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Opioids AND Pain

Michael A Ulm, Adam C ElNaggar, Todd D Tillmanns
OBJECTIVE: Compare postoperative pain scores following hysterectomy in patients receiving perioperative celecoxib versus postoperative ketorolac as part of a multimodal pain regimen. METHODS: Patients undergoing hysterectomy were randomized to receive scheduled intravenous ketorolac in the immediate postoperative period or oral celecoxib prior to surgery and continued for a total seven days. All patients received a common multimodal pain protocol consisting of scheduled acetaminophen, gabapentin, and opioids as needed...
August 15, 2018: Gynecologic Oncology
Sheng Shen, Zongyan Gao, Junyi Liu
BACKGROUND: Pain management after arthroplasties has become a serious problem. We perform a meta-analysis from randomized controlled trial (RCTs) to examine the efficacy and safety of methylprednisolone in the setting of postoperative pain after total knee arthroplasty (TKA). METHODS: We conduct electronic searches of Medline (1966 to October 2017), Embase (1980 to October 2017), ScienceDirect (1985 to October 2017) and the Web of Science (1995 to October 2017)...
August 15, 2018: International Journal of Surgery
Tang Li, Haiyun Wang, Jinxin Wang, Yimeng Chen, Chenyi Yang, Mingshu Zhao, Guolin Wang, Zhuo Yang
Chemokines related neuroinflammation and N-methyl-D-aspartate receptor (NMDAR) mediated nociceptive transmission are pivotal determinants in the pathogenesis of opioid-induced hyperalgesia (OIH), but little is known about specific mechanism and treatment. Chemokine CXCL12 with its receptor CXCR4 is implicated in different pathological pain, moreover, neurotoxicity of CXCL12 is associated with NMDAR activation. Recent studies recapitulate the anti-nociception of Annexin 1 (ANXA1) in inflammatory pain. This study examined whether ANXA1 prevented remifentanil-caused OIH through modulating CXCL12 and NMDAR pathway in rats...
August 15, 2018: Neuroscience Research
Ji Young Bang, Bryce Sutton, Robert H Hawes, Shyam Varadarajulu
BACKGROUND AND AIMS: Although frequently performed, the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for palliation of pain in pancreatic cancer is suboptimal. Recently, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been proposed as a palliative treatment option for pancreatic neoplasms. We performed a single-blind, randomized trial to compare the effectiveness of EUS-CPN and EUS-RFA for palliation of pain in pancreatic cancer. METHODS: Patients with abdominal pain due to locally advanced or metastatic pancreatic cancer underwent EUS-CPN (n=14) or EUS-RFA (n=12)...
August 15, 2018: Gastrointestinal Endoscopy
M H Park, J A Kim, H J Ahn, M K Yang, H J Son, B G Seong
We evaluated the effect of pre-operative serratus anterior plane block on postoperative pain and opioid consumption after thoracoscopic surgery. We randomly allocated 89 participants to block with 30 ml ropivacaine 0.375% (n = 44), or no block without placebo or sham procedure (n = 45). We analysed results from 42 participants in each group. Serratus anterior plane block reduced mean (SD) remifentanil dose during surgery, 0.12 (0.06) mg.h-1 vs. 0.16 (0.06) mg.h-1 , p = 0.016, and reduced mean (SD) fentanyl consumption in the first 24 postoperative hours, 3...
August 18, 2018: Anaesthesia
Jenny Lam, Toshiaki Suzuki, David Bernstein, Beiqun Zhao, Carlos Maeda, Thach Pham, Bryan J Sandler, Garth R Jacobsen, Joslin N Cheverie, Santiago Horgan
BACKGROUND: Laparoscopic sleeve gastrectomy is the most commonly performed bariatric surgery in the world. Enhanced recovery after surgery (ERAS) protocols have been shown to reduce complications and decrease length of stay for various types of surgeries. In this study, we propose an ERAS protocol for laparoscopic sleeve gastrectomy and compare the clinical outcomes with patients who received standard care. METHODS: We performed a single-institution retrospective analysis in patients who underwent laparoscopic sleeve gastrectomy from February 2015 to December 2017...
