heroin and Nausea

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.

Topics: Administration, Oral; Analgesics; Constipation; Delayed-Action Preparations; Drug Combinations; Heroin; Humans; Morphine; Morphine Dependence; Nausea; Neoplasms; Palliative Care; Respiratory Insufficiency

Topics: Analgesia; Analgesics; Animals; Blood Pressure; Cyclizine; Heart Arrest; Heroin; Humans; Injections, Intravenous; Methadone; Morphine; Myocardial Infarction; Nausea; Pain; Pentazocine; Pulmonary Circulation; Respiration; Shock, Cardiogenic; Spirometry; Vomiting

Intramuscular pethidine is routinely used throughout the UK for labour analgesia. Studies have suggested that pethidine provides little pain relief in labour and has a number of side effects affecting mother and neonate. It can cause nausea, vomiting and dysphoria in mothers and can cause reduced fetal heart rate variability and accelerations. Neonatal effects include respiratory depression and impaired feeding. There are few large studies comparing the relative side effects and efficacy of different opioids in labour. A small trial comparing intramuscular pethidine with diamorphine, showed diamorphine to have some benefits over pethidine when used for labour analgesia but the study did not investigate the adverse effects of either opioid.. The Intramuscular Diamorphine versus Intramuscular Pethidine (IDvIP) trial is a randomised double-blind two centre controlled trial comparing intramuscular diamorphine and pethidine regarding their analgesic efficacy in labour and their side effects in mother, fetus and neonate. Information about the trial will be provided to women in the antenatal period or in early labour. Consent and recruitment to the trial will be obtained when the mother requests opioid analgesia. The sample size requirement is 406 women with data on primary outcomes. The maternal primary outcomes are pain relief during the first 3 hours after trial analgesia and specifically pain relief after 60 minutes. The neonatal primary outcomes are need for resuscitation and Apgar Score <7 at 1 minute. The secondary outcomes are an additional measure of pain relief, maternal sedation, nausea and vomiting, maternal oxygen saturation, satisfaction with analgesia, whether method of analgesia would be used again, use of Entonox, umbilical arterial and venous pH, fetal heart rate, meconium staining, time from delivery to first breath, Apgar scores at 5 mins, naloxone requirement, transfer to neonatal intensive care unit, neonatal haemoglobin oxygen saturation at 30, 60, 90, and 120 mins after delivery, and neonatal sedation and feeding behaviour during first 2 hours.. If the trial demonstrates that diamorphine provides better analgesia with fewer side effects in mother and neonate this could lead to a change in national practice and result in diamorphine becoming the preferred intramuscular opioid for analgesia in labour.. ISRCTN14898678Eudra No: 2006-003250-18, REC Reference No: 06/Q1702/95, MHRA Authorisation No: 1443/0001/001-0001, NIHR UKCRN reference 6895, RfPB grant PB-PG-0407-13170_IR5.

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Apgar Score; Cardiotocography; Double-Blind Method; Feeding Behavior; Female; Heroin; Humans; Infant, Newborn; Injections, Intramuscular; Intensive Care, Neonatal; Labor Pain; Meperidine; Nausea; Oxygen; Patient Satisfaction; Pregnancy; Resuscitation; Vomiting

In a randomised study of analgesia following Caesarean section, we compared the efficacy and side effects of on-demand epidural diamorphine 2.5 mg with intravenous patient-controlled analgesia using diamorphine from the Baxter infusor system. Pain scores fell more rapidly in the epidural group, but by the fourth hour, and thereafter, both techniques had a similar analgesic effect. The patient-controlled analgesia group used significantly more diamorphine (p < 0.001), median 62 mg (range 18-120 mg) compared to the epidural group, median 10 mg (range 2.5-20 mg), over a significantly longer time period (p < 0.001), median 54.25 h (range 38-68 h) compared to the epidural group, median 40.75 h (range 6-70 h). The frequency and severity of nausea, vomiting and pruritus were similar in the two groups, however, the patient-controlled analgesia group were more sedated during the first postoperative day. This reached statistical significance (p < 0.05) between 9-24 h. Overall satisfaction scores (0-100) were high, but the patient-controlled analgesia group scored significantly higher: mean 85.5 (SD 12.2) compared to mean 77.0 (SD 11.7) in the epidural group.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Cesarean Section; Female; Heroin; Humans; Infusions, Intravenous; Nausea; Pain, Postoperative; Patient Satisfaction; Pregnancy; Pruritus; Time Factors; Vomiting

