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Opioid Overuse

Chris Maher, Martin Underwood, Rachelle Buchbinder
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review...
October 10, 2016: Lancet
Hans-Christoph Diener, Dagny Holle, Kasja Solbach, Charly Gaul
Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on ≥15 days per month for >3 months, and is caused by overuse of medication intended for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%, but the condition is much more common in people with headache, in particular chronic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication...
October 2016: Nature Reviews. Neurology
Hossein Ansari, Leila Kouti
Treatment of headache, specifically migraine attacks, has always been a challenging subject, especially for neurologist and pain specialists. Triptans are generally underutilized, despite being the gold standard abortive medication for migraine attacks. On the other hand, opioid analgesics are overused as a treatment for headache. One reason for this could be physician unfamiliarity with drug interactions between opioids and other medications, especially the possibility of serotonin toxicity. The general awareness of potential serotonin toxicity with using opioid analgesics is low...
August 2016: Current Pain and Headache Reports
Elizabeth Salt, Yevgeniya Gokun, Anna Rankin Kerr, Jeffery Talbert
BACKGROUND/OBJECTIVES: Low back pain (LBP), a prevalent costly condition, has evidence-based pharmacological and nonpharmacological treatments. Because the prevalence of LBP and the use of opioids differ between the U.S. Census Regions, we compared the treatments used for LBP and their related costs between regions. METHODS: Deidentified patient health claims data from persons with LBP along with treatments received were extracted from a large commercially insured data set (2007-2009; N = 1,630,438)...
July 2016: Orthopaedic Nursing
Tamara Pringsheim, William Jeptha Davenport, Michael J Marmura, Todd J Schwedt, Stephen Silberstein
The "Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies" provides levels of evidence for medication efficacy for acute treatment of migraine. The goal of this companion paper is to provide guidance on how to choose between evidence-based treatment options, and, based on the clinical characteristics of the patient and their migraine attacks, to provide guidance on designing an individualized strategy for managing migraine attacks. The acute pharmacological treatments described in the American Headache Society evidence assessment can be divided into those initially taken by the patient during the headache phase of the migraine attack, those taken by the patient later in the attack when initial treatments fail, and those administered intravenously or intramuscularly in urgent care settings...
July 2016: Headache
Zigor Aira, Teresa Barrenetxea, Itsaso Buesa, Gontzal García Del Caño, Jon Jatsu Azkue
UNLABELLED: The current study reports on a synaptic mechanism through which D1-like receptors (D1LRs) modulate spinal nociception and plasticity by regulating activation of the μ-opioid receptor (MOR).D1LR stimulation with agonist SKF 38393 concentration-dependently depressed C-fiber-evoked potentials in rats receiving spinal nerve ligation (SNL), but not in uninjured rats. Depression was prevented by MOR- but not GABA-receptor blockade. Neurons expressing the D1 subtype were immunopositive for met-enkephalin and vesicular glutamate transporter VGLUT2, but not for GABAergic marker vGAT...
May 18, 2016: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Chao Zhou, Curtis S Florence, Deborah Dowell
Deaths from opioid pain reliever overdose in the United States quadrupled between 1999 and 2013, concurrent with an increase in the use of the drugs. We used data from the Medical Expenditure Panel Survey to examine trends in opioid pain reliever expenditures, financing by various payers, and use from 1999 to 2012. We found major shifts in expenditures by payer type for these drugs, with private and public insurers paying a much larger share than patients in recent years. Consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents (a standard reference measure of strength for various opioids) declined from $4...
May 1, 2016: Health Affairs
Manuela Licata, Cecilia Rustichelli, Federica Palazzoli, Anna Ferrari, Carlo Baraldi, Daniele Vandelli, Patrizia Verri, Filippo Marchesi, Enrico Silingardi
Headache patients suffering from recurrent attacks are a population at risk of overuse and abuse of analgesic medications. Associated with triptans, the first-line drugs recommended for the acute treatment, these patients usually take other medications such as opioids analgesics for the attack treatment, antidepressants and antiepileptics for prophylaxis treatment and benzodiazepines, non-benzodiazepine hypnotics and antipsychotics for the treatment of comorbidities. Regular and frequent use of triptans, like of any other symptomatic analgesic, can cause chronic headache and medication-overuse headache (MOH)...
July 15, 2016: Journal of Pharmaceutical and Biomedical Analysis
Yoko Murphy, Emily Wilson, Elliot M Goldner, Benedikt Fischer
Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e...
