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https://www.readbyqxmd.com/read/29307505/practical-considerations-in-medical-cannabis-administration-and-dosing
#1
REVIEW
Caroline A MacCallum, Ethan B Russo
Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable...
January 4, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29278818/ondansetron-does-not-prevent-physical-dependence-in-patients-taking-opioid-medications-chronically-for-pain-control
#2
Larry F Chu, Tom Rico, Erika Cornell, Hannah Obasi, Ellen M Encisco, Haley Vertelney, Jamison G Gamble, Clayton W Crawford, John Sun, Anna Clemenson, Matthew J Erlendson, Robin Okada, Ian Carroll, J David Clark
OBJECTIVES: In this study, we investigated the co-administration of ondansetron with morphine, and whether it could prevent the development of physical dependence in patients taking opioids for the treatment of chronic pain. METHODS: A total of 48 chronic back pain patients (N = 48) participated in this double-blinded, placebo-controlled, randomized study. Patients were titrated onto sustained-release oral morphine and randomized to take 8 mg ondansetron or placebo three times daily concurrently with morphine during the 30-day titration...
August 14, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29231146/comparison-of-two-naloxone-regimens-in-addicted-methadone-overdosed-patients-a-clinical-trial-study
#3
Navid Khosravi, Nasim Zamani, Hossein Hassanian-Moghaddam, Ali Ostadi, Mitra Rahimi, Ali Kabir
BACKGROUND: Methadone toxicity is one of the major causes of death in opioid dependent individuals. OBJECTIVE: We aimed to compare two different protocols for naloxone in terms of reversal of overdose and frequency of complications in opioid-dependent methadone-intoxicated patients. METHODS: One-hundred opioid-dependent patients with signs/symptoms of methadone overdose were included. The patients were consecutively assigned into Tintinalli (group 1) or Goldfrank regimen protocol (group 2) of naloxone administration...
December 11, 2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29229211/the-use-of-rapid-onset-fentanyl-in-children-and-young-people-for-breakthrough-cancer-pain
#4
Lucy Coombes, Kimberley Burke, Anna-Karenia Anderson
BACKGROUND AND AIMS: No published studies have looked at the dosing and use of rapid onset fentanyl preparations in children. The primary aim of this study was to assess whether there is a correlation between effective dose of rapid onset fentanyl and background oral morphine equivalent analgesia in children less than 18 years old. Secondary objectives included establishing whether there is a correlation between effective dose of rapid onset fentanyl and age and weight. Reported side effects were also reviewed...
October 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29183228/recommendations-for-buprenorphine-and-methadone-therapy-in-opioid-use-disorder-a-european-consensus
#5
Maurice Dematteis, Marc Auriacombe, Oscar D'Agnone, Lorenzo Somaini, Néstor Szerman, Richard Littlewood, Farrukh Alam, Hannu Alho, Amine Benyamina, Julio Bobes, Jean Pierre Daulouede, Claudio Leonardi, Icro Maremmani, Marta Torrens, Stephan Walcher, Michael Soyka
Management of patients with opioid use disorder (OUD) commonly includes opioid agonist therapy (OAT) as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society. Areas covered: The use of methadone and buprenorphine within an integrated treatment plan in the management of patients with OUD: this work provides consensus recommendation on pharmacotherapy in OUD to assist clinicians with practical decision making in this field. Expert opinion: Pharmacotherapy is recommended as part of an integrated OUD treatment approach with psychosocial interventions, with the goal of reducing risks of illicit opioid use, overdose mortality, infection with HIV or HCV, improving health, psychological and social outcomes...
November 29, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29122828/referrals-to-a-perinatal-specialist-palliative-care-consult-service-in-ireland-2012-2015
#6
Des L McMahon, Marie Twomey, Maeve O'Reilly, Mary Devins
OBJECTIVE: To analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile. DESIGN: A retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015. SETTING: A consultant-led paediatric SPCS at Our Lady's Children's Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin...
November 9, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29120929/risk-factors-for-opioid-induced-respiratory-depression-and-failure-to-rescue-a-review
#7
Kapil Gupta, Arun Prasad, Mahesh Nagappa, Jean Wong, Lusine Abrahamyan, Frances F Chung
PURPOSE OF REVIEW: The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. RECENT FINDINGS: In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events...
