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Opioid management

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https://www.readbyqxmd.com/read/28938102/self-management-support-at-the-end-of-life-patients-carers-and-professionals-perspectives-on-managing-medicines
#1
N Campling, A Richardson, M Mulvey, M Bennett, B Johnston, S Latter
BACKGROUND: Pain is a frequently reported symptom by patients approaching the end of life and well-established that patients and carers hold fears relating to opioids, and experience side effects related to their use. The management of medicines is intrinsic to achieving effective pain relief. The concept of self-management support whilst well characterised in the context of chronic illness has not been elaborated with respect to end of life care. AIM: To identify patient, carer and professional views on the concept of self-management support at end of life, specifically in relation to analgesia and related medicines (for side-effect management) in order to describe, characterise and explain self-management support in this context...
September 6, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28937533/chronic-poststernotomy-pain-incidence-risk-factors-treatment-prevention-and-the-anesthesiologist-s-role
#2
Amanda M Kleiman, Daniel T Sanders, Edward C Nemergut, Julie L Huffmyer
Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects...
September 20, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28936915/review-of-the-evidence-best-analgesic-regimen-for-shoulder-surgery
#3
Yolanda Huang, Felicia Chiu, Christopher Aj Webb, Paul David Weyker
Multimodal pain management has been advocated in patients experiencing acute pain after surgical procedures due to tissue damage and the subsequent inflammatory response. For patients undergoing shoulder surgeries, studies have definitively shown that interscalene blocks (ISBs) via single-injection or continuous infusion can reduce the total opioid consumption and can lower pain scores after surgery. In some cases, ISBs can be used as the sole anesthetic during shoulder surgeries and spare patients of receiving general anesthesia...
September 22, 2017: Pain Management
https://www.readbyqxmd.com/read/28936080/maintainence-treatment-of-opioid-dependence-with-tramadol
#4
Siddharth Sarkar, Mohit Varshney, Vaibhav Patil, Rakesh Lal
BACKGROUND: Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance. METHODS: Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28935293/designing-safer-analgesics-via-%C3%AE-opioid-receptor-pathways
#5
REVIEW
H C Stephen Chan, Dillon McCarthy, Jianing Li, Krzysztof Palczewski, Shuguang Yuan
Pain is both a major clinical and economic problem, affecting more people than diabetes, heart disease, and cancer combined. While a variety of prescribed or over-the-counter (OTC) medications are available for pain management, opioid medications, especially those acting on the μ-opioid receptor (μOR) and related pathways, have proven to be the most effective, despite some serious side effects including respiration depression, pruritus, dependence, and constipation. It is therefore imperative that both academia and industry develop novel μOR analgesics which retain their opioid analgesic properties but with fewer or no adverse effects...
September 18, 2017: Trends in Pharmacological Sciences
https://www.readbyqxmd.com/read/28932964/treatment-strategies-for-the-opioid-dependent-patient
#6
REVIEW
Shweta Teckchandani, Meredith Barad
PURPOSE OF REVIEW: This review is intended to help the headache physician think through and plan for management issues concerning the use of opioids. We ask the headache physician to consider if there are instances where prescribing or continuing prescriptions of opiates is plausible, and if so, how can the physician proceed as safely as possible. Our goal is to start a conversation regarding the inevitable encounter with a patient on opiates or requesting opiates. RECENT FINDINGS: The use of opiates in our society has reached a crisis in staggering death and addiction rates...
September 20, 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28930903/effects-of-localized-cold-therapy-on-pain-in-postoperative-spinal-fusion-patients-a-randomized-control-trial
#7
Patricia Quinlan, Jack Davis, Kara Fields, Pia Madamba, Lisa Colman, Daniela Tinca, Regina Cannon Drake
BACKGROUND: Cold therapy used in the sports medicine settings has been found to be effective in reducing postoperative pain; however, there are limited studies that examine the effect of cold therapy on postoperative pain in patients with posterior lumbar spinal fusion. PURPOSE: The purpose of this study was to determine the effects of cold on postoperative spine pain and add to the body of knowledge specific to practical application of cold therapy in the spine surgery setting...
