keyword
https://read.qxmd.com/read/38533715/chronic-opioid-pain-treatment-converted-to-buprenorphine-a-case-series-using-a-3-step-low-dose-incremental-dosing-guideline
#1
JOURNAL ARTICLE
Gregory Acampora, Yi Zhang
We report a 30-case series from the Pain Management Center at the Massachusetts General Hospital where we have applied a guideline to convert chronic treatment for pain from full agonist opioids (FAO) to buprenorphine (BUP). Of the patients, 24 (80 percent) elected to continue BUP over FAO. Five conversions were stopped for side effects (fatigue) and/or lack of sufficient pain reduction. One patient elected not to participate on the day that the conversion was to begin. There were no major adverse events. We conclude that conversion to BUP should be considered as an alternative to treat patients on chronic opioids for pain...
2024: Journal of Opioid Management
https://read.qxmd.com/read/38528134/kappa-opioid-receptor-stimulation-in-the-nucleus-accumbens-shell-and-ethanol-drinking-differential-effects-by-rostro-caudal-location-and-level-of-drinking
#2
JOURNAL ARTICLE
Breanne E Pirino, Annie Hawks, Brody A Carpenter, Pelagia G Candelas, Andrew T Gargiulo, Genevieve R Curtis, Anushree N Karkhanis, Jessica R Barson
Although the kappa-opioid receptor (KOR) and its endogenous ligand, dynorphin, are believed to be involved in ethanol drinking, evidence on the direction of their effects has been mixed. The nucleus accumbens (NAc) shell densely expresses KORs, but previous studies have not found KOR activation to influence ethanol drinking. Using microinjections into the NAc shell of male and female Long-Evans rats that drank under the intermittent-access procedure, we found that the KOR agonist, U50,488, had no effect on ethanol drinking when injected into the middle NAc shell, but that it promoted intake in males and high-drinking females in the caudal NAc shell and high-drinking females in the rostral shell, and decreased intake in males and low-drinking females in the rostral shell...
March 25, 2024: Neuropsychopharmacology
https://read.qxmd.com/read/38508963/a-narrative-review-of-the-literature-relevant-to-obstetric-anesthesiologists-the-2023-gerard-w-ostheimer-lecture
#3
REVIEW
P Sultan
UNLABELLED: This narrative review of the 2023 Gerard W. Ostheimer lecture presented at the Society for Obstetric Anesthesia and Perinatology 2023 annual meeting summarizes 2022 literature relevant to obstetric anesthesiologists. ANTENATAL STUDIES: Neonatal morbidity is reduced with antenatal maternal buprenorphine compared with methadone for treatment of opioid use disorder. Antenatal pregnancy allergy testing is safe and feasible. ANALGESIA AND ANESTHESIA STUDIES: Intrathecal (IT) 3% chloroprocaine for cervical cerclage results in faster sensory block resolution and discharge readiness compared with bupivacaine...
January 3, 2024: International Journal of Obstetric Anesthesia
https://read.qxmd.com/read/38506955/pre-proenkephalin-1-is-downregulated-under-unloading-and-is-involved-in-osteoblast-biology
#4
JOURNAL ARTICLE
Chiara Puri, Charlotte Dannenberg, Argia Ucci, Marco Ponzetti, Elisa Pucci, Luciana Silvestri, Patrick Lau, Petra Frings-Meuthen, Martina Heer, Nadia Rucci, Anna Teti, Antonio Maurizi
Pre-proenkephalin 1 (Penk1) is a pro-neuropeptide that belongs to the typical opioid peptide's family, having analgesic properties. We previously found Penk1 to be the most downregulated gene in a whole gene profiling analysis performed in osteoblasts subjected to microgravity as a model of mechanical unloading. In this work, Penk1 downregulation was confirmed in the bones of two in vivo models of mechanical unloading: tail-suspended and botulinum toxin A (botox)-injected mice. Consistently, in the sera from healthy volunteers subjected to bed rest, we observed an inverse correlation between PENK1 and bed rest duration...
March 20, 2024: Calcified Tissue International
https://read.qxmd.com/read/38499359/multimodal-pain-management-and-postoperative-outcomes-in-inpatient-and-outpatient-shoulder-arthroplasties-a-population-based-study
#5
JOURNAL ARTICLE
Helen Liu, Haoyan Zhong, Nicole Zubizarreta, Paul Cagle, Jiabin Liu, Jashvant Poeran, Stavros G Memtsoudis
INTRODUCTION: Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery. METHODS: A retrospective review using the Premier Healthcare Database of patients who underwent inpatient or outpatient (reverse, total, partial) shoulder arthroplasty from 2010 to 2019. Opioid-only analgesia was compared with multimodal analgesia, categorized into 1, 2, or >2 additional analgesic modes, with/without a nerve block...
