Magdi Hanna

• MD ,FCA,MBBCh
• Managing Director at Analgesics & Pain Research

Introduction: Dexketoprofen/tramadol 25/75 mg (DKP/TRAM) is a fixed-dose combination of a cyclooxygenase inhibitor and opioid receptor agonist. To better understand the efficacy and safety of DKP/TRAM in the treatment of moderate to severe acute lower back pain (LBP) with or without radiculopathy, we carried out a large explorative phase IV interna...

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain, for which the management...

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain whose management is parti...

Introduction: Despite a wide range of treatment approaches and the availability of treatment recommendations or guidelines, no consensus on the most effective pharmacological therapy of low back pain (LBP) has been reached yet. Therefore, additional clinical evidence, particularly if built upon a rigorous clinical trial design, an evidence-based m...

It is crucial that acute pain be promptly and adequately treated in order to prevent it from transitioning to chronic pain, a devastating and sometimes permanent condition that is challenging to treat and associated with disability, reduced quality of life, and depression. Guidelines for the treatment of acute low-back pain (LBP) are predicated on...

A patient-centric approach to pain control represents a paradigm shift in analgesia and one that is both easy to endorse but challenging to execute. As pain mechanisms become increasingly elucidated, the understanding of pain has changed to encompass its complexities. Multiple types and mechanisms of pain have been described, and pain must be seen...

Acute postoperative pain is a normal and expected part of the patient’s postsurgical trajectory, and its intensity, severity, and duration vary with surgery-related and patient factors. In a subset of patients, postoperative pain does not resolve as the tissue heals but instead transitions to chronic postoperative pain, a challenging condition to t...

IntroductionRecently the DAVID study demonstrated the better analgesic efficacy of tramadol hydrochloride/dexketoprofen 75/25 mg (TRAM/DKP) over tramadol hydrochloride/paracetamol 75/650 mg (TRAM/paracetamol) in a model of moderate to severe acute pain following surgical removal of an impacted third molar. The aim of this subpopulation analysis was...

Introduction In 2016, the orally administered fixed-dose combination of dexketoprofen 25 mg and tramadol 75 mg (DKP/TRAM FDC) was approved in Europe for short-term treatment of moderate-to-severe acute pain, an indication that encompasses a wide range of post-operative and non-surgical painful conditions. This has suggested the necessity to have a...

Objectives To compare efficacy/safety of oral tramadol 75 mg/dexketoprofen 25 mg (TRAM/DKP) and TRAM 75 mg/paracetamol 650 mg (TRAM/paracetamol) in moderate to severe pain following surgical removal of impacted lower third molar. Design Multicentre, randomised, double-blind, placebo-controlled, phase IIIb study. Participants Healthy adult patient...

Objective: Dexketoprofen trometamol is a modified non-selective COX inhibitor with a rapid onset of action that is available as both oral and parenteral formulations. The aim of this narrative review was to assess the efficacy and tolerability/safety of dexketoprofen trometamol in acute pain states using the best available published scientific evid...

Background: Untreated and under-treated pain represent one of the most pervasive health problems, which is worsening as the population ages and accrues risk for pain. Multiple treatment options are available, most of which have one mechanism of action, and cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety concern...

Opioids have a pivotal role in the management of moderate to severe Pain in cancer patients. Appreciating their individual pharmacodynamics, as well as their pharmacokinetic profiles, which create subtle, differences in the way each opioid function. This will enhance the rational rather than the empirical use of opioids and minimise their potential...

Cancer Pain provides a comprehensive, practical guide to the management of pain in cancer patients. Beginning with a discussion of current issues in the control of cancer pain, the initial chapters provide a clear, concise explanation of cancer pain syndromes, an up-to-date understanding of the pathophysiological mechanism and recent developments i...

Chronic pain is an extremely prevalent and complicated symptom in patients with active cancer. It is a complex and dynamic syndrome that encompasses multiple pathophysiological mechanisms and one that demands an up-to-date and flexible therapeutic toolkit.

ABSTRACT The prevalence and socioeconomic impact of chronic pain are Europe is described. Effects on quality of life and a proposed strategy for the future are discussed. Recommendations come from the OPENMinds group.  This feature is adapted from paineurope 2011; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. pain...

Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and cons...

Surrogate pain models have been extensively tested in Normal Human Volunteers (NHV). There are few studies that examined pain models in chronic pain patients. Patients are likely to have altered pain mechanisms. It is of interest to test patient pain responses to selective pain stimuli under controlled laboratory conditions. The Institutional Ethic...

Breakthrough pain (BTP) management is an unmet clinical need. BTP is poorly diagnosed, rarely evaluated and inadequately treated. BTP is transitory exacerbation of pain experienced by the patient who has relatively stable and adequately controlled baseline pain. BTP is reported to be common in adults and children with cancer as well as in non-cance...