February 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29094098/managing-pain-in-patients-with-cancer-the-chinese-good-pain-management-experience
#8
REVIEW
Shi-Ying Yu, Jie-Jun Wang, Yu-Guang Huang, Bing Hu, Kun Wang, Ping Ping Li, Yi-Long Wu, He-Long Zhang, Li Zhang, Qing-Yuan Zhang, Shu-Kui Qin
Purpose: The number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer...
October 2017: Journal of Global Oncology
https://www.readbyqxmd.com/read/29084358/high-dose-opioids-for-chronic-non-cancer-pain-an-overview-of-cochrane-reviews
#9
REVIEW
Charl Els, Tanya D Jackson, Reidar Hagtvedt, Diane Kunyk, Barend Sonnenberg, Vernon G Lappi, Sebastian Straube
BACKGROUND: Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue where opioids are routinely used for pain management. There are concerns that the use of high doses of opioids for chronic non-cancer pain lacks evidence of effectiveness and may increase the risk of adverse events. OBJECTIVES: To describe the evidence from Cochrane Reviews and Overviews regarding the efficacy and safety of high-dose opioids (here defined as 200 mg morphine equivalent or more per day) for chronic non-cancer pain...
October 30, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29033356/benefits-of-intraoperative-analgesia-guided-by-the-analgesia-nociception-index-ani-in-bariatric-surgery-an-unmatched-case-control-study
#10
Lisa Le Gall, Anaëlle David, Pauline Carles, Sébastien Leuillet, Brigitte Chastel, Catherine Fleureau, Antoine Dewitte, Alexandre Ouattara
INTRODUCTION: Analgesia Nociception Index (ANI) has been proposed for the evaluation of the nociception-antinociception balance in the perioperative period. In obese patients, where the management of analgesia may be rendered difficult by pharmacological changes, we hypothesised that the monitoring of analgesia with ANI would reduce intraoperative opioid consumption during bariatric surgery. METHODS: This monocentric, observational, unmatched case-control study aimed to compare perioperative data from obese subjects (body mass index ≥35kgm-2) during bariatric surgery with or without the use of ANI monitoring (ANI+ group versus ANI- group)...
October 12, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28923526/results-of-a-double-blind-randomized-placebo-controlled-study-of-nabiximols-oromucosal-spray-as-adjunctive-therapy-in-advanced-cancer-patients-with-chronic-uncontrolled-pain
#11
Aron H Lichtman, Eberhard Albert Lux, Robert McQuade, Sandro Rossetti, Raymond Sanchez, Wei Sun, Stephen Wright, Elena Kornyeyeva, Marie T Fallon
CONTEXT: Prior phase 2/3 studies found that cannabinoids might provide adjunctive analgesia in advanced cancer patients with uncontrolled pain. OBJECTIVE: To assess adjunctive nabiximols (Sativex(®)), an extract of Cannabis sativa containing two potentially therapeutic cannabinoids (Δ9-tetrahydrocannabinol [27 mg/mL] and cannabidiol [25mg/mL]), in advanced cancer patients with chronic pain unalleviated by optimized opioid therapy. METHODS: Phase 3, double-blind, randomized, placebo-controlled trial in patients with advanced cancer and average pain NRS scores ≥ 4 and ≤ 8 despite optimized opioid therapy...
September 15, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28893309/efficacy-and-safety-of-controlled-release-oxycodone-naloxone-versus-controlled-release-oxycodone-in-korean-patients-with-cancer-related-pain-a-randomized-controlled-trial
#12
Kyung-Hee Lee, Tae Won Kim, Jung-Hun Kang, Jin-Soo Kim, Jin-Seok Ahn, Sun-Young Kim, Hwan-Jung Yun, Young-Jun Eum, Sung Ae Koh, Min Kyoung Kim, Yong Sang Hong, Jeong Eun Kim, Gyeong-Won Lee
BACKGROUND: Controlled-release oxycodone/naloxone (OXN-CR) maintains the effect of opioid-induced analgesia through oxycodone while reducing the occurrence rate of opioid-induced constipation through naloxone. The present study was designed to assess the non-inferiority of OXN-CR to controlled-release oxycodone (OX-CR) for the control of cancer-related pain in Korean patients. METHODS: In this randomized, open-labeled, parallel-group, phase IV study, we enrolled patients aged 20 years or older with moderate to severe cancer-related pain [numeric rating scale (NRS) pain score ≥4] from seven Korean oncology/hematology centers...
