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https://www.readbyqxmd.com/read/28717823/-interdisciplinary-pain-assessment-in-the-hospital-setting-merely-a%C3%A2-door-opener-to-multimodal-pain-therapy
#1
E Sens, M Mothes-Lasch, J F Lutz
BACKGROUND: Chronic pain is characterized by a complex interaction of somatic, mental and social factors. Assessing these factors in patients with chronic pain is vital during the diagnostic work-up and when making a structured treatment plan. Interdisciplinary pain assessment (ISA) is the most promising method to deal with these challenges. This article presents our experience in performing pain assessments in the hospital setting and also illustrates the characteristic features of chronic pain patients undergoing such assessments...
July 17, 2017: Der Schmerz
https://www.readbyqxmd.com/read/28715848/patient-outcomes-in-dose-reduction-or-discontinuation-of-long-term-opioid-therapy-a-systematic-review
#2
Joseph W Frank, Travis I Lovejoy, William C Becker, Benjamin J Morasco, Christopher J Koenig, Lilian Hoffecker, Hannah R Dischinger, Steven K Dobscha, Erin E Krebs
Background: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed. Purpose: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain. Data Sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts...
July 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28714716/cb%C3%A2-receptor-antagonism-in-the-bed-nucleus-of-the-stria-terminalis-interferes-with-affective-opioid-withdrawal-in-rats
#3
Kiri L Wills, Marieka V DeVuono, Cheryl L Limebeer, Kiran Vemuri, Alexandros Makriyannis, Linda A Parker
The bed nucleus of the stria terminalis (BNST) is a region of the extended amygdala that is implicated in addiction, anxiety, and stress related behaviors. This region has been identified in mediating the aversive state of naloxone-precipitated morphine withdrawal (MWD) and cannabinoid Type I (CB1) receptors have been found to modulate neurotransmission within this region. Previous findings suggest that the CB1 antagonist/inverse agonist, AM251, administered systemically or by infusion into the central nucleus of the amygdala (CeA) prevented the aversive affective properties of MWD as measured by conditioned place aversion learning...
August 2017: Behavioral Neuroscience
https://www.readbyqxmd.com/read/28709955/neonatal-injury-results-in-sex-dependent-nociceptive-hypersensitivity-and-social-behavioral-deficits-during-adolescence-without-altering-morphine-response
#4
Nikita N Burke, Tuan Trang
Neonatal injury is associated with persistent changes in sensory function and altered nociceptive thresholds that give rise to aberrant pain sensitivity in later life. While these changes are well documented in adult rodents, little is known about the consequences of neonatal injury during adolescence. Since adolescence is a critical developmental period during which persistent pain conditions can arise, we examined the impact of neonatal injury on nociception, social behavior and response to morphine in adolescent Sprague Dawley rats...
July 11, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28700791/efficacy-of-tramadol-extended-release-for-opioid-withdrawal-a-randomized-clinical-trial
#5
Kelly E Dunn, D Andrew Tompkins, George E Bigelow, Eric C Strain
Importance: Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. Objective: To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. Design, Setting, and Participants: A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD...
July 12, 2017: JAMA Psychiatry
https://www.readbyqxmd.com/read/28700092/oral-paracetamol-acetaminophen-for-cancer-pain
#6
REVIEW
Philip J Wiffen, Sheena Derry, R Andrew Moore, Ewan D McNicol, Rae F Bell, Daniel B Carr, Mairead McIntyre, Bee Wee
BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Non-opioid drugs are commonly used to treat mild to moderate cancer pain, and are recommended for this purpose in the WHO cancer pain treatment ladder, either alone or in combination with opioids.A previous Cochrane review that examined the evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain was withdrawn in 2015 because it was out of date; the date of the last search was 2005...
July 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28700091/oral-nonsteroidal-anti-inflammatory-drugs-nsaids-for-cancer-pain-in-adults
#7
REVIEW
Sheena Derry, Philip J Wiffen, R Andrew Moore, Ewan D McNicol, Rae F Bell, Daniel B Carr, Mairead McIntyre, Bee Wee
BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Non-opioid drugs are commonly used to treat cancer pain, and are recommended for this purpose in the World Health Organization (WHO) cancer pain treatment ladder, either alone or in combination with opioids.A previous Cochrane review that examined the evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain was withdrawn in 2015 because it was out of date; the date of the last search was 2005...
July 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28699845/development-and-implementation-of-an-alcohol-withdrawal-protocol-using-a-5-item-brief-alcohol-withdrawal-scale-baws
#8
Darius A Rastegar, Dinah Applewhite, Anika A H Alvanzo, Christopher Welsh, Timothy Niessen, Edward S Chen
BACKGROUND: The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. METHODS: We initially piloted a 6-item withdrawal scale developed at another institution...
