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Nonopioid pain control

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https://www.readbyqxmd.com/read/28815639/safety-tolerability-and-pharmacokinetic-characteristics-of%C3%A2-a-novel-nonopioid-analgesic-vvz-149-injections-in-healthy-volunteers-a-first-in-class-first-in-human-study
#1
Jaeseong Oh, SeungHwan Lee, Anhye Kim, Jangsoo Yoon, Kyungho Jang, Doo H Lee, Sunyoung Cho, Sang Rim Lee, Kyung-Sang Yu, Jae-Yong Chung
VVZ-149, a dual antagonist of GlyT2 and 5HT2 A receptors, is an investigational analgesic with a novel mechanism of action that is currently under early-stage clinical development as an injectable agent for the treatment of postoperative pain. Here, the safety, tolerability, and pharmacokinetics of VVZ-149 injections in healthy male volunteers were explored in a randomized, double-blind, single- and multiple-ascending-dose (SAD and MAD, respectively), placebo-controlled clinical study. Subjects randomly received a 4-hour intravenous infusion of 0...
August 16, 2017: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28743507/ketamine-for-pain-management-side-effects-potential-adverse-events
#2
Cheryl A Allen, Julius R Ivester
An old anesthetic agent, ketamine is finding new use in lower doses for analgesic purposes. There are concerns stemming from its potential side effects-specifically psychomimetic effects. These side effects are directly related to dose amount. The doses used for analgesic purposes are much lower than those used for anesthesia purposes. A literature review was performed to ascertain potential side effects and/or adverse events when using ketamine for analgesia purposes. The search included CINAHL, PubMed, and Ovid using the search terms "ketamine," "ketamine infusion," "pain," "adverse events," "practice guideline," and "randomized controlled trial...
July 22, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/28731925/thoracic-paravertebral-block-for-postoperative-pain-management-after-renal-surgery-a-randomised-controlled-trial
#3
Maja Copik, Szymon Bialka, Andrzej Daszkiewicz, Hanna Misiolek
BACKGROUND: Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE: To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN: A randomised, open label study. SETTING: A single university hospital...
September 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28719091/multimodal-analgesia-as-an-alternative-to-the-risks-of-opioid-monotherapy-in-surgical-pain-management
#4
John J Savarese, Norman G Tabler
Clinicians have long been aware of the danger of overreliance on opioids to manage acute pain, such as the pain accompanying surgery. The risk of adverse drug events is higher with opioids than with any other common class of drugs. Overreliance on opioids increases length of stay and hospital costs, while decreasing patient satisfaction. Opioids can lead to problems that continue well after discharge, including chronic pain, abuse and addiction, and even death. Increasingly, prescribed opioids have proved to lead to heroin addiction...
July 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/28635354/the-effects-of-food-on-opioid-induced-nausea-and-vomiting-and-pharmacological-parameters-a-systematic-review
#5
Robert B Raffa, Robert Colucci, Joseph V Pergolizzi
Opioids remain the standard of care for treating moderate to severe pain resulting from surgery or injury in cases of acute pain, and are recommended for patients who have not responded to nonopioid analgesics. Effective management of pain has an impact on clinical course and often depends on achieving an acceptable balance between opioid efficacy, safety, and tolerability. Common opioid-related adverse events such as nausea and vomiting are associated with an overall lower achievement of effective pain management and patient satisfaction...
June 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28598927/intraoperative-analgesia-nociception-index-guided-fentanyl-administration-during-sevoflurane-anesthesia-in-lumbar-discectomy-and-laminectomy-a-randomized-clinical-trial
#6
RANDOMIZED CONTROLLED TRIAL
Henry D Upton, Guy L Ludbrook, Andrew Wing, Jamie W Sleigh
BACKGROUND: The "Analgesia Nociception Index" (ANI; MetroDoloris Medical Systems, Lille, France) is a proposed noninvasive guide to analgesia derived from an electrocardiogram trace. ANI is scaled from 0 to 100; with previous studies suggesting that values ≥50 can indicate adequate analgesia. This clinical trial was designed to investigate the effect of intraoperative ANI-guided fentanyl administration on postoperative pain, under anesthetic conditions optimized for ANI functioning...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28586638/efficacy-of-codeine-when-added-to-paracetamol-acetaminophen-and-ibuprofen-for-relief-of-postoperative-pain-after-surgical-removal-of-impacted-third-molars-a-double-blinded-randomized-control-trial
#7
Adrian D Best, R K De Silva, W M Thomson, Darryl C Tong, Claire M Cameron, Harsha L De Silva
PURPOSE: The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. MATERIALS AND METHODS: This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal...
