deamino-arginine-vasopressin and Pain

Renal colic is a prevalent cause of abdominal pain in the emergency department. Although non-steroidal anti-inflammatory drugs and opioids are used for the treatment of renal colic, some adverse effects have been reported. Therefore, desmopressin -a synthetic analogue of vasopressin- has been proposed as another treatment choice. In the present study, indomethacin in combination with nasal desmopressin was compared with indomethacin alone in the management of renal colic.. Included in the study were 124 patients with initial diagnosis of renal colic and randomized to receive indomethacin suppository (100 mg) with either desmopressin intranasal spray (4 puffs, total dose of 40 micrograms) and or placebo intranasal spray.. All the included patients were finally diagnosed with renal colic. There was no difference between the two groups in pain at the baseline (p = 0.4) and both treatments reduced pain successfully (p < 0.001). There was no significant difference between the two groups in pain reduction (p = 0.35).. While there was significant pain reduction in both patients groups, pain reduction of NSAIDs (e.g. indomethacin) in renal colic, does not significantly improve when given in combination with desmopressin.

Topics: Adult; Chi-Square Distribution; Deamino Arginine Vasopressin; Double-Blind Method; Drug Combinations; Female; Humans; Indomethacin; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Patient Safety; Placebos; Prospective Studies; Renal Colic

The aim of this study was to assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis. The study included 72 patients randomized into three different groups: group A received desmopressin (40 mg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale at baseline, 10, 30 min and 1 h after administering the treatments. Rescue analgesia was given at 30 min if needed. On admission, the pain level was the same in all three groups (group A 85; and group B and C 90 each). At 10 min the pain decreased minimally in all the groups but more in group B and C (group A 80 and group B and C 70 each). At 30 min pain scores were 75, 37.5 and 40 for group A, B and C, respectively, indicating that there was no significant pain relief in desmopressin group. Rescue analgesic had to be given to all patients in group A and two patients in group B and three patients in group C. Pain relief in the desmopressin only group was significantly less at 1 h even after rescue analgesia (pain scores of 27.5, 15 and 20 for group A, B and C respectively). Intranasal desmopressin is not an effective analgesic in renal colic: exerts mild analgesic effect over a period of 30 min. It does not potentiate the effect of diclofenac.

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Antidiuretic Agents; Deamino Arginine Vasopressin; Diclofenac; Humans; Injections, Intramuscular; Nasal Sprays; Pain; Pain Measurement; Renal Colic

The aim of the present experiment was to test whether vasopressin modulates pain perception in man. Twenty-four male volunteers participated in four sessions, each 2 weeks apart. After an adaptation session the subjects were treated intranasally with either 30 or 60 micrograms desmopressin (DDAVP) or placebo according to a cross-over double-blind design. Pain induction involved mechanical, thermal, and ischemic stimulation DDAVP had no unitary effects on pain perception in the different pain tests. The 30 micrograms dose induced sensitization to thermal stimuli. Neither treatment influenced ischemic pain perception. The mechanical pain threshold of the index finger was increased by the 60 micrograms dose only. After treatment with either dosage of DDAVP the subjects generally tolerated the pressure on their index finger for a longer time than after placebo treatment.

Topics: Administration, Intranasal; Adrenocorticotropic Hormone; Adult; Arm; Blood Pressure; Cross-Over Studies; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Hot Temperature; Humans; Hydrocortisone; Ischemia; Male; Pain; Pain Measurement; Perception

Quantitative trait locus mapping of chemical/inflammatory pain in the mouse identified the Avpr1a gene, which encodes the vasopressin-1A receptor (V1AR), as being responsible for strain-dependent pain sensitivity to formalin and capsaicin. A genetic association study in humans revealed the influence of a single nucleotide polymorphism (rs10877969) in AVPR1A on capsaicin pain levels, but only in male subjects reporting stress at the time of testing. The analgesic efficacy of the vasopressin analog desmopressin revealed a similar interaction between the drug and acute stress, as desmopressin inhibition of capsaicin pain was only observed in nonstressed subjects. Additional experiments in mice confirmed the male-specific interaction of V1AR and stress, leading to the conclusion that vasopressin activates endogenous analgesia mechanisms unless they have already been activated by stress. These findings represent, to the best of our knowledge, the first explicit demonstration of analgesic efficacy depending on the emotional state of the recipient, and illustrate the heuristic power of a bench-to-bedside-to-bench translational strategy.

Topics: Analgesics; Animals; Animals, Newborn; Capsaicin; Deamino Arginine Vasopressin; Disease Models, Animal; Female; Genetic Association Studies; Habituation, Psychophysiologic; Humans; Male; Mice; Mice, Inbred C57BL; Mice, Transgenic; Molecular Weight; Pain; Pain Measurement; Pain Threshold; Polymorphism, Single Nucleotide; Quantitative Trait Loci; Receptors, Vasopressin; Sex Factors; Stress, Psychological; Vasopressins

Patients with renal colic are usually treated in emergency care units or by their family doctors and require immediate diagnosis and treatment. The life-time risk is up to 10 %. The prevalence amounts to 4.7 % in Germany. In addition to confirming the diagnosis and inducing an adequate pain therapy it's very important for patients to be directed correctly and, above all, prevention is important, too. Without treatment the recurrence rate ranges between 50 and 100 %. Particularly, these principals should give useful advice, wherever patients are treated without urological department.

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Colic; Cyclooxygenase Inhibitors; Deamino Arginine Vasopressin; Diclofenac; Emergencies; Humans; Kidney Calculi; Kidney Diseases; Lithotripsy; Pain; Parasympatholytics; Recurrence; Renal Agents; Risk Factors; Ureteral Calculi; Urinary Calculi

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Colic; Deamino Arginine Vasopressin; Dogs; Humans; Kidney Diseases; Pain; Renal Agents

An analogue of arginine vasopressin (desmopressin, DDAVP) was evaluated for production chronic hyponatremia and prevention of sickle cell crisis. With sodium restriction (100 meq Na + / day) and water loading ( greater than 3 liters/day), persistent hyponatremia could not be achieved, nor could crises be prevented or aborted. Patients would not comply with a regimen of lower salt and higher fluid intake. More rigorous treatment might be practical during acute sickle cell crises, and a regimen similar to that used here might be more effective in children, whose renal concentrating mechanisms are still intact.

Topics: Adult; Anemia, Sickle Cell; Arginine Vasopressin; Deamino Arginine Vasopressin; Erythrocyte Aging; Female; Humans; Hyponatremia; Male; Osmolar Concentration; Pain; Sodium; Urine