March 18, 2024: Regional Anesthesia and Pain Medicine
https://read.qxmd.com/read/38499298/patient-perspectives-on-primary-care-providers-role-in-long-term-opioid-therapy
#6
JOURNAL ARTICLE
Lisa Eveline Maria Davies, Elsemiek A W Jansen-Groot Koerkamp, Ellen S Koster, Kelly-Jo Dalusong, Brigitte Koch, Arnt Schellekens, Mette Heringa, Marcel Bouvy
INTRODUCTION: Over the past decade, long-term use of prescription opioids for chronic non-cancer pain (CNCP) has risen globally despite the associated risks. The majority of opioid users receive their first prescription in primary care. AIM: To investigate the perspective of long-term opioid users in primary care regarding the role of healthcare providers (HCP) in their prolonged opioid use. DESIGN AND SETTING: Semi-structured interviews in Dutch primary care Methods: We recruited long-term opioid users for CNCP from seven community pharmacies in the Netherlands...
March 18, 2024: British Journal of General Practice
https://read.qxmd.com/read/38495063/perioperative-opioid-related-harms-opportunities-to-minimize-risk
#7
REVIEW
Dominic Alessio-Bilowus, Alexandra O Luby, Samantha Cooley, Sarah Evilsizer, Elizabeth Seese, Mark Bicket, Jennifer F Waljee
Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities...
February 2024: Seminars in Plastic Surgery
https://read.qxmd.com/read/38493440/persistent-opioid-use-after-hospital-admission-from-surgery-in-new-zealand-a-population-based-study
#8
JOURNAL ARTICLE
Jiayi Gong, Peter Jones, Chris Frampton, Kebede Beyene, Amy Hai Yan Chan
BACKGROUND: Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals. METHOD: We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019...
March 18, 2024: Anesthesia and Analgesia
https://read.qxmd.com/read/38466269/opioid-prescribing-and-outcomes-in-patients-with-sickle-cell-disease-post-2016-cdc-guideline
#9
JOURNAL ARTICLE
Hyeun Ah Kang, Bofei Wang, Jamie C Barner, Kenneth I Ataga, Robert C Mignacca, Alicia Chang, Yahan Zhang
IMPORTANCE: Although the intention of the 2016 US Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain was not to limit pain treatment for patients with sickle cell disease (SCD), clinicians and patients have recognized the possibility that the guideline may have altered outcomes for this population. However, the outcomes of the 2016 guideline for this patient population are unknown. OBJECTIVE: To examine changes in opioid prescribing patterns and health outcomes among patients with SCD before and after the release of the 2016 CDC guideline...
March 11, 2024: JAMA Internal Medicine
https://read.qxmd.com/read/38457606/opioid-use-in-cancer-patients-compared-with-non-cancer-pain-patients-in-a-veterans-population
#10
JOURNAL ARTICLE
Seshadri C Mudumbai, Han He, Ji-Qing Chen, Aditi Kapoor, Samantha Regala, Edward R Mariano, Randall S Stafford, Christian C Abnet, Ruth M Pfeiffer, Neal D Freedman, Arash Etemadi
BACKGROUND: Opioid safety initiatives may secondarily impact opioid prescribing and pain outcomes for cancer care. METHODS: We reviewed electronic health record data at a tertiary Veterans Affairs system (VA Palo Alto) for all patients from 2015-2021. We collected outpatient Schedule II opioid prescriptions data and calculated morphine milligram equivalents (MMEs) using CDC conversion formulas. To determine the clinical impact of changes in opioid prescription, we used the highest level of pain reported by each patient on the 0 to 10 Numeric Rating Scale (NRS) in each year, categorized into mild (0-3), moderate (4-6), and severe (7 and above)...
March 8, 2024: JNCI Cancer Spectrum
https://read.qxmd.com/read/38456177/delayed-hip-arthroscopy-for-femoroacetabular-impingement-syndrome-does-not-increase-revision-but-does-increase-rates-of-chronic-opiate-use
#11
JOURNAL ARTICLE
Kian Niknam, Ryan Freshman, Sergio E Flores, Drew A Lansdown, Stephanie E Wong, Alan L Zhang
INTRODUCTION: In recent years, the utilization of hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS) has increased due to its low complication rates, positive impact on patient-reported outcomes (PROs), and association with faster rehabilitation. Despite this, there are high rates of revision and conversion to total hip arthroplasty (THA) in some of these patients. It is unclear whether time from initial FAIS diagnosis to surgery is a risk factor for poor outcomes. In this study, we examined the relationship between timing of hip arthroscopy for FAIS and rates of 2-year revision hip procedures, 2-year conversion to total hip arthroplasty (THA), post-operative medical complications, and opioid prescriptions...