July 12, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28687506/effects-of-alkaloid-rich-extract-from-mitragyna-speciosa-korth-havil-on-naloxone-precipitated-morphine-withdrawal-symptoms-and-local-field-potential-in-the-nucleus-accumbens-of-mice
#9
Dania Cheaha, Chayaporn Reakkamnuan, Jakkrit Nukitram, Somsmorn Chittrakarn, Pimpimol Phukpattaranont, Niwat Keawpradub, Ekkasit Kumarnsit
ETHNOPHARMACOLOGICAL RELEVANCE: Mitragyna speciosa (Korth.) Havil. (M. speciosa) is among the most well-known plants used in ethnic practice of Southeast Asia. It has gained increasing attention as a plant with potential to substitute morphine in addiction treatment program. However, its action on the central nervous system is controversial. AIM OF THE STUDY: This study investigated the effects of M. speciosa alkaloid extract on naloxone-precipitated morphine withdrawal and neural signaling in the nucleus accumbens (NAc, brain reward center) of mice...
July 5, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28683783/polydrug-abuse-among-opioid-maintenance-treatment-patients-is-related-to-inadequate-dose-of-maintenance-treatment-medicine
#10
Pertti Kalevi Heikman, Leea Hellevi Muhonen, Ilkka Antero Ojanperä
BACKGROUND: Polydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal polydrug abuse in its current scope. Furthermore, there are few studies focusing on the relationship between polydrug abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the polydrug abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients...
July 6, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28683172/opioids-for-cancer-pain-an-overview-of-cochrane-reviews
#11
REVIEW
Philip J Wiffen, Bee Wee, Sheena Derry, Rae F Bell, R Andrew Moore
BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Opioid (morphine-like) drugs are commonly used to treat moderate or severe cancer pain, and are recommended for this purpose in the World Health Organization (WHO) pain treatment ladder. The most commonly-used opioid drugs are buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, tramadol, and tapentadol...
July 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28669739/an-evidence-based-recommendation-to-increase-the-dosing-frequency-of-buprenorphine-during-pregnancy
#12
Steve N Caritis, Jaime R Bastian, Hongfei Zhang, Hari Kalluri, Dennis English, Michael England, Stephanie Bobby, Raman Venkataramanan
BACKGROUND: Dose-adjusted plasma concentrations of buprenorphine are significantly decreased during pregnancy compared to the non-pregnant state. This observation suggests that pregnant women may need a higher dose of buprenorphine than non-pregnant individuals in order to maintain similar drug exposure (plasma concentrations over time after a dose). The current dosing recommendations for buprenorphine during pregnancy address the total daily dose of buprenorphine to be administered but the frequency of dosing is not clearly addressed...
June 29, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28663110/sucrose-and-naltrexone-prevent-increased-pain-sensitivity-and-impaired-long-term-memory-induced-by-repetitive-neonatal-noxious-stimulation-role-of-bdnf-and-%C3%AE-endorphin
#13
Khawla Q Nuseir, Karem H Alzoubi, Ahmed Alhusban, Areej Bawaane, Mohammed Al-Azzani, Omar F Khabour
Pain in neonates is associated with short and long-term adverse outcomes. Data demonstrated that long-term consequences of untreated pain are linked to the plasticity of the neonate's brain. Sucrose is effective and safe for reducing painful procedures from single events. However, the mechanism of sucrose-induced analgesia is not fully understood. The role of the opioid system in this analgesia using the opioid receptor antagonist Naltrexone was investigated, plus the long-term effects on learning and memory formation during adulthood...
June 27, 2017: Physiology & Behavior
https://www.readbyqxmd.com/read/28657160/ketamine-as-an-adjuvant-to-opioids-for-cancer-pain
#14
REVIEW
Rae F Bell, Christopher Eccleston, Eija A Kalso
BACKGROUND: This is an update of a review first published in 2003 and updated in 2012.Ketamine is a commonly used anaesthetic agent, and in subanaesthetic doses is also given as an adjuvant to opioids for the treatment of refractory cancer pain, when opioids alone or in combination with appropriate adjuvant analgesics prove to be ineffective. Ketamine is known to have psychomimetic (including hallucinogenic), urological, and hepatic adverse effects. OBJECTIVES: To determine the effectiveness and adverse effects of ketamine as an adjuvant to opioids for refractory cancer pain in adults...
