 32 patients with severe cancer pain were randomized to receive methylphenidate 10 mg with breakfast and 5 mg with lunch versus placebo in a double-blind, crossover manner. Pain intensity, drowsiness, and activity improved significantly with methylphenidate, and no significant toxicity was observed. Both patients and investigators expressed a blinded preference for methylphenidate.

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