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Opioid management

Chang Ju Hwang, Sung Soo Chung, Kyu-Yeol Lee, Jae Hyup Lee, Seong-Hwan Moon, Jin-Hyok Kim, Kyu-Jung Cho, Jae-Sung Ahn, Dong-Soo Kim, Ye-Soo Park, Hye-Jeong Park
Background: A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. Methods: In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks...
March 2018: Clinics in Orthopedic Surgery
Joseph Guarisco, Adam Salup
Background: Pain management is one of the most common reasons patients visit the emergency department. Understanding the contributions of emergency medicine-and specifically Ochsner Health System's emergency providers-to the opioid crisis is important. Benchmark prescribing data indicated that Ochsner Health System emergency medicine providers' opioid prescription rates were significantly higher than the national average in emergency medicine. Methods: Data relevant to visit and opioid prescription counts were extracted from the organization's electronic health record system...
2018: Ochsner Journal
Eboni G Price-Haywood, Wanda Robinson, Jewel Harden-Barrios, Jeffrey Burton, Todd Burstain
Background: Opioid prescription drug abuse is a major public health concern. Healthcare provider prescribing patterns, especially among non-pain management specialists, are a major factor. Practice guidelines recommend what to do for safe opioid prescribing but do not provide guidance on how to implement best practices. Methods: We describe the implementation of electronic medical record clinical decision support (EMR CDS) for opioid management of chronic noncancer pain in an integrated delivery system...
2018: Ochsner Journal
Patricia Sobradillo Ecenarro, Marta Inchausti Iguiñiz, Sandra Pedrero Tejada, Nuria Marina Malanda, María Alfonso Imizcoz, Laura Ansola Marlasca, Bernardino Alcázar Navarrete
Chronic obstructive pulmonary disease is progressive and in its advanced stage is associated with major disability. Previous studies suggest that patients with this disease receive little palliative care, even in very advanced stages. Given this, our objectives were to describe the clinical practice of Spanish pulmonologists in the care of patients with end-stage chronic obstructive pulmonary disease, to identify potential barriers to implementing palliative care in these patients and to correlate these responses with doctor's years of experience...
March 20, 2018: COPD
Jessica A Walsh, Oluwakayode Adejoro, Benjamin Chastek, Jacqueline B Palmer, Peter Hur
BACKGROUND: In patients with psoriatic arthritis (PsA), limited data exist regarding patterns of biologic therapy use. OBJECTIVE: To examine treatment patterns and therapy modifications in U.S. patients with PsA receiving a tumor necrosis factor inhibitor (TNFi) or an anti-interleukin (IL)-12/23 inhibitor. METHODS: Adults with PsA who newly initiated a biologic therapy (index biologic) between January 1, 2013, and January 31, 2015, were included from the Optum Research Database...
March 20, 2018: Journal of Managed Care & Specialty Pharmacy
Nalini Vadivelu, Alice M Kai, Gopal Kodumudi, Dan Haddad, Vijay Kodumudi, Niketh Kuruvilla, Alan David Kaye, Richard D Urman
PURPOSE OF REVIEW: In the present investigation, current literature on the relationship between substance abuse and pain is evaluated in order to improve clinical management and its implications on the increasingly challenging chronic pain and substance abuse epidemic. The relationship between substance abuse and chronic pain are evaluated, and this review provides recommendations on the management of this special patient population. RECENT FINDINGS: Currently, there are limited guidelines for prescribing opioids and other analgesics in the chronic pain population...
March 19, 2018: Current Pain and Headache Reports
Jessica S Merlin, Jane M Liebschutz, Joanna L Starrels
No abstract text is available yet for this article.
March 19, 2018: Journal of General Internal Medicine
Frédérique Rodieux, Laszlo Vutskits, Klara M Posfay-Barbe, Walid Habre, Valérie Piguet, Jules A Desmeules, Caroline F Samer
Children represent a vulnerable population in which management of nociceptive pain is complex. Drug responses in children differ from adults due to age-related differences. Moreover, therapeutic choices are limited by the lack of indication for a number of analgesic drugs due to the challenge of conducting clinical trials in children. Furthermore the assessment of efficacy as well as tolerance may be complicated by children's inability to communicate properly. According to the World Health Organization, weak opioids such as tramadol and codeine, may be used in addition to paracetamol and ibuprofen for moderate nociceptive pain in both children and adults...
2018: Frontiers in Pharmacology
Stephen R Humble, Nicolas Varela, Asantha Jayaweera, Arun Bhaskar
PURPOSE OF REVIEW: Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. RECENT FINDINGS: Cancer is now not always a short-lived, fatal disease and is now moving towards a chronic illness. Poorly managed perioperative pain is the greatest risk factor for CPSP...
March 16, 2018: Current Opinion in Supportive and Palliative Care
Veronica Fassio, Sherrie L Aspinall, Xinhua Zhao, Donald R Miller, Jasvinder A Singh, Chester B Good, Francesca E Cunningham
OBJECTIVES: To describe the prevalence and incidence of opioid and nonsteroidal anti-inflammatory drug (NSAID) use before and since the start of the Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) and to assess rates of adverse events (AEs). STUDY DESIGN: Historical cohort study. METHODS: The OSI began in August 2012 and was fully implemented by the end of fiscal year (FY) 2013. The study timeframe was categorized into baseline (FY 2011-2012), transition (FY 2013), and postimplementation (FY 2014-2015) phases...
