Caffeine in Pain Perception and Management

Introduction: Caffeine is considered to be one of the most frequently used pharmacologically active substances in the world. Caffeine is a psychoactive and central nervous system stimuli that has the ability to increase energy, decrease fatigue, promote alertness and wakefulness. Potential role of caffeine's nociceptive properties shows that it may play a relevant role in pain modulation. Although caffeine at dietary levels is not a sufficient analgesic in its own, it has been included in many over-the-counter and prescription drugs. This review addresses caffeine's analgesic properties in pain management. Results: Caffeine shows relevant role in pain modulation through blocking adenosine receptors which are involved in nociception. Studies show that habitual dietary caffeine consumption results in decreased pain sensitivity.As an adjuvant to commonly used analgesics, caffeine provides an important increase in pain relief in various types of pain such as postoperative dental pain, headaches, or fibromyalgia.Conclusions: In conclusion, caffeine is associated with decreased pain sensitivity. Addition of caffeine to analgesics has resulted in their enhanced analgesic efficacy in pain treatment.

Efficacy and Safety of Two Fixed-Dose Combinations of Tramadol Hydrochloride and Diclofenac Sodium in Postoperative Dental Pain

Objective To evaluate the analgesic efficacy and safety of tramadol hydrochloride/diclofenac sodium fixed-dose combination 25 mg/25 mg (FDC 25/25) and 50 mg/50 mg (FDC 50/50) vs tramadol 50 mg (T50) and diclofenac 50 mg (D50) monotherapies in acute postoperative dental pain. Setting Eight sites across Mexico. Subjects Adults (N = 829) with moderate to severe pain after third molar extraction. Design Prospective, randomized, double-blind, diclofenac- and tramadol-controlled, parallel-group, noninferiority, phase 3 trial. Methods Subjects were randomized to receive three doses (one every eight hours) of oral FDC 25/25, FDC 50/50, T50, or D50 over a 24-hour period. Pain intensity and pain relief were evaluated frequently over the 24 hours postdose. Secondary measures included peak pain relief, onset, and duration of effect. The primary objective was to compare the analgesic efficacy and safety of FDC 50/50 or analgesic noninferiority of FDC 25/25 vs D50 or T50. The primary efficacy end point was total pain relief over four hours after dose 1 (TOTPAR4). Results TOTPAR4 scores showed that FDC 25/25 was noninferior (P < 0.0001, delta = 1.5) and FDC 50/50 was superior (P < 0.0001) to the individual components. All secondary efficacy measures supported these results. The safety profile of FDC 25/25 and FDC 50/50 was consistent with the known safety profile of D50 and T50 monotherapies, with no unexpected safety findings observed. Conclusions Tramadol/diclofenac FDC 25/25 and FDC 50/50 provide superior analgesia for acute pain after third molar extraction than either of the individual components. Minor adverse effects appeared to be related to the higher doses of tramadol.

Conquest of Pain: Analgesics: From Morphine to Lyrica

To live is to endure pain has been understood by almost everybody who is mature enough to gain some philosophical perspective on life. C’est la vie! as the French would say. Indeed, pain existed before the dawn of humanity—some research suggests that even plants respond to pain. According to ancient Greek myth, Prometheus stole fire from Olympus to give it to mortals. Zeus punished him by chaining him to a rock and having a great eagle feast on his liver daily, inflicting unbearable agony. Zeus also sent Pandora to Earth, unleashing pain (one of the items in Pandora’s box) and many evils as a vengeance to mankind. Without an understanding of pain, our ancestors resorted to many measures to ease pain; some were successful to some extent, and some were completely futile. Witches and shamans were sought out to exorcise pain from the body. From a psychological perspective, they might be effective for some believers. The hypnotizing technique reached its crescendo in the 18th century in France when Monsieur Anton Mesmer “mesmerized” many French citizens, liberating them from their pains. As civilization progressed, alcohol became more and more a universal painkiller after it was observed that drunkards were oblivious to pain. Chinese surgeon Hua Tuo (115–205 ad) gave his patients an effervescent powder (possibly cannabis) in wine that produced numbness and insensibility before surgical operations. Another ancient invention in Chinese medicine was the use of acupuncture to ease pain. Acupuncture, now an increasingly popular treatment for persistent as well as intermittent pain, is thought to work by increasing the release of endorphins, chemicals that block pain signals from reaching the brain. A recent survey by the National Institute of Health (NIH) indicated that acupuncture showed efficacy in adult postoperative pain, chemotherapy nausea and vomiting, and postoperative dental pain. There is no doubt that acupuncture works for some patients’ minor pain, through either physiological or psychological means, or both. or both. During the hype of the Great Culture Revolution (1966–1976), it was even claimed that major operations were carried out using acupuncture without any other anesthetics.