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https://www.readbyqxmd.com/read/29346699/teaching-chronic-pain-in-the-family-medicine-residency
#1
Kimberly Zoberi, Kelly M Everard
BACKGROUND AND OBJECTIVES: Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. METHODS: Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors' attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring)...
January 2018: Family Medicine
https://www.readbyqxmd.com/read/29346579/web-based-cognitive-behavior-therapy-for-chronic-pain-patients-with-aberrant-drug-related-behavior-outcomes-from-a-randomized-controlled-trial
#2
Honoria Guarino, Chunki Fong, Lisa A Marsch, Michelle C Acosta, Cassandra Syckes, Sarah K Moore, Ricardo A Cruciani, Russell K Portenoy, Dennis C Turk, Andrew Rosenblum
Objective: There is high unmet need for effective behavioral treatments for chronic pain patients at risk for or with demonstrated histories of opioid misuse. Despite growing evidence supporting technology-based delivery of self-management interventions for chronic pain, very few such programs target co-occurring chronic pain and aberrant drug-related behavior. This randomized controlled trial evaluated the effectiveness of a novel, web-based self-management intervention, grounded in cognitive behavior therapy, for chronic pain patients with aberrant drug-related behavior...
January 13, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29338578/cannabis-use-is-associated-with-lower-odds-of-prescription-opioid-analgesic-use-among-hiv-infected-individuals-with-chronic-pain
#3
Nancy L Sohler, Joanna L Starrels, Laila Khalid, Marcus A Bachhuber, Julia H Arnsten, Shadi Nahvi, John Jost, Chinazo O Cunningham
BACKGROUND: Chronic pain is common in the United States and prescribed opioid analgesics use for noncancer pain has increased dramatically in the past two decades, possibly accounting for the current opioid addiction epidemic. Co-morbid drug use in those prescribed opioid analgesics is common, but there are few data on polysubstance use patterns. OBJECTIVE: We explored patterns of use of cigarette, alcohol, and illicit drugs in HIV-infected people with chronic pain who were prescribed opioid analgesics...
January 17, 2018: Substance Use & Misuse
https://www.readbyqxmd.com/read/29338150/the-role-of-cannabinoids-in-pain-control-the-good-the-bad-and-the-ugly
#4
Joseph V Pergolizzi, Jo Ann Lequang, Robert Taylor, Robert B Raffa, Daniel Colucci
Cannabinoids appear to possess many potential medical uses, which may extend to pain control. A narrative review of the literature has found a variety of studies testing botanical and synthetic cannabinoids in different pain syndromes (acute pain, cancer pain, chronic noncancer pain, fibromyalgia pain, migraine, neuropathic pain, visceral pain, and others). Results from these studies are mixed; cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29334531/dangerously-numb-opioids-benzodiazepines-chronic-pain-and-posttraumatic-stress-disorder
#5
Mark Sullivan
No abstract text is available yet for this article.
December 6, 2017: Pain
https://www.readbyqxmd.com/read/29330245/impact-of-pharmacist-previsit-input-to-providers-on-chronic-opioid-prescribing-safety
#6
Nicholas Cox, Casey R Tak, Susan E Cochella, Eric Leishman, Karen Gunning
INTRODUCTION: Primary care providers (PCPs) account for half of opioid prescriptions, often feel chronic pain patients are challenging to manage, and there is wide variability in practice patterns. The purpose of this pilot study was to evaluate the impact of a previsit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to guideline recommendations at a family medicine residency clinic. METHODS: All adult patients with an appointment for chronic pain who were prescribed >50 morphine milligram equivalents (MMEs)/day had charts reviewed by a pharmacist before each appointment; recommendations were sent electronically to the provider before the appointment...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330240/structured-management-of-chronic-nonmalignant-pain-with-opioids-in-a-rural-primary-care-office
#7
Kevin S McCann, Shawndra Barker, Raymond Cousins, Adam Franks, Clinton McDaniel, Stephen Petrany, Eric Riley
INTRODUCTION: The use of opioid medication for nonmalignant chronic pain (NMCP) increased dramatically during the last 20 years. There have been regulatory changes implemented to reduce the risk of harm to both patients and society. Much of the burden of monitoring these patients is falling on primary care physicians (PCPs), who do not have the time or resources to handle what is entailed in a best-practice approach to NMCP. METHODS: A retrospective study was conducted with all patients on opioid medication for NMCP who were enrolled onto an individual PCP's practice...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29327358/opioid-medication-use-in-patients-with-gastrointestinal-diagnoses-vs-unexplained-gastrointestinal-symptoms-in-the-us-veterans-health-administration
#8
G S Sayuk, N Kanuri, C P Gyawali, B M Gott, B D Nix, R A Rosenheck
BACKGROUND: While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. AIM: To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. METHODS: Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID...
