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Opioid titration

Dong-Liang Chen, Yu-Hong Li, Zhi-Juan Wang, Ye-Ke Zhu
Gabapentin has been used as an adjuvant for treatment of cancer pain. Previous studies showed that opioids combined with gabapentin for management of cancer pain reduced the dosage of opioids.The objective of this study was to explore the clinical effect and patients' satisfaction of oxycontin combined with gabapentin in treatment of severe cancer pain. After titration of morphine, 60 severe cancer patients with visual analog score (VAS) more than 7 were randomly divided into trial group (n = 30) and control group (n = 30)...
October 2016: Medicine (Baltimore)
Julie M Waldfogel, Suzanne Nesbit, Steven P Cohen, Sydney M Dy
Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. This case report describes a 28-year-old man with metastatic pancreatic neuroendocrine cancer with severe, intractable pain despite high-dose opioids including methadone and a hydromorphone patient-controlled analgesia (PCA)...
October 18, 2016: Journal of Pain & Palliative Care Pharmacotherapy
C W Cheung, T Cw Chan, P P Chen, M C Chu, W Cm Chui, P T Ho, F Lam, S W Law, J Ly Lee, S Hs Wong, V Kc Wong
Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain...
October 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Sheena Derry, Cathy Stannard, Peter Cole, Philip J Wiffen, Roger Knaggs, Dominic Aldington, R Andrew Moore
BACKGROUND: Opioid drugs, including fentanyl, are commonly used to treat neuropathic pain, and are considered effective by some professionals. Most reviews have examined all opioids together. This review sought evidence specifically for fentanyl, at any dose, and by any route of administration. Other opioids are considered in separate reviews. OBJECTIVES: To assess the analgesic efficacy of fentanyl for chronic neuropathic pain in adults, and the adverse events associated with its use in clinical trials...
October 11, 2016: Cochrane Database of Systematic Reviews
Sohita Dhillon
Hydrocodone bitartrate extended-release (Hysingla(®) ER; referred to hereafter as hydrocodone ER) was the first single-entity hydrocodone formulation recognized by the US FDA as having abuse-deterrent properties. It is indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Once-daily oral hydrocodone ER provides consistent plasma hydrocodone concentrations and sustained analgesia over the 24-h dosing interval...
November 2016: Clinical Drug Investigation
Vilnis Silins, Christopher Brasher, Freedom Antus, Daphné Michelet, Julie Hilly, Robert Grace, Souhayl Dahmani
BACKGROUND: Morphine is the most commonly used postoperative analgesic for moderate to severe pain in paediatric patients, but there is little research into predictive factors correlating with post-operative morphine consumption. METHODS: All patients undergoing surgery who received morphine postoperatively over eight months were prospectively enrolled. Data analysed included total morphine consumption to day 3, age, weight, type of surgery, ASA status, preoperative opioid administration, predicted postoperative pain intensity (according to French Society of Anaesthesiology and Intensive Care classification) and surgery duration...
October 4, 2016: Anaesthesia, Critical Care & Pain Medicine
Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, Marilène Filbet
CONTEXT: In the European Association for Palliative Care recommendations for cancer pain management, there was no consensus regarding the indications, titration or monitoring of methadone. OBJECTIVES: This national, randomized, multicentre trial aimed to compare two methadone titration methods (stop-and-go vs progressive) in patients with cancer-related pain who were inadequately relieved by or intolerant to level 3 opioids. METHODS: The primary endpoint was the rate of success/failure at Day 4, defined as pain relief (reduction of at least two points on the visual scale and a pain score <5 for 2 consecutive days) and no overdose (Rudkin scale ≥3 and respiratory rate <8/min)...
September 29, 2016: Journal of Pain and Symptom Management
Elizabeth Allocco, Marjorie Melker, Florencia Rojas-Miguez, Caitlin Bradley, Kristen A Hahn, Elisha M Wachman
BACKGROUND: Twenty percent to 40% of infants exposed to in utero opioid were delivered preterm. There is currently no neonatal abstinence syndrome (NAS) scoring tool known to accurately evaluate preterm opioid-exposed infants. This can lead to difficulties in titrating pharmacotherapy in this population. PURPOSE: To describe NAS symptoms in preterm opioid-exposed infants in comparison with matched full-term controls. METHODS: This was a retrospective cohort study from a single tertiary care center of methadone-exposed infants born between 2006 and 2010...
October 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Allan W Belcher, Ashish K Khanna, Steve Leung, Amanda J Naylor, Matthew T Hutcherson, Bianka M Nguyen, Natalya Makarova, Daniel I Sessler, P J Devereaux, Leif Saager
BACKGROUND: Opioids can contribute to postoperative desaturation. Short-acting opioids, titrated to need, may cause less desaturation than longer-acting opioids. We thus tested the primary hypothesis that long-acting patient-controlled intravenous opioids are associated with more hypoxemia (defined as an integrated area under a postoperative oxyhemoglobin saturation of 95%) than short-acting opioids. METHODS: This analysis was a substudy of VISION, a prospective cohort study focused on perioperative cardiovascular events (NCT00512109)...
September 7, 2016: Anesthesia and Analgesia
Young Ju Won, Byung Gun Lim, So Hyun Lee, Sangwoo Park, Heezoo Kim, Il Ok Lee, Myoung Hoon Kong
BACKGROUND: The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy...
August 2016: Medicine (Baltimore)
Rachit Shah, Alexander Strom, Andrew Zhou, Kimberly M Maize, Barry C Finzel, Carston R Wagner
Hint1 has recently emerged to be an important target of interest due to its involvement in the regulation of a broad range of CNS functions including opioid signaling, tolerance, neuropathic pain, and nicotine dependence. A series of inhibitors were rationally designed, synthesized, and tested for their inhibitory activity against hHint1 using isothermal titration calorimetry (ITC). The studies resulted in the development of the first small-molecule inhibitors of hHint1 with submicromolar binding affinities...
