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Benzodiazepines for chronic pain

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https://www.readbyqxmd.com/read/29752012/impact-of-multidisciplinary-chart-reviews-on-opioid-dose-reduction-and-monitoring-practices
#1
Julianna Rivich, Jocelyn McCauliff, Allison Schroeder
INTRODUCTION: The Veterans Affairs (VA) Eastern Colorado Health Care System implemented an Opioid Safety Initiative (OSI); this included multidisciplinary chart reviews of patients with chronic, non-malignant pain on high-dose opioid therapy to provide safety recommendations to prescribers through the electronic medical record. Our study objective was to evaluate the impact of these documented recommendations. Outcomes included change in total daily opioid dose, concurrent prescribing of opioids and benzodiazepines, adherence to local VA/Veterans Integrated Service Network (VISN) policy, and monitoring practices...
April 27, 2018: Addictive Behaviors
https://www.readbyqxmd.com/read/29733095/assessment-of-outcomes-following-high-dose-opioid-tapering-in-a-veterans-healthcare-system
#2
Lauren Hundley, Shelley Spradley, Scott Donelenko
OBJECTIVE: To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. DESIGN: IRB and VA Office of Research and Development-approved retrospective, observational chart review. SETTING: North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included...
March 2018: Journal of Opioid Management
https://www.readbyqxmd.com/read/29692877/predictors-of-transitioning-to-incident-chronic-opioid-therapy-among-working-age-adults-in-the-united-states
#3
J Douglas Thornton, Nilanjana Dwibedi, Virginia Scott, Charles D Ponte, Douglas Ziedonis, Nethra Sambamoorthi, Usha Sambamoorthi
Background: Opioids have been prescribed and used for chronic noncancer pain at prolific rates in the United States during the past 2 decades. Patients who transition to incident chronic opioid therapy are at increased risk for significant negative health consequences, including cardiovascular risk, endocrine disorders, opioid use disorder, and death. Objective: To identify the leading predictors associated with transitioning to incident chronic opioid therapy among working-age adults without cancer...
February 2018: American Health & Drug Benefits
https://www.readbyqxmd.com/read/29678564/prescription-medication-use-among-community-based-us-adults-with-chronic-low-back-pain-a-cross-sectional-population-based-study
#4
Anna Shmagel, Linh Ngo, Kristine Ensrud, Robert Foley
Many classes of medications have been evaluated in chronic low back pain (cLBP), however their utilization in the community remains unclear. We examine patterns of prescription medication use among Americans with cLBP in a nationally representative, community-based sample. The Back Pain Survey was administered to a representative sample of US adults aged 20-69 (N = 5103) during the 2009-2010 cycle of the National Health and Nutrition Examination Survey (NHANES). cLBP was defined as self-reported pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold on most days for at least 3 months (N = 700)...
April 17, 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29621539/molecular-determinants-of-kv7-1-kcne1-channel-inhibition-by-amitriptyline
#5
Kathya Villatoro-Gómez, David O Pacheco-Rojas, Eloy G Moreno-Galindo, Ricardo A Navarro-Polanco, Martin Tristani-Firouzi, Dimitris Gazgalis, Meng Cui, José A Sánchez-Chapula, Tania Ferrer
Amitriptyline (AMIT) is a compound widely prescribed for psychiatric and non- psychiatric conditions including depression, migraine, chronic pain, and anorexia. However, AMIT has been associated with risks of cardiac arrhythmia and sudden death since it can induce prolongation of the QT interval on the surface electrocardiogram and torsade de pointes ventricular arrhythmia. These complications have been attributed to the inhibition of the rapid delayed rectifier potassium current (IKr ). The slow delayed rectifier potassium current (IKs ) is the main repolarizing cardiac current when IKr is compromised and it has an important role in cardiac repolarization at fast heart rates induced by an elevated sympathetic tone...
April 2, 2018: Biochemical Pharmacology
https://www.readbyqxmd.com/read/29595408/an-electronic-intervention-to-improve-safety-for-pain-patients-co-prescribed-chronic-opioids-and-benzodiazepines
#6
Tauheed Zaman, Tessa L Rife, Steven L Batki, David L Pennington
BACKGROUND: Co-prescribing opioids and benzodiazepines increases overdose risk. A paucity of literature exists evaluating strategies to improve safety of co-prescribing. This study evaluated an electronic intervention to improve safety for patients co-prescribed chronic opioids for pain and benzodiazepines at 3- and 6-months. METHODS: Prospective cohort study conducted December 2015 through May 2016 at San Francisco Veterans Affairs Health Care System. A clinical dashboard identified 145 eligible patients prescribed chronic opioids and benzodiazepines...
