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opioid rotation

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https://www.readbyqxmd.com/read/28913486/the-switch-from-buprenorphine-to-tapentadol-is-it-worth
#1
REVIEW
Adriana Miclescu
Opioid analgesia continues to be the primary pharmacologic intervention for managing acute pain and malignant pain in both hospitalized and ambulatory patients. The increasing use of opioids in chronic nonmalignant pain is more problematic. Opioid treatment is complicated with the risks raised by adverse effects, especially cognitive disturbance, respiratory depression but also the risk of tolerance, opioid abuse and drug-disease interactions. Despite the growing number of available opioids within the last years, adequate trials of opioid rotation are lacking and most of the information is anecdotal...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28735847/transcutaneous-electrical-nerve-stimulation-for-postoperative-pain-relief-after-arthroscopic-rotator-cuff-repair-a-prospective-double-blinded-randomized-trial
#2
Siddharth A Mahure, Andrew S Rokito, Young W Kwon
BACKGROUND: Arthroscopic rotator cuff repair (ARCR) can be associated with significant postoperative pain. Concern for opioid abuse has led surgeons to identify alternative, efficacious methods of postoperative analgesia. To determine whether transcutaneous electrical nerve stimulation (TENS) can have a similarly beneficial effect after shoulder procedures, we conducted a prospective double-blinded randomized trial in patients undergoing outpatient ARCR. METHODS: All patients undergoing ARCR of a full-thickness rotator cuff tear by the senior authors were identified...
July 20, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28731784/response-to-the-article-overall-survival-among-cancer-patients-undergoing-opioid-rotation-to-methadone-compared-to-other-opioids
#3
Marieke H J van den Beuken-van Everdingen, Sander M J van Kuijk, Elbert A Joosten
No abstract text is available yet for this article.
July 21, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28711751/the-conversion-ratio-from-intravenous-hydromorphone-to-oral-opioids-in-cancer-patients
#4
Akhila Reddy, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Sara Dost, Ann Nguyen, Yvonne Heung, Simeon Kwan, Angelique Wong, Imelda Pangemanan, Ahsan Azhar, Supakarn Tayjasanant, Edenmae Rodriguez, Jessica Waletich, Kyu-Hyoung Lim, Jimin Wu, Diane Liu, Janet Williams, Sriram Yennurajalingam, Eduardo Bruera
CONTEXT: The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients. OBJECTIVES: We aimed to determine the CR and ORR from IV hydromorphone to oral hydromorphone and MEDD (obtained from oral morphine and oxycodone). METHODS: A total of 4745 consecutive inpatient palliative care consults during 2010-14 were reviewed for conversions from IV hydromorphone to oral hydromorphone, morphine or oxycodone...
July 13, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28700116/an-integrative-literature-review-exploring-the-clinical-management-of-delirium-in-patients-with-advanced-cancer
#5
REVIEW
Hayley Lawley, Alistair Hewison
AIM: The aim of this paper is to present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer. BACKGROUND: Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However the research into the effectiveness of treatments for delirium in people with advanced cancer is limited...
July 12, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28635354/the-effects-of-food-on-opioid-induced-nausea-and-vomiting-and-pharmacological-parameters-a-systematic-review
#6
REVIEW
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...
September 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28609231/methadone-dose-selection-for-treatment-of-pain-compared-with-consensus-recommendations
#7
Parisa Karimian, Rabia S Atayee, Toluwalase A Ajayi, Kyle P Edmonds
BACKGROUND: Many factors make methadone an appealing option for treatment of pain in patients seen by palliative care; however, complex drug-related properties and variable patient response complicate appropriate conversion ratios from other opioids to methadone. Currently, there is no consensus regarding one accepted conversion method. OBJECTIVE: Current patterns of prescribing for clinicians at a three-hospital academic health system on initial rotation to methadone for the management of pain were compared with a series of consensus recommendations for methadone dose calculation...
June 13, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28595427/challenging-equipotency-calculation-for-hydromorphone-after-long-term-intravenous-application
#8
Benjamin Luchting, Banafscheh Rachinger-Adam, Nikolai Hulde, Jens Heyn, Shahnaz Christina Azad
In advanced stages, most cancer patients suffer from pain which can usually be well controlled following the World Health Organization (WHO) level scheme. While the majority of patients report adequate pain relief by strong opioids (WHO III), some require an opioid rotation. Despite the existence of conversion tables, these rotations mea lead to inadequate pain control or life threatening events. Here, we report about a patient with urothelial cell carcinoma presenting in our Department of Pain Medicine with massive pain aggravation up to NRS values of 10/10 despite administration of the highest dose of intravenously applied hydromorphone...
March 16, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28571723/opioid-consumption-after-rotator-cuff-repair
#9
Robert W Westermann, Chris A Anthony, Nic Bedard, Natalie Glass, Matt Bollier, Carolyn M Hettrich, Brian R Wolf
PURPOSE: Rising perioperative opioid use in the United States is of increasing concern. The purposes of this study were (1) to define opioid consumption after rotator cuff repair (RCR) in the United States and (2) to evaluate patient factors that may be associated with prolonged opioid use after arthroscopic RCR. METHODS: All arthroscopic RCRs performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR...
