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Nonopioid pain control

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https://www.readbyqxmd.com/read/29437536/opioid-stewardship-in-otolaryngology-state-of-the-art-review
#1
John D Cramer, Brad Wisler, And Christopher J Gouveia
Objective The United States is facing an epidemic of opioid addiction. Deaths from opioid overdose have quadrupled in the past 15 years and now surpass annual deaths during the height of the human immunodeficiency virus epidemic. There is a link between opioid prescriptions after surgery, opioid misuse, opioid diversion, and use of other drugs of abuse. As surgeons, otolaryngologists contribute to this crisis. Our objective is to outline the risk of abuse from opioids in the management of acute postoperative pain in otolaryngology-head and neck surgery (OHNS) and strategies to avoid misuse...
February 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29408973/analyzing-analgesic-medications-in-community-dwelling-older-adults
#2
Ann L Horgas, Urszula Snigurska, Michelle Z Farland, Michael Marsiske
Objectives: Analyzing medication data for research purposes is complex, and methods are rarely described in the literature. Our objective was to describe methods of quantifying opioid and nonopioid analgesics and to compare the utility of five different analgesic coding methods when analyzing relationships between pain, analgesic use, and clinical outcomes. In this study, we used physical function as the outcome variable for its clinical relevance and its relationship to pain in older adults...
February 2, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29371190/minimizing-opioid-use-after-acute-major-trauma
#3
Douglas Oyler, Andrew C Bernard, Jeremy D VanHoose, Sara E Parli, C Scott Ellis, David Li, Levi D Procter, Phillip K Chang
PURPOSE: Results of an initiative at an academic medical center to reduce prescription opioid use in patients with acute traumatic injuries are reported. METHODS: In 2014, the University of Kentucky Hospital trauma service implemented a pain management strategy consisting of patient and provider education emphasizing the use of nonopioid analgesics to minimize opioid use without compromising analgesia effectiveness. To assess the impact of the initiative, a retrospective analysis of data on cohorts of patients admitted with acute trauma before (n = 489) and after (n = 424) project implementation was conducted...
February 1, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29357325/buprenorphine-formulations-clinical-best-practice-strategies-recommendations-for-perioperative-management-of-patients-undergoing-surgical-or-interventional-pain-procedures
#4
Adrian B Jonan, Alan D Kaye, Richard D Urman
BACKGROUND: Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesia challenging. OBJECTIVES: To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period...
January 2018: Pain Physician
https://www.readbyqxmd.com/read/29338150/the-role-of-cannabinoids-in-pain-control-the-good-the-bad-and-the-ugly
#5
Joseph V Pergolizzi, Jo Ann Lequang, Robert Taylor, Robert B Raffa, Daniel Colucci
Cannabinoids appear to possess many potential medical uses, which may extend to pain control. A narrative review of the literature has found a variety of studies testing botanical and synthetic cannabinoids in different pain syndromes (acute pain, cancer pain, chronic noncancer pain, fibromyalgia pain, migraine, neuropathic pain, visceral pain, and others). Results from these studies are mixed; cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29180895/postoperative-pain-management-in-the-postanesthesia-care-unit-an-update
#6
REVIEW
Jie Luo, Su Min
Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients' participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29155191/ultrasound-guided-pudendal-block-is-a-viable-alternative-to-caudal-block-for-hypospadias-surgery-a-single-surgeon-pilot-study
#7
Sarah Hecht, Jorge Piñeda, Aaron Bayne
OBJECTIVE: To evaluate pudendal nerve block as an alternative to caudal block for hypospadias surgery. METHODS: Data were obtained by chart review. Children who underwent hypospadias repair between 2012 and 2016 by a single surgeon at an academic institution were included. Patients received ultrasound-guided pudendal block (n=21) or caudal block (n=19) as a regional adjunct to general anesthesia. Primary outcomes included analgesic requirement and postoperative length of stay in the recovery unit...
November 16, 2017: Urology
https://www.readbyqxmd.com/read/29153297/pain-management-practice-and-guidelines-in-jordanian-pediatric-intensive-care-units
#8
Ahmad Ismail, Paula Forgeron, Viola Polomeno, Huda Gharaibeh, Denise Harrison
Limited knowledge exists of current pain management practices and supporting guidelines in Jordanian pediatric intensive care units. To determine the current pain management practices and the availability and content of practice guidelines in Jordanian pediatric intensive care units, we conducted a cross-sectional and multisite survey of four pediatric intensive care units in Jordan. A questionnaire was developed and orally administered over the phone or in person to head nurses or their nominees to capture pain management practices and the existence and content of guidelines...
