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Opioid management

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https://www.readbyqxmd.com/read/28546740/new-developments-in-managing-opioid-addiction-impact-of-a-subdermal-buprenorphine-implant
#1
REVIEW
MariaLisa Itzoe, Michael Guarnieri
Opioid addiction to prescription and illicit drugs is a serious and growing problem. In the US alone, >2.4 million people suffer from opioid use disorder. Government and pharmaceutical agencies have begun to address this crisis with recently released and revised task forces and medication-assisted therapies (MAT). For decades, oral or intravenous (IV) MATs have helped patients in their recovery by administration of opioid agonists (methadone, buprenorphine, oxycodone), antagonists (naltrexone, naloxone), and combinations of the two (buprenorphine/naloxone)...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28543418/reconciling-patient-safety-and-epistemic-humility-an-ethical-use-of-opioid-treatment-plans
#2
Anita Ho
In this issue of the Hastings Center Report, Joshua Rager and Peter Schwartz suggest using opioid treatment agreements as public health monitoring tools to inform patients about "the requirements entailed by undergoing opioid therapy," rather than as contractual agreements to alter patients' individual behavior or to benefit them directly. Because Rager and Schwartz's argument presents suspected OTA violations as a justification to stop providing opioids yet does not highlight the broader epistemic and systemic context within which clinicians prescribe these medications, their proposal may perpetuate a climate of distrust and stigmatization without correcting systemic factors that may have placed patients and others at risk in the first place...
May 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28543191/methadone-buprenorphine-and-naltrexone-for-the-treatment-of-opioid-use-disorder-in-pregnant-women
#3
Tran H Tran, Brooke L Griffin, Rebecca H Stone, Kathleen M Vest, Timothy J Todd
Pregnant women with opioid use disorder can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment. In this review, we compare the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discuss the potential behavioral and developmental effects of these agents seen in offspring in animal studies. Important clinical considerations in the management of opioid use disorder in pregnant women and their infants are also discussed...
May 24, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28541461/screening-with-quantification-for-64-drugs-and-metabolites-in-human-urine-using-uplc-ms-ms-analysis-and-a-threshold-accurate-calibration
#4
Thomas G Rosano, Patrice Y Ohouo, Michelle Wood
Drug and metabolite (analytes) identification together with quantification is an important analytical tool in forensic and clinical toxicology. We report the development and validation of a definitive detection and quantification method (UPLC-MS-MS) for initial screening of 64 analytes in urine. The principle of the method is a quantitative extension of a recently reported threshold accurate calibration (TAC) technique which employs a rapid dual-specimen analysis i.e., with and without addition of a reference-analyte standard for normalization of matrix effects...
May 24, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28538457/patterns-of-opioid-prescribing-for-an-orthopaedic-trauma-population
#5
John Ruder, Meghan K Wally, McKell Oliverio, Rachel B Seymour, Joseph R Hsu
OBJECTIVES: To determine opioid-prescribing practices to the orthopaedic trauma (OT) population at one Level I trauma center. DESIGN: A retrospective study of discharge prescriptions for adult patients with OT. Prescription details, injury burden, and patient demographics were abstracted for patients from initial injury through a 2-month follow-up. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Adult patients with OT admitted over a 30-day period (n = 110)...
June 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28537967/nortriptyline-enhances-morphine-conditioned-place-preference-in-neuropathic-rats-role-of-the-central-noradrenergic-system
#6
Wenli Mi, Shuxing Wang, Zerong You, Grewo Lim, Michael F McCabe, Hyangin Kim, Lucy Chen, Jianren Mao
BACKGROUND: Combination drug therapy is commonly used to treat chronic pain conditions such as neuropathic pain, and antidepressant is often used together with opioid analgesics. While rewarding is an intrinsic property of opioid analgesics, it is unknown whether the use of an antidepressant would influence opioid reward, which may contribute to opioid addiction. In this study, we examined whether nortriptyline (a tricyclic antidepressant and a first-line medication for neuropathic pain) would enhance the morphine rewarding property in both naive and chronic constriction sciatic nerve injury (CCI) rats...
