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Opioid management

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https://www.readbyqxmd.com/read/29791238/low-dose-ketamine-infusion-for-adjunct-management-during-vaso-occlusive-episodes-in-adults-with-sickle-cell-disease-a-case-series
#1
Nicole Palm, Catherine Floroff, Tanna B Hassig, Alice Boylan, Julie Kanter
The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs)...
May 23, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29790369/an-innovative-perioperative-pain-program-for-chronic-opioid-users-an-academic-medical-center-s-response-to-the-opioid-crisis
#2
Marie N Hanna, Traci J Speed, Ronen Shechter, Michael C Grant, Rosanne Sheinberg, Elizabeth Goldberg, Claudia M Campbell, Nicholas Theodore, Colleen G Koch, Kayode Williams
Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users. This program involves multidisciplinary teams that include acute and chronic pain specialists, psychiatrists, integrative medicine specialists, and physical medicine and rehabilitation services...
May 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29790354/-opioids-and-new-trends-in-pain-therapy
#3
Jan Lejčko
Opioids are well known for their ability to reduce the perception of pain without a loss of consciousness. However, the influence of opioids on organism is very complex. Clinical pharmacology of currently available opioid analgesics is determined by three major factors - their opioid receptor properties, pharmacokinetic properties and genetic polymorphism in the opiate receptor and cytochrome P450 isoform. In acute severe pain are opioids very efficient. Long-term experience with opioid analgesia in patients with cancer pain has shown high favorable risk/benefit ratio...
2018: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29789018/pain-clinic-definitions-in-the-medical-literature-and-u-s-state-laws-an-integrative-systematic-review-and-comparison
#4
REVIEW
Barbara Andraka-Christou, Joshua B Rager, Brittany Brown-Podgorski, Ross D Silverman, Dennis P Watson
BACKGROUND: In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice...
May 22, 2018: Substance Abuse Treatment, Prevention, and Policy
https://www.readbyqxmd.com/read/29788532/the-effect-of-adding-magnesium-sulfate-to-epidural-bupivacaine-and-morphine-on-post-thoracotomy-pain-management-a-randomized-double-blind-clinical-trial
#5
Behrooz Farzanegan, Mahdi Zangi, Kimia Saeedi, Ali Khalili, Mehdi Rajabi, Alireza Jahangirifard, Habib Emami, Amir Ali Mahboobipour, Shadi Baniasadi
Post-thoracotomy pain is very severe and may cause pulmonary complications. Thoracic epidural analgesia can greatly decrease the pain experience and its consequences. However, finding new methods to decrease the amount of administered opioids is an important issue of research. We aimed to evaluate the effect of adding epidural magnesium sulfate to bupivacaine and morphine on pain control and the amount of opioid consumption after thoracotomy. Eighty patients undergoing thoracotomy at a tertiary cardiothoracic referral centre were enrolled in a randomized, double-blind trial...
May 22, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29787389/liposomal-bupivacaine-does-not-reduce-inpatient-opioid-prescription-or-related-complications-after-knee-arthroplasty-a-database-analysis
#6
Lukas Pichler, Jashvant Poeran, Nicole Zubizarreta, Crispiana Cozowicz, Eric C Sun, Madhu Mazumdar, Stavros G Memtsoudis
BACKGROUND: Although some trials suggest benefits of liposomal bupivacaine, data on real-world use and effectiveness is lacking. This study analyzed the impact of liposomal bupivacaine use (regardless of administration route) on inpatient opioid prescription, resource utilization, and opioid-related complications among patients undergoing total knee arthroplasties with a peripheral nerve block. It was hypothesized that liposomal bupivacaine has limited clinical influence on the studied outcomes...
May 21, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29786144/self-initiated-use-of-topical-cannabidiol-oil-for-epidermolysis-bullosa
#7
Malcolm P Chelliah, Zachary Zinn, Phoung Khuu, Joyce M C Teng
Epidermolysis bullosa is a rare blistering skin disorder that is challenging to manage because skin fragility and repeated wound healing cause itching, pain, limited mobility, and recurrent infections. Cannabidiol, an active cannabinoid found in cannabis, is postulated to have antiinflammatory and analgesic effects. We report 3 cases of self-initiated topical cannabidiol use in patients with epidermolysis bullosa in an observational study. One patient was weaned completely off oral opioid analgesics. All 3 reported faster wound healing, less blistering, and amelioration of pain with cannabidiol use...
