Pain Medications - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

PAIN MEDICATIONS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J ...

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PAIN

MEDICATIONS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Pain Medications: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84148-9 1. Pain Medications-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on pain medications. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PAIN MEDICATIONS ................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Pain Medications .......................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 13 The National Library of Medicine: PubMed ................................................................................ 13 CHAPTER 2. NUTRITION AND PAIN MEDICATIONS........................................................................ 27 Overview...................................................................................................................................... 27 Finding Nutrition Studies on Pain Medications ......................................................................... 27 Federal Resources on Nutrition ................................................................................................... 29 Additional Web Resources ........................................................................................................... 29 CHAPTER 3. ALTERNATIVE MEDICINE AND PAIN MEDICATIONS ................................................. 31 Overview...................................................................................................................................... 31 National Center for Complementary and Alternative Medicine.................................................. 31 Additional Web Resources ........................................................................................................... 37 General References ....................................................................................................................... 47 CHAPTER 4. PATENTS ON PAIN MEDICATIONS .............................................................................. 49 Overview...................................................................................................................................... 49 Patents on Pain Medications ....................................................................................................... 49 Patent Applications on Pain Medications ................................................................................... 77 Keeping Current ........................................................................................................................ 102 CHAPTER 5. BOOKS ON PAIN MEDICATIONS................................................................................ 103 Overview.................................................................................................................................... 103 Book Summaries: Federal Agencies............................................................................................ 103 Book Summaries: Online Booksellers......................................................................................... 106 The National Library of Medicine Book Index ........................................................................... 109 Chapters on Pain Medications ................................................................................................... 109 CHAPTER 6. MULTIMEDIA ON PAIN MEDICATIONS ..................................................................... 111 Overview.................................................................................................................................... 111 Audio Recordings....................................................................................................................... 111 CHAPTER 7. PERIODICALS AND NEWS ON PAIN MEDICATIONS .................................................. 113 Overview.................................................................................................................................... 113 News Services and Press Releases.............................................................................................. 113 Newsletters on Pain Medications .............................................................................................. 115 Newsletter Articles .................................................................................................................... 115 Academic Periodicals covering Pain Medications...................................................................... 117 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 119 Overview.................................................................................................................................... 119 U.S. Pharmacopeia..................................................................................................................... 119 Commercial Databases ............................................................................................................... 123 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 127 Overview.................................................................................................................................... 127 NIH Guidelines.......................................................................................................................... 127 NIH Databases........................................................................................................................... 129 Other Commercial Databases..................................................................................................... 131 APPENDIX B. PATIENT RESOURCES ............................................................................................... 133 Overview.................................................................................................................................... 133 Patient Guideline Sources.......................................................................................................... 133 Finding Associations.................................................................................................................. 171 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 173

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Overview.................................................................................................................................... 173 Preparation................................................................................................................................. 173 Finding a Local Medical Library................................................................................................ 173 Medical Libraries in the U.S. and Canada ................................................................................. 173 ONLINE GLOSSARIES................................................................................................................ 179 Online Dictionary Directories ................................................................................................... 182 PAIN MEDICATIONS DICTIONARY...................................................................................... 183 INDEX .............................................................................................................................................. 259

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with pain medications is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about pain medications, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to pain medications, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on pain medications. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to pain medications, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on pain medications. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON PAIN MEDICATIONS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on pain medications.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and pain medications, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “pain medications” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Pain and Principles of Effective Analgesic Use for Dental Pain Control Source: Journal of the Tennessee Dental Association. 81(1): 10-16. Winter 2001. Contact: Available from Journal of the Tennessee Dental Association. 2104 Sunset Place, Nashville, TN 37212. E-mail: [email protected]. Summary: Patients have the right to expect effective pain control and relief following dental treatment. In recent years, clinical guidelines on pain control have been published and disseminated. This article reviews current concepts of pain and principles of effective pharmacologic pain control. The author considers the classification of pain, pain assessment, misconceptions regarding pain and analgesics (pain medications), the choice of analgesic regimen, choosing an analgesic, local anesthetics, non opioid analgesics, opioid analgesics, and the principles of analgesic use. The author stresses

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that patients should be followed closely, particularly when beginning or changing analgesic regimens. Analgesics are more beneficial if the clinician monitors pain relief and side effects frequently and adjusts the regimen as needed. Accurate assessment, methodical prevention, and aggressive treatment are the tools required to keep pain at a minimum. 33 references. 1 figure. 2 tables.

Federally Funded Research on Pain Medications The U.S. Government supports a variety of research studies relating to pain medications. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to pain medications. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore pain medications. The following is typical of the type of information found when searching the CRISP database for pain medications: •

Project Title: ACQUISTION OF A 600MHZ NMR SPECTROMETER Principal Investigator & Institution: Albert, Arlene D.; Professor; Molecular and Cell Biology; University of Connecticut Storrs Unit 1133 Storrs-Mansfield, Ct 06269 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2004 Summary: (provided by applicant): Funds are requested for the purchase of a 600 MHz NMR spectrometer, which will be located in the Department of Chemistry at the University of Connecticut. The instrument will mainly serve the Departments of Molecular and Cell Biology, Chemistry and Pharmaceutical Chemistry at the University of Connecticut - Storrs campus. This instrument will serve five major users and as well as several minor users. The research foci in the main group are: (1) the study of the structure and function of proteins (agrin, rhodopsin, bacteriorhodopsin, lac permease and G-protein coupled receptors); (2) the study of protein folding and dynamics; (3) probing the molecular mechanisms of DNA damage, repair and mutagenesis; (4) probing the endocannabinoid receptor sites to develop therapeutic targets for drug addictions and new pain medications. This instrument will be housed in the 950+ sq.ft. Department of Chemistry NMR facility together with a Bruker DRX-400. The University has three instruments on campus, a Bruker DMX-500, a CheMagnetics CMX-300 (solid state) and the Bruker DRX-400 mentioned above. These instruments lack the resolution, sensitivity and available time to run the projects described above. These researchers currently travel a minimum of an hour to acquire the data needed on several funded projects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Project Title: ANALGESIC REGIMENS FOR SURGERY AND INFLAMMATION IN MICE Principal Investigator & Institution: Toth, Linda A.; Professor; Pharmacology; Southern Illinois University Carbondale 900 S. Normal Carbondale, Il 629014709 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 30-APR-2007 Summary: (provided by applicant): Recognizing and alleviating pain are common challenges in laboratory animal medicine and are mandated by the Animal Welfare Act and the Public Health Service Policy on the Use of Laboratory Animals. However, available data on effective post-surgical analgesia for rodents has been collected primarily by studying rats; relatively few studies specifically assess analgesic efficacy for clinical use in mice. The development of clinical approaches for veterinary medical management of mice has lagged behind the explosive expansion in the availability and scientific use of genetically modified strains of mice, particularly with respect to their increasing importance in studies requiring surgical manipulation. The need to identify efficacious analgesic regimens for mice will become even more imperative should the United States Department of Agriculture eventually amend its definition of "animal" to include the genus Mus. This application proposes to evaluate the efficacy of several oral analgesic regimens for treatment of acute, surgical, and inflammatory pain in mice. Oral administration of analgesic medications via the drinking water is advantageous in a research setting because it permits large numbers of animals to be treated efficiently and without additional manipulation. However, important considerations are to assure both that the therapeutic regimen has efficacy against the pain the animals are experiencing and that the animals voluntarily consume enough medication to achieve effective doses. Much of the available literature does not address these issues. Preliminary work indicates that ibuprofen administered in the drinking water promotes behavioral recuperation in mice that have undergone abdominal surgery. This application proposes to extend that work by identifying additional or superior analgesic regimens for acute, surgical or inflammatory pain in mice. The data should reveal new and practical strategies for relief of post-procedural pain in mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANTI TNF ANTIBODY IN RHEUMATOID ARTHRITIS Principal Investigator & Institution: St Clair, Eugene W.; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001 Summary: Purpose: The purpose of this study is to evaluate the efficacy and safety of chronic Anti-tumor necrosis factor (TNF) Chimeric Monoclonal Antibody (cA2) treatment in patients with active rheumatoid arthritis (RA) despite treatment with methotrexate (MTX). Additional objectives of the study are to determine the efficacy and safety of cA2 treatment in providing continued reduction in signs and symptoms, reduction of disability, slowing of joint damage, promotion of disease remission and improvement in quality of life at 1 year following the onset of treatment. RA is a chronic autoimmune disorder of unknown etiology that occurs in approximately 1% of the population. MTX has become the drug of choice for many rheumatologists because of its superior efficacy and faster mode of action. However, despite treatment with MTX, many patients only experience partial relief of symptoms and continue to exhibit active disease. Cytokines such as TNF-a are abundant in inflamed joints and promote the influx of neutrophils into synovial fluid and entry of lymphocytes and monocytes into the synovial tissue. TNF appears to be a key mediator since it regulates other

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proinflammatory cytokines. Methods: Patients will be randomized into one of five treatment groups: Group I receives placebo infusions, Group II receives 3 mg/kg at weeks 0, 2 and 6 and every 8 weeks through week 54 (with placebo infusions at the interim visits), Group III receives 3 mg/kg cA2 infusions at each visit, Group IV receives 10 mg/kg cA2 infusions at weeks 0, 2 and 6 and every 8 weeks through week 54 (with placebo infusions at the interim visits), and Group V receives 10 mg/kg cA2 infusions at each visit. The study was extended to allow for an additional 12 infusions of the same blinded dose regimen patients were randomized to in the first 54 weeks of treatment. Patients will be required to make 2 safety follow-up visits after their last infusion. Results: Study enrollment began in April of 1997 and is now complete with 25 patients randomized. Thirty-six patients were screened for the study. By race and gender, they include: 21 Caucasian females; 12 Caucasian males and 3 African American females. There were two adverse events leading to patient withdrawals in 2 cases. One patient was withdrawn due to a decrease in the number of white blood cells. This event was judged possibly related to the study medication. Follow-up studies show an improvement in this laboratory finding since termination of the study agent. This patient will not receive further treatments of the study medication under this protocol. This patient is participating in follow-up evaluations. Another patient was withdrawn because they were unable to return for the required visits after a partial lumbar hemilaminectomy on November 6, 1997. This patient was allowed, by the sponsor, to continue in the study despite the surgical event. However, a slow recovery period made this too difficult for the patient. This patient agreed to return periodically for safety evaluations, however, she has not returned for follow-up. Her husband gave permission to contact her local physician to request follow-up information on her condition. On 9/8/98, her physician informed me that he had terminated this patient from his care because of abuse of pain medications. At the time of contact this patient was in a hospital's de-tox unit for abuse of pain meds and alcohol. Her physician informed me that to his knowledge, the patient has not been diagnosed with any other autoimmune diseases, has not developed a malignancy, or developed a serious infection requirring hospitalization, and the patient was alive. No other follow-up information has been obtained since that time. Four patients were withdrawn from the study because of worsening of their arthritis or no clinical improvement in their arthritis. All four patients are participating in follow-up evaluations. An analysis of the week 30 data from the study reveals improvement of joint count tenderness and swelling as well as quality of life changes. Data also show a significant response to treatment at both dose levels. Significance: Current treatment of RA is often unsuccessful and has not been shown to prevent joint damage. The proposed study is potentially an effective treatment for RA because of its ability to bind to human TNF and neutralize its biologic activity. Future Plans: The sponsor of the study plans to file for FDA approval of this drug in 1999. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOBEHAVIORAL INTERVENTIONS FOR ORAL PAIN AND MUCOSITIS Principal Investigator & Institution: Mcguire, Deborah B.; Associate Professor; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-FEB-1995; Project End 31-AUG-2003 Summary: Oral pain and mucositis are highly prevalent treatment side effects in cancer patients receiving autologous stem cell transplants of marrow or peripheral blood origin. Interventions are needed that address both the underlying mechanisms of mucositis and pain while simultaneously involving the family caregivers who are so

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important in cancer care The primary aim of this project is to test whether a comprehensive biobehavioral intervention combining misoprostol (a prostaglandin E1 analogue) with psychoeducation that systematically includes family caregivers will reduce severity of oral tissue injury and associated acute oral pain and increase adherence to oral care and pain management standards of care. The secondary aim is to analyze and compare selected costs (pain medications, nutritional support and prolonged hospital stay or readmission due to mucositis) in patients receiving misoprostol plus psychoeducation, misoprostol alone, and usual care. An experimental design will be conducted at the transplant centers of Emory University and the University of Pennsylvania. Consenting patients will be randomly assigned to usual care, misoprostol alone, or misoprostol plus psychoeducation. Mucositis, pain, adherence to oral care and pain management standards, and other relevant data will be collected prior to transplant and at five timepoints afterward until 11 days posttransplant. The study should help delineate the efficacy of a comprehensive intervention that incorporates family caregivers and lead to development of cost-effective models for managing symptoms that prepare patients and family caregivers for home management and undergoing complex medical therapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CAREGIVERS INTERVENTION

OF

CANCER

PAIN

PATIENTS:

COPING

Principal Investigator & Institution: Weitzner, Michael A.; Professor of Oncology & Psychiatry; Psychiatry and Behavioral Med; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Three out of four families in the United States will have at least one family member diagnosed with cancer. In the majority of these families, one or more members will be responsible for providing care to the cancer patient. Up to 50- 80% of these patients will have significant pain, the majority not receiving adequate treatment. Important forces such as the movement out of the hospital created by diagnosis-related groups and the significant force of managed care have created a reality in which families and patients are finding themselves at home providing very complex care when that may not be their preference. The provision of this care is made more difficult by the presence of unrelieved pain. The reality is that the living room has become the intensive care unit and the place where family caregivers are exhausted and burdened. Family caregivers who have very little information about pharmacology, dosing of medications, and assessing or treating pain are asked to become around-the-clock care providers. Attention to caregiving issues is important in order to understand how this major, unpaid segment of our health care system works and what we can do to minimize the stress of caregiving. Research focusing on the family caregiver of the cancer patient with pain is limited. Much descriptive work has focused on the cancer patient with pain, with few outcome measures included for the caregiver. Most work suggests that caregivers have increased emotional distress. The impact of caregiving for cancer patients with pain on family members' quality of life (QOL) remains unclear since valid caregiver-specific QOL instruments have not been used. Another factor limiting research progress is the lack of an empirically validated conceptual model for understanding individual differences in QOL or improving QOL among caregivers of cancer patients with pain. The proposed program of research seeks to increase knowledge about caregiving for cancer patients with pain by using a valid, caregiver-specific QOL instrument and an empirically validated stress process model.

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Using the stress process model for caregiving, a psycho-education and coping skills intervention will be evaluated using a randomized, controlled design. Caregiver/patient dyads (n = 300) will be randomly assigned to standard care or standard care plus the coping skills intervention. The caregiver will attend six weekly one-hour visits containing didactic information regarding pain assessment, pain medications, side effects, recognition of emotional distress in the patient, stress management, and communication with the pain team, as well as role play scenarios around these themes. The effectiveness of the intervention will be tested as well as identification of potential mediators and moderators of the effectiveness of the intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC PAIN MANAGEMENT IN PRIMARY CARE Principal Investigator & Institution: Von Korff, Michael R.; Senior Investigator; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JAN-1989; Project End 31-AUG-2004 Summary: This research seeks a more effective and cost-effective integration of medical care and self-care for chronic and recurrent pain in pr5imary care settings. Aim 1: Identify improved methods for analysis of automated health care and medicine use data for TMD pain, headache and back pain patients. Identify potentially modifiable determinants of long-term frequent use of health care and pain medications for these conditions. Study One: We will study determinants of health care and prescription medicine use for pain over a five-year time span. {{Methods for analysis of automated health care and medicine use data will be assessed to test more powerful and informative approaches. Using improved analytic methods,}} we will assess the ability of patient variables to predict and explain frequent use of health care, opioid medications and sedative- hypnotic medications for patients with TMD (n=391), back pain (n=833) and headache (n=869) over a five year time-span. Aim 2: Evaluate the effectiveness of Self-Care Group interventions guided by a stepped care model. Study Two: Data from two randomized controlled trials of Self- Care Groups (SCG) initiated in 1996-98) as part of the current Program Project will be used to identify factors influencing the long-term effectiveness of SCG (participation, baseline severity, self-care orientation, prognostic variables). Study Three: A new randomized controlled trial will evaluate Self-Care Groups fully integrated into primary care. This trial will evaluate the initial benefits and the long-term effectiveness of Self-Care Groups among actively recruited back pain patients (n=250). The intervention will target patients with enduring activity limitations and higher use of health care for back pain {{Patients with continuing activity limitations will receive more intensive intervention according to a stepped care protocol.}} Patients will be followed-up 2, 6, 12 and {{24}} months after randomization. The primary outcome will be activity limitations (Roland Disability Score with added items concerning occupational role disability). Aim 3: Assess the impact of Self-Care Groups (SCG) on long-term health care and prescription medication use. Determine the effect of SCG on health care costs. Study Four: Using automated health care and medicine use data and improved analytic methods, we will investigate the long-term effects of SCG on: (1) use of health care; (2) use of prescription pain medications; and (3) health care costs for back pain (total n from three SCG trials=731). Since the SCG interventions have been shown to reduce worry, enhance confidence in self-care, and reduce activity limitations, this research will provide an experimental test of whether modifying these factors reduces subsequent use of health care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF OPIOIDS ON SLEEP AND FATIGUE Principal Investigator & Institution: Dimsdale, Joel E.; Professor; Psychiatry; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2005 Summary: (provided by applicant): The goal of this R21 application is to refine an experimental design to examine the impact of commonly used pain medications on sleep and next-day fatigue. However, before such studies can be conducted in patients with acute or chronic pain associated with cancer or other severe chronic illness, crucial information is needed to optimize the study design. This proposal seeks to answer certain experimental methodological design questions that can be safely, quickly, and inexpensively addressed in healthy volunteers. This R21 application will generate data guiding the research design and power estimates for subsequent RO1 applications intended to address the impact of pain medication on sleep and fatigue in patients with acute or chronic pain. There are 5 specific aims: 1. Characterize the effect of a typical nighttime dose of MS-Contin and methadone on cytokines, polysomnographic sleep and on rest/activity patterns in healthy volunteers: 2. Characterize daytime fatigue the day after drug administration with self-reported measure of fatigue and mood 3. Characterize neuropsychological performance on the day after drug administration. 4. Estimate the covariance structure of sleep measures to assess the comparative advantages of a crossover or parallel groups design. 5. Evaluate the necessity of repeated first nights and whether this is the optimum design for follow-up studies. Over a two-year period, 50 healthy volunteer subjects will be examined with polysomnography, actigraphy, and neuropsychological tests. Data will be collected on self-reported mood and fatigue, as well as proinflammatory cytokine levels (IL-6, IL1beta, and TNF-alpha. The study design involves a double-blind, placebo-controlled crossover. Each individual will be admitted to the UCSD GCRC on 3 pairs of nights. Each admission will feature an acclimation night in the sleep laboratory followed by a night providing placebo, MS-Contin (15 rag) or methadone (5 mg). On the morning after each dosing subjects will complete fatigue and mood ratings and will perform a brief neuropsychological test battery. They will also undergo actigraphy monitoring for 3 continuous days to examine whether there are subtle lingering effects of the drugs. Blood levels ofproinflammatory cytokines will be obtained at various points before and after drug dosing and the next morning to test the hypothesis that opioid-induced changes in these cytokines are associated with sleep disruption and increased fatigue. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: END OF LIFE CARE IN RESIDENTIAL CARE AND NURSING HOMES Principal Investigator & Institution: Zimmerman, Sheryl I.; Assistant Professor; Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Nearly three million elderly are housed in long-term care (LTC) settings, and the numbers and proportions of persons who live and die there are increasing. Until recently, most LTC was provided in nursing homes (NHs), but non-nursing home residential care/assisted living (RC/AL) has been proliferating as an alternative to NH care. RC/AL facilities are extremely varied, ranging from small board and care homes to large complexes; in many cases, their residents resemble persons in NHs, including elderly with Alzheimer's Disease and related dementia. Despite their prevalence, and

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the fact that they are becoming significant providers of end-of-life care, virtually no information exists regarding how LTC facilities attend to the end-of-life of their residents; for RC/AL facilities, such information is completely lacking. This study will collect data from an established, stratified, random sample of LTC facilities and residents across four states to describe how care is provided in these diverse RC/AL facilities (stratified to include small facilities; larger, traditional facilities; and larger, new-model facilities) and NHs, and will compare the structure and process of that care, select outcomes of care, and the relationship between care and outcomes for a diverse group of residents. Specifically, data will be collected from 193 RC/AL facilities and 40 NHs participating in NIA's Collaborative Studies of Long-Term Care, to describe, compare, and evaluate the structure (the facility's capacity to provide care; the care setting) and process (the manner in which care is delivered; the application of care) of end-of-life care. Data also will be collected for a stratified sample of 450 of the residents who die or are transferred up to three days before their death, to describe: (1) the characteristics of the residents who die, such as their age, cognitive and comorbid status, and cause and site of death; (2) the care provided to these residents at the end-of-life, such as primary careprovider continuity and training to manage pain (structure), and advance care planning, administration of pain medications, and emotional support (process); and (3) select outcomes of end-of-life care, such as resident discomfort and quality of life, and family and staff satisfaction with care. Analyses also will determine the relationship between the structure and process and select outcomes of end-of-life care [e.g., the relationship between careprovider training (structure), administration of pain medications (process), and resident discomfort (outcome)]. This project will constitute a significant advance in the data available to maximize the end-of-life experience of millions of elderly who die in LTC settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING OF CARE BY REVERSAL OF OPIOID CONSTIPATION Principal Investigator & Institution: Yuan, Chun-Su; Anesthesia and Critical Care; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2001; Project Start 18-FEB-2000; Project End 31-JAN-2004 Summary: Morphine and other opioids are widely used analgesics in advanced cancer patients, and constipation is the most common treatment-associated side effect of opioid pain medications. Conventional measures for opioid-induced constipation are often insufficient, and constipation becomes a limiting factor in opioid use and opioid dose in these patients. A significant number of hospice patients receiving chronic opioids for pain would rather endure their pain than face the severe incapacitating constipation that opioids cause. Thus, opioid-induced constipation, a symptom secondary to the treatment, has a significant negative impact on the quality of life of these terminal patients. Palliative care and end of life management practices have received insufficient attention in the past, and the need to enhance palliative care of dying patients has become apparent in this country. In this proposed project, the efficacy of a novel peripheral opioid receptor antagonist, methylnaltrexone, in the treatment of chronic opioid-induced constipation, will be evaluated. Specific Aim 1 and 2 studies will utilize a clinical pharmacology approach (Phase II/III trials) to evaluate the efficacy and doseresponse of intravenous and oral methylnaltrexone in reversing chronic opioid-induced gut motility changes and constipation in methadone addicts and patients with advanced malignant conditions. These trials will be randomized, double-blind, placebo-controlled studies. In these studies, the oral-cecal transit time will be measured using the lactulose hydrogen breath test, and positive laxation response and opioid analgesic effect will be

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evaluated. In addition, subjective visual analog scale (VAS) scores for constipation, stool frequency and consistency, and "overall well being" will be recorded. Pharmacokinetic data will also be collected. In these studies, mechanisms underlying opioid gastrointestinal pharmacology in humans, an issue that has not been addressed before, will be investigated, since translation of data from previous animal experiments to humans may be problematic due to differences in the physiology of the opioid systems. Bringing methylnaltrexone, the first selective peripheral opioid receptor antagonist, to clinical application will be a significant advance in palliative care. Successful completion of this project will lead to a number of future studies in which other applications of methylnaltrexone, as well as its mechanisms of action of both opioids and their antagonism in humans, can be explored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL ANTI-PAIN MEDICATIONS FOR CANCER Principal Investigator & Institution: Shefter, Eli; Irisys Research and Development, Llc 6190 Cornerstone E, Ste 106 San Diego, Ca 92121 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): The chemical synthesis and biological evaluation of novel, highly potent agents for the treatment of both severe acute and chronic pain associated with cancer and other diseases that has minimal side effects such as addiction liability, imniunosuppression and respiratory depression is very urgent. For "proof of principle," in Phase I, congeners of agents 100-fold more active than morphine will be synthesized and tested in vitro and in vivo for analgesic activity and safety. In later studies, additional lead optimization of the most promising drug candidate will be explored by parallel synthesis combinatorial chemistry. In Phase II, the optimized compounds will be tested in animals for analgesic activity and thorough safety evaluation. Because there is a great need for stable, long lasting, potent, orally active pain medication to treat pain associated with cancer and other diseases, the successful completion of the work proposed will lead to important new innovation in the pain medication field. The long-term goal of our work is to develop effective anti-pain agents in animals that can be taken forward into the clinic for testing as a human medication. We expect that development of the novel pain relief drug candidates proposed will provide new agents useful in the amelioration of human suffering. This will improve the quality of life for tens of thousands of Americans. PROPOSED COMMERCIAL APPLICATION: The need for potent, orally active pain medication to alleviate the severe pain experienced by patients with cancer and other diseases is immense. Procurement of a long lasting oral anti-pain medication that has significantly fewer side effects than narcotics currently in use will provide a therapeutic that is currently not available. The potential commercial application of the work is that the research could lead to a 'blockbuster' drug product. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PAIN RELIEVING PROPERTIES OF ANALGESIC METABOLITES Principal Investigator & Institution: Vaccarino, Anthony L.; St. Charles Pharmaceuticals 2020 Gravier St New Orleans, La 70112 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 15-MAR-2004 Summary: (provided by applicant): Acetaminophen is used extensively in the management of mild to moderate pain. Even so, acetaminophen can cause hepatotoxicty after ingestion of large doses or from chronic use of smaller doses, particularly in the

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elderly, when liver function is compromised, or with concurrent alcohol use. Acetaminophen-induced liver injury is due not to the drug itself but to the formation of a toxic metabolite that normally would be detoxified by conjugation with glutathione. However, with an acute overdose or chronic use, glutathione stores are depleted and the toxic metabolite binds to liver cell proteins and causes hepatic necrosis. We have been exploring a series of new and proprietary acetaminophen derivatives, in which the lead compound (SCP-1) has good oral efficacy and produces little if any hepatotoxicity. Because the metabolic conversion of SCP-1 to acetaminophen is minimal, SCP-1 has its effects through different pathways than acetaminophen and SCP-1 is not a 'pro-drug' of acetaminophen. This Phase I application explores whether two major SCP-1 metabolites possess analgesic activity without hepatotoxicity in order to (1) understand the mechanisms of SCP-1 drug action, and (2) determine the feasibility of developing these metabolites for use in targeted populations in which the biotransformation of analgesic medications, including acetaminophen or SCP-1, could reduce therapeutic activity and/or increase the unwanted side-effects. It will determine whether the two SCP-1 metabolites have analgesic effects comparable to or better than SCP-1 or acetaminophen in two animal models of pain. It will also determine hepatotoxicity after chronic and acute dosing. If the SCP-1 metabolites show analgesic properties without hepatotoxicity, further drug development will be proposed under a Phase II SBIR with eventual clinical trials in special populations that have high levels of factors that influence the biotransformation of drugs into active metabolites, including patients with liver disease, malnutrition, obesity, genetically determined polymorphisms, concurrent use of drugs that inhibit metabolic enzymes, alcohol use, and the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RAPID MEDICATIONS

TRANSDERMAL

DELIVERY

OF

OPIOID

PAIN

Principal Investigator & Institution: Smith, Alan M.; Altea Therapeutics Corporation Tucker, Ga 30084 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 14-JAN-2003 Summary: (provided by applicant): The American Medical Association reports that undertreatment of pain is a major problem for cancer patients as well as for other disease conditions. Approximately 50-75% of cancer patients have pain that is undertreated, and 25% die in severe unrelieved pain. Noninvasive pain medication delivery systems are ideally suited to improve the quality of life for those who experience chronic pain. Currently available noninvasive systems are slow, variable, or require frequent dosing. The goal of this project is to demonstrate the capability of a novel thermal microporation method to enable rapid infusion of pain medication through the skin. The microporation method is a noninvasive, painless, needless, patchbased system which creates an array of microscopic openings in the stratum corneum that increases the drug flux significantly compared to drugs delivered through intact skin. Four top opioid candidates for microporation delivery will be evaluated with an in vitro drug delivery model system that involves studying freshly harvested hairless mouse skin to determine optimal formulation and microporation delivery parameters. The opioid candidates to be tested in vitro with the thermal microporation method include morphine, hydromorphone, fentanyl, and alfentanil. A small pilot clinical study will also be performed to determine the feasibility of delivering fentanyl with a commercially available transdermal patch in conjunction with the microporation system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “pain medications” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for pain medications in the PubMed Central database: •

An unexpected benefit of pre-emptive rectal analgesic administration: the "key" to postoperative analgesia. by Parlow JL.; 2000 Dec 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80584

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with pain medications, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “pain medications” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for pain medications (hyperlinks lead to article summaries): •

3 4

A comparison of the efficacy of alfentanil and remifentanil analgesic infusions for spinal surgery. Author(s): Faponle AF, Watt JW. Source: West Afr J Med. 2002 July-September; 21(3): 180-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744560&dopt=Abstract

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A joint statement from 21 health organizations and the Drug Enforcement Administration. Promoting pain relief and preventing abuse of pain medications: a critical balancing act. Author(s): Drug Enforcement Administration. Source: Journal of Pain and Symptom Management. 2002 August; 24(2): 147. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269265&dopt=Abstract

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A simple pain model for the evaluation of analgesic effects of NSAIDs in healthy subjects. Author(s): Sycha T, Gustorff B, Lehr S, Tanew A, Eichler HG, Schmetterer L. Source: British Journal of Clinical Pharmacology. 2003 August; 56(2): 165-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12895189&dopt=Abstract

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Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. Author(s): Karst M, Salim K, Burstein S, Conrad I, Hoy L, Schneider U. Source: Jama : the Journal of the American Medical Association. 2003 October 1; 290(13): 1757-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14519710&dopt=Abstract

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Analgesic effects and pharmacokinetics of a low dose of ketamine preoperatively administered epidurally or intravenously. Author(s): Xie H, Wang X, Liu G, Wang G. Source: The Clinical Journal of Pain. 2003 September-October; 19(5): 317-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966258&dopt=Abstract

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Analgesic effects of parecoxib following total abdominal hysterectomy. Author(s): Ng A, Smith G, Davidson AC. Source: British Journal of Anaesthesia. 2003 June; 90(6): 746-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765890&dopt=Abstract

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Analgesic efficacy of flupirtine in primary care of patients with osteoporosis related pain. A multivariate analysis. Author(s): Ringe JD, Miethe D, Pittrow D, Wegscheider K. Source: Arzneimittel-Forschung. 2003; 53(7): 496-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918215&dopt=Abstract

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Analgesic efficacy of inhaled morphine in patients after bunionectomy surgery. Author(s): Thipphawong JB, Babul N, Morishige RJ, Findlay HK, Reber KR, Millward GJ, Otulana BA. Source: Anesthesiology. 2003 September; 99(3): 693-700; Discussion 6A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960555&dopt=Abstract

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Analgesic efficacy of low-dose diclofenac versus paracetamol and placebo in postoperative dental pain. Author(s): Kubitzek F, Ziegler G, Gold MS, Liu JM, Ionescu E. Source: J Orofac Pain. 2003 Summer; 17(3): 237-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520769&dopt=Abstract

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Analgesic efficacy of morphine applied topically to painful ulcers. Author(s): Zeppetella G, Paul J, Ribeiro MD. Source: Journal of Pain and Symptom Management. 2003 June; 25(6): 555-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782436&dopt=Abstract

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Analgesic efficacy of non-steroidal anti-inflammatory drugs in experimental pain in humans. Author(s): Walker JS, Arroyo JF, Nguyen T, Day RO. Source: British Journal of Clinical Pharmacology. 1993 November; 36(5): 417-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959289&dopt=Abstract

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Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy. Author(s): Viitanen H, Tuominen N, Vaaraniemi H, Nikanne E, Annila P. Source: British Journal of Anaesthesia. 2003 September; 91(3): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925475&dopt=Abstract

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Analgesics and hypertension: causality or correlation? Author(s): Glaser JH. Source: Archives of Internal Medicine. 2003 May 12; 163(9): 1114; Author Reply 1115-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742817&dopt=Abstract

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Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease. Author(s): Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR. Source: The British Journal of Surgery. 2003 October; 90(10): 1267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515298&dopt=Abstract

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Awareness and use of over-the-counter pain medications: a survey of emergency department patients. Author(s): Cham E, Hall L, Ernst AA, Weiss SJ. Source: Southern Medical Journal. 2002 May; 95(5): 529-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12005011&dopt=Abstract

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Baseline pain and response to analgesic medications in the postsurgery dental pain model. Author(s): Averbuch M, Katzper M. Source: Journal of Clinical Pharmacology. 2000 February; 40(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10664918&dopt=Abstract

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Caffeine as a promoter of analgesic-associated nephropathy--where is the evidence? Author(s): Fox JM, Siebers U. Source: Fundamental & Clinical Pharmacology. 2003 June; 17(3): 377-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803578&dopt=Abstract

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Chronic urticaria with multiple NSAID intolerance: is tramadol always a safe alternative analgesic? Author(s): Asero R. Source: J Investig Allergol Clin Immunol. 2003; 13(1): 56-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861852&dopt=Abstract

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Chronic-pain medications: equivalence levels and method of quantifying usage. Author(s): Masters Steedman S, Middaugh SJ, Kee WG, Carson DS, Harden RN, Miller MC. Source: The Clinical Journal of Pain. 1992 September; 8(3): 204-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1421733&dopt=Abstract

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Clinical application of opioid equianalgesic data. Author(s): Gammaitoni AR, Fine P, Alvarez N, McPherson ML, Bergmark S. Source: The Clinical Journal of Pain. 2003 September-October; 19(5): 286-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966254&dopt=Abstract

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Clinical pharmacology of chronic orofacial pain medications. Author(s): Paul RE, Hersh EV. Source: Compendium. 1989 September; 10(9): 492, 494-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2637065&dopt=Abstract

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Combination spinal analgesic chemotherapy: an additional clinical trial of opioid plus local anesthetic. Author(s): Goudas LC, Carr DB, Walker SM, Cousins MJ. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1841. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761027&dopt=Abstract

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Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Author(s): Gottschalk A, Burmeister MA, Radtke P, Krieg M, Farokhzad F, Kreissl S, Strauss M, Standl T. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1086-91, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500162&dopt=Abstract

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Conversion to oral controlled-release oxycodone from intravenous opioid analgesic in the postoperative setting. Author(s): Ginsberg B, Sinatra RS, Adler LJ, Crews JC, Hord AH, Laurito CE, Ashburn MA. Source: Pain Medicine (Malden, Mass.). 2003 March; 4(1): 31-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873276&dopt=Abstract

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Cost-effectiveness of different postoperative analgesic treatments. Author(s): Engoren M. Source: Expert Opinion on Pharmacotherapy. 2003 September; 4(9): 1507-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12943480&dopt=Abstract

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Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Author(s): Rodriguez MJ, Contreras D, Galvez R, Castro A, Camba MA, Busquets C, Herrera J. Source: Pain. 2003 July; 104(1-2): 103-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855319&dopt=Abstract

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Effect of ethnicity and race on the use of pain medications in children with long bone fractures in the emergency department. Author(s): Yen K, Kim M, Stremski ES, Gorelick MH. Source: Annals of Emergency Medicine. 2003 July; 42(1): 41-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827122&dopt=Abstract

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Effective analgesic modalities for ambulatory patients. Author(s): Redmond M, Florence B, Glass PS. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 329-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812399&dopt=Abstract

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Evaluation of pediatric pain medications. Author(s): Schnurrer JA, Marvin JA, Heimbach DM. Source: The Journal of Burn Care & Rehabilitation. 1985 March-April; 6(2): 105-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3855187&dopt=Abstract

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Factors affecting intravenous analgesic requirements after colectomy. Author(s): Joels CS, Mostafa G, Matthews BD, Kercher KW, Sing RF, Norton HJ, Heniford BT. Source: Journal of the American College of Surgeons. 2003 November; 197(5): 780-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585414&dopt=Abstract

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Factors associated with analgesic and psychotropic medications use by communitydwelling older people with chronic pain. Author(s): Kung F, Gibson SJ, Helme RD. Source: Aust N Z J Public Health. 1999 October; 23(5): 471-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10575767&dopt=Abstract

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Family members' perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents. Author(s): Hall-Lord ML, Johansson I, Schmidt I, Larsson BW. Source: Health & Social Care in the Community. 2003 May; 11(3): 262-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823431&dopt=Abstract

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Gender differences in response to drugs: pain medications. Author(s): Schwartz JB. Source: J Gend Specif Med. 1999 September-October; 2(5): 28-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252832&dopt=Abstract

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Impact of analgesic drug-use guidelines for the management of postoperative pain: a drug utilization study. Author(s): Vallano A, Llinares J, Amau JM, Martorell M, Girona L, Laporte JR. Source: Int J Clin Pharmacol Ther. 2003 April; 41(4): 165-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712962&dopt=Abstract

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Indigent patient programs provide assistance in acquiring pain medications. Author(s): Meares C. Source: Oncology Nursing Forum. 1993 October; 20(9): 1435-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8265449&dopt=Abstract

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Influence of diets containing differing lipid profiles on pain perception and the analgesic efficacy of opioids in human experimental pain. Author(s): McCleane G. Source: Pain. 2003 August; 104(3): 429-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927614&dopt=Abstract

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Intra-articular (IA) catheter administration of postoperative analgesics. A new trial design allows evaluation of baseline pain, demonstrates large variation in need of analgesics, and finds no analgesic effect of IA ketamine compared with IA saline. Author(s): Rosseland LA, Stubhaug A, Sandberg L, Breivik H. Source: Pain. 2003 July; 104(1-2): 25-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855311&dopt=Abstract

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It is important to know how analgesics work. Author(s): Schofield E. Source: Nurs Times. 2003 August 12-18; 99(32): 31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515548&dopt=Abstract

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Lower body osteoarticular pain and dose of analgesic medications in older disabled women: the Women's Health and Aging Study. Author(s): Pahor M, Guralnik JM, Wan JY, Ferrucci L, Penninx BW, Lyles A, Ling S, Fried LP. Source: American Journal of Public Health. 1999 June; 89(6): 930-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10358691&dopt=Abstract

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Managing pain medications at home. Author(s): Howard-Ruben J. Source: Oncology Nursing Forum. 1985 July-August; 12(4): 78-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3847999&dopt=Abstract

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Mechanism of action of analgesics used to treat osteoarthritis pain. Author(s): Raffa RB. Source: Rheumatic Diseases Clinics of North America. 2003 November; 29(4): 733-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14603580&dopt=Abstract

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Metabotropic glutamate receptor involvement in models of acute and persistent pain: prospects for the development of novel analgesics. Author(s): Varney MA, Gereau RW 4th. Source: Current Drug Targets. Cns and Neurological Disorders. 2002 June; 1(3): 283-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769620&dopt=Abstract

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N-(4-tertiarybutylphenyl)-4-(3-chloropyridin-2-yl)tetrahydropyrazine -1(2H)-carboxamide (BCTC), a novel, orally effective vanilloid receptor 1 antagonist with analgesic properties: I. in vitro characterization and pharmacokinetic properties. Author(s): Valenzano KJ, Grant ER, Wu G, Hachicha M, Schmid L, Tafesse L, Sun Q, Rotshteyn Y, Francis J, Limberis J, Malik S, Whittemore ER, Hodges D. Source: The Journal of Pharmacology and Experimental Therapeutics. 2003 July; 306(1): 377-86. Epub 2003 April 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721338&dopt=Abstract

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New drug buprenorphine can treat patients addicted to heroin or prescription pain medications. Author(s): Clark HW. Source: W V Med J. 2003 January-February; 99(1): 42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762216&dopt=Abstract

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NIH-FDA Analgesic Drug Development Workshop: translating scientific advances into improved pain relief. Author(s): Dionne RA, Witter J. Source: The Clinical Journal of Pain. 2003 May-June; 19(3): 139-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792552&dopt=Abstract

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Nimesulide: is it only an anti-inflammatory, analgesic drug? Author(s): Melchiorre D, Maddali Bongi S, Maresca M. Source: Clin Exp Rheumatol. 2003 May-June; 21(3): 408. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846072&dopt=Abstract

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Non-opioid analgesic poisoning. Author(s): Volans G, Hartley V, McCrea S, Monaghan J. Source: Clinical Medicine (London, England). 2003 March-April; 3(2): 119-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737366&dopt=Abstract

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Nonopioid and adjuvant analgesics in chronic pain management: strategies for effective use. Author(s): Gordon DB. Source: Nurs Clin North Am. 2003 September; 38(3): 447-64, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567202&dopt=Abstract

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Opioid and non-opioid analgesics. Author(s): Schug SA, Garrett WR, Gillespie G. Source: Best Pract Res Clin Anaesthesiol. 2003 March; 17(1): 91-110. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751551&dopt=Abstract

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Pain in hospitalized patients with AIDS: analgesic and psychotropic medications. Author(s): Lebovits AH, Smith G, Maignan M, Lefkowitz M. Source: The Clinical Journal of Pain. 1994 June; 10(2): 156-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8075469&dopt=Abstract

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Pain medication use before ED arrival. Author(s): Fosnocht DE, Swanson ER, Donaldson GW, Blackburn CC, Chapman CR. Source: The American Journal of Emergency Medicine. 2003 September; 21(5): 435-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523885&dopt=Abstract

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Pain medications and addiction. Author(s): Miller M. Source: Wis Med J. 1996 June; 95(6): 332-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8693746&dopt=Abstract

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Pain medications and recovery. Author(s): Szalavitz M. Source: Notes Undergr. 1998-99 Winter; (No 38): 6-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366196&dopt=Abstract

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Pain medications for dentistry. Author(s): Olmsted JS. Source: Scada J. 1982; 2: 33-43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6131531&dopt=Abstract

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Pain modulation and the action of analgesic medications. Author(s): Fields H. Source: Annals of Neurology. 1994; 35 Suppl: S42-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8185297&dopt=Abstract

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Patient-controlled analgesia: a method for the controlled self-administration of opioid pain medications. Author(s): Nolan MF, Wilson MC. Source: Physical Therapy. 1995 May; 75(5): 374-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7732081&dopt=Abstract

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Pharmacist's international experience puts pain medications in a new light. Author(s): Landis NT. Source: Am J Hosp Pharm. 1994 April 1; 51(7): 861-2, 865. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7517101&dopt=Abstract

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Pharmacists' knowledge of and attitudes toward opioid pain medications in relation to federal and state policies. Author(s): Joranson DE, Gilson AM. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2001 March-April; 41(2): 213-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297334&dopt=Abstract

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Potential utility of the peripheral analgesic properties of morphine in stomatitisrelated pain: a pilot study. Author(s): Cerchietti LC, Navigante AH, Korte MW, Cohen AM, Quiroga PN, Villaamil EC, Bonomi MR, Roth BM. Source: Pain. 2003 September; 105(1-2): 265-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499444&dopt=Abstract

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Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery. Author(s): Burmeister MA, Gottschalk A, Freitag M, Horn EP, Bohme C, Becker C, Standl TG. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 JuneJuly; 50(6): 568-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826548&dopt=Abstract

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Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery. Author(s): Unlugenc H, Ozalevli M, Gunes Y, Guler T, Isik G. Source: British Journal of Anaesthesia. 2003 August; 91(2): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878619&dopt=Abstract

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Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III). Author(s): Paulose-Ram R, Hirsch R, Dillon C, Losonczy K, Cooper M, Ostchega Y. Source: Pharmacoepidemiology and Drug Safety. 2003 June; 12(4): 315-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812012&dopt=Abstract

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Prospective evaluation of pain medication requirements and recovery after radical perineal prostatectomy. Author(s): Weizer AZ, Silverstein AD, Young MD, Vieweg J, Paulson DF, Dahm P. Source: Urology. 2003 October; 62(4): 693-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14550445&dopt=Abstract

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Quantitative sensory testing and human surgery: effects of analgesic management on postoperative neuroplasticity. Author(s): Wilder-Smith OH, Tassonyi E, Crul BJ, Arendt-Nielsen L. Source: Anesthesiology. 2003 May; 98(5): 1214-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717144&dopt=Abstract

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Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs. control group. Author(s): Morrison JE Jr, Jacobs VR. Source: Zentralblatt Fur Gynakologie. 2003 January; 125(1): 17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877104&dopt=Abstract

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Relief of pain by oral medications. A controlled evaluation of analgesic combinations. Author(s): Moertel CG, Ahmann DL, Taylor WF, Schwartau N. Source: Jama : the Journal of the American Medical Association. 1974 July 1; 229(1): 55-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4599149&dopt=Abstract

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Review of the analgesic efficacy of ibuprofen. Author(s): Beaver WT. Source: Int J Clin Pract Suppl. 2003 April; (135): 13-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723741&dopt=Abstract

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Self-administered pain medications. A practical approach in an OB/GYN setting. Author(s): Werrbach K, Wroblewski M. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2003 April-May; 7(2): 132-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735222&dopt=Abstract

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Should opioid analgesics be used in the management of chronic pain in opiate addicts? Author(s): Collins ED, Streltzer J. Source: The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2003 March-April; 12(2): 93-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746085&dopt=Abstract

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The analgesic effect of interscalene block using clonidine as an analgesic for shoulder arthroscopy: where is the catheter? Author(s): Blumenthal S, Nadig M, Borgeat A. Source: Anesthesia and Analgesia. 2003 September; 97(3): 928; Author Reply 928. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933447&dopt=Abstract

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The analgesic effect of oral delta-9-tetrahydrocannabinol (THC), morphine, and a THC-morphine combination in healthy subjects under experimental pain conditions. Author(s): Naef M, Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Zbinden A, Brenneisen R. Source: Pain. 2003 September; 105(1-2): 79-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499423&dopt=Abstract

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The analgesic effect of oral morphine or pentazocine for extracorporeal shock wave lithotripsy. Author(s): Han YY, Lu HC, Tsai HJ, Hseu SS, Chan KH, Tsai SK. Source: Acta Anaesthesiol Sin. 2003 March; 41(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747344&dopt=Abstract

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The cholecystokinin antagonist proglumide enhances the analgesic effect of dihydrocodeine. Author(s): McCleane GJ. Source: The Clinical Journal of Pain. 2003 May-June; 19(3): 200-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792559&dopt=Abstract

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The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy. Author(s): Izdes S, Orhun S, Turanli S, Erkilic E, Kanbak O. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1016-9, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500150&dopt=Abstract

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The separation of codeine from nonprescription combination analgesic products. Author(s): Fleming GF, McElnay JC, Hughes CM. Source: Substance Use & Misuse. 2003 July; 38(9): 1217-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908809&dopt=Abstract

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The site of action of epidural fentanyl infusions in the presence of local anesthetics: a minimum local analgesic concentration infusion study in nulliparous labor. Author(s): Ginosar Y, Columb MO, Cohen SE, Mirikatani E, Tingle MS, Ratner EF, Angst MS, Riley ET. Source: Anesthesia and Analgesia. 2003 November; 97(5): 1439-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570662&dopt=Abstract

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Ultracet: a new combination analgesic. Author(s): Hiller B, Rosenberg M. Source: J Mass Dent Soc. 2003 Summer; 52(2): 38-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886580&dopt=Abstract

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Use of a simple pain model to evaluate analgesic activity of ibuprofen versus paracetamol. Author(s): Lala I, Leech P, Montgomery L, Bhagat K. Source: East Afr Med J. 2000 September; 77(9): 504-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12862143&dopt=Abstract

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Utilization of pain medications in hospitalized psychiatric patients. Author(s): Wise TN, Mann LS. Source: General Hospital Psychiatry. 1996 November; 18(6): 422-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8937908&dopt=Abstract

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When patients refuse pain medications. Author(s): Wallace KG. Source: The American Journal of Nursing. 1996 February; 96(2): 20-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8629693&dopt=Abstract

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CHAPTER 2. NUTRITION AND PAIN MEDICATIONS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and pain medications.

