Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Pharmacology & Toxicology. Title from title-page of electronic thesis. Bibliography: leaves 131-159.

Background Various analgesics are available for post-operative pain after third molar surgery. Combinations of different classes of analgesics may improve the overall efficacy of pain control as they covers different pain pathways. A great variation of combinations and dosages of analgesics have been suggested in the literature, yet it was still unclear what combination(s) and dosages were the most effective for acute post-operative dental pain. A systematic review of randomized clinical trials would help clinicians to make clinical judgment of which analgesic combination(s) would be the best for their patients for acute post-operative dental pain in terms of efficacy and safety. Aim To conduct a systematic review of randomized clinical trials to answer the clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative dental pain control?” Methods A structured systematic literature search, with predefined inclusion and exclusion criteria, of the relevant computer databases and journals was performed. The search and the evaluations of articles were done by 2 independent reviewers in 3 rounds. Studies that fulfilled the pre-set criteria were included to enter the final review. The analgesic efficacy of the analgesic combinations reported in the included studies were presented by the objective pain measurements, sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 and TOTPAR6 of various combinations were adjusted after deducting from the effect of placebos of the respective studies. The adverse effects of the different analgesic combinations were also presented. Results There were 13 studies with 2843 subjects included in the final review. Eight groups of drug combinations with 13 different dosages were reported. The efficacies of the reported analgesic combinations have SPID6 scores ranged from 1.46 to 6.44 and TOTPAR6 scores ranged from 3.24 – 10.3. Among the analgesic combinations, ibuprofen 400mg + oxycodone HCL 5mg had the highest adjusted SPID6 (6.44), and a very higher adjusted TOTPAR6 (9.31), representing its efficacy could be superior to the other different analgesic combinations reported in this study. Nausea was the most common adverse effect of the analgesic combinations, with prevalence ranged from 0-55%. Most of the common adverse effects were related to the use of opioids in the combination. Three combinations of different dosages containing ibuprofen and caffeine were reported with the lowest prevalence of adverse effect. Conclusions This systematic review of randomized clinical trials has presented the efficacy and adverse effects of the various analgesic combinations for acute post-operative dental pain control. We have identified ibuprofen 400mg with oxycodone 5mg was more effective when compared to the other 12 combinations. Nausea was the most common adverse effects in an analgesic combination containing an opioid. Ibuprofen 200mg with caffeine 100mg or 200mg has a reasonable analgesic effect with fewer side effects when compared to the other analgesic combinations. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

published_or_final_version / Physiology / Master / Master of Philosophy

No description available.

This thesis investigated the contribution of descending fibers from the rostral ventromedial medulla (RVM) to nociception, and to opioid and non-opioid analgesia in rats. Inactivation of descending fibers was induced by microinjection of the GAGA-A agonist muscimol in the RVM, and nociception was evaluated using the tail immersion, hot plate and formalin tests. In all three tests, microinjection of muscimol (6.25--400 ng) in the RVM increased nociceptive responses of animals, suggesting that descending fibers tonically inhibit dorsal horn neurons of the spinal cord. In the formalin test, microinjection of muscimol (50 ng) in the RVM reduced the slope of the formalin concentration-response relation, so that responses were increased at low, but not at high concentrations of formalin. Conversely, microinjection of the GABA-A antagonist bicuculline in the RVM decreased the slope of the formalin concentration-response relation, so that responses were decreased at high but not at low concentrations of formalin. Microinjection of muscimol in the RVM abolished analgesia induced by systemic morphine in the tail immersion and hot plate tests, but only decreased analgesia by 60% in the formalin test. Microinjection of muscimol (50 ng) in the RVM abolished morphine analgesia elicited intracerebroventricularly, suggesting that the supraspinal effects of morphine are mediated via descending fibers from the RVM. Peripheral effects may account for the residual analgesic effect of systemic morphine after inactivation of descending fibers in the formalin test. Microinjection of muscimol (50 ng) in the RVM abolished buprenorphine analgesia in all tests. The dopamine uptake inhibitor nomifensine was devoid of analgesic activity in the tail immersion and hot plate tests. In the formalin test, nomifensine produced a dose-dependent analgesia, which was not affected by the microinjection of muscimol (50 ng) in the RVM. It is concluded that, descending fibers from the RVM tonically inhib

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 6 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 6 uppsatser.

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 107-121) Also available in print.

Thesis (M.A.(Applied))--Victoria University of Wellington, 2004. / Includes bibliographical references.