Choice of strong analgesic in terminal cancer: diamorphine or morphine?

Abstract:

:A controlled trial of diamorphine (diacetylmorphine, heroin) and morphine is reported in which the two drugs were administered regularly by mouth in individually determined effective analgesic doses. Elixirs contained cocaine hydrochloride 10 mg/dose; other drugs were prescribed when indicated clinically. 699 patients entered the trial and, of these, 146 crossed from diamorphine to morphine, or vice versa, after about two weeks using an oral potency ratio of 1.5/1 determined in a pilot trial. Additional medication and survival were closely similar in both treatment groups. In the female crossover patients, no difference was noted in relation either to pain or the other symptoms evaluated. On the other hand, male crossover patients experienced more pain, and were more depressed, while receiving diamorphine. In these, the potency ratio of diamorphine to morphine appeared to be less than 1.5/1. If this is allowed for, then the difference in mood is probably not significant. Compared with male patients, fewer females required a dose of 10 mg or more, but more were prescribed an anxiolytic. The ability to do without a 2 a.m. dose appeared to be related more to the size of the dose than to gender or treatment. It is concluded that, provided allowance is made for the difference in potency, morphine is a satisfactory substitute for orally administered diamorphine. However, when injections are necessary, the greater solubility of its hydrochloride gives diamorphine an important practical advantage over morphine, especially when large doses are required.

journal_name

Pain

journal_title

Pain

authors

Twycross RG

doi

10.1016/0304-3959(77)90072-0

subject

Has Abstract

pub_date

1977-04-01 00:00:00

pages

93-104

issue

2

eissn

0304-3959

issn

1872-6623

pii

00006396-197704000-00001

journal_volume

3

pub_type

临床试验,杂志文章

相关文献

PAIN文献大全
  • Dual influence of the striatum on neuropathic hypersensitivity.

    abstract::We studied whether striatal alpha(2)-adrenoceptors or N-methyl-d-aspartate (NMDA) receptors influence descending regulation of neuropathic hypersensitivity in the rat by microinjecting an alpha(2)-adrenoceptor agonist or NMDA-receptor antagonist into the dorsal striatum in animals with a spinal nerve ligation-induced ...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2007.08.009

    authors: Pertovaara A,Wei H

    更新日期:2008-07-01 00:00:00

  • Location-specific responses to nociceptive input support the purposeful nature of motor adaptation to pain.

    abstract::Movement is changed in pain, but the mechanisms remain unclear. Key questions are unresolved such as whether activation can be inhomogeneously distributed within a muscle in a manner that is specific to the location of noxious input. This study addressed this question using high-density electromyography (EMG) to study...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000001317

    authors: Gallina A,Salomoni SE,Hall LM,Tucker K,Garland SJ,Hodges PW

    更新日期:2018-11-01 00:00:00

  • Patterns of prescription opioid utilization among adolescents and adults with comorbid chronic pain and mental health diagnosis.

    abstract::Our goal was to examine the association between mental health disorders (MHD) and subsequent risk of opioid use among commercially insured youth and adults (aged 14-64 years) with comorbid chronic noncancer pain (CNCP) conditions. We conducted a retrospective cohort study using IQVIA Health Plan Claims database from J...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000001934

    authors: Olopoenia A,Onukwugha E,Simoni-Wastila L,Camelo-Castillo W,Villalonga-Olives E,Gandhi AB,Slejko J

    更新日期:2020-10-01 00:00:00

  • Differential expression of systemic inflammatory mediators in amputees with chronic residual limb pain.

    abstract::Chronic postsurgical pain impacts most amputees, with more than half experiencing neuralgic residual limb pain. The transition from normal acute postamputation pain to chronic residual limb pain likely involves both peripheral and central inflammatory mechanisms. As part of the Veterans Integrated Pain Evaluation Rese...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000000728

    authors: Chamessian A,Van de Ven T,Buchheit T,Hsia HL,McDuffie M,Gamazon ER,Walsh C,Bruehl S,Buckenmaier C' 3rd,Shaw A

    更新日期:2017-01-01 00:00:00

  • Diffuse noxious inhibitory controls and nerve injury: restoring an imbalance between descending monoamine inhibitions and facilitations.

    abstract::Diffuse noxious inhibitory controls (DNICs) utilize descending inhibitory controls through poorly understood brain stem pathways. The human counterpart, conditioned pain modulation, is reduced in patients with neuropathy aligned with animal data showing a loss of descending inhibitory noradrenaline controls together w...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000000240

    authors: Bannister K,Patel R,Goncalves L,Townson L,Dickenson AH

    更新日期:2015-09-01 00:00:00

  • Genetic influence on variability in human acute experimental pain sensitivity associated with gender, ethnicity and psychological temperament.