Finding Nutrition Studies on Pain Medications The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “pain medications” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on pain medications: •

Devil's claw: from African traditional remedy to modern analgesic and antiinflammatory. Source: Wegener, T. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (50) page 47-54. 0899-5648

The following information is typical of that found when using the “Full IBIDS Database” to search for “pain medications” (or a synonym): •

A randomized, double-blind, placebo-controlled comparison of the analgesic efficacy, onset of action, and tolerability of ibuprofen arginate and ibuprofen in postoperative dental pain. Author(s): Scirex Corporation Inc, Austin, Texas 78705, USA. Source: Black, P Max, M B Desjardins, P Norwood, T Ardia, A Pallotta, T Clin-Ther. 2002 July; 24(7): 1072-89 0149-2918

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Acetaminophen, aspirin, or Ibuprofen in combination analgesic products. Author(s): The Rush Pain Center, Rush Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Suite 550, Chicago, IL 60612-3833. Source: Barkin, R L Am-J-Ther. 2001 Nov-December; 8(6): 433-42 1075-2765

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Clinical pharmacology of chronic orofacial pain medications. Source: Paul, R E Hersh, E V Compendium. 1989 September; 10(9): 492, 494-8 0894-1009

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Double-blind, randomized comparison of the analgesic and pharmacokinetic profiles of controlled- and immediate-release oral oxycodone in cancer pain patients. Author(s): Oncology and Hematology Associates, Woodbury, New Jersey, USA. Source: Stambaugh, J E Reder, R F Stambaugh, M D Stambaugh, H Davis, M J-ClinPharmacol. 2001 May; 41(5): 500-6 0091-2700

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Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics. Author(s): Rehabilitation Sciences Research Group, School of Health Sciences, University of Ulster, Jordanstown, Northern Ireland, United Kingdom. Source: Barlas, P Craig, J A Robinson, J Walsh, D M Baxter, G D Allen, J M Arch-PhysMed-Rehabil. 2000 July; 81(7): 966-72 0003-9993

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Narcotic analgesics, their detection and pain measurement in the horse: a review. Author(s): Department of Veterinary Physiology, College of Veterinary Medicine, Louisiana State University, Baton Rouge. Source: Kamerling, S Wood, T DeQuick, D Weckman, T J Tai, C Blake, J W Tobin, T Equine-Vet-J. 1989 January; 21(1): 4-12 0425-1644

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The onset of action and the analgesic efficacy of Saridon (a propyphenazone/paracetamol/ caffeine combination) in comparison with paracetamol, ibuprofen, aspirin and placebo (pooled statistical analysis). Author(s): Oral and Maxillofacial Surgery Cranial Pain Research, Tucson, Arizona, USA. Source: Kiersch, T A Minic, M R Curr-Med-Res-Opin. 2002; 18(1): 18-25 0300-7995

Nutrition

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to pain medications; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com

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Minerals Naproxen/Naproxen Sodium Source: Healthnotes, Inc.; www.healthnotes.com Sulfur Source: Integrative Medicine Communications; www.drkoop.com

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Food and Diet Nutritional Yeast Alternative names: Brewer's Yeast Source: Integrative Medicine Communications; www.drkoop.com Pain Source: Healthnotes, Inc.; www.healthnotes.com Sprains and Strains Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICATIONS

MEDICINE

AND

PAIN

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to pain medications. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to pain medications and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “pain medications” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to pain medications: •

A preliminary study on the analgesic activity of Grangea maderaspatana. Author(s): Ahmed M, Islam MM, Hossain CF, Khan OF. Source: Fitoterapia. 2001 June; 72(5): 553-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11429253&dopt=Abstract

•

A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Author(s): Hughes R, Carr A. Source: Rheumatology (Oxford, England). 2002 March; 41(3): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11934964&dopt=Abstract

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A single-blind placebo-controlled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects. Author(s): Johnson MI, Tabasam G. Source: Clinical Physiology and Functional Imaging. 2002 May; 22(3): 187-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12076344&dopt=Abstract

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Analgesic activity of Enhydra fluctuans. Author(s): Rahman MT, Begum N, Alimuzzaman M, Khan MO. Source: Fitoterapia. 2002 December; 73(7-8): 707-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490236&dopt=Abstract

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Analgesic activity of Peperomia pellucida aerial parts in mice. Author(s): Aziba PI, Adedeji A, Ekor M, Adeyemi O. Source: Fitoterapia. 2001 January; 72(1): 57-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11163942&dopt=Abstract

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Analgesic and antiinflammatory activities of an extract from Parkia biglobosa used in traditional medicine in the Ivory Coast. Author(s): Kouadio F, Kanko C, Juge M, Grimaud N, Jean A, N'Guessan YT, Petit JY. Source: Phytotherapy Research : Ptr. 2000 December; 14(8): 635-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11114002&dopt=Abstract

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Analgesic and antiinflammatory activities of vernonioside B2 from Vernonia condensata. Author(s): Valverde AL, Cardoso GL, Pereira NA, Silva AJ, Kuster RM. Source: Phytotherapy Research : Ptr. 2001 May; 15(3): 263-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11351366&dopt=Abstract

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Analgesic and anti-inflammatory activity of Crinum glaucum aqueous extract. Author(s): Okpo SO, Fatokun F, Adeyemi OO. Source: Journal of Ethnopharmacology. 2001 December; 78(2-3): 207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11694366&dopt=Abstract

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Analgesic and antiinflammatory effects of chalcones isolated from Myracrodruon urundeuva allemao. Author(s): Viana GS, Bandeira MA, Matos FJ. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2003 March; 10(2-3): 189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725575&dopt=Abstract

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Analgesic and anti-inflammatory effects of Mangifera indica L. extract (Vimang). Author(s): Garrido G, Gonzalez D, Delporte C, Backhouse N, Quintero G, Nunez-Selles AJ, Morales MA.

Alternative Medicine 33

Source: Phytotherapy Research : Ptr. 2001 February; 15(1): 18-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11180516&dopt=Abstract •

Analgesic and anti-inflammatory effects of the aqueous extract of leaves of Persea americana mill (lauraceae). Author(s): Adeyemi OO, Okpo SO, Ogunti OO. Source: Fitoterapia. 2002 August; 73(5): 375-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12165331&dopt=Abstract

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Analgesic and antipyretic activities of Rumex patientia extract on mice and rabbits. Author(s): Suleyman H, Demirezer LO, Kuruuzum-Uz A. Source: Pharmazie. 2001 October; 56(10): 815-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11683131&dopt=Abstract

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Analgesic and antipyretic effects of Myrica salicifolia (Myricaceae). Author(s): Njung'e K, Muriuki G, Mwangi JW, Kuria KA. Source: Phytotherapy Research : Ptr. 2002 March; 16 Suppl 1: S73-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11933145&dopt=Abstract

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Analgesic properties of Epilobium angustifolium, evaluated by the hot plate test and the writhing test. Author(s): Tita B, Abdel-Haq H, Vitalone A, Mazzanti G, Saso L. Source: Farmaco (Societa Chimica Italiana : 1989). 2001 May-July; 56(5-7): 341-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482754&dopt=Abstract

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Analgesic sesquiterpene dilactone from Mikania cordata. Author(s): Ahmed M, Rahman MT, Alimuzzaman M, Shilpi JA. Source: Fitoterapia. 2001 December; 72(8): 919-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11731117&dopt=Abstract

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Anti-inflammatory and analgesic activity in the polyherbal formulation Maharasnadhi Quathar. Author(s): Thabrew MI, Dharmasiri MG, Senaratne L. Source: Journal of Ethnopharmacology. 2003 April; 85(2-3): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639750&dopt=Abstract

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Anti-inflammatory and analgesic activity of Bouchea fluminensis. Author(s): Costa VB, Coube CS, Marinho BG, Matheus ME, Leitao SG, Fernandes PD. Source: Fitoterapia. 2003 June; 74(4): 364-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781807&dopt=Abstract

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Anti-inflammatory and analgesic activity of Hypericum empetrifolium Willd. (Guttiferae). Author(s): Trovato A, Raneri E, Kouladis M, Tzakou O, Taviano MF, Galati EM. Source: Farmaco (Societa Chimica Italiana : 1989). 2001 May-July; 56(5-7): 455-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482777&dopt=Abstract

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Anti-inflammatory and analgesic activity of Indian Hypericum perforatum L. Author(s): Kumar V, Singh PN, Bhattacharya SK. Source: Indian J Exp Biol. 2001 April; 39(4): 339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491578&dopt=Abstract

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Anti-inflammatory and analgesic effect of herbal preparation: septilin. Author(s): Khanna N, Sharma SB. Source: Indian Journal of Medical Sciences. 2001 April; 55(4): 195-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11665389&dopt=Abstract

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Anti-inflammatory and analgesic effects of a mixture of fatty acids isolated and purified from sugar cane wax oil. Author(s): Ledon N, Casaco A, Rodriguez V, Cruz J, Gonzalez R, Tolon Z, Cano M, Rojas E. Source: Planta Medica. 2003 April; 69(4): 367-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709906&dopt=Abstract

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Antiinflammatory and analgesic effects of Carthamus lanatus aerial parts. Author(s): Bocheva A, Mikhova B, Taskova R, Mitova M, Duddeck H. Source: Fitoterapia. 2003 September; 74(6): 559-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946718&dopt=Abstract

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Anti-inflammatory and analgesic properties of the stem bark extract of Mitragyna ciliata (Rubiaceae) Aubrev. & Pellegr. Author(s): Dongmo AB, Kamanyi A, Dzikouk G, Nkeh BC, Tan PV, Nguelefack T, Nole T, Bopelet M, Wagner H. Source: Journal of Ethnopharmacology. 2003 January; 84(1): 17-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499071&dopt=Abstract

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Anti-inflammatory and analgesic properties of the stem bark extracts of Erythrophleum suaveolens (Caesalpiniaceae), Guillemin & Perrottet. Author(s): Dongmo AB, Kamanyi A, Anchang MS, Chungag-Anye Nkeh B, Njamen D, Nguelefack TB, Nole T, Wagner H. Source: Journal of Ethnopharmacology. 2001 October; 77(2-3): 137-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535356&dopt=Abstract

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Anti-inflammatory, analgesic activity and acute toxicity of Glaucium grandiflorum extract. Author(s): Morteza-Semnani K, Saeedi M, Hamidian M, Vafamehr H, Dehpour AR. Source: Journal of Ethnopharmacology. 2002 May; 80(2-3): 181-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12007708&dopt=Abstract

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Anti-inflammatory, analgesic and anti-lymphocytic activities of the aqueous extract of Crinum giganteum. Author(s): Kapu SD, Ngwai YB, Kayode O, Akah PA, Wambebe C, Gamaniel K. Source: Journal of Ethnopharmacology. 2001 November; 78(1): 7-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585682&dopt=Abstract

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Anti-inflammatory, analgesic and antipyretic properties of Clitoria ternatea root. Author(s): Devi BP, Boominathan R, Mandal SC. Source: Fitoterapia. 2003 June; 74(4): 345-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781804&dopt=Abstract

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Antiinflammatory, analgesic and free radical scavenging activities of the marine microalgae Chlorella stigmatophora and Phaeodactylum tricornutum. Author(s): Guzman S, Gato A, Calleja JM. Source: Phytotherapy Research : Ptr. 2001 May; 15(3): 224-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11351357&dopt=Abstract

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Berberis crataegina DC. root exhibits potent anti-inflammatory, analgesic and febrifuge effects in mice and rats. Author(s): Yesilada E, Kupeli E. Source: Journal of Ethnopharmacology. 2002 February; 79(2): 237-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801387&dopt=Abstract

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Chemical composition and analgesic activity of Calophyllum brasiliense leaves. Author(s): da Silva KL, dos Santos AR, Mattos PE, Yunes RA, Delle-Monache F, Cechinel-Filho V. Source: Therapie. 2001 July-August; 56(4): 431-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677868&dopt=Abstract

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Evaluation of analgesic effect of Datura fastuosa leaves and seed extracts. Author(s): Abena AA, Miguel LM, Mouanga A, Hondi Assah T, Diatewa M. Source: Fitoterapia. 2003 July; 74(5): 486-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12837368&dopt=Abstract

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Evaluation of the analgesic activity of an ethanol extract of Miconia fallax. Author(s): Andrade e Silva ML, Cunha WR, Pedro C, Aparecida Garcia P, Martins C.

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Source: Boll Chim Farm. 2002 March-April; 141(2): 158-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135166&dopt=Abstract •

Evaluation of the anti-inflammatory and analgesic properties of Chasmanthera dependens leaf methanol extract. Author(s): Morebise O, Awe EO, Makinde JM, Olajide OA. Source: Fitoterapia. 2001 June; 72(5): 497-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11429242&dopt=Abstract

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Evaluation of the antinflammatory and analgesic activity of Sideritis canariensis var. pannosa in mice. Author(s): Hernandez-Perez M, Rabanal RM. Source: Journal of Ethnopharmacology. 2002 June; 81(1): 43-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12020926&dopt=Abstract

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Involvement of NMDA receptors in the analgesic properties of psychotridine. Author(s): Amador TA, Verotta L, Nunes DS, Elisabetsky E. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2001 May; 8(3): 202-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11417913&dopt=Abstract

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Nitric oxide and cyclooxygenase may participate in the analgesic and antiinflammatory effect of the cucurbitacins fraction from Wilbrandia ebracteata. Author(s): Peters RR, Baier Krepsky P, Siqueira-Junior JM, da Silva Rocha JC, Marques Bezerra M, de Albuquerque Ribeiro R, de Brum-Fernandes AJ, Rocha Farias M, Castro da Rocha FA, Ribeiro-do-Valle RM. Source: Life Sciences. 2003 September 12; 73(17): 2185-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927589&dopt=Abstract

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Pain medications and recovery. Author(s): Szalavitz M. Source: Notes Undergr. 1998-99 Winter; (No 38): 6-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366196&dopt=Abstract

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Phytochemical analysis and analgesic properties of Curcuma zedoaria grown in Brazil. Author(s): Navarro Dde F, de Souza MM, Neto RA, Golin V, Niero R, Yunes RA, Delle Monache F, Cechinel Filho V. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 July; 9(5): 427-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222663&dopt=Abstract

Alternative Medicine 37

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Pseudo-akuammigine, an alkaloid from Picralima nitida seeds, has anti-inflammatory and analgesic actions in rats. Author(s): Duwiejua M, Woode E, Obiri DD. Source: Journal of Ethnopharmacology. 2002 June; 81(1): 73-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12020930&dopt=Abstract

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Studies on analgesic activity of Cleome viscosa in mice. Author(s): Parimaladevi B, Boominathan R, Mandal SC. Source: Fitoterapia. 2003 April; 74(3): 262-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727491&dopt=Abstract

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The analgesic action of semen coicis on severe functional dysmenorrhea--a sequential trial observation. Author(s): Zhang Y, Hou G, Yue Y. Source: J Tradit Chin Med. 2000 December; 20(4): 293-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11263287&dopt=Abstract

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The analgesic effect of oral delta-9-tetrahydrocannabinol (THC), morphine, and a THC-morphine combination in healthy subjects under experimental pain conditions. Author(s): Naef M, Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Zbinden A, Brenneisen R. Source: Pain. 2003 September; 105(1-2): 79-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499423&dopt=Abstract

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The analgesic, antipyretic and anti-inflammatory activity of Diospyros variegata Kruz. Author(s): Trongsakul S, Panthong A, Kanjanapothi D, Taesotikul T. Source: Journal of Ethnopharmacology. 2003 April; 85(2-3): 221-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639744&dopt=Abstract

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The anti-inflammatory and analgesic effects of a crude extract of Petiveria alliacea L. (Phytolaccaceae). Author(s): Lopes-Martins RA, Pegoraro DH, Woisky R, Penna SC, Sertie JA. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 April; 9(3): 245-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12046866&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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Pain Medications

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to pain medications; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Anaphylaxis Source: Integrative Medicine Communications; www.drkoop.com Anemia Source: Integrative Medicine Communications; www.drkoop.com Ascariasis Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Chickenpox and Shingles Source: Integrative Medicine Communications; www.drkoop.com Cold Sores Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Diverticular Disease Source: Healthnotes, Inc.; www.healthnotes.com

Alternative Medicine 39

Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Frostbite Source: Integrative Medicine Communications; www.drkoop.com Genital Herpes Source: Healthnotes, Inc.; www.healthnotes.com Gout Source: Integrative Medicine Communications; www.drkoop.com Guinea Worm Disease Source: Integrative Medicine Communications; www.drkoop.com Herpes Zoster and Varicella Viruses Source: Integrative Medicine Communications; www.drkoop.com Histoplasmosis Source: Integrative Medicine Communications; www.drkoop.com Hookworm Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Loiasis Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Lymphatic Filariasis Source: Integrative Medicine Communications; www.drkoop.com Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Prima Communications, Inc.www.personalhealthzone.com

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Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com Pinworm Source: Integrative Medicine Communications; www.drkoop.com PMS Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Healthnotes, Inc.; www.healthnotes.com Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com Rheumatoid Arthritis Source: Integrative Medicine Communications; www.drkoop.com Rheumatoid Arthritis Source: Prima Communications, Inc.www.personalhealthzone.com River Blindness Source: Integrative Medicine Communications; www.drkoop.com Roundworms Source: Integrative Medicine Communications; www.drkoop.com Serum Sickness Source: Integrative Medicine Communications; www.drkoop.com Shingles and Chickenpox Source: Integrative Medicine Communications; www.drkoop.com Shingles and Postherpetic Neuralgia Source: Healthnotes, Inc.; www.healthnotes.com Temporomandibular Joint Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Tendinitis Source: Healthnotes, Inc.; www.healthnotes.com Tension Headache Source: Healthnotes, Inc.; www.healthnotes.com Threadworm Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 41

Thyroid Inflammation Source: Integrative Medicine Communications; www.drkoop.com Thyroiditis Source: Integrative Medicine Communications; www.drkoop.com TMJ Source: Integrative Medicine Communications; www.drkoop.com Trichinosis Source: Integrative Medicine Communications; www.drkoop.com Varicella and Herpes Zoster Viruses Source: Integrative Medicine Communications; www.drkoop.com Visceral Larva Migrans Source: Integrative Medicine Communications; www.drkoop.com Whipworm Source: Integrative Medicine Communications; www.drkoop.com Wounds Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Acupuncture Anesthesia Alternative names: acupuncture analgesia acupuncture assisted anesthesia anesthetic acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Auricular Analgesia Alternative names: auricular analgesic acupuncture auricular acupuncture analgesia Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Guided Imagery Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,699,00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705,00.html Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931,00.html •

Chinese Medicine Chuanwu Alternative names: Common Monkshood Mother Root; Radix Aconiti Source: Chinese Materia Medica Dingxiang Alternative names: Clove; Flos Caryophylli Source: Chinese Materia Medica Dingxiang Luoleyou Alternative names: Ocimum Oil; Oleum Ocimi Gratissimi Source: Chinese Materia Medica Shangshi Zhitong Gao Alternative names: Shangshi Zhitong Plaster; Shangshi Zhitong Gao
(Shang Shi Zhi Tong Gao) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shangshi%20Zhitong%20Gao &mh=10&sb=---&view_records=View+Records

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Herbs and Supplements Aralia Alternative names: Spikenard; Aralia sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Aristolochia Alternative names: Snakeroot, Guaco; Aristolochia sp Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Arnica Alternative names: Arnica montana L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Asian Ginseng Alternative names: Ginseng, Asian Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 43

Boswellia Alternative names: Frankincense; Boswellia serrata Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Clonidine Source: Healthnotes, Inc.; www.healthnotes.com Codeine Source: Healthnotes, Inc.; www.healthnotes.com Comfrey Alternative names: Symphytum officinale, Knitbone Source: Integrative Medicine Communications; www.drkoop.com Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Cynara Artichoke Alternative names: Artichoke; Cynara scolymus L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Devil's Claw Alternative names: Harpagophytum procumbens, Harpagophytum zeyheri Source: Integrative Medicine Communications; www.drkoop.com Eleuthero Alternative names: Siberian Ginseng, Eleuthero; Acanthopanax/Eleutherococcus senticosus Rupr. & Maxim. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Etodolac Source: Healthnotes, Inc.; www.healthnotes.com Fentanyl Source: Healthnotes, Inc.; www.healthnotes.com Flurbiprofen Source: Healthnotes, Inc.; www.healthnotes.com Garcinia Man Alternative names: Mangosteen; Garcinia mangostana Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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Pain Medications

Glycyrrhiza Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Harpagophytum Procumbens Source: Integrative Medicine Communications; www.drkoop.com Harpagophytum Zeyheri Source: Integrative Medicine Communications; www.drkoop.com Hydrocodone Source: Healthnotes, Inc.; www.healthnotes.com Ibuprofen Source: Healthnotes, Inc.; www.healthnotes.com Indomethacin Source: Healthnotes, Inc.; www.healthnotes.com Ipriflavone Source: Prima Communications, Inc.www.personalhealthzone.com Jamaica Dogwood Alternative names: Piscidia erythrina, Piscidia piscipula Source: Integrative Medicine Communications; www.drkoop.com Juniperus Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Kava Alternative names: Piper methysticum Source: Healthnotes, Inc.; www.healthnotes.com Ketorolac Source: Healthnotes, Inc.; www.healthnotes.com Knitbone Source: Integrative Medicine Communications; www.drkoop.com Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Momordica Alternative names: Bitter Gourd, Karela; Momordica charantia Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org MSM Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,807,00.html

Alternative Medicine 45

Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Nabumetone Source: Healthnotes, Inc.; www.healthnotes.com Noni Alternative names: Morinda citrifolia Source: Healthnotes, Inc.; www.healthnotes.com Non-Steroidal Anti-inflammatory Drugs Source: Healthnotes, Inc.; www.healthnotes.com Oxaprozin Source: Healthnotes, Inc.; www.healthnotes.com Oxycodone Source: Healthnotes, Inc.; www.healthnotes.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Panax Ginseng Alternative names: Asian Ginseng Source: Integrative Medicine Communications; www.drkoop.com Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Phenazopyridine Source: Healthnotes, Inc.; www.healthnotes.com Phenylalanine Source: Prima Communications, Inc.www.personalhealthzone.com Piper Alternative names: Kava; Piper methysticum Forst.f Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Piscidia Erythrina Source: Integrative Medicine Communications; www.drkoop.com Piscidia Piscipula Source: Integrative Medicine Communications; www.drkoop.com Propoxyphene Source: Healthnotes, Inc.; www.healthnotes.com

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Rofecoxib Source: Healthnotes, Inc.; www.healthnotes.com Salsalate Source: Healthnotes, Inc.; www.healthnotes.com Sambucus Alternative names: Black Elderberry; Sambucus nigra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Sulindac Source: Healthnotes, Inc.; www.healthnotes.com Suma Source: Healthnotes, Inc.; www.healthnotes.com Symphytum Officinale Source: Integrative Medicine Communications; www.drkoop.com Tanacetum V Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Thymus Alternative names: Thyme; Thymus vulgaris Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tramadol Source: Healthnotes, Inc.; www.healthnotes.com Vitex Alternative names: Chaste; Vitex agnus-castus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Willow Alternative names: Salix alba Source: Healthnotes, Inc.; www.healthnotes.com Willow Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Withania Ashwagandha Alternative names: Ashwagandha; Withania somnifera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zanthoxylum Alternative names: Prickly Ash; Zanthoxylum sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

Alternative Medicine 47

Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON PAIN MEDICATIONS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “pain medications” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on pain medications, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Pain Medications By performing a patent search focusing on pain medications, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on pain medications: •

1-(aryloxyalkyl)-4-(heteroaryl)piperidines antipsychotics and analgesics

and

related

compounds

useful

as

Inventor(s): Bordeau; Kenneth J. (Kintnersville, PA), Chiang; Yulin (Covent Station, NJ), Glamkowski; Edward J. (Warren, NJ), Helsley; Grover C. (Stockton, NJ), Strupczewski; Joseph T. (Flemington, NJ) Assignee(s): Aventis Pharmaceuticals Inc. () Patent Number: 6,140,345 Date filed: June 6, 1995 Abstract: Heteroarylpiperidines, pyrrolidines, and piperazines are useful as antipsychotic and analgesic agents, the compounds are especially useful for treating psychoses by administering to a mammal a psychoses-treating effective amount of one of the compounds. Depot derivatives of the compounds are useful for providing long acting effects of the compounds. The compounds are also useful as analgesics by administering a pain-relieving effective amount of one of the compounds to a mammal. Excerpt(s): This invention relates to heteroarylpiperidines, pyrrolidines and piperazines. More particularly, this invention relates to heteroarylpiperidines, pyrrolidines and piperazines having antipsychotic activity and to their use as antipsychotic drugs. The therapeutic treatment of schizophrenic patients by administration of neuroleptic drugs, such as chlorpromazine, haloperidol, sulpiride, and chemically closely related compounds, is widespread. While control of schizophrenic symptoms has been successful, treatment with these drugs does not cure the psychotic patient, who will almost certainly relapse if medication is discontinued. There exists a continuing need in the art for antipsychotic drugs for the treatment of psychoses. Moreover, some of the known neuroleptics produce unwanted side effects. For example, the side effects of many antipsychotic drugs include the so-called extrapyramidal symptoms, such as rigidity and tremor, continuous restless walking, and tardive dyskinesia which causes facial grimacing, and involuntary movements of the face and extremities. Orthostatic hypotension is also common. Thus, there also exists a need in the art for antipsychotic drugs that produce fewer or less severe manifestations of these common side effects. Web site: http://www.delphion.com/details?pn=US06140345__ •

Administration media for analgesic, anti-inflammatory and anti-pyretic drugs containing nitrous oxide and pharmaceutical compositions containing such media and drugs Inventor(s): Meyer; Petrus Johannes (Randburg, ZA) Assignee(s): Pitmy International N.V. (Bonaire, NL) Patent Number: 6,221,377 Date filed: May 13, 1998 Abstract: Administration mediums comprising solutions of nitrous oxide in water, alcohols, ethers or oils, and optionally including essential fatty acids or C.sub.1 -C.sub.6 alkyl esters thereof enhance the action of analgesic, anti-inflammatory and anti-pyretic

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drugs. The drugs may be combined with the medium into a pharmaceutical composition or may be taken orally by swallowing the drug with the aid of the medium. Excerpt(s): Non-narcotic analgesics, most of which are also known as non-steroidal antiinflammatory drugs [NSAID], are widely administered orally in the treatment of mild to severe pain. Within this class, the compounds vary widely in their chemical structure and in their biological profiles as analgesics, anti-inflammatory agents and anti-pyretic agents. Aspirin, acetaminophen and phenacetin have long been among the most commonly used members of this group; more recently, however, a large number of alternative non-narcotic agents offering a variety of advantages over the earlier drugs have been developed. Tolerance or addiction to these drugs is not generally a problem with their continuous use in the treatment of pain or in the treatment of acute or chronic inflammatory states [notably, rheumatoid arthritis and osteoarthritis]; nevertheless, these drugs generally have a higher potential for adverse side-effects at the upper limits of their effective dose ranges. Moreover, above each drug's upper limit or ceiling, administration of additional drugs does not usually increase the analgesic or antiinflammatory effect. Among the newer compounds in the non-narcotic analgesic/nonsteroidal anti-inflammatory group are compounds such as diflunisal [Dolobid.RTM.], ibuprofen [Brufen.RTM.], naproxen [Naprosyn.RTM.], fenoprofen [Fenopron.RTM.], piroxicam [Feldene.RTM.], flurbiprofen, mefenamic acid [Ponstan.RTM.] and sulindac [Clinoril.RTM.]. See also Physicans' Desk Reference, 35th edition, 1981, and The Merck Index, ninth edition, Merck & Co., Rahway, New Jersey (1976), for information on specific non-steroidal anti-inflammatory agents. Also see, generally, Wiseman, "Pharmacological Studies with a New Class of Non-steroidal Anti-Inflammatory Agents--Tbe Oxicams--With Special Reference to Piroxicam (Feldene.RTM.)", The American Journal of Medicine, Feb. 16, 1982:2-8; Foley et al, The Management of Cancer Pain, Volume II--The Rational Use of Analgesics in the Management of Cancer Pain, Hoffman-La Roche Inc., 1981; and Cutting's Handbook of Pharmacology, sixth edition, ed. T. Z. Czaky, M.D. Appleton-Century-Crofts, New York, 1979, Chapter 49: 538-550. The exact mechanism of action of this group of compounds and the relationship between chemical structure and analgesic, anti-inflammatory and anti-pyretic effect of these compounds are not yet fully understood despite the fact that some of these products, like aspirin and acetaminophen have been in use for many years. The recent contributions of John Vane in "Towards a better aspirin", Nature Volume 367, Jan. 20, 1993, pages 215 to 216 and of the authors referred to therein, which links such activities to the ability of these compounds to inhibit the enzyme known as cyclooxygenase [COX] of which two, and possibly three, isoforms exist, will no doubt play an important role in the future understanding of the mode of action and properties of this group of compounds. Narcotic analgesics are often used when pain control with non-narcotic analgesics is ineffective. While the drugs in this group vary considerably in their chemical structures and pharmacological properties, almost all suffer the disadvantages of tolerance and possible addiction with continued usage. Within the narcotic analgesic group, the drugs can be classified as narcotic agonists or narcotic antagonists. Narcotic agonists include the morphine group, the pethidine group and the methadone group. While some narcotic antagonists are pure antagonists [which are not analgesics], other narcotic antagonists are agonist-antagonists [i.e. antagonists with analgesic properties]; the agonist-antagonists are generally categorised as morphine-like or nalorphine-like]. Many of the narcotic analgesics are not effective orally, but are rather used parenterally. The orally active narcotic analgesics include such compounds as codeine, oxycodone, pethidine, dextro-propoxyphene [Doloxene.RTM.], methadone, propiram, buprenorphine, pentazocine [Sosegon.RTM.] and nalbuphine [Nubain.RTM.]. For more specific information on these compounds, see Physicians' Desk Reference, 35th edition,

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1981, and The Merck Index, ninth edition, Merck & Co., Inc., Rahway, New Jersey 1976). Also see, generally, the Foley et al reference cited hereinabove and Cutting's Handbook of Pharacology, sixth edition, ed. T. Z. Czaky, M.D., Appleton-Century-Crofts, New York, 1979, Chapter 50: 551-566. Web site: http://www.delphion.com/details?pn=US06221377__ •

Analgesic and refreshing herbal composition and a process for preparing the same Inventor(s): Bindra; Ratan Lal (Lucknow, IN), Gupta; Rashmi (Lucknow, IN), Kumar; Sushil (Lucknow, IN), Shukla; Yogendra Nath (Lucknow, IN), Singh; Anil Kumar (Lucknow, IN) Assignee(s): Council of Scientific & Industrial Research (New Delhi, IN) Patent Number: 6,531,115 Date filed: January 3, 2001 Abstract: The invention provides an analgesic and refreshing herbal composition useful as dentrifrices, said composition comprising 50-60% Wt. of betle extract (from Piper betle leaves); 40-50% Wt. of one or more group I essential oil selected from Levender officinal, Dementholised oil (ex-Mentha arvensis), Fennel oil and Ocimum gratissimum; 3.5-6% Wt. of one or more group II essential oils and their isolates selected from Ocimum Sanctum, Pulegone (ex Mentha pulegonium), Carvone (ex. Dill seed) and Menthol (ex. Mentha arvensis); 1-5% Wt. of one or more group III essential oils selected from Camphor, turpentine oil, Cedarwood oil and Safrole oil, along with 0.5-2% Wt. of Thymol and 0.25-1% Wt. of preservative/antioxidant, and a process for preparing the composition. Excerpt(s): The present invention relates to an analgesic and refreshing herbal composition useful dentrifrices and a process for the preparation of the same. Toothache is very common in human being of all age groups of both sex. Dental caries are caused due to the combined action of lactic acid, proteolytic enzymes and bacteria present in the oral cavity. Deep cavity in tooth, as a result of inflammation of the pulp causes pulpits. The root end abscess occurs in a tooth that has a dead nerve. Inflammation and swelling of the gingiva produce a deeper crevice or trough leading to gingivals abscess a periodontal disease. The application of tooth paint to the affected part produces counter irritation and local anaesthetic action, which in turn stops feeling sensation of pain. Various formulations of such preparations available in market have been published in Indian Pharmaceutical Guide (1994) 32nd Edition published by Pamposh Publication, New Delhi, India. In seven formulations/preparations essential oil or isolates have been used as the major ingredients. Dabur India Ltd. markets two preparations, one having clove oil while the other named "Dar-Dant" a mixture of phenol, camphor, menthol and ajowan oil. Baidyanath Ayurved Bhawan also has two preparations--"Dant Dard Ki Dawa" and "Denta Beshari". The first one has phenol, camphor, Thymol, chlorobutol (I.P.), clove oil and chloroform while the second one has tannic acid, phenol, clove oil, cinnam m oil and glycerol (I.P.). Dentacare by Kothari Laboratory have borax, methyl salicylate, clove oil, tannic acid, potassium iodide, camphor and phenol. Dentolin by Jupiter Pharmaceuticals Pvt. Ltd. have creosote oil, clove oil, tincture myrrh, tincture iodine, procaine H, camphor, glycerin and chloroform while Dentosol by Synthochem have camphor, menthol, Thymol and katha. Web site: http://www.delphion.com/details?pn=US06531115__

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Analgesic anti-inflammatory composition and method of preparing from dodonaea sp Inventor(s): Janakiram; Chodavarapu (C.I.J.R. Technical Consultancy Services and Research Foundation, 805 Asisa, New Delhi 110 001, IN), Khalilullah; Mahmud (C.I.J.R. Technical Consultacy Services and Research Foundation, 805 Asisa, New Delhi 110 001, IN) Assignee(s): none reported Patent Number: 6,143,303 Date filed: August 14, 1999 Abstract: An anti-inflammatory, analgesic composition is prepared using an extract from a plant of the family Dodonaea in a dermatologically acceptable carrier, with or without a dermal absorption enhancer such as eucalyptus oil. The extract is prepared by solvent extraction of the plant matter, either whole or separated into various parts, such as leaves, bark, seeds, roots and flowers. Excerpt(s): The instant invention relates generally to topically-applied pharmaceutical compositions for providing analgesic and anti-inflammatory relief in humans and more specifically to compositions containing an extract of the Hop Bush plant (Dodonaea sp.). The invention also relates to a process for preparing such a therapeutic extract from the raw plant material of the Hop Bush plant. Topical compositions for providing pain relief and anti-inflammatory action are known in the art, For example, U.S. Pat. No. 5,178,879 (Adekunle, M. et al., Jan. 12, 1993) discloses a topical pain relief gel containing capsaicin, water, alcohol and a carboxypolymethylene emulsifier. U.S. Pat. No. 5,288,491 (Moniz, H., Feb. 22, 1994) discloses a method for processing the noni (Morinda citrifolia) plant into powder for use in therapeutic compositions. Web site: http://www.delphion.com/details?pn=US06143303__

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Analgesic composition and method for using same Inventor(s): Fairbanks; Carolyn A. (Rochester, MN), Kitto; Kelley F. (Minneapolis, MN), Stone; Laura S. (E. Richmondhill, CA), Wilcox; George L. (Golden Valley, MN) Assignee(s): Solvay Pharmaceuticals GmbH (Hannover, DE) Patent Number: 6,204,271 Date filed: September 14, 1998 Abstract: A pharmaceutical analgesic composition comprise an opioid analgesic agent and moxonidine as a non-opioid agent with analgesic activity. Administration of an opioid analgesic agent and moxonidine as a non-opioid agent produces analgesia in the treatment of pain in mammals. Excerpt(s): Opioid analgesics such as e.g. morphine are the most powerful analgesic drugs. The pain relieving activity of opioid analgesics includes a depressive effect on the central nervous system. The analgesic activity of opioid analgesics such as morphine and deltorphin II can be mediated via different opioid receptors, for example via receptors.mu.-opioid and.delta.-opioid receptors. Opioid analgesics are invaluable for the treatment of severe acute or chronic pain as, for example, may occur in bone degenerative diseases and cancer conditions. They are easy to administer and they provide effective pain relief in most patients. Due to the excellent overall tolerability of opioids the doses of morphine and other strong opioids can be increased to relatively high levels. Yet, in particular upon long term use, there is a development of

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unacceptable side effects. These side effects include the development of physical dependence and tolerance, sedation, respiratory depression, hypotension, increase in cerebrospinal fluid pressure, nausea, vomiting and constipation. In some patients, particularly in the chronically ill, the opioid side effects make it impossible to continuously administer sufficiently high dosages to adequately control pain over the needed period of time. There are also some pain conditions that do not sufficiently respond to opioid pain treatment alone. Therefore, there is a constant need for improved opioid containing analgesic combinations with increased analgesic activity which comprise opioid and non-opioid analgesically active agents and which offer the possibility of reducing the opioid dose needed for efficient pain relief and thereby also reducing the opioid side effects that might result from the otherwise required higher dosages. It is therefore an object of the present invention to provide an opioid containing analgesic composition having high analgesic potency and a reduced propensity for causing undesirable side effects. Web site: http://www.delphion.com/details?pn=US06204271__ •

Analgesic dosage units for coordinated administration Inventor(s): Weinstein; Allan (3301 New Mexico Ave., Washington, DC 20016), Weinstein; Robert (229 Berkeley St., Boston, MA 02116) Assignee(s): none reported Patent Number: 6,258,379 Date filed: July 12, 1999 Abstract: A pharmaceutical dispensing kit that includes at least two different analgesic dosage units that have been formulated for use with each other, each of the analgesics being formulated for administration during a particular time of day and/or with relation to a particular event, the kit including a housing which contains said dosage units and which contains indicia identifying said dosage units and instructions coordinating use of the different dosage units together as a treatment regimen for pain. The dosage units may be packaged in bulk and distinguished by differences in geometry, size, markings, type of formulation (e.g., tablet versus soft gel capsule), and/or color, all types of indicia useful with this invention. A method for treating pain that uses the novel kit is also provided. Excerpt(s): The present invention relates to an analgesic treatment regimen comprising different dosage units separately adapted for administration as a function of an event or the time of day, packaged with indicia for clarity of identification of the dosage units, and with instructions for use of the dosage units together in a pain treatment regimen. The invention also relates to packaging having both the different dosage units. Time of day and activity (or event) are important, and often overlooked, considerations in the management of pain. For example, pain can interfere with sleep, and continued sleep deficit or interruption can aggravate the patient's condition and sensitivity to pain, in addition to taking its toll on the patient's general welfare. An analgesic medication having (or formulated to have) stimulant properties has drawbacks when sleep or sedation is desired, even though such a pharmaceutical preparation may be an otherwise effective formulation for pain. Many commercially available formulations contain caffeine (or other stimulants) because of its known synergistic effect with certain analgesic compounds. However, the instructions given for these medications may be devoid of any appreciation for problems relating to the administration of such medications when sleep or sedation is desired or necessary. Accordingly, patients taking

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such medications may suffer from irritability, insomnia, and/or sleeplessness, which they and/or their physician usually fail to attribute to the analgesic medication. Web site: http://www.delphion.com/details?pn=US06258379__ •

Analgesic drug composition containing a capsaicinoid and potentiator therefor Inventor(s): Caruso; Frank S. (Colts Neck, NJ) Assignee(s): Endo Pharmaceuticals Inc. (Chadds Ford, PA) Patent Number: 6,277,398 Date filed: November 16, 1999 Abstract: The analgesic effectiveness of a capsaicinoid such as capsaicin is potentiated by an analgesic potentiator selected from the group consisting of dextromethorphan, dextrorphan and pharmaceutically acceptable salts thereof. Excerpt(s): This invention relates to analgesic drugs and methods of inducing analgesia. More particularly, this invention relates to an analgesic drug containing, as an analgesic component, at least one capsaicinoid and, as a potentiator for the capsaicinoid, dextromethorphan, dextrorphan and/or pharmaceutically acceptable salt thereof. Capsicum oleoresin, an extract of capsicum (dried red pepper and other species of the genus Capsicum such as Capsicum frutescens and Capsicum annum), contains the capsaicinoid capsaicin (trans-8-methyl-N-vanillyl-6-noneamide). Both capsicum oleoresin and capsicum have for many years been used in a variety of over-the-counter topical analgesic medications such as HEET, INFRA-RUB, OMEGAOIL, and SLOAN's LINIMENT. See also, U.S. Pat. No. 3,880,996 which discloses a topically administered analgesic compositions for the symptomatic relief of localized pain of musculo-skeletal etiology containing, inter alia, capsicum oleoresin. Cutaneous pain and other sensations of inflammatory pain are thought to be mediated by substance P, an endogenous neuropeptide. Capsaicin enhances the release of substance P from neurons preventing its reaccumulation. As a result of this effect, capsaicin is believed to render skin insensitive to pain by depleting substance P from peripheral sensory neurons. See, Jessell et al., "Capsaicin-induced depletion of substance P from primary sensory neurones", Brain Research, 152 (1978) 183-188. Web site: http://www.delphion.com/details?pn=US06277398__

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Analgesic from snake venom Inventor(s): Primor; Naftali (Rehovot, IL), Shulov; Abaron (late of Mevaseret Zion, IL) Assignee(s): S.I.S. Shulov Institute for Science Ltd. (Rehovot, IL) Patent Number: 6,555,109 Date filed: November 2, 2000 Abstract: A substantially non-toxic fraction isolated from the venom of Vipera xanthina is disclosed which fraction has an analgesic effect. The fraction is preferably purified on an ion exchange column from Vipera xanthina palestinae. Also described are a pharmaceutical composition for use as an analgesic comprising the non-toxic fraction, and a method for the relief of pain comprising administrating the non-toxic fraction.

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Excerpt(s): The present invention relates to the use of snake venom as an analgesic. Although pain is a crucially important physiological response, it also results in unnecessary suffering and agony. The control and relief of pain is an important branch of medicine. Pain may come about both as a result of disease as well as a result of medical treatment such as chemotherapy. In either case, it is important to alleviate the pain as much as possible so as to enable the sufferer to function normally. Two neural pathways relating to pain act concurrently in the body: (1) a sensory pathway which senses tissue damage and subsequently produces a feeling of pain; (2) an analgesic pathway which reduces the feeling of pain and prevents the flow of information about the pain to the central nervous system (CNS), thus allowing the organism to maintain it's normal activity in spite of an injury. Anesthesia can be realized either by use of a drug which inhibits peripheral nerves that act as pain sensors or by enhancement of the natural analgesic system. Since these are different pathways, they are affected by different substances. For example, aspirin and lidocaine are active on the peripheral sensory pathway, while morphine and related substances are active on the analgesic system. Web site: http://www.delphion.com/details?pn=US06555109__ •

Analgesic immediate and controlled release pharmaceutical composition Inventor(s): Heinicke; Grant Wayne (Fairview Park, AU), Smith; Ian Keith (Blair Athol, AU) Assignee(s): F.H. Faulding & Co., Limited (Underdale, AU) Patent Number: 6,194,000 Date filed: April 17, 1998 Abstract: Disclosed is a method for the therapeutic treatment of pain related to wind up in a human or animal. The method of the invention is practiced by administering to the subject an effective amount of an analgesic pharmaceutical composition which includes a NMDA receptor antagonist in an immediate release form combined with an NMDA receptor antagonist in a sustained release form. The immediate release form and sustained release forn are present in sufficient amounts to diminsh or abolish wind up. Excerpt(s): The present invention relates to pharmaceutical compositions and is particularly concerned with pharmaceutical compositions containing N-methyl-Daspartate (NMDA) receptor antagonists and their use in the treatment of pain. The amino acid glutamate is an excitatory neurotransmitter that is an agonist at many postsynaptic terminals of the central nervous system. The glutamate receptor complex is termed the NMDA receptor and is a potential target for therapeutic drugs. This receptor incorporates an ion channel complex which is novel because it is gated by both dual ligand binding (glutamate and glycine) and membrane voltage. Because of the novel requirements for activation, it is believed that the NMDA receptor complex plays only a minor role in routine synaptic transmission. However, the receptor complex may be activated following repeated afferent stimuli as occurs during trauma such as surgery. Repeated stimuli cause a temporal summation of C-fibre-mediated responses of dorsal horn nociceptive neurones; this phenomenon, increased output to a constant input, is known as wind-up. Studies indicate that activation of the NMDA receptor complex in the spinal dorsal horn leads to increased spontaneous neural discharge, expanded receptive fields and exaggerated responses to afferent input. These neural mechanisms may be expressed physically as hyperalgesia (increased pain sensation) and allodynia (pain arising from a stimulus that is not normally painful).