May 22, 2018: Pediatric Dermatology
https://www.readbyqxmd.com/read/29785136/psychological-factors-as-predictors-of-early-postoperative-pain-after-open-nephrectomy
#8
Ana Mimic, Carsten Bantel, Jelena Jovicic, Branko Mimic, Darija Kisic-Tepavcevic, Otas Durutovic, Nebojsa Ladjevic
Purpose: There is an increasing interest in the identification of predictors for individual responses to analgesics and surgical pain. In this study, we aimed to determine psychological factors that might contribute to this response. We hence investigated patients undergoing a standardized surgical intervention (open nephrectomy). Patients and methods: Between May 2014 and April 2015, we conducted a prospective observational cohort study. The following psychological tests were administered preoperatively: Mini-Mental State Examination, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Pain Catastrophizing Scale...
2018: Journal of Pain Research
https://www.readbyqxmd.com/read/29781960/a-peripherally-restricted-cannabinoid-1-receptor-agonist-as-a-novel-analgesic-in-cancer-induced-bone-pain
#9
Hong Zhang, Dominique M Lund, Haley A Ciccone, William D Staatz, Mohab M Ibrahim, Tally M Largent-Milnes, Herbert H Seltzman, Igor Spigelman, Todd W Vanderah
Many malignant cancers, including breast cancer, have a propensity to invade bones, leading to excruciating bone pain. Opioids are the primary analgesics used to alleviate this cancer-induced bone pain (CIBP) but are associated with numerous severe side effects, including enhanced bone degradation, which significantly impairs patients' quality of life. In contrast, agonists activating only peripheral CB1 receptors (CB1Rs) have been shown to effectively alleviate multiple chronic pain conditions with limited side effects, yet no studies have evaluated their role(s) in CIBP...
May 16, 2018: Pain
https://www.readbyqxmd.com/read/29781876/postpartum-pain-management
#10
(no author information available yet)
Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad...
May 17, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29781504/epidural-versus-non-epidural-or-no-analgesia-for-pain-management-in-labour
#11
REVIEW
Millicent Anim-Somuah, Rebecca Md Smyth, Allan M Cyna, Anna Cuthbert
BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour...
May 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29780163/heteromerization-of-%C3%AE-opioid-receptor-and-cholecystokinin-b-receptor-through-the-third-transmembrane-domain-of-the-%C3%AE-opioid-receptor-contributes-to-the-anti-opioid-effects-of-cholecystokinin-octapeptide
#12
Yin Yang, Qian Li, Qi-Hua He, Ji-Sheng Han, Li Su, You Wan
Activation of the cholecystokinin type B receptor (CCKBR) by cholecystokinin octapeptide (CCK-8) inhibits opioid analgesia. Chronic opiate treatment leads to an increase in the CCK-8 concentration and thus enhances the antagonism of CCK-8 against opioid analgesia; the underlying molecular mechanisms remain of great interest. In the present study, we validated the colocalization of the μ-opioid receptor (MOR) and CCKBR in pain signal transmission-related spinal cord dorsal horn and dorsal root ganglion neurons of rats...
May 21, 2018: Experimental & Molecular Medicine
https://www.readbyqxmd.com/read/29779793/older-adults-response-to-analgesic-adverse-drug-reactions-a-pilot-study
#13
Deborah Dillon McDonald, Sarah Coughlin, Candy Jin
Older adults who take analgesics for chronic pain are at increased risk for adverse drug events (ADEs). The purpose of this descriptive pilot survey was to examine how older adults self-identify analgesic ADEs, and actions they take in response to analgesic ADEs. Twenty-two community dwelling older adults with chronic pain who reported an analgesic ADE associated with their chronic pain management were interviewed and asked to describe their analgesic related ADE. Written responses were content analyzed. Nineteen opioids were reported by 15, 11 NSAIDs were reported by 8, and acetaminophen was reported by 2 older adults as associated with an ADE...
May 17, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29779792/predictors-of-weeks-to-opioid-cessation-after-lumbar-fusion-a-prospective-cohort-study
#14
Maureen P Lall, Elizabeth Restrepo
Although the use of prescription opioid analgesics to treat acute, postoperative pain is a well-established practice, the role of opioids in the management of persistent, postoperative pain remains ill-defined. Nevertheless, high rates of long-term opioid use following lumbar fusion have been reported. The goal of this prospective, longitudinal study was to identify predictors of weeks to opioid cessation in a cohort of patients undergoing elective lumbar fusion. Prior to surgery, participants self-reported demographic and clinical data and completed a validated measure of pain catastrophizing...
