TY - JOUR T1 - Acute high dose-fentanyl exposure produces hyperalgesia and tactile allodynia after coronary artery bypass surgery A1 - Yildirim, V A1 - Doganci, S A1 - Cinar, S A1 - Eskin, M B A1 - Ozkan, G A1 - Eksert, S A1 - Ince, M E A1 - Dogrul, A Y1 - 2014/// KW - aged KW - allodynia KW - anesthesia induction KW - article KW - constipation KW - continuous infusion KW - controlled study KW - coronary artery bypass surgery KW - diarrhea KW - dizziness KW - drug dose comparison KW - drug exposure KW - drug megadose KW - elective surgery KW - female KW - fentanyl KW - human KW - hyperalgesia KW - intensive care unit KW - intraoperative period KW - low drug dose KW - major clinical study KW - male KW - nausea KW - pain threshold KW - postoperative period KW - preoperative evaluation KW - propofol KW - pruritus KW - randomized controlled trial KW - respiration depression KW - somnolence KW - talinat KW - urine retention KW - visual analog scale KW - vomiting KW - von Frey test JF - European Review for Medical and Pharmacological Sciences VL - 18 LA - English IS - 22 SP - 3425 EP - 3434 CY - S. Doganci, Department of Cardiovascular Surgery, Gulhane Military Academy of Medicine, Ankara, Turkey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L606157024&from=export N2 - OBJECTIVE: Opioid-induced hyperalgesia is well known complication of acute high dose and chronic opioid therapy. In this study, we evaluated development of opioid-induced hyperalgesia following intraoperative short-term use of ì-opioid agonist fentanyl after coronary artery bypass surgery. PATIENTS AND METHODS: 100 patients undergoing elective coronary artery bypass graft surgery is divided into two groups. In group I (low dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2 mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10 mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal thresholds were measured before surgery and in 1st, 3rd and 7th postoperative days by using Von Frey filaments and a thermal source, respectively. RESULTS: Tactile thresholds were significantly decreased at the first (6.08 ± 0.21 and 3.76 ± 0.13 g; p > 0.001) and third (6.76 ± 0.24 and 4.96 ± 0.16 g; p > 0.001) postoperative days compared to baseline preoperative values (7.72 ± 0.26, and 7.60 ± 0.21 g; p = 816) in two groups. Postoperative 1st(13.45 ± 0.33 and 10.05 ± 0.24 sec; p > 0.001) and 3rd day (14.77 ± 0.28 and 13.17 ± 0.26 sec; p > 0.001) assessments showed a statistically significant thermal hyperalgesia compared to the preoperative baseline values (16.67 ± 0.51 and 16.45 ± 0.42 sec; p = 0.997) in two groups. This decrease in both tactile and thermal thresholds returned to baseline control values at the 7th day of measurement. CONCLUSIONS: Our results showed that patients undergoing coronary artery bypass surgery receiving fentanyl anesthesia developed postoperative tactile allodynia and thermal hyperalgesia and this was more prominent in high dose group. ER - TY - JOUR T1 - Opioid Induced Hyperalgesia A1 - Yi, Peter A1 - Pryzbylkowski, Peter Y1 - 2015/// KW - Opioid KW - Opioid Induced Hyperalgesia JF - Pain Medicine (United States) VL - 16 SP - S32 EP - S36 DO - 10.1111/pme.12914 N2 - Objective: To discuss the phenomenon of opioid induced hyperalgesia (OIH) and investigate the data and clinical recommendations available on this topic. Design: A literature search on the topic of OIH was performed. Relevant studies pertaining to OIH were included in this review. Results: Existing studies and reviews on the pathophysiology, diagnosis, and clinical management of OIH are discussed with updated data and literature references. Conclusion: As more opioids are prescribed, especially to treat chronic nonmalignant pain, OIH becomes more of a relevant and significant issue. Although the exact mechanisms of OIH are not clearly understood further research is required to broaden and develop our knowledge of this topic. ER - TY - JOUR T1 - Association of body mass index with chronic pain prevalence : a large population ‑ based cross ‑ sectional study in Japan A1 - Yamada, Keiko A1 - Kubota, Yasuhiko A1 - Iso, Hiroyasu A1 - Oka, Hiroyuki A1 - Katsuhira, Junji A1 - Matsudaira, Ko Y1 - 2018/// KW - Chronic pain,Body mass index,Underweight,Overweigh KW - body mass index KW - chronic pain KW - obese KW - overweight KW - underweight PB - Springer Japan JF - Journal of Anesthesia IS - 0123456789 SN - 0054001824868 DO - 10.1007/s00540-018-2486-8 UR - https://doi.org/10.1007/s00540-018-2486-8 ER - TY - JOUR T1 - Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator. A1 - Wong, Marron A1 - Vogell, Alison A1 - Wright, Kelly A1 - Isaacson, Keith A1 - Loring, Megan A1 - Morris, Stephanie Y1 - 2019/03// KW - Adult KW - Aged KW - Analgesics, Opioid KW - Female KW - Follow-Up Studies KW - Health Care Surveys KW - Humans KW - Hysterectomy KW - Inappropriate Prescribing KW - Laparoscopy KW - Massachusetts KW - Middle Aged KW - Opioid-Related Disorders KW - Pain Measurement KW - Pain, Postoperative KW - Postoperative Care KW - Practice Patterns, Physicians' KW - Prospective Studies