    abstract::While a variety of cultural, psychological and physiological factors contribute to variability in both clinical and experimental contexts, the role of genetic factors in human pain sensitivity is increasingly recognized as an important element. This study was performed to evaluate genetic influences on variability in ...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2004.02.027

    authors: Kim H,Neubert JK,San Miguel A,Xu K,Krishnaraju RK,Iadarola MJ,Goldman D,Dionne RA

    更新日期:2004-06-01 00:00:00

  • The analgesic effect of transcutaneous electrical nerve stimulation (TNS) in patients with rheumatoid arthritis. A comparative study of different pulse patterns.

    abstract::Transcutaneous electrical nerve stimulation (TNS) was used on 20 patients with severe wrist pain due to rheumatoid arthritis. Three different stimulation frequencies were used: high 70 Hz stimulation (70 TNS), low frequency 3 Hz stimulation (3 TNS) and brief trains of stimuli with an internal frequency of 70 Hz and wi...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(79)90051-4

    authors: Mannheimer C,Carlsson CA

    更新日期:1979-06-01 00:00:00

  • Nitrous oxide inhibits glutamatergic transmission in spinal dorsal horn neurons.

    abstract::The effects of nitrous oxide (N2O) are thought to be mediated by several pharmacological pathways at different levels of the central nervous system. Here, we focus on excitatory glutamatergic transmission in the superficial dorsal horn of the spinal cord with respect to its importance for the nociceptive processing. T...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2007.03.026

    authors: Georgiev SK,Kohno T,Ikoma M,Yamakura T,Baba H

    更新日期:2008-01-01 00:00:00

  • Impairment of corneal pain perception in cluster headache.

    abstract::Despite many studies, the mechanisms underlying the pathogenesis of pain in cluster headache (CH) still remain obscure. An involvement of substance P (SP) containing neurons of the Gasserian ganglion and/or of the spinal trigeminal nucleus has recently been suggested, e.g., by impairment of inhibitory descending pathw...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(91)90219-N

    authors: Sandrini G,Alfonsi E,Ruiz L,Pavesi G,Micieli G,Manzoni GC,Mancia D,Nappi G

    更新日期:1991-12-01 00:00:00

  • Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults.

    abstract::Despite decades of research, hundreds of studies, and a number of recent reviews, the effects of aging on the experience of pain remain poorly understood. Many prior investigators have reported increases in persistent pain conditions and diminished tolerance for certain types of laboratory-induced pain among the elder...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/s0304-3959(02)00324-x

    authors: Edwards RR,Fillingim RB,Ness TJ

    更新日期:2003-01-01 00:00:00

  • Effects of acetaminophen and antipyrine on non-inflammatory pain and EEG activity.

    abstract::Antinociceptive effects of the 2 (each 1000 mg, orally) non-steroidal anti-inflammatory drugs (NSAIDs) acetaminophen (paracetamol) and antipyrine (phenazone) were investigated with a non-inflammatory experimental pain model in 32 healthy volunteers. Phasic pain was induced by intracutaneously applied brief electrical ...

    journal_title:Pain

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/0304-3959(92)90165-8

    authors: Bromm B,Forth W,Richter E,Scharein E

    更新日期:1992-08-01 00:00:00

  • Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain.

    abstract::Drawing on advances in chronic pain metrics, a simplified Graded Chronic Pain Scale-Revised was developed to differentiate mild, bothersome, and high-impact chronic pain. Graded Chronic Pain Scale-Revised was validated among adult enrollees of 2 health plans (N = 2021). In this population, the prevalence of chronic pa...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000001758

    authors: Von Korff M,DeBar LL,Krebs EE,Kerns RD,Deyo RA,Keefe FJ

    更新日期:2020-03-01 00:00:00

  • Effectiveness of group acceptance and commitment therapy for fibromyalgia: a 6-month randomized controlled trial (EFFIGACT study).

    abstract::In the last decade, there has been burgeoning interest in the effectiveness of third-generation psychological therapies for managing fibromyalgia (FM) symptoms. The present study examined the effectiveness of acceptance and commitment therapy (ACT) on functional status as well as the role of pain acceptance as a media...

    journal_title:Pain

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.pain.2013.12.029

    authors: Luciano JV,Guallar JA,Aguado J,López-Del-Hoyo Y,Olivan B,Magallón R,Alda M,Serrano-Blanco A,Gili M,Garcia-Campayo J

    更新日期:2014-04-01 00:00:00

  • The relationship between paraspinal EMG and chronic low back pain.