August 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28489639/evaluation-of-analgesia-tolerance-and-the-mechanism-of-action-of-morphine-6-o-sulfate-across-multiple-pain-modalities-in-sprague-dawley-rats
#10
Jai Shankar K Yadlapalli, Navdeep Dogra, Anqi W Walbaum, William D Wessinger, Paul L Prather, Peter A Crooks, Maxim Dobretsov
BACKGROUND: Morphine-6-O-sulfate (M6S) is a mixed μ/δ-opioid receptor (OR) agonist and potential alternative to morphine for treatment of chronic multimodal pain. METHODS: To provide more support for this hypothesis, the antinociceptive effects of M6S and morphine were compared in tests that access a range of pain modalities, including hot plate threshold (HPT), pinprick sensitivity threshold (PST) and paw pressure threshold tests. RESULTS: Acutely, M6S was 2- to 3-fold more potent than morphine in HPT and PST tests, specifically, derived from best-fit analysis of dose-response relationships of morphine/M6S half-effective dose (ED50) ratios (lower, upper 95% confidence interval [CI]) were 2...
September 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28453454/the-effect-of-intra-articular-hyaluronate-and-tramadol-injection-on-patients-with-adhesive-capsulitis-of-the-shoulder
#11
Kyung-Hee Kim, Jung-Woo Suh, Ki Young Oh
BACKGROUND: Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis. OBJECTIVES: To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone...
August 3, 2017: Journal of Back and Musculoskeletal Rehabilitation
https://www.readbyqxmd.com/read/28441678/the-addiction-recovery-clinic-a-novel-primary-care-based-approach-to-teaching-addiction-medicine
#12
Stephen R Holt, Nora Segar, Dana A Cavallo, Jeanette M Tetrault
PROBLEM: Substance use is highly prevalent in the United States, but little time in the curriculum is devoted to training internal medicine residents in addiction medicine. APPROACH: In 2014, the authors developed and launched the Addiction Recovery Clinic (ARC) to address this educational gap while also providing outpatient clinical services to patients with substance use disorders. The ARC is embedded within the residency primary care practice and is staffed by three to four internal medicine residents, two board-certified addiction medicine specialists, one chief resident, and one psychologist...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28371835/effectiveness-and-safety-of-once-daily-extended-release-hydrocodone-in-individuals-previously-receiving-immediate-release-oxycodone-for-chronic-pain
#13
Joseph Pergolizzi, Maribeth Kowalski, Ellie He
Objectives. : This study evaluated the safety and effectiveness of a once-daily, single-entity, extended-release hydrocodone bitartrate (HYD) among patients with chronic noncancer and non-neuropathic pain who required opioid rotation from a previous analgesic regimen that primarily consisted of immediate-release (IR) oxycodone. Methods. : Post hoc analyses of a primary study that assessed HYD 20 to 120 mg over a 52-week period are presented. The primary study included a dose titration period (up to 45 days), a 52-week maintenance period, and an optional taper period (up to 14 days)...
March 28, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28326948/rare-presentation-of-intrathecal-morphine-withdrawal-psychosis
#14
Rohit Aiyer, Vivek Jain, Anurag Bhatia, Boris Mekinulov, Semih Gungor
We report a case of a 57-year-old male patient with intrathecal morphine pump failure who presented with psychosis as part of a clinical presentation of opioid withdrawal. The patient was being treated for chronic back pain with an intrathecal morphine pump for several years. The patient spontaneously started to experience psychotic symptoms which included disorganized thinking, delusional thoughts, paranoia, auditory and visual hallucinations. Upon interrogation of intrathecal pump, it was found not to be functioning, thereby not delivering intrathecal morphine...
February 28, 2017: Pain Management
https://www.readbyqxmd.com/read/28299720/ketamine-infusion-as-a-counter-measure-for-opioid-tolerance-in-mechanically-ventilated-children-a-pilot-study
#15
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
https://www.readbyqxmd.com/read/28272092/chest-pain-from-hypermobility-responding-to-physical-therapy-in-an-adolescent
#16
Megan N Nash, Chloe A Liu, Brienna Maestas, Kristine U Layugan, Catherine C Culver, Jennifer King, David Kurahara
Hypermobility syndrome usually causes pain in limbs from extension type injuries. The authors report on a 16-yr-old female adolescent with incapacitating chest pain secondary to extreme hypermobility of the chest. This pain led the patient to see multiple specialists without improvement or diagnosis. Physical examination results revealed a very hypermobile patient who was able to internally rotate her shoulders inward until her elbows touched. This unusual hyperextension maneuver was achieved by holding the shoulders in anteversion with her hands on her hips (see figures in the article)...
March 6, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28223843/the-use-of-rotation-to-fentanyl-in-cancer-related-pain
#17
Delia Dima, Ciprian Tomuleasa, Ioana Frinc, Sergiu Pasca, Lorand Magdo, Ioana Berindan-Neagoe, Mihai Muresan, Cosmin Lisencu, Alexandru Irimie, Mihnea Zdrenghea
Pain is commonly diagnosed with respect to cancer and heart diseases, being a major symptom in most neoplastic diseases. Uncontrolled pain leads to a decrease in the quality of life and an increase in the morbidity of the patient. Opioids represent the best analgetic supportive therapy and are frequently used in patients suffering from cancer and experiencing a high level of pain. Opioid treatment starts with a gradual titration of the dose until the minimum effective dose and the maximum tolerated dose are determined...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28182507/unused-opioid-pills-after-outpatient-shoulder-surgeries-given-current-perioperative-prescribing-habits
#18
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...
March 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28162375/-153-levorphanol-another-choice-in-opioid-rotation
#19
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
#20
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
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