KW - Risk Factors KW - diagnosis KW - drug therapy KW - etiology KW - methods KW - prevention & control KW - statistics & numerical data KW - therapeutic use JF - American journal of obstetrics and gynecology VL - 220 LA - eng IS - 3 SP - 259.e1 EP - 259.e11 DO - 10.1016/j.ajog.2018.10.022 N2 - BACKGROUND: In the setting of America's opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions. OBJECTIVES: The objectives of the study were to describe opioid prescribing practices by a group of minimally invasive gynecologic surgeons, to measure postoperative opioid use after minimally invasive hysterectomy, and to identify preoperative factors that could predict whether a patient will be a low or high postoperative opioid user. STUDY DESIGN: This was a prospective survey-based study including 125 women undergoing laparoscopic hysterectomy for benign indications at 2 community teaching hospitals. Patients were preoperatively surveyed about demographics, past medical history, and current and expected pain scores and were screened for anxiety, depression, and pain catastrophizing. At 1 and 2 weeks after surgery, patients were surveyed about their pain and pain medication use. RESULTS: Ninety-eight percent of patients were prescribed an opioid for acute postoperative pain. The median opioid prescription was for 150 morphine milligram equivalents, equivalent to 20 tablets of oxycodone 5 mg, while median patient postoperative use was 37.5 morphine milligram equivalents, equivalent to 5 tablets of oxycodone 5 mg. Ninety percent of patients had leftover opioids at 2 weeks after surgery, and most leftover opioids were stored in an unsecure location. Preoperative factors that were most strongly correlated with postoperative opioid use included a history of chronic pelvic pain or endometriosis, preoperative opioid use, anxiety, depression, pain catastrophizing, preoperative pain score, anticipated postoperative pain score, and anticipated postoperative pain medication needs. A predictive calculator was developed based on these factors to help identify patients who are likely to be a high opioid user (defined as taking greater than 112.5 morphine milligram equivalents) or a low opioid user (defined as taking 37.5 morphine milligram equivalents or less). CONCLUSION: On average, surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy for acute postoperative pain control. Individualizing patients' opioid prescriptions based on preoperative risk factors could help reduce excess prescription opioids. ER - TY - JOUR T1 - Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally. A1 - Wong, Anselm A1 - Macleod, Dawson A1 - Robinson, Jeff A1 - Koutsogiannis, Zeff A1 - Graudins, Andis A1 - Greene, Shaun L Y1 - 2015/// KW - Acute Disease KW - Administration, Oral KW - Adolescent KW - Adult KW - Aged KW - Analgesics, Opioid KW - Child KW - Child, Preschool KW - Databases, Factual KW - Drug Combinations KW - Female KW - Humans KW - Incidence KW - Infant KW - Injections, Intravenous KW - Male KW - Middle Aged KW - Naloxone KW - Narcotic Antagonists KW - Oxycodone KW - Poison Control Centers KW - Risk Factors KW - Substance Abuse, Intravenous KW - Substance Withdrawal Syndrome KW - Tablets KW - Victoria KW - Young Adult KW - administration & dosage KW - adverse effects KW - diagnosis KW - epidemiology KW - metabolism KW - pharmacokinetics JF - Clinical toxicology (Philadelphia, Pa.) VL - 53 LA - eng IS - 8 SP - 815 EP - 818 DO - 10.3109/15563650.2015.1060486 N2 - CONTEXT: Oral oxycodone/naloxone preparations are designed to reduce the incidence of constipation associated with oxycodone use. The low oral bioavailability (< 2%) of naloxone makes the precipitation of the acute opioid withdrawal symptoms unlikely following oral oxycodone/naloxone exposure. The incidence of acute opioid withdrawal symptoms following both oral and intravenous administration of oxycodone/naloxone preparations has not been described. OBJECTIVE: The aim of the study was to investigate the incidence and circumstances associated with oxycodone/naloxone-induced acute opioid withdrawal. METHODS: An observational case series of acute opioid withdrawal following oxycodone/naloxone administration were selected from all calls received by the Victoria Poisons Information Centre from January 2012 to December 2014. Data collected included patient demographics, reported symptoms, type of caller, intentional or accidental exposure and advice given. RESULTS: There were 107 reported exposures to oxycodone/naloxone preparations. Route of exposure was oral in 92 (86%) and intravenous injection of crushed tablets in 14 (14%) of cases, respectively. Nine callers had a history of long-standing opioid treatment and developed withdrawal symptoms with oral oxycodone/naloxone. Temporal relationship between first dose, increased dose and chewing tablets was described. There were 14 exposures to crushed oxycodone/naloxone tablets injected intravenously; all precipitated an acute withdrawal state. DISCUSSION: The development of opioid withdrawal symptoms with intravenous injection of