July 2016: Clinical Drug Investigation
William B Weeks, John Ventura, Brian Justice, Eugene Hsu, Arnold Milstein
No abstract text is available yet for this article.
July 2016: Spine Journal: Official Journal of the North American Spine Society
A Donnet, D Braunstein, V Pradel, V Sciortino, V Allaria-Lapierre, J Micallef, M Lanteri-Minet
OBJECTIVE: The objective of this study was to estimate and to characterize the actual patterns of ergot use and overuse in France using a drug reimbursement database. METHODS: We included all people covered by the French General Health Insurance System (GHIS) from the Provence-Alpes-Côte-d'Azur (PACA) and Corsica administrative areas who had at least one prescription of ergot between May 2010 and December 2011. All prescriptions of ergots, migraine prophylactic treatment, and psychotropic medications were extracted from the GHIS database...
March 2016: Headache
Alessandro Rizzardo, Luca Miceli, Rym Bednarova, Giovanni Maria Guadagnin, Rodolfo Sbrojavacca, Giorgio Della Rocca
BACKGROUND: Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). PATIENTS AND METHODS: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago...
2016: Therapeutics and Clinical Risk Management
Janice L Clarke, Alexis Skoufalos, Richard Scranton
No abstract text is available yet for this article.
March 2016: Population Health Management
Leo Bastiaens, James Galus, Cherise Mazur
The objective of this study was to evaluate the extent of gabapentin misuse in a dually diagnosed correctional population, and to evaluate if this abuse is specific to the presence of an opioid use disorder (OUD). Two-hundred and fifty former inmates, living in a correctional community center, who were referred for a psychiatric evaluation, were asked, through a brief written questionnaire, whether or not they used the following drugs for non-medical use in the past: opiates, gabapentin, buproprion, quetiapine, and fluoxetine...
February 18, 2016: Psychiatric Quarterly
Angeliki Vgontzas, Larry Charleston, Matthew S Robbins
Children and adolescents with sickle cell disease (SCD) have a high prevalence of recurrent headaches (24.0-43.9 %). Acute presentation with headache can be diagnostically challenging, as the clinician must consider evaluation of several potentially devastating conditions including vascular diseases (stroke, hemorrhage, venous sinus thrombosis, moyamoya, posterior reversible encephalopathy syndrome), facial and orbital bone infarcts, dental pain, and osteomyelitis. Patients with SCD and primary headache disorders may benefit from comprehensive headache treatment plans that include abortive therapy, prophylactic therapy, and non-pharmacological modalities...
March 2016: Current Pain and Headache Reports
L Timmerman, D L Stronks, J G Groeneweg, F J Huygen
BACKGROUND: Chronic pain is commonly treated with analgesic medication. Non-adherence to prescribed pain medication is very common and may result in sub-optimal treatment outcome. The aim of this review was to investigate the prevalence of medication non-adherence and to present determinants that may help identify patients at risk for non-adherence to analgesic medication. METHODS: A search was performed in PubMed and Embase with systematic approach including PRISMA recommendations...
April 2016: Acta Anaesthesiologica Scandinavica
S Vähäaho, T Söderlund, I Tulikoura, J Reitala, M Niemelä, L Handolin
PURPOSE: The aim of the present study was to characterize traumatic deaths of major trauma patients occurring in a university trauma centre and to assess retrospectively the quality of given care by evaluating whether any of the deaths could be identified as potentially preventable. METHODS: All consecutive deaths of trauma patients between January 1, 2004 and December 31, 2008 in the Töölö Hospital Trauma Centre were retrospectively reviewed. The inclusion criterion was death of a trauma patient occurring during stay at hospital...
December 2014: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Michael K Nicholas
No abstract text is available yet for this article.
February 2016: Pain
Michael E M Larson, Richard L Berg, Joyce Flanagan
OBJECTIVE: To use urine drug testing (UDT) results and other covariates to develop a model for the assessment of opioid medication prescription adherence. DESIGN: Retrospective study. SETTING: The Pain Management Clinic at one center of a large, private, multispecialty healthcare system (consisting of 52 regional centers) in northcentral and western Wisconsin. PARTICIPANTS: Seven hundred thirty-three Pain Management Clinic patients with an opioid prescription and UDT between June 1, 2007 and May 17, 2010...
November 2015: Journal of Opioid Management
David A Keith
No abstract text is available yet for this article.
2015: Journal of the Massachusetts Dental Society
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