August 11, 2016: ACS Medicinal Chemistry Letters
Declan Walsh, Mellar Davis, Carla Ripamonti, Eduardo Bruera, Andrew Davies, Alex Molassiotis
PURPOSE: The aim of this paper is to review the existing literature related to the management of nausea and vomiting (N & V) in advanced cancer and derive clinical evidence-based recommendations for its management. METHODS: Available systematic reviews on antiemetic drug effectiveness were used. One generic systematic review of antiemetics in advanced cancer (to 2009) was updated to February 2016. Agreement on recommendations was reached between panel members, and these were voted in favor unanimously by the larger antiemetic committee membership (n = 37)...
August 17, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Kaitlin M Best, David Wypij, Lisa A Asaro, Martha A Q Curley
OBJECTIVE: To generate a multidimensional predictive model of risk factors for iatrogenic withdrawal syndrome in critically ill children. DESIGN: Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. SETTING: PICU. PATIENTS: Children who received greater than or equal to 5 days of sedation during mechanical ventilation for acute respiratory failure...
August 4, 2016: Critical Care Medicine
Florence T Baralatei, Richard J Ackermann
Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal examination to detect masses or evidence of bowel obstruction and rectal examination to exclude fecal impaction, constipation should be managed with a stimulant laxative (eg, senna) or an osmotic laxative (eg, sorbitol). Dyspnea also is common, and often improves with use of a fan to blow air into the face, as well with breathing and relaxation exercises...
August 2016: FP Essentials
Sangeeta Mehta, Maureen Meade, Lisa Burry, Ranjeeta Mallick, Christina Katsios, Dean Fergusson, Peter Dodek, Karen Burns, Margaret Herridge, John W Devlin, Maged Tanios, Robert Fowler, Michael Jacka, Yoanna Skrobik, Kendiss Olafson, Deborah Cook
BACKGROUND: Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation...
August 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
Helen Gaskell, Sheena Derry, Cathy Stannard, R Andrew Moore
BACKGROUND: This is an update of an earlier review that considered both neuropathic pain and fibromyalgia (Issue 6, 2014), which has now been split into separate reviews for the two conditions. This review considers neuropathic pain only.Opioid drugs, including oxycodone, are commonly used to treat neuropathic pain, and are considered effective by some professionals. Most reviews have examined all opioids together. This review sought evidence specifically for oxycodone, at any dose, and by any route of administration...
2016: Cochrane Database of Systematic Reviews
Marc A Russo, Danielle M Santarelli
OBJECTIVE: To assess the effectiveness and tolerability of tapentadol sustained release (SR) following its introduction to the Australian private market. DESIGN: A retrospective audit of routine clinical practice with data collection beginning 2 months after the first tapentadol SR prescription. SETTING: A multidisciplinary Australian pain clinic. PATIENTS: Fifty patients who were prescribed tapentadol SR as part of routine clinical management at the pain clinic...
May 2016: Journal of Opioid Management
Erzsébet Lackó, Pál Riba, Zoltán Giricz, András Váradi, Laura Cornic, Mihály Balogh, Kornél Király, Kata Csekő, Shaaban A Mousa, Sándor Hosztafi, Michael Schäfer, Zoltán Sándor Zádori, Zsuzsanna Helyes, Péter Ferdinandy, Susanna Fürst, Mahmoud Al-Khrasani
Growing data support peripheral opioid antinociceptive effects, particularly in inflammatory pain models. Here, we examined the antinociceptive effects of subcutaneously administered, recently synthesized 14-O-methylmorphine-6-O-sulfate (14-O-MeM6SU) compared with morphine-6-O-sulfate (M6SU) in a rat model of inflammatory pain induced by an injection of complete Freund's adjuvant and in a mouse model of visceral pain evoked by acetic acid. Subcutaneous doses of 14-O-MeM6SU and M6SU up to 126 and 547 nmol/kg, respectively, produced significant and subcutaneous or intraplantar naloxone methiodide (NAL-M)-reversible antinociception in inflamed paws compared with noninflamed paws...
October 2016: Journal of Pharmacology and Experimental Therapeutics
Joseph Gimbel, Egilius L H Spierings, Nathaniel Katz, Qinfang Xiang, Evan Tzanis, Andrew Finn
A buccal film of buprenorphine (BBUP) was evaluated for safety and efficacy in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal study in opioid-experienced patients (30 to ≤160 mg/d morphine sulfate equivalent) with moderate to severe chronic low back pain taking around-the-clock opioid analgesics. Patients' opioid doses were tapered to ≤30 mg morphine sulfate equivalent before open-label titration with BBUP (range, 150-900 μg every 12 hours). Patients who responded (received adequate analgesia that was generally well tolerated for 14 days) were randomized to receive buprenorphine (n = 254) or placebo (n = 257) buccal film...
November 2016: Pain
Luis Cabezón-Gutiérrez, Parham Khosravi-Shahi, Sara Custodio-Cabello, Francisco Muñiz-González, Maria Del Puerto Cano-Aguirre, Soledad Alonso-Viteri
BACKGROUND: Episodic breathlessness (EB) or dyspnea is a common symptom with a very negative impact on the quality of life of patients with cancer and with non-oncological advanced diseases, mainly cardiorespiratory and neurological. OBJECTIVE: The purpose of this non-systematic review is to ascertain the role played by opioids in the management of episodic breathlessness. METHODS: A non-systematic literature review was done in the databases MEDLINE, COCHRANE, and DATABASE, and articles of greater scientific rigor, mainly reviews or prospective studies/randomized clinical trials published to date (August 2015), were selected...
September 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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