oxycodone/naloxone is likely a result of bypassing first-pass metabolism. Withdrawal symptoms after ingesting increased dose, first dose or chewing oxycodone/naloxone suggests that there is a systemic absorption of naloxone in opioid-dependent callers. CONCLUSION: Oxycodone with naloxone tablets can lead to acute opioid withdrawal symptoms if crushed and injected parentally. First dose, increased dose and chewing of these opioid-naloxone combination tablets in opioid-dependent people can also result in acute opioid withdrawal symptoms or diminished pain relief. ER - TY - JOUR T1 - The Effect of Ageing on Cytochrome P450 Enzymes: Consequences for Drug Biotransformation in the Elderly A1 - Wauthier, V. A1 - Verbeeck, R. A1 - Buc Calderon, P. Y1 - 2007/03// JF - Current Medicinal Chemistry VL - 14 IS - 7 SP - 745 EP - 757 DO - 10.2174/092986707780090981 UR - http://www.eurekaselect.com/openurl/content.php?genre=article&issn=0929-8673&volume=14&issue=7&spage=745 ER - TY - JOUR T1 - Opioid pharmaceuticals and addiction: The issues, and research directions seeking solutions A1 - Walwyn, Wendy M. A1 - Miotto, Karen A. A1 - Evans, Christopher J. Y1 - 2010/05// JF - Drug and Alcohol Dependence VL - 108 IS - 3 SP - 156 EP - 165 DO - 10.1016/j.drugalcdep.2010.01.001 UR - https://linkinghub.elsevier.com/retrieve/pii/S0376871610000244 ER - TY - JOUR T1 - A comparison of opioid-related adverse events with fentanyl iontophoretic transdermal system versus morphine intravenous patient-controlled analgesia in acute postoperative pain A1 - Viscusi, Eugene R. A1 - Grond, Stefan A1 - Ding, Li A1 - Danesi, Hassan A1 - Jones, James B. A1 - Sinatra, Raymond S. Y1 - 2016/// KW - fentanyl KW - iontophoretic transdermal system KW - morphine KW - opioid-related adverse drug events KW - patient-controlled analgesia KW - postoperative pain PB - Pain Manag JF - Pain management VL - 6 IS - 1 SP - 19 EP - 24 DO - 10.2217/pmt.15.49 UR - https://pubmed.ncbi.nlm.nih.gov/26376128/ N2 - OBJECTIVE: This analysis compared opioid-related adverse events (ORADEs) observed with fentanyl iontophoretic transdermal system (ITS) versus morphine intravenous (iv.) patient-controlled analgesia (PCA) in the management of postoperative pain. METHODS: Safety data from four Phase IIIB randomized, active-comparator trials were pooled for this analysis (n = 1288 fentanyl ITS and 1313 morphine iv. PCA patients). Treatment-emergent adverse events were collected via spontaneous report. In this post hoc analysis, ORADEs were defined as apnea, confusion, constipation, dyspnea, hypotension, hypoventilation, hypoxia, ileus, nausea, pruritus, somnolence, tachycardia, urinary retention and vomiting. Odds ratios (OR) and 95% CI were calculated for all ORADEs and p-values were based on logistic regression with treatment as effect. RESULTS: There were fewer patients in the fentanyl ITS group compared with the morphine iv. PCA group who experienced at least one ORADE (52.7 vs 59.1%, respectively; OR: 0.772: 95% CI: 0.661-0.901; p = 0.0011). The ORADEs that occurred less frequently in the fentanyl ITS group than in the morphine iv. PCA group included hypotension (3.7 vs 5.5%, respectively; OR: 0.667; 95% CI: 0.459-0.969; p = 0.0338), hypoventilation (0.9 vs 1.9%, respectively; OR: 0.444; 95% CI: 0.217-0.906; p = 0.0256), nausea (40.3 vs 44.5%, respectively; OR: 0.842; 95% CI: 0.721-0.984; p = 0.0310), pruritus (5.5 vs 9.4%, respectively; OR: 0.559; 95% CI: 0.413-0.757; p = 0.0002) and tachycardia (1.6 vs 2.8%, respectively; OR: 0.489; 95% CI: 0.277-0.863; p = 0.0136). No ORADEs occurred more frequently in the fentanyl ITS group compared with the morphine iv. PCA group. CONCLUSION: Fentanyl ITS, in the management of acute postoperative pain, offered safety advantages in terms of ORADEs compared with morphine iv. PCA. ER - TY - JOUR T1 - Drug Dosage in the Elderly A1 - Turnheim, Klaus Y1 - 1998/// JF - Drugs & Aging VL - 13 IS - 5 SP - 357 EP - 379 DO - 10.2165/00002512-199813050-00003 UR - http://link.springer.com/10.2165/00002512-199813050-00003 ER - TY - JOUR T1 - Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy A1 - Tseng, WC A1 - Lin, WL A1 - Lai, HC A1 - Huang, TW A1 - Medicine, PH Chen - A1 - 2019, undefined JF - ncbi.nlm.nih.gov UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641791/ ER - TY - JOUR T1 - PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation A1 - Tricco, Andrea C. A1 - Lillie, Erin A1 - Zarin, Wasifa A1 - O'Brien, Kelly K. A1 - Colquhoun, Heather A1 - Levac, Danielle A1 - Moher, David A1 - Peters, Micah D.J. A1 - Horsley, Tanya A1 - Weeks, Laura A1 - Hempel, Susanne A1 - Akl, Elie A. A1 - Chang, Christine A1 - McGowan, Jessie A1 - Stewart, Lesley A1 - Hartling, Lisa A1 - Aldcroft, Adrian A1 - Wilson, Michael G. A1 - Garritty, Chantelle A1 - Lewin, Simon A1 - Godfrey, Christina M. A1 - MacDonald, Marilyn T. A1 - Langlois, Etienne V. A1 - Soares-Weiser, Karla A1 - Moriarty, Jo A1 - Clifford, Tammy A1 - Tunçalp, Özge A1 - Straus, Sharon E. Y1 - 2018/// JF - Annals of Internal Medicine VL - 169 IS - 7 SP - 467 EP - 473 DO - 10.7326/M18-0850 N2 - Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews. ER - TY - JOUR T1 - Role of CYP2D6 polymorphisms in the outcome of postoperative pain treatment A1 - Seripa, D A1 - Latina, P A1 - Fontana, A A1 - Medicine, C Gravina - … A1 - 2015, undefined JF - academic.oup.com UR - https://academic.oup.com/painmedicine/article-abstract/16/10/2012/2460560 ER - TY - JOUR T1 - Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy A1 - Sera, Leah Church A1 - McPherson, Mary Lynn Y1 - 2012/// KW - Aging KW - Drug therapy KW - Elderly KW - Pharmacodynamics KW - Pharmacokinetics KW - Polypharmacy PB - Elsevier JF - Clinics in Geriatric Medicine VL - 28 IS - 2 SP - 273 EP - 286 SN - 0749-0690 DO - 10.1016/j.cger.2012.01.007 UR - http://dx.doi.org/10.1016/j.cger.2012.01.007 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Sera, McPherson - 2012 - Pharmacokinetics and Pharmacodynamic Changes Associated with Aging and Implications for Drug Therapy.pdf N2 - The population of older adults continues to increase, and polypharmacy in this population is more the rule than the exception. Physiologic changes that occur with aging result in multiple alterations to the pharmacokinetics and pharmacodynamics of drugs, which, in turn, increase the risk of adverse drug reactions. Consideration of initial dose adjustment, along with frequent medication reconciliation and analysis of the medication list, are keys to providing optimal pharmaceutical care for elderly patients. ER - TY - JOUR T1 - Medication reconciliation and review for older emergency patients requires improvement in Finland A1 - Schepela, L A1 - Lehtonenc, L A1 - Airaksinenb, M A1 - Ojalae, R A1 - Ahonene, J A1 - Lapatto-Reiniluotoc, O Y1 - 2018/// KW - Finland KW - accuracy KW - aged KW - aged hospital patient KW - anemia KW - antibiotic agent KW - anticoagulant agent KW - antihypertensive agent KW - article KW - benzodiazepine derivative KW - bile duct disease KW - bleeding KW - cholinergic receptor blocking agent KW - clinical pharmacist KW - clinical pharmacy KW - collapse KW - constipation KW - cytostatic agent KW - diarrhea KW - diuretic agent KW - dizziness KW - drug safety KW - drug utilization review KW - dyspnea KW - emergency patient KW - emergency ward KW - falling KW - female KW - fever KW - foot ulcer KW - hematemesis KW - hematuria KW - hospital admission KW - hospital pharmacist KW - human KW - infection KW - intestine obstruction KW - leg pain KW - major clinical study KW - male KW - medication therapy management KW - melena KW - muscle spasm KW - non prescription drug KW - opiate KW - oral antidiabetic agent KW - polypharmacy KW - potentially inappropriate medication KW - retroperitoneal hemorrhage KW - seizure KW - side effect KW - stomach pain KW - total quality management KW - university hospital JF - International Journal of Risk and Safety in Medicine VL - 30 LA - English IS - 1 SP - 19 EP - 31 CY - L. Schepela, HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Lotta Linnea Schepel, Stenbäckinkatu 9, Helsinki, Finland DO - 10.3233/JRS-180030 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624460310&from=export UR - http://dx.doi.org/10.3233/JRS-180030 N2 - BACKGROUND: 10-30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors. OBJECTIVES: To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs). METHODS: DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH). One-hundred-and-fifty patients aged =65-years, living at home and using =6 medicines were studied. RESULTS: 100% of patients (N = 75) in HUS and 99% in KUH (N = 75), had discrepancies in their admission-medication chart recorded by the nurse or physician. Associations between admission-diagnosis and drug-related problems were found in 12 patients (16%) in HUS and 22 patients (29%) in KUH. Of these, high-alert medications (e.g. antithrombotics, cytostatics, opioids) were linked to eight patients (11%) in HUS and six patients (8%) in KUH. Other acute DRPs were identified in 19 patients (25%) in HUS and 54 patients (72%) in KUH. Furthermore, 67 patients (89%) in HUS and all patients in KUH had non-acute DRPs. CONCLUSIONS: Medication reconciliation and review at admission of older ED patients requires improvement in Finland. ER - TY - JOUR T1 - Changes in gastrointestinal function attributed to aging A1 - Russell, R M Y1 - 1992/06// JF - The American Journal of Clinical Nutrition VL - 55 IS - 6 SP - 1203S EP - 1207S DO - 10.1093/ajcn/55.6.1203S UR - https://academic.oup.com/ajcn/article/55/6/1203S-1207S/4715439 ER - TY - JOUR T1 - Prescriptions for opioids and opioid-included polypharmacy: An analysis of the National Hospital Ambulatory Medical Care Survey. A1 - Rivera, Jessica C Y1 - 2020/// KW - Analgesics, Opioid KW - Emergency Service, Hospital KW - Health Care Surveys KW - Hospitals KW - Humans KW - Polypharmacy KW - Practice Patterns, Physicians' KW - Prescriptions KW - statistics & numerical data KW - therapeutic use JF - Journal of opioid management VL - 16 LA - eng IS - 5 SP - 329 EP - 339 DO - 10.5055/jom.2020.0588 N2 - OBJECTIVE: Opioid-associated complications are compounded by