May 17, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29777950/acceptance-and-commitment-therapy-for-prevention-of-chronic-post-surgical-pain-and-opioid-use-in-at-risk-veterans-a-pilot-randomized-controlled-study
#15
Lilian Dindo, M Bridget Zimmerman, Katherine Hadlandsmyth, Barbara StMarie, Jennie Embree, James Marchman, Toni Tripp-Reimer, Barbara Rakel
High levels of pain, significant anxiety, and/or depressive symptoms prior to surgery put patients at elevated risk forchronic pain and prolonged opioid use following surgery. The purpose of this preliminary study was to assess the efficacy of a one-day Acceptance and Commitment Therapy (ACT) workshop in "at-risk" Veterans for the prevention of chronic pain and opioid use following orthopedic surgery. In a randomized controlled trial, 88 at-risk Veterans undergoing orthopedic surgery were assigned to Treatment as Usual (TAU; N =44) or TAU plus a 1-day ACT workshop (N = 44)...
May 16, 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29776790/-modern-treatment-of-mesenteric-ischemia
#16
Alexandre Nuzzo, Audrey Huguet, Olivier Corcos
Acute mesenteric ischemia is a highly morbid affliction which requires urgent care. Acute mesenteric ischemia consists in an ischemia injury of the small bowel, secondary to vascular insufficiency, either occlusive (thrombosis, embolism, arterial, venous) or non-occlusive (low flow or vasospasm). Given that the superior mesenteric artery supplies the small bowel as well as the right part of the colon, any ischemic process involving the right colon should be considered an acute mesenteric ischemia until proven otherwise...
May 15, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29776349/randomised-controlled-trial-rct-of-cannabinoid-replacement-therapy-nabiximols-for-the-management-of-treatment-resistant-cannabis-dependent-patients-a-study-protocol
#17
Anjali K Bhardwaj, David J Allsop, Jan Copeland, Iain S McGregor, Adrian Dunlop, Marian Shanahan, Raimondo Bruno, Nghi Phung, Mark Montebello, Craig Sadler, Jessica Gugusheff, Melissa Jackson, Jennifer Luksza, Nicholas Lintzeris
BACKGROUND: The cannabis extract nabiximols (Sativex®) effectively supresses withdrawal symptoms and cravings in treatment resistant cannabis dependent individuals, who have high relapse rates following conventional withdrawal treatments. This study examines the efficacy, safety and cost-effectiveness of longer-term nabiximols treatment for outpatient cannabis dependent patients who have not responded to previous conventional treatment approaches. METHODS/DESIGN: A phase III multi-site outpatient, randomised, double-blinded, placebo controlled parallel design, comparing a 12-week course of nabiximols to placebo, with follow up at 24 weeks after enrolment...
May 18, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29775955/posttraumatic-stress-disorder-and-chronic-pain-are-associated-with-opioid-use-disorder-results-from-a-2012-2013-american-nationally-representative-survey
#18
Elena Bilevicius, Jordana L Sommer, Gordon J G Asmundson, Renée El-Gabalawy
BACKGROUND: Chronic pain conditions and posttraumatic stress disorder (PTSD) commonly co-occur and are associated with opioid use disorder (OUD). The aims of this paper were to identify prevalence estimates of OUD among individuals with and without PTSD and assess independent and combined contributions of PTSD and chronic pain conditions on OUD in a nationally representative sample. METHODS: Data were extracted from 36,309 individuals from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions...
May 7, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29774938/-analysis-of-risk-factors-of-prolonged-postoperative-ileus-after-gastric-cancer-surgery
#19
Ning Wang, Lin Chen, Mingsen Li, Naizhong Jin, Bo Wei
OBJECTIVE: To investigate the risk factors of prolonged postoperative ileus (PPOI) after gastric cancer surgery. METHODS: Definition of PPOI was that gastrointestinal function did not return to normal within 96 hours after operation. Diagnostic criteria of PPOI were as follows: according with over 2 below conditions at postoperative 97-hour: (1) moderate to severe sick (mild: 1-3 points, moderate: 4-7 points, severe: 8-10 points) or vomiting occurred in past 12 hours...
May 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/29774774/undertreatment-of-pain-and-low-use-of-opioids-in-latin-america
#20
César Amescua García, Joao Batista Santos Garcia, María Del Rosario Berenguel Cook, Frantz Colimon, José Alberto Flores Cantisani, Carlos Guerrero, María Del Rocío Guillén Núnez, John Jairo Hernández Castro, Durval Campos Kraychete, Argelia Lara-Solares, Osvandré Lech, María Antonieta Rico Pazos, Manuel Sempértegui Gallegos, Lizandra Pattaro Marcondes
Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries...
May 18, 2018: Pain Management
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