Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: A randomized open trial

Neuropathic cancer pain represents a major challenge. Treatment often requires adjuvant analgesics, including gabapentin, to complement the effects of opioids. This study aimed to compare the effectiveness and safety of gabapentin combined with an opioid versus opioid monotherapy for the management of neuropathic cancer pain. Seventy-five cancer patients who were receiving opioid therapy and reported sufficient pain relief of nociceptive, but not neuropathic, pain were enrolled. Sixty-three patients completed the study. Patients were randomized to one of the following treatment protocols: 1) gabapentin adjuvant to ongoing opioid treatment titrated according to pain response while opioid dose was kept constant (group GO), and 2) continuation of opioid monotherapy according to the World Health Organization treatment ladder approach (group OO). Changes in pain intensity, allodynia, and analgesic drug consumption were evaluated at Day 4 and Day 13. Side effects were also recorded. Both treatments resulted in a significant reduction of pain intentsity at Day 4 and Day 13 compared to baseline. However, mean pain intensity for burning and shooting pain was significantly higher in the OO group compared to the GO group at both the fourth (P = 0.0001) and 13th (P = 0.0001) days of the study. An earlier significant decrease (at Day 4, P = 0.002) was observed for allodynia in the GO group compared to the OO group. The rate of side effects in the GO group was significantly lower than that in the OO group (P = 0.015). These data suggest that gabapentin added to an opioid provides better relief of neuropathic pain in cancer patients than opioid monotherapy; this combination of gabapentin and an opioid may represent a potential first-line regimen for the management of pain in these patients

Effect of intravenous administration of paracetamol on morphine consumption in cancer pain control

The present study aimed to examine the effectiveness of intravenous administration of paracetamol added to morphine in the control of cancer pain and its possible contribution as reduction of opioid consumption and opioid-related side effects

Cytotoxic effects of four different endodontic materials in human periodontal ligament fibroblasts

The purpose of this study was to compare the cytotoxicity, induced apoptosis and/or necrosis, and apoptotic mechanisms in human periodontal ligament (PDL) fibroblasts treated with four different endodontic materials: White ProRoot mineral trioxide aggregate (MTA) (MTA/Dentsply; Tulsa Dental, Memphis, TN), Diaket (ESPE, Seefeld, Germany), Endion (VOCO, Cuxhaven, Germany), and CYMED 8410 (NANO, Kaohsiung, Taiwan). The effects of these four materials on the viability of PDL fibroblasts were determined by MTT (3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-SH-tetrazolium bromide) assay. Apoptotic pathways were evaluated via several mechanisms. Exposure to MTA for 24, 48, and 72 hours resulted in no significant differences in MTT reduction and viable cell number compared with controls. However, treatment of PDL fibroblasts with Diaket Endion, and CYMED 8410 for 24, 48, and 72 hours resulted in cytotoxicity with MTT and a reduction of viable cell number with trypan blue dye exclusion test compared with controls (from p < 0.05 to p < 0.001). Annexin V-FITC/PI staining showed that Diaket, Endion, and CYMED 8410 induced higher percentages of apoptosis and/or necrosis than in controls (45.6%, 25.5%, and 6.3%, respectively). Results of cell-cycle analyses were concordant with annexin V-FITC/PI staining findings. These results suggest that MTA is a very biocompatible filling material. However, Diaket, Endion, and CYMED 8410 are toxic to PDL fibroblasts in vitro. The main form of cell death induced by these filling materials was determined to be apoptosis and/or necrosis

Postoperative chronic pain incidence and etiology in coronary artery bypass graft surgery: a prospective study

Introduction: Post-operative chronic pain (POCP), after updated by Werner-Kongsgaard, is defined as the pain developed after the surgical procedure or increased in intensity after the procedure, as the continuation of acute postoperative pain, localized in the surgical area, lasted at least 3 months, and other causes of pain excluded. In our study, we aimed to prospectively examine the prevalence of POCP and risk factors in the first three months after coronary artery bypass graft surgery (CABGS)

Proteasome Inhibitor Bortezomib Increases Radiation Sensitivity in Androgen Independent Human Prostate Cancer Cells

