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Opioid dosing

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https://www.readbyqxmd.com/read/28937443/reducing-disability-durations-and-medical-costs-for-patients-with-a-carpal-tunnel-release-surgery-through-the-use-of-opioid-prescribing-guidelines
#1
Fraser W Gaspar, Roman Kownacki, Catherine S Zaidel, Craig F Conlon, Kurt T Hegmann
OBJECTIVE: The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined. METHODS: Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids...
September 20, 2017: Journal of Occupational and Environmental Medicine
https://www.readbyqxmd.com/read/28936080/maintainence-treatment-of-opioid-dependence-with-tramadol
#2
Siddharth Sarkar, Mohit Varshney, Vaibhav Patil, Rakesh Lal
BACKGROUND: Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance. METHODS: Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28935654/opioid-prescription-morbidity-and-mortality-in-united-states-dialysis-patients
#3
Paul L Kimmel, Chyng-Wen Fwu, Kevin C Abbott, Anne W Eggers, Prudence P Kline, Paul W Eggers
Aggressive pain treatment was advocated for ESRD patients, but new Centers for Disease Control and Prevention guidelines recommend cautious opioid prescription. Little is known regarding outcomes associated with ESRD opioid prescription. We assessed opioid prescriptions and associations between opioid prescription and dose and patient outcomes using 2006-2010 US Renal Data System information in patients on maintenance dialysis with Medicare Part A, B, and D coverage in each study year (n=671,281, of whom 271,285 were unique patients)...
September 21, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28934555/cardiovascular-effects-of-methadone-and-concomitant-use-of-diazepam-during-methadone-maintenance-treatment-induction-low-concentration-risk
#4
Vesna Mijatović, Isidora Samojlik, Stojan Petković, Saša Vukmirović, Arsen Uvelin, Aleksandra Dickov
Background The aim is to evaluate the role of diazepam concentrations in development of low-concentration-methadone-associated QTc prolongation in patients with opioid use disorder during methadone maintenance treatment (MMT) induction. Research design and methods Individuals with addiction disorder on MMT were studied before the beginning of MMT and after one and six months of MMT. Serum concentrations of methadone, diazepam, electrolytes and ECG were analyzed. Results Thirty patients were enrolled. The mean methadone concentration at time points was 177±119 ng/ml and 343±182 ng/ml, while the mean diazepam concentration was 561±437 ng/ml and 1045±933 ng/ml...
September 21, 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/28934186/opioid-overdose-outbreak-west-virginia-august-2016
#5
Joel Massey, Michael Kilkenny, Samantha Batdorf, Sarah K Sanders, Debra Ellison, John Halpin, R Matthew Gladden, Danae Bixler, Loretta Haddy, Rahul Gupta
On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters...
September 22, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28933336/bioavailability-of-oxycodone-after-administration-of-a-new-prolonged-release-once-daily-tablet-formulation-in-healthy-subjects-in-comparison-to-an-established-twice-daily-tablet%C3%A2
#6
Bernhard Scheidel, Martina A Maritz, Yves J Gschwind, Kerstin Steigerwald, Volker Guth, Peter Kovacs, Helene Rey
OBJECTIVE: To evaluate and to compare the bioavailability, the influence of food intake on the bioavailability, and the safety and tolerability of a newly-developed oxycodone once-daily (OOD) prolonged-release tablet with an established oxycodone twice-daily (OTD) prolonged-release tablet after single-dose administration under fasting or fed conditions as well as after multiple-dose administration. MATERIALS AND METHODS: Three single-center, open-label, randomized, balanced, two-treatment, two-period, two-sequence crossover studies were conducted...
September 21, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28929914/the-conundrum-of-opioid-tapering-in-long-term-opioid-therapy-for-chronic-pain-a-commentary
#7
Ajay Manhapra, Albert A Arias, Jane C Ballantyne
BACKGROUND: In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking...
September 20, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28928973/prospective-replication-study-implicates-the-catechol-o-methyltransferase-val-158-met-polymorphism-as-a-biomarker-for-the-response-to-morphine-in-patients-with-cancer
#8
Hiromichi Matsuoka, Chihiro Makimura, Atsuko Koyama, Yoshihiko Fujita, Junji Tsurutani, Kiyohiro Sakai, Ryo Sakamoto, Kazuto Nishio, Kazuhiko Nakagawa
Genetic differences in humans cause clinical difficulties in opioid treatment. Previous studies indicate that a single nucleotide polymorphism in the catechol-O-methyltransferase (COMT) gene (rs4680; p.Val(158)Met) may present as a predictive biomarker for the response to morphine treatment. In our previous pilot exploratory study, patients with a G/G genotype were demonstrated to require a higher dose of morphine, compared with patients with A/A and A/G genotypes. In the present study, the aim was to replicate the findings in an independent cohort of opioid-treatment-naïve patients exhibiting various types of cancer...
