Journal ArticleDOI
On the Mechanism by Which Midazolam Causes Spinally Mediated Analgesia
TLDR
The authors concluded that the segmental analgesia produced by intrathecally midazolam is mediated by the benzodiazepine-GABA receptor complex that is involved in other benzODiazepine actions.Abstract:
The electrical current thresholds for pain (ECTP) in the skin of the neck and tail were measured in rats with chronically implanted lumbar subarachnoid catheters The effects of a benzodiazepine antagonist and a gamma-aminobutyric acid (GABA) antagonist on the analgesic effects of equivalent doses of midazolam, fentanyl, and ketocyclazocine were studied These were the minimum doses producing maximal segmental analgesia when given intrathecally (ie, they all caused a significant and maximum increase in ECTP in the tail, which was similar for all three drugs, but no significant change in the ECTP in the neck) Flumazenil (Ro 15-1788) administration caused a parallel shift to the right of the dose-response curve for midazolam spinal analgesia Segmental analgesia following midazolam was also significantly attenuated (P less than 005) when the selective GABA antagonist bicuculline was given intrathecally at the same time as midazolam The highest dose of bicuculline used (50 pmol) caused no significant attenuation of the segmental analgesic effects of either ketocyclazocine or fentanyl The authors concluded that the segmental analgesia produced by intrathecal midazolam is mediated by the benzodiazepine-GABA receptor complex that is involved in other benzodiazepine actionsread more
Citations
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Chloride Regulation in the Pain Pathway
TL;DR: The current state of knowledge in this area is summarized with particular attention to how such findings relate to endogenous mechanisms of hyperalgesia and allodynia and potential applications for therapeutics based on modulation of intracellular Cl(-) gradients or pharmacological interventions targeting GABA(A) receptors.
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Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study.
TL;DR: It is concluded that intrathecal midazolam is an effective treatment for chronic mechanical low back pain.
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Evidence-Based Review of the Literature on Intrathecal Delivery of Pain Medication
Gary J. Bennett,Mario Serafini,Kim J. Burchiel,Eric Buchser,Ashley Classen,Tim Deer,Stuart L. Du Pen,F. Michael Ferrante,Samuel J. Hassenbusch,Leland Lou,Jan Maeyaert,Richard Penn,Russell K. Portenoy,Richard Rauck,K. Dean Willis,Tony L. Yaksh +15 more
TL;DR: The need for additional large published controlled studies was highlighted by this review, especially for promising agents that have been shown to be safe and efficacious in recent clinical studies.
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Adjuvants to local anesthetics: Current understanding and future trends
TL;DR: Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects.
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Recent management advances in acute postoperative pain.
TL;DR: An overview of new analgesic medications and techniques introduced that target the preoperative, intraoperative, and postoperative periods to better manage acute postoperative pain are provided, with improvements in analgesic efficacy and safety over more traditional pain management approaches.
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