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https://www.readbyqxmd.com/read/28731948/managing-cancer-pain-in-older-adults
#1
Emily J Guerard, James F Cleary
Managing cancer pain in older adults can be complex and challenging. Understanding the unique needs of older patients with cancer is important to safe and effective pain management. The goals of this review are to discuss the assessment of older adults with cancer-related pain, treatment of cancer pain, and adverse effects or potential risks from treatment that are unique to older patients. A detailed pain assessment and when possible utilizing the geriatric assessment are vital to developing a cancer pain management plan...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28722116/opioids-for-cancer-related-pain-in-children-and-adolescents
#2
REVIEW
Philip J Wiffen, Tess E Cooper, Anna-Karenia Anderson, Andrew L Gray, Marie-Claude Grégoire, Gustaf Ljungman, Boris Zernikow
BACKGROUND: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization (WHO) guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. Views on children's pain have changed over time and relief of pain is now seen as important. In the past, pain was largely dismissed and was frequently left untreated, and it was assumed that children quickly forgot about painful experiences...
July 19, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28683172/opioids-for-cancer-pain-an-overview-of-cochrane-reviews
#3
REVIEW
Philip J Wiffen, Bee Wee, Sheena Derry, Rae F Bell, R Andrew Moore
BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Opioid (morphine-like) drugs are commonly used to treat moderate or severe cancer pain, and are recommended for this purpose in the World Health Organization (WHO) pain treatment ladder. The most commonly-used opioid drugs are buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, tramadol, and tapentadol...
July 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28668543/decreasing-opioid-utilization-in-rehabilitation-patients-using-a-clinical-nurse-specialist-pain-consultant-program
#4
Michael S Urton, Elaine Rohlik, Meagan Farrell, Wing Ng, Elizabeth K Woodard
OBJECTIVE: To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization. DESIGN: Retrospective chart review of patients discharged during six months prior to and six months following introduction of the CNS role. SETTING: Not-for-profit 98-bed community inpatient rehabilitation hospital. PARTICIPANTS: Two population-based samples of adult, inpatient rehabilitation patients with daily opioid use ≥ 30 mg morphine equivalent dose (MED)/day on admission and length of stay ≥ 24 days...
June 28, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28657160/ketamine-as-an-adjuvant-to-opioids-for-cancer-pain
#5
REVIEW
Rae F Bell, Christopher Eccleston, Eija A Kalso
BACKGROUND: This is an update of a review first published in 2003 and updated in 2012.Ketamine is a commonly used anaesthetic agent, and in subanaesthetic doses is also given as an adjuvant to opioids for the treatment of refractory cancer pain, when opioids alone or in combination with appropriate adjuvant analgesics prove to be ineffective. Ketamine is known to have psychomimetic (including hallucinogenic), urological, and hepatic adverse effects. OBJECTIVES: To determine the effectiveness and adverse effects of ketamine as an adjuvant to opioids for refractory cancer pain in adults...
June 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28644196/cebranopadol-a-novel-first-in-class-analgesic-drug-candidate-first-experience-in-patients-with-chronic-low-back-pain-in-a-randomized-clinical-trial
#6
Annette Christoph, Marie-Henriette Eerdekens, Maurits Kok, Gisela Volkers, Rainer Freynhagen
Chronic low back pain (LBP) is a common condition, usually with involvement of nociceptive and neuropathic pain components, high economic burden and impact on quality of life. Cebranopadol is a potent, first-in-class drug candidate with a novel mechanistic approach, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. We conducted the first Phase II, randomized, doubleblind, placebo- and active-controlled trial, evaluating the analgesic efficacy, safety, and tolerability of cebranopadol in patients with moderate to severe chronic LBP with and without neuropathic pain component...
June 21, 2017: Pain
https://www.readbyqxmd.com/read/28640990/opiate-antagonists-do-not-interfere-with-the-clinical-benefits-of-stimulants-in-adhd-a-double-blind-placebo-controlled-trial-of-the-mixed-opioid-receptor-antagonist-naltrexone
#7
Thomas J Spencer, Pradeep Bhide, Jinmin Zhu, Stephen V Faraone, Maura Fitzgerald, Amy M Yule, Mai Uchida, Andrea E Spencer, Anna M Hall, Ariana J Koster, Joseph Biederman
OBJECTIVE: Methylphenidate activates μ-opioid receptors, which are linked to euphoria. μ-Opioid antagonists, such as naltrexone, may attenuate the euphoric effects of stimulants, thereby minimizing their abuse potential. This study assessed whether the combination of naltrexone with methylphenidate is well-tolerated while preserving the clinical benefits of stimulants in subjects with attention-deficit/hyperactivity disorder (ADHD). METHODS: We conducted a 6-week, double-blind, placebo-controlled, randomized clinical trial of naltrexone in adults with DSM-IV ADHD receiving open treatment with a long-acting formulation of methylphenidate from January 2013 to July 2015...
