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Rotations among opioids

Carlos A Uquillas, Brian M Capogna, William H Rossy, Siddharth A Mahure, Andrew S Rokito
Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge...
July 2016: Journal of Shoulder and Elbow Surgery
Lara Dhingra, Ebtesam Ahmed, Jae Shin, Elyssa Scharaga, Maximilian Magun
OBJECTIVE: Cognitive effects and sedation (CES) are prevalent in chronic nonmalignant pain populations receiving long-term opioid therapy and are among the most common reasons patients discontinue opioid use. In this narrative review, we describe the phenomenology, epidemiology, mechanisms, assessment, and management of opioid-related CES. DESIGN: We reviewed the empirical and theoretical literature on CES in opioid-treated populations with chronic pain. Data on long-term opioid therapy (≥ 3 months in duration) in chronic nonmalignant pain patients were sought...
October 2015: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Zong-Jie Gan, Yu-Hua Wang, Yun-Gen Xu, Ting Guo, Jun Wang, Qiao Song, Xue-Jun Xu, Shi-Yuan Hu, Yu-Jun Wang, De-Chuan Wang, De-Zhu Sun, Di Zhang, Tao Xi, Hao-Dong Li, Hai-Bo Zhang, Tai-Jun Hang, Hong-Guo Lu, Jing-Gen Liu
A novel series of 1-(pyrrolidin-1-ylmethyl)-2-[(3-oxo-indan)-formyl]-1,2,3,4-tetrahydroisoquinoline derivatives maj-3a-maj-3u were synthesized and evaluated in vitro for their binding affinity at κ-opioid receptors. Maj-3c displayed the highest affinity for κ-opioid receptors (Ki = 0.033 nM) among all the compounds evaluated. Furthermore, all four stereoisomers of compound 3c were prepared, and (1S,18S)-3c was identified as the most potent (Ki = 0.0059 nM) κ-opioid receptor agonist among the four stereoisomers...
May 28, 2015: Organic & Biomolecular Chemistry
Takahiro Hayashi, Saori Ikehata, Haruna Matsuzaki, Kimio Yasuda, Toshiyasu Makihara, Akihiko Futamura, Yuki Arakawa, Rika Kuki, Kumiko Fukuura, Hiroshi Takahashi, Naoharu Mori, Takashi Higashiguchi, Shigeki Yamadaa
Morphine, oxycodone, and fentanyl are commonly used to control cancer pain. Because these drugs have differences in receptor affinity or pharmacokinetic parameters, changing the opioid formulation may result in an unexpected outcome, depending on the patient's condition. This study investigated whether low serum protein levels influence the effectiveness of opioid rotation by determining the impact of serum albumin levels on the analgesic effect before and after opioid rotation from morphine or oxycodone to fentanyl in cancer patients...
2014: Biological & Pharmaceutical Bulletin
Junko Ajimi, Masanobu Yoshikawa, Shigeru Takahashi, Masaaki Miura, Hideo Tsukamoto, Mitsuru Kawaguchi, Hiroyuki Kobayashi, Toshiyasu Suzuki
PURPOSE: The N- and C-terminal regions of dynorphin (Dyn) A (1-17) activate opioid and N-methyl-D-aspartate receptors, respectively. Earlier studies demonstrated that Dyn-converting enzyme cleaved Dyn A (1-17) mainly at the Arg(6)-Arg(7) bond, resulting in the production of N- and C-terminal region peptide fragments, and that this enzyme was not inhibited by a mixture of the three peptidase inhibitors (PIs) amastatin (A), captopril (C), and phosphoramidon (P). The purpose of the present study was to evaluate antinociceptive potential and toxicity with intracerebroventricular administration of Dyn A (1-17) or (1-13) under pretreatment with a mixture of A, C, and P and/or Dyn-converting enzyme inhibitor (p-hydroxymercuribenzoate)...
February 2015: Journal of Anesthesia
Akiko Inoue, Akira Onose, Hiroka Onishi, Hisayo Isono, Matakichi Miyamoto, Hiroshi Nagata, Terue Sakakibara
A 48-year-old man with no remarkable medical history presented with upper abdominal pain for approximately 1 month. He was diagnosed as having pancreatic carcinoma with liver and lung metastasis and complicating carcinomatous peritonitis. Despite chemotherapy, his performance status worsened, his appetite deteriorated, and his pain became intolerable. The patient opted to return home for palliative care, and his parents, aged over 70 years, supported this decision. Although corticosteroid and opiate administration was attempted to improve appetite loss and pain, oral administration became difficult over a short span of time...