other concomitant drugs that affect the central nervous system (CNS). This analysis aims to describe opioid and CNS polypharmacy from a representative sample of emergency department (ED) encounters to identify patient- and facility-level characteristics associated with these prescription outcomes. DESIGN: Generalized linear regression multivariable modeling was used to test for associations between the prescrip-tion outcomes and individual and group level predictors. SETTING: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED encounters from 2006-2015 were analyzed. PARTICIPANTS: Survey entrants who received ED care within the above timeframe were analyzed. MAIN OUTCOMES: The primary outcomes were dichotomous variables of an opioid or CNS polypharmacy prescription. RESULTS: Twenty-five percent of encounters resulted in an opioid prescription plus another CNS medication prescription. Diagnoses of a blood disorder, musculoskeletal disorder or gastrointestinal disorder were associated with opioid prescription. Fifty-five percent of the presenting pain level treated with an opioid was reported as severe while 11 percent of opioid prescriptions were given to patients reporting no pain or mild pain. Non-Hispanic blacks had the lowest odds of receiving an opioid or CNS polypharmacy prescription compared to Non-Hispanic whites. Hospitals located within areas of increasing levels of poverty had decreasing odds of dispensing opioids following an ED encounter. CONCLUSION: Opioid prescriptions resulted from one-quarter of ED encounters despite the acute care setting of the ED and included 11 percent frequency of prescription for patients reporting no pain or mild pain. ER - TY - JOUR T1 - PATIENT-CONTROLLED ANALGESIA LEADS TO INCREASED HOSPITAL LENGTH OF STAY, GREATER TIME TO ORAL INTAKE, AND HIGHER RATES OF OUTPATIENT OPIOID USAGE COMPARED TO CONVENTIONAL IV PUSH ADMINISTRATION IN ACUTE PANCREATITIS A1 - Reddy, S A1 - Smith, G R A1 - Samuel, K A1 - Lou, C A1 - Kwasny, M A1 - Komanduri, S Y1 - 2020/// KW - ICD-10 KW - ICD-9 KW - acute pancreatitis KW - adult KW - adverse drug reaction KW - chronic pancreatitis KW - clinical trial KW - conference abstract KW - data warehouse KW - demography KW - drug therapy KW - feeding KW - female KW - hospital readmission KW - human KW - ileus KW - least square analysis KW - length of stay KW - major clinical study KW - male KW - mental health KW - naloxone KW - opiate KW - opioid induced constipation KW - outpatient KW - patient controlled analgesia KW - race KW - randomized controlled trial KW - respiration depression KW - retrospective study KW - side effect KW - tertiary care center JF - Gastroenterology VL - 158 LA - English IS - 6 SP - S EP - 332-S-333 DO - 10.1016/S0016-5085(20)31527-4 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005914619&from=export UR - http://dx.doi.org/10.1016/S0016-5085(20)31527-4 N2 - Introduction: The optimal method of analgesia for patients with acute pancreatitis (AP) is unclear. Patient-controlled analgesia (PCA) is often preferred by patients as it offers rapid titration of doses to manage varying levels of pain. However, there is a paucity of evidence defining the outcomes and safety of PCA compared to conventional IV “Push” (IVP) opioid administration in the setting of AP. Methods: We performed a retrospective study of patients admitted to a single tertiary care center between 2008-2018. Patients with AP were identified through our institution’s Enterprise Data Warehouse using ICD-9 and ICD-10 codes. All patients admitted with a diagnosis of AP were initially included. Exclusion criteria included history of chronic pancreatitis, direct admission to the ICU, and opioid use six months prior to their admission. Baseline demographics including etiology of AP, severity, and method of opioid delivery were recorded. Primary endpoints included length of stay (LOS), readmission rates, and subsequent outpatient opioid use. Secondary endpoints included time to oral intake and adverse drug events. Data was analyzed using General Linear Mixed Models with links corresponding to the distribution of outcomes. Results: A total of 763 patients with AP were identified (116 receiving PCA and 647 patients receiving IVP analgesia). There was no significant difference in age, sex, race, or etiology between the two groups but patients who received PCA had greater disease severity (p<0.001, Table 1). Patients receiving PCA had increased LOS compared with patients receiving IVP (least-squares mean of 9.9 days [95% CI: 8.7-11.3] vs. 6.4 days [95% CI: 5.7-7.1], respectively; p<0.001, Table 2). In addition, patients within the PCA group took longer to transition to oral opioids (least-squares mean of 6.8 days [95% CI: 5.9-7.9] vs. 4.1 days [95% CI: 3.6-4.6], respectively; p<0.001), had a greater time to oral feeding (6.3 days [95% CI: 5.5-7.3] vs. 3.5 days [95% CI: 3.1-3.9]; p<0.001), and required opioids upon discharge more often (OR: 2.7; 95% CI: 1.6-4.3) compared with patients receiving IVP despite disease severity. While altered mental status (OR: 5.9; 95% CI: 