September 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28930773/a-case-of-opioid-overdose-and-subsequent-death-after-medically-supervised-withdrawal-the-problematic-role-of-rapid-tapers-for-opioid-use-disorder
#8
Derek C Chang, Jan Klimas, Evan Wood, Nadia Fairbairn
BACKGROUND: Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term tapers of opioid agonist/partial agonist medications, such as methadone and buprenorphine/naloxone, are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still commonplace in medically supervised withdrawal settings. CASE SUMMARY: We report a case of an individual with opioid use disorder who was prescribed a rapid buprenorphine/naloxone taper in a medically supervised withdrawal facility and who had a subsequent opioid overdose and death after discharge...
September 19, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28929914/the-conundrum-of-opioid-tapering-in-long-term-opioid-therapy-for-chronic-pain-a-commentary
#9
Ajay Manhapra, Albert A Arias, Jane C Ballantyne
BACKGROUND: In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking...
September 20, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28929035/porcine-urinary-bladder-matrix-for-management-of-infected-radiation-mastectomy-wound
#10
Yana Puckett, Theophilus Pham, Shirley McReynolds, Catherine A Ronaghan
We present a case report on the successful healing of a Pseudomonas infection wound in a 52-year-old female with morbid obesity, noninsulin dependent diabetes mellitus and a history of tobacco use, who presented with Stage IIIA (T3, N2, Mo) infiltrating ductal carcinoma. The patient received neoadjuvant chemotherapy prior to her bilateral skin-sparing total mastectomies with right axillary sentinel lymphadenectomy. She also had staged reconstruction with temporary breast implants and plans for deep inferior epigastric perforator flaps...
July 10, 2017: Curēus
https://www.readbyqxmd.com/read/28928569/comparison-of-epidural-analgesia-with-transversus-abdominis-plane-analgesia-for-postoperative-pain-relief-in-patients-undergoing-lower-abdominal-surgery-a-prospective-randomized-study
#11
Sadasivan Shankar Iyer, Harshit Bavishi, Chadalavada Venkataram Mohan, Navdeep Kaur
BACKGROUND: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. MATERIALS AND METHODS: Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928561/periprocedural-management-of-vein-of-galen-aneurysmal-malformation-patients-an-11-year-experience
#12
Ajay Prasad Hrishi, Karen Ruby Lionel
CONTEXT: The vein of Galen aneurysmal malformation (VGAM) is a rare arteriovenous malformation where a dilated median prosencephalic vein provides a low-resistance conduit for intracerebral blood flow resulting in high-output cardiac failure, severe pulmonary hypertension, with or without central nervous system symptoms secondary to hydrocephalus, in the neonatal and pediatric population. AIM: This study aims to analysis of the anesthetic management of this unique subset of patients with VGAM...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28926291/has-province-wide-symptom-screening-changed-opioid-prescribing-rates-in-older-patients-with-cancer
#13
Lisa Barbera, Rinku Sutradhar, Anna Chu, Hsien Seow, Craig C Earle, Mary Ann O'Brien, Deborah Dudgeon, Carlo DeAngelis, Clare Atzema, Amna Husain, Ying Liu, Doris Howell
PURPOSE: Previous work in Ontario demonstrated that 33% of patients with cancer with severe pain did not receive opioids at the time of their pain assessment. With efforts to increase symptom screening and management since then, the objective of this study was to examine temporal trends in opioid prescribing. METHODS: The cohort was comprised of Ontario residents ≥ 65 years of age with a cancer history who were eligible for the government pharmacare program and had a pain assessment using the Edmonton Symptom Assessment System...
September 19, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28924009/site-specific-regulation-of-p2x7-receptor-function-in-microglia-gates-morphine-analgesic-tolerance
#14
Heather Leduc-Pessah, Nicholas L Weilinger, Churmy Y Fan, Nicole E Burma, Roger J Thompson, Tuan Trang
Tolerance to the analgesic effects of opioids is a major problem in chronic pain management. Microglia are implicated in opioid tolerance, but the core mechanisms regulating their response to opioids remain obscure. By selectively ablating microglia in the spinal cord using a saporin-conjugated antibody to Mac1, we demonstrate a causal role for microglia in the development, but not maintenance, of morphine tolerance in male rats. Increased P2X7 receptor (P2X7R) activity is a cardinal feature of microglial activation, and in this study we found that morphine potentiates P2X7R-mediated Ca(2+) responses in resident spinal microglia acutely isolated from morphine tolerant rats...