August 17, 2018: Surgical Endoscopy
Mohan Stewart, Jolanda Cibere, Eric C Sayre, Jacek A Kopec
OBJECTIVE: Pain management is a cornerstone of osteoarthritis (OA) management. The aim of this review is to obtain current, literature-based estimates of the effect of common pharmacologic treatments on pain reduction in OA. METHODS: A MEDLINE search (2006-2016) was conducted for randomized controlled trials studying acetaminophen, oral NSAIDs, topical NSAIDs, COX-2 inhibitors, and opioids in the treatment of OA pain. Drug effect on pain was estimated using relative change in pain, and expressed as percentage change...
August 17, 2018: Rheumatology International
Michael D Perloff, Justin S Chung
OBJECTIVE: After medication failure, patients with refractory trigeminal neuralgia (TGN) often present urgently and seek more potent or invasive therapies such as opioids or surgical options. Peripheral nerve blocks, safe and simple, may offer extended pain relief prior to opioid use or more invasive ganglion level procedures. METHODS: We report a retrospective case-series (urgent care, at a large urban medical center, over a 2 year period) of nine patients with intractable primary TGN who underwent peripheral trigeminal nerve blocks after failing conservative medical therapy...
August 8, 2018: American Journal of Emergency Medicine
Douglas P Barnaby, Andrew E Chertoff, Andrew J Restivo, Caron M Campbell, Scott Pearlman, Deborah White, Polly E Bijur, E John Gallagher
STUDY OBJECTIVE: As clinicians look to nonnarcotic analgesics in the emergency department (ED), it is essential to understand the effectiveness and adverse effects of nonopioid medications in comparison with existing opioid treatments. Studies of intravenous acetaminophen for acute pain in the ED demonstrate mixed results and suffer from small sample sizes and methodological limitations. This study compares intravenous hydromorphone with intravenous acetaminophen in adult ED patients presenting with acute pain...
August 14, 2018: Annals of Emergency Medicine
Heidi N Overton, Marie N Hanna, William E Bruhn, Susan Hutfless, Mark C Bicket, Martin A Makary
BACKGROUND: One in 16 surgical patients prescribed opioids become long-term users. Overprescribing opioids after surgery is common and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesize a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures. STUDY DESIGN: We used a 3-step modified Delphi method involving a multidisciplinary expert panel of 6 relevant stakeholder groups (surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) to develop consensus ranges for outpatient opioid prescribing at the time of discharge after 20 common procedures in 8 surgical specialties...
August 2, 2018: Journal of the American College of Surgeons
Rachel L Goldberg, Janine K Cataldo
Due to marijuana's analgesic effects and its growing national legal status, it is likely that marijuana's rising prevalence will impact prescription pain reliever (PPR) use. The present study investigates the relationship between marijuana and PPR use among U.S. adult current cigarette smokers. Data were analyzed from the Tobacco and Attitudes Beliefs Survey II, with 348 current cigarette smokers, aged 24-88. Logistic regression was used to examine the likelihood of current (past 30 days) PPR use by marijuana use (never, ever, and current) among cigarette smokers...
August 17, 2018: Journal of Psychoactive Drugs
Andrew K Chang, Polly E Bijur, Ashar Ata, Caron Campbell, Scott Pearlman, Deborah White, Andrew Chertoff, Andrew Restivo, E John Gallagher
OBJECTIVES: Older adults are at risk for undertreatment of pain. We examined IV acetaminophen as an analgesic adjunct to IV opioids in the care of older emergency department (ED) patients with acute severe pain. METHODS: This was a randomized clinical trial conducted in two emergency departments in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 mg IV hydromorphone and 1 gram IV acetaminophen or 0.5 mg IV hydromorphone and 100 cc normal saline placebo...
August 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kathleen M Adelgais, J Matthew Sholl, Rachael Alter, Kristin Lauria Gurley, Camille Broadwater-Hollifield, Peter Taillac
BACKGROUND: Individual states, regions, and local emergency medical service (EMS) agencies are responsible for the development and implementation of prehospital patient care protocols. Many states lack model prehospital guidelines for managing common conditions. Recently developed national evidence-based guidelines (EBGs) may address this gap. Barriers to statewide dissemination and implementation of model guidelines have not been studied. The objective of this study was to examine barriers and enablers to dissemination and implementation of an evidence-based guideline for traumatic pain management across 5 states...
