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Nitrous oxide for chronic pain

I Sleeman, L Wiblin, D Burn
Nitrous oxide is commonly used as an analgesic and anaesthetic agent. Nitrous oxide is also in use in industry as an aerosol propellant and is now recognised as a recreational drug whose use is growing, especially among the young. Nitrous oxide from whipped cream canisters is inhaled to produce a dissociative, intoxicated state. Nitrous oxide is known to inactivate vitamin B12 via oxidation, which can precipitate a demyelinating myelopathy akin to the classical B12 deficiency syndrome, subacute combined degeneration of the spinal cord...
September 2016: Journal of the Royal College of Physicians of Edinburgh
M T V Chan, P J Peyton, P S Myles, K Leslie, N Buckley, J Kasza, M J Paech, W S Beattie, D I Sessler, A Forbes, S Wallace, Y Chen, Y Tian, W K K Wu
BACKGROUND: Previous animal and clinical studies showed that nitrous oxide may produce long-term analgesia. The aim of this study was to evaluate the effect of nitrous oxide in preventing chronic postsurgical pain. We also explored whether methylenetetrahydrofolate reductase gene polymorphisms (1298A>C, 667C>T) would enhance nitrous oxide analgesia. METHODS: We conducted a telephone interview at 12 months after surgery on 2924 (41.1%) patients enrolled in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia-II trial...
December 2016: British Journal of Anaesthesia
Andrea Messeri, Elena Amore, Stefano Dugheri, Alessandro Bonari, Ilenia Pompilio, Giulio Arcangeli, Giuliana Rizzo
BACKGROUND: Nitrous oxide (N2 O 50% in oxygen) is commonly used for painful procedures in children. Potential negative health effects associated with chronic workplace exposure limit its use. Safe occupational N2 O exposure concentrations are below 25 ppm environmental concentration as a time-weighted average (TWA) and below 200 ppm as a short-time exposure level (STEL) of 15 min. AIM: The aim was to assess occupational exposure of staff during nitrous oxide administration to children using different inhalation delivery devices and scavenging systems...
September 2016: Paediatric Anaesthesia
(no author information available yet)
To combat the prescription opioid problem, St. Joseph's Healthcare System in Paterson, NJ, has developed a new program that gives providers options they can use to effectively alleviate pain without resorting to highly addictive medication. Launched in January 2016 in the ED at St. Joseph's Regional Medical Center (SJRMC), the Alternatives to Opioids (ALTO) program utilizes protocols that primarily target five common conditions: renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures...
June 2016: ED Management: the Monthly Update on Emergency Department Management
Alparslan Turan, Sheryar Sarwar, Abdulkadir Atim, Anupa Deogaonkar, Hani F Yousef, Sumit Katyal, Jinbo Liu, Jing You, Daniel Leizman, Nagy Mekhail, Daniel I Sessler
BACKGROUND: Neuropathic back pain is mediated, at least partially, by N-methyl-D-aspartate (NMDA) receptors. Nitrous oxide (N2O) is an NMDA receptor antagonist. We therefore tested the primary hypothesis that patients receiving N2O have lower pain scores after epidural steroid injection than patients not receiving N2O. METHODS: Patients with recurrent low back pain scheduled for epidural steroid blocks were randomly assigned to receive either oxygen (O2, n = 39) or the combination of 50% O2 and 50% N2O during and after each block (N2O, n = 39)...
November 2015: Anesthesia and Analgesia
Meric Ben Boujema, Emilie Laboureyras, Jan Pype, Baptiste Bessière, Guy Simonnet
BACKGROUND: Despite numerous pharmacological approaches, there are no common analgesic drugs that produce meaningful relief for the majority of patients with neuropathic pain. Although nitrous oxide (N2O) is a weak analgesic that acts via opioid-dependent mechanisms, it is also an antagonist of the N-methyl-D-aspartate receptor (NMDAR). The NMDAR plays a critical role in the development of pain sensitization induced by nerve injury. OBJECTIVE: Using the chronic constriction injury of the sciatic nerve in male rats as a preclinical model of neuropathic pain, the first aim of the present study was to evaluate the lowest N2O concentration and the shortest time of N2O postinjury exposure that would produce persistent relief of neuropathic pain...
