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opioid rotation

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https://www.readbyqxmd.com/read/28182507/unused-opioid-pills-after-outpatient-shoulder-surgeries-given-current-perioperative-prescribing-habits
#1
Kanupriya Kumar, Lawrence V Gulotta, Joshua S Dines, Answorth A Allen, Jennifer Cheng, Kara G Fields, Jacques T YaDeau, Christopher L Wu
BACKGROUND: In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills...
February 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28162375/-153-levorphanol-another-choice-in-opioid-rotation
#2
S Nalamachu, J Gudin
No abstract text is available yet for this article.
April 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28156658/changes-in-opioid-type-and-dose-among-cancer-patients-referred-to-outpatient-palliative-care
#3
Joseph Baidoo, Yee Choon Meng, Donna S Zhukovsky, Kimberson Cochien Tanco, Holly A Stewart, Tonya Edwards, Manju P Joy, Leela Kuriakose, Zhanni Lu, Diane D Liu, Janet L Williams, Eduardo Bruera
: 106 Background: Opioid prescriptions are regulated at both federal and state levels. Examples of such regulations include use of risk evaluation and mitigation strategies (REMS), mandatory sharing of prescription data with state prescription drug monitoring programs and the reclassification of hydrocodone as schedule II opioid in October 2014. One possible consequence of such changes would be earlier referral to palliative care (PC) for opioid management. Alternatively, primary oncologist may treat patients with weak opioids or use strong opioids with lower daily dose...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156619/a-randomized-controlled-trial-rct-of-2-dose-ratios-for-conversion-from-parenteral-to-oral-methadone-in-patients-with-cancer-pain
#4
Josep Porta-Sales, Maria Nabal-Vicuña, Leyre Diez-Porres, Jaume Canal, Alberto Alonso-Babarro, Yolanda Vilches, Silvia Llorens, Mireia Sanllorente, Silvia Perez-Pujol, Eduardo Bruera
: 206 Background: Methadone (M) is frequently used for severe cancer pain using the parenteral and oral route. The most commonly used dose ratio (DR) parenteral: oral is 1:2. However, methadone is highly bioavailable and a lower ratio might result in similar analgesia with less toxicity. The main objective of this RCT is to compare success and side effects with 2 ratios of parenteral to oral M: 1:2 vs 1:1.2 in hospitalized patients with cancer pain. METHODS: Inpatients with cancer pain well controlled with parenteral M requiring rotation to the oral route...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156454/evaluating-the-prognostic-effect-of-a-pain-classification-system-in-patients-with-advanced-cancer
#5
Kimberson Cochien Tanco, Ali Haider, Courtney Maligi, Minjeong Park, Diane D Liu, Eduardo Bruera
: 95 Background: The Edmonton Classification System for Cancer Pain (ECS-CP) has been shown to predict pain management complexity based on five features: pain mechanism, incident pain, psychological distress, addictive behavior, and cognitive function. The main objective of our study was to explore the association between increasing sum of negative ECS-CP features and achievement of good pain control at first follow up visit at an outpatient palliative care clinic. METHODS: Initial and follow up clinical information of 409 eligible supportive care outpatients such as patient demographics, ECS-CP assessment, morphine equivalent daily dose (MEDD), opioid rotation, Edmonton Symptom Assessment Score (ESAS), and personalized pain goal (PPG) were retrospectively reviewed and analyzed...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156444/the-conversion-ratio-from-intravenous-iv-hydromorphone-to-oral-po-opioids-in-patients-with-cancer
#6
Sara Dost, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Jimin Wu, Diane D Liu, Sriram Yennu, Eduardo Bruera
: 197 Background: Inpatients with cancer frequently undergo conversions from IV to PO hydromorphone (HM) or opioid rotation (OR) from IV HM to another PO opioid prior to discharge. Currently used conversion ratios (CR) between IV and PO HM range from 2-5 and opioid rotation ratios (ORR) between IV HM and oral morphine equivalent daily dose (MEDD) range from 10-20. This large variation in ratios may lead to uncontrolled pain or overdosing. Our aim was to determine the accurate CR from IV to PO HM and ORR from IV HM to PO morphine and oxycodone (measured as MEDD)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28025374/effect-of-local-anesthetic-concentration-0-2-vs-0-1-ropivacaine-on-pulmonary-function-and-analgesia-after-ultrasound-guided-interscalene-brachial-plexus-block-a-randomized-controlled-study
#7
Andrew K Wong, Lauren Georgiades Keeney, Liting Chen, Rebekah Williams, Jiabin Liu, Nabil M Elkassabany
OBJECTIVE: This study aims to assess diaphragmatic excursion and measure pulmonary functions as measures of the degree to which the phrenic nerve is blocked after ISB with two different concentrations of ropivacaine: 0.2% and 0.1%. DESIGN: Randomized, double-blinded study. SETTING AND PATIENTS: Ambulatory surgical facility. SUBJECTS: Fifty patients undergoing shoulder arthroscopy for rotator cuff repair. METHODS: Patients were randomized to receive ultrasound-guided ISB with 20 mL of either 0...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27997283/overall-survival-among-cancer-patients-undergoing-opioid-rotation-to-methadone-compared-to-other-opioids
#8
Akhila Reddy, Ulrich S Schuler, Maxine de la Cruz, Sriram Yennurajalingam, Jimin Wu, Diane Liu, Eduardo Bruera
BACKGROUND: Methadone has been associated with lower overall survival (OS) in patients with chronic pain. There are no data available on the association of methadone with OS in cancer patients. OBJECTIVE: Our aim was to compare the OS in cancer outpatients undergoing opioid rotation (OR) to methadone and other strong opioids. DESIGN: Demographics, symptoms, and morphine equivalent daily dose (MEDD) were collected in patients who underwent OR from strong opioids to either methadone or other strong opioids and returned for a follow-up within six weeks...