November 15, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29121327/short-acting-opioids-are-associated-with-comparable-analgesia-to-long-acting-opioids-in-patients-with-chronic-osteoarthritis-with-a-reduced-opioid-equivalence-dosing
#9
Ameer Ghodke, Stephanie Barquero, Paul R Chelminski, Timothy J Ives
Setting: There are no studies that exist within the primary care setting that address optimal opioid therapy in osteoarthritis patients. In light of the recently released US Centers for Disease Control and Prevention guidelines on opioid use in chronic noncancer pain, there is a pressing need to better characterize the effectiveness of long- and short-acting opioids. Objective: To examine the effectiveness of short-acting opioids (SAO) vs long-acting opioids (LAO) and combination therapies (SAO and LAO) for treating chronic osteoarthritis pain in a retrospective trial...
November 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29117012/scheduled-intravenous-acetaminophen-improves-patient-satisfaction-with-postcraniotomy-pain-management-a-prospective-randomized-placebo-controlled-double-blind-study
#10
Carlos A Artime, Hassan Aijazi, Haijun Zhang, Tariq Syed, Chunyan Cai, Sam D Gumbert, Lara Ferrario, Katherine C Normand, George W Williams, Carin A Hagberg
BACKGROUND: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. MATERIALS AND METHODS: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery...
November 7, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/29106649/pain-management-for-primary-care-providers-a-narrative-review-of-high-impact-studies-2014-2016
#11
William C Becker, Matthew J Bair, Michael Picchioni, Joanna L Starrels, Joseph W Frank
Objective: This manuscript reviews high-impact, peer-reviewed studies published from January 2014 to March 2016 that are relevant to pain management in primary care. Given the recent release of the US Centers for Disease Control and Prevention's "Guideline for Prescribing Opioids for Chronic Pain" emphasizing the primacy of nonopioid treatment, we focused our review on nonopioid pain management. Design: Narrative review of peer-reviewed literature. Methods: We searched three article summary services and queried expert contacts for high-impact, English-language studies related to the management of pain in adults in primary care...
July 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29049119/a-review-of-opioid-sparing-modalities-in-perioperative-pain-management-methods-to-decrease-opioid-use-postoperatively
#12
REVIEW
Kanupriya Kumar, Meghan A Kirksey, Silvia Duong, Christopher L Wu
There is an epidemic of opioid use, abuse, and misuse in the United States, which results in significant morbidity and mortality. It may be difficult to reduce perioperative opioid use given known acute surgical trauma and resultant pain; however, the discrete and often limited nature of postoperative pain also may make management easier in part by utilizing nonopioid modalities, such as regional anesthesia/analgesia, and multimodal analgesia, which may decrease the need for powerful opioids. This article reviews the relevant literature describing the use of adjunct medications, regional anesthesia and analgesic techniques, and regional block additives in the context of providing adequate pain control while lessening opioid use...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049114/alternatives-to-opioids-in-the-pharmacologic-management-of-chronic-pain-syndromes-a-narrative-review-of-randomized-controlled-and-blinded-clinical-trials
#13
REVIEW
Andrea L Nicol, Robert W Hurley, Honorio T Benzon
Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers use nonopioid medications to treat chronic pain; however, for some patients, opioid analgesics are the exclusive treatment of chronic pain...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049110/evidence-for-the-efficacy-of-systemic-opioid-sparing-analgesics-in-pediatric-surgical-populations-a-systematic-review
#14
REVIEW
Alyssa Zhu, Hubert A Benzon, T Anthony Anderson
While a large number of studies has examined the efficacy of opioid-sparing analgesics in adult surgical populations, fewer studies are available to guide postoperative pain treatment in pediatric patients. We systematically reviewed available publications on the use of systemic nonopioid agents for postoperative analgesia in pediatric surgical populations. A comprehensive literature search identified meta-analyses and randomized controlled trials (RCTs) assessing the effects of systemic, nonopioid agents on postoperative narcotic requirements or pain scores in pediatric surgical populations...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29048520/pain-acceptance-as-a-predictor-of-medical-utilization-and-school-absenteeism-in-adolescents-with-chronic-pain
#15
Michelle A Clementi, Grace S Kao, Evelyn Monico
Objective: Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain. Methods: In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month)...
October 12, 2017: Journal of Pediatric Psychology
https://www.readbyqxmd.com/read/29026331/poorly-controlled-postoperative-pain-prevalence-consequences-and-prevention
#16
REVIEW
Tong J Gan
This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs...
2017: Journal of Pain Research
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
#17
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
#18
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
#19
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
#20
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
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