May 15, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28564673/postoperative-multimodal-analgesia-pain-management-with-nonopioid-analgesics-and-techniques-a-review
#8
Elizabeth C Wick, Michael C Grant, Christopher L Wu
Importance: Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens. Observations: Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or the N-methyl-d-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia...
July 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28459476/an-osteopathic-approach-to-chronic-pain-management
#9
John A Jerome
Chronic pain reduces quality of life and productivity, costing billions in health care dollars and lost revenue. Physicians routinely prescribe opioids, which has led to opioid addiction and overdose. The US surgeon general recommends nonpharmacologic treatment for patients with chronic pain. A paradigm shift is necessary for patients to partner with physicians to take control of their own health. This article outlines the cognitive behavioral approaches, nonopioid therapies, and nonpharmacologic therapies that osteopathic physicians can integrate in their treatment of patients with chronic pain...
May 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28387833/endocannabinoid-and-opioid-system-interactions-in-exercise-induced-hypoalgesia
#10
Kevin M Crombie, Angelique G Brellenthin, Cecilia J Hillard, Kelli F Koltyn
Objective.:  The purpose of this study was to examine the interaction between the endogenous opioid and endocannabinoid (eCB) systems in a pain modulatory process known as exercise-induced hypoalgesia (EIH). Design.:  Randomized controlled trial. Setting.:  Clinical research unit in a hospital. Subjects.:  Fifty-eight healthy men and women (mean age = 21 ± 3 years) participated in this study. Methods: ...
April 6, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28345743/opioids-and-nonopioids-for-postoperative-pain-control-in-patients-with-chronic-kidney-disease
#11
Michele Binhas, Julia Egbeola-Martial, Michael D Kluger, Francoise Roudot-Thoraval, Philippe Grimbert
OBJECTIVES: To evaluate postoperative pain management (POPM) practices by anesthesiologists caring for patients with chronic kidney disease (CKD). DESIGN: Prospective one-time survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). SETTING: A self-administered online questionnaire was distributed to members of SFAR nationally. PARTICIPANTS: Three hundred seven SFAR members participated in the study...
January 2017: Journal of Opioid Management
https://www.readbyqxmd.com/read/28345440/the-economic-burden-of-opioid-abuse-updated-findings
#12
Noam Y Kirson, Lauren M Scarpati, Caroline J Enloe, Aliya P Dincer, Howard G Birnbaum, Tracy J Mayne
BACKGROUND: Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annual excess costs of opioid abuse to payers range from approximately $10,000 to $20,000 per patient. OBJECTIVES: To (a) provide a comprehensive, current estimate of the economic burden of opioid abuse to commercial payers and (b) explore the drivers of these excess costs of abuse...
April 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28074028/assessment-of-postoperative-pain-control-with-an-elastomeric-pain-pump-following-cardiothoracic-surgery
#13
Anuvrat Chopra, Jeff Hurren, Susan Szpunar, Stephanie B Edwin
Objective: To assess the effectiveness of local anesthesia, delivered via elastomeric pump to manage pain in patients undergoing cardiothoracic surgery. Methods: A retrospective, comparative analysis evaluating adult cardiothoracic surgery patients (by median sternotomy) who received continuous infusion bupivacaine + traditional methods of pain control (N = 100) or traditional pain control alone (N = 100) from July 2011-October 2013. The primary efficacy end point was total postoperative opioid requirements for 96 hours following surgery...
August 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28069072/pansaid-paracetamol-and-nsaid-in-combination-study-protocol-for-a-randomised-trial
#14
Kasper Højgaard Thybo, Daniel Hägi-Pedersen, Jørn Wetterslev, Jørgen Berg Dahl, Henrik Morville Schrøder, Hans Henrik Bülow, Jan Gottfrid Bjørck, Ole Mathiesen
BACKGROUND: Effective postoperative pain management is essential for the rehabilitation of the surgical patient. No 'gold standard' exists after total hip arthroplasty (THA) and combinations of different nonopioid medications are used with virtually no evidence for additional analgesic efficacy compared to monotherapy. The objective of this trial is to investigate the analgesic effects and safety of paracetamol and ibuprofen alone and in combination in different dosages after THA. METHODS: PANSAID is a placebo-controlled, parallel four-group, multicentre trial with centralised computer-generated allocation sequence and allocation concealment and with varying block size and stratification by site...
