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Opioid dose ranges

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https://www.readbyqxmd.com/read/29222126/autoimmune-crmp5-neuropathy-phenotype-and-outcome-defined-from-105-cases
#1
Divyanshu Dubey, Vanda A Lennon, Avi Gadoth, Sean J Pittock, Eoin P Flanagan, John E Schmeling, Andrew McKeon, Christopher J Klein
OBJECTIVE: To establish the phenotype and clinical outcomes of collapsin response-mediator protein-5 (CRMP5) autoimmune neuropathy in comparison with anti-neuronal nuclear antibody type 1 (ANNA1)-immunoglobulin G (IgG) neuropathy. METHODS: Patients with CRMP5-IgG and/or ANNA1-IgGs were identified in our service-line testing, and medical records were reviewed. RESULTS: One hundred five patients with CRMP5-IgG neuropathy (88% smokers; 69% having cancer, most commonly small cell lung cancer [75%]) were identified and compared to 51 patients with ANNA1-IgG neuropathy, 27 with coexisting CRMP5-IgG...
December 8, 2017: Neurology
https://www.readbyqxmd.com/read/29208477/impact-of-opioid-therapy-on-sleep-and-respiratory-patterns-in-adults-with-advanced-cancer-receiving-palliative-care
#2
Phillip Good, Ross Pinkerton, Simon Bowler, Justin Craig, Janet Hardy
CONTEXT: In advanced cancer, abnormal sleep patterns may contribute to poor quality of life but the impact of opioid related sleep disorders has not been explored in detail in these patients. OBJECTIVE: To document sleep and respiratory patterns in patients with cancer, receiving a range of opioids, determine factors that contribute to severity of central or obstructive apnoea and to what extent these contribute to sleep disturbance. METHODS: Adults with advanced cancer admitted to a palliative care service underwent a sleep analysis by an unattended polysomnograph...
December 2, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29189368/opioid-prescribing-for-the-treatment-of-acute-pain-in-children-on-hospital-discharge
#3
Constance L Monitto, Aaron Hsu, Shuna Gao, Paul T Vozzo, Paul S Park, Deborah Roter, Gayane Yenokyan, Elizabeth D White, Deepa Kattail, Amy E Edgeworth, Kelly J Vasquenza, Sara E Atwater, Joanne E Shay, Jessica A George, Barbara A Vickers, Sabine Kost-Byerly, Benjamin H Lee, Myron Yaster
BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy...
December 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29184448/older-adults-and-high-risk-medication-administration-in-the-emergency-department
#4
Mitchell Kim, Steven H Mitchell, Medley Gatewood, Katherine A Bennett, Paul R Sutton, Carol A Crawford, Itay Bentov, Mamatha Damodarasamy, Stephen J Kaplan, May J Reed
Background: Older adults are susceptible to adverse effects from opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (BZDs). We investigated factors associated with the administration of elevated doses of these medications of interest to older adults (≥65 years old) in the emergency department (ED). Patients and methods: ED records were queried for the administration of medications of interest to older adults at two academic medical center EDs over a 6-month period...
2017: Drug, Healthcare and Patient Safety
https://www.readbyqxmd.com/read/29179909/surgical-interns-preparedness-for-opioid-prescribing-before-and-after-a-training-intervention
#5
Michael J Nooromid, Neel A Mansukhani, Benjamin W Deschner, Simon Moradian, Nabil Issa, Karen J Ho, Jonah J Stulberg
INTRODUCTION: Exposure to pain management curriculum in medical school is currently variable. This paper reports on formal prescribing education, self-perceived prescribing readiness, and prescribing practices among incoming surgical residents before and after a pain management training session. METHODS: Pre-residency survey of thirty surgical interns at a single urban medical center, followed by a repeat survey after an educational session on prescription writing and opioid abuse...
November 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29156914/palliative-radiotherapy-utilization-within-a-regional-australian-palliative-care-unit
#6
Peter Eastman, Anna Dowd, James Goonan, Helen Farrell, Graham Pitson
BACKGROUND: Palliative radiotherapy has been demonstrated to be efficacious for symptom management in advanced malignancy however there are limited data investigating its use for inpatient palliative care patients. The aim of the current paper was to evaluate the utilization of radiotherapy amongst patients admitted to a regional Australian palliative care unit (PCU). METHODS: A retrospective cohort study was undertaken involving all Barwon Health PCU patients who received radiotherapy whilst an inpatient...