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Web site: http://www.delphion.com/details?pn=US06194000__ •

Analgesic tablet compositions Inventor(s): Ahlgren; Nils W. (Sunnyvale, CA), Ayer; Atul D. (Palo Alto, CA), Hwang; Paul M. (Mountain View, CA), Johnson; Deborah J. (Fremont, CA), Kuczynski; Anthony L. (Mountain View, CA), Merrill; Sonya (San Jose, CA) Assignee(s): Alza Corporation (Mt. View, CA) Patent Number: 6,284,274 Date filed: March 3, 2000 Abstract: An opiate analgesic composition and a non-opiate analgesic composition are disclosed for delivering an analgesic in either embodiment to a patient in need of relief from pain. The analgesics are present optionally with a nonionic surfactant and with an osmotic composition comprising a carbonate or bicarbonate for delivering the opiate analgesic and non-opiate analgesic from a dosage form. Excerpt(s): This invention pertains to a novel dosage form for the delivery of opiate and non-opiate analgesics. The invention concerns also a dosage form comprising a composition of matter that provides for a high dose of the analgesic in the dosage form, which analgesic is delivered at a controlled rate over an extended time. The invention relates additionally to a composition of matter for use in a dosage form for delivering the analgesic to produce the analgesic effect. The invention concerns further a method of administering the dosage form for delivering the analgesic to produce an analgesic effect in a patient in need of analgesia. Pain is a universal experience; everyone knows what is meant by pain. To relieve pain in patients, opiate analgesics and non-opiate analgesics are administered for their therapeutic purpose. These analgesics are used to relieve pain by acting centrally to elevate pain threshold, usually without disturbing consciousness and usually without altering sensory modalities. Presently, both pharmacy and medicine administer multidoses of these analgesics for the relief of pain, as a dosage form comprising a long-term dose administered at a controlled rate over time appears to be absent in the pharmaceutical and medicinal arts. In view of the foregoing, it is readily apparent that a serious need exists for an improvement for delivering opiate analgesics and for delivering non-opiate analgesics for their therapeutic effect. Thus, it is an immediate object of the present invention to provide a dosage form that comprises a drug analgesic composition present as a layer containing a therapeutic dose of a member selected from the group consisting of an opiate analgesic and non-opiate analgesic, which in either analgesic manufacture is administered in a preferred, essentially zero-order dose over an extended time for their therapeutic effect. Further, it is an object of the present invention to provide a novel composition of matter, manufactured as an osmotic composition in a layer, with fluid imbibing properties for expanding and pushing the opiate analgesic or non-opiate analgesic at a controlled rate over time from the dosage form. Web site: http://www.delphion.com/details?pn=US06284274__

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Anti-inflammatory analgesic Inventor(s): Koda; Shigeru (Shizuoka, JP), Niyiro; Yasunori (Fujinomiya, JP), Sugiyama; Satoru (Nagoya, JP) Assignee(s): Nippon Hypox Laboratories Inc. (Tokyo, JP) Patent Number: 6,447,817 Date filed: January 23, 2001 Abstract: The present invention is concerned with an anti-inflammation analgesic preparation which contains a specific 3-0-substituted ascorbic acid as an active ingredient, shows excellent anti-inflammation analgesic effects and is excellent in shelf life, safety to a skin and endermic absorptivity of the active ingredient. Excerpt(s): The present invention relates to an anti-inflammation analgesic preparation. More specifically, it relates to an anti-inflammation analgesic preparation which exhibits an excellent anti-inflammation analgesic effect on pains involving a swelling of a muscle, a joint or a bone and a fatigue involving lassitude and which is excellent in a shelf life, safety to a skin and endermic absorptivity of an effective ingredient. It has been found that a cyclooxygenase inhibitor is useful in an anti-inflammation analgesic preparation, and since then, a variety of anti-inflammation analgesic preparations containing a cyclooxygenase inhibitor have been proposed. At present, however, on the basis of any cyclooxygenase inhibitor, there has been obtained no satisfactory antiinflammation analgesic preparation which is free from side effects and useful against lumbago, bruise, sprain, stiff shoulder, arthralgia, myalgia, a swelling and a pain after muscle fatigue or bone fracture, shoulder periarthritis, tendon-thecitis, peritendinitis, inflammation of lateral epicondyle of humerus, a swelling after injury, an ache, a swelling and a pain from rheumatism or osteoarthritis and a pain and fatigue of a leg and loins from excess exercise or labor. Meanwhile, ascorbic acid has been studied with regard to its various physiological activities and is well recognized to be a vitamin indispensable for keeping health. It is clear from many reports that it is useful for strengthening a blood vessel wall due to promotion of the biosynthesis of glucocorticoids which are distributed in adrenal gland to a greater extent and are antiinflammation factor in oroganisms or the synthesis of collagen. However, there has been completed no technique to utilize ascorbic acid in an anti-inflammation analgesic preparation, since ascorbic acid is readily decomposed upon contact to light, heat, water and metal ion or has a problem on endermic absorptivity. Web site: http://www.delphion.com/details?pn=US06447817__

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Combination of a selective NMDA NR2B antagonist and an opioid analgesic Inventor(s): Boyce; Susan (Bishops Stortford, GB) Assignee(s): Merck Sharpe & Dohme Limited (GB) Patent Number: 6,538,008 Date filed: August 22, 2000 Abstract: A combination of a selective NMDA NR2B antagonist and an opioid analgesic is useful in the treatment of pain or nociception. Excerpt(s): This is an application under 35 U.S.C. 371 of PCT/GB99/00585 and claims priority from Great Britain Application No. 9804885.3, filed Mar. 6, 1998. This invention relates to the treatment or prevention of pain or nociception by the administration of a

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combination of a selective NMDA NR2B antagonist and an opioid analgesic. Pain has been defined as the sensory experience perceived by nerve tissue distinct from sensations of touch, pressure, heat and cold. It is often described by sufferers by such terms as bright, dull, aching, pricking, cutting, burning, etc. This range of sensations, as well as the variation in perception of pain by different individuals, renders a precise definition of pain near impossible. Pain as suffering, however, is generally considered to include both the original sensation and the reaction to that sensation. Where pain is "caused" by the stimulation of nociceptive receptors and transmitted over intact neural pathways, this is termed nociceptive pain. Alternatively, pain may be caused by damage to neural structures, often manifesting itself as neural supersensitivity, and is classed as neuropathic pain. Web site: http://www.delphion.com/details?pn=US06538008__ •

EMU oil-based formulations for use as an analgesic, anesthetic and antipruritic Inventor(s): Barr; Teresa L. (Port Townsend, WA), Pearson; Maurine (7100 Cross Timbers Rd., Flower Mound, TX 75022) Assignee(s): Pearson; Maurine (Pilot Point, TX) Patent Number: 6,528,040 Date filed: August 24, 2001 Abstract: An analgesic, anesthetic and antipruritic formulation is provided containing 0.01 to 13 wt % alkyl esters; and 20 to 70 wt % Emu oil; 10 to 33 wt % benzyl alcohol; 10 to 33 wt % benzoin; 0.2 to 2 wt % allantoin; 0.25 to 1.25 wt % methylparaben and 0.01 to 0.30 wt % propylparaben. The formulation may be formulated as a spray or transdermal formula. The formulation may be used for treatment of chronic cutaneous ulcers and burn wounds. Excerpt(s): Found in the wild only in Australia, Emus (dromiceius novae-hollandiae) are the second largest members of the ratite group of flightless birds in the world. The Emu have wings but they are very tiny. They can run up to. 35-40 miles an hour, as they have very large and strong legs. Although a very docile creature, the Emu's legs are so strong; one kick can break a man's leg. Now Emus are being farmed in many parts of the world. They are raised for their valuable products, which include very low fat meat, supple leather hides, decorative and nutritional eggs, and very rich oil, which are obtained from the Emu. Emus are by nature, very healthy and immune to many diseases. Emus are referred to a "living dinosaurs," as their skeletal structure closely resembles some dinosaurs. Emus living today closely resemble their ancestors of millions of years ago. Emu oil, a food by product, is obtained from the fat of the Emu. It is an all-natural substance. When processed, the fat is taken through a series of steps to refine, sterilize and deodorize the oil. Not all Emu oil on the market is refined. Some Emu oil is simply rendered, which means the oil is simply filtered, and may contain contaminants. Emu oil contains high amounts of EFA's (essential fatty acids). EFA's produce energy in the process of oxidation. In humans EFA's govern growth, vitality and mental state of mind. Oxidation is the central and most important living process in our body. Emu oil by nature is not regarded as a sterile ingredient. Due to lack of regulatory controls and procedures, Emu oil is processed in many different ways, i.e., some forms of rendering, which is simply a filtration process, which leaves the Emu oil with its natural yellow color, and a slight odor. The present invention uses a refinement process, which yields a clearly pure Emu oil product, creamy white and odor free. The present invention utilizes a sterilization technique to render the Emu oil in the present invention free of

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contaminants to be used as a preparation and treatment for cutaneous wounds and burn ulcers. Web site: http://www.delphion.com/details?pn=US06528040__ •

Fast dissolving compositions having analgesic activity Inventor(s): Castegini; Franco (Milan, IT), Di Toro; Mauro (Milan, IT), Grassano; Alessandro (Milan, IT), Marchiorri; Maurizio (Milan, IT) Assignee(s): Zambon Group S.p.A. (Milan, IT) Patent Number: 6,197,336 Date filed: May 26, 1999 Abstract: An analgesic composition useful in the preparation of fast dissolving tablets is provided, where the composition is the result of combining ibuprofen, arginine, linear PVP and an alkaline bicarbonate to which usual excipients for the preparation of tablets are added. Excerpt(s): The present invention relates to an analgesic composition useful for preparing fast dissolving tablets containing ibuprofen and arginine and the tablets made therefrom. Ibuprofen is the International common name of the compound 2-(4isobutylphenyl)-propionic acid, which is a known drug with analgesic, as well as antiinflammatory and antipyretic, activity of broad diffusion. In U.S. Pat. No. 4,279,926, ibuprofen salts with basic amino acids such as arginine and lysine have been described. Web site: http://www.delphion.com/details?pn=US06197336__

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Fast-acting analgesic Inventor(s): Berndl; Gunther (Herxheim, DE), Breitenbach; Jorg (Mannheim, DE), Leipold; Bernd (Mannheim, DE), Neumann; Jorg (Limburgerhof, DE), Rosenberg; Jorg (Ellerstadt, DE), Vollgraf; Christiane (Bobenheim-Roxheim, DE), Zeidler; Jurgen (Mutterstadt, DE) Assignee(s): BASF Aktiengesellschaft (Ludwigshafen, DE) Patent Number: 6,322,816 Date filed: February 1, 2000 Abstract: A fast-acting analgesic comprises as analgesic substance ibuprofen in an adjuvant matrix with a porous structure and a density of greater than 1 and up to 2.5 g/cm.sup.3. Excerpt(s): The present invention relates to a fast-acting analgesic preparation comprising as analgesic substance ibuprofen in an adjuvant matrix, where the preparation has a porous structure and a density of greater than 1 and up to 2.5 g/cm.sup.3. The invention furthermore relates to a process for producing the preparation. The use of ibuprofen, 2-(4-isobutylphenyl)propionic acid, as nonsteroidal analgesic has been known for a relatively long time. Ibuprofen has an asymmetric carbon atom and, in the form used therapeutically, is generally in the form of the racemate. Web site: http://www.delphion.com/details?pn=US06322816__

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Ibuprofen and narcotic analgesic compositions Inventor(s): Kushla; Gregory P. (Florham Park, NJ), Lai; Jin-Wang (Edison, NJ), Polli; Gerald P. (Valley Forge, PA) Assignee(s): Knoll Pharmaceutical Company (Mt. Olive, NJ) Patent Number: 6,348,216 Date filed: June 10, 1997 Abstract: Provided herein are compositions and methods of making compositions of ibuprofen in combination with a narcotic analgesic. Specifically provided is a pharmaceutical tablet composition comprising ibuprofen; a narcotic analgesic; colloidal silicon dioxide; a filler selected from the group consisting of microcrystalline cellulose and powdered cellulose; a disintegrant selected from the group consisting of croscarmellose sodium, crospovidone, and sodium starch glycolate; a binder consisting of an akylhydroxy methylcellulose; a starch; and a lubricant. Also provided herein is a method of preparing a pharmaceutical tablet composition comprising: (a) Granulating ibuprofen, a narcotic analgesic, a first glidant, a first disintegrant, a binder, and starch to form granules wherein said granulating step comprises a wet granulation process; (b) blending the granules with extra-granular material comprised of a second glidant, a second disintegrant, a filler and starch to form a blend of granules and extra-granular material; and (c) compressing the blend into a tablet. Excerpt(s): This invention is related to the field of pharmaceutical compositions and methods of preparing pharmaceutical compositions. Specifically, this invention is related to solid dosage compositions of ibuprofen in combination with a narcotic analgesic. Solid dosage forms of ibuprofen, a non-steroidal anti-inflammatory agent, are known. Although tablet compositions of ibuprofen are known and commercially available, problems of poor tablet compression, stability and disintegration persist and are well documented. For example, it is known that ibuprofen tablets made from wet granulation methods "age" over time which tends to have a negative impact on dissolution. (See U.S. Pat. No. 4,609,675 to Franz). Franz theorizes that the tablets "age" over time because of sintering which is described as a type of cementing of the ibuprofen particles to one another. Franz states that one way to minimize sintering is to increase the amount of excipients or diluents used in the compositions in order to isolate the ibuprofen particles. This causes problems in formulating high dose ibuprofen tablets because the tablets are too large when they are made by a wet granulation process. In an effort to overcome this problem, Franz prepared a dry granulation of high dose ibuprofen in combination with croscarmellose, noting that it was unexpected to formulate a successful composition in view of his experience that other disintegrants such as corn starch and crospovidone did not work. Franz also describes that croscarmellose improved dissolution characteristics of the tablets when they contained 1.34% to 7.01% croscarmellose but decreased dissolution characteristics when the tablets contained croscarmellose in excess of 7.01%. U.S. Pat. No. 4,911,921 to Denton et al. notes that they were able to overcome the problem of using a large amount of excipients in wet granulation methods used to make ibuprofen tablets. Denton et al. notes that Franz was able to overcome these problems by using a dry mixing method using amounts of croscarmellose up to 15% and preferably about 7 to 8%. Denton describes the use of agglomerates of ibuprofen and binder held together by binder and polyvinylpyrrolidone. Denton et al. describes the use of a dry composition comprised of lactose. Web site: http://www.delphion.com/details?pn=US06348216__

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Magnetic analgesic therapeutic device Inventor(s): Engel; Peter H. (619 S. June St., Los Angeles, CA 90005) Assignee(s): none reported Patent Number: 6,146,324 Date filed: June 26, 1999 Abstract: A therapeutic magnetic and analgesic pad or bandage formed of opposed strips interconnected to define a space or pocket therebetween for receiving a plurality of permanent magnets for generating a magnetic field to effect healing and/or reducing pain of an injured body part. The strip of the bandage or pad adapted to be placed in contact with the injured body part is formed of a synthetic water insoluble resin material which is impregnated with an analgesic ingredient in a manner whereby the analgesic ingredient is gradually released in a dry volatile state and imparted to the injured body part to synergistically further minimize pain and enhance healing. Excerpt(s): The present invention relates in general to a magnetic therapy device and more particularly to a magnetic analgesic bandage or pad to promote healing and reduce or alleviate pain. The use of magnetic fields to promote healing and reduce pain is well known in the medical profession. There have been many studies in which it has been found that the use of a magnetic field can speed up post-operative healing. Additionally, there have been many studies in which the use of a magnetic field helps to alleviate pain due to muscle strains, tennis elbows, sore muscles, lower back pain, arthritis and the like. While there have been many different theories advanced as to why magnetic therapy works, it is still not clearly understood exactly how magnetic therapy aids in healing and in reducing pain. However, it is clear that many people's lives have been greatly improved by the use of magnetic therapy. Many devices have, therefore, been developed to practice magnetic therapy. One such magnet device for therapeutic use is disclosed in U.S. Pat. No. 4,549,532 entitled "Flexible Magnetic Sheet for Therapeutic Use" issuing to Baermann on Oct. 29, 1985, which is herein incorporated by reference. Therein disclosed is a permanent magnet sheet having alternating poles for applying a magnetic field to portions of the body for therapeutic purposes. Magnetic therapy devices generally take the form of placing a specially adapted permanent magnet pad adjacent a particular portion of the body. Accordingly, there are separate specialized products specifically adapted for back pain, neck pain, elbow pain, wrist pain, knee pain, and other various parts of the body. Often, an individual wishing to benefit from magnetic therapy is required to purchase a relatively large number of specialized devices for placing a permanent magnet adjacent different portions of the body. This is often inconvenient and expensive. Accordingly, there is a need for an improved permanent magnet device for use in magnetic therapy that can be applied easily to different locations of the body. Relief of pain, particularly that resulting from a sport's injury and/or from sprained or strained muscles, was also heretofore achieved by the application of topical medical ointments or fluids such as liniment, oil of wintergreen, and other topical preparations that include a suitable analgesic ingredient. Such topical preparations, while effective, are messy and likely to soil any clothing with which they may come into contact. Web site: http://www.delphion.com/details?pn=US06146324__

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Method and analgesic preparations for sustained and extended corneal analgesia with subanesthetic concentrations of lidocaine Inventor(s): Shahinia, Jr.; Lee (1506 Country Club Dr., Los Altos, CA 94024) Assignee(s): none reported Patent Number: 6,350,781 Date filed: August 25, 2000 Abstract: A preparation suitable for sustained and extended corneal analgesia and for repeated administration consisting of subanesthetic concentrations of lidocaine. A method for corneal analgesia by administering to a patient an ophthalmic analgesic solution containing lidocaine in subanesthetic 0.4% concentration. Excerpt(s): The current invention concerns a method for ophthalmic analgesia achieved with nontoxic subanesthetic concentration of multiple doses of topically administered lidocaine. In particular, the invention concerns administration of diluted topical lidocaine preparation comprising about and up to about 0.4% (4000.mu.g/ml) of lidocaine and a topical ophthalmic preparation for corneal analgesia having a fast onset of pain relief and extended duration of the corneal analgesia. The lidocaine preparation may be administered for several months without accompanying toxic symptoms. Trauma to the eye, particularly corneal injury and abrasion, tends to be excruciatingly painful. While many anesthetic agents such as proparacaine, cocaine, procaine, tetracaine, hexylcaine, bupivacaine, lidocaine, benoxinate, mepivacaine, prilocaine and etidocaine, to name a few, are well known to attain temporary anesthesia and suppression of pain, concentrations of these agents needed to achieve corneal anesthesia are between 0.25% and 4%. At these concentrations, these agents can only be administered for a very short period of time necessary to achieve local anesthesia and permit performance of ophthalmic procedures such as examination of a painful eye, measurement of intraocular pressure, gonioscopic examination, removal of foreign bodies and sutures from the cornea, diagnostic conjunctival and corneal scrapings, radial keratotomy, and other surgical procedures. The onset of the anesthesia is very rapid, typically under 15 seconds, and typically lasts for about 10-30 minutes. Unfortunately, application of local anesthetics to the cornea at these concentrations causes the development of temporary superficial corneal epithelial lesions. Upon repeated application for prolonged anesthesia, these lesions progress to extensive erosions of the corneal epithelium and grayish infiltrates of the corneal stroma which can lead to permanent scarring and loss of vision. Prolonged application, of local anesthetics is further associated with delayed corneal reepithelialization after wounding, altered lacrimation and tear film stability, corneal swelling, and disruption of epithelial cell mitosis and migration. Web site: http://www.delphion.com/details?pn=US06350781__

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Method and simultaneously enhancing analgesic potency and attenuating dependence liability caused by morphine and other bimodally-acting opioid agonists Inventor(s): Crain; Stanley M. (Leonia, NJ), Shen; Ke-fei (Flushing, NY) Assignee(s): Albert Einstein College of Medicine of Yeshiva University (Bronx, NY) Patent Number: 6,362,194 Date filed: June 1, 2000

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Abstract: This invention relates to a method for selectively enhancing the analgesic potency of a bimodally-acting opioid agonist such as morphine and simultaneously attenuating anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects associated with the administration of the bimodally-acting opioid agonist. The method of the present invention comprises administering to a subject an analgesic or sub-analgesic amount of a bimodally-acting opioid agonist such as morphine and an amount of an excitatory opioid receptor antagonist such as naltrexone or nalmefene effective to enhance the analgesic potency of the bimodally-acting opioid agonist and attenuate the anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects of the bimodally-acting opioid agonist. Excerpt(s): This invention relates to a method of enhancing the analgesic (inhibitory) effects of bimodally-acting opioid agonists, including morphine, codeine and otherclinically used opioid analgesics, while at the same time attenuating anti-analgesia, physical dependence, tolerance, hyperexcitability, hyperalgesia, and other undesirable (excitatory) side effects typically caused by chronic use of bimodally-acting opioid agonists. In the instant invention, a very low dose of a selective excitatory opioid receptor antagonist, an opioid which binds to and acts as an antagonist to excitatory but not inhibitory opioid receptors on nociceptive neurons which mediate pain, is combined with a dose of a bimodally-acting opioid agonist so as to enhance the degree of analgesia (inhibitory effects) and attenuate the undesired side effects (excitatory effects). Morphine or other bimodally-acting opioid agonists are administered to relieve severe pain due to the fact that they have analgesic effects mediated by their activation of inhibitory opioid receptors on nociceptive neurons (see North, Trends Neurosci., Vol. 9, pp. 114-117 (1986) and Crain and Shen, Trends Pharmacol. Sci., Vol. 11, pp. 77-81 (1990)). Web site: http://www.delphion.com/details?pn=US06362194__ •

Morphine and diamorphine salts of anionic non-narcotic analgesics of the substituted carboxylic acid type Inventor(s): Asmussen; Bodo (Bendorf-Sayn, DE), Muller; Walter (Neuwied, DE), Riess; Walter (Ansbach, DE) Assignee(s): LTS Lohmann Therapie-Systeme GmbH (DE) Patent Number: 6,156,764 Date filed: October 28, 1999 Abstract: The present invention relates to morphine and diamorphine salts of anionic non-narcotic analgesics belonging to the type of substituted carboxylic acids, preferably the morphine and diamorphine salts of diclofenac (Formula 1); to processes for their production, the use of these salts in the treatment of diseases, as well as to pharmaceutical preparations comprising these salts. Excerpt(s): The present invention relates to morphine and diamorphine salts of anionic non-narcotic analgesics belonging to the type of substituted carboxylic acids, preferably the morphine and diamorphine salts of diclofenac (Formula 1). The present invention further relates to processes for their production, the use of these salts in the treatment of diseases, as well as to pharmaceutical preparations comprising these salts. Pain is one of the most frequent signs of a disease or a damage. Though pain is to be understood as a warning and protective function of the organism, patients concerned generally call for pain-killing or at least pain-relieving substances. For this reason, one of the most important concerns in medicine is to provide such substances. The function of these

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substances, so-called analgesics, is to reduce or suppress the sensation of pain when given in therapeutic doses without having a general narcotic effect in these doses. Based on their potency, therapeutic mechanism and side effects one distinguishes between two groups of analgesics: very potent analgesics acting on the central nervous system and low to moderately potent ones primarily having a peripheral action. Active substances acting on the central nervous system frequently involve a habit-forming potential which might develop into addiction. Morphine (Formula 3a) is one example of an active substance acting on the central nervous system and having such a risk. In the form of its inorganic salts, for example its hydrochloride or sulfate, morphine is commercially available for parenteral or peroral application to control acute posttraumatic or postoperative pain, as well as chronic pain, for example, in the state of advanced cancer. A derivative of morphine, diacetylmorphine (Formula 3b), also known as diamorphine or heroin, is dealt and consumed among drug addicts without any pharmacological, pharmaceutical, or pharmacokinetic control. Its qualified use in the treatment of drug addiction is a scientific and sociological problem that has not yet been solved. Web site: http://www.delphion.com/details?pn=US06156764__ •

Nitroxyderivatives having antinflammatory, analgesic and antithrombotic activity Inventor(s): Benedini; Francesca (Milan, IT), Del Soldato; Piero (Monza, IT) Assignee(s): Nicox S.A. (Paris, FR) Patent Number: 6,613,784 Date filed: August 30, 2001 Abstract: Organic or inorganic salts of compounds of general formula: A--X.sub.1 -N(O).sub.z for use as medicaments having anti-inflammatory, analgesic and antithrombotic activity, wherein A is R(COX.sub.u).sub.t wherein t is 0 or 1; u is 0 or 1 and X is O, NH, NR.sub.1c wherein R.sub.1c us a C.sub.1 -C.sub.10 alkyl and R is, for example, (Ia) wherein R.sub.1 is acetoxy, preferably in ortho position with respect to -CO-- and R.sub.2 is hydrogen or acetylsalicylsalicylic acid derivatives; and X.sub.1 is the formula (B), Y being a ring containing at least one salified nitrogen atom. Excerpt(s): The present invention relates to new products having anti-inflammatory, analgesic and antithrombotic activity. Specifically it relates to cyclo-oxygenase (COX) inhibitors. It is known that the anti-inflammatory and antithrombotic efficacy of NSAIDs (Non steroid antiinflammatory drugs), also known as FANS (non steroid antiinflammatory drugs), but esoecially their tolerability, seem to be considerably affected by their inhibitory activity of the cyclo-oxygenase (COX) both in the inflammatory site and in the healthy tissue. See for example FASEB Journal 1, 89, 1987; Bioch. Biophys. Acta 1083, 1, 1991. The drawback of these products is that they are toxic, as already described in U.S. Pat. No. 5,861,426. Web site: http://www.delphion.com/details?pn=US06613784__

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Oral analgesic compositions Inventor(s): Kay; Martha Francine (Marlton, NJ), Ratnaraj; Teresa Ruth (Sicklerville, NJ), Sandler; Patricia Lynn (Media, PA) Assignee(s): American Home Products Corporation (Madison, NJ) Patent Number: 6,344,480 Date filed: October 17, 1997 Abstract: Alkanol flee glycol based oral analgesic compositions are provided, protected against microbiological degradation by a preservative agent which is a combination of methylparaben and phenylcarbiniol. Excerpt(s): This invention relates to oral alkanol free glycol based analgesic compositions containing high concentrations of benzocaine. More particularly, this invention relates to oral analgesic compositions in liquid and gel form having high potency and protected from microbiological degradation by a preservative agent which is a combination of methylparaben and phenylcarbinol. An anesthetic composition comprising high concentrations of benzocaine is described in U.S. Pat. No. 5,446,063. The benzocaine is dispersed or suspended in an admixture of water and emollient vehicle and is not completely dissolved. Another benzocainie composition comprising high concentrations of benzocaine is described in U.S. Pat. No. 4,241,048. That patent discloses a composition containing benzocaine suspended in an essentially anhydrous carrier also containing a crystal growth suppressing agent. These prior art patents disclose the use of preservatives including methylparaben and propylparaben. According to this invention, an oral analgesic glycol based composition which is anhydrous and alkanol free, containing high concentrations of benzocaine, is provided in liquid or gel form and which is protected from bacterial degradation by a preservative agent which is a combination of methylparaben and phenylcarbinol. The benzocaine compositions of the invention contain about 5 to about 20% by weight of benzocaine, based on the weight of the total composition. The amount of glycol based solvent system is about 40% to about 80% by weight based on the weight of the total composition when in liquid form, and about 40% to about 60% when in gel form. The glycol based solvent system contains about 80% to about 100% by weight of polyethylene glycol when in liquid form and in gel form, based on the weight of the glycol based solvent system, and advantageously up to about 20% by weight of a cosolvent for the benzocaine compatible with polyethylene glycol, based on the weight of the glycol based solvent system. The methylparaben component of the preservative agent can be about 0.05 to about 0.2% by weight of the total composition and the phenylcarbinol component of the preservative agent can be about 0.25 to about 0.5% by weight of the total composition. Co-solvents for the benzocaine compatible with polyethylene glycol are propylene glycol and glycerine. Web site: http://www.delphion.com/details?pn=US06344480__

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Oral dosage for the controlled release of analgesic Inventor(s): Chen; Chih-Ming (Davie, FL), Cheng; Xiu Xiu (Davie, FL), Jan; Steve (Coral Springs, FL) Assignee(s): Andrx Pharmaceuticals, Inc. (Fort Lauderdale, FL) Patent Number: 6,197,347 Date filed: June 29, 1998

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Abstract: An oral dosage form that provides for the controlled release of an analgesic wherein the dosage form comprises a core containing an analgesic that is coated with a mixture of an enteric polymer, a water insoluble polymer and a lubricant. Excerpt(s): The present invention relates to oral controlled release dosage formulations containing an analgesic. More specifically, the present invention relates to an oral dosage formulation in the form of a tablet or a capsule containing pellets comprising a nonsteroidal anti-inflammatory drug (NSAID), preferably a propionic acid derivative such as ibuprofen, naproxen, flubiprofen, indoprofen, ketoprofen or there pharmaceutically acceptable derivatives. Most preferably the NSAID is ketoprofen. Numerous techniques are in the prior art for preparing sustained or controlled release pharmaceutical formulations. One common technique involves surrounding an osmotically active drug core with a semipermeable membrane. The drug is released from the core over time by allowing a fluid such as gastric or intestinal fluid to permeate the coating membrane and dissolve the drug so the dissolved drug can permeate the membrane. In some cases a hydrogel is employed to push the active ingredient through the passageway in the membrane. Some representative examples of these osmotic tablet systems can be found in U.S. Pat. Nos. 3,845,770, 3,916,899, 3,952,741, 4,034,758, 4,077,407 and 4,783,337. Another common technique for preparing controlled release pharmaceutical formulations is to encapsulate a plurality of beads, pellets or tablets that are coated with varying levels of a diffusion barrier and/or different types of the diffusion barriers. Examples of these beaded formulations can be found in U.S. Pat. Nos. 5,376,384, 5,529,790, 5,470,584, 5,002,776, 5,445,829 and 5,578,321. The product ORUVAIL.RTM. which is commercially available from Wyeth-Ayerst Laboratories, is another example of a controlled release pharmaceutical formulation that employs the bead technology. The ORUVAIL.RTM. product is available in 100 mg, 150 mg and 200 mg capsules and contains hundreds of coated pellets that consist of ketoprofen, ethylcellulose, gelatin, shellac, silicon dioxide, sodium lauryl sulfate, starch, sucrose, talc, titanium dioxide, dyes and other proprietary ingredients. Web site: http://www.delphion.com/details?pn=US06197347__ •

Orally administered analgesic composition comprising myfadol Inventor(s): Shulman; Morton (1115 Thorntree La., Highland Park, IL 60035) Assignee(s): none reported Patent Number: 6,174,899 Date filed: May 14, 1998 Abstract: An orally administered analgesic product comprises 250-1,000 mg of myfadol and a carrier for the myfadol. The orally administered product may be a solid or a liquid. The analgesic effect of the product lasts for 2 to 4 hours or more. The product contains more than 4 mg of myfadol per kg of body weight of the human patient to whom the product is administered. The solid product may contain a delayed release agent that extends the analgesic effect of the myfadol to a total time of up to 12 hours. Excerpt(s): The present invention relates generally to analgesic compositions and methods for administering these compositions and more particularly to analgesic compositions comprising myfadol and to methods for administering these compositions orally. Analgesic compositions are pain relieving agents. Familiar analgesic compositions are aspirin and ibuprofin, both of which are non-steroidal antiinflammatory drugs (NSAID). A problem with NSAID-type analgesic compositions

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is that they have a plateau effect: they do a good job of relieving relatively mild levels of pain, but they are not good at relieving relatively severe levels of pain. Relief from severe levels of pain often requires the use of opioids. Opioid analgesic compositions are narcotic compositions, and they have drawbacks. Tolerance and addiction can develop after repeated use. In addition, opioid analgesic compositions are capable of producing respiratory depression, excessive sedation, and, on occasion, cardio-vascular depression. Web site: http://www.delphion.com/details?pn=US06174899__ •

Pain treatment method and apparatus using heating wrap and analgesic cream Inventor(s): Church; W. Edward (3810 Gunn Hwy., Tampa, FL 33624), Krafft; Randall (3810 Gunn Hwy., Tampa, FL 33624) Assignee(s): none reported Patent Number: 6,572,871 Date filed: January 6, 1999 Abstract: The present invention comprises a heating wrap for placement against an injured/painful area of a person's body and an analgesic cream being placed between the heating wrap and the injured/painful area. The invented cream is formulated specifically for use with a heating wrap to be heat-compatible. The added heat from the heating wrap enhances the permeability of the skin and the tendency of the cream to permeate into the skin. The cream preferably includes an ingredient pharmaceutically categorized as an analgesic agent and an ingredient pharmaceutically categorized as an anti-inflammatory agent. Preferably, the cream does not include ingredients at levels that irritate human skin at the elevated temperatures of the heating wrap, that is, at about 110-140 degrees F. wrap temperatures. The heat wrap may be a pad that includes a flexible sleeve for receiving and surrounding the pad, plus a set of straps for holding the pad or pad/sleeve combination on the body area that is to be treated. Also, the preferred heating wrap includes a thin sheet that will absorb water, which sheet may be dampened with water and inserted between the heating pad and surrounding flexible sleeve, for providing moist heat treatment. Excerpt(s): This invention pertains generally to heating pads and to methods for using heating pads. More specifically, this invention pertains to using a heating pad in conjunction with a heat-activated analgesic cream to provide pain relief. For a long time, mankind has used heat to help heal wounds, bruises and discomforts. Heat has been applied to the human body in many ways. Mankind has also used analgesic creams to treat the pain of arthritis, backache, muscle pain, joint pain, abdominal pain, strains and bruises. Analgesic creams also have been applied to the human body in many ways. Conventional analgesic creams include one or more ingredients that relieve pain when topically applied, for example, a salicylate ingredient in the range of 10-60 wt % of the cream. Still, there has not been to date an effective treatment technique which combines the positive effects of heating pad treatment with the simultaneous use of an analgesic cream. This invention addresses that need for such a treatment. Web site: http://www.delphion.com/details?pn=US06572871__

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Pharmaceutical composition comprising an aqueous extract of a mixture of anemarrhena rhizoma and phellodedron bark for analgesic and anti-inflammation Inventor(s): Chung; Young-Shin (Seoul, KR), Han; Young-Bok (Seoul, KR), Hong; EunKyung (Seoul, KR), Kim; Sung-Jin (Seoul, KR), Lee; Kyung-Yung (Seoul, KR), Shin; Young-Lok (Seoul, KR) Assignee(s): Medvill Co., Ltd. (Seoul, KR) Patent Number: 6,193,977 Date filed: March 14, 2000 Abstract: The present invention is directed to a pharmaceutical composition comprising an extract of a mixture of Anemarrhena Rhizoma, a member of the family Liliaceae and, Phellodendron bark, a member of the family Rutaceae that produces analgesic and antiinflammatory effects, and its preparing method. The present invention is applicable to act on inflammation and pain, for example, chronic gastritis, arthralgia, benign prostate hyperplasia, chronic and recurrent cystitis, cervical disc, degenerative joint arthritis, rheumatoid arthritis, tennis elbow, osteoportotic pain, migraine, diabetic neuropathy pain, right flank pain, etc. The present invention a crude extract suitable for long-period administration with less side effects. Also, the present invention does not lead to dependency or resistance. Excerpt(s): The present invention relates generally to a pharmaceutical composition comprising aqueous extracts of Anemarrhena Rhizoma, a member of the family Liliaceae, and Phellodendron Bark, a member of the family Lilium for analgesic and anti-inflammation, and its preparing method. More particularly, it relates to a pharmaceutical composition comprising mixed aqueous extracts of Anemarrhena Rhizoma and Phellodendron Bark for analgesic and anti-inflammation against chronic gastritis, arthralgia, benign prostate hyperplasia, chronic and recurrent cystitis, cervical disc, degenerative joint arthritis, rheumatoid arthritis, tennis elbow, osteoportotic pain, migraine, diabetic neuropathy pain, Rt. flank pain, etc. There are two types of pain, one of which is fast pain sensed immediately in response to stimulants and the other is slow pain sensed gradually. The slow pain results from injuries to both the skin and the internal tissue and lasts long, while the fast pain results from injuries to the skin rather than to the internal tissue. The pain is sensed through receptors distributed over the skin and tissue, especially, those for mechanical, thermal and chemical stimulants. Upon receipt of stimulation, the receptors transmit sensation to the central nerve system. Examples of the chemicals exciting the chemical type of pain receptors include bradykinin, potassium ions, acids, proteolytic enzymes, etc. Compared to the other types of sensation, the lasting pain becomes more sensitive to stimulants and develops intolerance even to a weak stimulant. In the body system, neurons of the brain and the vertebral column secrete those substances such as morphine that elicit an analgesic effect, and regulate the pain. Examples of the analgesic substances include endorphin, enkephalin and dynorphin secreted from the brain, and serotonin and enkephalin from the vertebral column. Web site: http://www.delphion.com/details?pn=US06193977__

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Pharmaceutical preparations for external use containing non-steroidal antiinflammatory and analgesic agents Inventor(s): Kaneko; Teruhisa (Tokyo, JP), Kawamura; Yoko (Tokyo, JP), Nagase; Masaaki (Hachioji, JP), Shinohara; Yuka (Tokyo, JP) Assignee(s): Bristol-Myers Squibb Co. (Princeton, NJ) Patent Number: 6,635,674 Date filed: May 2, 2001 Abstract: The present invention relates to an anti-inflammatory and analgesic pharmaceutical preparation for external use having excellent percutaneous absorption and applicability. The pharmaceutical preparations for external use of this invention comprise NSAIDs and, as a percutaneous absorption promoting agent, oleic acid, oleyl alcohol or a mixture thereof, in a pharmaceutically acceptable aqueous alcoholic solvent comprised of a monohydric saturated aliphatic alcohol of 1-4 carbon atoms, a polyhydric alcohol selected from the group consisting of saturated aliphatic glycols of 24 carbon atoms and glycerol, and water. Excerpt(s): This invention relates to an anti-inflammatory and analgesic pharmaceutical reparation for external use having excellent percutaneous absorption and applicability. Non-steroidal anti-inflammatory and analgesic agents have an excellent antiinflammatory and analgesic activity and have been widely used clinically in such dosage forms as ointments, gels, creams, lotions, adhesive plasters, capsules, suppositories and injections. It has been hitherto common that non-steroidal antiinflammatory and analgesic agents (hereinafter referred to as NSAIDs) have been orally administered in the dosage form of capsules, tablets, etc. Although oral dosage forms can be very effective when absorbed from the gastrointestinal tract, they can produce significant side effects. Therefore, oral dosage forms must be used with careful monitoring. Accordingly, to reduce side effects, such as gastrointestinal disorders, topical dosage forms have been developed, for example, gels (Japanese Patent Kokai Application No. 161323/1981), creams (Japanese Patent Kokai Application Nos. 103811/1983 and 298526/1987), ointments (Japanese Patent Kokai Application No. 39616/1983), adhesive plasters (Japanese Patent Kokai Application No. 250317/1989) and others. However, these prior art inventions have not resolved the problems of poor diffusion and transfer of the NSAIDs in the base phase of the adhesive plasters and inadequate drug release and percutaneous absorption from ointments (gel bases). Web site: http://www.delphion.com/details?pn=US06635674__

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Preemptive analgesic agent and methods of use Inventor(s): Zappala; Stephen M. (98 Rattlesnake Hill Rd., Andover, MA 01810) Assignee(s): none reported Patent Number: 6,329,398 Date filed: March 30, 2001 Abstract: A pharmacological agent for use as preemptive analgesia, comprising, 1% lidocaine HCL and 0.25% bupivacaine HCL in a ratio sufficient to provide analgesic effect quickly and for an extended period of time, preferably equal to or less than 10:1. Excerpt(s): This invention relates to analgesia and more specifically to preemptive analgesia used as an adjunct to reduce perioperative pain and methods of using the

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analgesia. It is known that perioperative pain may be reduced by beginning pain reduction therapy before surgery. This early intervention therapy is commonly known as preemptive analgesia, the purpose of which is to reduce the hypersensitization of nociceptors by blocking pain impulses from ever reaching the brain. Essentially, preemptive analgesia prevents the activation of the nociceptors before activation can occur. Preemptive analgesia has received widespread acceptance as an adjunct to reduce perioperative pain in patients who undergo surgical procedures as generally disclosed by Mayer et al. in U.S. Pat. No. 5,502,058. The technique is well accepted and involves the pharmacological interruption of afferent neurons to the dorsal horns of the spinal cord prior to the delivery of painful stimuli, such as a surgical incision. The anesthetic concept can be applied to most surgical procedures, minimizing postoperative pain as well as the necessity for narcotic or parenteral analgesia. Moreover, patients treated with preemptive analgesia have experienced reduced hospitalizations and a much shorter convalescence. Web site: http://www.delphion.com/details?pn=US06329398__ •

Preparations of non-steroidal analgesics Inventor(s): Breitenbach; Jorg (Mannheim, DE), Rosenberg; Joerg (Ellerstadt, DE) Assignee(s): BASF Aktiengesellschaft (Ludwigshafen, DE) Patent Number: 6,251,434 Date filed: July 15, 1998 Abstract: Preparations of non-steroidal analgesics with antipyretic and antiinflammatory effect are obtainable by extrusion and shaping of a melt, comprising, besides one or more active ingredients, a mixture ofa) 40-99.5% by weight of a homopolymer of N-vinylpyrrolidone with a Fikentscher K value of 30,b) 0.25-59.75% by weight of a water-soluble copolymer of N-vinylpyrrolidone, andc) 0.25-10% by weight of one or more physiologically acceptable salts of sodium or potassium,where the stated amounts are based on the total of components a), b) and c). Excerpt(s): where the stated amounts are based on the total of components a), b) and c), and subsequent shaping. The invention furthermore relates to a process for producing such preparations. Rapid release of the active ingredient is crucially important particularly with analgesics in order to achieve a rapid onset of the pain-relieving effect. Web site: http://www.delphion.com/details?pn=US06251434__

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Production of analgesic synergy by co-administration of sub-analgesic doses of a MU opioid agonist and a kappa-2 opioid agonist Inventor(s): Ross; Fraser (Clayfield, AU), Smith; Maree (Bardon, AU) Assignee(s): The Lynx Project Limited (Australian Capital Territory, AU), The University of Queensland (Queensland, AU) Patent Number: 6,310,072 Date filed: August 29, 1997 Abstract: An analgesic composition is disclosed comprising a sub-analgesic dosage of a.mu.-opioid agonist, optionally in the form of a pharmaceutically acceptable salt, and a sub-analgesic dosage of a.kappa.sub.2 -opioid agonist, optionally in the form of a

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pharmaceutically acceptable salt. There is also disclosed a method for producing analgesia in humans and lower animals which comprises administering concurrently to a human or lower animal in need of such treatment an analgesic composition of the invention. Excerpt(s): This invention relates to opioids, and in particular co-administration of subanalgesic doses of a.mu.-opioid agonist and a.kappa.sub.2 -opioid agonist for the production of analgesic synergy. Opioid analgesics such as morphine, hydromorphone, oxycodone and fentanyl are among the most powerfully acting and clinically useful drugs producing depression of the central nervous system. These analgesics are the mainstay for the treatment of moderate to severe cancer pain because they are simple to administer and they provide effective pain relief in most patients when used properly (Cancer Pain Relief, World Health Organization, 1986, Geneva). Unlike doses of nonopioid drugs, weak opioids and mixed opioid agonist-antagonists (e.g., buprenorphine), the doses of morphine and other strong opioids can be increased indefinitely, being limited only by the development of unacceptable side effects. These side effects include the development of physical dependence and tolerance, sedation, respiratory depression, hypotension, increase in cerebrospinal fluid pressure, nausea, vomiting and constipation. Web site: http://www.delphion.com/details?pn=US06310072__ •

Retro-inverso neurotrophic and analgesic peptides Inventor(s): O'Brien; John S. (La Jolla, CA), White; Michael T. (La Jolla, CA), Wright; David E. (Ramona, CA) Assignee(s): Myelos Corporation (San Diego, CA) Patent Number: 6,458,357 Date filed: September 3, 1998 Abstract: Retro-inverso peptide analogs derived from the active neurotrophic region of saposin C. The saposin C-derived peptides (prosaptides) induce neurite outgrowth in vitro, prevent programmed cell death, induce myelination and have an analgesic effect. They are useful in the treatment of central and peripheral nervous system disorders and pain management. The retro-inverso peptides are significantly more resistant to metabolic degradation than the corresponding non-inverted peptides. Excerpt(s): The present invention relates to neurotrophic and analgesic peptides and their methods of use. More specifically, the invention relates to stable, active retroinverso analogs of neurotrophic peptide fragments of saposin C. Demyelination is a defect common to a number of central nervous system (CNS) disorders, the most prevalent being multiple sclerosis (MS). MS, a chronic disorder which may lead to total disability, is characterized by damage to the myelin sheath, leaving the axons mostly intact. MS is the most prevalent neurological disease of young adults. The incidence of MS in the United States is approximately 300,000. Currently, the treatment for MS using anti-inflammatory drugs is palliative rather than curative; reversal of demyelination is minimal since these drugs act to reduce inflammation rather than promote repair (Interferon Therapy of Multiple Sclerosis, Reder, A. ed., Marcel Dekker, New York, 1997). Other central nervous system disorders involving demyelination include acute disseminated encephalomyelitis, trauma to brain and/or spinal cord, acute hemorrhagic leukodystrophy, progressive multifocal leukoencephalitis, metachromatic leukodystrophy, adrenal leukodystrophy and maldevelopment of the white matter in

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premature infants (periventricular leucomalacia). The peripheral nervous system (PNS) can also undergo demyelination, such as that occurring in Guillain-Barre syndrome (Pathologic Basis of Disease, Robbins et al. eds., W. B. Saunders, Philadelphia, 1979, pp. 1578-1582), traumatic injury and inflammatory or infectious neuropathies. Peripheral nerve injuries and peripheral neuropathies, such as those resulting from diabetes or chemotherapy, comprise the most prevalent peripheral nervous system disorders. Neurotrophins and neurotrophic factors are proteins or peptides capable of affecting the survival, target innervation and/or function of neuronal cell populations (Barde, Neuron, 2:1525-1534, 1989). The efficacy of neurotrophins both in vivo and in vitro has been well documented. For example, nerve growth factor (NGF) acts as a trophic factor for forebrain cholinergic, peripheral and sensory neurons (Hefti et al., Neurobiol. Aging, 10:515-533, 1989). In vivo experiments indicate that NGF can reverse naturally-occurring as well as physical traumatic injuries to peripheral nerves (Rich et al., J. Neurocytol., 16:261-268, 1987). Brain-derived neurotrophic factor (BDNF) is a trophic factor for peripheral sensory neurons, dopaminergic neurons of the substantia nigra, central cholinergic neurons and retinal ganglia (Henderson et al., Restor. Neurol. Neurosci., 5:15-28, 1993). BDNF has been shown to prevent normally-occurring cell death both in vitro and in vivo (Hofer et al., Nature, 331:261-262, 1988). Ciliary neurotrophic factor (CNTF) promotes survival of chicken embryo ciliary ganglia in vitro and supports survival of cultured sympathetic, sensory and spinal motor neurons (Ip et al., J. Physiol. Paris, 85:123-130, 1991). Web site: http://www.delphion.com/details?pn=US06458357__ •

Synergistic analgesic combination of oxycodone and rofecoxib Inventor(s): Burch; Ronald M. (Wilton, CT), Goldenheim; Paul D. (Wilton, CT), Sackler; Richard S. (Greenwich, CT) Assignee(s): Euro-Celtique S.A. (Luxembourg, LU) Patent Number: 6,552,031 Date filed: September 17, 1998 Abstract: Disclosed is a pharmaceutical composition, comprising a combination of a dose of rofecoxib or a pharmaceutically acceptable salt thereof and a dose of oxcodone or a pharmaceutically acceptable salt thereof, said combination in an amount sufficient to provide an analgesic effect in a human patient. Also disclosed is a method of effectively treating pain in humans or other mammals, comprising administering to the patient a combination of a dose of rofecoxib or a pharmaceutically acceptable salt thereof and a dose of oxycodone or a pharmaceutically acceptable salt thereof such that the dosing interval of the rofecoxib overlaps with the dosing interval of the oxycodone, said combination in an amount sufficient to provide an analgesic effect in a human patient. Excerpt(s): The invention relates to analgesic pharmaceutical compositions containing an opioid analgesic and a cyclooxygenase-2 (COX-2) inhibitor. The invention also relates to methods of treating pain comprising administering such pharmaceutical compositions to human patients. There is a continuing need for analgesic medications able to provide high efficacy pain relief while reducing the possibility of undesirable effects. Non-steroidal anti-inflammatory drugs ("NSAID'S"), including compounds such as ibuprofen, ketoprofen and diclofenac, have anti-inflammatory actions and are effective on pain associated with the release of prostaglandins and other mediators of inflammation. For example, diclofenac is considered to be extremely potent and effective

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as an analgesic and anti-inflammatory agent. Diclofenac is approved in the United States for the long-term symptomatic treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis. It is also considered to be useful for the short-term treatment of acute musculoskeletal injury, acute painful shoulder, postoperative pain and dysmenorrhea. However, NSAID'S such as diclofenac produce side effects in about 20% of patients that require cessation of medication. Side effects include, for example, gastrointestinal bleeding and the abnormal elevation of liver enzymes. The opioids are a group of drugs, both natural and synthetic, that are employed primarily as centrallyacting analgesics and are opium or morphine-like in their properties (Gilman et al., 1980, GOODMAN AND GILMAN'S. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, Chapter 24:494-534, Pub. Pergamon Press; hereby incorporated by reference). The opioids include morphine and morphine-like homologs, including, e.g., the semisynthetic derivatives codeine (methylmorphine) and hydrocodone (dihydrocodeinone) among many other such derivatives. Morphine and related opioids exhibit agonist activity at central nervous system or CNS (referring to the brain and spinal cord).mu. (mu) opioid receptors as well as showing affinity for the.delta. and.kappa. opioid receptors, to produce a range of effects including analgesia, drowsiness, changes in mood and mental clouding. In addition to potent analgesic effects, the morphine-related opioids may also cause a number of undesirable effects, including, for example, respiratory depression, nausea, vomiting, dizziness, mental clouding, dysphoria, pruritus, constipation, increased biliary tract pressure, urinary retention and hypotension. The development of tolerance to the opioid drugs and the risk of chemical dependence and abuse for these drugs is another undesirable effect. Web site: http://www.delphion.com/details?pn=US06552031__ •

