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morphine equivalents

Raafat M Reyad, Sameh M Hakim, Dina N Abbas, Hossam Z Ghobrial, Ekramey Mansour
BACKGROUND: The prevalence of pain in advanced pelvic cancer may reach up to 95%. Control of such pain is often difficult owing to a variety of neuroanatomical and functional peculiarities. Different modalities have been utilized to treat this pain including saddle chemical rhizolysis with the potential for jeopardizing the neural control of the sphincters. OBJECTIVE: The aim of this pilot study is to determine the feasibility of using selective thermal radiofrequency as an alternative to saddle chemical rhizolysis in patients with refractory perineal pain associated with pelvic malignancies...
November 2018: Pain Physician
Charles A Riley, Matthew Kim, Anthony P Sclafani, Aron Kallush, Klaus Kjaer, Ashutosh S Kacker, Abtin Tabaee
BACKGROUND: Opioid-based analgesics are routinely prescribed after elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach. METHODS: Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing attitudes toward pain, baseline anxiety, and depression before surgery...
December 3, 2018: International Forum of Allergy & Rhinology
Timothy E Newhook, Timothy J Vreeland, Whitney L Dewhurst, Xuemei Wang, Laura Prakash, Chun Feng, Morgan L Bruno, Michael P Kim, Thomas A Aloia, Jean-Nicolas Vauthey, Jeffrey E Lee, Matthew H G Katz, Ching-Wei D Tzeng
OBJECTIVE: To characterize opioid discharge prescriptions for pancreatectomy patients. BACKGROUND: Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated. METHODS: Characteristics of pancreatectomy patients (March 2016-August 2017) were retrospectively abstracted from a prospective database...
November 29, 2018: Annals of Surgery
Liliana Tenney, Lisa M McKenzie, Brenden Matus, Kathryn Mueller, Lee S Newman
OBJECTIVE: The aim of this study was to examine adherence of state guidelines for Colorado workers' compensation physicians/providers treating individuals as injured workers with chronic pain after initiation of an opioid management program and provider incentives. METHODS: A retrospective cohort of chronic, non-cancer pain claims was constructed from the Colorado's workers' compensation database. Adherence to treatment guidelines and opioid prescribing practices were evaluated during implementation of a new billing code to incentivize adherence...
November 30, 2018: American Journal of Industrial Medicine
David C Cron, Charles Hwang, Hsou M Hu, Jay S Lee, James M Dupree, John D Syrjamaki, Kevin C Chung, Chad M Brummett, Michael J Englesbe, Jennifer F Waljee
BACKGROUND: Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and nonteaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared with nonteaching hospitals. STUDY DESIGN: We used insurance claims from a statewide quality collaborative in Michigan to identify 17,075 opioid-naïve patients who underwent 22 surgical procedures across 76 hospitals from 2012 to 2016...
November 26, 2018: Surgery
(no author information available yet)
OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospective, randomized, single-blinded study was performed...
November 1, 2018: Journal of Neurosurgery. Spine
Sriram Yennurajalingam, Zhanni Lu, Suresh K Reddy, EdenMae C Rodriguez, Kristy Nguyen, Marie J Waletich-Flemming, Kyu-Hyoung Lim, Aksha Memon, Nhu-Nhu Nguyen, Kristy W Rofheart, Guoqin Wang, Srikanth Reddy Barla, Jimin Wu, Janet L Williams, Eduardo Bruera
PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014...
November 29, 2018: Journal of Oncology Practice
Willem K Scholten, Ann-Eva Christensen, Anne Estrup Olesen, Asbjørn Mohr Drewes
Opioid analgesics are the mainstay for treatment of moderate and severe pain but, in many countries, the consumption of these medicines is inadequate. Over time, various groups have published opioid analgesic metrics, including authors from the World Health Organization. They linked consumption to a level considered adequate based on the actual consumption in developed countries. In this study, we present our current results on the adequacy of opioid analgesic consumption. We included statistics for 18 controlled opioid medicines that are primarily used as analgesics, and we developed the Adequacy of Opioid Consumption (AOC) Index...
November 29, 2018: American Journal of Public Health
Udai S Sibia, Abigail E Mandelblatt, G Caleb Alexander, Paul J King, James H MacDonald
Prescription opioids are commonly prescribed for pain relief after total joint arthroplasty (TJA), yet little is known about the quantity of opioids prescribed after surgery. This study retrospectively reviewed a consecutive series of 1000 TJAs from April 2014 through September 2015. Postoperative opioid prescriptions were quantified using standardized morphine milligram equivalents (MME). Eighty-four percent of total knee arthroplasty (TKA) and 77% of total hip arthroplasty (THA) patients were opioid naïve...
2018: Journal of Surgical Orthopaedic Advances
Amanda M Midboe, Steve Martino, Sarah L Krein, Joseph W Frank, Jacob T Painter, Michael Chandler, Allison Schroeder, Brenda T Fenton, Lara Troszak, Taryn Erhardt, Robert D Kerns, William C Becker
BACKGROUND: Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain care. Collaborative care interventions that support primary care providers have been effective in medication tapering. We developed a patient-centered Primary Care-Integrated Pain Support (PIPS) collaborative care clinical program based on effective components of previous collaborative care interventions...
November 29, 2018: Implementation Science: IS
Amos Neheman, Eyal Kord, Andrew C Strine, Brian A VanderBrink, Eugene A Minevich, William R DeFoor, Pramod P Reddy, Paul H Noh
OBJECTIVE: To review and compare four different surgical approaches for partial nephrectomy of a nonfunctioning moiety in children with upper urinary tract duplication anomalies. MATERIALS AND METHODS: A retrospective review of all pediatric patients who underwent open (OPN), laparoscopic (LPN), robotic (RPN), or laparoendoscopic single site (LESS-PN) partial nephrectomy for the treatment of a nonfunctioning moiety in a duplicated collecting system at two medical centers between 2007 and 2017...