October 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28928658/anti-inflammatory-antinociceptive-and-antioxidant-activities-of-methanol-and-aqueous-extracts-of-anacyclus-pyrethrum-roots
#9
Houria Manouze, Otmane Bouchatta, A Chemseddoha Gadhi, Mohammed Bennis, Zahra Sokar, Saadia Ba-M'hamed
Anacyclus pyrethrum (L.) is a plant widely used in Moroccan traditional medicine to treat inflammatory and painful diseases. The objective of the present study was to evaluate the antinociceptive, anti-inflammatory and antioxidant activities of aqueous and methanol extracts of Anacyclus pyrethrum roots (AEAPR and MEAPR). The anti-inflammatory effect of AEAPR and MEAPR was determined in xylene-induced ear edema and Complete Freund's Adjuvant (CFA)-induced paw edema. The antinociceptive activity of AEAPR and MEAPR (125, 250, and 500 mg/kg) administered by gavage was examined in mice by using acetic acid-induced writhing, hot plate, and formalin tests, and the mechanical allodynia were assessed in CFA-induced paw edema...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28928576/relative-efficacy-of-ultrasound-guided-ilioinguinal-iliohypogastric-nerve-block-versus-transverse-abdominis-plane-block-for-postoperative-analgesia-following-lower-segment-cesarean-section-a-prospective-randomized-observer-blinded-trial
#10
L Vamsee Kiran, T Sivashanmugam, V R Hemanth Kumar, N Krishnaveni, S Parthasarathy
BACKGROUND: Quality of postoperative analgesia after cesarean section makes difference to mother in child bonding, early ambulation, and discharge. Ilioinguinal iliohypogastric (ILIH) and transverse abdominis plane (TAP) block had been tried to reduce the opioid analgesics, but the relative efficacy is unknown. Hence, this study was designed to compare the efficacy of these two regional analgesic techniques in sparing postoperative rescue analgesic requirement following lower segment cesarean section (LSCS)...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928557/a-comparative-evaluation-of-intravenous-dexmedetomidine-and-fentanyl-in-breast-cancer-surgery-a-prospective-randomized-and-controlled-trial
#11
Sakshi Goyal, Kewal Krishan Gupta, Vikram Mahajan
BACKGROUND AND AIM: Recent studies have advised narcotic less anaestheic techniques for breast cancer surgeries due to altered immune system by use of opioids. So we planned this study to compare the efficacy of dexmedtomidine with fentanyl in breast cancer surgery in terms of haemodynamic stability, anaesthetic sparing effects, recovery profile and postoperative analgesia. MATERIAL AND METHODS: In this randomized prospective controlled trial, a total of 60 female patients were randomly assigned into two groups...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928552/comparative-efficacy-of-minimal-concentration-of-racemic-bupivacaine-0-0625-with-fentanyl-and-ropivacaine-0-1-with-fentanyl-for-epidural-labor-analgesia
#12
T N Chethanananda, M R Shashank, N Madhu, J Achyutha, Karna Venkata Siva Kumar
BACKGROUND AND AIMS: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. SETTINGS AND DESIGN: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28926159/randomized-controlled-feasibility-trial-of-intranasal-ketamine-compared-to-intranasal-fentanyl-for-analgesia-in-children-with-suspected-extremity-fractures
#13
Stacy L Reynolds, Kathleen K Bryant, Jonathan R Studnek, Melanie Hogg, Connell Dunn, Megan A Templin, Charity G Moore, James R Young, Katherine Rivera Walker, Michael S Runyon
OBJECTIVE: We compared the tolerability and efficacy of intranasal sub-dissociative ketamine to intranasal fentanyl for analgesia of children with acute traumatic pain and investigated the feasibility of a larger non-inferiority trial that could investigate the potential opioid sparing effects of intranasal ketamine. METHODS: This randomized controlled trial compared intranasal ketamine 1 mg/kg to intranasal fentanyl 1.5 μg/kg in children 4-17 years old with acute pain from suspected, isolated extremity fractures presenting to an urban level II pediatric trauma center from December 2015 to November 2016...
September 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency 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
#14
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/28923348/stimulation-of-accumbal-gabaa-receptors-inhibits-delta2-but-not-delta1-opioid-receptor-mediated-dopamine-efflux-in-the-nucleus-accumbens-of-freely-moving-rats
#15
Yuri Aono, Yuri Kiguchi, Yuriko Watanabe, John L Waddington, Tadashi Saigusa
The nucleus accumbens contains delta-opioid receptors that may reduce inhibitory neurotransmission. Reduction in GABAA receptor-mediated inhibition of accumbal dopamine release due to delta-opioid receptor activation should be suppressed by stimulating accumbal GABAA receptors. As delta-opioid receptors are divided into delta2- and delta1-opioid receptors, we analysed the effects of the GABAA receptor agonist muscimol on delta2- and delta1-opioid receptor-mediated accumbal dopamine efflux in freely moving rats using in vivo microdialysis...