Tachykinin antagonist and an opioid analgesic effective at treating pain or nociception Inventor(s): Hill; Raymond George (Royston, GB) Assignee(s): Merck Sharp & Dohme Limited (Hoddesdon, GB) Patent Number: 6,180,624 Date filed: February 25, 1999 Abstract: This invention relates to methods and compositions for treating pain and nociception in a patient by administering a combination of a morpholine or thiomorpholine tachykinin antagonist and an opioid analgesic. Excerpt(s): This invention relates to the treatment or prevention of pain or nociception by the administration of a combination of a tachykinin antagonist, in particular an NK-1 receptor antagonist, and an opioid analgesic. Pain has been defined as the sensory experience perceived by nerve tissue distinct from sensations of touch, pressure, heat and cold. It is often described by sufferers by such terms as bright, dull, aching, pricking, cutting, burning, etc. This range of sensations, as well as the variation in perception of pain by different individuals, renders a precise definition of pain near impossible. Pain as suffering, however, is generally considered to include both the original sensation and the reaction to that sensation. Where pain is "caused" by the stimulation of nociceptive receptors and transmitted over intact neural pathways, this is termed nociceptive pain. Alternatively, pain may be caused by damage to neural structures, often manifesting itself as neural supersensitivity, and is classed as neuropathic pain. The level of stimulation at which pain is perceived is referred to as the "pain threshold". Where the pain threshold is raised, for instance, by the administration

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of an analgesic drug, a greater intensity or more prolonged stimulus is required before pain is experienced. Analgesics are a class of pharmaceutical agent which, following administration to a patient in need of such treatment, relieve pain without loss of consciousness. This is in contrast to other pain-relieving drugs, for example, general anaesthetics which obtund pain by producing a hiatus in consciousness, or local anaesthetics which block transmission in peripheral nerve fibres thereby preventing pain. Web site: http://www.delphion.com/details?pn=US06180624__ •

Topical application of opioid analgesic drugs such as morphine Inventor(s): Elkhoury; George F. (1561 Ramillo Ave., Long Beach, CA 90815) Assignee(s): none reported Patent Number: 6,143,278 Date filed: February 23, 1998 Abstract: The invention is directed to methods and pharmaceutical compositions for the topical administration of opioid analgesic drugs such as morphine. In particular, the invention relates to topical administration of an opioid analgesic agent, e.g., morphine sulfate, in admixture with a skin- or mucosal-specific penetration enhancer, to produce a localized analgesic effect in inflamed or non-inflamed skin or mucosal tissue, and without a transdermal or transmucosal migration of opioid agent, e.g., into the systemic circulation. Excerpt(s): Morphine is the prototype of the class of opioid analgesic drugs which exert their effects by activating opioid receptors within the brain. When morphine is referred to individually in this application, this reference is meant to encompass other opioid drugs and is not meant to be morphine exclusively. Historically, narcotics have been used since the 18th century in the forms of oral or injectable morphine or opium in order to accomplish pain relief. Morphine is considered to be unsurpassed as an analgesic for severe pain. Unfortunately, morphine and other opioid drugs have a number of severe side effects which hamper their wide spread use and acceptance by both physicians and patients. These side effects include: addiction, nausea, inhibition of breathing, somnolence and dysphoria, all of which are mediated by morphine's action within the brain. It is still the current belief that narcotics ingested or injected will cross to the blood stream and from there go to the brain where there are morphine receptors. At that time, the narcotics are believed to attach to these morphine receptors and create a dullness of the pain but with all of the side effects described above. Of course, the worst potential effect is the addiction that can occur if the morphine is used beyond a few days or weeks on a continuous basis. Because of the fear of addiction, the use of morphine as an analgesic has been restricted. In addition, major research efforts have been directed toward the development of morphine-like drugs that act within the brain but are devoid of the side effects. The market for these other drugs has never fully materialized because these drugs were not perceived as having the same analgesic properties of morphine and because typically these drugs were not produced to be both available in oral and injectable formats. Web site: http://www.delphion.com/details?pn=US06143278__

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Treatment of sickle cell anemia crises with fructose-1,6-diphosphate as an analgesic drug Inventor(s): Fox; Anthony W. (Rancho LaCosta, CA), Marangos; Paul J. (Encinitas, CA), Markov; Angel K. (Jackson, MS) Assignee(s): Questcor Pharmaceuticals, Inc. (Union City, CA) Patent Number: 6,312,707 Date filed: June 12, 2000 Abstract: Fructose-1,6-diphosphate (FDP) has been shown, in double-blinded controlled clinical trials on patients with sickle cell anemia, to substantially reduce the pain suffered by such patients during the recurrent ischemic crises that are caused by red blood cell sickling. Tests on patients who have been hospitalized for such crises demonstrated that when they received an intravenous injection of FDP, they reported substantially lower pain levels during their hospital stays than control groups that received identical treatment without any FDP. Apparently, FDP has never previously been used or even tested in human clinical trials, to treat sickle cell anemia. In addition, FDP has never previously been reported to have any analgesic (pain-reducing) activity. Excerpt(s): This invention relates to the use of a naturally occurring sugar-phosphate compound called fructose-1,6-diphosphate, for treating the sporadic crises that arise in people suffering from sickle cell anemia. Accordingly, sickle cell anemia and 1,6-FDP have both been studied extensively. However, there apparently has never been any prior effort to treat sickle cell anemia, using 1,6FDP. This genetic mutation is relatively common in Africa, since a person who carries a single copy of the mutated gene has a relatively high resistance to malaria, without suffering from major adverse health effects. Accordingly, it has been estimated that roughly 30% of all people native to Nigeria (as just one example) carry at least one such gene (Barnhart et al 1976). About 8% of African-Americans also carry at least one such gene, although local populations often contain higher levels. The gene which disposes red blood cells to sickling is often referred to as HbS, where "Hb" refers to hemoglobin, and "S" refers to sickling. By contrast, a normal, healthy, adult hemoglobin is usually referred to as HbA. Web site: http://www.delphion.com/details?pn=US06312707__

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Tri-compound analgesic for treating inflammation and pain Inventor(s): Generale; Robert James (620 Timpson St., Pelham, NY 10803) Assignee(s): none reported Patent Number: 6,492,334 Date filed: August 26, 2000 Abstract: A composition of an analgesic choline bitartrate, and myo-inositol and method for using same are described herein.The composition alleviates inflammation and pain due to such causes as sciatica, injury, trauma and arthritis without the negative side effect attributable to NSAIDs. Excerpt(s): This invention relates to analgesics, specifically to a method of controlling inflammation and pain. All early attempts at controlling pain were eventually superseded. Shortcomings of effectiveness and negative side effects were the reasons. This has been true since the historic use of herbs. Until 1955 aspirin was the primary over the counter inflammation and pain drug. It relieves inflammation and pain, but is

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particularly antagonistic to the stomach. Long term use may cause bleeding and ulcers. Acetaminophen was introduced as an analgesic without the side effects of aspirin. However, it has no effect on inflammation and it can only be used as an analgesic. Although acetaminophen does not distress the stomach, continued use will tax the liver. Web site: http://www.delphion.com/details?pn=US06492334__ •

Vanilloid analogues containing resinferatoxin pharmacophores as potent vanilloid receptor agonists and analgesics, compositions and uses thereof Inventor(s): Kim; Hee-Doo (Seoul, KR), Lee; Jeewoo (Seoul, KR), Oh; Uhtaek (Seoul, KR), Park; Hyeung-Geun (Seoul, KR), Park; Young-Ho (Seoul, KR), Suh; Young-Ger (Seoul, KR) Assignee(s): Digital Biotech Co., Ltd. (KR), Pacific Corporation (KR) Patent Number: 6,476,076 Date filed: August 20, 2001 Abstract: The present invention is related to new vanilloid analogues containing resiniferatoxin pharmacophores, pharmaceutical compositions comprising such analogues, and their uses as vanilloid receptor agonists and potent analgesics. The present invention provides a pharmaceutical composition for treating acute, chronic, inflammatory or neuropathic pains or for treating bladder hypersensitivity. Excerpt(s): The present invention relates to vanilloid analogues containing resiniferatoxin pharmacophores, pharmaceutical compositions comprising such analogues, and methods of using such analogues as vanilloid receptor agonists and potent analgesics. Capsaicin (CAP), which has the structure shown hereinafter, stimulates and then desensitizes sensory afferent C-fibers. The induced desensitization may have an application in arthritis, asthma, allergic responses including rhinitis, fever, pain, bladder hypersensitivity and the like. Besides, the vanilloid receptor(VR)(or capsaicin receptor) is a specific neuronal membrane recognition site for CAP and related irritant compounds. It is expressed almost exclusively by primary sensory neurons involved in nociception and neurogenic inflammation. The receptor functions as a cation-selective ion channel with a preference for calcium, and its functional subtype, VR1, activated by both CAP and noxious heat has recently been cloned. Its desensitization caused by specific ligands has been recognized as a promising therapeutic approach to mitigate neuropathic pain and other pathological conditions in which neuropeptides released from primary sensory neurons play a crucial role. Web site: http://www.delphion.com/details?pn=US06476076__

Patent Applications on Pain Medications As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to pain medications:

9

This has been a common practice outside the United States prior to December 2000.

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Analgesic agent Inventor(s): Chi, Yu-Ming; (Kitaibaraki-Shi, JP), Nakamura, Motoyuki; (Kitaibaraki-Shi, JP), Nohara, Toshihiro; (Kumamoto-Shi, JP), Sakurada, Shinobu; (Sendai-Shi, JP), Yoshizawa, Toyokichi; (Kitaibaraki-Shi, JP) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt PC; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20030100516 Date filed: January 22, 2001 Abstract: An analgesic agent is provided which has analgesic action and antiinflammatory action without significant side effects found in conventional analgesics. The analgesic agent comprises as an active ingredient a cyclobutanedicarboxylic acid derivative, containing substituted diphenyl, represented by formula (I): 1wherein X.sub.1, X.sub.2, Y.sub.1, Y.sub.2, Z.sub.1, and Z.sub.2, which may be the same or different, each independently represent a hydrogen atom, hydroxyl, a halogen atom, alkyl, alkoxy, or a nitrogen-containing group; and R.sub.1 and R.sub.2, which may be the same or different, each independently represent hydroxyl, a halogen atom, alkoxy, aryloxy, terpeneoxy, saccharide, or a nitrogen-containing group. Excerpt(s): The present invention relates to an analgesic agent, and a process for producing a derivative for use in said analgesic agent. More particularly, the present invention relates to an analgesic agent comprising as an active ingredient a cyclobutanedicarboxylic acid derivative, containing substituted diphenyl, represented by a specific chemical structural formula, and a process for producing said derivative for use in the analgesic agent. In general, analgesics refer to drugs which eliminate or alleviate pain without losing consciousness. The analgesics are generally classified, for example, into: narcotic analgesics, which have been regarded as acting on the central nerve, such as morphine; non-narcotic analgesics such as aspirin and indometacin; and narcotic antagonistic analgesics which develop analgesic action through a mechanism similar to that of narcotic analgesics. Among them, morphine is a plant-derived component, which has been begun to be used as an analgesic agent since before Christ and is still frequently used even at present, and is regarded as very important in improving the quality of life (QOL) of patients with pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Analgesic and anti-inflammatory compositions comprising domperidone and methods of using same Inventor(s): On, Ninh; (London, GB) Correspondence: Arent Fox Kintner Plotkin & Kahn; 1050 Connecticut Avenue, N.W.; Suite 600; Washington; DC; 20036; US Patent Application Number: 20020025971 Date filed: September 21, 2001 Abstract: The present invention provides a method for eliciting an onset hastened analgesic and anti-inflammatory response and combating nausea in acute migraine attacks. This method comprises administering a pharmaceutical composition comprising more than one active ingredient, wherein said more than one active ingredient consist essentially of:(i) domperidone or an analogue thereof in an amount sufficient to hasten

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the onset of the analgesic and anti-inflammatory response and to combat nausea in an acute migraine attack, and(ii) a NSAID, a pharmaceutically acceptable salt thereof or a pure (-) or pure (+) optical isomeric form thereof in an analgesically and antiinflammatory effective amount, wherein said NSAID is selected from the group consisting of proprionic acid derivatives, acetic acid derivatives, fenamic acid derivatives, biphenylcarboxylic acid derivatives and oxicams. Excerpt(s): The current means of combating migraine attacks include simple analgesics such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDS) and paracetamol, taken at the earliest signs of an attack [1,2,3]. Aspirin, paracetamol and phenacetin have long been among the most commonly used members of the NSAIDS class. Amongst the newer NSAIDS are ibuprofen, ketoprofen, mefenamic acid, diflunisal, naproxen and piroxicam. The most widely used NSAIDS available over the counter that have fewer gastro intestinal side effects than aspirin are paracetamol and ibuprofen. Combined preparations of paracetamol or aspirin with an anti-emetic agent such as buclizine or metoclopramide, have been used to alleviate the nausea symptoms that often accompanied a migraine attack. Commercially, they are available as Migraleve Duo.RTM., Paramax.RTM., Migravess.RTM. Narcotic analgesics such as codeine have also been employed together with NSAIDS to obtain synergistic analgesia, for example Migraleve Yellow.RTM., co-codamol. Gastric stasis, commonly present in migraine[4], causes the poor absorption of the analgesics. Dispersible and effervescent formulations have been used in an attempt to overcome this [4]. Metoclopramide, an anti-emetic, also relieves gastric stasis which has been found useful counteracting the reduced analgesic effects of paracetamol in migraine attacks [1,4,5]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Analgesic and anti-inflammatory biphenylylylacetic acid

patches

for

external

use

containing

4-

Inventor(s): Kawaji, Toshikuni; (Kagawa, JP) Correspondence: Crowell & Moring Llp; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20030088199 Date filed: August 8, 2002 Abstract: An aqueous hot melted type adhesive base material containing 4-biphenylyl acetic acid (BPAA) is provided. The adhesive base material contains constant amounts of BPAA and has good drug releasability, so that bioavailability of the drug is enhanced. An analgesic and anti-inflammatory external plaster containing BPAA is also provided. The plaster is obtained by dissolving BPAA into an aqueous hot melted type adhesive base material comprising as essential components a styrene-isoprene-styrene block copolymer, an adhesive resin, an antioxidant, lanolin, and water. Excerpt(s): The present invention relates to plasters containing 4-biphenylyl acetic acid (general name: FELBINAC; hereinafter simply referred as to "BPAA"), and more particularly, to analgesic and anti-inflammatory external plasters in which BPAA is dissolved into an aqueous hot melted type adhesive base material comprising a styreneisoprene-styrene block copolymer, an adhesive resin, an antioxidant, lanolin, and water as essential components. BPAA is a pharmacologically active agent that is widely used in various external preparations, such as ointments, lotions, and aqueous plasters (cataplasm), for the purposes of relieving pain and alleviating inflammation in various

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disease conditions, including osteoarthritis, muscle- and fascia-related lumbago, periarthritis humeroscapularis, tendinitis, tenosynovitis, peritendinitis, external humeral epicondylitis (such as tennis elbow), sore muscle, and post-traumatic swelling and pain. Among these external preparations, ointments and lotions have been considered less suitable for administration of BPAA continuously and in constant dosages and are also thought to be inconvenient since they may stick elsewhere other than the intended application site, and may sometimes soil the clothes at the time of administration. On the other hand, an aqueous plaster, though not associated with these problems, has a low adhesiveness and thus requires fixing means such as a strip of surgical tape so that it stays on flextion parts such as elbows and knees. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Analgesic and glucosamine compositions Inventor(s): Cowan, Alan; (Ambler, PA), Raffa, Robert; (Norristown, PA), Tallarida, Ronald; (Mantua, NJ) Correspondence: Robert L. Andersen; Ratner & Prestia; One Westlakes, Berwyn, Suite 301; P.O. Box 980; Valley Forge; PA; 19482-0980; US Patent Application Number: 20020058642 Date filed: September 25, 2001 Abstract: This invention relates to a composition comprising a glucosamine material and an analgesic compound such as a nonsteroidal anti-inflammatory drug (NSAID) and/or an opioid analgesic and its use for treatment of pain in pharmaceutical or veterinary applications. When the components of the compositions are administered within certain ratios, the analgesic efficacy of the composition is super-additive (synergistic) relative to the analgesic efficacy of the analgesic compound alone. Excerpt(s): The invention relates to analgesic compositions which comprise a glucosamine material in combination with an analgesic compound. Depending on the choice of analgesic compound and the weight ratio of glucosamine to analgesic compound, the analgesic efficacy of the composition may be either additive or superadditive. Drugs such as aspirin, ibuprofen, acetaminophen, and morphine are used as analgesics. Ibuprofen, aspirin and other analgesic nonsteroidal anti-inflammatory drugs (commonly referred to as NSAIDs) and acetaminophen are only useful in relieving pain of moderate intensity, whereas opioid analgesics such as morphine are useful in relieving more intense pain. However, opioids exhibit side-effects including addictive properties, and ibuprofen, aspirin, other NSAIDs and acetaminophen can cause serious gastrointestinal, renal, and cardiovascular side effects, especially when used in high doses and/or over long periods of time. NSAIDs, which are non-opioid analgesics, have been combined with other drugs, including opioid analgesic agents, in order to achieve an effective degree of analgesia with a lower dosage of NSAID and/or other analgesic compound. These combination products exhibit a variety of effects on the level of analgesia, which may be sub-additive (inhibitory), additive, or super-additive (synergistic). For example, U.S. Pat. No. 4,571,400 discloses that the combination of dihydrocodeine (an opioid analgesic) and ibuprofen (an NSAID) provides superadditive analgesia when the components are combined within certain ratios. A. Pircio et al., Arch. Int. Pharmacodyn., 235,116 (1978) report that a mixture of butorphanol (an opioid analgesic) with acetaminophen (a non-opioid analgesic) in a 1:125 ratio yielded super-additive analgesia, but that a 1:10 mixture of the same components yielded merely additive analgesic effects. A combination of tolmetin (an NSAID) with

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acetaminophen (a non-opioid analgesic) has been reported to enable a marked reduction in the amount of tolmetin required to produce analgesia (G. Stacher et al., Int. J. Clin. Pharmacol. Biopharmacy, 17, 250 (1977)). However, it is also known that the daily consumption of non-opioid analgesics, either alone or in combination, in large amounts or over time also poses health risks. Moreover, it is known that the effects on the level of analgesia obtained when combining such analgesics is highly unpredictable, depending on the choice of analgesics combined and the ratios at which they are combined. Specifically, a particular combination may provide a sub-additive level of analgesia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

ANALGESIC COMBINATION Inventor(s): FIERUS, MONIKA; (LEVERKUSEN, DE), NEUSER, DIETER; (LANGENFELD, DE), WIEHL, WOLFGANG; (KOLN, DE) Correspondence: Norris, Mclaughlin & Marcus, P.A.; Attn: Kurt G. Briscoe; 220 East 42nd Street; 30 TH Floor; New York; NY; 10017; US Patent Application Number: 20010002999 Date filed: October 8, 1999 Abstract: The present invention relates to medicinal preparations which can be administered orally and contain a fixed combination of at least one locally acting analgesic with a rapid onset of action and at least one systemically acting analgesic with a sustained action. Excerpt(s): Locally acting analgesics with a rapid onset of action which can be used, for example, in the form of sprays or pastilles are already known. Local anaesthetics of this type display their action after less than one minute but have only a short duration of action so that frequent remedication is necessary, which adversely affects safety and patient compliance. Examples of particularly interesting locally acting analgesics which may be mentioned are the benzocaines. They inhibit impulse formation and conduction in nerves by blocking the flow of sodium. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Analgesic combination of oxycodone and meloxicam Inventor(s): Burch, Ronald M.; (Wilton, CT), Goldenheim, Paul D.; (Wilton, CT), Sackler, Richard S.; (Greenwich, CT) Correspondence: Davidson, Davidson & Kappel, Llc; 485 Seventh Avenue, 14th Floor; New York; NY; 10018; US Patent Application Number: 20020099049 Date filed: January 25, 2002 Abstract: Disclosed is a pharmaceutical composition, comprising a combination of a dose of meloxicam or a pharmaceutically acceptable salt thereof and a dose of oxycodone or a pharmaceutically acceptable salt thereof, said combination in an amount sufficient to provide an analgesic effect in a human patient. Also disclosed is a method of effectively treating pain in humans or other mammals, comprising administering to the patient a combination of a dose of meloxicam or a pharmaceutically acceptable salt thereof and a dose of oxycodone or a pharmaceutically acceptable salt thereof such that

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the dosing interval of the meloxicam overlaps with the dosing interval of the oxycodone, said combination in an amount sufficient to provide an analgesic effect in a human patient. Excerpt(s): The invention relates to analgesic pharmaceutical compositions containing an opioid analgesic and a cyclooxygenase-2 (COX-2) inhibitor. The invention also relates to methods of treating pain comprising administering such pharmaceutical compositions to human patients. There is a continuing need for analgesic medications able to provide high efficacy pain relief while reducing the possibility of undesirable effects. Non-steroidal anti-inflammatory drugs ("NSAID'S"), including compounds such as ibuprofen, ketoprofen and diclofenac, have anti-inflammatory actions and are effective on pain associated with the release of prostaglandins and other mediators of inflammation. For example, diclofenac is considered to be extremely potent and effective as an analgesic and anti-inflammatory agent. Diclofenac is approved in the United States for the long-term symptomatic treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis. It is also considered to be useful for the short-term treatment of acute musculoskeletal injury, acute painful shoulder, postoperative pain and dysmenorrhea. However, NSAID'S such as diclofenac produce side effects in about 20% of patients that require cessation of medication. Side effects include, for example, gastrointestinal bleeding and the abnormal elevation of liver enzymes. The opioids are a group of drugs, both natural and synthetic, that are employed primarily as centrallyacting analgesics and are opium or morphine-like in their properties (Gilman et al., 1980, GOODMAN AND GILMAN'S. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, Chapter 24:494-534, Pub. Pergamon Press; hereby incorporated by reference). The opioids include morphine and morphine-like homologs, including, e.g., the semisynthetic derivatives codeine (methylmorphine) and hydrocodone (dihydrocodeinone) among many other such derivatives. Morphine and related opioids exhibit agonist activity at central nervous system or CNS (referring to the brain and spinal cord).mu. (mu) opioid receptors as well as showing affinity for the.delta. and.kappa. opioid receptors, to produce a range of effects including analgesia, drowsiness, changes in mood and mental clouding. In addition to potent analgesic effects, the morphine-related opioids may also cause a number of undesirable effects, including, for example, respiratory depression, nausea, vomiting, dizziness, mental clouding, dysphoria, pruritus, constipation, increased biliary tract pressure, urinary retention and hypotension. The development of tolerance to the opioid drugs and the risk of chemical dependence and abuse for these drugs is another undesirable effect. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Analgesic composition and method Inventor(s): Ku, Baoshan; (Beijing, CN), Shum, Frank Hay Kong; (North Point, HK) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 220400747; US Patent Application Number: 20020198226 Date filed: February 5, 2002 Abstract: A pharmaceutical analgesic composition comprising an opioid analgesic agent and a compound that binds to the SS1 or SS2 subunit of a sodium channel, such as tetrodotoxin and saxitoxin, and analogs thereof. Administration of an opioid analgesic agent and a compound that binds to the SS1 or SS2 subunit of a sodium channel, such as

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tetrodotoxin and saxitoxin, and analogs thereof, produces analgesia in the treatment of pain in mammals. Excerpt(s): The present invention relates to a method of producing analgesia in a mammal experiencing pain, comprising administering to the mammal a composition comprising a synergistically effective analgesic combination of an opioid analgesic agent and a compound that binds to the SS1 or SS2 subunit of a sodium channel in a pharmaceutically suitable vehicle. According to U.S. Pat. No. 6,150,524, opioid analgesics such as morphine are the most powerful analgesics for treating severe chronic and acute pain. An example of chronic pain is the pain experienced by cancer patients. An example of acute pain is the pain experienced after operations. The pain relieving activity of opioid analgesics includes a depressive effect on the central nervous system. The analgesic activity of opioid analgesics such as morphine and deltorphin II can be mediated via different opioid receptors, for example, via.mu.-opioid and.delta.opioid receptors. Opioid analgesics are invaluable for the treatment of severe acute or chronic pain as, for example, may occur in bone degenerative diseases and cancer conditions. They are easy to administer and they provide effective pain relief in most patients. Due to the excellent overall tolerability of opioids, the doses of morphine and other strong opioids can be increased to relatively high levels. The opioids used for treating such pain are indeed highly effective but have a number of unpleasant and/or undesirable side effects (e.g. a short duration of activity, respiratory depression, nausea, constipation, diuresis and euphoria and they are also addictive). In some patients, particularly in the chronically ill, the opioid side effects make it impossible to continuously administer sufficiently high dosages to adequately control pain over the needed period of time. There are also some pain conditions that do not sufficiently respond to opioid pain treatment alone. Therefore, there is a constant need for improved opioid containing analgesic combinations with increased analgesic activity which comprise opioid and non-opioid analgesically active agents and which offer the possibility of reducing the opioid dose needed for efficient pain relief and thereby also reducing the opioid side effects that might result from the otherwise required higher dosages. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Analgesic compositions containing buprenorphine Inventor(s): Chapleo, Christopher Bourne; (Gainsborough, GB), McCormack, Keith; (Kilburn, GB), Varey, Nicolas Calvert; (Goole, GB) Correspondence: Frederick H. Rabin; Fish & Richardson P.C.; Suite 2800; 45 Rockefeller Plaza; New York; NY; 10111; US Patent Application Number: 20030004178 Date filed: May 14, 2002 Abstract: An analgesic composition in parenteral unit dosage form or in a unit dosage form suitable for delivery via the mucosa comprising an amount of buprenorphine which is less than the clinical dose required to achieve pain relief and an amount of naloxone such that the ratio by weight of buprenorphine to naloxone is in the range of from 12.5:1 to 27.5:1, or an amount of naltrexone or nalmefene such that the ratio by weight of buprenorphine to naltrexone or nalmefene is in the range of from 12.5:1 to 22.5:1. The analgesic action of the buprenorphine is potentiated by the low dose of naloxone, naltrexone or nalmefene.

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Excerpt(s): This is a continuation-in-part of application No. PCT/GB00/04372 filed on Nov. 17, 2000, which is a continuation-in-part of U.S. Provisional Application No. 60/176,208 filed on Jan. 14, 2000. The present invention relates to analgesic compositions, containing buprenorphine and, in particular, to compositions which contain buprenorphine at a sub-clinical analgesic dose level in combination with naloxone, naltrexone or nalmefene. Buprenorphine (International Non-proprietary Name for N-cyclopropylmethyl-7.alpha.-[1-(S)-hydroxy-1,2,2-trimethylpropyl]6,14-endoethano-6,7,8,14-tetrahydronororipavine) has been shown in clinical trials to be a potent opiate partial agonist analgesic lacking the psychotomimetic effects found with other opiate analgesics. Buprenorphine effectively relieves moderate to severe pain in doses of 0.1 mg or more administered either parenterally or sublingually. The optimum therapeutic range for single doses is 0.3 mg-0.6 mg by injection and 0.2 mg-0.8 mg for sublingual tablets. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Analgesic delivery systems and methods of use Inventor(s): Druzgala, Pascal; (Santa Rosa, CA) Correspondence: Saliwanchik Lloyd & Saliwanchik; A Professional Association; 2421 N.W. 41st Street; Suite A-1; Gainesville; FL; 326066669 Patent Application Number: 20030130314 Date filed: December 17, 2002 Abstract: Novel and advantageous delivery systems for the delivery of analgesic compounds and compositions to patients who are suffering from intractable pain are provided. In some embodiments, these patients already are under the background influence of an opioid agonist. The subject invention also provides methods of managing pain comprising the administration of analgesic compounds via transdermal or transmucosal delivery routes. Excerpt(s): This application claims the benefit of provisional patent application Serial No. 60/341,743, filed Dec. 17, 2001, which is hereby incorporated by reference in its entirety. Pain management is an area of great interest in the medical community. Management of pain, and particularly chronic pain, is complex and frequently unsuccessful. In many instances patients enduring chronic or acute pain are under treatment with opioid-based analgesics. The first line of treatment usually involves administration of.mu.-opioid agonists, e.g., narcotics such as morphine. While it is possible to manage pain in this manner, it is sometimes necessary to provide additional medications for the control of pain. For example, some patients experience "breakthrough pain". Typically, patients experiencing breakthrough pain are already under the background influence of opioid therapy for severe pain (for example, terminally ill cancer patients or patients who have experienced major surgery). These patients, even under the background influence of an opioid, suffer episodes of extreme pain when they are moved or when their dressings are changed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Analgesic screening method and composition Inventor(s): Bowersox, Stephen S.; (Menlo Park, CA), Miljanich, George P.; (Redwood City, CA), Miller, James L.; (Los Altos, CA), Nadasdi, Laszlo; (Walnut Creek, CA) Correspondence: Elan Pharmaceuticals, INC.; Intellectual Property Department; 800 Gateway Boulevard; South San Francisco; CA; 94080; US Patent Application Number: 20030040028 Date filed: October 22, 2002 Abstract: Disclosed is a method of selecting analgesic agents based on their selective ability to block tetrodotoxin-insensitive sodium channels, particularly in comparison to blocking tetrodotoxin-sensitive sodium channels. Also disclosed is a novel class of compounds that is selective for blocking tetrodotoxin-insensitive sodium channels. Excerpt(s): This application is a continuation of U.S. patent application having Ser. No. 08/829,452, filed Mar. 28, 1997, which claims priority to Provisional U.S. Patent Application having Serial No. 60/014,437, filed Mar. 29, 1996, both of which are herein incorporated by reference. The present invention relates to a screening method for identifying analgesic compositions and to a novel class of analgesic agents. Akopian, A. N., et al., Nature 379:257-262 (1996). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Animal model for evaluating analgesics Inventor(s): Jamali, Fahkreddin; (Edmonton, CA) Correspondence: Cahn & Samuels Llp; 2000 P Street NW; Suite 200; Washington; DC; 20036; US Patent Application Number: 20020192161 Date filed: April 10, 2002 Abstract: The invention is an animal model for testing the effectiveness of analgesics, such as NSAID, formulations or any other medicament administered for acute pain or trauma. Excerpt(s): Not applicable. The present invention is directed to an animal model for testing the absorption rate of NSAID formulations, and for testing absorption rates of in suppressed vagal systems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Anti-inflammation analgesic preparation Inventor(s): Koda, Shigeru; (Shizuoka, JP), Niyiro, Yasunori; (Fujinomiya-shi, JP), Sugiyama, Satoru; (Nagoya-shi, JP) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe RD.; Arlington; VA; 22201-4714; US Patent Application Number: 20030045572 Date filed: July 2, 2002

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Abstract: The present invention is concerned with an anti-inflammation analgesic preparation which contains a specific 3-0-substituted ascorbic acid as an active ingredient, shows excellent anti-inflammation analgesic effects and is excellent in shelf life, safety to a skin and endermic absorptivity of the active ingredient. Excerpt(s): The present invention relates to an anti-inflammation analgesic preparation. More specifically, it relates to an anti-inflammation analgesic preparation which exhibits an excellent anti-inflammation analgesic effect on pains involving a swelling of a muscle, a joint or a bone and a fatigue involving lassitude and which is excellent in a shelf life, safety to a skin and endermic absorptivity of an effective ingredient. It has been found that a cyclooxygenase inhibitor is useful in an anti-inflammation analgesic preparation, and since then, a variety of anti-inflammation analgesic preparations containing a cyclooxygenase inhibitor have been proposed. At present, however, on the basis of any cyclooxygenase inhibitor, there has been obtained no satisfactory antiinflammation analgesic preparation which is free from side effects and useful against lumbago, bruise, sprain, stiff shoulder, arthralgia, myalgia, a swelling and a pain after muscle fatigue or bone fracture, shoulder periarthritis, tendon-thecitis, peritendinitis, inflammation of lateral epicondyle of humerus, a swelling after injury, an ache, a swelling and a pain from rheumatism or osteoarthritis and a pain and fatigue of a leg and loins from excess exercise or labor. Meanwhile, ascorbic acid has been studied with regard to its various physiological activities and is well recognized to be a vitamin indispensable for keeping health. It is clear from many reports that it is useful for strengthening a blood vessel wall due to promotion of the biosynthesis of glucocorticoids which are distributed in adrenal gland to a greater extent and are antiinflammation factor in oroganisms or the synthesis of collagen. However, there has been completed no technique to utilize ascorbic acid in an anti-inflammation analgesic preparation, since ascorbic acid is readily decomposed upon contact to light, heat, water and metal ion or has a problem on endermic absorptivity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Boric acid analgesic composition and method of treatment using the same Inventor(s): Jones, Annie L.; (Detroit, MI) Correspondence: Flynn, Thiel, Boutell & Tanis, P.C.; 2026 Rambling Road; Kalamazoo; MI; 49008-1699; US Patent Application Number: 20020182167 Date filed: April 1, 2002 Abstract: An analgesic composition that can be applied topically comprises boric acid and a suitable carrier. The inventive analgesic composition can be used to provide pain relief to a person suffering from arthritis and any general pain associated with muscles or joints. Excerpt(s): This invention relates generally to an analgesic composition which can be provided topically to provide relief from pain associated with joints and muscles. Analgesic compositions are agents which relieve pain by acting centrally to elevate pain threshold without disturbing consciousness or altering other sensory modalities. There are numerous analgesic compositions on the market used to provide pain relief from a wide variety of disorders. These analgesics generally are administered parenterally, orally or topically. Although parenteral and oral analgesics typically have an advantage of getting the analgesic composition quickly into the blood stream of the subject to effect

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rapid pain relief, they also have problems in that, with parenteral administration, there is a requirement of asepsis at administration, the risk of tissue toxicity from local irritation, the real or psychological pain factor and the difficulty of correcting an error and, with oral administration, there is a problem that oral administrations do not always give rise to sufficiently high plasma concentrations to be effective, some drugs may be absorbed unpredictably or irradically, the patient may have an absorption malfunction and some drugs cannot be administered orally to patients with gastrointestinal intolerance or who have had gastrointestinal surgery. Due to the problems outlined above, the topical administration of an analgesic composition is desirable in some situations. Topical administration is typically employed to deliver an analgesic composition at or immediately beneath the point of application. This route of administration has problems in that generally most of the drug that is absorbed through the epidermis diffuses into the circulation system resulting in inadequate levels of the drug being delivered to the desired treatment site. This necessitates that the topical composition contain the analgesic in an undesirably large concentration in order to assure adequate delivery of the analgesic to the treatment site. This can result in the topical analgesic composition being unnecessarily expensive and difficult to ascertain the therapeutically effective amount of the analgesic composition to be used in the treatment. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Combination of trimebutine with an opioid analgesic Inventor(s): Hamon, Jacques; (Orsay, FR), Roman, Francois; (Vitry-sur-Seine, FR) Correspondence: Charles W Ashbrook; Warner Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20030027835 Date filed: November 1, 2001 Abstract: The invention provides a combination of of trimebutine [2-dimethylamino-2phenylbutyl-3, 4, 5-trimethoxy-benzoate hydrogen maleate] or its corresponding stereoisomers with an opioid analgesic for the preparation of a medicament to prevent and/or treat pain or nociception. Excerpt(s): The field of the invention is related to methods for preventing and/or treating pain. More particularly the invention concerns a combination of trimebutine [2dimethylamino-2-phenylbutyl-3, 4, 5-trimethoxy-benzoate hydrogen maleate] or its corresponding stereoisomers with an opioid analgesic for preventing and/or treating pain as well as nociception. Trimebutine [2-dimethylamino-2-phenylbutyl 3, 4, 5trimethoxybenzoate hydrogen maleate; TMB] has been used in many countries since 1969 for the treatment of functional bowel disorders, including irritable bowel syndrome (IBS). The efficacy of the compound to relieve abdominal pain has been demonstrated in various clinical studies using different protocols of treatment (Luttecke, 1980; Moshal and Herron, 1979, Toussaint et al., 1981; Ghidini et al. 1986). Trimebutine was found to display weak agonist activity for rat brain and guinea-pig (Roman et al., 1987) or canine (Allescher et al., 1991) intestinal opioid receptors, without selectivity for any of the.mu.,.delta.- and.kappa.-subtypes. This weak activity was confirmed when using isolated intestinal fragments under transmural stimulation (Pascaud et al., 1987). This property could be responsible for the modulatory action of trimebutine on intestinal motility in fasted dog. Trimebutine given either intravenously or orally delays the appearance of a phase III of the migrating motor complex (MMC) in the stomach and the duodenum by

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inducing a premature phase III, migrating along the whole intestine (Bueno et al., 1987). In man, trimebutine stimulates intestinal motility in both fed and fasted states (Grandjouan et al.,1989). Furthermore, trimebutine reverses the effect of stress in jejunal motility (Delis et al., 1994). More recently, trimebutine has been shown able to influence the activity of visceral afferents by decreasing the intensity of the recto-colonic reflex in rats as evidenced by the inhibition of colonic motility consecutive to rectal distension (Julia et al., 1996). This result may be related to the beneficial effects found with trimebutine in patients with IBS and more specifically in the treatment of attacks of abdominal pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Combination sustained release-immediate release oral dosage forms with an opioid analgesic and a non-opioid analgesic Inventor(s): Jim, Fai; (Franklin Square, NY), Kao, Huaihung; (Syosset, NY), Zeng, Yadi; (Fort Lee, NJ) Correspondence: Kramer Levin Naftalis & Frankel Llp; 919 Third Avenue; New York; NY; 10022; US Patent Application Number: 20030092724 Date filed: September 17, 2002 Abstract: The present invention relates to new and useful oral tablet compositions which include an immediate release portion having an opioid analgesic and a non-opioid analgesic, providing for a rapid onset of therapeutic effect, and a sustained release portion of an opioid analgesic and a non-opioid analgesic, providing for a relatively longer duration of therapeutic effect. A multilayer oral dosage form containing a sustained release layer, which includes oxycodone and APAP, hydrocodone and APAP, or oxymorphone and APAP, and an immediate release layer containing the same active ingredients as the sustained release layer, is also disclosed. Also disclosed are oral tablet compositions, containing a sustained release core, which includes oxycodone and APAP, hydrocodone and APAP, or oxymorphone and APAP, and an immediate release coating containing the same active ingredients as the sustained release core, are also disclosed. In addition, methods of making and using such oral tablet compositions are disclosed. Excerpt(s): This application claims priority to U.S. Provisional Application Serial No. 60/322,667, filed Sep. 17, 2001 and U.S. Provisional Application Serial No. 60/323,546, filed Sep. 19, 2001, the specifications of which are incorporated by reference into this application in their entirety. The present invention relates to new and useful oral tablet compositions that include an immediate release portion having a combination of an opioid analgesic and a non-opioid analgesic, which will provide a rapid onset of therapeutic effect, and a sustained release portion with a combination of an opioid analgesic and a non-opioid analgesic, which will provide for a longer duration of therapeutic effect. Sustained release oral dosage forms of therapeutically active substances are well known in the pharmaceutical arts. These dosage forms provide a relatively long duration of action as the active agent is gradually released in the gastrointestinal tract. However, they may not provide a sufficiently early onset of therapeutic effect as is commonly seen with some immediate release dosage forms. On the other hand, though immediate release dosage forms may provide early onset of activities, the duration of therapeutic effect may be relatively short, which might require repeated dosing every few hours or so. Unless the dosing of the immediate release

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dosage form is carefully monitored, maintaining a constant plasma level of active agents without wide fluctuations is often difficult. Hence, an orally administered tablet formulation which provides a favorable dissolution profile which may lead to a relatively constant plasma level of active agents and which provides both an early onset and a long duration of therapeutic effect would be highly desirable. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compositions and methods for enhancing analgesic potency of tramadol and attenuating its adverse side effects Inventor(s): Barbier, Remi; (San Francisco, CA), Crain, Stanley M.; (State College, PA), Friedmann, Nadav; (Lafayette, CA), Remien, Mary; (San Francisco, CA), Shen, Ke-Fei; (Flushing, NY), Sherman, Barry; (Hillsborough, CA) Correspondence: Mcandrews Held & Malloy, Ltd; 500 West Madison Street; Suite 3400; Chicago; IL; 60661 Patent Application Number: 20030148941 Date filed: March 12, 2002 Abstract: The invention generally relates to compositions and methods with tramadol and an opioid antagonist to enhance analgesic potency and/or attenuate one or more adverse effects of tramadol, including adverse side effect(s) in humans such as nausea, vomiting, dizziness, headache, sedation (somnolence) or pruritis. This invention relates to compositions and methods for selectively enhancing the analgesic potency of tramadol and simultaneously attenuating anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects associated with the administration of tramadol. The methods of the present invention comprise administering to a subject an analgesic or subanalgesic amount of tramadol and an amount of excitatory opioid receptor antagonist such as naltrexone or nalmefene effective to enhance the analgesic potency of tramadol and attenuate the anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects of tramadol. Excerpt(s): This is a continuation-in-part of co-pending application Ser. No. 09/306,164 filed May 6, 1999, the content of which is hereby incorporated by reference in its entirety. Morphine or other bimodally-acting opioid agonists are administered to relieve severe pain due to the fact that they have analgesic effects mediated by their activation of inhibitory opioid receptors on nociceptive neurons (see North, Trends Neurosci., Vol. 9, pp. 114-117 (1986) and Crain and Shen, Trends Pharmacol. Sci., Vol. 11, pp. 77-81 (1990)). However, morphine and other bimodally-acting opioid agonists also activate opioid excitatory receptors on nociceptive neurons, which attenuate the analgesic potency of the opioids and result in the development of physical dependence and increased tolerance (see Shen and Crain, Brain Res., Vol. 597, pp. 74-83 (1992)), as well as hyperexcitability, hyperalgesia and other undesirable (excitatory) side effects. As a result, a long-standing need has existed to develop a method of both enhancing the analgesic (inhibitory) effects of bimodally-acting opioid agonists and blocking or preventing undesirable (excitatory) side effects caused by such opioid agonists. Tramadol is an orally active, clinically effective, centrally acting analgene compound with opioid and non-opioid activity. This synthetic analgesic has a novel mechanism of action involving a complementary and synergistic interaction between inhibition of neuronal monamine uptake and weak affinity for opioid receptors (Raffa et al., Rev. Contemp. Pharmacother. 6:485-497 (1995)). Tramadol is generally well tolerated, with dizziness, nausea, constipation, headache, somnolence (sedation), vomiting, pruritis,

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CNS stimulation, sezures, asthenia, dyspepsia, diarrhea, dry mouth and/or sweating as adverse side effects. Respiratory depression is uncommon (Lee et al., Drugs 46: 313-340 (1993); Vickers et al., Anaesthesia 47: 291-296 (1992)). Tramadol is marketed in the United States as ULTRAM.RTM. Data from a double-blind, crossover study suggest that oral tramadol 120 mg is equipotent to oral morphine 30 mg (Wilder et al., Ann. Oncol. 5: 141-146 (1994)). A need thus exists for compositions and methods that could enhance the analgesic potency of tramadol and/or block or prevent its adverse side effects, particularly its principal adverse effects in humans. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compositions for sustained release of analgesic agents, and methods of making and using the same Inventor(s): Dang, Wenbin; (Ellicott City, MD), Dordunoo, Stephen; (Baltimore, MD), Kader, Abdul; (Perry Hall, MD) Correspondence: Foley, Hoag & Eliot Llp; One Post Office Square; Boston; MA; 02109; US Patent Application Number: 20020045668 Date filed: July 17, 2001 Abstract: The present invention relates to compositions of a biocompatible polymer containing an analgesic agent, and methods of making and using the same. In certain embodiments, the polymer contains phosphorous linkages. Excerpt(s): This application claims the benefit of priority to Provisional Patent Application No. 60/218,629, filed Jul. 17, 2000, which application is hereby incorporated by reference in its entirety. In order to provide local or regional blockade for extended periods, clinicians often use analgesics administered through a catheter or syringe to a site where the pain is to be blocked. This method of treatment requires repeated administration when the pain is to be blocked for more than a short period of time, e.g., for more than one day. The anesthetic is typically administered as a bolus or through an indwelling catheter connected to an infusion pump. These methods have the disadvantage of potentially causing irreversible damage to nerves or surrounding tissues due to fluctuations in concentration and high levels of anesthetic. In addition, anesthetics administered by these methods often travel beyond the target area, and are not delivered in a linear, continuous manner. As a result, analgesia rarely lasts for longer than six to twelve hours, more typically four to six hours. In the case of a pump, the infusion lines are difficult to position and secure, the patient has limited, encumbered mobility and, when the patient is a small child or mentally impaired, may accidentally disengage the pump. Sustained release compositions could potentially provide for a sustained, controlled, constant localized release for longer periods of time than can be achieved by injection or topical administration. These devices typically consist of a polymeric matrix or liposome from which drug is released by diffusion and/or degradation of the matrix. The release pattern is usually principally determined by the matrix material, as well as by the percent loading, method of manufacture, type of drug being administered and type of device, for example, microsphere. A major advantage of a biodegradable sustained release system over others is that it does not require the surgical removal of the drug depleted device, which is slowly degraded and absorbed by the patient's body, and ultimately cleared along with other soluble metabolic waste products.