January 10, 2017: Trials
https://www.readbyqxmd.com/read/28053554/postoperative-opioid-sparing-with-injectable-hydroxypropyl-%C3%AE-cyclodextrin-diclofenac-pooled-analysis-of-data-from-two-phase-iii-clinical-trials
#15
Tong J Gan, Neil Singla, Stephen E Daniels, Douglas A Hamilton, Peter G Lacouture, Christian Rd Reyes, Daniel B Carr
PURPOSE: Use of nonopioid analgesics (including nonsteroidal anti-inflammatory drugs) for postoperative pain management can reduce opioid consumption and potentially prevent opioid-related adverse events. This study examined the postoperative opioid-sparing effect of repeated-dose injectable diclofenac formulated with hydroxypropyl-β-cyclodextrin (HPβCD)-diclofenac. PATIENTS AND METHODS: Pooled data from two double-blind, randomized, placebo- and active comparator-controlled Phase III trials were analyzed...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28045611/establishment-of-personalized-pain-goals-in-oncology-patients-to-improve-care-and-decrease-costs
#16
Dylan Zylla, Amber Larson, Gladys Chuy, Lisa Illig, Adina Peck, Sarah Van Peursem, James W Fulbright, Pamala A Pawloski, Sara Richter, Jeanne Mettner
PURPOSE: Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking. METHODS: We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments. In June 2014, we instituted a pain intervention by creating a pain management information handout for patients, educating clinicians on opioid cost-effectiveness, and implementing a nursing protocol to document personalized pain goals (PPGs)...
March 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28030443/dipyrone-metamizole-markedly-interferes-with-platelet-inhibition-by-aspirin-in-patients-with-acute-and-chronic-pain-a-case-control-study
#17
Andrea Schmitz, Larissa Romann, Peter Kienbaum, Goran Pavlaković, Robert Werdehausen, Thomas Hohlfeld
BACKGROUND: Nonopioid analgesic drugs may interfere with platelet inhibition by aspirin. Recent in vitro and clinical studies in patients with cardiovascular disease have suggested that this pharmacodynamic interaction may also occur with dipyrone, a nonopioid analgesic popular in Europe, Asia and South America. OBJECTIVE: Dipyrone is used extensively in acute and chronic pain. This study was undertaken to provide clinical data, so far missing, on its interactions in this group of patients...
May 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/27878902/a-retrospective-comparison-of-intrathecal-morphine-and-epidural-hydromorphone-for-analgesia-following-posterior-spinal-fusion-in-adolescents-with-idiopathic-scoliosis
#18
Rebecca A Hong, Kathleen M Gibbons, G Ying Li, Ashlee Holman, Terri Voepel-Lewis
BACKGROUND: Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively...
January 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27861834/an-algorithm-for-opioid-and-barbiturate-reduction-in-the-acute-management-of-headache-in-the-emergency-department
#19
Zubair A Ahmed, Dimitrios A Nacopoulos, Seby John, Nancy Papesh, David Levine, Cynthia C Bamford
OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications...
January 2017: Headache
https://www.readbyqxmd.com/read/27858921/effectiveness-of-postoperative-intravenous-acetaminophen-acelio-after-gastrectomy-a-propensity-score-matched-analysis
#20
Yu Ohkura, Shusuke Haruta, Junichi Shindoh, Tsuyoshi Tanaka, Masaki Ueno, Harushi Udagawa
The aim of this study was to investigate the efficacy of postoperative scheduled intravenous acetaminophen to reduce the opioid use and enhance recovery after gastrectomy.Opioid use is reportedly associated with delayed recovery of gastrointestinal (GI) peristalsis and postoperative nausea/vomiting (PONV) despite of acceptable efficacy for pain control.Of 147 and 96 consecutive patients who underwent gastrectomy for gastric cancer before and after introduction of postoperative scheduled intravenous acetaminophen, propensity score matched population was created and short-term clinical outcomes were compared...
November 2016: Medicine (Baltimore)
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