2.1-16.7) and opioid-induced constipation/ileus (OR: 3.2; 95% CI: 1.8-5.8) occurred more often with PCA, there were no differences in readmission rates (OR: 1.4; 95% CI: 0.88-2.2), respiratory depression (OR: 1.4; 95% CI: 0.44-4.5), or naloxone usage (OR: 1.3; 95% CI: 0.76-2.1). Conclusion: In the setting of AP, the use of PCA resulted in increased LOS, longer time to oral intake, greater outpatient opioid use, and higher rates of adverse drug events independent of disease severity suggesting that traditional IVP opioid administration may be optimal. Future randomized controlled trials comparing IVP and PCA are needed to identify the most effective method of opioid administration in AP. ER - TY - JOUR T1 - Comparison of effects of intraoperative and postoperative methadone: acute tolerance to the postoperative dose? A1 - Porter, E J A1 - McQuay, H J A1 - Bullingham, R E A1 - Weir, L A1 - Allen, M C A1 - Moore, R A Y1 - 1983/04// KW - Adult KW - Aged KW - Anesthesia, Intravenous KW - Drug Tolerance KW - Female KW - Hip Prosthesis KW - Humans KW - Infusions, Parenteral KW - Intraoperative Period KW - Male KW - Methadone KW - Middle Aged KW - Pain, Postoperative KW - Postoperative Period KW - Respiration KW - administration & dosage KW - blood KW - drug effects KW - drug therapy KW - therapeutic use JF - British journal of anaesthesia VL - 55 LA - eng IS - 4 SP - 325 EP - 332 DO - 10.1093/bja/55.4.325 N2 - The effects of methadone 10 mg administered in two different clinical contexts, at induction of anaesthesia and following operation, were studied in two groups of patients undergoing elective total hip replacement. The intraoperative group received methadone 10 mg i.v. at induction of anaesthesia as part of a balanced anaesthetic technique. The postoperative group received methadone 10 mg i.v. following operation, extradural bupivacaine being used for the operative period. A demand analgesia system delivering methadone i.v. was used after operation in both groups. Arterial blood-gas tensions, cortisol and glucose concentrations, analgesic effects and plasma methadone concentrations were compared in the two groups. The only major difference between the two groups was in analgesic requirement. At the time of connection to the demand system the two groups had the same plasma methadone concentrations. Subsequently, the postoperative group had a significantly greater analgesic requirement which resulted in significantly greater plasma methadone concentrations the following morning. Thus, the administration of methadone following operation appeared to exert less analgesic effect than the same dose given during operation. The reasons for this are discussed. ER - TY - JOUR T1 - An update on oxycodone: lessons for death investigators in Australia. A1 - Pilgrim, Jennifer L A1 - Yafistham, Sabrina Putrianita A1 - Gaya, Sanjeev A1 - Saar, Eva A1 - Drummer, Olaf H Y1 - 2015/03// KW - Adolescent KW - Adult KW - Age Factors KW - Aged KW - Analgesics, Opioid KW - Australia KW - Autopsy KW - Cause of Death KW - Child KW - Child, Preschool KW - Comorbidity KW - Databases, Factual KW - Drug Interactions KW - Drug Overdose KW - Female KW - Forensic Toxicology KW - Humans KW - Inappropriate Prescribing KW - Infant KW - Infant, Newborn KW - Male KW - Middle Aged KW - Opioid-Related Disorders KW - Oxycodone KW - Practice Patterns, Physicians' KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - Time Factors KW - Young Adult KW - adverse effects KW - diagnosis KW - epidemiology KW - methods KW - mortality JF - Forensic science, medicine, and pathology VL - 11 LA - eng IS - 1 SP - 3 EP - 12 DO - 10.1007/s12024-014-9624-x N2 - Oxycodone is one of the most abused prescription drugs. Iatrogenic factors that lead to oxycodone-related death, such as mis-prescribing, present an opportunity for death prevention if identified early. This study investigated deaths involving oxycodone in Australia to explore potentially inappropriate prescribing and the coroner's investigation. The National Coronial Information System identified cases from 2001 to 2011 where oxycodone was detected by toxicological analysis. There were 806 oxycodone-related deaths, with a significant increase in the 11-year period, from 21 deaths in 2001, up almost sevenfold in 2011 (139 deaths). Most deaths were caused by combined drug toxicity (63.4%) or oxycodone toxicity alone (11.8%). Most individuals were male (59.1%), aged 35-44 years (26.7%), who died unintentionally (56.4%), with mental illness (52.1%) and/or a history of acute or chronic pain (46.2%). 