July 2024: Journal of Orthopaedics
https://read.qxmd.com/read/38449021/use-of-prescription-opioids-in-israel-and-socio-economic-correlations-between-2010-and-2020
#12
JOURNAL ARTICLE
Limor Adler, Bar Cohen, Shirley Shapiro Ben Daviv, Ori Liran, Daniella Rahamim-Cohen, Afif Nakhleh, Arnon Shahar, Joseph Azuri
BACKGROUND: The use of opioids has increased dramatically over the past several years in Israel. The aim of this study was to explore the trends of opioid consumption in Israel over a decade (2010-2020) stratified by socioeconomic status (SES), residence in the periphery, and ethnic background. METHODS: This cross-sectional study included all adult Maccabi Healthcare Services (MHS) patients who filled at least one prescription for opioids during the past decade...
March 7, 2024: Israel Journal of Health Policy Research
https://read.qxmd.com/read/38446478/older-adult-and-primary-care-practitioner-perspectives-on-using-prescribing-and-deprescribing-opioids-for-chronic-pain
#13
JOURNAL ARTICLE
Timothy S Anderson, Brianna X Wang, Julia H Lindenberg, Shoshana J Herzig, Dylan M Berens, Mara A Schonberg
IMPORTANCE: Guidelines recommend deprescribing opioids in older adults due to risk of adverse effects, yet little is known about patient-clinician opioid deprescribing conversations. OBJECTIVE: To understand the experiences of older adults and primary care practitioners (PCPs) with using opioids for chronic pain and discussing opioid deprescribing. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study conducted semistructured individual qualitative interviews with 18 PCPs and 29 adults 65 years or older prescribed opioids between September 15, 2022, and April 26, 2023, at a Boston-based academic medical center...
March 4, 2024: JAMA Network Open
https://read.qxmd.com/read/38440153/systematic-review-and-meta-analysis-of-vaginal-natural-orifice-transluminal-endoscopic-surgery-vs-laparoscopic-hysterectomy
#14
REVIEW
Greg J Marchand, Ahmed Taher Masoud, Hollie Ulibarri, Amanda Arroyo, Carmen Moir, Madison Blanco, Daniela Gonzalez Herrera, Brooke Hamilton, Kate Ruffley, Mary Petersen, Sarena Fernandez, Ali Azadi
OBJECTIVE: Because vaginal natural orifice transluminal endoscopic surgery and laparoscopic hysterectomy techniques both aim to decrease tissue injury and postoperative morbidity and mortality and to improve a patient's quality of life, we sought to evaluate the safety and effectiveness of a hysterectomy by vaginal natural orifice transluminal endoscopic surgery and compared that with conventional laparoscopic hysterectomy among women with benign gynecologic diseases. DATA SOURCES: We used Scopus, Medline, ClinicalTrials...
February 2024: AJOG global reports
https://read.qxmd.com/read/38426533/a-nationwide-survey-study-of-recovery-community-centers-supporting-people-in-recovery-from-substance-use-disorder
#15
JOURNAL ARTICLE
Bettina B Hoeppner, Hazel V Simpson, Catherine Weerts, Marion J Riggs, Alivia C Williamson, Diadora Finley-Abboud, Lauren A Hoffman, Philip X Rutherford, Patty McCarthy, Julia Ojeda, Amy A Mericle, Vinod Rao, Brandon G Bergman, Akosua B Dankwah, John F Kelly
OBJECTIVE: The medical community has become aware of its role in contributing to the opioid epidemic and must be part of its resolution. Recovery community centers (RCCs) represent a new underused component of recovery support. METHODS: This study performed an online national survey of all RCCs identified in the United States, and used US Census ZIP code tabulation area data to describe the communities they serve. RESULTS: Residents of areas with RCCs were more likely to be Black (16...