    abstract::Two models of the relationship between paraspinal EMG and low back pain have been proposed. Specific predictions arising from these are listed and the literature relating to them reviewed. Recent research on patterns of EMG rather than absolute levels is also discussed. It is concluded that there is no consistent evid...

    journal_title:Pain

    pub_type: 杂志文章,评审

    doi:10.1016/0304-3959(84)90093-9

    authors: Nouwen A,Bush C

    更新日期:1984-10-01 00:00:00

  • The expression of pain in infants and toddlers: developmental changes in facial action.

    abstract::Age-related changes in the facial expression of pain during the first 18 months of life have important implications for our understanding of pain and pain assessment. We examined facial reactions video recorded during routine immunization injections in 75 infants stratified into 2-, 4-, 6-, 12-, and 18-month age group...

    journal_title:Pain

    pub_type: 临床试验,杂志文章

    doi:10.1016/s0304-3959(97)00034-1

    authors: Lilley CM,Craig KD,Grunau RE

    更新日期:1997-08-01 00:00:00

  • Paraplegia following coeliac plexus block.

    abstract::Coeliac plexus block (CPB) is one of the few neurolytic procedures that is still considered very useful in managing chronic cancer pain. We describe what we believe to be the fifth case in the literature of paraplegia following coeliac plexus block with ethyl alcohol. Clinical and neurophysiological examination confir...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(93)90015-H

    authors: De Conno F,Caraceni A,Aldrighetti L,Magnani G,Ferla G,Comi G,Ventafridda V

    更新日期:1993-12-01 00:00:00

  • Activation of cyclin-dependent kinase 5 (Cdk5) in primary sensory and dorsal horn neurons by peripheral inflammation contributes to heat hyperalgesia.

    abstract::Cyclin-dependent kinase 5 (Cdk5) is a unique member of the CDK family. It is predominantly expressed in postmitotic neurons and has been implicated in neuronal plasticity. The present study showed that Cdk5 and p35 were expressed in primary sensory and dorsal horn neurons, while p25, an N-terminal truncated derivative...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2006.08.008

    authors: Yang YR,He Y,Zhang Y,Li Y,Li Y,Han Y,Zhu H,Wang Y

    更新日期:2007-01-01 00:00:00

  • Sequential analysis of child pain behavior and maternal responses: an observational study.

    abstract::This laboratory-based study examined lagged associations between child pain behavior and maternal responses as a function of maternal catastrophizing (CAT). Mothers completed the parent version of the Pain Catastrophizing Scale. Children participated in a validated water ingestion procedure to induce abdominal discomf...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000000963

    authors: Langer SL,Romano J,Brown JD,Nielson H,Ou B,Rauch C,Zullo L,Levy RL

    更新日期:2017-09-01 00:00:00

  • Differential effects of morphine on the affective and the sensory component of carrageenan-induced nociception in the rat.

    abstract::Pain is generally considered to have a sensory and an affective component. Clinical research has suggested that morphine more potently attenuates the affective component as compared to the sensory component. Because preclinical nociception models typically focus on the sensory component of nociception, and do not asse...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2007.07.027

    authors: van der Kam EL,De Vry J,Schiene K,Tzschentke TM

    更新日期:2008-06-01 00:00:00

  • Plasma and saliva substance P levels: the effects of acute pain in pregnant and non-pregnant women.

    abstract::Substance P like immunoreactivity (SPLI) and total protein (TP) concentrations in plasma and saliva were measured in 80 healthy female patients divided into the following four groups: women in group 1 were not pregnant and they were awaiting tubal ligation; women in group 2 were not pregnant but they experienced acute...

    journal_title:Pain

    pub_type: 临床试验,杂志文章

    doi:10.1016/S0304-3959(96)03258-7

    authors: Dalby PL,Ramanathan S,Rudy TE,Roy L,Amenta JS,Aber A

    更新日期:1997-02-01 00:00:00

  • Chronic fentanyl or buprenorphine infusion in the mouse: similar analgesic profile but different effects on immune responses.

    abstract::It is known that morphine has a negative impact on the immune responses. The potent opioids fentanyl and buprenorphine have recently become available as transdermal preparation for the treatment of chronic pain. We analyze the effect of fentanyl and buprenorphine on splenic cellular immune responses in the mouse. The ...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2004.04.020

    authors: Martucci C,Panerai AE,Sacerdote P

    更新日期:2004-07-01 00:00:00

  • Activation of sphingosine-1-phosphate receptor subtype 1 in the central nervous system contributes to morphine-induced hyperalgesia and antinociceptive tolerance in rodents.