October 1, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/29149605/bias-factor-and-therapeutic-window-correlate-to-predict-safer-opioid-analgesics
#7
Cullen L Schmid, Nicole M Kennedy, Nicolette C Ross, Kimberly M Lovell, Zhizhou Yue, Jenny Morgenweck, Michael D Cameron, Thomas D Bannister, Laura M Bohn
Biased agonism has been proposed as a means to separate desirable and adverse drug responses downstream of G protein-coupled receptor (GPCR) targets. Herein, we describe structural features of a series of mu-opioid-receptor (MOR)-selective agonists that preferentially activate receptors to couple to G proteins or to recruit βarrestin proteins. By comparing relative bias for MOR-mediated signaling in each pathway, we demonstrate a strong correlation between the respiratory suppression/antinociception therapeutic window in a series of compounds spanning a wide range of signaling bias...
November 16, 2017: Cell
https://www.readbyqxmd.com/read/29138592/dose-related-beneficial-and-harmful-effects-of-gabapentin-in-postoperative-pain-management-post-hoc-analyses-from-a-systematic-review-with-meta-analyses-and-trial-sequential-analyses
#8
REVIEW
Maria Louise Fabritius, Jørn Wetterslev, Ole Mathiesen, Jørgen B Dahl
Background: During the last 15 years, gabapentin has become an established component of postoperative pain treatment. Gabapentin has been employed in a wide range of doses, but little is known about the optimal dose, providing the best balance between benefit and harm. This systematic review with meta-analyses aimed to explore the beneficial and harmful effects of various doses of gabapentin administered to surgical patients. Materials and methods: Data in this paper were derived from an original review, and the subgroup analyses were predefined in an International Prospective Register of Systematic Reviews published protocol: PROSPERO (ID: CRD42013006538)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29127600/a-review-of-current-and-emerging-approaches-to-pain-management-in-the-emergency-department
#9
REVIEW
Knox H Todd
INTRODUCTION: Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches...
December 2017: Pain and Therapy
https://www.readbyqxmd.com/read/29124404/pediatric-patients-receiving-naloxone-within-48%C3%A2-h-of-anesthesia-a-case-control-study
#10
Vinay K Donempudi, Juraj Sprung, Toby N Weingarten
PURPOSE: Excessive narcotization in pediatric surgical patients has not been well characterized. This report describes the use of postoperative naloxone in pediatric patients. METHODS: Pediatric surgical patients from January 1, 2010, through June 30, 2016, who underwent general anesthesia and received naloxone within 48 h postoperatively were identified and matched 1:1 with controls by age, sex, and procedure. Cases and controls underwent retrospective chart review...
November 9, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/29084357/adverse-events-associated-with-medium-and-long-term-use-of-opioids-for-chronic-non-cancer-pain-an-overview-of-cochrane-reviews
#11
REVIEW
Charl Els, Tanya D Jackson, Diane Kunyk, Vernon G Lappi, Barend Sonnenberg, Reidar Hagtvedt, Sangita Sharma, Fariba Kolahdooz, Sebastian Straube
BACKGROUND: Chronic pain is common and can be challenging to manage. Despite increased utilisation of opioids, the safety and efficacy of long-term use of these compounds for chronic non-cancer pain (CNCP) remains controversial. This overview of Cochrane Reviews complements the overview entitled 'High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews'. OBJECTIVES: To provide an overview of the occurrence and nature of adverse events associated with any opioid agent (any dose, frequency, or route of administration) used on a medium- or long-term basis for the treatment of CNCP in adults...
October 30, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29065873/high-variability-of-tb-hiv-hepatitis-c-treatment-and-opioid-substitution-therapy-among-prisoners-in-germany
#12
Jana Müller, Daniel Schmidt, Christian Kollan, Marc Lehmann, Viviane Bremer, Ruth Zimmermann
BACKGROUND: In Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period...
October 25, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29057787/vitamin-d-in-pain-management
#13
REVIEW
Maria Helde-Frankling, Linda Björkhem-Bergman
Vitamin D is a hormone synthesized in the skin in the presence of sunlight. Like other hormones, vitamin D plays a role in a wide range of processes in the body. Here we review the possible role of vitamin D in nociceptive and inflammatory pain. In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses. Recent interventional studies have shown promising effects of vitamin D supplementation on cancer pain and muscular pain-but only in patients with insufficient levels of vitamin D when starting intervention...
October 18, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29051703/buprenorphine-naloxone-maintenance-therapy-an-observational-retrospective-report-on-the-effect-of-dose-on-18%C3%A2-months-retention-in-an-office-based-treatment-program
#14
Theodore V Parran, A G Mace, Yael J Dahan, Christopher A Adelman, Mykola Kolganov
CONTEXT AND OBJECTIVE: Buprenorphine has been available with few reports of the dose range necessary to adequately maintain patients. We report on the effect of 8 mg/d versus 16 mg/d of buprenorphine on long-term patient retention in office-based opioid maintenance (OBOMT). DESIGN SETTING AND PARTICIPANTS: Case series, at an urban hospital-based primary care clinic providing OBOMT to 157 opiate-dependent, low socioeconomic status, uninsured, nonhomeless patients...