June 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28655025/effect-of-buprenorphine-weekly-depot-cam2038-and-hydromorphone-blockade-in-individuals-with-opioid-use-disorder-a-randomized-clinical-trial
#15
Sharon L Walsh, Sandra D Comer, Michelle R Lofwall, Bradley Vince, Naama Levy-Cooperman, Debra Kelsh, Marion A Coe, Jermaine D Jones, Paul A Nuzzo, Fredrik Tiberg, Behshad Sheldon, Sonnie Kim
Importance: Buprenorphine is an efficacious, widely used treatment for opioid use disorder (OUD). Daily oral transmucosal formulations can be associated with misuse, diversion, and nonadherence; these limitations may be obviated by a sustained release formulation. Objective: To evaluate the ability of a novel, weekly, subcutaneous buprenorphine depot formulation, CAM2038, to block euphorigenic opioid effects and suppress opioid withdrawal in non-treatment-seeking individuals with OUD...
June 22, 2017: JAMA Psychiatry
https://www.readbyqxmd.com/read/28654797/simvastatin-prevents-morphine-induced-tolerance-and-dependence-in-mice
#16
Nasim Sadat Pajohanfar, Ehsan Mohebbi, Ahmad Hosseini-Bandegharaei, Mohamadraza Amin, Golnaz Vaseghi, Bahareh Amin
BACKGROUND: Tolerance to analgesic effects of opioids and dependence to them are main concerns in the treatment of chronic pain conditions, limiting clinical application of these drugs. This study aimed to evaluate the effect of simvastatin on the morphine-induced tolerance and dependence in mice. MATERIAL AND METHODS: For this purpose, mice were treated with either daily morphine (20 mg/kg, s.c.) alone, or in combination with simvastatin (2.5, 5 and 10mg/kg, i...
June 24, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28650702/a-case-report-of-methadone-associated-hypoglycemia-in-an-11-month-old-male
#17
Michael S Toce, Margaret A Stefater, David T Breault, Michele M Burns
BACKGROUND: Methadone is a synthetic μ-opioid receptor agonist that is used in the management of pain, neonatal abstinence withdrawal syndrome, and opioid dependence. Overdose can cause miosis, respiratory depression, and central nervous system depression. Rarely, hypoglycemia has been reported. We present the case of an 11-month-old male who developed hypoketotic, hyperinsulinemic, hypoglycemia after an acute, unintentional methadone exposure. CASE DETAILS: The patient was a previously healthy 11-month-old male who presented in respiratory failure...
June 26, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28650234/antinociceptive-and-respiratory-effects-following-application-of-transdermal-fentanyl-patches-and-assessment-of-brain-%C3%AE-opioid-receptor-mrna-expression-in-ball-pythons
#18
Rima J Kharbush, Allison Gutwillig, Kate E Hartzler, Rebecca S Kimyon, Alyssa N Gardner, Andrew D Abbott, Sherry K Cox, Jyoti J Watters, Kurt K Sladky, Stephen M Johnson
OBJECTIVE To quantify plasma fentanyl concentrations (PFCs) and evaluate antinociceptive and respiratory effects following application of transdermal fentanyl patches (TFPs) and assess cerebrospinal μ-opioid receptor mRNA expression in ball pythons (compared with findings in turtles). ANIMALS 44 ball pythons (Python regius) and 10 turtles (Trachemys scripta elegans). PROCEDURES To administer 3 or 12 μg of fentanyl/h, a quarter or whole TFP (TFP-3 and TFP-12, respectively) was used. At intervals after TFP-12 application in snakes, PFCs were measured by reverse-phase high-pressure liquid chromatography...
July 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28648162/-treatment-of-acute-pain-in-opioid-addicts
#19
Henrik Rindom, Jette Højsted, Nina Brünés
The challenge of managing acute pain in opioid-addicted patients is a question of fully understanding the pharmacological effects of the illegal drugs and to prevent overdosing or withdrawal symptoms. It requires a thorough knowledge of the patient's daily consumption of legal and illegal drugs and an understanding obtained through an accepting and empathetic communication with the patient. Substitution management aims to prevent opioid withdrawal symptoms and is not a means of managing pain. When planning the pain management the patient must receive at least 25% of the daily methadone dose, recalculated into equipotent substitute morphine...
June 26, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28645616/epidemiological-and-sociodemographic-factors-associated-with-complicated-alcohol-withdrawal-syndrome
#20
R Monte-Secades, M Blanco-Soto, J A Díaz-Peromingo, A Sanvisens-Bergé, M C Martín-González, A Barbosa, B Rosón-Hernández, M A Tejero-Delgado, R Puerta-Louro, R Rabuñal-Rey
OBJECTIVES: To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). MATERIAL AND METHODS: A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens...
June 20, 2017: Revista Clínica Española
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