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Delivery of analgesics through an inhalation route Inventor(s): Rabinowitz, Joshua D.; (Mountain View, CA), Zaffaroni, Alejandro C.; (Atherton, CA) Correspondence: Richard R. Eckman; Morrison & Foerster Llp; 755 Page Mill Road; Palo Alto; CA; 94304-1018; US Patent Application Number: 20030017117 Date filed: May 16, 2002 Abstract: The present invention relates to the delivery of analgesics through an inhalation route. Specifically, it relates to aerosols containing acetaminophen, orphenadrine or tramadol that are used in inhalation therapy. In a composition aspect of the present invention, the aerosol comprises particles comprising at least 5 percent by weight of acetaminophen, orphenadrine or tramadol. In a method aspect of the present invention, one of acetaminophen, orphenadrine or tramadol is delivered to a mammal through an inhalation route. The method comprises: a) heating a composition, wherein the composition comprises at least 5 percent by weight of acetaminophen, orphenadrine or tramadol, to form a vapor; and, b) allowing the vapor to cool, thereby forming a condensation aerosol comprising particles, which is inhaled by the mammal. In a kit aspect of the present invention, a kit for delivering acetaminophen, orphenadrine or tramadol through an inhalation route to a mammal is provided which comprises: a) a composition comprising at least 5 percent by weight of acetaminophen, orphenadrine or tramadol; and, b) a device that forms an acetaminophen, orphenadrine or tramadol containing aerosol from the composition, for inhalation by the mammal. Excerpt(s): This application claims priority to U.S. provisional application Serial No. 60/294,203 entitled "Thermal Vapor Delivery of Drugs," filed May 24, 2001, Rabinowitz and Zaffaroni, the entire disclosure of which is hereby incorporated by reference. This application further claims priority to U.S. provisional application Serial No. 60/317,479 entitled "Aerosol Drug Delivery," filed Sep. 5, 2001, Rabinowitz and Zaffaroni, the entire disclosure of which is hereby incorporated by reference. The present invention relates to the delivery of analgesics through an inhalation route. Specifically, it relates to aerosols containing acetaminophen, orphenadrine or tramadol that are used in inhalation therapy. There are a number of compositions currently marketed as analgesics. The compositions contain at least one active ingredient that provides for the observed therapeutic effects. Among the active ingredients given in analgesic compositions are acetaminophen, orphenadrine and tramadol. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Individualization of therapy with analgesics Inventor(s): Leyland-Jones, Brian; (Miami, FL) Correspondence: Hamilton, Brook, Smith & Reynolds, P.C.; 530 Virginia Road; P.O. Box 9133; Concord; MA; 01742-9133; US Patent Application Number: 20030077222 Date filed: May 7, 2002

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Abstract: The invention relates to the individualization of therapy on the basis of a phenotypic profile of an individual. More specifically, the present invention relates to the use of metabolic phenotyping for the individualization of treatment with analgesics. Excerpt(s): This application is a new application which claims the benefit of U.S. Provisional Application No. 60/288,786, filed on May 7, 2001. The entire teachings of the above application is incorporated herein by reference. The invention relates to a system and method for individualization of therapy with analgesics. More specifically, the present invention relates to the use of metabolic phenotyping in individualizing treatment with analgesics. For the majority of drugs (or xenobiotics) administered to humans, their fate is to be metabolized in the liver, into a form less toxic and lipophilic with their subsequent excretion in the urine. Their metabolism involves two systems (Phase I and Phase II) which act consecutively: Phase I enzymes include the cytochrome P450 system which includes at least 20 enzymes catalyzing oxidation reactions as well as carboxylesterase, amindases, epoxide hydrolase, quinine reductase, alcohol and aldehyde dehydrogenase, xanthine oxidase and flavin-containing monooxygenase. These enzymes are localized in the microsomal fraction. Phase II enzymes include the conjugation system which involves at least 5 enzymes including, N-acetyltransferases (NAT), UDP-glucoronyltransferases (UGT), sulfotransferases (SUT), and glutathione-Stransferases (GST). A detailed description of the complex human drug metabolizing systems is provided in Kumar and Surapaneni (Medicinal Res. Rev. (2001) 21(5):397-411) and patent application WO 01/59127 A2. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and composition for potentiating an opiate analgesic Inventor(s): Gulati, Anil; (Naperville, IL) Correspondence: Marshall, Gerstein & Borun; 6300 Sears Tower; 233 South Wacker; Chicago; IL; 60606-6357; US Patent Application Number: 20030100507 Date filed: November 21, 2002 Abstract: Composition and methods of treating pain and reducing or reversing tolerance to opiate analgesics are disclosed. The composition and method utilize an opiate analgesic and an endothelin antagonist as active agents to treat pain in mammals, including humans. Excerpt(s): This application claims the benefit of U.S. provisional patent application Serial No. 60/333,599, filed Nov. 27, 2001. The present invention relates to the treatment of pain using an opiate analgesic and an endothelin receptor antagonist. More particularly, the present invention relates to a method of potentiating the effects of an opiate analgesic, like morphine, in a mammal by administration of a therapeutically effective amount of an endothelin receptor antagonist. The composition and method permit a reduction in the opiate analgesic dose to provide a desired analgesic effect, without effecting the cataleptic action of the opiate analgesic. The present invention also relates to a method of reducing or reversing tolerance to an opiate analgesic in an individual undergoing opiate analgesic treatment by administering a therapeuticaly effective amount of an endothelin receptor antagonist. The present composition and methods also reduce the incidence of opiate analgesic addiction. Analgesics are agents that relieve pain by acting centrally to elevate pain threshold, preferably without disturbing consciousness or altering other sensory functions. A mechanism by which

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analgesic drugs obtund pain (i.e., raise the pain threshold) has been formulated. Research in this area has resulted in the development of a number of opiate and opioid analgesics having diverse pharmacological actions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for administering an analgesic Inventor(s): Novack, Gary D.; (San Rafael, CA), Schneider, Stephen A.; (Palo Alto, CA) Correspondence: Mika Mayer; Morrison & Foerster Llp; 755 Page Mill Road; Palo Alto; CA; 94304-1018; US Patent Application Number: 20030138508 Date filed: December 17, 2002 Abstract: A method is provided to parenterally administering an analgesic (i.e., fentanyl) to a patient in the presence of a cannabinoid receptor agonist. This has been found to unexpectedly result in an almost order of magnitude increase in the therapeutic index over that of administering fentanyl alone. The respective amounts of the cannabinoid receptor agonist and fentanyl are selected to achieve the therapeutic index of the analgesic is greater than about 1000. While the method of the present invention contemplates administering the drug by all the medication routes other than orally, the preferred route is via inhalation. Excerpt(s): This application claims priority to U.S. provisional application Serial No. 60/342,066 entitled "Method for Administering an Analgesic," filed Dec. 18, 2001, Gary Novak and Stephen A. Schneider, the entire disclosure of which is hereby incorporated by reference. This application further claims priority to U.S. provisional application Serial No. 60/412,068 entitled "Method for Administering an Analgesic," filed Sep. 18, 2002, Gary D. Novack and Stephen A. Schneider, the entire disclosure of which is hereby incorporated by reference. This invention relates to a method for parenterally administering to a patient an analgesic in the presence of a cannabinoid receptor agonist. It is well known that THC and other extracts of cannabinoid affect both peripheral and central nervous system activity. Behavioral effects of such compounds are characterized at low doses as a mixture of depressant and stimulatory effects and at higher doses as predominantly CNS depressants (Dewey, 1986). The depressant effects of cannabinoids produce hyperreflexia. Cannabinoids generally cause a reduction in spontaneous locomotor activity and a decrease in response rates. Cannabinoids also impair learning and memory in rodents and non-human primates. Other effects that have been shown in the mouse include hypothermia (Compton et al., 1993), immobility (catalepsy) and antinociception, which comprise the "tetrad" of tests for cannabinoid activity (Martin, 1985). The mechanisms which underly the other effects of the cannabinoids as tested in the "tetrad" have been shown to be pertussis toxin-senstitive (Lichtman et al., 1996) and thus, are likely mediated via G-protein activation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for alleviating pain or providing an analgesic effect in a patient Inventor(s): Bridon, Dominique P.; (Outremont, CA), Ezrin, Alan M.; (Moraga, CA), Holmes, Darren L.; (Montreal, CA), Milner, Peter G.; (Los Altos Hills, CA) Correspondence: Michael R. Ward; Morrison & Foerster Llp; 425 Market Street; San Francisco; CA; 94105-2482; US Patent Application Number: 20010018420 Date filed: March 1, 2001 Abstract: Conjugates are prepared from antinociceptive agents, particularly opioids or opioid analogs, more particularly dynorphins, endorphins, deltorphins, enkephalins or analogs thereof, by combining said antinociceptive agent with a material providing a functionally reactive group capable of reacting with a blood component (preferably a blood cell or protein). Said conjugates permit extension of the therapeutic life of the antinociceptive agent. They may be administered to patients to alleviate pain, produce analgesic effects, or assist in cases of narcotics withdrawal, and may also be used as probes for receptor activity. The administration to the patient may be made either in vivo or ex vivo and may be performed by either introducing the derivative including the reactive functional group into the patient's vascular system or preparing such a conjugate externally (or in vitro) and introducing that conjugate to the patient's vascular system Excerpt(s): This invention relates to conjugates of antinociceptive agents, notably opioids, and endogenous carriers, particularly to opioids and various blood components, particularly blood proteins. Antinociceptive agents comprise a large class of drugs that are used to alleviate pain. They include compounds such as steroids, analgesics, barbiturates and opioids. The opioids comprise a large class of drugs, clinically used to relieve pain, and which include both plant-derived and synthetic alkaloids and peptides found indigenously in brains of mammals. The latter comprise three distinct families: beta-endorphin and other peptides derived from proopiomelanocortin, the enkephalins and the dynorphins. Opioids interact with neuronal cells and modulate physiological functions such as nociception. One of the physiological effects attributed to this class of compounds is analgesia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of making ibuprofen and narcotic analgesic compositions Inventor(s): Kushla, Gregory P.; (Florham Park, NJ), Lai, Jin-Wang; (Edison, NJ), Polli, Gerald P.; (Valley Forge, PA) Correspondence: Lahive & Cockfield; 28 State Street; Boston; MA; 02109; US Patent Application Number: 20020127274 Date filed: December 21, 2001 Abstract: Provided herein are compositions and methods of making compositions of ibuprofen in combination with a narcotic analgesic. Specifically provided is a pharmaceutical tablet composition comprising ibuprofen; a narcotic analgesic; colloidal silicon dioxide; a filler selected from the group consisting of microcrystalline cellulose and powdered cellulose; a disintegrant selected from the group consisting of croscarmellose sodium, crospovidone, and sodium starch glycolate; a binder consisting of an akylhydroxy methylcellulose; a starch; and a lubricant. Also provided herein is a

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method of preparing a pharmaceutical tablet composition comprising: (a) Granulating ibuprofen, a narcotic analgesic, a first glidant, a first disintegrant, a binder, and starch to form granules wherein said granulating step comprises a wet granulation process; (b) blending the granules with extra-granular material comprised of a second glidant, a second disintegrant, a filler and starch to form a blend of granules and extra-granular material; and (c) compressing the blend into a tablet. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/020973 filed on Jun. 10, 1996. This invention is related to the field of pharmaceutical compositions and methods of preparing pharmaceutical compositions. Specifically, this invention is related to solid dosage compositions of ibuprofen in combination with a narcotic analgesic. Solid dosage forms of ibuprofen, a non-steroidal anti-inflammatory agent, are known. Although tablet compositions of ibuprofen are known and commercially available, problems of poor tablet compression, stability and disintegration persist and are well documented. For example, it is known that ibuprofen tablets made from wet granulation methods "age" over time which tends to have a negative impact on dissolution. (See U.S. Pat. No. 4,609,675 to Franz). Franz theorizes that the tablets "age" over time because of sintering which is described as a type of cementing of the ibuprofen particles to one another. Franz states that one way to minimize sintering is to increase the amount of excipients or diluents used in the compositions in order to isolate the ibuprofen particles. This causes problems in formulating high dose ibuprofen tablets because the tablets are too large when they are made by a wet granulation process. In an effort to overcome this problem, Franz prepared a dry granulation of high dose ibuprofen in combination with croscarmellose, noting that it was unexpected to formulate a successful composition in view of his experience that other disintegrants such as corn starch and crospovidone did not work. Franz also describes that croscarmellose improved dissolution characteristics of the tablets when they contained 1.34% to 7.01% croscarmellose but decreased dissolution characteristics when the tablets contained croscarmellose in excess of 7.01%. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

METHOD OF SIMULTANEOUSLY ENHANCING ANALGESIC POTENCY AND ATTENUATING ADVERSE SIDE EFFECTS CAUSED BY TRAMADOL AND OTHER BIMODALLY-ACTING OPIOID AGONISTS Inventor(s): CRAIN, STANLEY M.; (LEONIA, NJ), SHEN, KE-FEI; (FLUSHING, NY) Correspondence: Craig J Arnold Esq; Amster Rothstein & Ebenstein; 90 Park Avenue; New York; NY; 10016 Patent Application Number: 20010006967 Date filed: May 6, 1999 Abstract: This invention relates to a method for selectively enhancing the analgesic potency of a bimodally-acting opioid agonist such as tramadol and simultaneously attenuating anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects associated with the administration of the bimodally-acting opioid agonist. The method of the present invention comprises administering to a subject an analgesic or sub-analgesic amount of a bimodally-acting opioid agonist such as tramadol and an amount of an excitatory opioid receptor antagonist such as naltrexone or nalmefene effective to enhance the analgesic potency of the bimodally-acting opioid agonist and attenuate the anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects of the bimodally-acting opioid agonist.

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Excerpt(s): This is a continuation-in-part of copending application Ser. No. 09/094,977, filed Jun. 16, 1998, which is a continuation of application Ser. No. 08/759,590, filed Dec. 3, 1996, now U.S. Pat. No. 5,767,125, which is a continuation-in-part of application Ser. No. 08/276,966, filed Jul. 19, 1994, now U.S. Pat. No. 5,512,578, which is a continuationin-part of application Ser. No. 08/097,460, filed Jul. 27, 1993, now U.S. Pat. No. 5,472,943, which is a continuation-in-part of application Ser. No. 07/947,690, filed Sep. 19, 1992, now abandoned, the contents of which are hereby incorporated by reference in their entirety. This invention relates to a method of enhancing the analgesic (inhibitory) effects of bimodally-acting opioid agonists, including morphine, codeine and other clinically used opioid analgesics, while at the same time attenuating anti-analgesia, physical dependence, tolerance, hyperexcitability, hyperalgesia, and other undesirable (excitatory) side effects typically caused by chronic use of bimodally-acting opioid agonists. "Bimodally-acting opioid agonists" are opioid agonists that bind to and activate both inhibitory and excitatory opioid receptors on nociceptive neurons which mediate pain. Opioid analgesia results from activation by opioid agonists of inhibitory opioid receptors on neurons in the nociceptive (pain) pathways of the peripheral and central nervous systems. The undesirable side effects, including anti-analgesic actions, hyperexcitability and hyperalgesia, the development of physical dependence, and some types of tolerance result from sustained activation by bimodally-acting opioid agonists of excitatory opioid receptors on neurons in the nociceptive (pain) pathways of the peripheral and central nervous systems. In the instant invention, a very low dose of a selective excitatory opioid receptor antagonist, an opioid which binds to and acts as an antagonist to excitatory but not inhibitory opioid receptors on nociceptive neurons which mediate pain, is combined with a dose of a bimodally-acting opioid agonist so as to enhance the degree of analgesia (inhibitory effects) and attenuate the undesired side effects (excitatory effects). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Nociceptin-based analgesics Inventor(s): Judd, Amrit K.; (North Logan, UT) Correspondence: Madson & Metcalf; Gateway Tower West; Suite 900; 15 West South Temple; Salt Lake City; UT; 84101 Patent Application Number: 20030166571 Date filed: October 9, 2002 Abstract: The invention relates to a family of hexapeptide compounds exhibiting activity with regard to the ORL-1 receptor. The compounds share a general formula of Arg-TyrTyr-Arg-Trp-Arg, and may be constructed having modifications or substitutions at any position, and may include modifications of the amino- and carboxy-termini of the hexapeptide. These compounds include agents exhibiting agonist activity and antagonist activity when exposed to the human ORL-1 receptor. As such, the hexapeptides may be useful as analgesics, anxiolytics, diuretics, and anti-cancer agents. Excerpt(s): This application is related to and claims the benefit of U.S. Provisional Patent Application No. 60/327,888, filed Oct. 9, 2001, of Amrit K. Judd entitled "Development of Nociceptin-Based Analgesics," which is incorporated herein by reference. The present invention relates to analgesic compounds targeted to the ORL1 receptor. More specifically, the present invention relates to agonist and antagonist compounds targeted to the ORL1 receptor and methods for their use. It has been estimated that as much as 30% of the population of the industrialized countries of the world suffers from some

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degree of chronic pain. Many individuals suffering from chronic pain are forced to incur significant direct medical and pharmaceutical expenses. Such individuals often also suffer losses in income and productivity. In the United States, it is estimated that the combined value of these losses and costs is in excess of $50 billion annually. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel long acting, reversible veterinary sedative & analgesic and method of use Inventor(s): Tobin, Thomas; (Lexington, KY) Correspondence: King & Schickli, Pllc; 247 North Broadway; Lexington; KY; 40507; US Patent Application Number: 20020091161 Date filed: May 24, 2001 Abstract: A veterinary composition comprising a guanidine derivative, e.g., guanabenz or guanabenz acetate is provided which produces a rapid acting and long lasting sedative and analgesic effect in a subject animal that is selectively reversible. The use of guanabenz in the horse provides for a safe, effective, long lasting and rapidly reversible sedative and analgesic which can be used on the standing animal. Methods of use of the compositions of the invention are also provided. Excerpt(s): This application claims the benefit of priority in U.S. Provisional Application Ser. No. 60/206,625,) filed on May 24, 2000. The present invention relates to the field of veterinary medicine and to compositions and methods of use for rapid acting reversible sedatives, tranquilizers and analgesics in animals. In particular, the present invention relates to a rapid acting reversible sedative and analgesic having.alpha. adrenergic agonist activity that is adapted for use in the standing animal. Veterinary medicine and especially in large animal practice, e.g., equine and bovine medicine and surgery, has incorporated various diagnostic, therapeutic and surgical procedures into the daily routine of the large animal practitioner. Many of these procedures are greatly facilitated and can be accomplished in the standing animal if the animal remains clam, motionless, and virtually pain free. An additional consideration is that it may also be beneficial to calm the animal, e.g., the cow or horse, before bringing it into proximity of expensive equipment or to minimize the potential for human injury. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Opiod analgesic Inventor(s): Brogmann, Bianca; (Limburg-Eschhofen, DE), Hahn, Udo; (Nentershausen, DE), Spitzley, Christof; (Nentershausen, DE), Wimmer, Walter; (Limburg, DE) Correspondence: Davidson, Davidson & Kappel, Llc; 14th Floor; 485 Seventh Avenue; New York; NY; 10018; US Patent Application Number: 20020165248 Date filed: April 23, 2002 Abstract: The invention is relative to a pharmaceutical preparation, especially for oral administration, with at least one active substance and with formulation components influencing the release of active substance, which preparation comprises at least one opiod analgesic as active substance that is formulated proportionally on the one hand for rapid release and on the other hand for delayed release in such a manner that the in

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vitro release rate from the preparation according to the Ph. Eur. paddle test shows a mean value of above 40% by weight after one hour and that the in vitro release rate shows a mean value that is still below 80% by weight after four hours. Excerpt(s): So-called "multiphase" pharmaceutical preparations in which the activesubstance content is formulated on the one hand for a rapid release and on the other hand for a delayed (retarded) release have long been known. Such preparations have also already been frequently described for analgesics. EP-A 0,243,366 teaches a sustained-[controlled-]release formulation for tramadol that is suitable for a uniform and long-lasting release of the active substance over twenty-four hours or longer. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Oral administration of 6-hydroxy-oxymorphone for use as an analgesic Inventor(s): Kao, Huai-Hung; (Syosset, NY), Lee, David; (Wilmington, DE), McCall, Troy; (Germantown, TN), Smith-Carliss, Richard; (Westchester, PA) Correspondence: Schnader Harrison Segal & Lewis, Llp; 1600 Market Street; Suite 3600; Philadelphia; PA; 19103 Patent Application Number: 20030130297 Date filed: July 3, 2002 Abstract: In a method of treating pain, a patient is administered a pharmaceutical composition of 6-hydroxy oxymorphone in amount sufficient to induce analgesia. In one embodiment, the pharmaceutical composition is administered orally. Any known or later developed method of oral delivery may be used. To achieve the desired analgesic effect, blood plasma levels of 6-hydroxy oxymorphone are raised to at least approximately 0.2 ng/mL. Most preferably blood plasma levels of 6-hydroxy oxymorphone range at least 0.3 ng/mL during treatment. Administration of compositions containing 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia is also contemplated. Excerpt(s): This application relates to provisional patent application serial Nos. 60/329,445 filed Oct. 15, 2001,.60/329,432 filed Oct. 15, 2001, 60/303,357 filed Jul. 6, 2001, and 60/329,444 filed Oct. 15, 2001. The invention relates to methods for alleviating pain. More particularly, the invention relates to methods for alleviating pain by administering 6-hydroxy oxymorphone. Most particularly, the invention relates to methods of inducing analgesia by increasing blood plasma levels of 6-hydroxy oxymorphone through oral administration of a pharmaceutical composition containing 6-hydroxy oxymorphone. The present invention provides methods of treating pain by administering a pharmaceutical composition comprising 6-hydroxy oxymorphone in an amount sufficient to induce analgesia. In one embodiment, the pharmaceutical composition is administered orally. Any known or later developed method of oral delivery may be used. To achieve the desired analgesic effect, blood plasma levels of 6hydroxy oxymorphone are raised to at least about 0.2 ng/mL. Most preferably blood plasma levels of 6-hydroxy oxymorphone of at least about 0.3 ng/mL during treatment. Methods for administering compositions comprising 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia are also provided. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Orally administered analgesic compositions containing nalbuphine Inventor(s): Hsiong, Cheng-Huei; (Taipei, TW), Hu, Oliver Yoa-Pu; (Taipei, TW) Correspondence: Venable, Baetjer, Howard And Civiletti, Llp; P.O. Box 34385; Washington; DC; 20043-9998; US Patent Application Number: 20030105120 Date filed: November 26, 2001 Abstract: The present invention provides orally administered pharmaceutical compositions which contains an effective amount of free base or pharmaceutcially acceptable salts of nalbuphine and/or nalbuphine ester, an oily substance, and a solubility-assisting agent. The oily substance is preferably sesame oil. The solubilityassisting agent is preferably benzyl benzoate. The pharmaceutical composition is useful as an analgesic. The compositions achieves a much higher bioavailability rate and yields much longer lasting effects on nalbuphine than other nalbuphine products currently in the market. Excerpt(s): The present invention relates to novel analgesic pharmaceutical compositions containing free base or pharmaceutically acceptable salts of nalbuphine and/or nalbuphine ester, an oily substance, and a solubility-assisting agent. In particular, the present invention relates to orally administered nalbuphine and/or nalbuphine ester which demonstrates long lasting effect and greater bioavailability for pain relief in animals. The preferred oily substance is sesame oil. The preferred solubility-assisting agent is benzyl benzoate. Nalbuphine is a synthetic opiate agonistantagonist that is chemically related to both naloxone, a narcotic antagonist, and oxymorphone, a potent narcotic analgesic. Nalbuphine simultaneously exhibits a dual action of agonism and antagonism towards opioids-receptors. Schmidt, W. F. et al., Drug Alcohol Depend., Vol. 14, page 339 (1985). Opiate receptors include mu, kappa, and delta, which have been reclassified by an International Union of Pharmacology subcommittee as OP1 (delta), OP2 (kappa), and OP3 (mu). Nalbuphine acts on specific opiate-receptor subtypes: it is a potent mu-antagonist with less dysphoric effects, and its agonistic effects at kappa1- and kappa3-receptors provide analgesia. Actions of nalbuphine at the kappa-receptors produce alterations in the perception of pain as well as the emotional response to pain, possibly by altering the release of neurotransmitters from afferent nerves sensitive to painful stimuli. As an adjunct to anesthesia, nalbuphine protects against the hemodynamic responses to stress produced by surgery. Additionally, nalbuphine paradoxically produces opiate withdrawal if administered to opiate-dependent patients, which is a function of antagonism at the mu-receptor. Stimulation at mu-receptor produces respiratory depression. However, nalbuphine causes less respiratory depression than morphine or related agents. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Salts of analgesic substances in oil, and methods of making and using the same Inventor(s): Dang, Wenbin; (Ellicott City, MD), Dordunoo, Stephen; (Baltimore, MD), Kader, Abdul; (Perry Hall, MD) Correspondence: Foley Hoag Llp; Patent Group, World Trade Center West; 155 Seaport Boulevard; Boston; MA; 02110-2600; US Patent Application Number: 20030069318 Date filed: August 21, 2001

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Abstract: The present invention relates in part to compositions comprising salts of an analgesic agent and an oil, and methods of using and making the same. In certain embodiments, the compositions may be used as part of a treatment regimen to alleviate pain. Excerpt(s): In order to administer a drug or substance such as an analgesic for extended periods, clinicians often administer such drugs through a catheter or syringe to a site where the pain is to be blocked. This method of treatment requires repeated administration when the pain is to be blocked for more than a short period of time, e.g., for more than one day. The analgesic is typically administered as a bolus or through an indwelling catheter connected to an infusion pump or by multiple injections. These methods have the disadvantage of potentially causing irreversible damage to nerves or surrounding tissues due to fluctuations in concentration and high levels of anesthetic and repeated injections. The therapeutic effect of the analgesia rarely lasts for longer than six to twelve hours, more typically four to six hours. In the case of a pump, the infusion lines are difficult to position and secure, the patient has limited, encumbered mobility and, when the patient is a small child or mentally impaired, may accidentally disengage the pump. Pharmaceutical compositions that exhibit therapeutic effects over an extended period of time could potentially provide for treatment for longer periods of time than may be achieved by other means of administration, such as a bolus injection or topical administration of analgesic alone. Such compositions may address certain of the failings of other means of administering analgesic substances identified above and otherwise known to those of skill in the art. In part, the present invention is directed to a pharmaceutical formulation that permits administration of the salt of an analgesic substance such that the agent achieves a therapeutic effect over an extended period of time. Certain subject compositions comprise a salt of an analgesic agent incorporated into an oil. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Selenocosmia huwena toxin and analgesic uses thereof Inventor(s): Song-Ping, Liang; (ChangSha, CN) Correspondence: Y. Rocky Tsao; Fish & Richardson P.C.; 225 Franklin Street; Boston; MA; 02110-2804; US Patent Application Number: 20030013647 Date filed: February 13, 2001 Abstract: Disclosed is a analgesic composition containing the purified HWAP-I polypeptide of the Chinese bird spider, Selenocosmia Huwena. Excerpt(s): Pursuant to 35 U.S.C. 35.sctn.119, this application claims priority from China application No. 00104254.8, filed Apr. 11, 2000. Analgesics and other medicines that relieve pain are critical therapeutics that vastly improve the quality of life of sufferers and their caretakers. Analgesics not only relieve pain, but also the dread, tension, anxiety and unpleasant perceptions inflicted by acute pain. Existing analgesics can be classified into at least two categories, non-steroidal anti-inflammatory drugs (NSAIDs), and narcotic analgesics. NSAIDs (e.g., aspirin) inhibit the synthesis of prostaglandin, thereby decreasing the sensitivity of nerve endings. NSAIDs are primarily used to relieve inflammatory pain and other kinds of dull pain. Narcotic analgesics (e.g., morphine) act on.mu.-type opium receptors of the central nerve system, mainly in the thalamencephalon and cortex, to relieve sharp pain, as well as dull pain. Although

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widely used to treat pain, e.g., in late stage cancer patients, and post-operative patients, narcotic analgesics are highly addictive and are associated with severe withdrawal symptoms. Their dosage has to be increased continuously to sustain their analgesic effects. Further narcotic analgesics have little if any therapeutic value for pain caused by neurotrosis. The invention is based, in part, on the discovery that purified HWAP-J polypeptide of the Chinese bird spider, Selenocosmia huwena. is a very effective analgesic. Accordingly, the invention features a method of reducing perceived pain in a subject. The method includes administering to the subject an effective amount of a purified polypeptide having an amino acid sequence at least 70%, 80%, 90%, 92%, or 95% identical to SEQ ID NO:1. The purified polypeptide can be HWAP-I which has the amino acid sequence of SEQ ID NO:1. The polypeptide can be administered as an epidural or as a parenteral solution. In addition, the purified polypeptide can be applied locally (e.g., by injection or topical application). The purified polypeptide can be formulated as a pharmaceutical composition, e.g., with a pharmaceutically acceptable carrier, in a sterile solution, e.g., a sterile saline solution. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Sustained-release analgesic compounds Inventor(s): Ashton, Paul A.; (Boston, MA), Cynkowska, Grazyna; (Brookline, MA), Cynkowski, Tadeusz; (Brookline, MA), Mickunas, Edmund; (Holliston, MA), Smith, Thomas J.; (Weston, MA) Correspondence: Mcdermott, Will & Emery; 600 13th Street, N.W.; Washington; DC; 20005-3096; US Patent Application Number: 20030022876 Date filed: June 5, 2002 Abstract: A pharmaceutically active inventive compound comprises two independently active analgesic moieties covalently conjoined through a physiologically labile linker. A preferred embodiment comprises an opioid, such as morphine, covalently linked to at least one analgesic compound selected from the group consisting of an opioid or a nonopioid compound through a physiologically labile linker. Suitable covalent linkers are covalently bonded to the two independently active analgesic compounds through one or more lactone, lactam, or sulfonamido linkages. Suitable linkers include endogenous carboxylate, amido, and sulfonamido moieties, and exogenous moieties that form the aforementioned lactone, lactam or sulfonamido linkages. Excerpt(s): The present invention relates generally to compounds, compositions, articles of manufacture and methods for treating acute or chronic pain in a mammal. In particular, the present invention relates to a sustained release system that relieves local pain, while reducing or eliminating adverse systemic side effects. The pain response is a protective reflex system, warning an individual of hostile situations and tissue injury. Although the following discussion focuses on pain management in humans, the person of skill in the art should appreciate that general concepts of pain are applicable to mammals in general, and that the concepts of pain management are applicable to veterinary medicine as well as to human medicine. Pain may be classified by etiology, duration and severity. Etiologically, pain may be classified as somatogenic (i.e. organic) or psychogenic (occurring without associated organic pathology sufficient to explain the severity and/or duration of the pain). Somatogenic pain may be further sub-classified as nociceptive (arising out of stimulation of somatic or visceral pain-sensitive nerve fibers) or neuropathic (resulting from dysfunction of the nervous system).

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Topical analgesics and methods of use Inventor(s): Salmonson, Roger S.; (Westborough, MA) Correspondence: Jenifer E. Haeckl, ESQ.; Mirick, O'connell, Demallie & Lougee, Llp; 1700 West Park Drive; Westborough; MA; 01581; US Patent Application Number: 20020142053 Date filed: April 1, 2002 Abstract: Topical analgesics, generally comprising calendula oil and cornmint oil, and methods of use. Excerpt(s): This invention relates to topical analgesics and more specifically to topical analgesics that are particularly useful for reducing pain and pain associated with menstrual cramps and methods of use. Topically applied pharmaceuticals, including topical analgesics, are a well known means for administering medicines in a targeted manner by applying the topical directly to the skin at or near the source of the pain or injury. Various formulations are available for a variety of general and specific uses. For example, Bockow, in U.S. Pat. No. 5,650,157, discloses topically applied pharmaceutical compositions comprising marine oils rich in omega-3 fatty acids used in connection with a wide variety of medicinal agents including anti-inflammatory agents, analgesics, vasodilatory agents, anti-pruritic agents, anesthestics, counterirritants, astringents, and astringents, among others. Further, Taylor-McCord, in U.S. Pat. No. 5,266,318, discloses nonionic therapeutic mixtures comprising aloe vera gel that is useful for treating bums, sores, skin abrasions and other superficial skin ailments. However, there are no currently known topical analgesics that are suitable for reducing pain associated with menstrual cramping. It is therefore a primary object of this invention to provide a topical analgesic that reduces underlying pain when applied directly to the skin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with pain medications, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “pain medications” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on pain medications. You can also use this procedure to view pending patent applications concerning pain medications. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON PAIN MEDICATIONS Overview This chapter provides bibliographic book references relating to pain medications. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on pain medications include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “pain medications” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on pain medications: •

Dying at Home: A Family Guide for Caregiving. 2nd ed Source: Baltimore, MD: Johns Hopkins University Press. 1999. 298 p. Contact: Johns Hopkins University Press. 2715 North Charles Street, Baltimore, MD 21218-4363. (410) 516-6900; FAX: (410) 516-6998. Website: www.press.jhu.edu. ISBN: 0801862027 (hardback); 0801862035 (pbk.). PRICE: $49.95 (hardcover); $17.95 (pbk.). Summary: This book is a guide to caring for a dying loved one at home. It is based on extensive interviews with family members of thirteen individuals who died at home under a range of circumstances and from different illnesses, including Alzheimer's disease. The book addresses the concerns and problems of those who face this decision. It explains how to prepare the home environment for caregiving, how to use professional caregivers in the home setting, how to manage the patient's pain and agitation, how to recognize impending death, and what to do immediately after death. It

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also discusses the renewed interest in home death, the hospital phase of care, the caregiving role, social support, caregiver strain, coping, the funeral, and dealing with grief. Appendices provide additional information about daily caregiving tasks, resources, pain medications, and HIV caregiving as well as sample letters and the Michigan Dignified Death Act. The book also has a glossary, a bibliography, and an index. •

Numb Toes and Aching Soles: Coping with Peripheral Neuropathy Source: San Antonio, TX: MedPress. 1999. 300 p. Contact: Available from MedPress. P.O. Box 691546, San Antonio, TX 78269. (888) 6339898. Website: www.medpress.com. PRICE: $19.95 for soft back book; $29.95 for case bound book; plus shipping and handling. ISBN 0967110726. Summary: This book offers strategies and information for people coping with peripheral neuropathy (PN), a condition that results in loss of sensation and weakness, most frequently in the feet and hands, and that can produce significant pain and discomfort. People with PN can also experience dizziness, bladder problems, constipation, and sometimes sexual dysfunction. The author, who is a physician with peripheral neuropathy, describes how PN affects the body, its causes, symptoms, tests, and treatments, both conventional and alternative. Nine chapters cover the types of PN, symptoms and effects, and diagnosis; the physical and psychological basis of PN pain; pain medications including non opioid drugs, costs, topical medications, other non opioid analgesics, and opioids; other medical therapies, including hematological treatments, and nerve based treatments such as nerve blocks and direct nerve stimulation; alternative treatments, such as physical therapy, psychotherapy, hyperbaric oxygen therapy, acupuncture, touch (and near touch) therapies, magnets, and chelation; the role of nutrients, including vitamins, minerals, herbs, and other supplements; experimental or 'unapproved' drugs, including aldose reductase inhibitors, aminoguanidine (pimagedine), COX 2, frogs and snails, lamotrigine (Lamictal), memantine, 'natural' pain relievers, nerve regenerating compounds, nimodipine, peptide T, and PN 401; special considerations for PN patients with diabetes or HIV; and coping strategies. The book includes reports from more than 200 patients who share which treatments worked for them and which ones didn't. Also included is a form with which readers can request updated information. A subject index concludes the book.

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Dying at Home: A Family Guide for Caregiving Source: Baltimore, MD: Johns Hopkins University Press. 1991. 257 p. Contact: Johns Hopkins University Press. 701 West 40th Street, Baltimore, MD 212184319. (800) 537-5487; (410) 515-6956. PRICE: $22.95. Summary: This guide for families caring for a loved one who is dying at home is based on extensive interviews with people whose stories represent a range of socioeconomic backgrounds, caregiver relationships, and causes of death. The intent of the book is to present the actual experiences of these caregivers. Many excerpts from the interviews are interspersed throughout the text. Although only one of the stories specifically involves a person with Alzheimer's disease, the issues and problems discussed in the book are not disease specific and are relevant to caregivers of Alzheimer's disease patients. The book addresses such issues as the decision to care for a dying person at home, preparing to bring the person home, using professional caregivers, the caregiving role, maintaining the dignity of the individual, social support, the well being of the caregiver, signs of approaching death, what to do immediately after death, planning the

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funeral, the grief process, and handling practical matters that arise when someone dies. Appendices contain information about caregiving tasks, lists of additional resources, and information about pain medications. 22 references. •

Living Well With Osteoarthritis: A Self-Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 32 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail: [email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 97146A-07-99. Summary: This illustrated handbook provides people who have osteoarthritis (OA) with information on the diagnosis and management of this chronic condition. OA is caused by wear and tear that damages joints. The areas commonly affected include the hands, spine, hips, knees, and feet. Risk factors for OA include aging, heredity, injury to a joint, overuse, and excess weight. In a normal joint, cartilage protects the end of each bone, synovial fluid lubricates the joint, ligaments attach bone to bone, tendons attach muscles to the bones, and muscles move the bones. In general, OA damages joints after cartilage wears away and frays, and bones grate together where cartilage is missing. Common symptoms include joint pain, swelling, and stiffness. Diagnosis is based on the results of a physical examination, a medical history, and x rays. Various health care professionals may be involved in the care of a person who has OA, and the patient and team will develop a self management plan. Maintaining a positive outlook and staying active are important aspects of self care. Regular physical activity will help increase flexibility, strengthen muscles and tendons, build endurance, maintain or reach a healthy weight, and lift spirits. The handbook presents examples of exercises for increasing flexibility, strengthening muscles, and building endurance. The handbook also offers guidelines on using the food guide pyramid and nutrition facts labels to follow a balanced meal plan, performing daily tasks, using mobility aids and special assistive devices, and managing pain through relaxation techniques and pain medications. The handbook concludes with information on sources of information and support.

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Kidney Stones Handbook: A Patient's Guide to Hope, Cure and Prevention. 2nd ed Source: Roseville, CA: Four Geez Press. 1999. 283 p. Contact: Available from Four Geez Press. 1911 Douglas Blvd., Suite 85-131, Roseville, CA 95661. (800) 2-Kidneys. Website: www.readerndex.com/fourgeez. PRICE: $17.95 plus shipping and handling. ISBN: 0963706861. Summary: This patient education handbook describes how virtually every patient who follows treatment based on appropriate testing, proper interpretation, and sound medical principles can substantially reduce or eliminate all future kidney stone production. The book covers common causes of kidney stones, the risk factors for kidney stone formation, which foods contribute to forming kidney stones in people who are prone to stone formation, pain medications, the need for metabolic stone risk testing (and how to obtain it), what to expect from lithotripsy, how to select realistic preventive treatment, surgical treatment for kidney stones, and patient rights. The authors emphasize the need for patients to educate themselves and to take a proactive approach to preventing new stones, in many cases to the point of educating their physicians and demanding appropriate diagnostic and treatment methods. The book also includes medical references for patients and physicians. The book includes a glossary of terms, a list of common medications and their uses, and a subject index.

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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “pain medications” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “pain medications” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “pain medications” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Agonist and antagonist actions of narcotic analgesic drugs; ISBN: 0839107250; http://www.amazon.com/exec/obidos/ASIN/0839107250/icongroupinterna

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Analgesic and Nsaid-Induced Kidney Disease (Oxford Monographs on Clinical Nephrology) by J.H. Stewart (Editor), Columba Stewart (1995); ISBN: 019261956X; http://www.amazon.com/exec/obidos/ASIN/019261956X/icongroupinterna

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Analgesics [DOWNLOAD: PDF] by Mintel International Group Ltd. (Author); ISBN: B00007EIFM; http://www.amazon.com/exec/obidos/ASIN/B00007EIFM/icongroupinterna

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Analgesics and Renal Disease Who Is at Risk by Cliver Wood (Editor); ISBN: 0905958233; http://www.amazon.com/exec/obidos/ASIN/0905958233/icongroupinterna

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Analgesics Industry Guide [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3R1; http://www.amazon.com/exec/obidos/ASIN/B00008R3R1/icongroupinterna

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Analgesics: Neurochemical, Behavioral, and Clinical Perspectives by Michael J. Kuhar, Gavril W. Pasternak (Editor); ISBN: 0890047936; http://www.amazon.com/exec/obidos/ASIN/0890047936/icongroupinterna

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Antipyretic Analgesics: New Insights by K. Brune (Editor), B. Santoso (Editor); ISBN: 3764326557; http://www.amazon.com/exec/obidos/ASIN/3764326557/icongroupinterna

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Aspirin Alternatives: The Top Natural Pain-Relieving Analgesics by Raymond M. Lombardi, Raymond M. Lombardi; ISBN: 189076602X; http://www.amazon.com/exec/obidos/ASIN/189076602X/icongroupinterna

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Czech Republic Analgesics Report 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B000083FJ0; http://www.amazon.com/exec/obidos/ASIN/B000083FJ0/icongroupinterna

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Diflunisal : profile of a modern analgesic : proceedings of an International Symposium; ISBN: 0865550115; http://www.amazon.com/exec/obidos/ASIN/0865550115/icongroupinterna

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European OTC Internal Analgesic Markets: New Products Open Up Marketing Opportunities by Market Intelligence (1995); ISBN: 0788902210; http://www.amazon.com/exec/obidos/ASIN/0788902210/icongroupinterna

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Mechanisms of Pain and Analgesic Compounds by Roland F. Beers, Edward G. Bassett (Editor) (1979); ISBN: 0890043043; http://www.amazon.com/exec/obidos/ASIN/0890043043/icongroupinterna

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Narcotic Analgesics in Anesthesiology by Luke M. Kitahata (Editor); ISBN: 0683046195; http://www.amazon.com/exec/obidos/ASIN/0683046195/icongroupinterna

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New Pharmacological and Epidemiological Data in Analgesics Research by K. Brune (Editor) (1990); ISBN: 081762452X; http://www.amazon.com/exec/obidos/ASIN/081762452X/icongroupinterna

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New Pharmacological and Epidemiological Data in Analgesics Research (1990); ISBN: 376432452X; http://www.amazon.com/exec/obidos/ASIN/376432452X/icongroupinterna

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Non-Opioid (Otc Analgesics: Risks/Benefits in Perspective) by K. Brune (Editor) (1988); ISBN: 3764322519; http://www.amazon.com/exec/obidos/ASIN/3764322519/icongroupinterna

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Non-opioid (OTC) analgesics : risks/benefits in perspective; ISBN: 0817622519; http://www.amazon.com/exec/obidos/ASIN/0817622519/icongroupinterna

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Non-Opioid Analgesics in the Treatment of Acute Pain: Johannesbergs Slott, Sweden, March 14th, 1996 by Michael J. Parnham (Editor) (1997); ISBN: 0817656804; http://www.amazon.com/exec/obidos/ASIN/0817656804/icongroupinterna

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Opioid Agonists, Antagonists and Mixed Narcotic Analgesics (1987); ISBN: 3540174710; http://www.amazon.com/exec/obidos/ASIN/3540174710/icongroupinterna

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Opioid Agonists, Antagonists and Mixed Narcotic Analgesics: Theoretical Background and Considerations for Practical Use by Enno Freye, W. A. Coleman (Translator); ISBN: 0387174710; http://www.amazon.com/exec/obidos/ASIN/0387174710/icongroupinterna

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Opioid Analgesics in the Management of Clinical Pain (Advances in Pain Research and Therapy, Vol. 8) by Kathleen M. Foley, Charles E. Inturrisi (Editor); ISBN: 0881671088; http://www.amazon.com/exec/obidos/ASIN/0881671088/icongroupinterna

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OTC analgesics in Australia [DOWNLOAD: PDF] by Euromonitor International (Author); ISBN: B0000713JY; http://www.amazon.com/exec/obidos/ASIN/B0000713JY/icongroupinterna

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OTC Analgesics Market - US Report [DOWNLOAD: PDF] by Mintel International Group Ltd. (Author); ISBN: B00005TYMO; http://www.amazon.com/exec/obidos/ASIN/B00005TYMO/icongroupinterna

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Pain Management: Assessment & Overview of Analgesics (CD-ROM for Windows, Institutional Version) by Margo McCaffery, Chris Pasero; ISBN: 0781720419; http://www.amazon.com/exec/obidos/ASIN/0781720419/icongroupinterna

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Pharmacological Basis of Anesthesiology: Clinical Pharmacology of New Analgesics and Anesthetics by Mario Tiengo (Editor) (1983); ISBN: 0890049734; http://www.amazon.com/exec/obidos/ASIN/0890049734/icongroupinterna

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Platelets Analgesics and Asthma by M. Schmitz-Schumann (Editor) (1987); ISBN: 3764318066; http://www.amazon.com/exec/obidos/ASIN/3764318066/icongroupinterna

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Poland Analgesics Report 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B000083FIA; http://www.amazon.com/exec/obidos/ASIN/B000083FIA/icongroupinterna

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Safety and Efficacy of Non-Prescription (Otc) Analgesics and Nsaids: Proceedings of the International Conference Held at the South San Francisco Conference Center, San Francisco, Ca, USA on Monday 17th March 1997 by K. D. Rainsford (Editor), M. C. Powanda (Editor) (1998); ISBN: 0792387376; http://www.amazon.com/exec/obidos/ASIN/0792387376/icongroupinterna

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Side-Effects of Anti-Inflammatory Analgesic Drugs by Kim D. Rainsford (Editor), Giampaolo Velo (Editor) (1984); ISBN: 0890049718; http://www.amazon.com/exec/obidos/ASIN/0890049718/icongroupinterna

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Side-Effects of Anti-Inflammatory Drugs: Proceedings of the 2nd International Meeting on the Side-Effects of Anti-Inflammatory-Analgesic Drugs, Held (Inflammation and Drug Therapy Series) by International Meeting on the Side-Effects of Anti-Inflammatory Analges, et al; ISBN: 0852006934; http://www.amazon.com/exec/obidos/ASIN/0852006934/icongroupinterna

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Survival Strategies In Consumer Healthcare: Analgesics [DOWNLOAD: PDF] by Nicholas Hall & Company (Author); ISBN: B00006AB35; http://www.amazon.com/exec/obidos/ASIN/B00006AB35/icongroupinterna

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Symposium on Analgesics : [papers]; ISBN: 9630509210; http://www.amazon.com/exec/obidos/ASIN/9630509210/icongroupinterna

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The 2000-2005 Outlook for Analgesics in the Middle East by Inc. Icon Group International (Editor) (2001); ISBN: 0757675212; http://www.amazon.com/exec/obidos/ASIN/0757675212/icongroupinterna

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The 2000-2005 World Outlook for Analgesics (Strategic Planning Series) by The Research Group, et al; ISBN: 0757650988; http://www.amazon.com/exec/obidos/ASIN/0757650988/icongroupinterna

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The 2003-2008 World Outlook for Analgesics [DOWNLOAD: PDF]; ISBN: B00009KFP0; http://www.amazon.com/exec/obidos/ASIN/B00009KFP0/icongroupinterna

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The Incurable Cancer Patient at the End of Life: Medical Care Utilization, Quality of Life and the Additive Analgesic Effect of Paracetamol in Concurrent Morphine Therapy (Comprehensive Summaries of Uppsala Dissertations from the Faculty of mediciNe, 1013) by Bertil Axelsson (2001); ISBN: 9155449689; http://www.amazon.com/exec/obidos/ASIN/9155449689/icongroupinterna

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Update on Non-narcotic Analgesic Research by W.D. Gerber, G. Nappi (1993); ISBN: 3764329173; http://www.amazon.com/exec/obidos/ASIN/3764329173/icongroupinterna

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Update on Non-Narcotic Analgesic Research: Fiuggi, Italy, October 2Nd-3Rd, 1992 by Wolf-Dieter Gerber (Editor), G. Nappi (Editor) (1996); ISBN: 0817629173; http://www.amazon.com/exec/obidos/ASIN/0817629173/icongroupinterna

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US ANALGESICS REPORT 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006SLEC; http://www.amazon.com/exec/obidos/ASIN/B00006SLEC/icongroupinterna

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US INTERNAL ANALGESICS REPORT 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006SLEH; http://www.amazon.com/exec/obidos/ASIN/B00006SLEH/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “pain medications” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Pain sourcebook: basic consumer health information about specific forms of acute and chronic pain: including muscle and skeletal pain, nerve pain, cancer pain, and disorders characterized by pain, such as fibromyalgia, shingles, angina, arthritis, and headaches: a long with information about pain medications and management techniques, complementary and alternative pain relief options, tips for people living with chronic pain: a glossary, and a directory of sources for further information Author: Bellenir, Karen.; Year: 2002; Detroit, MI: Omnigraphics, c2002; ISBN: 0780806123 http://www.amazon.com/exec/obidos/ASIN/0780806123/icongroupinterna

Chapters on Pain Medications In order to find chapters that specifically relate to pain medications, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and pain medications using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “pain medications” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on pain medications: •

Medical Problem: How is it Treated? Source: in Trachter, A.B. Coping with Crohn's Disease. Oakland, CA: New Harbinger Publications, Inc. 2001. p.37-52. Contact: Available from New Harbinger Publications, Inc. 5674 Shattuck Avenue, Oakland, California 94609. (800) 748-6273 or (510) 652-0215. Fax: (510) 652-5472. E-mail: [email protected]. Website: http://www.newharbinger.com/contactus.htm. PRICE: $15.95 plus shipping and handling. ISBN: 1572242655.

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Summary: Crohn's disease (CD) is a chronic gastrointestinal inflammatory disease that may affect any part of the digestive tract. The disease process can be somewhat mild, or it can be devastating. However, the diagnosis of any chronic medical condition can be overwhelming. This chapter is from a book that offers a comprehensive discussion of the emotional and physical aspects of living with a chronic illness. The book provides basic medical information, but it is primarily designed to be used as a tool to aid the activities of daily life, as well as to promote a healthy lifestyle, despite the disease. In this chapter, the author outlines the medical treatment options that may be undertaken to cope with the symptoms of the disease. Topics include making lifestyle changes to accommodate taking medications; medications and their effects, including nonspecific medications, antidiarrheal agents and pain medications, antibiotics, medications to avoid, corticosteroids (prednisone and methylprednisolone), sulfasalazine (azulfidine), 5ASA drugs (aminosalicylates), immunomodulators, cyclosporine, methotrexate, infliximab (Remicade), and interluken 10/11; handling emotional reactions to medications, including depression and sleep disturbances; and what happens if one stops taking medications, including the role of maintenance medications. •

Considerations for Female Patients Source: in Newman, M.G. and van Winkelhoff, A.J., eds. Antibiotic and Antimicrobial Use in Dental Practice. 2nd ed. Chicago, IL: Quintessence Publishing Co, Inc. 2001. p. 235-242. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $32.00 plus shipping and handling. ISBN: 0867153970. Summary: This chapter discusses side effects and risks associated with the use of antibiotics and antimicrobials in women, with an emphasis on the effects of such treatment on pregnant and lactating women. The chapter is from a textbook that integrates basic facts and principles of antibiotic therapy with recently-emerged concepts of care. The author discusses considerations for antibiotic prescriptions, including vaginitis (a common side effect), and contraceptive failure; antibiotics that cross the placenta and reach the fetus; specific antibiotics and their effects in pregnant and lactating women, including penicillins, tetracycline, cephalosporins, erythromycin, clindamycin, metronidazole, azithromycin, aminoglycosides, sulfonamides, and chloramphenicol; periodontal considerations; and a final note on oral pain medications for pregnant or lactating women who are undergoing dental treatment. Important principles, key facts, and clinical insights are highlighted and the chapter concludes with a list of references. 1 figure. 2 tables. 33 references.