312 cases (39%) described a legitimate prescription for oxycodone, of which most involved non-cancer related chronic pain. About three quarters of the indications were deemed appropriate. There were at least 43 different indications treated with oxycodone that were inappropriate. The majority of oxycodone-related cases involved minor to no description of the drugs involved (n = 600; 74.4%). A moderate description of oxycodone involvement was given in 162 cases (20.1%), while only 44 cases (5.5%) involved a thorough examination and recommendations from the coroners on oxycodone and other drugs involved in death. This study emphasized the need for medical practitioners to exercise caution when prescribing oxycodone and for coroners to provide more consistent and detailed information regarding drug use, in order to identify and implement preventive strategies. ER - TY - CHAP T1 - 2017 Guidance for the Conduct of JBI Scoping Reviews A1 - Peters, Micah A1 - Godfrey, Christina A1 - Khalil, Hanan A1 - Mcinerney, Patricia A1 - Soares, Cassia A1 - Parker, Deborah Y1 - 2017/09// N2 - The Chapter is freely available at: https://reviewersmanual.joannabriggs.org/display/MANUAL/Chapter+11%3A+Scoping+reviews Evidence-based practice is an expanding field and together with a rapid increase in the availability of primary research, the conduct of reviews has also escalated. Different forms of evidence and different kinds of review objectives and questions call for the development of new approaches that are designed to more effectively and rigorously synthesize the evidence. In 2009 Grant and Booth identified 14 different types of reviews (Grant and Booth, 2009). Scoping reviews, also called “mapping reviews” or “scoping studies” are one of these (Ehrich et al. 2002; Anderson et al. 2008). In 2005 Arksey and O’Malley proposed a framework for conducting them (Arksey and O’Malley, 2005). The Arksey and O’Malley framework was advanced and extended in 2010 by Levac, Colquhoun and O’Brien (2010) and then further refined and corresponding guidance developed by the present authors (Peters et al. 2015). ER - TY - JOUR T1 - Opioids and the Management of Chronic Severe Pain in the Elderly : Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids Morphine , Oxycodone ) A1 - Pergolizzi, Joseph A1 - Böger, Rainer H A1 - Budd, Keith A1 - Dahan, Albert A1 - Erdine, Serdar A1 - Hans, Guy A1 - Kress, Hans-georg A1 - Langford, Richard A1 - Likar, Rudolf A1 - Raffa, Robert B A1 - Sacerdote, Paola Y1 - 2008/// VL - 8 IS - 4 SP - 287 EP - 313 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Pergolizzi et al. - 2008 - Opioids and the Management of Chronic Severe Pain in the Elderly Consensus Statement of an International Exp.pdf ER - TY - JOUR T1 - Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain. A1 - Patel, Pina M A1 - Goodman, Lauren F A1 - Knepel, Sheri A A1 - Miller, Charles C A1 - Azimi, Asma A1 - Phillips, Gary A1 - Gustin, Jillian L A1 - Hartman, Amber Y1 - 2017/10// KW - Acute Pain KW - Adult KW - Aged KW - Aged, 80 and over KW - Analgesics, Opioid KW - Cancer Pain KW - Drug Tolerance KW - Emergency Medical Services KW - Emergency Service, Hospital KW - Female KW - Humans KW - Likelihood Functions KW - Logistic Models KW - Male KW - Middle Aged KW - Pain Management KW - Palliative Care KW - Retrospective Studies KW - administration & dosage KW - drug therapy KW - therapeutic use JF - Journal of pain and symptom management VL - 54 LA - eng IS - 4 SP - 501 EP - 507 DO - 10.1016/j.jpainsymman.2017.07.013 N2 - CONTEXT: There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. OBJECTIVES: To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use. METHODS: We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated. RESULTS: Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001). CONCLUSIONS: Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated. ER - TY - JOUR T1 - Intraoperative loading attenuates nausea and vomiting of tramadol patient‐controlled analgesia.(Show‐Chwan Memorial Hospital, Changhua, Taiwan) Can J Anaesth A1 - Pang, WW A1 - Mok, MS A1 - Huang, S A1 - …, CP Hung - Pain A1 - 2001, undefined JF - Wiley Online Library UR - https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1533-2500.2001.001002203.x ER - TY - RPRT T1 - Acute pain in the elderly: Management options A1 - Nuevo, Florian R Y1 - 2004/// KW - acute postoperative pain KW - epidural analgesia KW - geriatric pain KW - patient-controlled JF - Geriatrics and Gerontology International SP - 243 EP - 244 SN - 9780199234721 DO - 10.1093/med/9780199234721.001.0001 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Nuevo - 2004 - Acute pain in the elderly Management options.pdf ER - TY - JOUR T1 - Opioid Therapy in Acute and Chronic Pain. A1 - Nafziger, Anne N A1 - Barkin, Robert L Y1 - 2018/09// KW - Acute Pain KW - Analgesics, Opioid KW - Chronic Pain KW - Decision Making KW - Drug Tolerance KW - Humans KW - Medication Adherence KW - Opioid-Related Disorders KW - Substance Withdrawal Syndrome KW - Substance-Related Disorders KW - administration & dosage KW - drug therapy KW - pharmacokinetics KW - therapeutic use JF - Journal of clinical pharmacology VL - 58 LA - eng IS - 9 SP - 1111 EP - 1122 DO - 10.1002/jcph.1276 N2 - This is an article in the Core Entrustables in Clinical Pharmacology series that describes opioid therapy in acute and chronic pain. Opioid use during surgical procedures or anesthesia is not discussed. Basic pharmacokinetic and pharmacodynamic properties of opioids are reviewed. The safe and effective use of opioids, including clinical assessment and treatment