Opioid analgesics have proven efficacy in the short-term management of chronic cancer pain, but data on their long-term use is more limited. OROS(R) hydromorphone is a controlled-release formulation of oral hydromorphone that may be particularly well suited to long-term management of chronic cancer pain because it provides stable plasma concentrati...

Long-acting opioid formulations are advocated for maintaining pain control in chronic cancer pain. OROS(R) hydromorphone is a sustained-release formulation of hydromorphone that requires dosing once daily to maintain therapeutic concentrations. The objective of this study was to demonstrate the clinical equivalence of immediate-release and sustaine...

Based on the high prevalence of health anxiety among patients with chronic pain and the conceptual overlap between the diagnostic criteria for hypochondriasis and pain disorder, it has been suggested that the cognitive-behavioural theory of severe and persistent health anxiety can be applied to understand the problems presented by a subgroup of chr...

Neuropathic pain remains one of the most challenging pain syndromes; under-diagnosed, poorly managed and associated with significant co-morbidity. With standard therapeutic treatments, responders rarely exceed 50% pain relief and the majority suffer from residual pain. Titration to optimum dose is often limited by dose-related adverse events. This...

Although chronic pain and depression commonly co-occur, causal relationships have yet to be established. A reciprocal relationship, with depression increasing pain and vice versa, is most frequently suggested, but experimental evidence is needed to validate such a view. The most straightforward approach would be a demonstration that increasing or d...

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free control...

Breakthrough pain (BTP) is an unmet clinical need that is still poorly diagnosed, evaluated and inadequately treated. The prevalence of BTP has been estimated to affect at least 64% of cancer patients. Two pain-relief strategies were proposed: preventive and active ('rescue'). Oral short-acting opioid seems to be the most popular approach for BTP t...

"Mental defeat" has been found to be an important psychologic reaction to painful trauma. Chronic pain patients also report mental defeat in relation to their experience of pain episodes. A measure of mental defeat was devised and evaluated in terms of (1) psychometric properties and (2) specificity of scores in relation to disabling chronic pain....

An application of the cognitive-behavioural model of health anxiety (hypochondriasis) to chronic pain depends on the extent to which high levels of health anxiety occur in chronic pain, which has yet to be established. The occurrence of health anxiety in consecutively recruited chronic pain patients (n=161) and nonclinical controls with (n=34) and...

Morphine-6-glucuronide (M6G) has promising preclinical characteristics and encouraging pharmacokinetic features for acute nociceptive pain. Early studies have produced a good safety profile when compared to morphine sulfate, although in surrogate pain models studies, a mixed picture emerged. A study to evaluate the efficacy and safety profile in a...

Multimodal analgesia is thought to produce balanced and effective postoperative pain control. A combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates could result in synergistic analgesia by acting through different mechanisms. Currently there are very few parenterally administered NSAIDs suitable for the immediate postope...

Many patients with neuropathic pain have coexistent sensory deficits. Neuropathic pain may be alleviated by a variety of drugs but sensory deficits are assumed to be permanent. In an audit of the effects of gabapentin therapy on patients with neuropathic pain, monthly detailed sensory examinations were performed during the first three months of tre...

An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in...

The efficacy of Diamorphine on post operative pain was compared when used by PCA , epidural and epidural combination with local anaesthetics pubivacain . The addition of local anaesthetics did not add any benifit

Nineteen of 25 patients (14 female) with advanced malignant disease completed a randomized controlled trial of a new high-dose (200 mg) tablet formulation of controlled-release morphine. Compared with the currently available 100-mg tablets there were no differences in pain severity or adverse effects with the new formulation. In four patients, full...

The anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2-3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically...

During the period from September 1990 to March 1992, 155 nerve blocks were performed for 125 patients as part of the clinical management of pain due to malignant disease. The efficacy, in terms of pain score reduction, and spontaneously reported side effects secondary to these procedures were prospectively audited. Neural blockade was undertaken in...

Twelve patients with chronic renal failure (dialysis-dependent) and six with good renal function after renal transplantation received i.v. morphine-6-glucuronide (M6G) 30 fig kg-1 as part of a standardized anaesthetic technique for minor surgery. Continuous peritoneal dialysis was commenced 6 h after M6G administration in six of the dialysis-depend...

The effects of renal impairment of the PK of M-6-G and the influence of dialysis

In an open multicentre study, 40 cancer patients requiring opioid analgesia received transdermal fentanyl after their pain had been stabilised with oral morphine. Fentanyl dose was calculated according to a standard conversion chart: 21 patients received 25 μg/hour, 11 received 50 μg/hour, four received 75 μg/hour and four received 100 μg/ hour fen...

Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (263K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 249 Selected References These references are in PubMed. This may not be the complete lis...