Analgesia provided by either 5 mg diamorphine, or 5 mg methadone administered by the epidural route during elective caesarean section was compared in 40 women. The median time to further analgesia in the methadone group was 395 min, and 720 min in the diamorphine group, P = 0.0003. Linear analogue scores to assess pain were measured 2-hourly for 12 h, then again at 24 h postoperatively. Pain scores were significantly lower in the diamorphine group at 8 and 10 h. The median cumulative i.m. morphine dose administered during the first 24 h was 20 mg in the methadone group and 0 mg in the diamorphine group (P = 0.0005). Nausea and pruritus were common side effects in both groups. Continuous pulse oximetry data were available for 12 h post-operatively in 15 patients receiving methadone, and in 17 patients receiving diamorphine. One or more episodes of significant desaturation (< 90% for 30 s), occurred in three patients receiving methadone, and in nine patients receiving diamorphine. Desaturation to 90-92% occurred in a further three patients given epidural diamorphine, and in one further patient given epidural methadone.

Topics: Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Double-Blind Method; Female; Heroin; Humans; Hypoxia; Incidence; Methadone; Morphine; Nausea; Oxygen; Pain Measurement; Pain, Postoperative; Pregnancy; Prochlorperazine; Pruritus; Time Factors

The dose requirements and side effects of morphine were compared with those of diamorphine administered by patient-controlled analgesia in 40 patients following elective total hip replacement. Patients were allocated randomly to receive in a double-blind manner either morphine or diamorphine for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative sedation, nausea, well-being, pain relief and requirements for antiemetic drugs. The dose requirement for diamorphine was approximately 50% of that for morphine.

Topics: Adult; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Double-Blind Method; Female; Heroin; Hip Prosthesis; Humans; Male; Middle Aged; Morphine; Nausea; Pain Measurement; Pain, Postoperative

Intrathecal diamorphine is associated with a high incidence of emetic symptoms. Six anti-emetic drugs representing various chemical groups were given in random order to patients undergoing total hip replacement and who had received intrathecal diamorphine 0.5-1.0 mg. The phenothiazines, perphenazine and prochlorperazine, were more effective than the others. It is suggested that this might be a useful model for the evaluation of new anti-emetics.

Topics: Aged; Antiemetics; Drug Evaluation; Heroin; Hip Prosthesis; Humans; Injections, Spinal; Nausea; Pain, Postoperative; Random Allocation; Vomiting

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Female; Heroin; Humans; Methadone; Nausea; Placebos; Propranolol; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; Vomiting

To investigate the manifestations and incidence of headaches caused by heroin in Chinese women.. This was a survey study conducted from 29 June to 3 July 2015 with women attending the Shanxi Drug Rehabilitation Centre for Women (China). All study subjects were newly admitted and had not begun their drug rehabilitation. Demographic characteristics, heroin usage and headache episodes within the previous 3 months were surveyed, especially the presence of a headache within 2 hours of heroin use. Details of the severity, location, premonitory symptoms and characteristics of headaches were recorded.. Of the 90 heroin-dependent patients, 74 experienced headache attacks within 2 hours of heroin use, and the headaches subsided within 72 hours of discontinuation of heroin use. Most heroin-induced headaches were similar to migraines and manifested as pulsating pain in 54 patients (51/74, 68.9%); bilateral pain was reported by 46 patients (46/74, 62.2%). Approximately half of the patients with heroin-induced headaches also reported accompanying symptoms of nausea, vomiting, and light and sound sensitivity.. Heroin-induced headache may eventually be listed as a new class of headache in the International Classification of Headache Disorders.

Topics: Adult; China; Female; Headache Disorders; Heroin; Heroin Dependence; Humans; Incidence; Nausea; Photophobia; Self Report; Severity of Illness Index; Vomiting; Young Adult

Topics: Adrenergic alpha-1 Receptor Agonists; Adult; Analgesics, Opioid; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Local; Antiemetics; Blood Pressure; Bupivacaine; Cesarean Section; Female; Heart Rate; Heroin; Humans; Nausea; Ondansetron; Phenylephrine; Predictive Value of Tests; Pregnancy

Topics: Amphetamines; Behavior; Cannabis; Drug Therapy; Epilepsy; Heroin; Humans; Illicit Drugs; Lysergic Acid Diethylamide; Mental Disorders; Nausea; Obesity; Pain; Vomiting

Topics: Adult; Heroin; Humans; Methohexital; Morphine; Nausea; Nitrous Oxide; Preanesthetic Medication; Vomiting