    abstract:ABSTRACT:Morphine-induced alterations in sphingolipid metabolism in the spinal cord and increased formation of the bioactive sphingolipid metabolite sphingosine-1-phosphate (S1P) have been implicated in the development of morphine-induced hyperalgesia (OIH; increased pain sensitivity) and antinociceptive tolerance. The...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000001888

    authors: Doyle TM,Janes K,Chen Z,Grace PM,Esposito E,Cuzzocrea S,Largent-Milnes TM,Neumann WL,Watkins LR,Spiegel S,Vanderah TW,Salvemini D

    更新日期:2020-09-01 00:00:00

  • An empirical taxometric alternative to traditional classification of temporomandibular disorders.

    abstract::A number of investigators have suggested that the generic classification temporomandibular disorders (TMD) may consist of several subsets of patients. Two primary factors are to be significant in discriminating subgroups, namely, presence or absence of TM joint abnormalities and psychological characteristics such as t...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(89)90090-0

    authors: Rudy TE,Turk DC,Zaki HS,Curtin HD

    更新日期:1989-03-01 00:00:00

  • Spinal substance P release in vivo during the induction of long-term potentiation in dorsal horn neurons.

    abstract::Long-term potentiation (LTP) in wide dynamic range (WDR) neurons in the dorsal horn has been suggested to contribute to central sensitization and the development of chronic pain. Indirect experimental evidence indicates an involvement of substance P (SP), in this respect. The aim of the present study was to monitor th...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/s0304-3959(01)00414-6

    authors: Afrah AW,Fiskå A,Gjerstad J,Gustafsson H,Tjølsen A,Olgart L,Stiller CO,Hole K,Brodin E

    更新日期:2002-03-01 00:00:00

  • Empathy hurts: compassion for another increases both sensory and affective components of pain perception.

    abstract::Recent studies demonstrate that some brain structures activated by pain are also engaged when an individual observes someone else in pain, and that these empathy-related responses are modulated as a function of the affective link between the empath and the individual in pain. In this study we test the hypothesis that ...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2007.07.017

    authors: Loggia ML,Mogil JS,Bushnell MC

    更新日期:2008-05-01 00:00:00

  • Activity of nociceptive modulatory neurons in the rostral ventromedial medulla associated with volume expansion-induced antinociception.

    abstract::A wide range of environmental stimuli have been shown to induce antinociception. Investigation of the brain regions contributing to environmentally induced antinociception (EIA) has focused primarily on the effect of disrupting neural transmission at various CNS sites. In contrast, the present study analyzed changes i...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(93)90108-2

    authors: Morgan MM,Fields HL

    更新日期:1993-01-01 00:00:00

  • Pain quality descriptors in community-dwelling older adults with nonmalignant pain.

    abstract::This study aimed to characterize the prevalence of various pain qualities in older adults with chronic nonmalignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference, distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Stud...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000000719

    authors: Thakral M,Shi L,Foust JB,Patel KV,Shmerling RH,Bean JF,Leveille SG

    更新日期:2016-12-01 00:00:00

  • Autoimmunity against the β2 adrenergic receptor and muscarinic-2 receptor in complex regional pain syndrome.

    abstract::Complex regional pain syndrome (CRPS) is a painful condition affecting one or more extremities of the body, marked by a wide variety of symptoms and signs that are often difficult to manage because the pathophysiology is incompletely understood. Thus, diverse treatments might be ineffective. A recent report revealed t...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/j.pain.2011.06.012

    authors: Kohr D,Singh P,Tschernatsch M,Kaps M,Pouokam E,Diener M,Kummer W,Birklein F,Vincent A,Goebel A,Wallukat G,Blaes F

    更新日期:2011-12-01 00:00:00

  • Disruption and restoration of dorsal horn sensory map after peripheral nerve crush and regeneration.

    abstract::Formalin injection into the hindpaw of rats produces many neurons with c-fos protein-like immunoreactivity (fos-neurons) in the medial 3/4 of the ipsilateral dorsal horn laminae I and II at the junction of 4th and 5th lumbar segments (the sciatic territory). The tibial nerve transection 2 or 3 days earlier resulted in...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1016/0304-3959(95)00014-J

    authors: Sugimoto T,Yoshida A,Nishijima K,Ichikawa H

    更新日期:1995-10-01 00:00:00

  • Sociodemographic disparities in chronic pain, based on 12-year longitudinal data.

    abstract::Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n...

    journal_title:Pain

    pub_type: 杂志文章

    doi:10.1097/j.pain.0000000000000762

    authors: Grol-Prokopczyk H

    更新日期:2017-02-01 00:00:00