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Benzodiazepines for chronic pain

Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
October 14, 2016: Clinical Therapeutics
Dermot P Maher, Pauline Woo, Waylan Wong, Xiao Zhang, Roya Yumul, Charles Louy
OBJECTIVE: To determine perioperative treatments and events associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) responses among patients who undergo total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). DESIGN: Retrospective analysis. SETTING: Single tertiary care, academic, urban, level 1 trauma center. PARTICIPANTS: Final cohort represents 301 consecutive surgical inpatients meeting criteria for evaluation by HCAHPS survey...
November 2016: Journal of Clinical Anesthesia
Chouki Chenaf, Jean-Luc Kabore, Jessica Delorme, Bruno Pereira, Aurélien Mulliez, Lucie Roche, Alain Eschalier, Noémie Delage, Nicolas Authier
: Codeine is a widely used opioid analgesic but studies on its misuse in chronic non-cancer pain (CNCP) are still lacking. The aim of this study was to assess the incidence of codeine shopping behavior in CNCP patients and to identify the associated risk factors. This was a population-based retrospective cohort study from the French health insurance claims database from 2004 to 2014. The main outcome was the one-year incidence of codeine shopping behavior defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies...
September 1, 2016: Journal of Pain: Official Journal of the American Pain Society
Roger L Bertholf, Rohit Sharma, Gary M Reisfield
Urine drug testing (UDT) has become an essential component in the management of patients prescribed opioid analgesics for the treatment of chronic non-malignant pain. Several laboratory methods are available to monitor adherence with the pharmacological regimen and abstinence from illicit or unauthorized medications. Immunochemical screening methods are rapid and economical, but they have limitations, including lack of specificity, and confirmatory methods are often necessary to verify presumptive positive results...
August 22, 2016: Journal of Analytical Toxicology
Jean-Daniel Carrier, Pasquale Roberge, Josiane Courteau, Alain Vanasse
OBJECTIVE: To identify predictive variables of incident chronic benzodiazepine (BZD) use that could be assessed by prescribing physicians. DESIGN: Retrospective cohort study using public health and drug insurance administrative data. SETTING: Quebec. PARTICIPANTS: New adult BZD users from January 1, 1999, to March 31, 2006, with a diagnosis of depressive disorder in the previous year were included. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation...
August 2016: Canadian Family Physician Médecin de Famille Canadien
Gregory J Pfister, Robert M Burkes, Brian Guinn, Jacquelene Steele, Robert R Kelley, Timothy L Wiemken, Mohamed Saad, Julio Ramirez, Rodrigo Cavallazzi
PURPOSE: There is a scarcity of studies assessing the patient population admitted to the intensive care unit (ICU) with opioid overdose. We sought to characterize the epidemiologic features and outcomes of this patient population. MATERIALS AND METHODS: This is a retrospective cohort study of adult patients admitted to the ICU at University of Louisville Hospital for opioid overdose. We reviewed each patient's hospital record for demographic data, comorbidities, opioid used, coingestions, and outcomes...
October 2016: Journal of Critical Care
Anna Shmagel, Erin Krebs, Kristine Ensrud, Robert Foley
STUDY DESIGN: A population-based cross-sectional survey. OBJECTIVE: The aim of this study was to compare the prevalence of illicit drug use among US adults with and without chronic low back pain (cLBP). SUMMARY OF BACKGROUND DATA: Although addictive medications, such as opioids and benzodiazepines, are frequently prescribed to patients with cLBP, little is known about illicit drug use among Americans with cLBP. METHODS: We used data from the back pain survey, administered to a representative sample of US adults aged 20 to 69 years (N = 5103) during the 2009 to 2010 cycle of the National Health and Nutrition Examination Survey (NHANES)...
September 2016: Spine
Victoria Menzies, Leroy R Thacker, Sallie D Mayer, Anna M Young, Shelby Evans, Linda Barstow
The major therapeutic approach for treating fibromyalgia (FM), a chronic widespread pain syndrome, is pharmacotherapy-centered symptom management. Complexity of treatment often leads to multiple medication prescriptions. While there is no current alternative to the probable need for polypharmacy in this patient population, there remains concern related to potential side effects and adverse drug events. In this secondary analysis of data on medications taken collected from two parent studies, all medications were broken down into the following categories: opioid, nonopioid, antidepressant, anticonvulsant, muscle relaxant, and benzodiazepine...
July 18, 2016: Biological Research for Nursing
James Francescangeli, Sonia Vaida, Anthony S Bonavia
BACKGROUND: Serotonin syndrome (SS) involves serotonergic hyperactivity caused by excessive activation of 5-HT2A receptors. As the use of antidepressants increases, so does the population of patients at risk for developing this complication. The diagnosis is made based on current serotonergic medication use in conjunction with certain clinical signs. The severity of the clinical presentation may vary, especially when the complication occurs while the patient is under general anesthesia...
