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Benjamin W Friedman, Alexander Latev, Caron Campbell, Deborah White
BACKGROUND: Parenteral opioids are used in more than 50% of emergency department (ED) visits for migraine. Use of opioids for migraine has been associated with subsequent ED visits, perhaps because of opioid-induced euphoria. In this study, we quantify the extent to which nontherapeutic effects of opioids influence migraine outcomes. We hypothesized that "feeling good" and medication likeability would in fact be associated with receipt of opioids (rather than relief of migraine pain) and that receipt of opioids (rather than relief of migraine pain) would be associated with return visits to the ED...
March 8, 2018: Headache
Maryann Mazer-Amirshahi, Sergey Motov, Lewis S Nelson
Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain...
January 2018: Journal of Opioid Management
Bjug Borgundvaag, Shelley McLeod, Wayne Khuu, Catherine Varner, Mina Tadrous, Tara Gomes
BACKGROUND: Emergency physicians provide primary care to patients and often prescribe opioids for acutely painful self-limiting conditions. The objective of this study was to describe patterns of opioid prescribing by emergency physicians and family physicians and to explore the relation between setting of initiation of opioid treatment and adverse events over the subsequent 2 years. METHODS: This was a population-based cohort study using administrative data from Ontario...
March 1, 2018: CMAJ Open
Athena K Petrides, Stacy E F Melanson, Michalis Kantartjis, Rachel D Le, Christiana A Demetriou, James G Flood
BACKGROUND: Oral fluid (OF) has become an increasingly popular matrix to assess compliance in pain management and addiction settings as it reduces the likelihood of adulteration. However, drug concentrations and windows of detection are not as well studied in OF as in urine (UR). We compared the clinical utility and analytical performance of OF and UR as matrices for detecting common benzodiazepines and opioids. METHODS: OF and UR concentrations of 5 benzodiazepines and 7 opioids were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 263 paired OF and UR specimens...
February 27, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Yusuke Takagi, Etsuko Aruga
In 2010s, several opioids became available in Japan, including methadone, tapentadol and hydromorphone. Methadone was approved in September 2012 by Japanese regulatory authority. Since methadone is positioned as so-called "step 4 opioid" in Japan, it must be prescribed as alternative opioid switched from another of 60mg/day or greater equivalent dose of oral morphine. Diversity of pharmacokinetics among individuals and various drug interactions require close monitoring of adverse events. In spite of these cautions, unique characteristics such as inhibiting N-methyl-D-aspartate(NMDA)and in- ducing internalization/degradation of mu-delta opioid receptor heterodimers underline the value of methadone in opioid switching...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Amy Alexander, Liaqat Abbas, Mary Jones, Joseph Jones, Douglas Lewis, Adam Negrusz
Our laboratory received segments of umbilical cord that originated from identical twins for routine toxicology analysis. The specimens were analyzed multiple times by liquid chromatography tandem mass spectrometry. The umbilical cord from newborn #1 was positive for hydromorphone only (1.06 ng/g), and the umbilical cord from newborn #2 was positive for hydromorphone (0.81 ng/g) and benzoylecgonine (5.41 ng/g). The hydromorphone results are consistent with maternal administration of hydromorphone; however, the cause of the discrepant benzoylecgonine results in the umbilical cords from the identical twins is unknown...
February 15, 2018: Journal of Analytical Toxicology
Farnia Naeem, Chris Schramm, Benjamin W Friedman
PURPOSE OF REVIEW: The current article reviews recent data on treatment of acute headache patients in the acute care setting. RECENT FINDINGS: Intravenous fluid hydration, a common component of emergency department (ED) migraine therapy, does not improve pain outcomes and leads to longer ED lengths of stay. Therefore, intravenous fluids should be administered only to migraine patients with clinical evidence of dehydration. Similarly, intravenous ketamine has garnered interest as a treatment for acute pain but does not provide substantial relief to migraine patients...
February 15, 2018: Current Opinion in Neurology
Gudrun Kreye, Eva-Katharina Masel, Klaus Hackner, Beate Stich, Friedemann Nauck
Recently, the use of methadone in cancer patients has increased due to in vitro studies indicating that methadone is capable of inducing cell death. However, thus far there are no relevant clinical studies indicating that the use of methadone can prolong survival in cancer patients. Based on low-quality evidence, methadone is a drug that has similar analgesic benefits to morphine and has a role in the management of cancer pain in adults. Other opioids such as morphine, hydromorphone, and fentanyl are easier to manage but may be more expensive than methadone in many economies...
February 19, 2018: Wiener Medizinische Wochenschrift
D Sanchez-Migallon Guzman, J Douglas, H Beaufrère, J Paul-Murphy
No abstract text is available yet for this article.