December 2013: Gan to Kagaku Ryoho. Cancer & Chemotherapy
W Syrmis, P Good, J Wootton, G Spurling
BACKGROUND: Opioid switching or rotation is reported to be a common practice in palliative care. Published tables of opioid conversion ratios have been found to vary in their recommendations, potentially leading to significant differences in clinical practice. AIMS: To identify common practices in the calculation of opioid equianalgesia by specialist palliative medicine practitioners and trainees. METHOD: An anonymous, cross-sectional, online survey completed by 85 Australian palliative care specialists or advanced trainees...
May 2014: Internal Medicine Journal
Sang-Wook Shin, Gyeong-Jo Byeon, Ji-Uk Yoon, Young-Min Ok, Seung-Hoon Baek, Kyung-Hoon Kim, Seung-Jun Lee
PURPOSE: Ultrasound (US)-guided continuous interscalene brachial plexus block (CBPB) is known to provide effective pain relief for arthroscopic rotator cuff repair. This study was conducted to compare analgesic efficacy and forearm muscle tone of the basal infusion rate and bolus dose of 0.2 % ropivacaine for US-guided CBPB with intravenous patient-controlled analgesia (IV-PCA). METHODS: In a prospective trial, 99 patients scheduled to undergo arthroscopic rotator cuff repair were divided into three groups...
February 2014: Journal of Anesthesia
Akhila Reddy, Sriram Yennurajalingam, Kalyan Pulivarthi, Shana L Palla, Xuan Wang, Jung Hye Kwon, Susan Frisbee-Hume, Eduardo Bruera
BACKGROUND: Opioid rotation is used to treat uncontrolled pain and/or opioid-related adverse effects. Our aim was to determine the frequency, indications, outcomes, and predictors of successful opioid rotation in outpatients with cancer. METHODS: Medical records of consecutive outpatients with cancer who received strong opioids and returned for follow-up visit within ≤6 weeks to our supportive care center from January to December 2008 were reviewed. Data on patient characteristics, symptoms, opioid use, indications for opioid rotation, outcomes, and morphine equivalent daily dose were collected...
2013: Oncologist
Srinivas R Nalamachu
INTRODUCTION: Although chronic opioid therapy is usually initiated using short-acting opioids, many patients with chronic pain are subsequently converted to long-acting and extended-release preparations. In clinical practice, optimal management requires careful individualization of dosage in order to achieve an appropriate balance of efficacy and adverse effects. After successful initiation and stabilization of opioid treatment, subsequent changes in regimen may still be required to maintain efficacy with an acceptable adverse effect profile...
October 2012: Advances in Therapy
Astrid Behr, Ulderico Freo, Carlo Ori, Brigitte Westermann, Fernando Alemanno
PURPOSE: The aim of this study was to assess whether addition of epineural buprenorphine prolonged postoperative analgesia of middle interscalene brachial plexus block (MIB) with levobupivacaine. METHODS: One hundred and fifty consenting adult patients, scheduled for shoulder arthroscopic surgery for a rotator cuff tear under MIB with 29.5 ml of 0.75 % levobupivacaine, were randomized to receive additionally either saline or intramuscular buprenorphine 0.15 mg or epineural buprenorphine 0...
October 2012: Journal of Anesthesia
Mohammed Ilyas Ahmed Khan, Declan Walsh, Norman Brito-Dellan
An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects. A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure...
August 2011: American Journal of Hospice & Palliative Care
Charles E Argoff
The peer-reviewed literature yields a plethora of examples of variability in patient's responses to medications. The rapidly progressing field of pharmacogenetics offers insight into the variation in responses observed clinically, and in particular for the variability observed among patients administered mu opioid analgesics. Genetic variation leads to interperson variability in drug absorption, distribution, metabolism, and excretion, processes that have an important impact on the observed efficacy and toxicity of a drug...