June 20, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28635354/the-effects-of-food-on-opioid-induced-nausea-and-vomiting-and-pharmacological-parameters-a-systematic-review
#8
Robert B Raffa, Robert Colucci, Joseph V Pergolizzi
Opioids remain the standard of care for treating moderate to severe pain resulting from surgery or injury in cases of acute pain, and are recommended for patients who have not responded to nonopioid analgesics. Effective management of pain has an impact on clinical course and often depends on achieving an acceptable balance between opioid efficacy, safety, and tolerability. Common opioid-related adverse events such as nausea and vomiting are associated with an overall lower achievement of effective pain management and patient satisfaction...
June 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28631050/analgesia-nociception-index-ani-monitoring-in-patients-with-thoracic-paravertebral-block-a-randomized-controlled-study
#9
Nurseda Dundar, Alparslan Kus, Yavuz Gurkan, Kamil Toker, Mine Solak
The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who were scheduled to undergo breast surgery under general anesthesia. TPVB was performed in the preoperative period using 20 mL of bupivacaine 0.25% at T4 level. Anesthesia maintenance was provided with sevoflurane in O2: air mixture and remifentanil infusion...
June 19, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28623471/the-effect-of-intravenous-lidocaine-infusion-on-bispectral-index-during-major-abdominal-surgery
#10
Patrick Bazin, James Padley, Matthew Ho, Jennifer Stevens, Erez Ben-Menachem
Intraoperative lidocaine infusion has become widely accepted as an adjunct to general anesthesia where its use has been associated with opioid-sparing and enhanced recovery. The aims of this study were to determine whether or not intravenous (IV) lidocaine infusion (a) has an anesthetic sparing effect during major colorectal procedures and (b) if it also affects level of hypnosis as measured by bispectral index (BIS). Twenty-five patients undergoing laparotomy for resection of colorectal tumours were randomized to receive either IV lidocaine (1...
June 16, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28614197/sedation-management-in-children-supported-on-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure
#11
James B Schneider, Todd Sweberg, Lisa A Asaro, Aileen Kirby, David Wypij, Ravi R Thiagarajan, Martha A Q Curley
OBJECTIVES: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING: Twenty-one U.S. PICUs. PATIENTS: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome...
June 13, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28607342/continuous-regional-anesthesia-a-review-of-perioperative-outcome-benefits
#12
Dario Bugada, Daniela Ghisi, Edward R Mariano
Routine use of regional anesthesia for patients having surgery is supported by general safety and proven effectiveness as a targeted modality in the prevention and treatment of acute pain. Recently, perioperative physicians have become much more interested in improving long-term outcomes after surgery rather than focusing on the well-established short-term benefits of regional anesthesia. This interest has raised important questions regarding the potential influence of regional anesthesia on morbidity and mortality, persistent pain and cancer prognosis...
June 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28600725/tolerability-safety-and-effectiveness-of-oxycodone-deterx-in-elderly-patients-%C3%A2-65%C3%A2-years-of-age-with-chronic-low-back-pain-a-randomized-controlled-trial
#13
Ernest A Kopecky, Ben Vaughn, Scott Lagasse, Melinda O'Connor
TRIAL DESIGN: This was a phase III, randomized withdrawal, double-blind, placebo-controlled, enriched enrollment, parallel-group, multicenter study intended to demonstrate the safety, tolerability, and analgesic efficacy of oxycodone DETERx(®) (Xtampza™ ER) compared with matching placebo. METHODS: This post hoc analysis was performed using data from a subpopulation of enrolled patients who were ≥65 years of age. The study enrolled male and female patients with a clinical diagnosis of moderate-to-severe chronic low back pain for a minimum of 6 months prior to screening who required around-the-clock opioid therapy...