May 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#7
Melissa A Bender, Caroline Hurd, Nicole Solvang, Kathy Colagrossi, Diane Matsuwaka, J Randall Curtis
BACKGROUND: There are few published comfort care order sets for end-of-life symptom management, contributing to variability in treatment of common symptoms. At our academic medical centers, we have observed that rapid titration of opioid infusions using our original comfort care order set's titration algorithm causes increased discomfort from opioid toxicity. OBJECTIVE: The aim of this study was to describe the process and outcomes of a multiyear revision of a standardized comfort care order set for clinicians to treat end-of-life symptoms in hospitalized patients...
May 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28537354/the-use-of-transcutaneous-electrical-nerve-stimulation-after-total-knee-arthroplasty-a-prospective-randomized-controlled-trial
#8
Deepak Ramanathan, Anas Saleh, Alison K Klika, Carlos A Higuera, Wael K Barsoum
INTRODUCTION: Multimodal pain management is used after total knee arthroplasty (TKA) to reduce opioid intake. Transcutaneous electrical nerve stimulation (TENS) has generated much interest as a non-pharmacologic, patient-controlled therapy. The aims of this study were to evaluate the efficacy of TENS in reducing opioid intake and improving recovery after TKA. MATERIALS AND METHODS: This was a prospective, parallel-group, double-blinded, randomized trial of patients receiving femoral nerve catheter block with allocation to either active or placebo TENS device groups...
May 24, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28536900/hopes-for-the-future-of-pain-control
#9
REVIEW
Kirsty Bannister, Mateusz Kucharczyk, Anthony H Dickenson
Here we aim to present an accessible review of the pharmacological targets for pain management, and succinctly discuss the newest trends in pain therapy. A key task for current pain pharmacotherapy is the identification of receptors and channels orchestrating nociception. Notwithstanding peripheral alterations in the receptors and channels following pathophysiological events, the modulatory mechanisms in the central nervous system are also fundamental to the regulation of pain perception. Bridging preclinical and clinical studies of peripheral and central components of pain modulation, we present the different types of pain and relate these to pharmacological interventions...
May 23, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#10
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533287/trv0109101-a-g-protein-biased-agonist-of-the-%C3%A2%C2%B5-opioid-receptor-does-not-promote-opioid-induced-mechanical-allodynia-following-chronic-administration
#11
Michael Koblish, Richard Carr, Edward R Siuda, David H Rominger, William Gowen-MacDonald, Conrad L Cowan, Aimee L Crombie, Jonathan D Violin, Michael W Lark
Prescription opioids are a mainstay in the treatment of acute moderate to severe pain. However, chronic use leads to a host of adverse consequences including tolerance and opioid-induced hyperalgesia (OIH), leading to more complex treatment regimens and diminished patient compliance. Patients experiencing OIH paradoxically experience exaggerated nociceptive responses instead of pain reduction after chronic opioid usage. The development of OIH and tolerance tend to occur simultaneously and, thus, present a challenge when studying the molecular mechanisms driving each phenomenon...
May 22, 2017: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/28532487/degree-of-dyspnoea-at-admission-and-discharge-in-patients-with-heart-failure-and-respiratory-diseases
#12
Lourdes Vicent, Juan Manuel Nuñez Olarte, Luis Puente-Maestu, Alicia Oliva, Juan Carlos López, Andrea Postigo, Irene Martín, Raquel Luna, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND: Dyspnoea is a disabling symptom in patients admitted with heart failure (HF) and respiratory diseases (RD). The main aim of this study is to evaluate its intensity at admission and discharge and the relation with quality of life. We also describe its management, intensity, and evolution in HF and RD. METHODS: In this descriptive, cross-sectional study, we included prospectively all patients admitted with decompensated HF and chronic obstructive pulmonary disease (COPD)/pulmonary fibrosis during 4 months...
May 22, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28531306/association-of-long-term-opioid-therapy-with-functional-status-adverse-outcomes-and-mortality-among-patients-with-polyneuropathy
#13
E Matthew Hoffman, James C Watson, Jennifer St Sauver, Nathan P Staff, Christopher J Klein
Importance: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. Objectives: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality...