January 2010: Clinical Journal of Pain
Helena Knotkova, Perry G Fine, Russell K Portenoy
Opioid rotation refers to a switch from one opioid to another in an effort to improve the response to analgesic therapy or reduce adverse effects. It is a common method to address the problem of poor opioid responsiveness despite optimal dose titration. Guidelines for opioid rotation are empirical and begin with the selection of a safe and reasonably effective starting dose for the new opioid, followed by dose adjustment to optimize the balance between analgesia and side effects. The selection of a starting dose must be based on an estimate of the relative potency between the existing opioid and the new one...
September 2009: Journal of Pain and Symptom Management
Samer N Narouze, Harsh Govil, Maged Guirguis, Nagy A Mekhail
BACKGROUND: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. OBJECTIVE: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. METHODS: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively...
January 2009: Pain Physician
Emma Scott, Uma Borate, Stephen Heitner, Mark Chaitowitz, William Tester, Glenn Eiger
We aimed to improve internal medicine residents' deficiencies in pain management and evaluate the effectiveness of our intervention, which included an interactive conference series, e-mail vignettes, and didactic sessions. An anonymous survey was administered at the beginning and at the end of an academic year, before and after the intervention, respectively. We analyzed 65 preintervention and 63 postintervention surveys. Self-perception of competency in pain management increased from 40% to 60% (P = .02). Perception of adequacy of training increased from 38...
December 2008: American Journal of Hospice & Palliative Care
Juan-Diego Harris
Intolerable side effects contribute to poor outcomes among patients managed with opioids, and negotiating these side effects remains an important clinical challenge. Evidence-based approaches to minimizing the side-effect burden from opioids compiled from the literature, and including clinical practice recommendations, focus on (1) reducing the doses of systemic opioids, (2) managing the adverse symptoms of opioids, (3) integrating opioid rotation, and (4) changing the route of administration. These broad strategies, and specific recommendations for individual side effects of opioids, including those that often go unrecognized within the following organ systems: neurologic, cardiopulmonary, gastrointestinal, urologic, endocrinologic, dermatologic, and immunologic, are considered herein...
May 2008: Clinical Journal of Pain
Oscar A de Leon-Casasola
Pain remains a highly prevalent problem for patients with cancer and typically falls into one of 3 types: visceral, somatic, and neuropathic. A mechanistic, pathophysiologic approach to pain management involves a good assessment of the type of pain, followed by tailoring of the treatment based on the diagnosis. This pain management strategy can provide rapid pain control with a lower incidence of complications and side effects than other methods. Furthermore, pharmacogenetics may play an important role in individualizing therapies in the future, but for now this type of data offers explanations for phenomena commonly observed in clinical practice, such as (1) differences in individual analgesic and side-effect responses to various opioid agents, (2) incomplete cross-tolerance seen when switching between mu opioid analgesics, and (3) why opioid rotation can be beneficial for patients after an opioid therapy loses efficacy or becomes associated with intolerable side effects...
May 2008: Clinical Journal of Pain
Anette Bendiksen, Eva McGehee, Gitte Handberg
INTRODUCTION: The use of methadone may be difficult and its use in the treatment of chronic non-malignant pain is only sparsely described in literature, whereas several works have shown the advantage of methadone in the treatment of cancer pain. The aim of this analysis is to assess the advantages and disadvantages of methadone in the treatment of chronic pain and to evaluate the method used in The Pain Centre of the Funen Region when initiating treatment. MATERIALS AND METHOD: The analysis is retrospective and includes 83 patients in an ambulatory setting with chronic pain who were treated with methadone either as the primary choice of opioid or by rotation with another opioid using a rotation ratio of 10:1 (morphine:methadone) initially and subsequently titrating to maximum effect with fewest adverse events...
April 23, 2007: Ugeskrift for Laeger
Yasuko Akiyama, Masako Iseki, Rika Izawa, Kouta Ishii, Toyo Miyazaki, Seiko Yamaguchi, Yuichiro Tani
BACKGROUND: [corrected] The transdermal fentanyl patch (Durote patch) is an opioid preparation requiring replacement once in three days, which is occasionally prescribed to replace morphine preparations. The conversion ratio from morphine to fentanyl has been claimed to be 100:1 or 150:1, but there may exist individual variations. METHODS: We retrospectively evaluated the analgesic effects and adverse effects of fentanyl patch in 24 cases among 22 patients (11 men and 11 women)...
March 2007: Masui. the Japanese Journal of Anesthesiology
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