November 23, 2018: Urology
Rachel Wong, William Carroll, Astha Muttreja, Victor Garcia, Erin Taub, Alice Fernan
Objective: Chronic pain and opioid management are challenging in primary care, especially for trainees with discontinuous ambulatory schedules and less practice experience. The study objective was to improve adherence to quality metrics and office visit utilization in a resident clinic. Design: Before-after quality improvement intervention over two Plan-Do-Study-Act cycles. Setting. Suburban, university-affiliated Internal Medicine resident clinic. Methods: During the 2015-2017 academic years, two sequential interventions were implemented: 1) use of electronic pain and opioid management templates and workflow redesign routing opioid renewals through a registered nurse (RN); 2) RN previsit planning and daily nurse-physician huddles before patient visits...
November 23, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Andrea Jakubowski, Alexander Pappas, Lee Isaacsohn, Felipe Castillo, Mariya Masyukova, Richard Silvera, Louisa Holaday, Evan Rausch, Sameen Farooq, Keith T Veltri, Chinazo O Cunningham, Marcus A Bachhuber
BACKGROUND: Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York...
November 26, 2018: Substance Abuse
Melissa Medina, Shannon R Foiles, Matilde Francois, Carl V Asche, Jinma Ren, Dale K Mueller, Richard C Anderson
BACKGROUND: Thoracic Epidural has long been the most recommended treatment for postoperative pain management in general thoracic surgery. This study compares liposomal bupivacaine (LB) as an alternative method for pain control and compares it to the standard. METHODS: LB was compared to thoracic epidural bupivacaine hydrochloride (TE BH) in 387 patients who underwent video-assisted thoracoscopic pulmonary resection (VATS-R) at our institution. Patients received either continuous TE BH or intraoperative LB at a predetermined dose...
October 17, 2018: American Journal of Surgery
Rachael Dawson, Andrew Wignell, Paul Cooling, David Barrett, Harish Vyas, Patrick Davies
BACKGROUND: Plasma-Lyte 148 ® is a balanced, crystalloid intravenous (IV) fluid which is both calcium-free and isotonic. It prevents the hyperchloraemic metabolic acidosis and iatrogenic hyponatraemia seen with use of 0.9% sodium chloride and hypotonic solutions respectively. However, data on compatibility with commonly used drugs is lacking. AIM: To investigate the stability of Plasma-Lyte 148 ® and Plasma-Lyte 148 ® + 5% Glucose with eight commonly used therapeutic agents when compared with 5% Glucose and 0...
November 25, 2018: Paediatric Anaesthesia
Robin Ghertner
BACKGROUND: The role of prescription opioids in the opioid crisis has been well established. How the prevalence of prescription opioids relates to opioid hospitalizations has been understudied. Hospitalizations due to opioids are a distinct indicator of opioid misuse, have cost implications for health care systems, and may be an entry point into substance use treatment. METHODS: Administrative data were drawn for counties in 32 U.S. states from 2011 to 2014 to associate retail opioid sales rates with opioid-related hospitalization rates...
November 15, 2018: Drug and Alcohol Dependence
Erwan Treillet, Sophie Laurent, Yacine Hadjiat
Purpose: To review the recent literature on opioid rotation (ie, switching from one opioid drug to another or changing an opioid's administration route) in cancer patients experiencing severe pain and to develop a novel equianalgesia table for use in routine clinical practice. Methods: The MEDLINE database was searched with terms "cancer pain," "opioid rotation," "opioid switching," "opioid ratio," "opioid conversion ratio," and "opioid equianalgesia" for the major opioids (morphine, oxycodone, fentanyl, and hydromorphone) and the intravenous, subcutaneous, oral, and transdermal administration routes...
2018: Journal of Pain Research
David H Smith, Jennifer L Kuntz, Lynn L DeBar, Jill Mesa, Xiuhai Yang, Jennifer Schneider, Amanda Petrik, Katherine Reese, Lou Ann Thorsness, David Boardman, Eric S Johnson
OBJECTIVES: To determine whether a pharmacist-led, patient-directed intervention can reduce opioid use following total hip arthroplasty (THA) or total knee arthroplasty (TKA). STUDY DESIGN: Randomized trial. METHODS: Patients scheduled to undergo THA or TKA (during 2015 and 2016) were randomized to usual care or intervention. We ranked patients according to predicted risk of persistent opioid use and selected the top 60% for inclusion (n = 561); all contributed to the analysis...
November 2018: American Journal of Managed Care
Ilsley B Colton, Mayo H Fujii, Thomas P Ahern, Charles D MacLean, Julie E Lahiri, Matthew Alef, Andrew C Stanley, Georg Steinthorsson, Daniel J Bertges
The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients ( n = 110) about opioid use and pain management perceptions...
November 18, 2018: Vascular Medicine
Roy Hwang, Nicholas Field, Vignessh Kumar, Steven Paniccioli, Rachel Grey, Michael Briotte, Vishad Sukul, Julie G Pilitsis
INTRODUCTION: Placement of spinal cord stimulation (SCS) paddles under general anesthesia using intraoperative neuromonitoring (IONM) has been shown to be associated with equivocal or superior clinical outcomes in comparative studies. The value of IONM in percutaneous permanent SCS placement has not been demonstrated. METHODS: Outcomes for patients under percutaneous SCS placement performed with IONM were prospectively collected. Descriptive outcomes included numerical rating scale (NRS), the Oswestry disability index (ODI), McGill pain questionnaire, pain catastrophizing scale score (PCS), and Beck Depression Inventory...
November 16, 2018: Neuromodulation: Journal of the International Neuromodulation Society
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