OBJECTIVES To investigate the effects of a strong proteasome inhibitor, bortezomib alone or in combination with radiotherapy on androgen-independent DU145 human prostate cancer cells. Proteasomes play important roles in cell cycle, proliferation, apoptosis, angiogenesis, and cellular resistance to chemotherapy and radiotherapy. METHODS Increasing concentrations of bortezomib alone or in combination with radiation were applied to DU145 cells and IC50 values that inhibited cell growth by 50% were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium- bromide assay. Apoptosis was determined using annexin V staining by flow cytometry. mRNA levels of proapoptotic caspase-3 and antiapoptotic Bcl-2 genes were examined by reverse transcriptase polymerase chain reaction. RESULTS The IC50 value of bortezomib was found to be 28 mu M although 400- and 800-cGy radiation decreased the cell proliferation by 14% and 28%, respectively. In 400- and 800-cGy radiation applied DU145 cells, IC50 value of bortezomib decreased to 23- and 12 mu M, respectively. Exposure to 5 mu M bortezomib for 48 hours caused apoptosis in 35% of the population whereas 800-cGy radiation resulted apoptosis in 14% of cells. However, 42% of DU145 cells that were exposed to 800 cGy and 5 mu M bortezomib underwent apoptosis. Reverse transcriptase polymerase chain reaction results showed a significant decrease in mRNA levels of antiapoptotic Bcl-2 gene and an increase in proapoptotic caspase-3 gene expression in the combination group compared to control group. CONCLUSIONS Bortezomib increases radiation sensitivity in androgen-independent human DU145 prostate cancer cells through inhibition of Bcl-2 and induction of caspase-3 genes. UROLOGY 75: 793-798, 2010. (C) 2010 Elsevier Inc.Wo

Analysis of the incidence and predictive factors of chronic postoperative pain in adult population

Ama&ccedil;: Ameliyat Sonrası Kronik Ağrı (ASK) hastaların yaşam kalitesine olumsuz etkilerinin yanı sıra tıbbi ve hukuki sorunlara neden olur ve işg&uuml;c&uuml; kaybı nedeniyle ekonomik kayıpları doğurur. T&uuml;rkiye&rsquo;de ASK insidansını g&ouml;steren herhangi bir araştırma bulunmamaktadır. Bu &ccedil;alışmanın amacı, her t&uuml;rl&uuml; cerrahi girişimden ge&ccedil;ecek olan hastaların ASK gelişiminde en belirgin fakt&ouml;r&uuml; bulmaktır. Y&ouml;ntem: &Ccedil;alışmaya, beş hastanede ameliyat edilen hastalar (165 kadın, 146 erkek) dahil edilmiştir. Hasta veri kayıt ve takip formu hazırlanmıştır. T&uuml;m hastalar ağrı skorlarının sorulduğu telefon g&ouml;r&uuml;şmeleri ile 2 ay takip edilmiştir. İkinci ayda hastalardan ağrısı olduğunu bildirenler, ağrı b&ouml;l&uuml;m&uuml; tarafından yeniden değerlendirmeye alınmıştır. Bulgular: Altmış yedi olgu, cerrahiden iki ay sonra cerrahi m&uuml;dahale yapılan b&ouml;lgede uzun s&uuml;reli ağrı yakınmasında bulunmuş ve 46 hastada ASK tanısı konulmuştur (% 14,8). Olgular, 18-45 yaş (A) ve 45 yaşından b&uuml;y&uuml;k (B) olarak gruplandırıldığında, ASK&rsquo;ın varlığı istatistiksel olarak anlamlı bulunmuştur. ASK ve ASA skoru arasında istatistiksel olarak anlamlı ilişki belirlenmiştir. Elde edilen sonu&ccedil;lara g&ouml;re, 45 yaş &uuml;st&uuml; ve ASA skoru 3 olan hastalarda ASK oranı daha y&uuml;ksektir. Sonu&ccedil;: Literat&uuml;r&uuml;n aksine, sosyo-ekonomik durum, ameliyat tipi ve derecesi, coğrafi b&ouml;lge, v&uuml;cut kitle indeksi, cinsiyet, ağrı ila&ccedil;ları, sigara/alkol bağımlılığı ve bazı n&ouml;ropati ile ilgili kronik hastalıkların varlığı gibi diğer fakt&ouml;rlerin ASK olasılığında etkisi yoktur. Bununla birlikte, ASA ve yaş, ASK olasılığında &ouml;nemli rol oynamaktadır