May 22, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28530876/research-continuous-surveillance-of-sleep-apnea-patients-in-a-medical-surgical-unit
#14
Dana Supe, Leah Baron, Tom Decker, Kyle Parker, Jeanne Venella, Sarah Williams, Kari Beaton, John Zaleski
This report consists of two separate studies on the use of continuous capnography monitoring conducted in an effort to improve patient safety at Virtua Health System. The desire for improved patient safety is motivating continuous monitoring and improved surveillance in clinical areas not traditionally equipped for such monitoring. We explored the use of remote monitoring of capnography, using enterprise middleware, in patients recovering from surgery in a medical-surgical unit. Continuous monitoring traditionally has been used in higher-acuity settings, such as intensive care units...
May 2017: Biomedical Instrumentation & Technology
https://www.readbyqxmd.com/read/28527640/influences-on-patient-satisfaction-among-patients-who-use-emergency-departments-frequently-for-pain-related-complaints
#15
Patricia Newcomb, Marian Wilson, Ralph Baine, Terence McCarthy, Nicholas Penny, Caroline Nixon, Justin Orren
INTRODUCTION: The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief. METHODS: A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users with high ED utilization for pain complaints. Responses were compared with an age-matched control group (n = 305) of nonfrequent ED users...
May 17, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28526162/pharmacologic-considerations-of-anesthetic-agents-in-pediatric-patients-a-comprehensive-review
#16
REVIEW
Alan D Kaye, Charles J Fox, Ira W Padnos, Ken P Ehrhardt, James H Diaz, Elyse M Cornett, Debbie Chandler, Sudipta Sen, Shilpadevi Patil
Acute pain in the pediatric population has important differences in terms of biology, intrapopulation variation, and epidemiology. Discussion as to the pharmacologic considerations of anesthetic agents, such as induction agents, neuromuscular blockers, opioids, local anesthetics, and adjuvant agents, is presented in this article. Special considerations and concerns, such as risk for propofol infusion syndrome and adverse potential side effects of anesthesia agents, are discussed. Anesthesiologists managing pediatric patients need to have a firm understanding of physiologic and pharmacologic differences compared with the adult population...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526161/an-update-on-nonopioids-intravenous-or-oral-analgesics-for-perioperative-pain-management
#17
REVIEW
Alan D Kaye, Elyse M Cornett, Erik Helander, Bethany Menard, Eric Hsu, Brendon Hart, Andrew Brunk
Despite an appreciation for many unwanted physiologic effects from inadequate postoperative pain relief, moderate to severe postoperative pain remains commonplace. Although treatment options have evolved in recent years, the use of nonopioid analgesics agents can reduce acute pain-associated morbidity and mortality. This review focuses on the importance of effective postoperative nonopioid analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoid agents, NMDA antagonists, alpha 2 agonists, and steroids, in opioid sparing and enhancing recovery...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526150/pharmacogenomics-in-pain-management
#18
REVIEW
Ramsey Saba, Alan D Kaye, Richard D Urman
There is interpatient variability to analgesic administration. Much can be traced to pharmacogenomics variations between individuals. Certain ethnicities are more prone to reduced function of CYP2D6. Weak opioids are subject to interpatient variation based on their CYP2D6 type. Strong opioids have variations based on their transport and individual metabolism. Several cytochrome enzymes have been found to be involved with ketamine but there is no strong evidence of individual polymorphisms manifesting in clinical outcomes...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525633/scan-echo-for-pain-management-implementing-a-regional-telementoring-training-for-primary-care-providers
#19
Sherry Ball, Brigid Wilson, Scott Ober, Ali Mchaourab
Objective.:  The Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO) is a video teleconferencing-based training program where primary care providers are trained by a specialty care team to provide specialty care. A multidisciplinary team of pain management specialists at the Cleveland Veterans Affairs Medical Center established such a program for pain management; a description and preliminary effectiveness assessment of this training program is presented...
May 19, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28525527/is-it-useful-to-add-acetaminophen-to-high-potency-opioids-in-cancer-related-pain
#20
Oscar Corsi, Pedro E Pérez-Cruz
Pain is one of the most frequent and relevant symptoms in cancer patients. The World Health Organization's analgesic ladder proposes the use of strong opioids associated with adjuvants such as acetaminophen or nonsteroidal anti-inflammatory drugs in step III. However, it is unclear whether adding acetaminophen to an analgesic regimen based on strong opioids has any benefit in cancer patients with moderate to severe pain. To answer this question we searched in Epistemonikos database, which is maintained by screening multiple information sources...
May 4, 2017: Medwave
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