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Opioid dosing guidelines

Kathryn L Kreicher, Jeremy S Bordeaux
Importance: Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. Objective: To present the newest and best evidence to close common practice gaps in cutaneous surgery. Evidence Review: We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others...
October 20, 2016: JAMA Facial Plastic Surgery
C W Cheung, T Cw Chan, P P Chen, M C Chu, W Cm Chui, P T Ho, F Lam, S W Law, J Ly Lee, S Hs Wong, V Kc Wong
Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain...
October 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Kai-Hsiang Kang, Li-Fen Kuo, I-Chen Cheng, Chih-Shiuh Chang, Wen-Ing Tsay
BACKGROUND/PURPOSE: According to WHO guideline, the consumption of opioids is an important sign of national progress in cancer pain relief. However, precise data on the consumption of opioid analgesics consumption in Taiwan has not been published. We investigate opioid analgesic consumption in Taiwan between 2002 and 2014 compare the results with those in other countries to see what we could learn about other methods of pain management. To find out the different patterns between Taiwan and other country, improves the quality of pain management...
October 4, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Sebastian Botzenhardt, Asia N Rashed, Ian C K Wong, Stephen Tomlin, Antje Neubert
AIM: Analgesic and anti-inflammatory drugs are frequently prescribed in paediatrics. Prescribing and dosing patterns in hospitalised children are not well known. This study explores analgesic drug utilisation on five paediatric wards and discusses its findings in comparison with World Health Organization (WHO) guidelines. METHOD: A sub-analysis of a prospective, multicentre, observational cohort study was undertaken. Prescription data of children aged up to ≤18 years were collected between October 2008 and December 2009 on paediatric general medical wards in five hospitals in Australia, Germany, the United Kingdom (UK), Hong Kong (HK) and Malaysia...
September 30, 2016: Paediatric Drugs
Christopher L Owston
Chronic pain is a common problem, affecting more than 100 million people in the United States, and primary care providers are highly likely to encounter patients on chronic opioid therapy. Initial encounters with a new patient already on high-dose opioids can be difficult and lead to apprehension for both patient and provider. This article describes how to use current opioid prescribing guidelines, conduct a comprehensive pain assessment, and implement risk mitigation strategies to improve patient safety and effectively manage this patient population...
October 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
Kathryn J Hammer, Eve M Segal, Laura Alwan, Shan Li, Amila M Patel, Melinda Tran, Helen M Marshall
PURPOSE: The use of a collaborative drug therapy agreement (CDTA) by oncology pharmacists in a comprehensive pain clinic is described. SUMMARY: Recognizing the complex clinical services required by patients with cancer, the Seattle Cancer Care Alliance began offering cancer pain management through a specialized pain service. Initially, the clinic was staffed by one attending physician; however, as the volume of patient referrals increased, the clinic expanded into an interprofessional team that includes physicians, advanced practice providers, nurses, and pharmacists...
September 15, 2016: American Journal of Health-system Pharmacy: AJHP
Junndeep Sidhu, Neil Tickner
AIM: To evaluate clinical management of acute pain with respect to pain assessment, scoring and timing of analgesia and whether appropriate supportive medicines were prescribed alongside strong opiates. A previous pain audit found dosing of analgesia was appropriate but did not assess clinical management against pain scores. Our paediatric guideline does not currently stipulate guidance on appropriate time frames to administer analgesia and re-assess pain. Standards were developed with a multidisciplinary team to audit against...
September 2016: Archives of Disease in Childhood
Robert Hämmig, Antje Kemter, Johannes Strasser, Ulrich von Bardeleben, Barbara Gugger, Marc Walter, Kenneth M Dürsteler, Marc Vogel
BACKGROUND: Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine...
2016: Substance Abuse and Rehabilitation
Christopher A Bautista, Ana-Maria Iosif, Barth L Wilsey, Joy A Melnikow, Althea Crichlow, Stephen G Henry
OBJECTIVE:  To examine encounter-level factors associated with opioid dose increases during patients' first year on opioid therapy for chronic pain. DESIGN:  Case-control study analyzing all opioid prescriptions for patients with chronic pain during their first year after opioid initiation. Cases were patients who experienced an overall dose escalation of ≥ 30 mg morphine equivalents over the 1-year period; controls did not experience overall dose escalation...
July 31, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Diego Garcia-Borreguero, Michael H Silber, John W Winkelman, Birgit Högl, Jacquelyn Bainbridge, Mark Buchfuhrer, Georgios Hadjigeorgiou, Yuichi Inoue, Mauro Manconi, Wolfgang Oertel, William Ondo, Juliane Winkelmann, Richard P Allen
A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) in conjunction with the European Restless Legs Syndrome Study Group (EURLSSG) and the RLS Foundation (RLS-F) to develop evidence-based and consensus-based recommendations for the prevention and treatment of long-term pharmacologic treatment of dopaminergic-induced augmentation in restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force made the following prevention and treatment recommendations: As a means to prevent augmentation, medications such as α2δ ligands may be considered for initial RLS/WED treatment; these drugs are effective and have little risk of augmentation...