2017: Substance Abuse: Research and Treatment
https://www.readbyqxmd.com/read/29032350/identifying-characteristics-of-the-most-severely-impaired-chronic-pain-patients-treated-at-a-specialized-inpatient-pain-clinic
#15
Eva-Britt Hysing, Lena Smith, Mans Thulin, Rolf Karlsten, Stephen Butler, Torsten Gordh
BACKGROUND AND AIMS: Patients suffering from chronic nonmalignant pain constitute a heterogeneous population in terms of clinical presentation and treatment results. Few data are available about what distinguishes different groups in this huge population of patients with chronic persistent pain (CPP). A subgroup that is poorly studied, consists of the most severely impaired chronic pain patients. At the Uppsala University Hospital Pain Clinic, there is a specialized department accepting the most complex patients for rehabilitation...
October 12, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29029049/intraoperative-naloxone-reduces-remifentanil-induced-postoperative-hyperalgesia-but-not-pain-a-randomized-controlled-trial
#16
C-H Koo, S Yoon, B-R Kim, Y J Cho, T K Kim, Y Jeon, J-H Seo
Background: Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone. Methods: Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29028417/opioid-prescription-trends-among-patients-with-cancer-referred-to-outpatient-palliative-care-over-a-6-year-period
#17
Ali Haider, Donna S Zhukovsky, Yee Choon Meng, Joseph Baidoo, Kimberson C Tanco, Holly A Stewart, Tonya Edwards, Manju P Joy, Leela Kuriakose, Zhanni Lu, Janet L Williams, Diane D Liu, Eduardo Bruera
INTRODUCTION: In the United States, opioid regulations have become increasingly stringent in recent years. Increased regulatory scrutiny, in part, is related to heightened awareness through literature and a recent media blitz on the opioid prescription epidemic. These regulations have the potential to impact prescription trends by health care providers. Our objective was to evaluate changes in the type and dose of opioid prescriptions among patients who are referred by oncologists to an outpatient palliative care clinic...
October 13, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29025089/oral-ketamine-for-acute-pain-management-after-amputation-surgery
#18
Asokumar Buvanendran, Jeffrey S Kroin, Arvind Rajagopal, Sherry J Robison, Mario Moric, Kenneth J Tuman
Objective: Intravenous ketamine has been shown to provide postoperative analgesia in many clinical trials, in particular to reduce opioid consumption. The primary objective of this pilot study is to determine if multiple dosing over a three-day perioperative period with oral ketamine is a safe treatment method for acute pain after amputation surgery. Methods: Three consented subjects (age 57-60 years) undergoing elective amputation of the lower extremity were included in the study (Institutional Review Board and Food and Drug Administration Investigational New Drug approved)...
September 14, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29025085/effects-of-buprenorphine-on-responses-to-emotional-stimuli-in-individuals-with-a-range-of-mood-symptomatology
#19
Anya K Bershad, Nicholas A Ruiz, Harriet de Wit
Background: The opioid drug buprenorphine has been shown to modify responses to emotional stimuli and may have antidepressant properties. In preclinical studies, it shows antidepressant-like and anxiolytic-like effects, and a handful of clinical studies suggest it may reduce symptoms of depression in patients. We have shown that low doses of buprenorphine reduce responses to negative emotional stimuli in healthy adults. Here we extended these findings to individuals with symptoms of depression and anxiety...
September 1, 2017: International Journal of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28991111/an-intraplantar-hypertonic-saline-assay-in-mice-for-rapid-screening-of-analgesics
#20
Yahya I Asiri, Timothy Fung, Stephan K W Schwarz, Khalid A Asseri, Ian D Welch, Catherine A Schuppli, Alasdair M Barr, Richard A Wall, Ernest Puil, Bernard A MacLeod
BACKGROUND: Development of new analgesics is limited by shortcomings of existing preclinical screening assays such as wide variations in response, suitability for a narrow range of analgesics, and propensity to induce tissue damage. Our aim was to determine the feasibility of a new in vivo animal assay as an analgesic screen based on nociceptive responses (licking and biting) after intraplantar (i.pl.) injection of hypertonic saline (HS) in mice. METHODS: With approval from the Institutional Animal Care Committee, we conducted a randomized, investigator-blinded in vivo study in adult CD-1 mice...
October 5, 2017: Anesthesia and Analgesia
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