June 10, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28595427/challenging-equipotency-calculation-for-hydromorphone-after-long-term-intravenous-application
#14
Benjamin Luchting, Banafscheh Rachinger-Adam, Nikolai Hulde, Jens Heyn, Shahnaz Christina Azad
In advanced stages, most cancer patients suffer from pain which can usually be well controlled following the World Health Organization (WHO) level scheme. While the majority of patients report adequate pain relief by strong opioids (WHO III), some require an opioid rotation. Despite the existence of conversion tables, these rotations mea lead to inadequate pain control or life threatening events. Here, we report about a patient with urothelial cell carcinoma presenting in our Department of Pain Medicine with massive pain aggravation up to NRS values of 10/10 despite administration of the highest dose of intravenously applied hydromorphone...
March 16, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#15
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/28530786/morphine-for-chronic-neuropathic-pain-in-adults
#16
REVIEW
Tess E Cooper, Junqiao Chen, Philip J Wiffen, Sheena Derry, Daniel B Carr, Dominic Aldington, Peter Cole, R Andrew Moore
BACKGROUND: Neuropathic pain, which is caused by a lesion or disease affecting the somatosensory system, may be central or peripheral in origin. Neuropathic pain often includes symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the nervous system. Opioid drugs, including morphine, are commonly used to treat neuropathic pain...
May 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28514235/ondansetron-does-not-reduce-withdrawal-in-patients-with-physical-dependence-on-chronic-opioid-therapy
#17
Larry F Chu, John Sun, Anna Clemenson, Matthew J Erlendson, Tom Rico, Erika Cornell, Hannah Obasi, Zahra N Sayyid, Ellen M Encisco, Jeff Yu, Jamison G Gamble, Ian Carroll, J David Clark
OBJECTIVES: Individuals taking opioids for an extended period of time may become physically dependent, and will therefore experience opioid withdrawal should they stop taking the medication. Previous work in animal and human models has shown that the serotonin (5-HT3) receptor may be implicated in opioid withdrawal. In this study, we investigated if ondansetron, a 5-HT3-receptor antagonist, could reduce the symptoms of opioid withdrawal after chronic opioid exposure in humans. METHODS: In this double-blinded, randomized, crossover study, 33 chronic back pain patients (N = 33) were titrated onto sustained-release oral morphine for 30 days...
May 16, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28440034/role-of-transcranial-direct-current-stimulation-on-reduction-of-postsurgical-opioid-consumption-and-pain-in-total-knee-arthroplasty-double-randomized-clinical-trial
#18
E M Khedr, E S A Sharkawy, A M A Attia, N M Ibrahim Osman, Z M Sayed
BACKGROUND: Postoperative pain control is an important factor in determining recovery in total knee arthroplasty (TKA).The aim of the study was to assess the efficacy of 4 sessions of transcranial direct current stimulation (tDCS) over primary motor cortex (M1) in patients undergoing unilateral TKA. MATERIALS: Fifty patients undergoing TKA were included in the study. They were divided randomly into two groups (25 patients for each, using closed envelopes): real tDCS (2 mA, 20 min, with anodal stimulation applied over M1 postoperative for 4 consecutive days) and sham tDCS...
April 25, 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/28418067/a-case-series-of-vital-signs-controlled-patient-assisted-intravenous-analgesia-vpia-using-remifentanil-for-labour-and-delivery
#19
W L Leong, B L Sng, Q Zhang, N L R Han, R Sultana, A T H Sia
Intravenous remifentanil patient-controlled analgesia can be used during labour as an alternative to epidural analgesia. Adverse effects of opioids, including hypoxia and bradycardia, may lead to maternal morbidity and mortality. We devised an interactive feedback system based on a clinical proportional algorithm, to continuously monitor for adverse effects to enhance safety and better titrate analgesia. This vital signs-controlled, patient-assisted intravenous analgesia with remifentanil used a prototype delivery system linked to a pulse oximeter that evaluated maternal oxygen saturation and heart rate continuously...
April 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28375035/the-effects-of-intraoperative-esmolol-infusion-on-the-postoperative-pain-and-hemodynamic-stability-after-rhinoplasty
#20
Sepideh Vahabi, Yaser Rafieian, Abolfazl Abbas Zadeh
BACKGROUND: Esmolol an ultrashort acting cardioselective β1-adrenergic receptor antagonist), has been successfully employed for perioperative sympatholysis. In this study, we tested the hypothesis that perioperative esmolol administration resulted in decreased postoperative pain and improves the hemodynamic balance in patients with rhinoplasty. METHODS: In this clinical trial study, fifty-six patients (56) undergoing rhinoplasty surgery were randomly distributed into two groups (Group E and Group C)...
April 4, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
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