May 2016: Sleep Medicine
Jan Gaertner, Ulrike M Stamer, Constanze Remi, Raymond Voltz, Claudia Bausewein, Rainer Sabatowski, Stefan Wirz, Gabriele Müller-Mundt, Steffen T Simon, Anne Pralong, Friedemann Nauck, Markus Follmann, Lukas Radbruch, Winfried Meißner
BACKGROUND: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. AIM: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. DESIGN: First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted...
July 19, 2016: Palliative Medicine
Lorin R Browne, Manish I Shah, Jonathan R Studnek, Daniel G Ostermayer, Stacy Reynolds, Clare E Guse, David C Brousseau, E Brooke Lerner
BACKGROUND: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed...
July 13, 2016: Prehospital Emergency Care
Anne Z DePriest, Rebecca Heltsley, David L Black, John M Mitchell, Charles LoDico, Ronald Flegel, Edward J Cone
Oxymorphone (OM), a prescription opioid and metabolite of oxycodone, was included in the recently published proposed revisions to the Mandatory Guidelines for Federal Workplace Drug Testing Programs. To facilitate toxicological interpretation, this study characterized the time course of OM and its metabolite, noroxymorphone (NOM), in hydrolyzed and non-hydrolyzed urine specimens. Twelve healthy subjects were administered a single 10 mg controlled-release OM dose, followed by a periodic collection of pooled urine specimens for 54 h following administration...
July 11, 2016: Journal of Analytical Toxicology
Anne Z DePriest, Rebecca Heltsley, David L Black, John M Mitchell, Charles LoDico, Ronald Flegel, Edward J Cone
Hydromorphone (HM), a prescription opioid and metabolite of morphine and hydrocodone, has been included in proposed revisions to the Mandatory Guidelines for Federal Workplace Drug Testing Programs. This study characterized the time course of HM in hydrolyzed and non-hydrolyzed urine specimens. Twelve healthy subjects were administered a single 8 mg controlled-release HM dose, followed by periodic collection of pooled urine specimens for 54 h following administration. Analysis of total and free HM was conducted by liquid chromatography tandem mass spectrometry at a 50 ng/mL limit of quantitation...
July 11, 2016: Journal of Analytical Toxicology
Milica Prostran, Katarina Savić Vujović, Sonja Vučković, Branislava Medić, Dragana Srebro, Nevena Divac, Radan Stojanović, Aleksandar Vujović, Lepa Jovanović, Ana Jotić, Nataša Cerovac
Pain is a common symptom in older people. It is possible that pain is underreported in older persons due to an incorrect belief that it is an inevitable part of aging. Opioid analgesics are potent medications, with confirmed efficacy for the treatment of moderate to severe pain. These drugs are commonly used in older persons. However, there is insufficient evidence regarding safety of opioids in older patients. One of the reasons for this is the lack of randomized, controlled clinical trials. People of advanced age often have comorbidites and use other prescription drugs, as well as over-the-counter (OTC) compounds, thus making them more suceptible to the risk of interactions with opioids...
2016: Frontiers in Aging Neuroscience
Suzanne Nielsen, Raimondo Bruno, Louisa Degenhardt, Apo Demirkol, Nicholas Lintzeris
INTRODUCTION: Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people. DESIGN AND METHODS: A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations...
June 7, 2016: Drug and Alcohol Review
(no author information available yet)
Determined to make a dent in the growing problem of opioid addiction, the CDC has unveiled new guidelines for opioid prescribing for chronic pain. The recommendations urge providers to be more judicious in their prescribing, opting for opioids only after carefully weighing substantial risks and benefits. Public health authorities note the rampant use and misuse of opioids have "blurred the lines" between prescription opioids and illicit opioids. The new guidelines are designed to help frontline providers balance the need to manage their patients' chronic pain with the duty to curb dangerous prescribing practices...
May 2016: ED Management: the Monthly Update on Emergency Department Management
Christina Abdel Shaheed, Chris G Maher, Kylie A Williams, Richard Day, Andrew J McLachlan
IMPORTANCE: Opioid analgesics are commonly used for low back pain, however, to our knowledge there has been no systematic evaluation of the effect of opioid dose and use of enrichment study design on estimates of treatment effect. OBJECTIVE: To evaluate efficacy and tolerability of opioids in the management of back pain; and investigate the effect of opioid dose and use of an enrichment study design on treatment effect. DATA SOURCES: Medline, EMBASE, CENTRAL, CINAHL, and PsycINFO (inception to September 2015) with citation tracking from eligible randomized clinical trials (RCTs)...
July 1, 2016: JAMA Internal Medicine
Martha J Bojko, Alyona Mazhnaya, Ruthanne Marcus, Iuliia Makarenko, Zahedul Islam, Sergey Filippovych, Sergii Dvoriak, Frederick L Altice
Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered...
July 2016: Journal of Substance Abuse Treatment
Alexandra Fife, Andrea Postier, Andrew Flood, Stefan J Friedrichsdorf
OBJECTIVE: Methadone administration has increased in pediatric clinical settings. This review is an attempt to ascertain an equianalgesic dose ratio for methadone in the pediatric population using standard adult dose conversion guidelines. SETTING: US tertiary children's hospital. PATIENTS: Hospitalized pediatric patients, 0-18 years of age. MAIN OUTCOME MEASURES: A retrospective chart review was conducted for patients who were converted from their initial opioid therapy regimen (morphine, hydromorphone, and/or fentanyl) to methadone...
May 2016: Journal of Opioid Management
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