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CHAPTER 6. MULTIMEDIA ON PAIN MEDICATIONS Overview In this chapter, we show you how to keep current on multimedia sources of information on pain medications. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “pain medications” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on pain medications: •

Reassessment of the Renal Effect of Analgesics Source: Springfield, NJ: Scientific Therapeutics Information, Inc. 1995. 35 p. (soundrecording). Contact: Available from Scientific Therapeutics Information, Inc. 505 Morris Avenue, Springfield, NJ 07081. (201) 376-5655. Fax (201) 376-0611. PRICE: Single copy free. Summary: This clinical monograph provides clinicians with an overview of the renal effects of analgesics and clarifies the confusion in the media regarding the clinical relevance of a recently published report inferring an association between heavy use of certain analgesics and an increased risk of kidney failure (Perneger et al, 1994). The authors provide a review of the adverse renal effects of over-the-counter (OTC) analgesics. They identify types of adverse effects and patients at risk for these effects. Next, they briefly describe the etiology, incidence, and pathogenesis of chronic renal insufficiency. The authors explain factors that are related to underlying renal disease and influence the choice of an OTC analgesic in this population. With this background information, an expert panel provides an assessment of the Perneger study. The study

112 Pain Medications

methods, results, and conclusions are discussed and placed in clinical perspective. In closing, the panel provides recommendations regarding OTC analgesic use for pediatric and adult patients, including those with renal insufficiency. 1 figure. 5 tables. 60 references. (AA-M).

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CHAPTER 7. PERIODICALS MEDICATIONS

AND

NEWS

ON

PAIN

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover pain medications.

News Services and Press Releases One of the simplest ways of tracking press releases on pain medications is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “pain medications” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to pain medications. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “pain medications” (or synonyms). The following was recently listed in this archive for pain medications: •

FDA approves Amarin's generic form of Novartis pain medication Source: Reuters Industry Breifing Date: August 23, 2001

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•

Aradigm begins phase IIb trial of AERx analgesic system in cancer patients Source: Reuters Industry Breifing Date: September 28, 2000

•

FDA approves Watson's hydrocodone/acetaminophen analgesic Source: Reuters Industry Breifing Date: September 22, 2000

•

Blacks less likely than whites to get pain medication Source: Reuters Health eLine Date: December 28, 1999

•

Children receive inadequate pain medication during postoperative period Source: Reuters Medical News Date: July 03, 1998

•

How analgesics cause side effects Source: Reuters Health eLine Date: May 14, 1998 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “pain medications” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or

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you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “pain medications” (or synonyms). If you know the name of a company that is relevant to pain medications, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “pain medications” (or synonyms).

Newsletters on Pain Medications Find newsletters on pain medications using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “pain medications.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “pain medications” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Pain Management Vital in Pediatric Urology Source: Urology Times. 22(4): 13-14. April 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This article, from a professional newsletter, presents an interview with Dr. David Cohen on the contributions pediatric urologists can make to minimize their patients' discomfort. Dr. Cohen stresses that, when planning surgical procedures on infants or young children, urologists need to regard the reality of their patients' postoperative pain seriously and work as a team with anesthesiologists to manage the pain safely and effectively. Other topics include evaluating children's pain, communicating with children, the use of local anesthesia and caudal blocks, the use of a combination of techniques rather that a single technique for pain control, the role of preoperative education in reducing anxiety and postoperative discomfort, the role of parents in helping children with self-administration of pain medications, distraction and psychological techniques, and the importance of individualizing pain management for each patient's needs.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you

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prefer. For the format option, select “Newsletter Article.” Type “pain medications” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on pain medications: •

Irritable Bowel Syndrome: Clinical Issues Source: Participate. 9(1): 1-4. Spring 2000. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This article discusses irritable bowel syndrome (IBS), a very common condition that is characterized by abdominal pain associated with a change in a bowel pattern (constipation or diarrhea). IBS is considered a condition of the brain-gut connection and triggering factors may variously cause symptoms of diarrhea at one time and constipation at another. There is a wide range of severity of IBS, from mild or infrequent symptoms that the patient manages at home to very severe kinds of symptoms that can cause patients to seek relief with more frequent doctor visits. The article answers common questions about IBS and its treatments. IBS is in the group of conditions that are called functional gastrointestinal disorders, i.e., disorders of dysfunction, rather than pathology such as inflammation or visible tissue damage. Diagnosis include patient history, symptoms according to the Rome Criteria, and diagnostic tests such as colonoscopy or CT scan (computed tomography). Treatments are usually done in response to the specific symptoms. For example, in a patient who usually has constipation, treatment are used that increase the functioning of the bowel, the frequency, and the ease of having a bowel movement. For patients whose symptoms tend more to diarrhea, treatment includes anti diarrheal agents. Pain medications might also be indicated, particularly if the pain is meal related. Reduced dosage prescriptions of antidepressants can be effective to modulate or decrease pain. The author reviews new drugs currently under study, as well as ongoing research into the brain-gut connection. The author also discusses the impact of conceptualizing functional disorders within the traditional disease-based medical framework, which separates the mind from the body. IBS must be recognized as genuine, non trivial, and a disorder that is not fully explained as either psychiatric or organic.

•

Spinal Stenosis: Severity Determines Treatment Plan Source: Mayo Clinic Health Letter. 19(6): 1-3. June 2001. Contact: Available from Mayo Clinic Health Letter. 200 First Street, SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. E-mail: [email protected]. Summary: This newsletter article provides people who have spinal stenosis with information on the causes, symptoms, diagnosis, and management of this spinal condition. People who have spinal stenosis have a narrowing of the spinal canal. When the narrowing compresses nerves, pain can result. Spinal stenosis, which usually affects people 60 or older, is generally caused by backbone changes related to osteoarthritis, but it can occur in younger people born with a narrowed spinal canal or following spinal injury. The signs and symptoms of spinal stenosis tend to appear over time, and they generally worsen with walking and standing. Diagnosis is based on the medical history, a physical examination, and diagnostic imaging techniques such as magnetic resonance imaging and computerized tomography scans. Treatment decisions are based on the severity of the narrowing. Nonsurgical treatments for mild stenosis include dynamic

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lumbar stabilization and pain medications such as nonsteroidal antiinflammatory drugs, antiseizure medications, and tricyclic antidepressants. Surgery to treat spinal stenosis enlarges the area of the spinal canal at the point where the nerves are being compressed. Surgical procedures used to treat spinal stenosis are decompressive lumbar laminectomy, laminotomy, or spinal fusion. 1 figure.

Academic Periodicals covering Pain Medications Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to pain medications. In addition to these sources, you can search for articles covering pain medications that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for pain medications. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with pain medications. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

120 Pain Medications

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to pain medications: Acetaminophen and Salicylates •

Systemic - U.S. Brands: Excedrin Extra-Strength Caplets; Excedrin ExtraStrength Tablets; Excedrin Migraine; Gelpirin; Goody's Fast Pain Relief; Goody's Headache Powders; Rid-A-Pain Compound; Saleto; Supac; Vanquish Caplets http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203003.html

Acetaminophen, Sodium Bicarbonate, and Citric Acid •

Systemic - U.S. Brands: Bromo-Seltzer http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202005.html

Antihistamines, Decongestants, and Analgesics •

Systemic - U.S. Brands: Aclophen; Actifed Cold & Sinus; Actifed Cold & Sinus Caplets; Actifed Sinus Nighttime; Actifed Sinus Nighttime Caplets; Alka-Seltzer Plus Allergy Medicine Liqui-Gels; Alka-Seltzer Plus Cold Medicine; Alka-Seltzer Plus Cold Medicine Liqui-Gels; Allerest http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202062.html

Anti-Inflammatory Drugs, Nonsteroidal •

Systemic - U.S. Brands: Actron; Advil; Advil Caplets; Advil, Children's; Aleve; Anaprox; Anaprox DS; Ansaid; Bayer Select Ibuprofen Pain Relief Formula Caplets; Cataflam; Clinoril; Cotylbutazone; Cramp End; Daypro; Dolgesic; Dolobid; EC-Naprosyn; Excedrin IB; Excedrin IB Caple http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202743.html

Antipyrine and Benzocaine •

Otic - U.S. Brands: Allergen; Antiben; Auralgan; Aurodex; Auroto; Dolotic; Otocalm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202066.html

Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate, and Benzoic Acid •

Systemic - U.S. Brands: Atrosept; Dolsed; Hexalol; Prosed/DS; UAA; Urimed; Urised; Uriseptic; Uritab; Uritin; Uro-Ves http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202075.html

Baclofen •

Systemic - U.S. Brands: Lioresal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202080.html

Barbiturates, Aspirin, and Codeine •

Systemic - U.S. Brands: Ascomp with Codeine No.3; Butalbital Compound with Codeine; Butinal with Codeine No.3; Fiorinal with Codeine No.3; Idenal with Codeine; Isollyl with Codeine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202104.html

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Butalbital and Acetaminophen •

Systemic - U.S. Brands: Amaphen; Anolor-3002; Anoquan; Arcet; Bancap; Bucet; Butace; Conten; Dolmar; Endolor; Esgic; Esgic-Plus; Ezol; Femcet; Fioricet; Isocet; Medigesic; Pacaps; Pharmagesic; Phrenilin; Phrenilin Forte; Repan; Sedapap; Tencet; Tencon; Triad; Triaprin; Two-Dyne; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202102.html

Butalbital and Aspirin •

Systemic - U.S. Brands: Axotal; Butalgen; Fiorgen; Fiorinal; Fiormor; Fortabs; Isobutal; Isobutyl; Isolin; Isollyl; Laniroif; Lanorinal; Marnal; Vibutal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202103.html

Capsaicin •

Topical - U.S. Brands: Zostrix; Zostrix-HP http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202626.html

Clonidine •

Parenteral-Local - U.S. Brands: Duraclon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203089.html

Decongestants and Analgesics •

Systemic - U.S. Brands: Actifed Sinus Daytime; Actifed Sinus Daytime Caplets; Advil Cold and Sinus; Advil Cold and Sinus Caplets; Alka-Seltzer Plus Sinus Medicine; Allerest No-Drowsiness Caplets; Aspirin-Free Bayer Select Sinus Pain Relief Caplets; BC Cold Powder Non-Drowsy Fo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202184.html

Dezocine •

Systemic - U.S. Brands: Dalgan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202189.html

Fentanyl •

Systemic - U.S. Brands: Actiq http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203780.html

•

Transdermal-Systemic - U.S. Brands: Duragesic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202702.html

Hyaluronate Sodium •

Systemic - U.S. Brands: Hyalgan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203531.html

Hydrocodone and Ibuprofen •

Systemic - U.S. Brands: Vicoprofen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203600.html

Ketorolac •

Systemic - U.S. Brands: Toradol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202318.html

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Levomethadyl •

Systemic - U.S. Brands: Orlaam http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202766.html

Meprobamate and Aspirin •

Systemic - U.S. Brands: Epromate-M; Equagesic; Heptogesic; Meprogesic; Micrainin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202349.html

Narcotic Analgesics and Acetaminophen •

Systemic - U.S. Brands: Allay; Anexsia 5/500; Anexsia 7.5/650; Anolor DH 5; Bancap-HC; Capital with Codeine; Co-Gesic; Darvocet-N 100; Darvocet-N 50; DHCplus; Dolacet; Dolagesic; Duocet; E-Lor; Endocet; EZ III; Hycomed; HycoPap; Hydrocet; Hydrogesic; HY-PHEN; Lorcet 10/650; L http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202392.html

Narcotic Analgesics and Aspirin •

Systemic - U.S. Brands: Damason-P; Darvon Compound-65; Empirin with Codeine No.3; Empirin with Codeine No.4; Endodan; Lortab ASA; Panasal 5/500; PC-Cap; Percodan; Percodan-Demi; Propoxyphene Compound-65; Roxiprin; Synalgos-DC; Talwin Compound http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202393.html

Narcotic Analgesics for Pain Relief •

Systemic - U.S. Brands: Astramorph PF; Buprenex; Cotanal-65; Darvon; DarvonN; Demerol; Dilaudid; Dilaudid-5; Dilaudid-HP; Dolophine; Duramorph; Hydrostat IR; Kadian; Levo-Dromoran; M S Contin; Methadose; MS/L; MS/L Concentrate; MS/S; MSIR; Nubain; Numorphan; OMS Concentrate; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202390.html

Narcotic Analgesics for Surgery and Obstetrics •

Systemic - U.S. Brands: Alfenta; Astramorph; Astramorph PF; Buprenex; Demerol; Duramorph; Nubain; Stadol; Sublimaze; Sufenta; Ultiva http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202391.html

Orphenadrine and Aspirin •

Systemic - U.S. Brands: Norgesic; Norphadrine; Orphenagesic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202427.html

Phenazopyridine •

Systemic - U.S. Brands: Azo-Standard; Baridium; Eridium; Geridium; Phenazodine; Pyridiate; Pyridium; Urodine; Urogesic; Viridium http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202455.html

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Phenothiazines •

Systemic - U.S. Brands: Chlorpromazine Hydrochloride Intensol; Compazine; Compazine Spansule; Mellaril; Mellaril Concentrate; Mellaril-S; Permitil; Permitil Concentrate; Prolixin; Prolixin Concentrate; Prolixin Decanoate; Prolixin Enanthate; Serentil; Serentil Concentrate; Ste http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202457.html

Propiomazine •

Systemic - U.S. Brands: Largon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202487.html

Rofecoxib •

Systemic - U.S. Brands: Vioxx http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203782.html

Salicylates •

Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202515.html

Sulfonamides and Phenazopyridine •

Systemic - U.S. Brands: Azo Gantanol; Azo Gantrisin; Azo-Sulfamethoxazole; Azo-Sulfisoxazole; Azo-Truxazole; Sul-Azo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202542.html

Tramadol •

Systemic - U.S. Brands: Ultram http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202789.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

127

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

128 Pain Medications

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “pain medications” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 12150 302 1169 69 11 13701

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “pain medications” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

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The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on pain medications can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to pain medications. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to pain medications. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “pain medications”:

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Other guides About Your Medicines http://www.nlm.nih.gov/medlineplus/aboutyourmedicines.html Female Sexual Dysfunction http://www.nlm.nih.gov/medlineplus/femalesexualdysfunction.html Gout and Pseudogout http://www.nlm.nih.gov/medlineplus/goutandpseudogout.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Neck Disorders and Injuries http://www.nlm.nih.gov/medlineplus/neckdisordersandinjuries.html Reflex Sympathetic Dystrophy http://www.nlm.nih.gov/medlineplus/reflexsympatheticdystrophy.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on pain medications. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Chronic Pelvic Pain: A Patient Education Booklet Source: Birmingham, AL: International Pelvic Pain Society (IPPS). 1998. [12 p.]. Contact: Available from International Pelvic Pain Society. 2006 Brookwood Medical Center Drive, Suite 402, Birmingham, AL 35209. (205) 877-2950 or (800) 624-9676. Website: http://www.pelvicpain.org. PRICE: Single copy free. Summary: Chronic pelvic pain (CPP) is one of the most common medical problems affecting women today. This patient education booklet offers an overview of the principles of CPP and strategies for managing the condition. The booklet first reviews the definition of CPP and factors that must be present for the diagnosis. CPP is defined as any pelvic pain that lasts for more than 6 months. Often in CPP, the initial physical problem has lessened or even disappeared, but the pain continues because of changes in the nervous system, muscles, or other tissues. Six features are common in patients with

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CPP: the pain has been present for 6 months or more; conventional treatments have yielded little relief; the degree of pain perceived seems out of proportion to the degree of tissue damage detected by conventional means; physical appearance of depression is present (e.g., sleep disturbance, constipation, diminished appetite, and reduced body movements and reactions); physical activity has become increasingly limited; and emotional roles in the family are altered. In addition, by the time pain becomes chronic, multiple organ systems rather than a single problem are involved in the pain process. The booklet reviews the perception of pain, referred (antidromic) pain, central modulation by the brain, the importance of an accurate patient history, the physical examination, diagnostic tests, and therapeutic approaches. Treatment options can include pain medications (analgesics), antidepressants, time contingent therapy, the use of a contract between physician and patient, physical therapy, TENS (transcutaneous electrical nerve stimulation), psychological evaluation and therapy, family therapy, surgical evaluation and treatment, and regular physician visits. Readers are reminded that improvement of the CPP may take considerable time, even though the physician is trying to provide relief as soon as possible. Successful management of CPP is a realistic goal, even if elimination of the pain is not possible. The booklet concludes with a glossary of related medical terms and a sample drug contract. •

Anesthesia for the Dental Visit Source: JADA. Journal of the American Dental Association. 132(5): 703. May 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: Some people feel anxious or nervous about their dental visits. This fact sheet reviews the options of anesthesia for the dental visit, including local anesthetics, conscious sedation, and general anesthesia. Local anesthesia numbs the teeth and gums to prevent the patient from feeling discomfort during dental treatment. Local anesthesia can be topical or injectable. Antianxiety agents or sedatives can help the patient relax during dental procedures. These agents may be used with local anesthetics and pain medications during procedures such as placement of a crown. Two forms of conscious sedation are nitrous oxide (laughing gas) administration and intravenous sedation. General anesthesia causes a loss of consciousness and produces deep sleep. General anesthesia is used for patients with uncontrollable anxiety or patients who are unable to control their movements (such as young children or some people with disabilities). General anesthesia may also be used for long or complicated procedures such as surgical tooth extractions. The fact sheet concludes with suggestions for patients who are undergoing dental procedures, including the importance of telling the dentist about any medications (including alternative therapies such as herbs) that the patient is regularly taking.

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Acute Pancreatitis Source: Wexford, PA: National Pancreas Foundation. 200x. [4 p.]. Contact: Available from National Pancreas Foundation. P.O. Box 935, Wexford, PA 15090-0935. (866) 726-2737. Website: www.pancreasfoundation.org. PRICE: Single copy free. Summary: This brochure provides basic information about acute pancreatitis, a sudden inflammation of the pancreas that is usually associated with severe upper abdominal pain. The most common cause of acute pancreatitis is gallstones. Other causes include alcohol abuse, hereditary conditions, trauma, medications, infections, electrolyte

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abnormalities, high lipid levels, and hormonal abnormalities. The brochure reviews these causes, then discusses the clinical signs of acute pancreatitis, diagnostic tests used to confirm the condition, and treatment options. Treatment for acute pancreatitis depends on the severity of the condition. Sometimes the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Antibiotics are often prescribed if infection occurs and pain medications are often used to provide relief. Surgery is sometimes needed when complications such as infection, cysts, or bleeding occur. Patients usually recover fully form acute pancreatitis and do not experience recurrence if the cause is removed. 1 figure. •

Vasectomy: What to Expect From a Vasectomy Source: Kansas City, MO: American Academy of Family Physicians. 2000. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This brochure, written in nontechnical language, provides basic information about vasectomy, an operation that makes a man unable to get a woman pregnant. A vasectomy involves cutting the vas deferens (tube through which the sperm travels) on each side so that sperm can no longer get into the semen. The brochure is written in a question and answer format. Topics include a description of the operation, the effectiveness of vasectomy in preventing pregnancy, reasons not to have a vasectomy, how to prepare for the operation, post-procedure self care, pain medications, the length of time until a vasectomy is effective as a birth control measure, risk factors and complications that may occur, and the impact of a vasectomy on the man's sex life. One sidebar lists specific strategies for minimizing post-procedure discomfort. One illustration depicts the testicles, vas deferens, and prostate gland, and shows where the vas deferens are cut for vasectomy. 1 figure.

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Diverticulosis and Diverticulitis Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 1996. 5 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 6543810. Fax (301) 634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: Single copy free. Summary: This fact sheet describes diverticulosis and diverticulitis. Most people have small pouches in their colons that bulge outward through weak spots; each pouch is called a diverticulum. The condition of having diverticula is called diverticulosis; when the pouches become infected or inflamed, the condition is called diverticulitis. The fact sheet reviews the causes of diverticular disease, the symptoms of diverticulosis and diverticulitis, possible complications (bleeding, abscess, perforation, peritonitis, fistula, intestinal obstruction), how diverticular disease is diagnosed, and treatment options. The most common symptom of diverticulitis is abdominal pain. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. A high fiber diet and occasionally, mild pain medications will help relieve symptoms in most cases. Sometimes an attack of diverticulitis is serious enough to require a hospital stay and possibly surgery. The fact sheet lists common high fiber foods in the categories of fruits, vegetables, starchy vegetables, and grains. One sidebar summarizes the important

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points covered in the fact sheet. The fact sheet concludes with a brief description of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC). 1 figure. 1 table. 3 references. •

Care, Treatment, and Support Contact: Canadian Public Health Association, Canadian HIV/AIDS Clearinghouse, 4001565 Carling Ave Ste 400, Ottawa, (613) 725-3434, http://www.cpha.ca. Summary: This fact sheet discusses issues related to the care, treatment, and support of incarcerated persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). On some occasions prisoners in Canadian correctional facilities have complained that they have been receiving a lower standard of care. Other concerns include the increase in the number of sick inmates, a lack of health-care accessibility for prisoners needing long-term care, and the lack of availability of experimental drugs or nonconventional therapies. Because of the rigors of prison life and the lack of contingency plans to make sure inmates receive medications for HIV/AIDS, incarcerated persons are more likely to miss dosages, thereby hindering their treatment and widening the gap between care provided for prisoners and that available to the public. The fact sheet relates the story of Billy Bell, an HIV-positive prisoner who died of AIDS-related causes in the Canadian prison system and makes recommendations regarding how to improve medical care, treatment procedures, and treatment adherence support for incarcerated persons with HIV/AIDS in the Canadian prison system. These recommendations include improving accessibility to pain medications, experimental drugs and nonconventional therapies; ensuring that inmates have information about all available treatment options; emphasizing health promotion strategies among prisoners; heeding and dealing appropriately with complaints about care; and using outside experts to evaluate health-care in prisons.

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Total Knee Replacement Source: American Academy of Orthopaedic Surgeons. July 2001. 11 p. Contact: American Academy of Orthopedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (800) 346-2267 or (847) 823-7186. Website: http://www.aaos.org. Summary: This fact sheet discusses total knee replacement for patients who have knee damage due to arthritis or disability. The first knee replacement was performed in 1968. Many improvements have been made since then, and now 267,000 total knee replacements are performed in the US each year. The decision to have knee replacement surgery should be made by the patient, family physician, and orthopedic surgeon. Reasons to have knee replacement include knee deformity or stiffness, inability to tolerate medications, moderate to severe pain when the knee is at rest, and ineffectiveness of pain medications. An orthopedic evaluation consists of a medical history, physical exam and x-rays. Knee replacements can last may years although some activities may need to be avoided such as jogging and some sport activities. Before surgery the patient should have a medical evaluation, blood work, and other tests. Home planning after the surgery is necessary. The surgical procedure takes about two hours. The surgeon will remove the damaged bone and cartilage and replace it with a metal and plastic joint. There are three components to the replacement joint: the metal femoral component, the plastic tibial component, and the plastic patellar component. After surgery the patient needs to follow the surgeon's instructions to avoid blood clots. Some warning signs of blood clots are the sudden onset of chest pain, shortness of

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breath, and coughing. Knee replacements are successful in 90 percent of patients, significantly reducing pain and improving the patient's ability to perform activities of daily living. •

Medication Possibilities for Treatment of CVS Source: Canal Winchester, OH: Cyclic Vomiting Syndrome Association, USA/Canada. 2001. [1 p]. Contact: Available from Cyclic Vomiting Syndrome Association, USA/Canada. 3585 Cedar Hill Road, NW, Canal Winchester, OH 43110. (614) 837-2586. Fax (614) 837-2586. E-mail: [email protected]. Website: www.cvsaonline.org. PRICE: Single copy free. Summary: This fact sheet lists medication possibilities for the treatment of cyclic vomiting syndrome. Cyclic vomiting refers to discrete and severe episodes of vomiting, nausea, and lethargy (severe tiredness). Episodes are discrete in that the sufferer is free of nausea and vomiting between episodes. Episodes can occur on a routine schedule, be triggered by physical or psychological stress, or appear to come at random. Cyclic vomiting has many known causes, including intestinal blockage, brain disorders, kidney disease, and several different metabolic disorders. Many of these causes are treatable, so a careful diagnostic work up is important. However, in the vast majority of cases, none of the above causes can be found, and these individuals are given the diagnosis of cyclic vomiting syndrome (CVS). The fact sheet stresses that there is no single medication that proves to be the answer for every patient. It is not uncommon for a patient to need to adjust dosages, change medications, or take a break from a medication when it loses its effectiveness. There is currently an emphasis being placed on the importance of early medication intervention during the warning phase of an episode that comes before the vomiting begins. Early intervention can help prevent dehydration, electrolyte imbalances, and intense suffering. The fact sheet lists medications in six categories: abortive medications (to stop the episode once it has started), prophylactic medications, sedative medications, pain medications, gastric motility medications, and contraceptives (for episodes associated with menses). One side bar reviews the use of Zofran (ondansetron) for patients with CVS.

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Spinal Fusion Surgery Source: LaGrange, IL: North American Spine Society (NASS). 2001. 8 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Sets of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color patient education brochure uses a question and answer format to provide people who have spinal conditions with information on spinal fusion surgery. A surgeon may consider spinal fusion to treat a fractured vertebrae, correct certain types of spinal deformities such as scoliosis, eliminate pain from painful spinal motion, treat instability, and treat some cervical disc herniations. However, treatment of back or neck pain alone by spinal fusion is somewhat controversial because it is difficult to locate the source of pain in many patients. Surgical approaches and methods to fuse the spine all involve placement of a bone graft between the vertebrae. Fusion may or may not involve the use of hardware such as plates, screws, and cages. Regardless of whether or not hardware is used, bone or bone substitutes must be used to get the vertebrae to fuse together. Pain and recovery following spinal fusion are generally

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greater than with other types of spinal surgeries. Methods of postoperative pain control include oral pain medications, intravenous injections, and a patient controlled postoperative pain control pump. Return to normal activities is slower after spinal fusion because evidence of bone healing must be found before normal activities can be resumed. A brace is sometimes used for the early postoperative period. A postoperative rehabilitation that includes back strengthening exercises, a cardiovascular conditioning program, and a comprehensive program custom designed for the patient's work environment may be recommended. Spinal fusion is a good treatment for some spinal conditions, but it does not return the spine to normal. •

How to Care for Your Ankle Sprain Source: American Family Physician. 57(3): 485-486. February 1, 1998. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article for people who have sprained their ankle uses a question and answer format to provide them with information on how to care for the sprain. This type of injury occurs when the foot rolls or turns in on itself, and the ligaments that hold the ankle and foot bones in place are stretched and weakened. The RICE treatment is recommended after a sprain. RICE stands for resting the injured extremity, icing the injury to reduce swelling, compressing the injured area to decrease swelling and provide support, and elevating the injured extremity to decrease pain and swelling. Effective pain medications include antiinflammatory medicines such as ibuprofen, naprosyn, or ketoprofen. Acetaminophen may also be used. Once the sprain heals, exercises should be performed to help strengthen the ankle and prevent another injury. The article describes exercises people can perform following an ankle sprain and recommends ways to prevent another ankle sprain.

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Nitrous Oxide: Bringing Comfort to Your Dental Visit Source: St. Charles, IL: American Dental Association (ADA). 1997. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 443-9970; http://www.ada.org. PRICE: $19.00 per 100 copies; bulk orders available. Order Number W608. Summary: This mini-brochure (which folds to pocket size) describes how nitrous oxide can be used to provide a relaxed dental visit with a positive outcome. When patients are anxious or if relaxation techniques fail, the dentist may use sedatives or antianxiety agents such as nitrous oxide to help the patient relax. Nitrous oxide is a commonly used dental sedative that produces a giddiness or euphoria, which is why people frequently call it 'laughing gas.' It is inhaled, along with oxygen, through a nasal mask. It is used in a number of dental treatments such as tooth restoration, placement of crowns, and minor surgical procedures. Nitrous oxide is often used along with local anesthetics and pain medications. It has the effect of raising the pain threshold and may make the time appear to pass quickly. The brochure recommends that readers consult with their dentist if they have any additional questions about nitrous oxide.

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Sickle cell disease related pain: Assessment and management: A guide for patients and parents Source: Mount Desert, ME: New England Regional Genetics Group. 1994. 25 pp.

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Contact: Available from Victoria Odesina, New England Regional Genetics Group, P.O. Box 670, Mt. Desert, ME 04660. Telephone: (207) 288-2704 / fax: (207) 288-2705 / e-mail: [email protected] / Web site: http://www.acadia.net/nergg. Available at no charge. Summary: This pamphlet gives information for parents and patients in lay language about managing the pain of sickle cell disease. It discusses the onset and types of pain; pain medications from aspirin to morphine; other ways to manage pain, such as massage, and acupuncture; the relationship with the doctor; advocacy; and gives references and resources. [Funded by the Maternal and Child Health Bureau]. •

Treating Your Peptic Ulcer: A Guide for Patients Source: Wayne, PA: Astra Merck. 1996. 16 p. Contact: Available from Astra Merck Information Center. 725 Chesterbrook Boulevard, Wayne, PA 19087-5677. (800) 236-9933 or (610) 695-1000. PRICE: Single copy free. Summary: This patient education brochure provides basic information about peptic ulcers and how they are treated. Written in a question and answer format, the colorful brochure discusses the two types of peptic ulcers, duodenal and gastric; symptoms; causes, including H. pylori infection, the use of certain pain medications, and smoking cigarettes; diagnostic tests, including the upper GI endoscopy and an upper GI series (barium X-ray); goals of treatment; treatment options, including antacids, acid suppressors, and antibiotics; and quick tips for relieving peptic ulcer symptoms. The brochure includes a section of common concerns and recommended solutions, as well as guidelines for patient recordkeeping strategies. 3 figures. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “pain medications” (or synonyms). The following was recently posted: •

(1) Best practice evidence-based guideline for the appropriate prescribing of hormone replacement therapy. (2) Guideline update: hormone replacement therapy Source: Effective Practice Institute, University of Auckland - Academic Institution; 2001 May (revised information released on 2002 September 30); 185 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3107&nbr=2333&a mp;string=pain+AND+medications

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(1) Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. (2) Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therape Source: American Academy of Pediatrics - Medical Specialty Society; 1992 June (reaffirmed 1998; addendum published 2002 Oct); 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1775&nbr=1001&a mp;string=pain+AND+medication

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1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infar Source: American College of Cardiology Foundation - Medical Specialty Society; 1996 November 1 (revised 1999 Sep); 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2006&nbr=1232&a mp;string=pain+AND+medications

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2002 national guideline for the management of genital herpes Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3035&nbr=2261&a mp;string=pain+AND+medications

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2002 national guideline on the management of sexually acquired reactive arthritis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3045&nbr=2271&a mp;string=pain+AND+medications

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2002 national guidelines on the management of early syphilis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3036&nbr=2262&a mp;string=pain+AND+medications

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AAOS clinical guideline on osteoarthritis of the knee Source: American Academy of Orthopaedic Surgeons - Medical Specialty Society; 1996 (revised 2003); 17 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3856&nbr=3069&a mp;string=analgesic

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ACC/AHA 2002 guideline update for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) Source: American College of Cardiology Foundation - Medical Specialty Society; 1997 July (revised 2002 Sep); 59 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3427&nbr=2653&a mp;string=pain+AND+medications

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ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Managemen Source: American College of Cardiology Foundation - Medical Specialty Society; 1999 June (revised 2002); 127 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3588&nbr=2814&a mp;string=pain+AND+medications

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ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Source: American College of Cardiology Foundation - Medical Specialty Society; 2000 (revised online 2002 Mar); 95 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3190&nbr=2416&a mp;string=pain+AND+medications

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ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines). A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Perc Source: American College of Cardiology Foundation - Medical Specialty Society; 2001 June; 66 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2840&nbr=2066&a mp;string=pain+AND+medication

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ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evalua Source: American College of Cardiology Foundation - Medical Specialty Society; 1995 November 1 (revised 2001 Dec); 56 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3114&nbr=2340&a mp;string=pain+AND+medications

•

ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guide Source: American College of Cardiology Foundation - Medical Specialty Society; 2001 October; 70 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2968&nbr=2194&a mp;string=pain+AND+medications

Patient Resources

•

143

Achalasia Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2175&nbr=1401&a mp;string=pain+AND+medication Source: American College of Radiology - Medical Specialty Society; 1996 September (revised 2000); 27 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2569&nbr=1795&a mp;string=analgesic

•

ACR Appropriateness Criteria for chronic ankle pain Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2002); 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3554&nbr=2780&a mp;string=pain+AND+medications

•

ACR Appropriateness Criteria for chronic foot pain Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2002); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3555&nbr=2781&a mp;string=pain+AND+medications

•

Acute confusion/delirium Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1998; 41 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1344&nbr=536&am p;string=pain+AND+medication

•

Acute pain management Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 1999 April 6); 38 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1888&nbr=1114&a mp;string=analgesics

•

Acute sinusitis in adults Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 July (revised 2002 Dec); 30 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3673&nbr=2899&a mp;string=pain+AND+medications

144 Pain Medications

•

Adult low back pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Sep); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3498&nbr=2724&a mp;string=pain+AND+medications

•

Altered nutritional status Source: American Medical Directors Association - Professional Association; 2001; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3304&nbr=2530&a mp;string=pain+AND+medication

•

American Gastroenterological Association medical position statement: celiac sprue Source: American Gastroenterological Association - Medical Specialty Society; 2000 November 12 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3058&nbr=2284&a mp;string=pain+AND+medication

•

American Gastroenterological Association medical position statement: epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma Source: American Gastroenterological Association - Medical Specialty Society; 1999 May (reviewed 2001); 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3063&nbr=2289&a mp;string=pain+AND+medications

•

American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3065&nbr=2291&a mp;string=pain+AND+medications

•

American Gastroenterological Association medical position statement: irritable bowel syndrome Source: American Gastroenterological Association - Medical Specialty Society; 1996 November 10 (revised 2002 Dec); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3685&nbr=2911&a mp;string=pain+AND+medications

Patient Resources

•

145

American Gastroenterological Association medical position statement: treatment of pain in chronic pancreatitis Source: American Gastroenterological Association - Medical Specialty Society; 1998 April 9 (reviewed 2001); 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3068&nbr=2294&a mp;string=pain+AND+medications

•

Ankle sprain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 August (revised 2002 Mar); 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3356&nbr=2582&a mp;string=pain+AND+medications

•

Antithrombotic therapy. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1999 March; 70 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2907&nbr=2133&a mp;string=analgesics

•

ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery Source: American Society of Health-System Pharmacists - Professional Association; 1999; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1875&nbr=1101&a mp;string=pain+AND+medication

•

Aspirin for the primary prevention of cardiovascular events: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2002 January 15); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3079&nbr=2305&a mp;string=analgesics

•

Aspirin therapy in diabetes Source: American Diabetes Association - Professional Association; 1997 (revised 2000; republished 2003 Jan); 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3575&nbr=2801&a mp;string=analgesics

146 Pain Medications

•

Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=pain+AND+medications

•

Asthma Source: University of Michigan Health System - Academic Institution; 1996 December (revised 2000 Jan); 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2281&nbr=1507&a mp;string=pain+AND+medications

•

Basic guidelines for diabetes care Source: California Diabetes Prevention and Control Program - Private Nonprofit Organization; 1999 January (revised 2002 Jan); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3414&nbr=2640&a mp;string=analgesics

•

Cardiac rehabilitation Source: National Heart Foundation of New Zealand - Disease Specific Society; 2002 August; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3463&nbr=2689&a mp;string=pain+AND+medications

•

Cardiac rehabilitation. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2002 January; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3185&nbr=2411&a mp;string=pain+AND+medications

•

Cardiovascular disease in women: a guide to risk factor screening, prevention and management Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3487&nbr=2713&a mp;string=analgesics

Patient Resources

•

147

Care of the patient with anterior uveitis Source: American Optometric Association - Professional Association; 1997 (reviewed 1999); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1990&nbr=1216&a mp;string=pain+AND+medications

•

Care of the patient with open angle glaucoma Source: American Optometric Association - Professional Association; 1995 (reviewed 1998); 90 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1992&nbr=1218&a mp;string=pain+AND+medications

•

Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=pain+AND+medications

•

Chronic pain management in the long-term care setting Source: American Medical Directors Association - Professional Association; 1999; 34 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2158&nbr=1384&a mp;string=pain+AND+medications

•

Clinical policy guidelines Source: National Abortion Federation - Professional Association; 1996 (revised 2003); 54 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3689&nbr=2915&a mp;string=analgesic

•

Clinical policy: critical issues for the initial evaluation and management of patients presenting with a chief complaint of nontraumatic acute abdominal pain Source: American College of Emergency Physicians - Medical Specialty Society; 2000; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3300&nbr=2526&a mp;string=analgesics

148 Pain Medications

•

Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina Source: American College of Emergency Physicians - Medical Specialty Society; 2000; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3297&nbr=2523&a mp;string=pain+AND+medications

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Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS) Source: Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization; 2002 February; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3204&nbr=2430&a mp;string=pain+AND+medication

•

Clinical practice guideline for the management of cataract among adults Source: Family Medicine Research Group, UP-PGH - Academic Institution; 2001; 27 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2963&nbr=2189&a mp;string=analgesics

•

Clinical practice guideline for the management of postoperative pain Source: Department of Defense - Federal Government Agency [U.S.]; 2001 July (revised 2002 May); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3284&nbr=2510&a mp;string=pain+AND+medications

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Clinical practice guideline for the management of rheumatoid arthritis Source: Advanced Research Techniques in the Health Services - Private For Profit Research Organization; 2001; 170 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3683&nbr=2909&a mp;string=analgesics

•

Clinical practice guidelines for chronic non-malignant pain syndrome patients II: An evidence-based approach Source: Siskin Hospital for Physical Rehabilitation Hospital/Medical Center; 1995 (updated 1999); 12 pages

(Chattanooga,

TN)

http://www.guideline.gov/summary/summary.aspx?doc_id=2812&nbr=2038&a mp;string=pain+AND+medications

-

Patient Resources

•

149

Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient Source: American College of Critical Care Medicine - Professional Association; 1995 (revised 2002); 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3170&nbr=2396&a mp;string=pain+AND+medications

•

Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult Source: American College of Critical Care Medicine - Professional Association; 1995 (revised 2002); 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3171&nbr=2397&a mp;string=pain+AND+medications

•

Common gynecologic problems: a guide to diagnosis and treatment Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3486&nbr=2712&a mp;string=pain+AND+medications

•

Complex regional pain syndrome (CRPS) Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1905&nbr=1131&a mp;string=pain+AND+medication

•

Congestive heart failure in adults Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 October (revised 2002 Jan); 71 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3165&nbr=2391&a mp;string=pain+AND+medication

•

Conjunctivitis Source: American Academy of Ophthalmology - Medical Specialty Society; 1998 September; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1668&nbr=894&am p;string=pain+AND+medication

150 Pain Medications

•

Constipation in infants and children: evaluation and treatment Source: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - Professional Association; 1999 November; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3595&nbr=2821&a mp;string=pain+AND+medications

•

Control of pain in patients with cancer. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 June; 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2910&nbr=2136&a mp;string=pain+AND+medications

•

Coronary angiography and indications for CABG or angioplasty Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 March 27); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3382&nbr=2608&a mp;string=pain+AND+medications

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Criteria for ankle/foot Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1896&nbr=1122&a mp;string=pain+AND+medications

•

Criteria for cervical surgery related to entrapment of a single cervical nerve root Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 1 page http://www.guideline.gov/summary/summary.aspx?doc_id=1894&nbr=1120&a mp;string=pain+AND+medications

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Criteria for entrapment of a single lumbar nerve root Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 1 page http://www.guideline.gov/summary/summary.aspx?doc_id=1895&nbr=1121&a mp;string=pain+AND+medications

•

Deep venous thrombosis Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 Apr 20); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3384&nbr=2610&a mp;string=pain+AND+medications

Patient Resources

•

151

Diagnosis and management of aortic dissection Source: European Society of Cardiology - Medical Specialty Society; 2001 September; 40 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2975&nbr=2201&a mp;string=analgesic

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Diagnosis and management of headache Source: National Committee on Neuroscience (Singapore) - National Government Agency [Non-U.S.]; 2000 November; 25 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2838&nbr=2064&a mp;string=pain+AND+medications

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Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 June (revised 2002 May); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3355&nbr=2581&a mp;string=pain+AND+medications

•

Diagnosis and treatment of otitis media in children Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 May (revised 2002 Dec); 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3667&nbr=2893&a mp;string=pain+AND+medication

•

Drug therapy for peripheral vascular disease. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1998 July; 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2902&nbr=2128&a mp;string=analgesics

•

Dyspepsia Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 October (revised 2003 Jan); 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3664&nbr=2890&a mp;string=pain+AND+medications

•

Epididymitis. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3239&nbr=2465&a mp;string=pain+AND+medications

152 Pain Medications

•

Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy. Parts I and II Source: American Urological Association, Inc. - Medical Specialty Society; 2001 April; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2920&nbr=2146&a mp;string=analgesic

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Evidence-based clinical practice guideline. Breastfeeding support: prenatal care through the first year Source: Association of Women's Health, Obstetric, and Neonatal Nurses - Professional Association; 2000 January; 33 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2927&nbr=2153&a mp;string=pain+AND+medication

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Evidence-based clinical practice guideline. Nursing care of the woman receiving regional analgesia/anesthesia in labor Source: Association of Women's Health, Obstetric, and Neonatal Nurses - Professional Association; 2001 January; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2928&nbr=2154&a mp;string=pain+AND+medications

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Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain Source: American Society of Interventional Pain Physicians - Medical Specialty Society; 2003; 79 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3598&nbr=2824&a mp;string=pain+AND+medication

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Explantation of breast implants Source: American Society of Plastic Surgeons - Medical Specialty Society; 1998 June 26; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1715&nbr=941&am p;string=analgesic

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Fibrinolysis guidelines Source: Mount Auburn Hospital (Cambridge, MA) - Hospital/Medical Center; 1998 September; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1453&nbr=687&am p;string=analgesics

Patient Resources

•

153

Fibromyalgia Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1906&nbr=1132&a mp;string=pain+AND+medications

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General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) Source: American Academy of Family Physicians - Medical Specialty Society; 2002 February 8; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3180&nbr=2406&a mp;string=pain+AND+medications

•

Global initiative for asthma. Global strategy for asthma management and prevention Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1995 January (revised 2002); 176 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3203&nbr=2429&a mp;string=pain+AND+medication

•

Guideline for hospitalization for low back pain Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1891&nbr=1117&a mp;string=pain+AND+medication

•

Guideline for management of wounds in patients with lower-extremity arterial disease Source: Wound, Ostomy, and Continence Nurses Society - Professional Association; 2002 June; 44 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3290&nbr=2516&a mp;string=pain+AND+medications

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Guideline for the management of acute and chronic pain in sickle cell disease Source: American Pain Society - Professional Association; 1999 August; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2621&nbr=1847&a mp;string=analgesic

154 Pain Medications

•

Guideline on the role of bisphosphonates in breast cancer Source: American Society of Clinical Oncology - Medical Specialty Society; 2000 March; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2362&nbr=1588&a mp;string=pain+AND+medication

•

Guidelines for lumbar fusion (arthrodesis) Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999 (revised 2001); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3423&nbr=2649&a mp;string=pain+AND+medications

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Guidelines for outpatient prescription of controlled substances, schedules II-IV, for workers on time-loss Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1903&nbr=1129&a mp;string=pain+AND+medications

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Guidelines for outpatient prescription of oral opioids for injured workers with chronic, noncancer pain Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 2000 May 1; 17 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2609&nbr=1835&a mp;string=pain+AND+medications

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Guidelines for the management of heavy menstrual bleeding Source: New Zealand National Health Committee - National Government Agency [NonU.S.]; 1998 http://www.guideline.gov/summary/summary.aspx?doc_id=2184&nbr=1410&a mp;string=pain+AND+medications

•

Guidelines for the management of uterine fibroids Source: New Zealand Guidelines Group - Private Nonprofit Organization; 1999 August; 120 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2279&nbr=1505&a mp;string=analgesics

Patient Resources

•

155

Guidelines for the pediatric perioperative anesthesia environment Source: American Academy of Pediatrics - Medical Specialty Society; 1999 February; 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1774&nbr=1000&a mp;string=analgesic

•

Guidelines of care for liposuction Source: American Academy of Dermatology - Medical Specialty Society; 2001 January (electronic version released to the public); 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2710&nbr=1936&a mp;string=pain+AND+medications

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Hallux abductovalgus Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2337&nbr=1563&a mp;string=pain+AND+medications

•

Hallux limitus and hallux rigidus Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2341&nbr=1567&a mp;string=pain+AND+medications

•

Hallux valgus in the healthy adult Source: American College of Foot and Ankle Surgeons - Medical Specialty Society; 1992 (revised 1998); 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1624&nbr=850&am p;string=pain+AND+medications

•

Hammertoe syndrome Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2339&nbr=1565&a mp;string=pain+AND+medications

•

Heart failure Source: American Medical Directors Association - Professional Association; 1996 (revised 2002); 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3303&nbr=2529&a mp;string=pain+AND+medication

156 Pain Medications

•

Heart failure - systolic dysfunction Source: University of Michigan Health System - Academic Institution; 1999 August; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2282&nbr=1508&a mp;string=analgesics

•

Heel spur syndrome Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2342&nbr=1568&a mp;string=pain+AND+medications

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Heparin and low molecular weight heparin. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 31 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2722&nbr=1948&a mp;string=pain+AND+medications

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Herniated disc. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 104 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2803&nbr=2029&a mp;string=pain+AND+medications

•

Hypertension in older people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 January; 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2915&nbr=2141&a mp;string=analgesics

•

Intermetatarsal neuroma Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 17 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2340&nbr=1566&a mp;string=pain+AND+medications

Patient Resources

•

157

Interventions in the management of behavioural and psychological aspects of dementia. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1998 February; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2898&nbr=2124&a mp;string=pain+AND+medications

•

K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification Source: National Kidney Foundation - Disease Specific Society; 2002 February; 246 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3192&nbr=2418&a mp;string=analgesics

•

Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2003 March 28; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3734&nbr=2960&a mp;string=analgesics

•

Knee pain or swelling: acute or chronic Source: University of Michigan Health System - Academic Institution; 1997 November (revised 2002 Aug); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3540&nbr=2766&a mp;string=pain+AND+medications

•

Lipid management in adults Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 October (revised 2002 Jul); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3410&nbr=2636&a mp;string=analgesics

•

Long term management of asthma by classification in children Source: Community Collaboration on Healthcare Quality - Private Nonprofit Organization; 1998 May; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2164&nbr=1390&a mp;string=analgesics

158 Pain Medications

•

Long-term management of asthma Source: Finnish Medical Society Duodecim - Professional Association; 2001 January 4 (revised 2001 December 30); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3375&nbr=2601&a mp;string=pain+AND+medications

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Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=analgesics

•

Lung cancer prevention: the guidelines Source: American College of Chest Physicians - Medical Specialty Society; 2003 January; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3636&nbr=2862&a mp;string=analgesics

•

Lung cancer. Palliative care Source: American College of Chest Physicians - Medical Specialty Society; 2003 January; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3653&nbr=2879&a mp;string=pain+AND+medications