January 12, 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29323818/opioid-use-for-treatment-of-chronic-pain-an-overview-and-treatment-guideline-for-injured-workers-responses
#9
Sridhar V Vasudevan
No abstract text is available yet for this article.
June 2017: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/29319627/opioid-prescription-morbidity-and-mortality-in-us-transplant-recipients
#10
Kevin C Abbott, Chyng-Wen Fwu, Paul W Eggers, Anne W Eggers, Prudence P Kline, Paul L Kimmel
BACKGROUND: CDC guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients has not been described in a national population. METHODS: We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (chronic, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day, MME, of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment...
January 10, 2018: Transplantation
https://www.readbyqxmd.com/read/29318865/-advances-in-acupuncture-mechanism-research-on-the-changes-of-synaptic-plasticity-pain-memory-for-chronic-pain
#11
Yi-Ling Yang, Jian-Peng Huang, Li Jiang, Jian-Hua Liu
Previous studies have shown that there are many common structures between the neural network of pain and memory, and the main structure in the pain network is also part of the memory network. Chronic pain is characterized by recurrent attacks and is associated with persistent ectopic impulse, which causes changes in synaptic structure and function based on nerve activity. These changes may induce long-term potentiation of synaptic transmission, and ultimately lead to changes in the central nervous system to produce "pain memory"...
December 25, 2017: Zhen Ci Yan Jiu, Acupuncture Research
https://www.readbyqxmd.com/read/29317847/pharmacogenetic-guidance-individualized-medicine-promotes-enhanced-pain-outcomes
#12
Lisa Lynn Dragic, Erica L Wegrzyn, Michael E Schatman, Jeffrey Fudin
The use of pharmacogenomics has become more prevalent over the past several years in treating many disease states. Several cytochrome P450 enzymes play a role in the metabolism of many pain medications including opioids and antidepressants. Noncytochrome P450 enzymes such as methylenetetrahydrofolate reductase (MTHFR) and catechol-O-methyl transferase (COMT) also play a role in the explanation of opioid dosage requirements as well as in response to certain antidepressants. We present the case of a patient with reduced COMT and MTHFR expression treated with leucovorin 10 mg daily for the management of chronic pain...
2018: Journal of Pain Research
https://www.readbyqxmd.com/read/29316592/the-addition-of-diclofenac-to-a-multimodal-pain-control-regimen-decreases-postoperative-pain-and-opioid-consumption
#13
Nicole E George, Cheryle Gurk-Turner, Jennifer I Etcheson, Chukwuweike U Gwam, Randal De Souza, Spencer S Smith, James Nace, Ronald E Delanois
INTRODUCTION: Total knee arthroplasty (TKA) is a commonly-performed orthopaedic procedure in the United States. However, inadequate postoperative pain management following TKA has been associated with a number of negative consequences, including chronic postoperative pain requiring long-term opioid use. Multimodal pain control is a recently-popularized means of maximizing analgesia and postoperative outcomes. We aimed to evaluate the outcomes of a multimodal pain regimen incorporating diclofenac, including: 1) length of stay (LOS); 2) pain intensity; and 3) opioid consumption in primary TKA patients...
December 22, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29314075/alcohol-and-opioid-use-co-use-and-chronic-pain-in-the-context-of-the-opioid-epidemic-a-critical-review
#14
Katie Witkiewitz, Kevin E Vowles
The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder is a highly prevalent public health problem associated with considerable individual and societal costs. This paper provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on alcohol use disorder (AUD) and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD...