November 2015: Pain Research & Management: the Journal of the Canadian Pain Society
Robert S Pugliese, Evan J Slagle, Glenn R Oettinger, Kenneth J Neuburger, Timothy M Ambrose
PURPOSE: A case of subacute combined degeneration (SCD) of the spinal cord manifesting as severe ataxia and urinary retention in a patient with a history of heavy nitrous oxide abuse and self-supplementation with cyanocobalamin is reported. SUMMARY: A 27-year-old woman was treated in the emergency department for complaints of abdominal pain and inability to urinate for about 12 hours. The patient also complained of worsening lower-extremity weakness for 10 days and a "pins and needles" sensation in the lower extremities for approximately 1 year...
June 1, 2015: American Journal of Health-system Pharmacy: AJHP
Dariush Amanat, Hooman Ebrahimi, Maryam Zahed Zahedani, Nasim Zeini, Sara Pourshahidi, Zahra Ranjbar
BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa with treatment challenges for clinicians. AIMS: The objective of this study is to compare the effects of cryotherapy as a new modality with topical corticosteroids as a conventional therapy in the treatment of OLP. MATERIALS AND METHODS: Thirty patients with bilateral OLP lesions were selected. From each patient a lesion on one side was chosen randomly for a single session of cryotherapy with nitrous oxide gas and the lesion on the other side received triamcinolone acetonide 0...
November 2014: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
Luis Enrique Chaparro, Shane A Smith, R Andrew Moore, Philip J Wiffen, Ian Gilron
BACKGROUND: Chronic pain can often occur after surgery, substantially impairing patients' health and quality of life. It is caused by complex mechanisms that are not yet well understood. The predictable nature of most surgical procedures has allowed for the conduct of randomized controlled trials of pharmacological interventions aimed at preventing chronic postsurgical pain. OBJECTIVES: The primary objective was to evaluate the efficacy of systemic drugs for the prevention of chronic pain after surgery by examining the proportion of patients reporting pain three months or more after surgery...
2013: Cochrane Database of Systematic Reviews
Joseph D Tobias
OBJECTIVE: The objective of this review was to provide a general descriptive account of the physical properties, end-organ effects, therapeutic applications, and delivery techniques of nitrous oxide (N2O) as used in the arena of procedural sedation. DATA SOURCE: A computerized bibliographic search regarding the applications of nitrous for provision of sedation and analgesia during procedures with an emphasis on the pediatric population was performed. RESULTS: The end-organ effects of N2O have been well described in the operating room setting...
February 2013: Pediatric Emergency Care
Matthew T V Chan, Alex C M Wan, Tony Gin, Kate Leslie, Paul S Myles
Nitrous oxide is an antagonist at the N-methyl-D-aspartate receptor and may prevent the development of chronic postsurgical pain. We conducted a follow-up study in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA) trial patients to evaluate the preventive analgesic efficacy of nitrous oxide after major surgery. The ENIGMA trial was a randomized controlled trial of nitrous oxide-based or nitrous oxide-free general anesthesia in patients presenting for noncardiac surgery lasting more than 2 hours...
November 2011: Pain
Mihan J Javid, Mojgan Rahimi, Amir Keshvari
UNLABELLED: Laparoscopy is an effective method of implantation for peritoneal dialysis (PD) catheters. Use of the laparoscopic technique is increasing because of its potential advantages over other techniques. In most patients, selection for PD is based on negative criteria, and because of the need for general anesthesia, the laparoscopic technique can be life-threatening in these patients. On the other hand, local anesthesia is insufficient for laparoscopic catheter implantation. To avoid the need for general anesthesia and to achieve patient safety and satisfaction, we designed a type of conscious sedation (dissociative conscious sedation) and compared the efficacy of subcutaneous (SC) and intravenous (IV) ketamine added to narcotics in patients scheduled for laparoscopic implantation of a PD catheter...
May 2011: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
A Claeys, C Gaudy-Marqueste, V Pauly, F Pelletier, F Truchetet, T Boye, F Aubin, J L Schmutz, J J Grob, M A Richard
BACKGROUND: Mechanical debridement of fibrin and/or necrosis promotes healing of arterial and venous leg ulcers but is limited by pain associated with the procedure. OBJECTIVE: The main objective of this study was to compare the respective analgesic effect of nitrous oxide oxygen mixture (NOOM) inhalation and lidocaïne-prilocaïne cream (LPC) application during the mechanical repeated debridement of chronic arterial and venous leg ulcers. METHODS: In this randomized, multicentre, open-label study, pain was evaluated before and after each care and debridement session using a Visual Analog Scale (VAS) and a Verbal Rating Scale (VRS), in the context of usual debridement and wound care process...