•

Major depression in adults for mental health care providers Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 February (revised 2002 May); 43 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3354&nbr=2580&a mp;string=pain+AND+medication

•

Major depression, panic disorder and generalized anxiety disorder in adults in primary care Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 January (revised 2002 May); 55 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3350&nbr=2576&a mp;string=pain+AND+medication

Patient Resources

•

159

Male and female sterilisation Source: Royal College of Obstetricians and Gynaecologists - Medical Specialty Society; 1999 April; 86 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2557&nbr=1783&a mp;string=analgesic

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Management of acute myocardial infarction in patients presenting with ST-segment elevation Source: European Society of Cardiology - Medical Specialty Society; 1996 (revised 2003); 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3590&nbr=2816&a mp;string=pain+AND+medications

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Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=pain+AND+medications

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Management of Crohn's disease in adults Source: American College of Gastroenterology - Medical Specialty Society; 2001 March; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2802&nbr=2028&a mp;string=pain+AND+medication

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Management of early rheumatoid arthritis. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 December; 44 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2914&nbr=2140&a mp;string=pain+AND+medications

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Management of primary biliary cirrhosis Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2000 April; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3445&nbr=2671&a mp;string=pain+AND+medications

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Management of sore throat and indications for tonsillectomy. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1999 January; 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1841&nbr=1067&a mp;string=analgesics

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Management of stable angina. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 April; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2916&nbr=2142&a mp;string=pain+AND+medications

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Management of type 2 diabetes mellitus Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 March (revised 2002 Sep); 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3499&nbr=2725&a mp;string=analgesics

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Manual for radiation oncology nursing practice and education Source: Oncology Nursing Society - Professional Association; 1998; 79 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1687&nbr=913&am p;string=analgesic

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Metatarsalgia/intractable plantar keratosis/Tailor's bunion Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2343&nbr=1569&a mp;string=pain+AND+medications

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Migraine headache Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 November (revised 2002 Jul); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3441&nbr=2667&a mp;string=analgesic

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Naltrexone and alcoholism treatment Source: Substance Abuse and Mental Health Services Administration (U.S.) - Federal Government Agency [U.S.]; 1998; 94 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1565&nbr=791&am p;string=pain+AND+medications

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National High Blood Pressure Education Program: Working Group report on high blood pressure in pregnancy Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1990 (revised 2000 Jul); 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1478&nbr=704&am p;string=pain+AND+medication

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Oral hygiene care for functionally dependent and cognitively impaired older adults Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2002 November; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3611&nbr=2837&a mp;string=pain+AND+medications

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Osteoporosis Source: American Health Care Association - Professional Association; 1998; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1810&nbr=1036&a mp;string=pain+AND+medication

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Osteoporosis. Guide to prevention, diagnosis, and treatment Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 1999 (revised 2001); 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3430&nbr=2656&a mp;string=analgesic

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Osteoporosis: prevention and treatment Source: University of Michigan Health System - Academic Institution; 2002 March; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3541&nbr=2767&a mp;string=pain+AND+medication

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Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis Source: American Pain Society - Professional Association; 2002; 179 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3691&nbr=2917&a mp;string=pain+AND+medications

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Part I. Guidelines for the management of severe traumatic brain injury. In: Management and prognosis of severe traumatic brain injury Source: American Association of Neurological Surgeons - Medical Specialty Society; 2000; 165 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3121&nbr=2347&a mp;string=pain+AND+medications

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Pharmacologic management of acute attacks of migraine and prevention of migraine headache Source: American Academy of Family Physicians - Medical Specialty Society; 2002 November; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3592&nbr=2818&a mp;string=pain+AND+medications

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Plague as a biological weapon. Medical and public health management Source: Center for Civilian Biodefense Strategies, School of Medicine, Johns Hopkins University - Academic Institution; 2000 October 4; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2983&nbr=2209&a mp;string=pain+AND+medication

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Practice guideline for the treatment of patients with bipolar disorder (revision) Source: American Psychiatric Association - Medical Specialty Society; 1994 December (revised 2002 Apr); 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3302&nbr=2528&a mp;string=pain+AND+medications

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Practice guideline for the treatment of patients with borderline personality disorder Source: American Psychiatric Association - Medical Specialty Society; 2001 October; 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2972&nbr=2198&a mp;string=pain+AND+medications

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Practice guideline for the treatment of patients with delirium Source: American Psychiatric Association - Medical Specialty Society; 1999 May; 41 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2180&nbr=1406&a mp;string=analgesics

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Practice guideline for the treatment of patients with eating disorders Source: American Psychiatric Association - Medical Specialty Society; 1993 (updated 2000 Jan); 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2194&nbr=1420&a mp;string=pain+AND+medication

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Practice guideline for the treatment of patients with HIV/AIDS Source: American Psychiatric Association - Medical Specialty Society; 2000 November; 62 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2604&nbr=1830&a mp;string=pain+AND+medication

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Practice guidelines for obstetrical anesthesia Source: American Society of Anesthesiologists - Medical Specialty Society; 1999; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1853&nbr=1079&a mp;string=analgesic

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Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults Source: American Academy of Child and Adolescent Psychiatry - Medical Specialty Society; 2001 June 4; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3018&nbr=2244&a mp;string=pain+AND+medications

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Practice parameter: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Source: American Academy of Neurology - Medical Specialty Society; 2000 May; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2823&nbr=2049&a mp;string=pain+AND+medications

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Practice parameter: evidence-based guidelines for migraine headache (an evidencebased review). Report of the Quality Standards Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2000 September; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2820&nbr=2046&a mp;string=pain+AND+medications

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Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2001 May; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2818&nbr=2044&a mp;string=analgesics

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Practice parameters for the evaluation of chronic insomnia Source: American Academy of Sleep Medicine - Professional Association; 2000; 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2276&nbr=1502&a mp;string=pain+AND+medication

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Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder Source: American Academy of Sleep Medicine - Professional Association; 1999; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2274&nbr=1500&a mp;string=pain+AND+medications

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Preoperative evaluation Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 September (revised 2002 Mar); 27 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3357&nbr=2583&a mp;string=analgesic

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Prevention and management of hip fracture in older people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2002 January; 40 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3184&nbr=2410&a mp;string=analgesics

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Prevention and management of pain and stress in the neonate Source: American Academy of Pediatrics - Medical Specialty Society; 2000 February; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2597&nbr=1823&a mp;string=pain+AND+medications

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Prevention of infections related to peripheral intravenous devices Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2002 May; 38 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3438&nbr=2664&a mp;string=analgesics

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Prevention, diagnosis and treatment of failure to progress in obstetrical labor Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 September (revised 2002 Oct); 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3497&nbr=2723&a mp;string=pain+AND+medication

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Principles of appropriate antibiotic use for treatment of acute bronchitis in adults Source: American College of Physicians - Medical Specialty Society; 2001 March 20; 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2745&nbr=1971&a mp;string=analgesic

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Procedure guideline for pediatric sedation in nuclear medicine Source: Society of Nuclear Medicine, Inc - Medical Specialty Society; 1999 February http://www.guideline.gov/summary/summary.aspx?doc_id=1358&nbr=616&am p;string=analgesic

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Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 2003 March 14; 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3766&nbr=2992&a mp;string=analgesic

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Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update Source: American College of Rheumatology - Medical Specialty Society; 2000 September; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2935&nbr=2161&a mp;string=pain+AND+medications

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Recommendations for the treatment of dysmenorrhea Source: University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution; 2001 February; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2737&nbr=1963&a mp;string=pain+AND+medications

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Recommendations for the use of cardiac markers in coronary artery diseases Source: National Academy of Clinical Biochemistry - Professional Association; 1999; 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3519&nbr=2745&a mp;string=pain+AND+medication

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Role of progestogen in hormone therapy for postmenopausal women: position statement of The North American Menopause Society Source: The North American Menopause Society - Private Nonprofit Organization; 2003 Mar-April; 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3736&nbr=2962&a mp;string=pain+AND+medication

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Screening for otitis media with effusion. Recommendation statement from the Canadian Task Force on Preventive Health Care Source: Canadian Task Force on Preventive Health Care - National Government Agency [Non-U.S.]; 2001 October; 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3071&nbr=2297&a mp;string=pain+AND+medications

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Secondary prevention of coronary heart disease following myocardial infarction. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 January; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2303&nbr=1529&a mp;string=analgesics

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Sexual assault and STDs. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3246&nbr=2472&a mp;string=pain+AND+medication

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Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 370 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2720&nbr=1946&a mp;string=pain+AND+medications

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Smallpox vaccination and adverse reactions. Guidance for clinicians Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2003 January 24; 29 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3597&nbr=2823&a mp;string=analgesic

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Specialty referral guidelines for cardiovascular evaluation and management Source: American Healthways, Inc - Public For Profit Organization; 2002; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3168&nbr=2394&a mp;string=pain+AND+medications

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Spondylolysis, lytic spondylolisthesis and degenerative spondylolisthesis (SLD). In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 106 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2804&nbr=2030&a mp;string=analgesic

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Stable coronary artery disease Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 July (revised 2002 Jan); 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3158&nbr=2384&a mp;string=pain+AND+medications

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Substance abuse treatment for persons with HIV/AIDS Source: Substance Abuse and Mental Health Services Administration (U.S.) - Federal Government Agency [U.S.]; 2000; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2544&nbr=1770&a mp;string=pain+AND+medications

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Systemic lupus erythematosus (SLE) Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3390&nbr=2616&a mp;string=analgesics

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•

The diagnosis and treatment of adult asthma Source: New Zealand Guidelines Group - Private Nonprofit Organization; 2002 September; 101 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3462&nbr=2688&a mp;string=analgesics

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The diagnosis and treatment of heel pain Source: American College of Foot and Ankle Surgeons - Medical Specialty Society; 2001 Sep-October; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3173&nbr=2399&a mp;string=analgesics

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The initial management of menorrhagia Source: Royal College of Obstetricians and Gynaecologists - Medical Specialty Society; 1998 October; 43 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2551&nbr=1777&a mp;string=pain+AND+medications

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The management of diabetes mellitus in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 December; 147 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2583&nbr=1809&a mp;string=pain+AND+medications

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The management of persistent pain in older persons Source: American Geriatrics Society - Medical Specialty Society; 1998 October (revised 2002 Jun); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3365&nbr=2591&a mp;string=pain+AND+medications

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The management of priapism Source: American Urological Association, Inc. - Medical Specialty Society; 2003; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3741&nbr=2967&a mp;string=pain+AND+medications

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Universe of Florida patients with acute ischemic brain attack Source: Florida Agency for Health Care Administration - State/Local Government Agency [U.S.]; 1999 March 5; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1801&nbr=1027&a mp;string=analgesics

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Unremitting low back pain. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2805&nbr=2031&a mp;string=analgesic

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Unstable angina pectoris Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 Apr 8); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3383&nbr=2609&a mp;string=pain+AND+medications

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Unstable chest pain Source: University of Texas Medical Branch Correctional Managed Care - Academic Institution; 2001 February (revised 2002 Nov); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3551&nbr=2777&a mp;string=pain+AND+medications

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Use of bisphosphonates in women with breast cancer Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 1998 November 9 (revised December 2002); 23 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3705&nbr=2931&a mp;string=analgesic

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Use of gemcitabine in the treatment of advanced pancreatic adenocarcinoma Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 1998 May 22 (revised online 2002 Nov); 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3603&nbr=2829&a mp;string=analgesic

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Use of granulocyte colony-stimulating factor (G-CSF) in patients receiving myelosuppressive chemotherapy for the treatment of cancer Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 1997 July 25 (updated online 2002 Nov); 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3537&nbr=2763&a mp;string=pain+AND+medication

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Use of strontium Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 1997 November 23 (updated online 2001 Oct); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3012&nbr=2238&a mp;string=pain+AND+medications

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VHA/DOD clinical practice guideline for the management of major depressive disorder in adults Source: Department of Defense - Federal Government Agency [U.S.]; 1997 (updated 2000); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2585&nbr=1811&a mp;string=pain+AND+medications

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VHA/DoD clinical practice guideline for the management of medically unexplained symptoms: chronic pain and fatigue Source: Department of Defense - Federal Government Agency [U.S.]; 2002 August; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3415&nbr=2641&a mp;string=pain+AND+medication

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VHA/DoD clinical practice guideline for the management of substance use disorders Source: Department of Defense - Federal Government Agency [U.S.]; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3169&nbr=2395&a mp;string=pain+AND+medications

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Viral upper respiratory infection (VURI) in adults and children Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Dec); 31 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3658&nbr=2884&a mp;string=pain+AND+medications

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Wheelchair biking for the treatment of depression Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2003 February; 53 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3682&nbr=2908&a mp;string=pain+AND+medication The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to pain medications. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to pain medications. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with pain medications. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about pain medications. For more information,

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see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “pain medications” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “pain medications”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “pain medications” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “pain medications” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on pain medications: •

Basic Guidelines for Pain Medications Analgesic nephropathy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000482.htm Pain medications Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm

•

Signs & Symptoms for Pain Medications Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Backache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm

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Blood in the urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm Bruising Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Decreased alertness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Decreased sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Decreased urine output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003147.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Flank pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003113.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Increased urinary frequency or urgency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Lethargy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm

Online Glossaries 181

Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Pain Medications Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Dialysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm Intravenous pyelogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003782.htm IVP Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003782.htm Protein in the urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003580.htm Toxicology screen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm

•

Surgery and Procedures for Pain Medications Kidney transplant Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003005.htm

•

Background Topics for Pain Medications Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Biofeedback Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002241.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm

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Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Necrosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm Necrotic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm Renal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002289.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

183

PAIN MEDICATIONS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abrasion: 1. The wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. An area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acclimation: Adaptation of animals or plants to new climate. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetyltransferases: Enzymes catalyzing the transfer of an acetyl group, usually from acetyl coenzyme A, to another compound. EC 2.3.1. [NIH] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In

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microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agrin: A protein component of the synaptic basal lamina. It has been shown to induce clustering of acetylcholine receptors on the surface of muscle fibers and other synaptic molecules in both synapse regeneration and development. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin,

Dictionary 185

and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+ and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70. [NIH]

Aldehydes: Organic compounds containing a carbonyl group in the form -CHO. [NIH] Aldose Reductase Inhibitor: A class of drugs being studied as a way to prevent eye and nerve damage in people with diabetes. Aldose reductase is an enzyme that is normally present in the eye and in many other parts of the body. It helps change glucose (sugar) into a sugar alcohol called sorbitol. Too much sorbitol trapped in eye and nerve cells can damage these cells, leading to retinopathy and neuropathy. Drugs that prevent or slow (inhibit) the action of aldose reductase are being studied as a way to prevent or delay these complications of diabetes. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfentanil: A short-acting opioid anesthetic and analgesic derivative of fentanyl. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form

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proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analgesics, Opioid: Narcotic or opioid substances, synthetic or semisynthetic agents producing profound analgesia, drowsiness, and changes in mood. Mood changes may be pleasurable, therefore creating a potential for the abuse of these agents; the prototype of these is morphine to which all other analgesics are compared. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU]

Dictionary 187

Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsants: Drugs used to prevent seizures or reduce their severity. [NIH] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU]

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Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthralgia: Pain in the joint. [NIH] Arthritis, Rheumatoid: A chronic systemic disease, primarily of the joints, marked by

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inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Asepsis: The prevention of access by infecting organisms to the locus of potential infection. [NIH]

Aspartate: A synthetic amino acid. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asthenia: Clinical sign or symptom manifested as debility, or lack or loss of strength and energy. [NIH] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress.

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Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Babesiosis: A group of tick-borne diseases of mammals including zoonoses in humans. They are caused by protozoans of the genus babesia, which parasitize erythrocytes, producing hemolysis. In the U.S., the organism's natural host is mice and transmission is by the deer tick ixodes scapularis. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriorhodopsin: A rhodopsin-like protein found in the purple membrane of Halobacterium halobium and other halophilic bacteria. Its molecular weight is 26,000 and it is bound to retinal in a 1:1 ratio. It has photoreactions similar to those observed in rhodopsin and functions as an energy transducer or proton pump. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barbiturates: A class of chemicals derived from barbituric acid or thiobarbituric acid. Many of these are medically important as sedatives and hypnotics (sedatives, barbiturate), as anesthetics, or as anticonvulsants. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzaldehyde: A colorless oily liquid used as a flavoring agent and to make dyes, perfumes, and pharmaceuticals. Benzaldehyde is chemically related to benzene. [NIH] Benzocaine: A surface anesthetic that acts by preventing transmission of impulses along nerve fibers and at nerve endings. [NIH] Benzoin: A white crystalline compound prepared by condensation of benzaldehyde in potassium cyanide and used in organic syntheses. [NIH]

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Benzyl Alcohol: A colorless liquid with a sharp burning taste and slight odor. It is used as a local anesthetic and to reduce pain associated with lidocaine injection. Also, it is used in the manufacture of other benzyl compounds, as a pharmaceutic aid, and in perfumery and flavoring. [NIH] Beta-Endorphin: A peptide consisting of amino acid sequence 61-91 of the endogenous pituitary hormone beta-lipotropin. The first four amino acids show a common tetrapeptide sequence with methionine- and leucine enkephalin. The compound shows opiate-like activity. Injection of beta-endorphin induces a profound analgesia of the whole body for several hours. This action is reversed after administration of naloxone. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the

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embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood Proteins: Proteins that are present in blood serum, including serum albumin, blood coagulation factors, and many other types of proteins. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bolus injection: The injection of a drug (or drugs) in a high quantity (called a bolus) at once, the opposite of gradual administration (as in intravenous infusion). [EU] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone metastases: Cancer that has spread from the original (primary) tumor to the bone. [NIH]

Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bone Substitutes: Synthetic or natural materials for the replacement of bones or bone tissue. They include hard tissue replacement polymers, natural coral, hydroxyapatite, betatricalcium phosphate, and various other biomaterials. The bone substitutes as inert materials can be incorporated into surrounding tissue or gradually replaced by original tissue. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH]

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Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Implants: Implants used to reconstruct and/or cosmetically enhance the female breast. They have an outer shell or envelope of silicone elastomer and are filled with either saline or silicone gel. The outer shell may be either smooth or textured. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bunion: A swelling of the bursa mucosa of the ball of the great toe, with thickening of the overlying skin and forcing of the toe outward. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Buprenorphine: A derivative of the opioid alkaloid thebaine that is a more potent and longer lasting analgesic than morphine. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use. [NIH] Butorphanol: A synthetic morphinan analgesic with narcotic antagonist action. It is used in the management of severe pain. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH]

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Calendula: Genus of annuals in the family Asteraceae that contains carotenoids, essential oils (oils, volatile), flavonoids, mucilage, saponins, and sterols. It is used both topically and internally. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Camphor: A bicyclic monoterpene ketone found widely in plant (primarily the camphor tree, Cinnamomum camphora). Natural camphor is used topically as a skin antipruritic and as an anti-infective agent. [NIH] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carboxylic Acids: Organic compounds containing the carboxy group (-COOH). This group of compounds includes amino acids and fatty acids. Carboxylic acids can be saturated, unsaturated, or aromatic. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through

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enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catalepsy: A condition characterized by inactivity, decreased responsiveness to stimuli, and a tendency to maintain an immobile posture. The limbs tend to remain in whatever position they are placed (waxy flexibility). Catalepsy may be associated with psychotic disorders (e.g., schizophrenia, catatonic), nervous system drug toxicity, and other conditions. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief

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constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrospinal Fluid Pressure: Manometric pressure of the cerebrospinal fluid as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called intracranial pressure. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chloroform: A commonly used laboratory solvent. It was previously used as an anesthetic, but was banned from use in the U.S. due to its suspected carcinogenecity. [NIH]

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Chlorpromazine: The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class chlorpromazine's antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Cinchona: A genus of rubiaceous South American trees that yields the toxic cinchona alkaloids from their bark; quinine, quinidine, chinconine, cinchonidine and others are used to treat malaria and cardiac arrhythmias. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH]

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Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colony-Stimulating Factors: Glycoproteins found in a subfraction of normal mammalian plasma and urine. They stimulate the proliferation of bone marrow cells in agar cultures and the formation of colonies of granulocytes and/or macrophages. The factors include interleukin-3 (IL-3), granulocyte colony-stimulating factor (G-CSF), macrophage colony-

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stimulating factor (M-CSF), and granulocyte-macrophage colony-stimulating factor (GMCSF). [NIH] Combinatorial: A cut-and-paste process that churns out thousands of potentially valuable compounds at once. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray

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machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH]

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Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convalescence: The period of recovery following an illness. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneal Stroma: The lamellated connective tissue constituting the thickest layer of the cornea between the Bowman and Descemet membranes. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH]

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Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclic Vomiting Syndrome: Sudden, repeated attacks of severe vomiting (especially in children), nausea, and physical exhaustion with no apparent cause. Can last from a few hours to 10 days. The episodes begin and end suddenly. Loss of fluids in the body and changes in chemicals in the body can require immediate medical attention. Also called abdominal migraine. [NIH] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized

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subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Demyelinating Diseases: Diseases characterized by loss or dysfunction of myelin in the central or peripheral nervous system. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton

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in the nucleus. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Dextrorphan: Dextro form of levorphanol. It acts as a noncompetitive NMDA receptor antagonist, among other effects, and has been proposed as a neuroprotective agent. It is also a metabolite of dextromethorphan. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Diflunisal: A salicylate derivative and anti-inflammatory analgesic with actions and side effects similar to those of aspirin. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate

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objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Domperidone: A specific blocker of dopamine receptors. It speeds gastrointestinal peristalsis, causes prolactin release, and is used as antiemetic and tool in the study of dopaminergic mechanisms. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH]

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Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Drug Toxicity: Manifestations of the adverse effects of drugs administered therapeutically or in the course of diagnostic techniques. It does not include accidental or intentional poisoning for which specific headings are available. [NIH] Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dynorphins: A class of opioid peptides including dynorphin A, dynorphin B, and smaller fragments of these peptides. Dynorphins prefer kappa-opioid receptors (receptors, opioid, kappa) and have been shown to play a role as central nervous system transmitters. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysmenorrhea: Painful menstruation. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphoria: Disquiet; restlessness; malaise. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU]

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Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emetic: An agent that causes vomiting. [EU] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalomyelitis: A general term indicating inflammation of the brain and spinal cord, often used to indicate an infectious process, but also applicable to a variety of autoimmune and toxic-metabolic conditions. There is significant overlap regarding the usage of this term and encephalitis in the literature. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Enterohepatic: Of or involving the intestine and liver. [EU] Enterohepatic Circulation: Recycling through liver by excretion in bile, reabsorption from intestines into portal circulation, passage back into liver, and re-excretion in bile. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epicondylitis: Inflammation of the epicondyle or of the tissues adjoining the epicondyle of the humerus. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said

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especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Etidocaine: A local anesthetic with rapid onset and long action, similar to bupivacaine. [NIH] Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. [NIH]

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Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excrete: To get rid of waste from the body. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Therapy: A form of group psychotherapy. It involves treatment of more than one member of the family simultaneously in the same session. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH]

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Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fenoprofen: An anti-inflammatory analgesic and antipyretic highly bound to plasma proteins. It is pharmacologically similar to aspirin, but causes less gastrointestinal bleeding. [NIH]

Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flank Pain: Pain emanating from below the ribs and above the ilium. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. [NIH]

Foot Bones: The tarsus, metatarsus, and phalanges. The tarsus consists of seven bones: calcaneum, astragalus, cuboid, navicular, internal, middle, and external cuneiform bones. The five metatarsal bones are numbered one through five, running medial to lateral. There are 14 phalanges in each foot, the great toe has two while the other toes have three each. [NIH]

Forearm: The part between the elbow and the wrist. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is

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used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical

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preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gemcitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH]

Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH]

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Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycols: A generic grouping for dihydric alcohols with the hydroxy groups (-OH) located on different carbon atoms. They are viscous liquids with high boiling points for their molecular weights. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granulocyte Colony-Stimulating Factor: A glycoprotein of MW 25 kDa containing internal disulfide bonds. It induces the survival, proliferation, and differentiation of neutrophilic granulocyte precursor cells and functionally activates mature blood neutrophils. Among the family of colony-stimulating factors, G-CSF is the most potent inducer of terminal differentiation to granulocytes and macrophages of leukemic myeloid cell lines. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH]

Guanidine: A strong organic base existing primarily as guanidium ions at physiological pH. It is found in the urine as a normal product of protein metabolism. It is also used in laboratory research as a protein denaturant. (From Martindale, the Extra Pharmacopoeia, 30th ed and Merck Index, 12th ed) It is also used in the treatment of myasthenia and as a fluorescent probe in HPLC. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Hallucinogens: Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. [NIH] Hallux Rigidus: A condition caused by degenerative arthritis (osteoarthritis) of the metatarsophalangeal joint of the great toe and characterized by pain and limited dorsiflexion, but relatively unrestricted plantar flexion. [NIH] Haloperidol: Butyrophenone derivative. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH]

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Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring.

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2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humeral: 1. Of, relating to, or situated in the region of the humerus: brachial. 2. Of or belonging to the shoulder. 3. Of, relating to, or being any of several body parts that are analogous in structure, function, or location to the humerus or shoulder. [EU] Hydrocodone: Narcotic analgesic related to codeine, but more potent and more addicting by weight. It is used also as cough suppressant. [NIH] Hydrofluoric Acid: A solution of hydrogen fluoride in water. It is a colorless fuming liquid which can cause painful burns. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH]

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Hydrogen Breath Test: A test for lactose intolerance. It measures breath samples for too much hydrogen. The body makes too much hydrogen when lactose is not broken down properly in the small intestine. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydromorphone: An opioid analgesic made from morphine and used mainly as an analgesic. It has a shorter duration of action than morphine. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxanthine: A purine and a reaction intermediate in the metabolism of adenosine and in the formation of nucleic acids by the salvage pathway. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH]

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Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU]

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Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds,

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wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress.

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Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactose Intolerance: The disease state resulting from the absence of lactase enzyme in the musocal cells of the gastrointestinal tract, and therefore an inability to break down the disaccharide lactose in milk for absorption from the gastrointestinal tract. It is manifested by indigestion of a mild nature to severe diarrhea. It may be due to inborn defect genetically conditioned or may be acquired. [NIH] Lactulose: A mild laxative. [NIH] Lanolin: A yellow fat obtained from sheep's wool. It is used as an emollient, cosmetic, and

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pharmaceutic aid. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lassitude: Weakness; exhaustion. [EU] Lauraceae: A family of mainly aromatic evergeen plants in the order Laurales. The laurel family includes 2,200 species in 45 genera and from these are derived medicinal extracts, essential oils, camphor and other products. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levo: It is an experimental treatment for heroin addiction that was developed by German scientists around 1948 as an analgesic. Like methadone, it binds with opioid receptors, but it is longer acting. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU]

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Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU]

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Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manic: Affected with mania. [EU] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Oncology: A subspecialty of internal medicine concerned with the study of neoplasms. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Mefenamic Acid: A non-steroidal anti-inflammatory agent with analgesic, anti-

224 Pain Medications

inflammatory, and antipyretic properties. It is an inhibitor of cyclooxygenase. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Memantine: Amantadine derivative that has some dopaminergic effects. It has been proposed as an antiparkinson agent. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menorrhagia: Excessive menstrual flow. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metatarsal Bones: The five long bones of the metatarsus articulating with the tarsal bones proximally and the toes (phalanges) distally. [NIH] Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] Metatarsus: The part of the foot between the tarsa and the toes. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methyl salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Methylcellulose: Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this

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substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH]

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Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Neurons: Neurons which activate muscle cells. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelin Sheath: The lipid-rich sheath investing many axons in both the central and peripheral nervous systems. The myelin sheath is an electrical insulator and allows faster

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and more energetically efficient conduction of impulses. The sheath is formed by the cell membranes of glial cells (Schwann cells in the peripheral and oligodendroglia in the central nervous system). Deterioration of the sheath in demyelinating diseases is a serious clinical problem. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myotonia: Prolonged failure of muscle relaxation after contraction. This may occur after voluntary contractions, muscle percussion, or electrical stimulation of the muscle. Myotonia is a characteristic feature of myotonic disorders. [NIH] Nalbuphine: A narcotic used as a pain medication. It appears to be an agonist at kappa opioid receptors and an antagonist or partial agonist at mu opioid receptors. [NIH] Nalorphine: A narcotic antagonist with some agonist properties. It is an antagonist at mu opioid receptors and an agonist at kappa opioid receptors. Given alone it produces a broad spectrum of unpleasant effects and it is considered to be clinically obsolete. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Narcotic Antagonists: Agents inhibiting the effect of narcotics on the central nervous system. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Nearsightedness: The common term for myopia. [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH]

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Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurogenic Inflammation: Inflammation caused by an injurious stimulus of peripheral neurons and resulting in release of neuropeptides which affect vascular permeability and help initiate proinflammatory and immune reactions at the site of injury. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of

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neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neurotrophins: A nerve growth factor. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]

Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH]

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Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligodendroglia: A class of neuroglial (macroglial) cells in the central nervous system. Oligodendroglia may be called interfascicular, perivascular, or perineuronal satellite cells according to their location. The most important recognized function of these cells is the formation of the insulating myelin sheaths of axons in the central nervous system. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few -

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morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A visual pigment protein found in the retinal rods. It combines with retinaldehyde to form rhodopsin. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orphenadrine: A muscarinic antagonist used to treat drug-induced parkinsonism and to relieve pain from muscle spasm. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otitis Media with Effusion: Inflammation of the middle ear with a clear pale yellowcolored transudate. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of

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Biochemistry, 1982, p471). [NIH] Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenase: Enzyme which breaks down heme, the iron-containing oxygen-carrying constituent of the red blood cells. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Pain Measurement: Scales, questionnaires, tests, and other methods used to assess pain severity and duration in patients or experimental animals to aid in diagnosis, therapy, and physiological studies. [NIH] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]

Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity.

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[NIH]

Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresthesia: Subjective cutaneous sensations (e.g., cold, warmth, tingling, pressure, etc.) that are experienced spontaneously in the absence of stimulation. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pellucida: The hyaline or faintly radially striated oesinophilic membrane in immediate contact with the outer wall of the ovum. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Fragments: Partial proteins formed by partial hydrolysis of complete proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or

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multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Periarthritis: Inflammation of the tissues around a joint. [EU] Perineal: Pertaining to the perineum. [EU] Perineal prostatectomy: Surgery to remove the prostate through an incision made between the scrotum and the anus. [NIH] Perineum: The area between the anus and the sex organs. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroral: Performed through or administered through the mouth. [EU] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently

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affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorous: Having to do with or containing the element phosphorus. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Piperidines: A family of hexahydropyridines. Piperidine itself is found in the pepper plant as the alkaloid piperine. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3-carboxamide 1,1dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the

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treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plana: The radiographic term applied to a vertebral body crushed to a thin plate. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH]

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Post-synaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Cyanide: Potassium cyanide (K(CN)). A highly poisonous compound that is an inhibitor of many metabolic processes, but has been shown to be an especially potent inhibitor of heme enzymes and hemeproteins. It is used in many industrial processes. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and

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cirrhosis in later stages of the disease. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Proglumide: 4-Benzamido-N,N-dipropylglutaramic acid. A drug that exerts an inhibitory effect on gastric secretion and reduces gastrointestinal motility. It is used clinically in the drug therapy of gastrointestinal ulcers. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextroisomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Propylene Glycol: A clear, colorless, viscous organic solvent and diluent used in pharmaceutical preparations. [NIH] Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate

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the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein Folding: A rapid biochemical reaction involved in the formation of proteins. It begins even before a protein has been completely synthesized and proceeds through discrete intermediates (primary, secondary, and tertiary structures) before the final structure (quaternary structure) is developed. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino

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acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychological Techniques: Methods used in the diagnosis and treatment of behavioral, personality, and mental disorders. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotomimetic: Psychosis miming. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH]

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Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Keratotomy: Commonly referred to as RK; a surgical procedure designed to correct myopia (nearsightedness) by flattening the cornea using radial cuts. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation Oncology: A subspecialty of medical oncology and radiology concerned with the radiotherapy of cancer. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons,

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and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rarefaction: The reduction of the density of a substance; the attenuation of a gas. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Opioid: Cell membrane proteins that bind opioids and trigger intracellular changes which influence the behavior of cells. The endogenous ligands for opioid receptors in mammals include three families of peptides, the enkephalins, endorphins, and dynorphins. The receptor classes include mu, delta, and kappa receptors. Sigma receptors

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bind several psychoactive substances, including certain opioids, but their endogenous ligands are not known. [NIH] Receptors, Opioid, kappa: A class of opioid receptors recognized by its pharmacological profile. Kappa opioid receptors bind dynorphins with a higher affinity than endorphins which are themselves preferred to enkephalins. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiratory Paralysis: Complete or severe weakness of the muscles of respiration. This condition may be associated with motor neuron diseases; peripheral nerve disorders; neuromuscular junction diseases; spinal cord diseases; injury to the phrenic nerve; and other

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disorders. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restless legs: Legs characterized by or showing inability to remain at rest. [EU] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Saline: A solution of salt and water. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH]

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Saxitoxin: Poison found in certain edible mollusks at certain times; elaborated by Gonyaulax species (Dinoflagellate protozoans) and consumed by mollusks, fishes, etc. without ill effects; it is neurotoxic and causes respiratory paralysis and other effects in mammals, known as paralytic shellfish poisoning. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizophrenia, Catatonic: A type of schizophrenia characterized by abnormality of motor behavior which may involve particular forms of stupor, rigidity, excitement or inappropriate posture. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH]

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Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedatives, Barbiturate: Those derivatives of barbituric or thiobarbituric acid that are used as hypnotics or sedatives. The structural class of all such derivatives, regardless of use, is barbiturates. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [NIH] Serrated: Having notches or teeth on the edge as a saw has. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell

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activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Snails: Marine, freshwater, or terrestrial mollusks of the class Gastropoda. Most have an enclosing spiral shell, and several genera harbor parasites pathogenic to man. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of

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dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spasmolytic: Checking spasms; antispasmodic. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH]

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Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spirochete: Lyme disease. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae.

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[EU]

Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strained: A stretched condition of a ligament. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Strontium: An element of the alkaline earth family of metals. It has the atomic symbol Sr, atomic number 38, and atomic weight 87.62. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sublingual: Located beneath the tongue. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulfotransferases: Enzymes which transfer sulfate groups to various acceptor molecules. They are involved in posttranslational sulfation of proteins and sulfate conjugation of exogenous chemicals and bile acids. EC 2.8.2. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH]

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Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Talc: A native magnesium silicate. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tarsus: The region of the articulation between the foot and the leg. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU]

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Tennis Elbow: A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists. [NIH] Tenosynovitis: Inflammation of a tendon sheath. [EU] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracaine: A potent local anesthetic of the ester type used for surface and spinal anesthesia. [NIH]

Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [NIH] Tetrodotoxin: Octahydro-12-(hydroxymethyl)-2-imino-5,9:7,10a-dimethano10aH(1,3)dioxocino(6,5-a)pyrimidine-4,7,10,11,12-pentol. An aminoperhydroquinazoline poison found mainly in the liver and ovaries of fishes in the order Tetradontiformes (pufferfish, globefish, toadfish), which are eaten. The toxin causes paresthesia and paralysis through interference with neuromuscular conduction. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH]

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Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tolmetin: An anti-inflammatory antipyretic and analgesic similar in mode of action to indomethacin. It has been proposed as an antirheumatic agent. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer

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both local and systemic cellular immunity to nonimmune recipients. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Trimebutine: Proposed spasmolytic with possible local anesthetic action used in gastrointestinal disorders. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Turpentine: The concrete oleoresin obtained from Pinus palustris Mill. (Pinaceae) and other species of Pinus. It contains a volatile oil, to which its properties are due, and to which form it is generally used. (Dorland, 28th ed) Turpentine is used as a solvent and an experimental irritant in biomedical research. Turpentine toxicity is of medical interest. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of

Dictionary 255

metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax

256 Pain Medications

and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]

Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venom: That produced by the poison glands of the mouth and injected by the fangs of poisonous snakes. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH]

Dictionary 257

Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [NIH] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

259

INDEX A Abdomen, 183, 192, 198, 208, 219, 222, 249, 252, 255, 256 Abdominal, 5, 14, 22, 68, 87, 116, 135, 136, 147, 183, 202, 220, 232, 234 Abdominal Pain, 68, 87, 116, 135, 136, 147, 183, 220, 234 Abrasion, 63, 183 Abscess, 52, 136, 183 Acceptor, 183, 231, 250, 254 Acclimation, 9, 183 Acetaminophen, 11, 15, 28, 51, 77, 80, 91, 114, 120, 121, 122, 139, 183 Acetylcholine, 183, 184, 197 Acetyltransferases, 92, 183 Acremonium, 183, 196 Activities of Daily Living, 138, 183 Acupuncture Analgesia, 41, 183 Adaptability, 183, 195 Adaptation, 183, 197 Adenocarcinoma, 144, 169, 184 Adenosine, 184, 193, 216, 235 Adjuvant, 20, 60, 184, 211 Adrenergic, 97, 184, 187, 188, 205, 208, 213 Adverse Effect, 89, 90, 111, 184, 206, 246 Aerobic, 184, 209 Aerosol, 91, 184, 229 Afferent, 56, 71, 77, 99, 184, 249 Affinity, 74, 82, 89, 184, 204, 221, 243, 247 Age Groups, 52, 184 Age of Onset, 184, 255 Aged, 80 and Over, 184 Agonist, 51, 56, 64, 71, 72, 74, 82, 84, 87, 93, 95, 96, 97, 99, 106, 184, 193, 205, 213, 227 Agrin, 4, 184 Akathisia, 184, 188 Albumin, 184, 192, 236, 246, 251 Aldehyde Dehydrogenase, 92, 185 Aldehydes, 185, 257 Aldose Reductase Inhibitor, 104, 185 Alertness, 180, 185, 193 Alfentanil, 12, 13, 185 Algorithms, 185, 191 Alimentary, 143, 185, 233 Alkaline, 60, 185, 190, 193, 250 Alkaloid, 37, 185, 193, 194, 198, 225, 232, 235, 241

Allergen, 120, 185, 203 Aloe, 102, 185 Alpha Particles, 185, 241 Alternative medicine, 31, 47, 114, 185, 199 Amebiasis, 185, 224 Amino Acid Sequence, 101, 185, 191 Amino Acids, 60, 185, 186, 191, 194, 208, 229, 233, 236, 239, 244, 254, 255 Amphetamines, 186, 198 Anaesthesia, 14, 15, 22, 90, 186, 217 Anaesthetic, 52, 186 Anal, 8, 186, 226, 233 Analgesics, Opioid, 3, 186 Analog, 11, 186, 197, 204 Analogous, 186, 215, 253 Anemia, 38, 76, 179, 186, 223 Anesthetics, 3, 24, 63, 90, 107, 135, 139, 186, 190, 208 Angina, 109, 142, 148, 160, 169, 186 Angina Pectoris, 169, 186 Angiography, 150, 186 Angioplasty, 150, 186 Animal model, 12, 85, 186 Anionic, 64, 186 Anions, 184, 187, 219, 246 Ankle, 139, 143, 145, 150, 155, 156, 160, 168, 187 Antagonism, 11, 99, 187, 193 Anti-Anxiety Agents, 187, 240, 253 Antibacterial, 187, 197, 248 Antibiotic, 110, 165, 187, 190, 193, 208, 221, 233, 248, 252 Antibody, 5, 184, 187, 199, 213, 215, 217, 218, 223, 225, 242, 248 Anticoagulant, 187, 239 Anticonvulsants, 187, 190 Antidepressive Agents, 187, 240 Antiemetic, 187, 188, 197, 205, 224 Antigen, 184, 187, 199, 215, 216, 217, 218, 223 Antihypertensive, 187, 213 Anti-infective, 187, 194, 219 Anti-Inflammatory Agents, 51, 102, 187, 189, 220 Antioxidant, 52, 79, 187, 189 Antipruritic, 59, 187, 194 Antipsychotic, 50, 188, 197, 228, 253

260 Pain Medications

Antipyretic, 33, 35, 37, 60, 71, 106, 183, 188, 204, 210, 220, 224, 241, 253 Antispasmodic, 188, 231, 248 Antithrombotic, 65, 145, 156, 167, 188, 239 Antitussive, 188, 204, 231, 238 Anuria, 188, 220 Anus, 186, 188, 192, 219, 234, 243 Anxiety, 100, 115, 135, 158, 184, 187, 188, 200, 232, 240, 253 Anxiety Disorders, 188, 232 Anxiolytic, 188, 230 Apathy, 188, 228 Applicability, 70, 188 Aqueous, 32, 33, 35, 69, 70, 79, 188, 190, 202, 221, 222 Arachidonic Acid, 188, 238 Arginine, 60, 188 Aromatic, 188, 194, 221, 248, 250 Arterial, 153, 188, 201, 216, 239, 251 Arteries, 188, 192, 201, 225, 227 Arteriolar, 188, 193 Arterioles, 188, 192, 194, 227 Arthralgia, 58, 69, 86, 188 Arthritis, Rheumatoid, 69, 188 Arthroscopy, 23, 24, 189 Articular, 19, 189, 231 Ascorbic Acid, 58, 86, 189, 216 Asepsis, 87, 189 Aspartate, 56, 189, 204, 220 Asphyxia, 189, 229 Asthenia, 90, 189 Astringents, 102, 189, 208 Asymptomatic, 152, 185, 189, 232 Atmospheric Pressure, 189, 216 Atrial, 142, 189, 201 Atrial Fibrillation, 142, 189 Atrium, 189, 201, 256 Atrophy, 189 Auricular, 41, 189 Autodigestion, 189, 232 Autoimmune disease, 6, 189, 226 Autologous, 6, 189 Autonomic, 183, 188, 189, 230, 234, 249 Autonomic Nervous System, 189, 234 Axons, 72, 190, 226, 228, 230, 234, 237, 249 Azithromycin, 110, 190 B Babesiosis, 190, 241 Back Pain, 8, 39, 62, 144, 153, 158, 169, 190, 222 Bacteria, 52, 187, 190, 200, 207, 210, 211, 225, 248, 255

Bactericidal, 190, 208 Bacteriorhodopsin, 4, 190 Bacteriostatic, 190, 208 Bacterium, 190, 200 Barbiturates, 94, 120, 190, 246 Barium, 140, 190 Basal Ganglia, 188, 190, 197 Base, 12, 70, 79, 99, 190, 203, 209, 213, 220, 251, 255 Benign, 69, 190, 213, 228, 242 Benzaldehyde, 190 Benzocaine, 66, 120, 190 Benzoin, 59, 190 Benzyl Alcohol, 59, 191 Beta-Endorphin, 94, 191 Bewilderment, 191, 200 Bile, 191, 207, 211, 222, 237, 249, 250 Bile Acids, 191, 249, 250 Bile Ducts, 191, 211, 237 Biliary, 74, 82, 159, 191, 232, 237 Biliary Tract, 74, 82, 191, 232 Bilirubin, 184, 191, 211 Bioavailability, 79, 99, 191 Biochemical, 191, 220, 221, 231, 239, 246 Biological Transport, 191, 204 Biopsy, 191, 234 Biosynthesis, 58, 86, 188, 191 Biotechnology, 13, 109, 114, 129, 191 Biotransformation, 12, 191 Bipolar Disorder, 162, 191 Bladder, 77, 104, 191, 202, 222, 226, 228, 239, 243, 255 Blastocyst, 191, 200, 236 Bloating, 192, 220 Blood Coagulation, 192, 193, 252 Blood Coagulation Factors, 192 Blood Glucose, 192, 214 Blood Platelets, 192, 246 Blood pressure, 161, 181, 187, 192, 196, 216, 225, 229, 234, 247 Blood Proteins, 94, 192 Blood vessel, 58, 86, 186, 192, 194, 195, 196, 201, 209, 222, 224, 234, 247, 252, 256 Blood Volume, 136, 192 Body Fluids, 192, 206, 210, 230, 247 Bolus, 90, 100, 192 Bolus infusion, 192 Bolus injection, 100, 192 Bone Marrow, 192, 198, 202, 217, 222, 225 Bone metastases, 165, 192 Bone scan, 192, 245 Bone Substitutes, 138, 192

Index 261

Bowel, 87, 116, 144, 186, 192, 204, 211, 219, 221, 234, 250 Bowel Movement, 116, 192, 204, 250 Brachial, 192, 215 Brachytherapy, 193, 219, 242 Bradykinin, 69, 193, 220, 236 Branch, 56, 169, 177, 193, 233, 241, 248, 252 Breakdown, 193, 204, 211 Breast Implants, 152, 193 Broad-spectrum, 193, 196 Bronchi, 193, 208 Bronchiseptica, 193, 235 Bronchitis, 165, 193, 208 Buccal, 193, 222, 249 Bunion, 160, 193 Bupivacaine, 63, 70, 193, 208, 221 Buprenorphine, 20, 51, 72, 83, 84, 193 Butorphanol, 80, 193 C Caffeine, 16, 28, 54, 193, 241 Calcium, 77, 193, 199, 229, 232, 246 Calendula, 102, 194 Callus, 194, 220 Camphor, 52, 194, 221 Cannabidiol, 194 Cannabinoids, 93, 194 Cannabinol, 194 Capillary, 193, 194, 256 Capillary Permeability, 193, 194 Capsaicin, 53, 55, 77, 121, 194 Capsicum, 55, 194 Capsules, 67, 70, 194, 205, 210, 212 Carbohydrate, 194, 212, 236 Carbon Dioxide, 194, 236 Carboxy, 96, 194 Carboxylic Acids, 64, 194 Carcinogen, 194, 225 Carcinogenic, 194, 238, 249 Cardiac, 146, 166, 189, 193, 194, 197, 201, 208, 211, 221, 227, 249 Cardiovascular, 80, 139, 145, 146, 167, 194, 209, 246 Carotene, 194, 244 Carotenoids, 194, 195 Case report, 195, 198 Case series, 195, 198 Catalepsy, 93, 195 Cataract, 148, 195 Catheterization, 186, 195 Cations, 195, 219 Cauda Equina, 195, 245 Caudal, 115, 195, 216, 236

Causality, 15, 195 Cell Death, 72, 73, 195, 228 Cell Division, 190, 195, 224, 225, 236, 238 Cell membrane, 191, 195, 211, 227, 235, 242, 247 Cellobiose, 195 Cellulose, 61, 94, 195, 211, 224, 236 Central Nervous System, 53, 56, 65, 72, 74, 82, 83, 93, 96, 183, 186, 190, 193, 196, 197, 198, 206, 211, 213, 225, 226, 227, 229, 230, 246 Central Nervous System Infections, 196, 213 Centrifugation, 196, 225 Cephalosporins, 110, 196 Cerebellar, 196, 254 Cerebellar Diseases, 196, 254 Cerebral, 190, 196, 203, 208, 209, 223, 232, 240, 241, 248 Cerebrospinal, 54, 72, 196 Cerebrospinal fluid, 54, 72, 196 Cerebrospinal Fluid Pressure, 54, 72, 196 Cerebrovascular, 196, 229 Cervical, 69, 138, 150, 196, 227 Cervix, 196, 210, 243 Character, 186, 196, 203 Chelation, 104, 196 Chemoreceptor, 188, 196 Chemotherapy, 16, 56, 73, 145, 147, 170, 196, 202, 230 Chest Pain, 137, 169, 196 Chloroform, 52, 196 Chlorpromazine, 50, 123, 197 Cholecystokinin, 24, 197 Cholesterol, 191, 197, 201, 211, 249 Choline, 76, 197 Cholinergic, 73, 188, 197 Chorea, 188, 197 Chromatin, 197, 229, 248 Chromosome, 197, 200, 221 Chronic, 5, 8, 9, 10, 11, 12, 14, 16, 18, 20, 23, 28, 51, 53, 59, 64, 65, 69, 72, 77, 83, 84, 96, 97, 101, 105, 109, 110, 111, 134, 142, 143, 144, 145, 147, 148, 152, 153, 154, 157, 159, 161, 164, 170, 181, 185, 188, 190, 193, 197, 207, 218, 220, 222, 232, 237, 247, 250, 255, 257 Chronic renal, 111, 197, 255 Ciliary, 73, 197, 226, 246, 255 Ciliary Body, 197, 246, 255 Cinchona, 197, 241 CIS, 197, 244