March 1, 2024: Journal of Addiction Medicine
https://read.qxmd.com/read/38412526/deployed-combat-use-of-methoxyflurane-for-analgesia
#16
JOURNAL ARTICLE
Steven Gremel Schauer, Andrew D Fisher, Michael D April
BACKGROUND: The U.S. Military needs fast-acting, non-opioid solutions for battlefield pain. The U.S. Military recently used morphine auto-injectors, which are now unavailable. Off-label ketamine and oral transmucosal fentanyl citrate use introduces challenges and is therefore uncommon among conventional forces. Sublingual suftentanil is the only recent pain medication acquired to fill this gap. Conversely, methoxyflurane delivered by a handheld inhaler is promising, fast-acting, and available to some partner forces...
March 13, 2024: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://read.qxmd.com/read/38408794/opioid-toxicity-after-oxycodone-naloxone-to-oxycodone-conversion-case-series
#17
JOURNAL ARTICLE
Mairead Doherty, Hannah Joan Featherstone, Clare McAleer, Chloe Webb, Maeve O'Reilly, Marie Twomey, Regina McQuillan
Combination preparations of oxycodone/naloxone are marketed to aid in the management of opioid induced bowel dysfunction, with caution advised in prescribing in cases of liver dysfunction.This case series demonstrates four cases of patients with normal liver function tests who developed significant opioid toxicity on conversion from combination oxycodone/naloxone to oxycodone at equivalent doses, necessitating significant dose reduction.In each case, a cause for intra-hepatic shunting such as cirrhosis, porto-systemic collaterals or thrombosis were identified, highlighting these as cautionary features when prescribing combination preparations of oxycodone/naloxone and the possible need for dose reduction if converting to oxycodone...
February 26, 2024: BMJ Supportive & Palliative Care
https://read.qxmd.com/read/38389624/caudal-neuraxial-blocks-for-pain-relief-from-pelvic-neuropathy-caused-by-extensive-diffuse-large-b-cell-lymphoma
#18
Amanda Myles, Ammar Toubasi, Elizabeth Soladoye, Narayana Gowda, Joan Morny
Central neuraxial blocks can be a vital therapeutic tool for neuropathic pain, but they are infrequently implemented for pain management in cancer patients. Upon a literature review, further data on the role or efficacy of central nerve blocks for neuropathic cancer pain would be beneficial. Additionally, evidence-based guidelines and practices are lacking regarding additional interventions for neuropathic pain relief, a common manifestation of cancer burden. Here, we report the case of a 29-year-old male patient who presented in the ED with intractable neuropathic pain from extensive diffuse large B-cell lymphoma...
January 2024: Curēus
https://read.qxmd.com/read/38370746/comparison-of-machine-leaning-models-for-prediction-of-acute-pain-severity-and-on-treatment-opioid-utilization-in-oral-cavity-and-oropharyngeal-cancer-patients-receiving-radiation-therapy-exploratory-analysis-from-a-large-scale-retrospective-cohort
#19
Vivian Salama, Laia Humbert-Vidan, Brandon Godinich, Kareem A Wahid, Dina M ElHabashy, Mohamed A Naser, Renjie He, Abdallah S R Mohamed, Ariana J Sahli, Katherine A Hutcheson, Gary Brandon Gunn, David I Rosenthal, Clifton D Fuller, Amy C Moreno
BACKGROUND: Acute pain is a common and debilitating symptom experienced by oral cavity and oropharyngeal cancer (OC/OPC) patients undergoing radiation therapy (RT). Uncontrolled pain can result in opioid overuse and increased risks of long-term opioid dependence. The specific aim of this exploratory analysis was the prediction of severe acute pain and opioid use in the acute on-treatment setting, to develop risk-stratification models for pragmatic clinical trials. MATERIALS AND METHODS: A retrospective study was conducted on 900 OC/OPC patients treated with RT during 2017 to 2023...
February 8, 2024: medRxiv
https://read.qxmd.com/read/38347761/prescription-opioid-decision-making-and-use-behaviors-in-adolescents-with-acute-pain-a-qualitative-study
#20
JOURNAL ARTICLE
Flavia P Kapos, Grace O Gordon, Cornelius B Groenewald, Katherine Slack, Vienna Wang, Tonya M Palermo, Anna C Wilson, Jennifer A Rabbitts
OBJECTIVES: Understanding adolescent perspectives on prescribed opioids in the context of medical care for acute pain is needed to prevent opioid-related adverse outcomes. We explored factors that may influence opioid decision-making and use behaviors among adolescents prescribed opioids for acute pain. METHODS: We conducted semi-structured interviews with nineteen adolescents (63% females, ages 12-17) prescribed opioids upon discharge from surgery or intensive care unit admission...
February 13, 2024: Clinical Journal of Pain
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