The limitation and dangers of the use of repeated Pethidine injections for pain control in acute sickle pain

The respiratory responses to intravenous morphine sulphate (0.12 mg/kg), morphine-6-glucuronide (M6G: 0.03 mg/kg) and placebo were assessed in 6 healthy volunteers, using a single blind randomised crossover design. Five of these subjects underwent an additional study of M6G at 0.06 mg/kg. Respiratory rate, minute volume and end-tidal CO2 were conti...

The effects of M-6-G and Morphine on ventilation parameters were compared, where M6G was found to produce significantly less respiratory depression than morphine

The pharmacokinetics and subjective side effects of i.v. morphine sulphate 120 μg kg−1 and morphine-6-glucuronide (M6G) 30 μg kg−1 were determined in six healthy volunteers, using a placebo-controlled, single-blind randomized crossover design. Five of these volunteers underwent an additional (non-randomized) study of M6G 60 μg kg−1. Subjective side...

M6G and Morphine pharmacokinetics were compared in healthy volunteers . M6G has higher concentration , low volume of distribution

Although cancer pain is often well controlled with strong opioid drugs, the dynamic nature of the disease might lead to the development of pain which changes in character as well as in intensity. Two cases are described which feature morphine resistant pain. We discuss how this problem might be recognized early before the dose of morphine is escala...

SUMMARY The analgesic efficacy and CSF pharmacokinetics of intrathecal morphine sulphate and morphine-6-glucuronide (M6G) were compared in a single-blind crossover study. Lumbar intrathecal catheters were sited in three patients with chronic cancer pain, and morphine sulphate 500 μg or M6G 500 μg given via the catheter on separate days. CSF was sam...

The efficacy and drug disposition of M6G and Morphine were compared. M6G was found to be twice a efficacious as Morphine . M6G has significantly longer T1/2 than Morphine

Over a four-year period from October 1984 to September 1988, a total of 101 coeliac plexus blocks were performed in this unit. Of these, 89 were in patients suffering intractable abdominal pain due to cancer, and 12 were in patients with pain secondary to benign disease processes. All were performed using X-ray screening and with intravenous sedati...

Ketanserin, a selective S2 serotonergic antagonist, was assessed against placebo in a double-blind cross-over study of 16 patients with chronic peripheral burning pain. Nine of these had signs of reflex sympathetic dystrophy (RSD). All patients underwent 4 intravenous regional treatments, 2 with ketanserin (10 mg for upper limb pain, 20 mg for lowe...

Twenty patients who had abdominal hysterectomy under general anaesthesia were randomly assigned to receive either epidural ketamine (30 mg), or epidural diamorphine (5 mg) peri-operatively and on first request for analgesia. Failure to obtain satisfactory analgesia with one of the agents was treated by epidural administration of the other. Pain was...

A case is described in which paraplegia followed a coeliac plexus block performed using 90% alcohol under X ray screening. The likely cause was an ischaemic injury to the cord secondary to damage to the artery of Adamkiewicz. This rare complication seems difficult to avoid.

The absorption of buccal morphine was compared with that of slow-release morphine sulphate in human volunteers. Morphine concentration was assayed by high pressure liquid chromatography in serum samples obtained at intervals up to 8 hours after administration of morphine 20 mg. Similar mean maximum concentrations were obtained by either route, but...

An open study of the effect of a standard course of unilateral ECT applied to 4 patients with intractable thalamic pain. There was no significant change in pain, personality or affective profiles after treatment. Venous plasma endorphins were measured during the ECT course and there were no significant correlations with treatment.

1. This study compared serum concentrations of morphine after administration of a buccal tablet (25mg) with those after intramuscular injection (10mg). 2. Buccal morphine was administered to eleven healthy volunteers and intramuscular morphine was given to five preoperative surgical patients. Serum morphine concentrations were assayed by high perfo...

A series of patients was studied retrospectively to assess the efficacy of psoas compartment block in the treatment of pain in malignant disease. Three case examples illustrate the indications for this technique. The psoas compartment block technique is particularly useful for patients who have not responded to opiates or find the side-effects of s...

Three cases of cancer pain, insensitive to systemic opioid treatment, but which yielded to opioid applied epidurally, are described. Distinction is made between intrinsic and acquired opioid insensitivity and it is emphasized that the role of epidural opioid administration in 'opioid-insensitive' cancer pain is in that group of patients exhibiting...

Fifty patients were admitted to a double-blind, double-dummy study comparing buccal morphine 10 mg tablets and intramuscular morphine sulphate 13.5 mg as premedication. This investigation was performed on the basis of favourable results obtained in an earlier 25 patient pilot study designed to examine the efficacy, safety and patient acceptability...

Fifty patients were admitted to a double-blind, double-dummy study comparing buccal morphine 10 mg tablets and intramuscular morphine sulphate 13.5 mg as premedication. This investigation was performed on the basis of favourable results obtained in an earlier 25 patient pilot study designed to examine the efficacy, safety and patient acceptability...