262 Pain Medications

Cisplatin, 197, 230 Citrus, 189, 197 Clindamycin, 110, 197 Clinical study, 12, 198, 201 Clinical trial, 4, 12, 16, 76, 84, 129, 198, 200, 201, 202, 205, 240, 242 Cloning, 191, 198 Coca, 198 Cocaine, 63, 198 Codeine, 24, 43, 51, 64, 74, 79, 82, 96, 120, 122, 198, 204, 215, 231, 232 Coenzyme, 183, 189, 198 Cofactor, 198, 239, 252 Cognition, 198, 228 Cognitive restructuring, 198, 250 Colectomy, 18, 198 Colitis, 198, 220 Collagen, 58, 86, 189, 198, 211, 238 Colloidal, 61, 94, 184, 198, 246 Colonoscopy, 116, 198 Colony-Stimulating Factors, 198, 213 Combinatorial, 11, 199 Complement, 199, 236 Complementary and alternative medicine, 31, 47, 199 Complementary medicine, 31, 199 Complete remission, 199, 243 Computational Biology, 129, 199 Computed tomography, 116, 199, 200, 245 Computerized axial tomography, 199, 200, 245 Computerized tomography, 116, 199, 200 Conception, 200, 210 Conduction, 81, 200, 227, 228, 252 Cone, 200, 250 Confusion, 111, 143, 180, 200, 205, 216, 228, 255 Congenita, 200, 241 Congestion, 188, 200, 208 Conjugated, 200, 202 Conjugation, 12, 92, 191, 200, 250 Connective Tissue, 189, 192, 198, 200, 201, 211, 222, 224, 234, 244 Conscious Sedation, 135, 200 Consciousness, 57, 75, 78, 86, 92, 135, 185, 186, 187, 200, 203, 205 Constipation, 10, 54, 72, 74, 82, 83, 89, 104, 116, 135, 136, 150, 188, 200, 211, 220, 234 Consumption, 81, 200, 204, 206, 209, 230, 232 Contraceptive, 110, 200 Contraindications, ii, 200

Control group, 23, 76, 200, 242 Controlled clinical trial, 76, 201, 242 Convalescence, 71, 201 Conventional therapy, 201 Conventional treatment, 135, 201 Coordination, 201, 226 Cor, 201 Cornea, 63, 201, 241, 245, 255 Corneal Stroma, 63, 201 Corneum, 12, 201, 208 Coronary, 142, 150, 166, 167, 186, 201, 225, 227 Coronary Circulation, 186, 201 Coronary heart disease, 166, 201 Coronary Thrombosis, 201, 225, 227 Cortex, 100, 201, 209, 238, 241 Cortical, 201, 209, 246 Corticosteroids, 110, 201, 212, 237 Cortisone, 202, 237 Cranial, 28, 196, 202, 213, 219, 232, 234, 255 Craniocerebral Trauma, 202, 213, 253 Crowns, 139, 202 Cryptosporidiosis, 190, 202 Curative, 72, 202, 252 Cutaneous, 55, 59, 60, 202, 222, 233 Cyclic, 138, 193, 202, 239, 245 Cyclic Vomiting Syndrome, 138, 202 Cyclosporine, 110, 202 Cystitis, 69, 134, 202 Cytochrome, 92, 202 Cytokine, 9, 202 Cytoplasm, 195, 202, 213, 225, 229, 244 Cytotoxic, 194, 202, 230, 242, 247 Cytotoxic chemotherapy, 202, 230 D Databases, Bibliographic, 129, 202 Decidua, 203, 236 Degenerative, 53, 69, 83, 151, 167, 203, 213, 226, 231, 244 Dehydration, 138, 203 Delirium, 143, 162, 188, 203 Delivery of Health Care, 203, 214 Dementia, 9, 157, 164, 188, 203 Demyelinating Diseases, 203, 227 Dendrites, 203, 229 Density, 60, 196, 203, 230, 236, 242, 248 Depersonalization, 203, 232, 245 Depressive Disorder, 170, 203, 222 Derealization, 203, 232 Dermal, 53, 203 Desensitization, 77, 203

Index 263

Deuterium, 203, 215 Dextromethorphan, 55, 204 Dextrorphan, 55, 204 Diabetes Mellitus, 38, 160, 168, 204, 212, 214, 218 Diagnosis-Related Groups, 7, 204 Diagnostic Imaging, 116, 204 Diagnostic procedure, 49, 114, 204 Diarrhea, 90, 116, 144, 185, 202, 204, 208, 211, 220 Diastolic, 204, 216 Diclofenac, 15, 64, 73, 82, 204 Diclofenac Sodium, 204 Diffusion, 60, 67, 70, 90, 191, 194, 204, 218 Diflunisal, 51, 79, 106, 204 Digestion, 185, 191, 192, 204, 206, 219, 222, 233, 249 Digestive system, 204, 226 Digestive tract, 110, 204, 247 Dihydrotestosterone, 204, 243 Dilatation, 186, 204, 238 Dilation, 193, 204 Direct, iii, 97, 104, 119, 204, 205, 212, 215, 226, 232, 241, 243, 251 Disinfectant, 204, 208 Disorientation, 200, 203, 205, 248 Dissection, 151, 205 Dissociation, 184, 205 Distal, 205, 234, 237 Diuresis, 83, 193, 205 Diverticula, 136, 205 Diverticulitis, 136, 205 Diverticulum, 136, 205 Dizziness, 74, 82, 89, 104, 205, 232, 256 Domperidone, 78, 205 Dopamine, 188, 197, 198, 205, 224 Dorsal, 56, 71, 205, 236, 249 Dorsum, 205 Dosage Forms, 61, 70, 88, 95, 205 Double-blinded, 76, 205 Drug Interactions, 123, 124, 205 Drug Tolerance, 206, 253 Drug Toxicity, 195, 206 Drug Utilization, 18, 206 Duct, 195, 206, 209, 256 Duodenum, 87, 191, 206, 249 Dyes, 67, 190, 206, 229 Dynorphins, 94, 206, 230, 242, 243 Dyskinesia, 50, 188, 206 Dysmenorrhea, 37, 39, 74, 82, 166, 206, 236 Dyspepsia, 90, 151, 206 Dysphoria, 74, 75, 82, 206

Dysphoric, 99, 203, 206 Dyspnea, 206, 232 Dystonia, 188, 206 Dystrophy, 134, 148, 206 E Eating Disorders, 163, 206 Effector, 183, 199, 206, 228, 229 Effector cell, 206, 228, 229 Efficacy, 5, 7, 10, 12, 13, 14, 15, 17, 18, 22, 23, 24, 28, 65, 73, 80, 82, 87, 108, 206 Ejaculation, 206, 246 Elastin, 198, 206 Elective, 206, 247 Electrolyte, 135, 138, 203, 206, 210, 220, 230, 237, 247, 255 Electrons, 187, 190, 207, 219, 231, 241, 242 Embryo, 73, 191, 207, 217 Emetic, 79, 207 Emodin, 185, 207 Emollient, 66, 207, 212, 220, 230 Encephalitis, 207 Encephalomyelitis, 72, 207 Endarterectomy, 186, 207 Endemic, 207, 223, 249 Endorphin, 69, 94, 191, 207 Endoscopy, 140, 207 Endotoxin, 207, 254 End-stage renal, 197, 207 Enhancer, 53, 75, 207 Enkephalin, 69, 191, 207 Enterohepatic, 207, 250 Enterohepatic Circulation, 207, 250 Environmental Health, 128, 130, 207 Enzymatic, 193, 195, 199, 207, 215, 244 Enzyme, 51, 185, 198, 206, 207, 217, 220, 224, 232, 233, 236, 240, 243, 246, 252, 254, 256, 257 Epicondylitis, 80, 207 Epidemic, 207, 249 Epidermis, 87, 201, 208, 215 Epidural, 22, 24, 101, 208 Epigastric, 208, 232 Epinephrine, 184, 205, 208, 230 Epithelial, 63, 184, 191, 197, 203, 208 Epithelial Cells, 208 Epithelium, 63, 208, 211, 219 Erection, 208, 237 Erythema, 208, 255 Erythrina, 44, 45, 208 Erythrocyte Volume, 192, 208 Erythrocytes, 186, 190, 192, 208, 243 Erythromycin, 110, 190, 208

264 Pain Medications

Esophagus, 204, 208, 249 Ethanol, 35, 208 Etidocaine, 63, 208 Eucalyptus, 53, 208 Euphoria, 83, 139, 208 Evacuation, 200, 209, 221 Evoke, 209, 249 Excipients, 60, 61, 95, 98, 209 Excitatory, 56, 64, 89, 95, 96, 209, 212 Excrete, 188, 209, 220 Exercise Test, 141, 209 Exhaustion, 187, 202, 209, 221, 223 Exocrine, 197, 209, 232 Exogenous, 101, 191, 209, 250, 255 Extensor, 209, 252 External-beam radiation, 209, 242 Extracellular, 200, 209, 247 Extracorporeal, 24, 209 Extraction, 53, 209 Extrapyramidal, 50, 184, 188, 205, 209 Extremity, 139, 153, 209 Exudate, 209, 230 F Facial, 50, 209 Family Planning, 129, 209 Family Therapy, 135, 209 Fat, 59, 188, 192, 194, 201, 209, 220, 221, 226, 230, 244, 251 Fatigue, 9, 58, 86, 170, 180, 209, 214, 226 Fatty acids, 34, 50, 59, 102, 184, 194, 209, 238 Febrile, 210, 223, 249 Feces, 200, 210, 250 Femoral, 137, 210 Femur, 210 Fenoprofen, 51, 210 Fentanyl, 12, 24, 43, 72, 93, 121, 185, 210 Fetus, 110, 210, 236, 237, 255 Fibrin, 192, 210, 234, 252 Filler, 61, 94, 210 Filtration, 59, 210, 220 Fistula, 136, 210 Flank Pain, 69, 210 Flatus, 210, 211 Flavoring Agents, 208, 210 Flexion, 210, 213 Fluid Therapy, 210, 230 Flurbiprofen, 43, 51, 210 Fold, 11, 210 Follow-Up Studies, 9, 210 Foot Bones, 139, 210 Forearm, 192, 210, 252

Fractionation, 165, 210 Fructose, 76, 210 Functional Disorders, 116, 211 Fungi, 200, 211, 225 Fungus, 196, 211 G Gallbladder, 183, 191, 197, 204, 211, 222 Gallstones, 135, 211 Gamma Rays, 211, 241, 242 Ganglia, 73, 183, 188, 190, 197, 211, 228, 234, 249 Gap Junctions, 211, 251 Gas, 135, 139, 194, 204, 210, 211, 215, 219, 229, 242, 250 Gastric, 67, 79, 138, 140, 189, 205, 211, 215, 233, 238 Gastric Juices, 211, 233 Gastric Mucosa, 211, 233 Gastrin, 211, 215 Gastritis, 69, 211 Gastrointestinal tract, 70, 88, 208, 211, 220, 246 Gelatin, 67, 211, 212, 250 Gels, 70, 120, 212 Gemcitabine, 169, 212 Gene, 76, 109, 191, 212 Genetics, 139, 140, 200, 212 Genital, 39, 141, 212 Gestation, 212, 236 Giardiasis, 212, 224 Ginseng, 42, 43, 45, 212 Gland, 58, 86, 136, 202, 212, 222, 232, 239, 245, 249, 252 Glottis, 212, 215, 235 Glucocorticoid, 212, 237 Gluconeogenesis, 212 Glucose, 185, 189, 192, 195, 204, 212, 213, 214, 216, 218, 244, 248 Glucose Intolerance, 204, 212 Glucuronic Acid, 212, 214 Glutamate, 19, 56, 204, 212 Glycerol, 52, 70, 212, 235 Glycine, 56, 212 Glycogen, 213, 226 Glycols, 70, 213 Glycoprotein, 213, 221, 252, 254 Gonadal, 213, 249 Governing Board, 213, 237 Graft, 138, 213, 215, 217 Granulocyte Colony-Stimulating Factor, 170, 198, 213 Granulocytes, 198, 213, 247, 257

Index 265

Growth, 59, 66, 73, 187, 190, 195, 213, 220, 223, 228, 229, 236, 245, 252, 254, 257 Guanabenz, 97, 213 Guanidine, 97, 213 H Hair follicles, 213, 257 Half-Life, 213, 236 Hallucinogens, 213, 240 Hallux Rigidus, 155, 213 Haloperidol, 50, 213 Haptens, 184, 213 Headache, 8, 40, 89, 151, 160, 162, 163, 180, 193, 213, 214, 216 Headache Disorders, 213, 214 Health Care Costs, 8, 214 Health Expenditures, 214 Health Promotion, 137, 214 Heart failure, 142, 149, 155, 156, 214 Hematuria, 152, 214 Heme, 191, 202, 214, 232, 237 Hemodialysis, 214, 220 Hemoglobin, 76, 186, 208, 214, 221 Hemorrhage, 202, 213, 214 Hemostasis, 214, 246 Heparin, 156, 214 Hepatic, 12, 185, 203, 214 Hepatotoxicity, 12, 214 Hereditary, 135, 214, 226 Heredity, 105, 212, 214 Herpes, 39, 41, 141, 215 Herpes Zoster, 39, 41, 215 Heterogeneity, 184, 215 Hiccup, 197, 215 Histamine, 188, 215 Homologous, 215, 251 Hormonal, 136, 189, 215 Hormone, 140, 166, 191, 201, 202, 208, 211, 215, 218, 219, 238, 244, 245, 246, 252 Hormone Replacement Therapy, 140, 215 Hormone therapy, 166, 215 Horny layer, 208, 215 Hospice, 10, 215 Hospital Costs, 204, 215 Host, 190, 215, 217, 255, 256 Humeral, 80, 215, 252 Hydrocodone, 44, 74, 82, 88, 114, 121, 215 Hydrofluoric Acid, 215, 247 Hydrogel, 67, 215 Hydrogen, 10, 65, 78, 87, 183, 190, 194, 203, 215, 216, 225, 226, 229, 231, 240 Hydrogen Breath Test, 10, 216

Hydrolysis, 191, 195, 197, 216, 233, 236, 240 Hydromorphone, 12, 72, 216 Hydrophilic, 215, 216 Hydroxylysine, 198, 216 Hydroxyproline, 198, 216 Hyperalgesia, 56, 64, 89, 95, 96, 216 Hyperbaric, 104, 216 Hyperbaric oxygen, 104, 216 Hyperplasia, 69, 216 Hypersensitivity, 77, 185, 203, 216, 244 Hypertension, 15, 156, 201, 213, 216, 253, 255 Hypertrophy, 201, 216 Hypnotic, 8, 216 Hypoglycaemia, 203, 216 Hypotension, 50, 54, 72, 74, 82, 188, 216 Hypothalamus, 183, 190, 207, 216 Hypothermia, 93, 216 Hypoxanthine, 216, 257 Hypoxia, 203, 216 Hysterectomy, 14, 216 I Ibuprofen, 5, 15, 23, 25, 28, 44, 51, 60, 61, 67, 73, 79, 80, 82, 94, 95, 120, 121, 139, 217, 220 Immune response, 184, 187, 189, 202, 213, 217, 250, 255, 256 Immune Sera, 217 Immune system, 206, 217, 222, 226, 255, 257 Immunity, 217, 230, 254 Immunization, 153, 217, 238 Immunodeficiency, 137, 217 Immunologic, 217, 242 Immunology, 184, 217 Immunotherapy, 203, 217 Impairment, 191, 203, 206, 217, 219, 224, 240 Implant radiation, 217, 219, 242 In vitro, 11, 12, 20, 72, 73, 94, 98, 217 In vivo, 11, 73, 94, 214, 217, 250 Incision, 71, 198, 217, 219, 234, 239 Incubation, 217, 235 Incubation period, 217, 235 Indicative, 106, 217, 233, 256 Indomethacin, 44, 217, 253 Induction, 188, 217, 220, 238 Infant, Newborn, 184, 218 Infarction, 141, 142, 148, 159, 166, 201, 218, 225, 227 Infiltration, 17, 218, 238

266 Pain Medications

Infusion, 6, 12, 24, 90, 100, 192, 218 Ingestion, 11, 218, 224, 236 Inhalation, 91, 93, 184, 215, 218, 236 Inlay, 218, 244 Innervation, 73, 218 Inorganic, 65, 197, 218 Inositol, 76, 218, 245 Insecticides, 218, 257 Insomnia, 55, 164, 218 Insulator, 218, 226 Insulin, 218, 255 Intensive Care, 7, 218 Intermittent, 210, 218, 222 Internal radiation, 218, 242 Intervertebral, 219, 222, 242, 245 Intervertebral Disk Displacement, 219, 222, 242, 245 Intestinal, 67, 79, 87, 136, 138, 195, 197, 202, 219 Intestinal Obstruction, 136, 219 Intestine, 88, 191, 192, 206, 207, 212, 215, 216, 219, 221, 234, 243, 247 Intoxication, 203, 219, 257 Intracellular, 193, 218, 219, 237, 239, 242, 243, 245, 246 Intracranial Pressure, 196, 219 Intramuscular, 219, 233 Intraocular, 63, 219 Intraocular pressure, 63, 219 Intravenous, 10, 17, 18, 76, 135, 136, 139, 165, 181, 192, 218, 219, 233 Intrinsic, 184, 219 Invasive, 217, 219, 223 Involuntary, 50, 197, 219, 227, 243, 247, 248 Iodine, 52, 219 Ion Channels, 219, 229, 251 Ion Exchange, 55, 196, 219 Ions, 69, 190, 205, 206, 213, 215, 219, 225, 247 Iris, 201, 219, 241, 255 Irritable Bowel Syndrome, 87, 116, 144, 211, 219 J Joint, 5, 14, 40, 58, 68, 69, 86, 105, 137, 151, 188, 189, 213, 220, 224, 231, 234, 249, 251 K Kallidin, 193, 220 Kb, 128, 220 Keratosis, 160, 220 Ketamine, 14, 19, 220 Ketoprofen, 67, 73, 79, 82, 139, 220

Ketorolac, 17, 44, 121, 220 Kidney Disease, 106, 128, 134, 136, 138, 157, 159, 220 Kidney Failure, 111, 207, 220 Kidney Failure, Acute, 220 Kidney Failure, Chronic, 220 Kidney stone, 105, 220 L Labile, 101, 199, 220 Lactose Intolerance, 216, 220 Lactulose, 10, 220 Lanolin, 79, 220 Large Intestine, 204, 219, 221, 243, 247 Lassitude, 58, 86, 221 Lauraceae, 33, 221 Laxative, 207, 220, 221, 224, 248 Lectins, 208, 221 Length of Stay, 204, 221 Lens, 195, 200, 221 Lesion, 221, 251, 255 Lethargy, 138, 180, 221 Leucine, 191, 221, 233 Leukocytes, 192, 213, 217, 221, 225, 229, 254 Levo, 122, 221, 238 Levorphanol, 204, 221 Library Services, 176, 221 Lidocaine, 56, 63, 70, 191, 221 Ligament, 221, 239, 249, 250 Ligands, 77, 221, 242 Lincomycin, 197, 221 Linkages, 90, 101, 214, 221, 233 Lipid, 18, 136, 157, 194, 197, 212, 218, 221, 222, 226 Lipophilic, 92, 221 Liposome, 90, 222 Lithium, 188, 222 Lithotripsy, 24, 105, 222 Liver scan, 222, 245 Localized, 55, 75, 90, 92, 218, 222, 227, 236, 255 Locomotion, 222, 236 Locomotor, 93, 222 Long-Term Care, 9, 137, 147, 222 Low Back Pain, 39, 144, 153, 169, 222 Lumbago, 58, 80, 86, 222 Lumbar, 6, 117, 150, 154, 190, 195, 196, 219, 222 Lupus, 167, 222 Lymph, 196, 222 Lymph node, 196, 222 Lymphatic, 39, 218, 222, 224, 252

Index 267

Lymphocyte, 187, 222, 223 Lymphocytic, 35, 222 Lymphoid, 201, 222 Lysine, 60, 216, 222 Lytic, 167, 222 M Magnetic Resonance Imaging, 116, 223, 245 Malaise, 206, 223 Malaria, 76, 197, 223 Malaria, Falciparum, 223 Malaria, Vivax, 223 Malignancy, 6, 223 Malignant, 10, 148, 184, 223, 228, 242 Malnutrition, 12, 185, 189, 223 Manic, 188, 191, 222, 223, 240 Mastectomy, 23, 223 Meat, 59, 223 Medial, 210, 223 Mediate, 64, 96, 205, 223 Mediator, 5, 197, 223, 246 Medical Oncology, 223, 241 Medical Staff, 205, 223 Medicament, 85, 87, 223, 250 MEDLINE, 129, 223 Medullary, 204, 223, 241 Mefenamic Acid, 51, 79, 223 Meiosis, 224, 251 Memantine, 104, 224 Membrane Glycoproteins, 224, 247 Memory, 93, 203, 224 Meninges, 196, 202, 224 Menopause, 166, 224, 236 Menorrhagia, 168, 224 Menstruation, 203, 206, 224 Mental Disorders, 224, 238, 240 Mental Health, iv, 4, 128, 130, 158, 160, 167, 224, 238, 241 Menthol, 52, 224 Mesenchymal, 189, 224 Mesolimbic, 188, 224 Metabolic disorder, 138, 224 Metabolite, 12, 191, 204, 224 Metatarsal Bones, 210, 224 Metatarsophalangeal Joint, 213, 224 Metatarsus, 210, 224 Methanol, 36, 224 Methionine, 191, 224 Methyl salicylate, 52, 224 Methylcellulose, 61, 94, 224 Metoclopramide, 79, 224 Metronidazole, 110, 224

MI, 32, 33, 86, 109, 182, 225 Microbe, 225, 253 Microbiological, 66, 225 Microbiology, 184, 225 Microorganism, 198, 225, 256 Microsomal, 92, 225 Migration, 63, 75, 225 Mitochondrial Swelling, 225, 228 Mitosis, 63, 221, 225 Mobility, 90, 100, 105, 225 Modification, 225, 241 Molecular, 4, 129, 131, 156, 190, 191, 199, 213, 214, 220, 225, 238, 243, 254 Molecular Structure, 225, 254 Molecule, 187, 190, 194, 198, 199, 205, 206, 216, 225, 231, 242, 246 Monitor, 225, 230 Monoclonal, 5, 225, 242 Monocytes, 5, 221, 225 Mononuclear, 225, 254 Morphological, 207, 211, 225 Morphology, 195, 226 Motility, 10, 87, 138, 211, 217, 226, 238, 246 Motion Sickness, 226, 227 Motor Neurons, 73, 226 Movement Disorders, 188, 226 Mucociliary, 226, 247 Mucosa, 83, 193, 197, 211, 222, 226, 238, 249 Mucositis, 6, 226 Multiple sclerosis, 72, 226 Multivariate Analysis, 14, 226 Muscle Fatigue, 58, 86, 226 Muscle Fibers, 184, 226 Muscle Relaxation, 186, 226, 227, 228 Muscular Dystrophies, 206, 226 Mutagenesis, 4, 226 Mutagens, 226 Myalgia, 58, 86, 226 Myasthenia, 213, 226 Myelin, 72, 203, 226, 230 Myelin Sheath, 72, 226, 230 Myocardial infarction, 141, 142, 148, 159, 166, 201, 225, 227 Myocardial Ischemia, 186, 227 Myocardium, 186, 225, 227 Myopia, 227, 241 Myotonia, 227, 241 N Nalbuphine, 51, 99, 227 Nalorphine, 51, 227 Naloxone, 83, 84, 99, 191, 227

268 Pain Medications

Naltrexone, 64, 83, 84, 89, 95, 160, 227 Narcosis, 227 Narcotic, 28, 51, 61, 64, 68, 71, 78, 79, 94, 95, 99, 100, 106, 107, 108, 122, 186, 193, 210, 215, 221, 225, 227, 229, 232, 238, 253 Narcotic Antagonists, 51, 227 Nearsightedness, 227, 241 Neck Pain, 62, 138, 227 Necrosis, 5, 12, 182, 218, 225, 227, 228, 254 Neoplasm, 228, 254 Nephropathy, 16, 179, 220, 228 Nerve, 52, 59, 69, 73, 74, 78, 100, 101, 104, 109, 135, 150, 183, 184, 185, 186, 190, 195, 203, 211, 218, 223, 226, 228, 229, 234, 236, 237, 238, 242, 243, 244, 245, 249, 253, 254, 255 Nerve Endings, 100, 190, 228, 229 Nerve Fibers, 101, 183, 190, 228, 249 Nerve Growth Factor, 73, 228, 229 Neural, 56, 59, 74, 184, 228, 247 Neural Pathways, 56, 59, 74, 228 Neuroeffector Junction, 228 Neurogenic, 77, 228, 255 Neurogenic Inflammation, 77, 228 Neuroleptic, 50, 184, 188, 228, 230 Neuroma, 156, 228 Neuromuscular, 149, 183, 228, 229, 243, 252, 255 Neuromuscular Blockade, 149, 228 Neuromuscular Junction, 183, 228, 229, 243 Neuronal, 73, 77, 89, 94, 227, 229, 234 Neurons, 55, 64, 69, 71, 73, 77, 89, 96, 198, 203, 209, 211, 226, 228, 229, 249, 251 Neuropathy, 69, 104, 185, 229, 234, 245 Neuropeptide, 55, 229 Neuropsychological Tests, 9, 229 Neurotoxic, 229, 245 Neurotoxicity, 204, 229 Neurotransmitters, 99, 229, 237 Neurotrophins, 73, 229 Neutrons, 185, 229, 241 Neutrophils, 5, 213, 221, 229 Nimodipine, 104, 229 Nitrogen, 65, 78, 185, 220, 229, 254 Nitrous Oxide, 50, 135, 139, 229 Nociceptors, 71, 229 Nonverbal Communication, 229, 240 Norepinephrine, 184, 205, 230 Nuclear, 165, 190, 200, 207, 211, 228, 230 Nuclear Medicine, 165, 230

Nuclei, 185, 200, 207, 223, 225, 229, 230, 240 Nucleic acid, 216, 226, 229, 230, 241 Nucleus, 190, 197, 202, 204, 211, 219, 224, 225, 229, 230, 238, 240 Nulliparous, 24, 230 Nutritional Status, 144, 230 Nutritional Support, 7, 230 O Ointments, 62, 70, 79, 205, 230 Oligodendroglia, 227, 230 Oliguria, 220, 230 Omega-3 fatty acid, 102, 230 Ondansetron, 138, 230 Opacity, 195, 203, 230 Ophthalmic, 63, 230 Opioid Peptides, 206, 230 Opium, 74, 75, 82, 100, 225, 230, 232 Opsin, 231, 244 Organelles, 196, 202, 225, 231 Orofacial, 16, 28, 231 Orphenadrine, 91, 122, 231 Orthostatic, 50, 188, 231 Osmosis, 231 Osmotic, 57, 67, 184, 225, 231, 246 Osteoarthritis, 19, 31, 39, 51, 58, 74, 80, 82, 86, 105, 116, 141, 161, 165, 213, 220, 231, 235 Osteoporosis, 14, 40, 161, 231 Otitis, 151, 166, 231 Otitis Media, 151, 166, 231 Otitis Media with Effusion, 166, 231 Outpatient, 24, 154, 231 Ovaries, 231, 243, 252 Overdose, 12, 231 Ovum, 203, 212, 231, 233, 238, 257 Oxidation, 59, 92, 183, 187, 191, 202, 231 Oxidation-Reduction, 191, 231 Oxycodone, 17, 28, 45, 51, 72, 73, 81, 88, 232 Oxygen Consumption, 209, 232 Oxygenase, 65, 232 P Paediatric, 15, 232 Pain Measurement, 28, 232 Pain Threshold, 57, 74, 86, 92, 139, 232 Palate, 232, 249 Palliative, 10, 72, 158, 232, 252 Pancreas, 135, 183, 204, 218, 232 Pancreatic, 144, 169, 197, 232 Pancreatitis, 135, 145, 232 Panic, 158, 232

Index 269

Panic Disorder, 158, 232 Papaverine, 231, 232 Paralysis, 232, 243, 245, 248, 252 Paranasal Sinuses, 232, 247 Parenteral, 65, 71, 83, 86, 101, 121, 233 Paresthesia, 233, 252 Parkinsonism, 188, 231, 233 Paroxysmal, 186, 214, 233, 235, 257 Partial remission, 233, 243 Particle, 222, 233, 248 Patch, 12, 233, 253 Pathogenesis, 111, 233 Pathologic, 73, 191, 201, 216, 233, 243 Patient Compliance, 81, 233 Patient Education, 105, 134, 138, 140, 174, 176, 182, 233 Pellucida, 32, 233 Pelvic, 134, 233, 239 Penicillin, 187, 233 Penis, 206, 233, 237, 243 Pepsin, 233 Pepsin A, 233 Peptic, 140, 233 Peptic Ulcer, 140, 233 Peptide, 72, 104, 191, 197, 230, 233, 236, 239, 240 Peptide Fragments, 72, 233 Perception, 18, 59, 74, 99, 135, 200, 203, 213, 233, 245 Percutaneous, 70, 142, 222, 234 Perforation, 136, 234 Periarthritis, 58, 80, 86, 234 Perineal, 22, 234 Perineal prostatectomy, 22, 234 Perineum, 234 Periodontal disease, 52, 210, 234 Perioperative, 70, 155, 234 Peripheral blood, 6, 234 Peripheral Nerves, 56, 73, 234, 249 Peripheral Nervous System, 72, 73, 203, 226, 234, 237, 250 Peripheral Neuropathy, 104, 234 Peripheral Vascular Disease, 151, 234 Peristalsis, 205, 234 Peritoneum, 234 Peritonitis, 136, 234 Peroral, 65, 234 Pertussis, 93, 234, 257 Pharmaceutical Preparations, 64, 70, 98, 196, 208, 212, 235, 238 Pharmaceutical Solutions, 205, 235 Pharmacokinetic, 11, 20, 28, 65, 235

Pharmacologic, 3, 145, 162, 186, 213, 235, 253, 255 Phospholipids, 209, 218, 235 Phosphorous, 90, 235 Phosphorus, 193, 235 Physical Examination, 105, 116, 135, 235 Physical Therapy, 21, 104, 135, 235 Physiologic, 184, 191, 204, 213, 224, 235, 238, 242, 243, 254 Physiology, 11, 28, 32, 184, 221, 235 Pigments, 194, 235, 244 Pilot study, 22, 235 Piperidines, 50, 235 Piroxicam, 24, 51, 79, 235 Placenta, 110, 236, 238 Plana, 236, 246 Plants, 183, 185, 194, 197, 198, 207, 212, 221, 226, 230, 235, 236, 244, 248, 253, 254 Plaque, 186, 236 Plasma, 87, 89, 98, 184, 192, 195, 198, 210, 211, 212, 214, 220, 236, 246 Plasma protein, 184, 210, 236, 246 Plasma Volume, 192, 236 Poisoning, 20, 203, 206, 219, 227, 236, 245 Polyethylene, 66, 236 Polymers, 192, 236, 239, 250 Polypeptide, 100, 101, 185, 198, 233, 236, 238, 239, 257 Polysaccharide, 187, 195, 236 Posterior, 186, 190, 205, 219, 227, 232, 236, 245 Postmenopausal, 166, 231, 236 Postoperative, 13, 15, 17, 18, 19, 23, 28, 65, 71, 74, 82, 114, 115, 139, 148, 236 Postoperative Period, 114, 139, 236 Postsynaptic, 228, 236, 246, 251 Post-synaptic, 56, 237 Post-traumatic, 80, 214, 226, 237 Potassium, 52, 69, 71, 190, 237 Potassium Cyanide, 190, 237 Potentiating, 92, 237 Practice Guidelines, 130, 140, 141, 142, 148, 149, 152, 157, 165, 169, 170, 237 Precipitating Factors, 195, 214, 237 Precursor, 188, 197, 205, 206, 207, 213, 230, 237, 254 Prednisolone, 237 Prednisone, 110, 237 Prenatal, 152, 207, 237 Prenatal Care, 152, 237 Presynaptic, 228, 237, 251 Presynaptic Terminals, 228, 237

270 Pain Medications

Prevalence, 9, 237 Priapism, 168, 237 Primary Biliary Cirrhosis, 159, 237 Primary Prevention, 145, 238 Probe, 213, 238 Procaine, 52, 63, 221, 238 Progeny, 200, 238 Progesterone, 238, 249 Progestogen, 166, 238 Proglumide, 24, 238 Progression, 186, 238 Progressive, 72, 197, 203, 206, 213, 220, 226, 228, 231, 238, 243, 254 Prolactin, 205, 238 Proline, 198, 216, 238 Promoter, 16, 238 Prone, 105, 238 Prophase, 238, 251 Prophylaxis, 163, 238, 255 Propoxyphene, 45, 51, 122, 238 Propylene Glycol, 66, 238 Prospective Payment System, 204, 238 Prostaglandin, 7, 100, 238 Prostaglandins A, 73, 82, 217, 239 Prostaglandins D, 239 Prostate, 69, 136, 234, 239, 243 Prostate gland, 136, 239 Prostatectomy, 22, 234, 239 Protein C, 4, 184, 185, 239 Protein Conformation, 185, 239 Protein Folding, 4, 239 Protein S, 109, 191, 208, 239, 244, 252 Proteolytic, 52, 69, 199, 240 Protocol, 6, 8, 240 Proton Pump, 190, 240 Protons, 185, 215, 240, 241 Protozoa, 200, 225, 240 Pruritic, 102, 240 Pruritus, 74, 82, 240, 255 Psychiatric, 25, 116, 162, 163, 224, 240 Psychiatry, 7, 9, 25, 163, 240, 250 Psychic, 240, 246 Psychogenic, 101, 240, 255 Psychological Techniques, 115, 240 Psychomotor, 203, 228, 240 Psychosis, 188, 240 Psychotherapy, 104, 209, 240 Psychotomimetic, 84, 240 Psychotropic, 18, 21, 240 Psychotropic Drugs, 18, 240 Public Health, 5, 18, 19, 130, 137, 162, 241 Public Policy, 129, 241

Publishing, 13, 110, 135, 241 Pulmonary, 192, 200, 201, 209, 220, 241, 251, 256 Pulmonary Artery, 192, 241, 256 Pulmonary Edema, 220, 241 Pupil, 201, 204, 241 Purines, 241, 257 Purulent, 183, 241, 255 Pyramidal Tracts, 209, 241 Q Quality of Life, 5, 7, 10, 11, 12, 78, 100, 108, 241 Quaternary, 239, 241 Quinine, 92, 197, 241 R Race, 6, 17, 225, 241 Radial Keratotomy, 63, 241 Radiation, 145, 160, 186, 209, 210, 211, 216, 217, 219, 224, 241, 242, 245, 257 Radiation Oncology, 160, 241 Radiation therapy, 145, 209, 210, 216, 219, 241 Radiculopathy, 242, 245 Radioactive, 192, 213, 215, 217, 218, 222, 230, 242, 245 Radiolabeled, 242 Radiological, 234, 242 Radiology, 143, 230, 241, 242 Radiotherapy, 165, 193, 241, 242 Random Allocation, 242 Randomization, 8, 242 Randomized, 6, 8, 10, 14, 28, 31, 206, 242 Randomized Controlled Trials, 8, 242 Rarefaction, 189, 242 Receptors, Opioid, 206, 242, 243 Receptors, Opioid, kappa, 206, 243 Receptors, Serotonin, 243, 246 Recombination, 200, 243 Rectal, 13, 15, 88, 243 Rectum, 188, 192, 204, 210, 211, 221, 239, 243, 250 Recuperation, 5, 243 Recurrence, 136, 191, 243 Red blood cells, 76, 208, 232, 243, 244 Reductase, 92, 104, 185, 243 Refer, 1, 78, 193, 199, 205, 211, 215, 222, 228, 229, 240, 243 Reflex, 88, 101, 134, 148, 243 Regeneration, 184, 243 Regimen, 3, 5, 6, 54, 100, 123, 206, 233, 243 Relapse, 50, 243 Relaxation Techniques, 105, 139, 243

Index 271

Remission, 5, 191, 199, 233, 243 Renal failure, 203, 243, 255 Renal pelvis, 220, 243 Reproductive system, 239, 243 Research Design, 9, 243 Resorption, 210, 243 Respiratory Paralysis, 243, 245 Response rate, 93, 244 Restless legs, 164, 244 Restoration, 139, 202, 235, 244 Retina, 197, 221, 227, 244, 246, 255 Retinal, 73, 190, 200, 231, 244 Retinol, 244 Retinopathy, 185, 244 Rheumatism, 58, 86, 217, 244 Rheumatoid, 5, 40, 51, 69, 74, 82, 148, 159, 161, 188, 220, 235, 244 Rheumatoid arthritis, 5, 51, 69, 74, 82, 148, 159, 161, 220, 235, 244 Rhinitis, 77, 193, 244 Ribosome, 244, 254 Rigidity, 50, 219, 233, 236, 244, 245 Risk factor, 105, 136, 146, 195, 244 Rods, 231, 244 S Salicylate, 52, 68, 204, 224, 244 Saline, 19, 101, 193, 244 Saponins, 194, 244, 249 Saxitoxin, 82, 245 Scans, 116, 245 Schizoid, 245, 257 Schizophrenia, 195, 245, 257 Schizophrenia, Catatonic, 195, 245 Schizotypal Personality Disorder, 203, 245, 257 Sciatica, 76, 158, 245 Sclera, 245, 255 Sclerosis, 72, 226, 245 Scoliosis, 138, 245 Screening, 85, 146, 166, 198, 245 Scrotum, 234, 245, 252, 256 Sebaceous, 245, 257 Second Messenger Systems, 229, 245 Secretion, 215, 238, 245, 246 Secretory, 228, 245, 251 Sedative, 8, 97, 138, 139, 198, 246 Sedatives, Barbiturate, 190, 246 Seizures, 187, 203, 233, 246 Self Care, 105, 136, 183, 246 Semen, 37, 136, 206, 239, 246 Seminal vesicles, 246, 256 Semisynthetic, 74, 82, 186, 197, 232, 246

Senile, 231, 246 Sensibility, 186, 216, 246 Serotonin, 69, 188, 230, 243, 246, 254 Serrata, 43, 197, 246 Serrated, 246 Serum, 40, 184, 192, 199, 217, 220, 234, 246, 254 Serum Albumin, 192, 246 Shock, 24, 222, 246, 254 Signal Transduction, 218, 246 Signs and Symptoms, 5, 116, 243, 247, 255 Silicon, 61, 67, 94, 247 Silicon Dioxide, 61, 67, 94, 247 Sinusitis, 143, 247 Skeletal, 55, 59, 109, 226, 247, 248 Skeleton, 210, 220, 239, 247 Skull, 202, 219, 247, 251 Small intestine, 191, 206, 212, 215, 216, 219, 247 Smooth muscle, 186, 193, 215, 225, 232, 247, 248, 250 Snails, 104, 247 Sneezing, 235, 247 Social Environment, 241, 247 Social Support, 104, 247, 250 Sodium, 30, 61, 67, 71, 81, 82, 83, 85, 94, 120, 121, 204, 241, 247 Sodium Channels, 85, 241, 247 Solvent, 53, 66, 70, 196, 208, 212, 224, 231, 235, 238, 247, 254 Soma, 248 Somatic, 101, 224, 225, 234, 248, 255 Somatic cells, 224, 225, 248 Somnolence, 75, 89, 248 Sorbitol, 185, 248 Sound wave, 200, 248 Spasm, 188, 215, 231, 248 Spasmodic, 235, 248 Spasmolytic, 248, 254 Spastic, 220, 248 Spatial disorientation, 205, 248 Specialist, 172, 204, 248 Species, 55, 194, 208, 221, 223, 224, 225, 241, 245, 248, 250, 254, 256, 257 Specificity, 184, 248 Spectrometer, 4, 248 Spectrum, 193, 196, 227, 248 Sperm, 136, 197, 248, 252, 256 Spermatozoa, 246, 248, 256 Spices, 194, 248 Spinal Nerve Roots, 242, 245, 249 Spinal Nerves, 234, 249

272 Pain Medications

Spinal Stenosis, 116, 249 Spinous, 208, 249 Spirochete, 249, 251 Spondylitis, 74, 82, 249 Spondylolisthesis, 167, 249 Sporadic, 76, 249 Sprains and Strains, 30, 222, 249 Sprue, 144, 249 Stabilization, 117, 249 Staging, 245, 249 Stasis, 79, 249 Sterile, 59, 101, 249 Sterilization, 59, 249 Steroid, 65, 202, 244, 249 Stimulant, 54, 69, 163, 193, 215, 220, 249 Stimulus, 56, 75, 206, 218, 219, 228, 243, 249, 252 Stomach, 77, 87, 183, 189, 204, 208, 211, 215, 227, 233, 247, 249 Stomatitis, 22, 249 Stool, 11, 219, 221, 250 Strained, 62, 250 Stress, 7, 88, 99, 138, 164, 189, 211, 219, 227, 244, 250, 255 Stress management, 8, 250 Strontium, 170, 250 Stupor, 221, 227, 245, 250 Styrene, 79, 250 Subacute, 218, 247, 250 Subarachnoid, 213, 250 Subclinical, 218, 246, 250 Subcutaneous, 233, 250 Sublingual, 84, 250 Subspecies, 248, 250 Substance P, 208, 224, 238, 245, 250 Suction, 210, 250 Sulfotransferases, 92, 250 Sulindac, 46, 51, 250 Supplementation, 185, 250 Suppositories, 70, 212, 250 Suppression, 63, 250 Surfactant, 57, 251 Symphysis, 239, 251 Symptomatic, 55, 74, 82, 187, 232, 251 Symptomatic treatment, 74, 82, 187, 251 Synapses, 228, 229, 251 Synapsis, 251 Synaptic, 56, 184, 237, 247, 251 Synaptic Transmission, 56, 251 Synergistic, 54, 73, 79, 80, 89, 238, 251 Synovial, 5, 105, 189, 251 Synovial Fluid, 5, 105, 251

Synovial Membrane, 189, 251 Syphilis, 141, 251 Systemic, 28, 75, 101, 120, 121, 122, 123, 167, 188, 192, 203, 208, 218, 237, 242, 249, 251, 254 Systemic disease, 188, 251 Systolic, 156, 216, 251 T Talc, 67, 251 Tardive, 50, 188, 251 Tarsus, 210, 251 Temporal, 56, 214, 251 Tendinitis, 40, 80, 251 Tennis Elbow, 62, 69, 80, 252 Tenosynovitis, 80, 252 Testicles, 136, 245, 252, 256 Testosterone, 243, 252 Tetracaine, 63, 252 Tetracycline, 110, 252 Tetrahydrocannabinol, 24, 37, 194, 252 Tetrodotoxin, 82, 85, 252 Therapeutics, 12, 20, 100, 111, 124, 252 Thermal, 12, 69, 91, 205, 229, 252 Thigh, 210, 252 Thoracic, 190, 252 Thorax, 183, 222, 252, 255 Threshold, 57, 74, 86, 93, 139, 216, 232, 252 Thrombin, 210, 239, 252 Thrombomodulin, 239, 252 Thrombosis, 150, 201, 225, 227, 239, 252, 256 Thrombus, 201, 218, 227, 252, 256 Thymus, 46, 217, 222, 252 Thyroid, 41, 219, 252 Time Management, 250, 253 Tin, 233, 234, 253 Tinnitus, 231, 253 Tolerance, 51, 54, 64, 68, 72, 74, 82, 89, 92, 95, 96, 183, 193, 206, 212, 253 Tolmetin, 80, 253 Tomography, 116, 199, 200, 245, 253 Topical, 53, 55, 62, 63, 70, 75, 87, 90, 100, 101, 102, 104, 121, 135, 189, 208, 253 Toxic, iv, 12, 55, 63, 65, 92, 197, 200, 207, 208, 217, 224, 229, 250, 253 Toxicity, 35, 87, 195, 205, 206, 207, 253, 254 Toxicology, 130, 181, 253 Toxins, 187, 207, 212, 218, 253 Toxoplasmosis, 190, 253 Trace element, 247, 253 Tramadol, 16, 22, 46, 89, 91, 95, 98, 123, 253

Index 273

Tranquilizing Agents, 240, 253 Transcutaneous, 135, 253 Transdermal, 12, 59, 75, 84, 121, 253 Transfection, 191, 253 Transfer Factor, 217, 253 Transferases, 92, 254 Translating, 20, 254 Translation, 11, 208, 254 Translocation, 208, 254 Transmitter, 183, 205, 219, 223, 230, 251, 254 Transplantation, 197, 217, 220, 254 Trauma, 56, 63, 72, 76, 85, 135, 202, 203, 213, 228, 232, 253, 254 Trees, 197, 208, 254 Tremor, 50, 233, 254 Trichomoniasis, 224, 254 Tricyclic, 117, 187, 254 Trigger zone, 188, 254 Trimebutine, 87, 254 Trophic, 73, 254 Tryptophan, 198, 246, 254 Tuberculosis, 200, 222, 254 Tumor Necrosis Factor, 5, 254 Tumour, 22, 254 Turpentine, 52, 254 Type 2 diabetes, 160, 254 U Ulcer, 140, 233, 255 Unconscious, 186, 217, 255 Uraemia, 232, 255 Uremia, 220, 243, 255 Ureter, 222, 243, 255 Urethra, 233, 239, 255 Urinary, 74, 82, 180, 202, 230, 239, 255, 257 Urinary Retention, 74, 82, 255 Urinate, 255 Urine, 92, 180, 181, 188, 191, 198, 205, 213, 214, 220, 230, 243, 255 Urticaria, 16, 255 Uterus, 196, 203, 210, 216, 224, 231, 238, 243, 255 Uvea, 255 Uveitis, 147, 255 V Vaccination, 167, 255 Vaccine, 184, 240, 255 Vagal, 85, 255

Vagina, 196, 224, 243, 255 Vaginitis, 110, 255 Vagus Nerve, 255 Vas Deferens, 136, 256 Vascular, 68, 94, 151, 214, 218, 228, 234, 236, 252, 255, 256 Vasculitis, 232, 256 Vasectomy, 136, 256 Vasodilator, 193, 205, 215, 232, 256 Vein, 219, 230, 256 Venereal, 251, 256 Venom, 55, 56, 256 Venous, 150, 239, 256 Venous Thrombosis, 150, 256 Ventricle, 201, 216, 241, 251, 256 Venules, 192, 194, 256 Vertebrae, 138, 219, 249, 256 Vertebral, 69, 236, 256 Vertigo, 231, 256 Vesicular, 215, 225, 256 Veterinary Medicine, 28, 97, 101, 129, 256 Virulence, 253, 256 Virus, 137, 196, 207, 236, 256 Viscera, 248, 256 Visceral, 41, 88, 101, 190, 234, 255, 256 Visceral Afferents, 88, 190, 255, 256 Vitamin A, 218, 244, 256 Vitro, 11, 12, 20, 72, 73, 94, 98, 214, 217, 256 Vivo, 11, 73, 94, 214, 217, 250, 257 Volition, 219, 257 Vulgaris, 46, 257 W Wakefulness, 203, 257 Wart, 220, 257 White blood cell, 6, 187, 221, 222, 257 Whooping Cough, 235, 257 Withdrawal, 94, 99, 101, 203, 257 X Xanthine, 92, 257 Xanthine Oxidase, 92, 257 Xenobiotics, 92, 257 Xenograft, 186, 257 X-ray, 137, 140, 199, 200, 211, 230, 241, 242, 245, 257 Z Zygote, 200, 257 Zymogen, 239, 257

274 Pain Medications

Index 275

276 Pain Medications

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Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

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