December 20, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27826213/management-of-moderate-to-severe-chronic-low-back-pain-with-buprenorphine-buccal-film-using-novel-bioerodible-mucoadhesive-technology
#9
REVIEW
Joseph V Pergolizzi, Robert B Raffa, Charles Fleischer, Gianpietro Zampogna, Robert Taylor
With a global prevalence of ~9%-12%, low back pain (LBP) is a serious public health issue, associated with high costs for treatment and lost productivity. Chronic LBP (cLBP) involves central sensitization, a neuropathic pain component, and may induce maladaptive coping strategies and depression. Treating cLBP is challenging, and current treatment options are not fully satisfactory. A new BioErodible MucoAdhesive (BEMA(®)) delivery system for buprenorphine has been developed to treat cLBP. The buccal buprenorphine (BBUP) film developed for this product (Belbuca™) allows for rapid delivery and titration over a greater range of doses than was previously available with transdermal buprenorphine systems...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27807793/opioids-and-gi-motility-friend-or-foe
#10
REVIEW
Allen A Lee, William L Hasler
The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS)...
November 2, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27611642/tapentadol-prolonged-release-for-chronic-pain-a-review-of-clinical-trials-and-5-years-of-routine-clinical-practice-data
#11
Ralf Baron, Leopold Eberhart, Kai-Uwe Kern, Stefan Regner, Roman Rolke, Christian Simanski, Thomas Tölle
Tapentadol prolonged release (PR) for the treatment of moderate to severe chronic pain combines 2 modes of action. These are μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule that allows higher analgesic potency through modulation of different pharmacological targets within the pain transmitting systems. At the same time, this can also serve as a clue for modulation of different pain-generating mechanisms according to nociceptive, neuropathic, or mixed pain conditions. Tapentadol PR has now been on the market for 5 years, with over 2...
September 9, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27492688/when-can-i-drive-after-orthopaedic-surgery-a-systematic-review
#12
REVIEW
Kevin J DiSilvestro, Adam J Santoro, Fotios P Tjoumakaris, Eric A Levicoff, Kevin B Freedman
BACKGROUND: Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures, but the data regarding this topic are diverse and sometimes conflicting. Some studies provide observer-reported outcome measures, such as brake response time or simulators, to estimate when patients can safely resume driving after surgery, and patient survey data describing when patients report a return to driving, but they do not all agree. We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive...
December 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27343780/association-of-clonidine-and-ropivacaine-in-brachial-plexus-block-for-shoulder-arthroscopy
#13
Raphael Faria-Silva, Daniel Câmara de Rezende, Juarez Mundim Ribeiro, Telmo Heleno Gomes, Braulio Antônio Maciel Faria Mota Oliveira, Fábio Maciel R Pereira, Ildeu Afonso de Almeida Filho, Antônio Enéas Rangel de Carvalho Junior
BACKGROUND AND OBJECTIVES: Arthroscopy for shoulder disorders is associated with severe and difficult to control pain, postoperatively. The addition of clonidine to local anesthetics for peripheral nerve block has become increasingly common, thanks to the potential ability of this drug to reduce the mass of local anesthetic required and to prolonging analgesia postoperatively. The present study aimed to evaluate the success of brachial plexus block for arthroscopic rotator cuff surgery using local anesthetic with or without clonidine...