September 2017: Veterinary Anaesthesia and Analgesia
Steven G Schauer, Allyson A Arana, Jason F Naylor, Guyon J Hill, Michael D April
BACKGROUND: Previous studies have evaluated prehospital analgesia during combat operations in Iraq and Afghanistan, but were limited to the adult population. However, a significant portion of the casualties of those conflicts were children. We describe the prehospital analgesia administered to wartime pediatric trauma patients. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients (<18 years of age) admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
February 7, 2018: Prehospital Emergency Care
Michael K Urban, Kristy M Labib, Shane C Reid, Amanda K Goon, Valeria Rotundo, Frank P Cammisa, Federico P Girardi
Background: The treatment of postoperative pain is a challenge after posterior spinal fusions. Pain management using predominantly opioids is often associated with multiple adverse effects, while multimodal postoperative analgesia may provide adequate pain relief with fewer opioid side effects. Questions/Purposes: The purpose of this review is to determine whether addition of 150 mg pregabalin daily would reduce narcotic requirements and improve outcomes after posterior lumbar fusion (PLF)...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Joseph M Banno, Katherine Shield, Krunal Patel, Anupam A Sule
Mycobacterium abscessus is a fast growing, non-tubercular mycobacterium (NTM) found in water. NTM bacteremia is usually seen in immunocompromised patients who have intravascular catheters. Mycobacterium abscessus bacteremia is often caused by exposure to contaminated water supply in hemodialysis units. A 28-year-old female with poorly controlled diabetes mellitus, end stage renal disease (on hemodialysis via Ash catheter), and recurrent deep vein thrombosis presented to the hospital with proximal right leg deep vein thrombosis...
November 27, 2017: Curēus
Linda Ma Pak, Simon Haroutounian, William G Hawkins, Lori Worley, Monika Kurtz, Karen Frey, Menelaos Karanikolas, Robert A Swarm, Michael M Bottros
INTRODUCTION: Epidural analgesia provides an important synergistic method of pain control. In addition to reducing perioperative opioid consumption, the deliverance of analgesia into the epidural space, effectively creating a sympathetic blockade, has a multitude of additional potential benefits, from decreasing the incidence of postoperative delirium to reducing the development of persistent postsurgical pain (PPSP). Prior studies have also identified a correlation between the use of epidural analgesia and improved oncological outcomes and survival...
January 26, 2018: BMJ Open
Ryan M Surmaitis, Alexandra Amaducci, Kathryn Henry, Michael Jong, Emily A Kiernan, Hope Kincaid, Lindsay J Houck, Sandra J Sabbatini, Marna Rayl Greenberg, Kenneth D Katz
PURPOSE: This study aimed to determine the current attitudes, perceptions, and practices of emergency medicine providers and nurses (RNs) regarding the discharge of adult patients from the emergency department (ED) after administration of opioid analgesics. METHODS: A cross-sectional survey was administered at 3 hospital sites with a combined annual ED census of >180,000 visits per year. All 59 attending emergency physicians (EPs), 233 RNs, and 23 advanced practice clinicians (APCs) who worked at these sites were eligible to participate...
January 19, 2018: Clinical Therapeutics
Christopher A Febres-Aldana, Lydia Hernandez Howard
Sickle cell disease (SCD) manifests itself with vaso-occlusive episodes leading to infarction. Placement of intravascular catheters provides a useful route for management of pain crises as well as other complications. However, catheter misuse is a commonly unrecognized problem, which can have lethal consequences. We present a case of fatal splenic sequestration/hyperhemolysis secondary to foreign body pulmonary and systemic embolization due to intravenous administration of hydromorphone pills in a young woman with SCD...
January 18, 2018: American Journal of Forensic Medicine and Pathology
Nafisseh S Warner, James C Watson, Markus A Bendel, Susan M Moeschler
OBJECTIVE: Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. CASE REPORT: A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief...
January 17, 2018: Regional Anesthesia and Pain Medicine
Paul Jack Karanicolas, Sean Cleary, Paul McHardy, Alex Kiss, Jason Sawyer, Ramy Behman, Salima Ladak, Stuart A McCluskey, Coimbatore Srinivas, Joel Katz, Natalie Coburn, Calvin Law, Alice C Wei, Paul Greig, Julie Hallet, Hance Clarke
OBJECTIVE: Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective of this trial was to assess the efficacy of a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter analgesia compared with IV PCA. METHODS: This was a blinded, randomized, controlled parallel-arm trial conducted at 2 high-volume centers. Patients undergoing liver resection through a subcostal incision were enrolled...
January 3, 2018: Annals of Surgery
Stephen F Butler, Emily C McNaughton, Ryan A Black, Theresa A Cassidy
OBJECTIVE: Formulating prescription opioids to limit abuse remains a priority. OROS® extended-release (ER) hydromorphone HCl (EXALGO®) may have low abuse potential. Three post-marketing studies of the relative abuse liability of OROS hydromorphone ER were conducted. METHODS: Estimates of abuse, unadjusted and adjusted for prescription volume, were generated for OROS hydromorphone ER and comparators from Q2 2010 through Q2 2014 for a high-risk, substance abuse treatment population and the general population using poison control center data...
January 2, 2018: Clinical Journal of Pain
Anita Slomski
No abstract text is available yet for this article.
December 26, 2017: JAMA: the Journal of the American Medical Association
Ivona Krizman-Matasic, Petra Kostanjevecki, Marijan Ahel, Senka Terzic
Although published literature provides a clear demonstration of widespread occurrence of opioid analgesics (OAs) in the aquatic environment, analytical methods suitable for a systematic study of this pharmaceutical class, which would include a broad spectrum of opioid analgesics and their metabolites, are still missing. In this work, a comprehensive multiresidue method for quantitative analysis of 27 opioid analgesics and their metabolites, including 2 morphine glucuronide conjugates, was developed and validated for three matrices: raw wastewater (RW), secondary effluent (SE) and river water...
December 11, 2017: Journal of Chromatography. A
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