March 29, 2018: Substance Abuse
https://www.readbyqxmd.com/read/29559866/intelligent-clinical-decision-support-to-improve-safe-opioid-management-of-chronic-noncancer-pain-in-primary-care
#7
Eboni G Price-Haywood, Wanda Robinson, Jewel Harden-Barrios, Jeffrey Burton, Todd Burstain
Background: Opioid prescription drug abuse is a major public health concern. Healthcare provider prescribing patterns, especially among non-pain management specialists, are a major factor. Practice guidelines recommend what to do for safe opioid prescribing but do not provide guidance on how to implement best practices. Methods: We describe the implementation of electronic medical record clinical decision support (EMR CDS) for opioid management of chronic noncancer pain in an integrated delivery system...
2018: Ochsner Journal
https://www.readbyqxmd.com/read/29460009/the-global-spine-care-initiative-applying-evidence-based-guidelines-on-the-non-invasive-management-of-back-and-neck-pain-to-low-and-middle-income-communities
#8
REVIEW
Roger Chou, Pierre Côté, Kristi Randhawa, Paola Torres, Hainan Yu, Margareta Nordin, Eric L Hurwitz, Scott Haldeman, Christine Cedraschi
PURPOSE: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. METHODS: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries...
February 19, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29457627/combination-pharmacotherapy-for-the-treatment-of-fibromyalgia-in-adults
#9
REVIEW
Joelle Thorpe, Bonnie Shum, R Andrew Moore, Philip J Wiffen, Ian Gilron
BACKGROUND: Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated. Combining different agents could provide superior pain relief and possibly also fewer side effects. OBJECTIVES: To assess the efficacy, safety, and tolerability of combination pharmacotherapy compared to monotherapy or placebo, or both, for the treatment of fibromyalgia pain in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, and Embase to September 2017...
February 19, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29404943/prediction-of-future-chronic-opioid-use-among-hospitalized-patients
#10
S L Calcaterra, S Scarbro, M L Hull, A D Forber, I A Binswanger, K L Colborn
BACKGROUND: Opioids are commonly prescribed in the hospital; yet, little is known about which patients will progress to chronic opioid therapy (COT) following discharge. We defined COT as receipt of ≥ 90-day supply of opioids with < 30-day gap in supply over a 180-day period or receipt of ≥ 10 opioid prescriptions over 1 year. Predictive tools to identify hospitalized patients at risk for future chronic opioid use could have clinical utility to improve pain management strategies and patient education during hospitalization and discharge...
February 5, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29371004/gender-differences-in-pain-experience-and-treatment-after-motor-vehicle-collisions-a-secondary-analysis-of-the-crash-injury-study
#11
Tracy E Madsen, Samuel McLean, Wanting Zhai, Sarah Linnstaedt, Michael C Kurz, Robert Swor, Phyllis Hendry, David Peak, Christopher Lewandowski, Claire Pearson, Brian O'Neil, Elizabeth Datner, David Lee, Francesca Beaudoin
PURPOSE: Little is known about gender differences in the treatment of pain after motor vehicle collisions (MVCs) in an emergency department (ED). We aimed to describe gender differences in pain experiences and treatment, specifically the use of opioids and benzodiazepines after ED discharge, for MVC-related pain. METHODS: This was a secondary analysis of previously collected data from the CRASH Injury studies. We included patients who were seen and discharged from an ED after an MVC and who were enrolled in 1 of 2 multicenter longitudinal prospective cohort studies (1 black/non-Hispanic and 1 white/non-Hispanic)...
February 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29370813/a-randomized-matched-pairs-study-of-feasibility-acceptability-and-effectiveness-of-systems-consultation-a-novel-implementation-strategy-for-adopting-clinical-guidelines-for-opioid-prescribing-in-primary-care
#12
Andrew Quanbeck, Randall T Brown, Aleksandra E Zgierska, Nora Jacobson, James M Robinson, Roberta A Johnson, Brienna M Deyo, Lynn Madden, Wen-Jan Tuan, Esra Alagoz
BACKGROUND: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. METHODS: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation...
January 25, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29179577/service-use-preceding-opioid-related-fatality
#13
Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Carlos Blanco
OBJECTIVE: This study analyzed health service patterns before opioid-related death among nonelderly individuals in the Medicaid program, focusing on decedents with and without past-year diagnoses of noncancer chronic pain. METHODS: The authors identified opioid-related decedents, age ≤64 years, in the Medicaid program and characterized their clinical diagnoses, filled medication prescriptions, and nonfatal poisoning events during the 30 days and 12 months before death...