February 2011: Journal of the European Academy of Dermatology and Venereology: JEADV
Baptiste Bessière, Emilie Laboureyras, Jérémy Chateauraynaud, Jean-Paul Laulin, Guy Simonnet
UNLABELLED: Using the rat chronic constriction injury (CCI) pain model, we evaluated whether nitrous oxide (N2O), a gas shown to have potent anti-hyperalgesic properties, may alleviate neuropathic pain. Mechanical nociceptive threshold was estimated using the paw pressure vocalization test. Thermal allodynia was challenged by measuring the struggle latency by immersion of the hind paw in a 10 degrees C water bath. A single 50% N2O exposure for 1 hour, 15 minutes not only induced potent anti-nociception during N2O exposure but also provoked a delayed and sustained reduction (37% to 46%) of pain hypersensitivity of the injured hind paw and abolished pain hypersensitivity of the contralateral uninjured hind paw for at least 1 month...
January 2010: Journal of Pain: Official Journal of the American Pain Society
Y Matsushita, M Ishikawa, K Abe, I Utsunomiya, T Chikuma, H Hojo, K Hoshi, R M Quock, K Taguchi
Prolonged exposure to nitrous oxide (N2O) results in development of acute tolerance to its antinociceptive effect. Cross-tolerance to N2O-induced antinociception is also observed in morphine-tolerant animals. Despite increasing evidence of tolerance development to N2O-induced antinociception, the details of the mechanisms that underlie this tolerance remain unknown. The present study was conducted to investigate the involvement of brain protein kinase C (PKC) isoform in these two types of tolerance to N2O-induced antinociception in mice...
August 24, 2007: Neuroscience
Douglas S Ramsay, Brian G Leroux, Marilynn Rothen, Christopher W Prall, Louis O Fiset, Stephen C Woods
Electrical tooth stimulation was used to investigate whether humans develop tolerance to nitrous oxide (N(2)O) analgesia within a single administration as well as over repeated administrations. In a double-blind cross-over experiment, 77 subjects received a 40-min administration of 38% N(2)O at one session and placebo gas at the other. The sessions were separated by 1 week and the order of gas administration was counterbalanced. Acute analgesic tolerance developed for pain threshold but not for detection threshold...
March 2005: Pain
Bo Bentsen, Ann Wenzel, Peter Svensson
The aim of this study was to evaluate whether distraction induced by video glasses had an effect on the perceived intensity of pain and unpleasantness during dental scaling compared with the effect of nitrous oxide (N(2)O) analgesia. The pain stimulus was dental scaling (removal of dental calculus) with an ultrasonic scaler. As a standardised, non-dental painful stimulus, Von Frey filaments were used. A total of 26 patients with superficial chronic periodontitis were enrolled in this randomised, controlled clinical study...
2003: European Journal of Pain: EJP
B Wennström, B Reinsfelt
BACKGROUND: Nausea, vomiting and pain are common complications after strabismus surgery in children. Diclofenac, a non-steroid anti-inflammatory drug, is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery. This open randomised study was designed to investigate the analgesic and anti-emetic properties of rectally administered diclofenac compared with opioid (morphine) given i.v. in connection with strabismus surgery in children...
April 2002: Acta Anaesthesiologica Scandinavica
Wade S Kingery, Geeta S Agashe, Tian Z Guo, Shigehito Sawamura, M Frances Davies, J David Clark, Brian K Kobilka, Mervyn Maze
BACKGROUND: The authors recently established that the analgesic actions of the inhalation anesthetic nitrous oxide were mediated by noradrenergic bulbospinal neurons and spinal alpha2B adrenoceptors. They now determined whether noradrenergic brainstem nuclei and descending spinal pathways are responsible for the antinociceptive actions of the inhalation anesthetic isoflurane, and which alpha adrenoceptors mediate this effect. METHODS: After selective lesioning of noradrenergic nuclei by intracerebroventricular application of the mitochondrial toxin saporin coupled to the antibody directed against dopamine beta hydroxylase (DbetaH-saporin), the antinociceptive action of isoflurane was determined...
February 2002: Anesthesiology
J Szymańska
Nitrous oxide may be used to alleviate dental anxiety and to diminish or eliminate dental pain. The benefit of nitrous oxide sedation is a cooperative and satisfied patient. By reducing the patient's perception of pain it allows them to relax and cooperate during dental procedures. However, the dental surgery personnel, chronically exposed to N2O, are at serious risk. The chronic effects of occupational exposure to nitrous oxide have long been the subject of debate. Safety standards have been established in the United States and Europe since many years...
2001: Annals of Agricultural and Environmental Medicine: AAEM
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