July 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27317188/efficacy-and-safety-of-once-daily-extended-release-er-hydrocodone-in-individuals-previously-receiving-er-morphine-for-chronic-pain
#14
Kathleen Broglio, Joseph Pergolizzi, Maribeth Kowalski, Shau Yu Lynch, Ellie He, Warren Wen
OBJECTIVES: This post hoc analysis examined the effectiveness and safety of hydrocodone bitartrate (HYD) in patients with moderate-to-severe chronic pain who were previously taking extended-release morphine (morphine ER) for pain management. STUDY DESIGN: The primary analysis was an open-label, 12-month study. SETTING: The study was conducted in 88 sites in the United States. METHODS: The study was approved by an institutional review board...
June 18, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27306912/efficacy-and-safety-of-methadone-as-a-second-line-opioid-for-cancer-pain-in-an-outpatient-clinic-a-prospective-open-label-study
#15
Josep Porta-Sales, Cristina Garzón-Rodríguez, Christian Villavicencio-Chávez, Silvia Llorens-Torromé, Jesús González-Barboteo
INTRODUCTION: Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic. PATIENTS AND METHODS: This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone...
August 2016: Oncologist
https://www.readbyqxmd.com/read/27146817/duration-of-sick-leave-after-shoulder-arthroscopy-in-germany-analysis-of-health-care-data
#16
Marius von Knoch, Dirk Enders, Natasha I Schlothauer, Hans Michael Klinger, Iris Pigeot
INTRODUCTION: The expected duration of incapacity after arthroscopic shoulder surgery is an important factor for therapy planning. The aim of this study was to analyze the duration of sick leave after arthroscopic shoulder surgery in Germany and to identify factors associated with a longer duration of sick leave. We hypothesized that certain patient-related factors may be associated with a longer duration of sick leave. METHODS: Routine health care data of all patients insured by one German health insurance company who underwent inpatient arthroscopic shoulder surgery between 2010 and 2012 were included in the analysis of the duration of sick leave in this retrospective cohort study (level III evidence)...
June 2016: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/27107906/postoperative-analgesia-in-a-prolonged-continuous-interscalene-block-versus-single-shot-block-in-outpatient-arthroscopic-rotator-cuff-repair-a-prospective-randomized-study
#17
Tariq Malik, Daniel Mass, Stephan Cohn
PURPOSE: To compare the analgesic efficacy of 3-day continuous interscalene brachial plexus block versus a single-shot block for arthroscopic rotator cuff repair. METHODS: Eighty-five patients scheduled for arthroscopic rotator cuff repair were randomly assigned to either the single-shot group (SSG) or continuous interscalene brachial block group (CG). Patients in the SSG received 2.5 mg/kg of 0.5% bupivacaine up to 25 mL; the CG received the same dose as a loading dose via catheter followed by an infusion of 0...
August 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27079219/postoperative-pain-control-after-arthroscopic-rotator-cuff-repair
#18
REVIEW
Carlos A Uquillas, Brian M Capogna, William H Rossy, Siddharth A Mahure, Andrew S Rokito
Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge...
July 2016: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/27076229/effect-of-local-anesthetic-concentration-0-2-vs-0-1-ropivacaine-on-pulmonary-function-and-analgesia-after-ultrasound-guided-interscalene-brachial-plexus-block-a-randomized-controlled-study
#19
Andrew K Wong, Lauren Georgiades Keeney, Liting Chen, Rebekah Williams, Jiabin Liu, Nabil M Elkassabany
OBJECTIVE: This study aims to assess diaphragmatic excursion and measure pulmonary functions as measures of the degree to which the phrenic nerve is blocked after ISB with two different concentrations of ropivacaine: 0.2% and 0.1%. DESIGN: Randomized, double-blinded study. SETTING AND PATIENTS: Ambulatory surgical facility. SUBJECTS: Fifty patients undergoing shoulder arthroscopy for rotator cuff repair. METHODS: Patients were randomized to receive ultrasound-guided ISB with 20 mL of either 0...
April 13, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27022964/methadone-as-first-line-opioid-treatment-for-cancer-pain-in-a-developing-country-palliative-care-unit
#20
Gabriela P Peirano, Guillermo P Mammana, Mariela S Bertolino, Tania Pastrana, Gloria F Vega, Jorgelina Russo, Gabriela Varela, Ernesto Vignaroli, Raúl Ruggiero, Arnaldo Armesto, Gabriela Camerano, Graciela Dran
PURPOSE: The use of methadone for cancer pain is limited by the need of expertise and close titration due to variable half-life. Yet, it is a helpful palliative strategy in low-resources countries given its long-acting effect at low cost and worth additional study. Our aim was to describe the prescription and outcomes of methadone as a first-line treatment for cancer pain in a tertiary palliative care unit (PCU) in Argentina. METHODS: Retrospective review of medical records of patients with moderate to severe cancer pain seen at the PCU in 1-year period, who initiated strong opioids at the first consultation...
August 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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