September 18, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28923307/association-between-opioid-use-and-risk-of-erectile-dysfunction-a-systematic-review-and-meta-analysis
#15
REVIEW
Shankun Zhao, Tuo Deng, Lianmin Luo, Jiamin Wang, Ermao Li, Luhao Liu, Futian Li, Jintai Luo, Zhigang Zhao
BACKGROUND: Opioid analgesics have been widely used to relieve chronic pain conditions; however, a connection between opioid analgesic administration and increased susceptibility to erectile dysfunction (ED) has been hypothesized. AIM: To evaluate whether opioid use was a risk factor for ED in a systematic review and meta-analysis. METHODS: The PubMed, Cochrane Library, and Embase databases were searched to identify eligible studies concerning opioid use and risk of ED from inception to April 2017...
September 8, 2017: Journal of Sexual Medicine
https://www.readbyqxmd.com/read/28920715/the-mixed-message-behind-medication-assisted-treatment-for-substance-use-disorder
#16
Sean M Robinson, Bryon Adinoff
The gap between treatment utilization and treatment need for substance use disorders (SUDs) remains a significant concern in our field. While the growing call to bridge this gap often takes the form of more treatment services and/or better integration of existing services, this perspective proposes that more effective labels for and transparent descriptions of existing services would also have a meaningful impact. Adopting the perspective of a consumer-based health-care model (wherein treatments and services are products and patients are consumers) allows us to consider how labels like Addiction-focused Medical Management, Medication-Assisted Treatment, Medication-Assisted Therapy, and others may actually be contributing to the underutilization problem rather than alleviating it...
September 18, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28920710/use-of-strong-opioids-for-chronic-pain-in-osteoarthritis-an-insight-into-the-latin-american-reality
#17
Miguel Angel Ruiz Iban, Javier Benavides, Juan Pablo Forero, Sacha Bittelman, Rafael Martinez, Miguel Angel Mite, Jorge Diaz Heredia, Sergio Ulloa, Mauro Marcelo Lizárraga Ferrand
Osteoarthritis is the most common cause of arthritis and one of the principle causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids...
September 18, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28919978/controlled-substance-agreements-for-opioids-in-a-primary-care-practice
#18
Lindsey M Philpot, Priya Ramar, Muhamad Y Elrashidi, Raphael Mwangi, Frederick North, Jon O Ebbert
BACKGROUND: Opioids are widely prescribed for chronic non cancer pain (CNCP). Controlled substance agreements (CSAs) are intended to increase adherence and mitigate risk with opioid prescribing. We evaluated the demographic characteristics of and opioid dosing for patients with CNCP enrolled in CSAs in a primary care practice. METHODS: We conducted a retrospective cohort study of 1066 patients enrolled in CSAs between May 9, 2013 and August 15, 2016 for CNCP in a Midwest primary care practice...
2017: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/28919813/a-prospective-double-blinded-randomized-comparison-of-ultrasound-guided-femoral-nerve-block-with-lateral-femoral-cutaneous-nerve-block-versus-standard-anesthetic-management-for-pain-control-during-and-after-traumatic-femur-fracture-repair-in-the-pediatric-population
#19
Nicole M Elsey, Joseph D Tobias, Kevin E Klingele, Ralph J Beltran, Tarun Bhalla, David Martin, Giorgio Veneziano, Julie Rice, Dmitry Tumin
BACKGROUND: Traumatic injury of the femur resulting in femoral fracture may result in significant postoperative pain. As with other causes of acute pain, regional anesthesia may offer a benefit over conventional therapy with intravenous opioids. This study prospectively assesses the effects of femoral nerve blockade with a lateral femoral cutaneous nerve block (FN-LFCN) on intraoperative anesthetic requirements, postoperative pain scores, and opioid requirements. MATERIALS AND METHODS: Seventeen pediatric patients (age 2-18 years) undergoing surgical repair of a traumatic femur fracture fulfilled the study criteria and were randomly assigned to general anesthesia with either an FN-LFCN block (n = 10) or intravenous opioids (n = 7)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28919771/the-challenge-of-perioperative-pain-management-in-opioid-tolerant-patients
#20
REVIEW
Flaminia Coluzzi, Francesca Bifulco, Arturo Cuomo, Mario Dauri, Claudio Leonardi, Rita Maria Melotti, Silvia Natoli, Patrizia Romualdi, Gennaro Savoia, Antonio Corcione
The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal...
2017: Therapeutics and Clinical Risk Management
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