November 28, 2017: American Journal of Psychiatry
https://www.readbyqxmd.com/read/29045696/group-visits-for-overdose-education-and-naloxone-distribution-in-primary-care-a-pilot-quality-improvement-initiative
#14
Juliette F Spelman, Stephanie Peglow, Amy R Schwartz, Lucille Burgo-Black, Katelyn McNamara, William C Becker
Objective: Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a take-home antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care. Design: Quality improvement intervention among two primary care clinics...
December 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28777177/chronic-insomnia-disorder
#15
Alon Y Avidan, David N Neubauer
PURPOSE OF REVIEW: Neurologists, along with all health care providers, commonly encounter patients with insomnia, which is a condition that impacts patients' underlying neurologic conditions in a bidirectional manner. While chronic insomnia is one of the most common sleep disturbances, only a small proportion of individuals with this condition discuss their sleep problems with their providers. When insomnia is described, it is more often in relationship to another medical problem, as opposed to an independent condition...
August 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28650247/burden-of-alcohol-abuse-or-dependence-among-long-term-opioid-users-with-chronic-noncancer-pain
#16
Pamela B Landsman-Blumberg, Nathaniel Katz, Kavita Gajria, Anna D Coutinho, Paul P Yeung, Richard White
BACKGROUND: Substance abuse disorders among chronic noncancer pain (CNCP) patients add to the clinical challenges and economic burden of caring for such patients. Despite potential risks, some CNCP patients with a history of alcohol abuse or dependence (AAD) and pain that is refractory to nonopioid treatment options may still need opioids for pain management. However, there is a lack of data on adverse outcomes in long-term opioid users with CNCP and a history of substance abuse or AAD disorders...
July 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28581025/clinical-characteristics-and-treatment-patterns-among-patients-diagnosed-with-cluster-headache-in-u-s-healthcare-claims-data
#17
Casey K Choong, Janet H Ford, Allen W Nyhuis, Shivang G Joshi, Rebecca L Robinson, Sheena K Aurora, James M Martinez
OBJECTIVE: To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH). BACKGROUND: CH is an uncommon trigeminal autonomic cephalalgia with limited evidence-based treatment options. Patients suffer from extremely painful unilateral headache attacks and autonomic symptoms with episodic and chronic cycles. DESIGN/METHODS: This retrospective analysis used insurance claims from Truven Health Analytics MarketScan(®) research databases from 2009 to 2014...
October 2017: Headache
https://www.readbyqxmd.com/read/28481052/long-term-opioid-therapy-in-denmark-a-disappointing-journey
#18
H Birke, O Ekholm, P Sjøgren, G P Kurita, J Højsted
BACKGROUND: Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long-term opioid users. METHODS: Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12,145)...
October 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/28388948/investigating-the-potential-of-the-anti-epileptic-drug-imepitoin-as-a-treatment-for-co-morbid-anxiety-in-dogs-with-idiopathic-epilepsy
#19
Rowena M A Packer, Luisa De Risio, Holger A Volk
BACKGROUND: Behavioural changes associated with idiopathic epilepsy (IE) have been identified in dogs, with fear and anxiety-related problems seen in both drug-naïve dogs and dogs treated with anti-epileptic drugs (AEDs). Treating anxiety-related behaviour in dogs with IE may be challenging, as seizures are a contraindication for many conventional anxiolytic drugs. In addition, many dogs with IE are already treated with AEDs to reduce their seizure frequency, which may have negative effects if used in polytherapy...
April 7, 2017: BMC Veterinary Research
https://www.readbyqxmd.com/read/28299720/ketamine-infusion-as-a-counter-measure-for-opioid-tolerance-in-mechanically-ventilated-children-a-pilot-study
#20
Felix Neunhoeffer, Anja Hanser, Martin Esslinger, Vanja Icheva, Matthias Kumpf, Ines Gerbig, Michael Hofbeck, Jörg Michel
BACKGROUND: Drug rotation to prevent opioid tolerance is well recognized in chronic pain management. However, ketamine infusion as a counter measure for opioid tolerance is rarely described in mechanically ventilated children developing tolerance from prolonged opioid infusion. PATIENTS AND METHODS: We performed a retrospective study in a 14-bed medical-surgical-cardiac pediatric intensive care unit. Thirty-two mechanically ventilated children who had developed tolerance from prolonged intravenous infusion of opioids received a continuous intravenous infusion of ketamine as an opioid substitute for more than 2 days, scheduled in a drug rotation protocol...
June 2017: Paediatric Drugs
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