August 17, 2018: Prehospital Emergency Care
Roxana M Grasu, Juan P Cata, Anh Q Dang, Claudio E Tatsui, Laurence D Rhines, Katherine B Hagan, Shreyas Bhavsar, Sally R Raty, Radha Arunkumar, Yury Potylchansky, Ian Lipski, Benjamin A Arnold, Thomas M McHugh, Justin E Bird, Andrea Rodriguez-Restrepo, Mike Hernandez, Keyuri U Popat
OBJECTIVE Enhanced Recovery After Surgery (ERAS) programs follow a multimodal, multidisciplinary perioperative care approach that combines evidence-based perioperative strategies to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, data regarding the development of ERAS programs in spine surgery are scarce. To evaluate the impact of an Enhanced Recovery After Spine Surgery (ERSS) program in a US academic cancer center, the authors introduced such a program and hypothesized that ERSS would have a significant influence on meaningful clinical measures of postoperative recovery, such as pain management, postoperative length of stay (LOS), and complications...
August 17, 2018: Journal of Neurosurgery. Spine
M M Wertli, J Steurer
Low back pain is common. In the acute (duration <6 weeks) and subacute pain phases (6-12 weeks) the main goal of pharmacological pain treatment is to enable patients to move and to stay as active as possible. In the chronic phase, pain medications can support non-pharmacological measures and improve physical function. Although almost every person will experience low back pain at least once in a lifetime, for many pain medications no clinical studies on their efficacy exist. Most data are available on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in acute and chronic low back pain; however, potential adverse effects and contraindications for NSAIDs need to be taken into account when the medication is prescribed...
August 16, 2018: Der Internist
Matthew J A Wilson, Christine MacArthur, Catherine A Hewitt, Kelly Handley, Fang Gao, Leanne Beeson, Jane Daniels
BACKGROUND: About a third of women receiving pethidine for labour pain subsequently require an epidural, which provides effective pain relief but increases the risk of instrumental vaginal delivery. Remifentanil patient-controlled analgesia (PCA) in labour is an alternative to pethidine, but is not widely used. We aimed to evaluate epidural analgesia progression among women using remifentanil PCA compared with pethidine. METHODS: We did an open-label, multicentre, randomised controlled trial in 14 UK maternity units...
August 13, 2018: Lancet
Emma Louise Healey, Ebenezer K Afolabi, Martyn Lewis, John J Edwards, Kelvin P Jordan, Andrew Finney, Clare Jinks, Elaine M Hay, Krysia S Dziedzic
BACKGROUND: Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake...
August 17, 2018: BMC Musculoskeletal Disorders
Doralina L Anghelescu, Varayini Pankayatselvan, Rosa Nguyen, Deborah Ward, Jianrong Wu, Huiyun Wu, Denaya D Edwards, Wayne Furman
The use of bisphosphonates for pain control in children with cancer is not extensively studied. We retrospectively evaluated 35 children with cancer treated with intravenous bisphosphonates for pain management at a single institution from 1998 through 2015. We analyzed pain scores and opioid and adjuvant medication consumption before bisphosphonate administration, daily for 2 weeks, and at 3 and 4 weeks after administration. We also determined the time interval between diagnosis and first administration of bisphosphonates and duration of life after bisphosphonate administration...
August 16, 2018: American Journal of Hospice & Palliative Care
Tommy Carlsson
AIM: The aim was to assess the methodological quality and describe recommendations for pain management in local clinical practice guidelines about induced second-trimester medical abortions at Swedish university and county hospitals. METHODS: In 2017, Swedish university and county hospitals that provided abortion care in the second trimester of pregnancy were contacted (n = 29), and guidelines from 25 were received (university: n = 6, county: n = 19). Guideline quality was assessed according to two systematic instruments...
August 16, 2018: Scandinavian Journal of Caring Sciences
Nabil M Elkassabany, Anthony Wang, Jason Ochroch, Matthew Mattera, Jiabin Liu, Andrew Kuntz
Objectives: Pain control after shoulder arthroscopy can be challenging, often relying on opioids. The study aims to measure the quality of recovery (QoR) before and after implementation of a "Multimodal Perioperative Pain Protocol" (MP3) in patients undergoing ambulatory shoulder arthroscopy. Design: Prospective cohort study. Setting: Free-standing ambulatory surgery facility of a tertiary care academic center. Subjects: Patients undergoing ambulatory shoulder arthroscopy...
August 3, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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