Join our community

Facebook/avncharityuk  @avncharityuk

Add EasyFundraising to your bookmarks and use each time you shop on-line

Add EasySearch to your bookmarks and use each time you search on-line

Members' feedback

"I'm finding it shocking and surprising the number of new people joining the community. Let me explain. I was diagnosed with AVN first in both knees back in 2005, over the next few years it was found in both hips and shoulders. I had never come across AVN before and felt like I was the only person with it, I was always having to explain to people what it was."
 
"Thankfully I found this website and community over a year ago and realised I was not the only one suffering with AVN, it has been such a help talking to fellow sufferers who understand what I am going through."
 
Text taken from a recent post in our community forum.

Join us

If you are suffering from avascular necrosis AVN Osteonecrosis ON, or are close to someone that is, please consider joining our AVN Charity UK community. You will find many shared experiences about AVN and how it affects each of us differently, importantly there are also excellent success stories about the road to "Pain Free".
 
We also welcome any health professionals who are involved in any way with Avascular Necrosis AVN, please let us know how you think you can help.
Article Index
Pain from AVN
Pain - Page 2
Pain - Page 3
Pain - Page 4
All Pages

..../Cont. Pain and pain management. Page 3 of 4

Analgesics cont/...

Recent work suggests that Codeine and Dihydrocodeine are merely pro drugs for Morphine, and exert their action through metabolism to this compound. Given that a significant number of the population do not have the metabolic pathway to facilitate this, it is not surprising that there is a significant failure rate to produce any analgesia at all and that patients getting analgesia seem to get limited relief-hence possibly the popularity of these preparations being compounded with Paracetamol. Analgesics for Avascular Necrosis AVN pain reliefAnalgesics for Avascular Necrosis AVN pain reliefThere is good evidence that in some patients, much of the analgesic effect in these combined preparations lies with the Paracetamol itself, whilst many of the side-effects lie with the opioid.

v) Tramadol hydrochloride is an orally active, clinically effective, centrally-acting analgesic. It can produce analgesia that has been compared to Codeine or Dextropropoxyphene. It has been used in post-surgical pain, obstetric pain, cancer pain and chronic pain of mechanical and neurogenic origin. Analgesic tolerance is not a significant problem, and psychological dependence and euphoric effects are minimal. There are a significant number of patients in the chronic group who develop side-effects, but many of those who tolerate the drug get useful benefit in pain reduction. This slow-release formulation is an appropriate vehicle for chronic pain management.

Tramadol has an affinity, albeit relatively weak, for mu opioid receptors. It is also a neuronal uptake inhibitor. The monoamine neurotransmitters 5HT (Serotonin) and Noradrenaline (NA) are involved in the inhibition of spinal cord dorsal horn neurone responses to painful stimulation (i.e. closing the gate). Analgesia can result from activating the pain inhibitory pathways originating from higher CNS levels, and containing these neurotransmitters. Tramadol inhibits the uptake of 5HT and Noradrenaline but not Adenosine, Cyclic AMP, Dopamine, or Gaba.

Metanalysis by Moore and McQuay indicates an appropriate dose response curve for Tramadol, and suggests a reduced number needed to treat to show therapeutic efficacy as compared with Codeine, in doses of 75 to 150 mg. Nausea, vomiting and dizziness are greater than with Codeine, somnolence about the same and constipation much less. In the chronic pain situation nausea and vomiting are attenuated with usage, as is somnolence for both drugs, but constipation remains a particular problem with Codeine and Dihydrocodeine, and less of a problem with Tramadol.

Side-effects from Tramadol can be minimised by starting with a low dose and increasing gradually. There is evidence that this reduces the side-effects and improves tolerance. According to need, it can be started in a low dose of 50 mg daily or twice a day, and gradually titrated to reach 50 mg three times a day by day 3. Once a patient is established on a therapeutic dose, they can be put on the slow-release formulation to provide round-the-clock analgesia.

From - The Pain Web



Last Updated on Thursday, 19 March 2015 22:02