psd-502 and Chronic-Disease

This study aimed to evaluate the effect of EMLA 5% cream applied to painful chronic leg ulcers (CLUs) as a primary dressing on wound healing and health-related quality of life (HRQoL). A pilot, parallel-group, nonblinded, randomized controlled trial was conducted in 6 community nursing procedure clinics in New South Wales, Australia. A total of 60 participants with painful CLUs of varied etiology were randomly assigned to the intervention (EMLA daily for 4 weeks as a primary dressing, followed by usual care) or usual care only. Wound size and HRQoL were measured at baseline, end of the intervention period (week 4), and week 12. At baseline, wound sizes were similar for both the intervention and control groups. During the intervention period, there was no significant difference in wound sizes between groups (intervention group: median (cm

Topics: Aged; Aged, 80 and over; Australia; Chronic Disease; Cross-Over Studies; Female; Follow-Up Studies; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Occlusive Dressings; Pain Measurement; Pilot Projects; Prilocaine; Quality of Life; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome; Wound Healing

This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29-99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers > 50 cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100 mm visual analogue scale (VAS). The median patient VAS scores were 18 mm and 53.5 mm in the Emla and placebo groups, respectively (p < 0.0001). The corresponding investigator values in the two groups were 20 mm and 49.5 mm, respectively (p = 0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Chronic Disease; Debridement; Double-Blind Method; Female; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Time Factors; Treatment Outcome

Although the lignocaine (lidocaine)-prilocaine cream EMLA has been extensively studied for the relief of acute treatment-related pain from sharp leg ulcer debridement, no data exist on systemic absorption from prolonged application in patients with chronically painful ulcers.. To study the plasma concentrations of lignocaine and prilocaine resulting from prolonged application of EMLA to leg ulcers.. A single 24-h application of 5-10 g (median 6.75) of EMLA was given to 10 patients with painful leg ulcers measuring 50-100 cm2. Venous blood samples, drawn between 0.5 and 27 h after cream application, were analysed by gas chromatography using a nitrogen-sensitive detector.. The peak plasma levels were in the range 185-705 ng mL(-1) and 62-277 ng mL(-1) for lignocaine and prilocaine, respectively, and were observed 2-4 h (in one patient 6-8 h) after application. The peak plasma concentration of lignocaine, but not of prilocaine, increased significantly with increasing dose. The cream was well tolerated by the patients.. The results indicate that a 24-h application of 5-10 g EMLA results in peak plasma concentrations of the two local anaesthetics, which combined are less than one-fifth of those associated with toxic reactions. The analgesic efficacy of EMLA for the relief of chronic ulcer pain deserves further study.

Topics: Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Chronic Disease; Dose-Response Relationship, Drug; Female; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Prilocaine; Regression Analysis

Atypical odontalgia is a distressing and unusual chronic orofacial pain condition. It is often difficult to diagnose because it is associated with a lack of clinical and radiographic abnormalities. The condition is poorly understood on a pathophysiological basis, and patients often undergo repetitive and unnecessary dental procedures in attempts to alleviate pain. In this study, 50 patients diagnosed with odontalgia were evaluated by pharmacological procedures, including topical anesthetic application and phentolamine infusion. Results of these pharmacological procedures suggest that atypical odontalgia is a neuropathic pain of the oral cavity that may have a component of sympathetically maintained pain. Therapeutic trials of topical capsaicin were carried out to assess its efficacy for pain reduction. Topical capsaicin was effective in most patients.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Capsaicin; Chi-Square Distribution; Chronic Disease; Facial Pain; Female; Humans; Infusions, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain Measurement; Phentolamine; Prilocaine; Reflex Sympathetic Dystrophy; Sex Factors; Single-Blind Method; Surveys and Questionnaires; Sympatholytics; Temporomandibular Joint Disorders; Toothache

Topics: Anesthetics, Combined; Anesthetics, Local; Anti-Bacterial Agents; Bacteroidaceae Infections; Bacteroides Infections; Chronic Disease; Conscious Sedation; Coronary Artery Disease; Dental Scaling; Disease Progression; Doxycycline; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Periodontal Diseases; Porphyromonas gingivalis; Prilocaine; Root Planing; Treponema denticola; Treponemal Infections