2016: American Journal of Case Reports
Tae Woo Park, Richard Saitz, Kerrie P Nelson, Ziming Xuan, Jane M Liebschutz, Karen E Lasser
BACKGROUND: Benzodiazepine use has been associated with addiction-related risks, but little is known about its association with aberrant drug-related behaviors in patients receiving opioids for chronic pain. We examined the association between receipt of a benzodiazepine prescription and two aberrant drug-related behaviors, early opioid refills and illicit drug (cocaine) use, in patients receiving opioids for non-cancer chronic pain. METHODS: This was a retrospective cohort study of 847 patients with ≥ one visit to either a hospital-based primary care clinic or one of two community health centers between 9/1/11 and 8/31/12...
April 19, 2016: Substance Abuse
Cuauhtly Gallegos-Sierra, Claudia Gutiérrez-Alfaro, Gerardo Evaristo-Méndez
BACKGROUND: Diverticular disease, and the diverticulitis, the main complication of it, are widely studied diseases with multiple chronic cases reported in the literature, but there are no atypical presentations with extra-abdominal symptoms coupled with seemingly unrelated entities, such as necrotising fasciitis. CLINICAL CASE: Female 52 years old, was admitted to the emergency department with back pain of 22 days duration. History of importance: Chronic use of benzodiazepines intramuscularly...
March 31, 2016: Cirugia y Cirujanos
Andrew Kamell, Lauren Kelley Smith
BACKGROUND: Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown. OBJECTIVES: Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature. METHODS: A survey was developed and distributed to hospices with inpatient units nationwide...
May 2016: Journal of Palliative Medicine
Deborah Dowell, Tamara M Haegerich, Roger Chou
IMPORTANCE: Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE: To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS: The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs...
April 19, 2016: JAMA: the Journal of the American Medical Association
Cibele Nasri-Heir, Julyana Gomes Zagury, Davis Thomas, Sowmya Ananthan
Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning...
October 2015: Journal of Indian Prosthodontic Society
Alexandre Zeitler, Nisrine Kamoun, Stéphanie Goyon, Jérôme Wahis, Alexandre Charlet, Pierrick Poisbeau, Pascal Darbon
Pain is an emotion and neuropathic pain symptoms are modulated by supraspinal structures such as the amygdala. The central nucleus of the amygdala is often called the 'nociceptive amygdala', but little is known about the role of the basolateral amygdala. Here, we monitored the mechanical nociceptive thresholds in a mouse model of neuropathic pain and infused modulators of the glutamate/GABAergic transmission in the basolateral nucleus of the amygdala (BLA) via chronically-implanted cannulas. We found that an N-methyl-D-aspartate-type glutamate receptor antagonist (MK-801) exerted a potent antiallodynic effect, whereas a transient allodynia was induced after perfusion of bicuculline, a GABA(A) receptor antagonist...
April 2016: European Journal of Neuroscience
H Birke, G P Kurita, P Sjøgren, J Højsted, M K Simonsen, K Juel, O Ekholm
BACKGROUND: Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population. METHODS: Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level...
May 2016: Acta Anaesthesiologica Scandinavica
Julie R Gaither, Joseph L Goulet, William C Becker, Stephen Crystal, E Jennifer Edelman, Kirsha Gordon, Robert D Kerns, David Rimland, Melissa Skanderson, Amy C Justice, David A Fiellin
PURPOSE: For patients receiving long-term opioid therapy (LtOT), the impact of guideline-concordant care on important clinical outcomes--notably mortality--is largely unknown, even among patients with a high comorbidity and mortality burden (e.g., HIV-infected patients). Our objective was to determine the association between receipt of guideline-concordant LtOT and 1-year all-cause mortality. METHODS: Among HIV-infected and uninfected patients initiating LtOT between 2000 and 2010 through the Department of Veterans Affairs, we used Cox regression with time-updated covariates and propensity-score matched analyses to examine the association between receipt of guideline-concordant care and 1-year all-cause mortality...
May 2016: Journal of General Internal Medicine
Jeremy D Coplan, Cindy J Aaronson, Venkatesh Panthangi, Younsuk Kim
Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models: (1) "the avoidance model"; (2) "the intolerance of uncertainty model"; (3) "the meta-cognitive model"; (4) "the emotion dysregulation model"; and (5) "the acceptance based model"...
December 22, 2015: World Journal of Psychiatry
Geza S Bodor
Chronic pain is often treated with narcotic analgesics. The most commonly used narcotic analgesics are the opiates (natural or modified compounds of the poppy plant) or opioids (synthetic chemicals that act on opiate receptors). While opiates and opioids are excellent analgesics, they can also have significant side effects that include respiratory depression, coma, or death. Tolerance, physical dependence, and addiction (psychological dependence) are other severe side effects of opioid use. Patients who develop dependence or addiction often times abuse other, non-opioid narcotics and may trade their prescription medication for illegal street drugs (called "diversion")...
2016: Methods in Molecular Biology
Jessica S Merlin, Ashutosh Tamhane, Joanna L Starrels, Stefan Kertesz, Michael Saag, Karen Cropsey
Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications...
March 2016: AIDS and Behavior
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