September 15, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/28919978/controlled-substance-agreements-for-opioids-in-a-primary-care-practice
#16
Lindsey M Philpot, Priya Ramar, Muhamad Y Elrashidi, Raphael Mwangi, Frederick North, Jon O Ebbert
BACKGROUND: Opioids are widely prescribed for chronic non cancer pain (CNCP). Controlled substance agreements (CSAs) are intended to increase adherence and mitigate risk with opioid prescribing. We evaluated the demographic characteristics of and opioid dosing for patients with CNCP enrolled in CSAs in a primary care practice. METHODS: We conducted a retrospective cohort study of 1066 patients enrolled in CSAs between May 9, 2013 and August 15, 2016 for CNCP in a Midwest primary care practice...
2017: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/28919810/a-comparison-between-the-administration-of-oral-prolonged-release-oxycodone-naloxone-and-transdermal-fentanyl-in-patients-with-moderate-to-severe-cancer-pain-a-propensity-score-analysis
#17
A Roberto, M T Greco, L Legramandi, F Galli, M Galli, O Corli
BACKGROUND: Opioids are the most important pharmacological treatment for moderate-to-severe cancer pain, but side effects limit their use. Transdermal fentanyl (TDF) and oral prolonged-release oxycodone-naloxone (OXN-PR) are effective in controlling chronic pain, with less constipation compared to other opioids. However, TDF and OXN-PR have never been directly compared. PATIENTS AND METHODS: Cancer patients with moderate-to-severe chronic pain were consecutively enrolled in two prospective 28-day trials, received either TDF or OXN-PR, and were assessed at baseline and after 7, 14, 21, and 28 days...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28917801/development-of-a-quantitative-approach-in-blood-plasma-for-low-dosed-hallucinogens-and-opioids-using-lc-high-resolution-mass-spectrometry
#18
Achim T Caspar, Andreas B Kollas, Hans H Maurer, Markus R Meyer
The WHO annually reports an increasing abuse of new psychoactive substances (NPS), which are a heterogeneous group of synthetic drugs and are consumed as substitute for controlled drugs of abuse. In this work, we focused on highly potent derivatives such those of phenethylamine (2C), N-2-methoxybenzyl phenethylamine (NBOMes), lysergic acid diethylamide (LSD), and fentanyl. Severe to fatal intoxications were described due to their high potency. Therefore, they have to be taken at very low doses resulting in low blood concentration in the low ng/mL range, which is a challenge for reliable analytical detection and quantification...
January 1, 2018: Talanta
https://www.readbyqxmd.com/read/28916995/effects-of-environmental-enrichment-on-self-administration-of-the-short-acting-opioid-remifentanil-in-male-rats
#19
Rebecca S Hofford, Jonathan J Chow, Joshua S Beckmann, Michael T Bardo
BACKGROUND: Opioid abuse is a major problem around the world. Identifying environmental factors that contribute to opioid abuse and addiction is necessary for decreasing this epidemic. In rodents, environmental enrichment protects against the development of low dose stimulant self-administration, but studies examining the effect of enrichment and isolation (compared to standard housing) on the development of intravenous opioid self-administration have not been conducted. The present study investigated the role of environmental enrichment on self-administration of the short-acting μ-opioid remifentanil...
September 15, 2017: Psychopharmacology
https://www.readbyqxmd.com/read/28916251/mk-801-but-not-naloxone-attenuates-high-dose-dextromethorphan-induced-convulsive-behavior-possible-involvement-of-the-glun2b-receptor
#20
Hai-Quyen Tran, Yoon Hee Chung, Eun-Joo Shin, The-Vinh Tran, Ji Hoon Jeong, Choon-Gon Jang, Seung-Yeol Nah, Kiyofumi Yamada, Toshitaka Nabeshima, Hyoung-Chun Kim
Dextromethorphan (DM) is a dextrorotatory isomer of levorphanol, a typical morphine-like opioid. When administered at supra-antitussive doses, DM produces psychotoxic and neurotoxic effects in humans. Although DM abuse has been well-documented, few studies have examined the effects of high-dose DM. The present study aimed to explore the effects of a single high dose of DM on mortality and seizure occurrence. After intraperitoneal administration with a high dose of DM (80mg/kg), Sprague-Dawley rats showed increased seizure occurrence and intensity...
September 13, 2017: Toxicology and Applied Pharmacology
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