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Combination Opioids

Jenna L McCauley, Renata S Leite, Valeria V Gordan, Roger B Fillingim, Gregg H Gilbert, Cyril Meyerowitz, David Cochran, D Brad Rindal, Kathleen T Brady
BACKGROUND: Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education. METHODS: The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation...
March 14, 2018: Journal of the American Dental Association
Lisa Barbera, Rinku Sutradhar, Anna Chu, Hsien Seow, Doris Howell, Craig C Earle, Mary Ann O'Brien, Deb Dudgeon, Clare Atzema, Amna Husain, Ying Liu, Carlo DeAngelis
BACKGROUND: Opioid prescribing has been increasingly scrutinized among non-cancer patients. As an unintended consequence, opioids may be under-prescribed for cancer patients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer. METHODS: From 2004 to 2013, Ontario residents 18-64 years eligible for government paid pharmacare were annually stratified into 3 groups: no cancer history, cancer diagnosis >5 years ago and cancer diagnosis ≤5 years ago...
March 13, 2018: Journal of Pain and Symptom Management
Omid Ahmadi, Amir Shirvani Dehkordi, Farhad Heydari, Mohammad Nasr Esfahani, Behzad Mahaki
Background: Renal colic is a painful medical emergency, needs urgent intervention to reduce pain. Nonsteroidal anti-inflammatory drugs, opioids, and entonox are pain-relieving agents. This study was aimed to compare fentanyl + entonox (nitrous oxide + O2 ) versus fentanyl + oxygen. Materials and Methods: One hundred and twenty patients with acute renal colic presenting to the emergency department were enrolled. First, 50 μg fentanyl was infused for all patients...
2018: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Christopher Keane, James E Egan, Mary Hawk
BACKGROUND: Opioid overdose deaths in the US rose dramatically in the past 16 years, creating an urgent national health crisis with no signs of immediate relief. In 2017, the President of the US officially declared the opioid epidemic to be a national emergency and called for additional resources to respond to the crisis. Distributing naloxone to community laypersons and people at high risk for opioid overdose can prevent overdose death, but optimal distribution methods have not yet been pinpointed...
March 7, 2018: International Journal on Drug Policy
Meritxell Llorca-Torralba, Juan A Mico, Esther Berrocoso
The persistent activation of N-methyl-d-aspartate acid receptors (NMDARs) seems to be responsible for a series of changes in neurons associated with neuropathic pain, including the failure of opioids that act through mu-opioid receptors (MORs) to provide efficacious pain relief. As the noradrenergic locus coeruleus (LC) forms part of the endogenous analgesic system, we explored how intra-LC administration of morphine, a MORs agonist, alone or in combination with MK-801, a NMDARs antagonist, affects the sensorial and affective dimension of pain in a rat model of neuropathic pain; chronic constriction injury (CCI)...
March 7, 2018: Progress in Neuro-psychopharmacology & Biological Psychiatry
Dilara Nemutlu Samur, Rana Arslan, Sule Aydın, Nurcan Bektas
The purpose of this study is to assess the possible anti-allodynic and antihyperalgesic effect of valnoctamide, an amide derivative of valproic acid, at the doses of 40, 70 and 100mg/kg (i.p.) in neuropathic pain model induced by chronic constriction injury in rats, by using dynamic plantar test and plantar test (Hargreaves method), and to evaluate that the possible role of certain serotonin, noradrenergic, opioid and GABAergic receptors by pre-treatment with 1mg/kg (i.p.) ketanserin, yohimbine, naloxone and 0...
March 6, 2018: European Journal of Pharmacology
R B Raffa, J V Pergolizzi, R Taylor, M H Ossipov
WHAT IS KNOWN AND OBJECTIVE: Advances in pain research have led to an understanding that many pains are driven by more than one underlying (patho)physiologic cause (ie, they are "multimechanistic") and that better pain relief is obtained with fewer adverse effects when an analgesic is correspondingly multimechanistic. At least two of the more-modern analgesics combine opioid and non-opioid mechanisms, and have become known as "atypical opioids." Less well known is that just as Nature evolved opioids, it also evolved atypical opioids, presaging modern drug discovery efforts...
March 8, 2018: Journal of Clinical Pharmacy and Therapeutics
Andres Zorrilla-Vaca, Jinlei Li
INTRODUCTION: Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA. METHODS: Our group conducted a systematic literature search in PubMed, EMBASE and Google Scholar...
March 8, 2018: Journal of Anesthesia
Cristiana Garisto, Zaccaria Ricci, Lorenzo Tofani, Simona Benegni, Chiara Pezzella, Paola Cogo
BACKGROUND: Dexmedetomidine is a selective agonist of α2 receptors that induces hypnotic, sedative and mild analgesic effect. The aim of our study was to test the effects of dexmedetomidine in combination with opioids and benzodiazepines compared to benzodiazepine-opioids alone. METHODS: A randomized controlled trial was conducted. Patients (children >30 days and <24 months undergoing correction of complex congenital heart diseases -CHD-) were randomized to receive 0...
March 7, 2018: Minerva Anestesiologica
Karima Hider-Mlynarz, Philippe Cavalié, Patrick Maison
AIMS: To describe consumption trends of three groups of analgesics (non-opioids, mild and strong opioids) between 2006 and 2015 in France, and compare this pattern of use with six European countries in 2015. METHODS: Annual drugs sales were extracted from the French national authority's consumption database and from the IMS-MIDAS and national databases for European countries. RESULTS: The use of mild opioids in France decreased by 53% during the last 10 years due to the declining use of dextropropoxyphene combinations, along with an increase in the use of non-opioids and strong opioids (from 72 to 93 and 2 to 2...