March 1, 2018: American Journal of Managed Care
Fabian Grass, Matthieu Cachemaille, David Martin, Nicolas Fournier, Dieter Hahnloser, Catherine Blanc, Nicolas Demartines, Martin Hübner
The purpose of this prospective cohort study was to compare multimodal pain management and pain perception after open vs. laparoscopic colorectal surgery within enhanced recovery care. Pain scores at rest and at mobilization were prospectively assessed in consecutive patients using Visual Analog Scales (VAS 0-10) and consumption of different analgesics was recorded daily until 96 hours postoperatively. Uni- and multivariate risk factors for pain peaks (≥ 4/10) were identified by logistic regression and compared between two propensity score matched groups (open vs...
2018: Bioscience Trends
Matthew Klinge, Tami Coppler, Jane M Liebschutz, Mohannad Dugum, Ajay Wassan, Andrea DiMartini, Shari Rogal
Purpose of review: The treatment of pain in patients with cirrhosis is complicated by unpredictable hepatic drug metabolism and a higher risk of adverse drug reactions. We aimed to conduct a scoping review regarding pain management in cirrhosis. Recent findings: Despite the high prevalence of pain in patients with cirrhosis, there is little literature to guide the management of pain in this population. Complex pain syndromes and disease-specific pain etiologies exist are common in patients with cirrhosis...
March 2018: Current Hepatology Reports
Thai Hoang, Hong Nguyen, Ray W Shiraishi, Mai Nguyen, Trista Bingham, Diep Nguyen, Tam Nguyen, Hao Duong, Sheryl Lyss, Hien Tran
BACKGROUND: Methadone maintenance treatment (MMT) is highly effective for reducing heroin use and HIV transmission among people who inject opioids. We sought to measure and understand factors associated with continued heroin use, a critical factor affecting treatment outcome among MMT patients in Vietnam. METHOD: We collected data from medical charts of a nationally representative sample of patients who were on MMT from May 2008 to December 2013. We selected 10 MMT clinics using probability proportional to size and 50 patients/clinic by systematic random sampling...
March 15, 2018: International Journal on Drug Policy
Jenna L McCauley, Renata S Leite, Valeria V Gordan, Roger B Fillingim, Gregg H Gilbert, Cyril Meyerowitz, David Cochran, D Brad Rindal, Kathleen T Brady
BACKGROUND: Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education. METHODS: The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation...
March 14, 2018: Journal of the American Dental Association
Lisa Barbera, Rinku Sutradhar, Anna Chu, Hsien Seow, Doris Howell, Craig C Earle, Mary Ann O'Brien, Deb Dudgeon, Clare Atzema, Amna Husain, Ying Liu, Carlo DeAngelis
BACKGROUND: Opioid prescribing has been increasingly scrutinized among non-cancer patients. As an unintended consequence, opioids may be under-prescribed for cancer patients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer. METHODS: From 2004 to 2013, Ontario residents 18-64 years eligible for government paid pharmacare were annually stratified into 3 groups: no cancer history, cancer diagnosis >5 years ago and cancer diagnosis ≤5 years ago...
March 13, 2018: Journal of Pain and Symptom Management
C Roger Goucke, Pongparadee Chaudakshetrin
Approximately 80% of the world's population lives in countries with little or no access to pain management. These countries also have 74% of the world's deaths from cancer and human immunodeficiency virus. Appropriate use of oral opioids can control 80%-90% of cancer pain. However, only 6.7% of the world's medical opioids are available in these low-resource countries. With the Lancet Commission on Global Surgery calling for a significant expansion of surgical services, postoperative pain management will need to be an increasing focus of our attention...
April 2018: Anesthesia and Analgesia
Amin A Ramzan, Stacy Fischer, Mary K Buss, Renata R Urban, Bruce Patsner, Linda R Duska, Christine M Fisher, Carolyn Lefkowits
As the only oncologists that provide both medical and surgical care, gynecologic oncologists encounter an exceptionally broad range of indications for prescribing opioids in clinical situations ranging from management of acute post-operative pain to chronic cancer-related pain to end-of-life care. While opioids are essential to the practice of gynecologic oncology, they can also have significant side effects and can be misused. Due to the explosive growth of opioid prescriptions and opioid-related overdoses and deaths during the first decade of the 21st century, there has been a recent concerted public health effort to prevent and treat opioid misuse through both legislation and education [1]...
March 12, 2018: Gynecologic Oncology
Marie Fallon, Jane Walker, Lesley Colvin, Aryelly Rodriguez, Gordon Murray, Michael Sharpe
Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC...
March 15, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Gladstone C McDowell, Joseph Winchell
OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan...
March 15, 2018: Postgraduate Medicine
Guillaume Charbonneau
No abstract text is available yet for this article.
March 2018: Canadian Family Physician Médecin de Famille Canadien
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