September 11, 2017: Chinese Journal of Cancer
https://www.readbyqxmd.com/read/28893017/a-comparative-study-of-analgesic-effect-of-intrathecal-nalbuphine-and-fentanyl-as-adjuvant-in-lower-limb-orthopaedic-surgery
#13
Shagufta Naaz, Usha Shukla, Swati Srivastava, Erum Ozair, Adil Asghar
INTRODUCTION: Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Nalbuphine is an agonist-antagonist and acts on kappa receptors providing analgesia. AIM: The study aims to compare the analgesic efficacy of fentanyl with that of two doses of nalbuphine when used with injection bupivacaine heavy in spinal anaesthesia. MATERIALS AND METHODS: A randomised, double blinded, prospective study on 90 patients of ASA I and II undergoing lower limb orthopaedic surgery under subarachnoid block was done...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28860712/a-comparison-of-oral-controlled-release-morphine-and-oxycodone-with-transdermal-formulations-of-buprenorphine-and-fentanyl-in-the-treatment-of-severe-pain-in-cancer-patients
#14
Krzysztof Nosek, Wojciech Leppert, Hanna Nosek, Jerzy Wordliczek, Dariusz Onichimowski
AIM OF THE STUDY: To compare analgesia and adverse effects during oral morphine and oxycodone and transdermal fentanyl and buprenorphine administration in cancer patients with pain. PATIENTS AND METHODS: Cancer patients treated at home and in outpatient clinics with severe pain (numerical rating scale score 6-10) fail to respond to non-opioids and/or weak opioids. All patients were randomized to either morphine, oxycodone, fentanyl or buprenorphine and divided into subgroups with predominant neuropathic and nociceptive pain component...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28794653/real-world-utilization-of-once-daily-extended-release-abuse-deterrent-formulation-of-hydrocodone-a-comparison-with-the-pre-approval-randomized-clinical-trials
#15
Louise Taber, T Christopher Bond, Xuezhe Wang, Aditi Kadakia, Tracy J Mayne
BACKGROUND AND OBJECTIVE: Hydrocodone bitartrate extended release (Hysingla(®) ER, HYD) was previously studied in a 12-week randomized, double-blind, placebo-controlled trial and a 52-week open-label safety study. Both of these preapproval studies allowed dose titration to efficacy. The purpose of the present analysis was to compare dosing and utilization patterns in these previous clinical trials with real-world data (RWD) usage in a retrospective claim analysis performed 12-14 months post approval in the US...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28768313/treatment-of-hailey-hailey-disease-with-low-dose-naltrexone
#16
Lauren N Albers, Jack L Arbiser, Ron J Feldman
Importance: Hailey-Hailey disease is a severe genetic blistering disease of intertriginous skin locations that can lead to poor quality of life and increased morbidities. Multiple therapies are available with inconsistent outcomes and potentially severe adverse effects. Objective: To determine whether low-dose naltrexone is an effective treatment for Hailey-Hailey disease. Design, Setting, and Participants: This study was a case series performed at a dermatology outpatient clinic of 3 patients with severe Hailey-Hailey disease recalcitrant to at least 4 therapies...
October 1, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28745394/opioids-for-chronic-non-cancer-pain-in-children-and-adolescents
#17
REVIEW
Tess E Cooper, Emma Fisher, Andrew L Gray, Elliot Krane, Navil Sethna, Miranda Al van Tilburg, Boris Zernikow, Philip J Wiffen
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 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. While in the past, pain was largely dismissed and was frequently left untreated, views on children's pain have changed over time, and relief of pain is now seen as importantWe designed a suite of seven reviews on chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol as priority areas) in order to review the evidence for children's pain utilising pharmacological interventions in children and adolescents...
July 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28731948/managing-cancer-pain-in-older-adults
#18
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
#19
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
#20
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
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