January 4, 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29306360/the-need-for-better-access-to-pain-treatment-learning-from-drug-consumption-trends-in-the-usa
#15
Damiana Scuteri, B Piro, Luigi Antonio Morrone, Maria Tiziana Corasaniti, M Vulnera, G Bagetta
The Authors of this letter look at consumption of opioids and a2- ligands, also known as "gabapentinoids", in Italy, and specifically in the Provincial Health District of Cosenza, as compared with USA trends of recent decades. Access to analgesic drugs since the introduction of Italian law 38/2010 is also evaluated and possible future measures for better management of chronic pain are proposed.
October 2017: Functional Neurology
https://www.readbyqxmd.com/read/29304922/the-appropriate-use-of-opioids-in-the-treatment-of-refractory-restless-legs-syndrome
#16
Michael H Silber, Philip M Becker, Mark J Buchfuhrer, Christopher J Earley, William G Ondo, Arthur S Walters, John W Winkelman
Restless legs syndrome (RLS) is a distinct disorder, differing from chronic pain in many ways. Refractory RLS is characterized by unresponsiveness to dopamine agonists or alpha-2-delta ligands due to inadequate efficacy, augmentation, or adverse effects. This may result in severely impaired quality of life, profound insomnia, and suicidal depression. Opioid therapy is a mainstay in the management of these patients. This article summarizes the basic science and clinical evidence in support of their use, including the positive result of a large controlled multicenter study of 306 subjects, and outlines an approach to their use in clinical practice...
January 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29303948/cognitive-behavioral-therapy-for-chronic-pain-one-therapeutic-approach-for-the-opioid-epidemic
#17
Muhammad Hassan Majeed, Donna M Sudak
Opioids are frequently prescribed for chronic pain. For the past 2 decades, long-term opioid analgesic therapy was considered the cornerstone of effective pain management for chronic nonmalignant conditions, despite a lack of documented effectiveness and safety, with the attendant risk of addiction, overdose, and death. Cognitive behavioral therapy (CBT) may be used effectively to treat chronic pain, either as a stand-alone treatment or with other nonopioid pharmacological treatments. CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes...
November 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/29302220/a-brief-review-of-the-genetics-and-pharmacogenetics-of-opioid-use-disorders
#18
Wade Berrettini
Increased physician prescribing of opioids to treat chronic nonprogressive pain has been accompanied by an increase in opioid addiction. Twin studies of opioid addiction are consistent with an inherited component of risk, approximately 50%. Several genome-wide association study (GWAS) reports indicate that genetic risk for opioid addiction is conveyed by many alleles of small effect (odds ratios <1.5). These reports have detected alleles in potassium-ion-channel genes (KCNC1 and KCNG2) and in a glutamate receptor auxiliary protein (CNIH3)...
September 2017: Dialogues in Clinical Neuroscience
https://www.readbyqxmd.com/read/29299954/the-impact-of-therapeutic-opioid-agonists-on-driving-related-psychomotor-skills-assessed-by-a-driving-simulator-or-an-on-road-driving-task-a-systematic-review
#19
Diana H Ferreira, Jason W Boland, Jane L Phillips, Lawrence Lam, David C Currow
BACKGROUND: Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety...
December 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29299814/randomized-trial-of-chronic-pain-self-management-program-in-the-community-or-clinic-for-low-income-primary-care-patients
#20
Barbara J Turner, Yuanyuan Liang, Maureen J Simmonds, Natalia Rodriguez, Raudel Bobadilla, Zenong Yin
BACKGROUND: Patients with chronic pain often lack the skills and resources necessary to manage this disease. OBJECTIVE: To develop a chronic pain self-management program reflecting community stakeholders' priorities and to compare functional outcomes from training in two settings. DESIGN: A parallel-group randomized trial. PARTICIPANTS: Eligible subjects were 35-70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics...
January 3, 2018: Journal of General Internal Medicine
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