March 7, 2018: British Journal of Clinical Pharmacology
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Ioannis D Gkegkes, Evelyn Eleni Minis, Christos Iavazzo
BACKGROUND: The role of analgesia is crucial in the management of postoperative pain. Different combinations of oral analgesics have been proposed in the past. The oxycodone/naloxone (OXN) combination is a recent addition and is being used by different surgical specialties. The aim of our study was to clarify the possible role, advantages, and disadvantages of OXN in the pain management of surgical patients. METHOD: The authors retrieved the included studies after performing a systematic search in PubMed and Scopus...
January 2018: Journal of Opioid Management
Caitlin V Bucher, A J Day, Maria Carvalho
Since the number of prescriptions for opioid medications have continued to rise, there have been questions about the safety of using opioids in pain management. Traditionally, opioid analgesics were reserved for a few select conditions, such as terminal illness and surgery, but currently opioids have been readily prescribed for multiple conditions. The objective of this manuscript is to clarify the current state of opioid use and to discuss alternative transdermal analgesic therapies in pain management. Transdermal compounded medications are patient-specific and customizable to include different types of drugs, in various dosage strengths, that are to be delivered simultaneously in one application...
January 2018: Journal of Opioid Management
Dimitra Tziona, Marianna Papaioannou, Argyro Mela, Styliani Potamianou, Alexandros Makris
PURPOSE: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. This study evaluates the technique of local infiltration analgesia (LIA), by comparing it to saline injections in addition to a standardized multimodal regimen including an adductor canal block. METHODS: Between September 2015 and March 2016, forty patients aged 18 years and older, ASA I-III, undergoing primary unilateral cemented TKA under spinal anesthesia were randomized to receive either LIA (LIA group) or normal saline (sham LIA group)...
March 5, 2018: Journal of Anesthesia
Tsung-Chih Tseng, Duen-Yi Huang, Liang-Chuan Lai, Haw Hwai, Yi-Wen Hsiao, Jyun-Pei Jhou, Eric Y Chuang, Shiang-Jong Tzeng
Known as a selective δ1 opioid receptor (DOR1) antagonist, the 7-benzylidenenaltrexone (BNTX) is also a DOR1-independent immunosuppressant with unknown mechanisms. Here we investigated if BNTX could be beneficial for diseased MRL/lpr lupus mice. We treated mice with 0.5, 2, 5 or 10 mg/kg/day of BNTX for 2 weeks. At as low as 2 mg/kg/day, BNTX significantly improved splenomegaly and lymphadenopathy. Notably, B cell numbers, particularly autoreactive plasma cells, were preferentially reduced; moreover, BNTX enhanced surface expression of FcγRIIB, an immune complex (IC)-dependent apoptotic trigger of B cells...
March 5, 2018: Journal of Molecular Medicine: Official Organ of the "Gesellschaft Deutscher Naturforscher und Ärzte"
Bjug Borgundvaag, Shelley McLeod, Wayne Khuu, Catherine Varner, Mina Tadrous, Tara Gomes
BACKGROUND: Emergency physicians provide primary care to patients and often prescribe opioids for acutely painful self-limiting conditions. The objective of this study was to describe patterns of opioid prescribing by emergency physicians and family physicians and to explore the relation between setting of initiation of opioid treatment and adverse events over the subsequent 2 years. METHODS: This was a population-based cohort study using administrative data from Ontario...
March 1, 2018: CMAJ Open
S Tahseen, H Shahnawaz, U Riaz, F M Khanzada, A Hussain, W Aslam, M von Euler-Chelpin
SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJECTIVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIV-infected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom...
February 1, 2018: International Journal of Tuberculosis and Lung Disease
F M Coppla, M Rezende, E de Paula, P V Farago, A D Loguercio, S Kossatz, A Reis
Bleaching-induced tooth sensitivity (TS) is highly prevalent. OBJECTIVE: This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect. METHOD: A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours...
March 2018: Operative Dentistry
David E Moody, Yueqiao Fu, Wenfang B Fang
The purpose of this study was to test the hypothesis that skeletal muscle relaxants could inhibit the in vitro metabolism of common co-medications opioids buprenorphine, methadone and oxycodone. The compounds (solubility-limited concentration (μM) studied) were: baclofen (1000), carisoprodol (200), its metabolite meprobamate (1000), chlorzoxazone (200), cyclobenzaprine (1000), metaxalone (50), methocarbamol (1000), orphenadrine (1000) and tizanidine (1000). Compounds were first incubated with human liver microsomes (HLM) ± pre-incubation, screened with pathway-specific cDNA-expressed cytochrome P450s (rCYP), and then IC50 values determined using either 8-concentration tests for those where the rCYP screen suggested an IC50 was achievable, or a 3-concentration test with downward extrapolation if screen suggested 50% inhibition was not achievable...
March 5, 2018: Basic & Clinical Pharmacology & Toxicology
Shawn M Varney, Crystal A Perez, Allyson A Araña, Katherine R Carey, Victoria J Ganem, Lee A Zarzabal, Rosemarie G Ramos, Vikhyat S Bebarta
Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients' opioid misuse risk...
March 3, 2018: Internal and Emergency Medicine
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