plan, equianalgesic dosing, opioid rotation, opioid risks and side effects, and clinical adherence monitoring are discussed. Individualized opioid use can be a safe and effective component of a patient-specific multimodal treatment plan for acute or chronic pain. Adverse effects and risks can be prevented or effectively managed when anticipated and recognized. The article is followed by 4 clinical vignettes with discussions. ER - TY - JOUR T1 - Comparative Rates of Mortality and Serious Adverse Effects Among Commonly Prescribed Opioid Analgesics A1 - Murphy, David L A1 - Lebin, Jacob A A1 - Severtson, Stevan G A1 - Olsen, Heather A A1 - Dasgupta, Nabarun A1 - Dart, Richard C Y1 - 2018/// PB - Springer International Publishing JF - Drug Safety DO - 10.1007/s40264-018-0660-4 UR - https://doi.org/10.1007/s40264-018-0660-4 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Murphy et al. - 2018 - Comparative Rates of Mortality and Serious Adverse Effects Among Commonly Prescribed Opioid Analgesics.pdf ER - TY - JOUR T1 - Opiod induced bowel dysfunction in acute pain; oral oxycodone versus IV morphine observational study; cost and incidence of side effects A1 - Mubarak, M A1 - Gopal, H A1 - Fitzgerald, J Y1 - 2012/// KW - analgesia KW - anesthesiology KW - antiemetic agent KW - clinical audit KW - constipation KW - cost of illness KW - decision making KW - defecation KW - diclofenac KW - gastroesophageal reflux KW - general anesthesia KW - human KW - intestine KW - intestine function KW - lactulose KW - laxative KW - morphine KW - observational study KW - ondansetron KW - opiate KW - oxycodone KW - pain KW - paracetamol KW - patient KW - postoperative nausea and vomiting KW - postoperative pain KW - procedures KW - prospective study KW - questionnaire KW - side effect KW - tablet JF - European Journal of Anaesthesiology VL - 29 LA - English SP - 208 EP - 209 CY - M. Mubarak, St James's University Hospital, Department of Anaesthesiology and Intensive Care, Dublin, Ireland UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71084682&from=export N2 - Background: Opioid-induced bowel dysfunction (OBD) is a common problem associated with the use of opioids for pain management. Symptoms of OBD include constipation and gastroesophageal reflux. The most common and debilitating of these symptoms is constipation. Aim: The Bowel Function Index (BFI) is a clinician-administered, patient-reported, 3-item questionnaire to evaluate opioid-induced constipation in acute pain pts. The aim of this audit is to compare the severity of OBD in oxynorm group versus the morphine one. Materials and Methods: A prospective study was conducted on 53 pts undergoing elective gynaecological procedures. we compared 25 pts using PCA morphine (30-140 mg) versus 28 pts using oral oxynorm (30-150 mg) regarding bowel dysfunction. The targeted Numerical Analogue Score was 0 to 2. BFI (numerical analogue scale 0 -100), calculated as the mean of three variables (ease of defaecation, feeling of incomplete bowel evacuation, and personal judgement of constipation) was used to evaluate bowel function in our cohort of pts with postoperative pain. All patients received standered general anaesthesia and postoperative paracetamol and diclofenac. Rescue laxatives (lactulose) and antiemetics (ondansetron) were used when required. Results and Discussion: Demographic data were comparable between both gps. In Morphine gp, 66.7% had PONV versus 42.8% in Oxynorm gp.There was no significant difference in the BFI (P 0.121) between our gps. Rescue laxative use and antiemetics were similar in both gps (p 0.298, 0.128). respectively). Opioids are often reduced in dosage or even discontinued as a result of impaired bowel function, leading to insufficient pain treatment.The total monthly cost per patient (pt) with severe constipation is significantly higher than cost for pt with no constipation (1525 vs1034). Morphine has been used as the standard opiod for many years. The recently emerged more expensive Oxycodone group is claimed to be better in terms of analgesia and side effects Conclusion(s): We did not find a significant difference in the incidence of Opioid Induced Constipation( OIC) between morphine and Oxycodone.There is an urgent need for more studies looking at cost of illness with OIC and to investigate the role of oral oxycodone/naloxone PR tablets in improving OBD. ER - TY - JOUR T1 - A review of opioid prescription in a teaching hospital in Colombia A1 - Moyano, Jairo A1 - Figuera, Albert Y1 - 2012/// KW - drug utilization KW - hydromorphone KW - morphine KW - pain KW - pethidine KW - tramadol JF - Journal of Pain Research IS - 5 SP - 237 EP - 242 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Press - 2012 - A review of opioid prescription in a teaching hospital in Colombia.pdf ER - TY - JOUR T1 - The Medical Consumption of Opioids in Colombia, 1997-2007 A1 - Moyano, Jairo Ricardo A1 - Figuers, Albert Y1 - 2010/// KW - availability KW - colombia KW - defined daily dose KW - opioids JF - Journal of Pain & Palliative Care Pharmacotherapy IS - 24 SP - 367 EP - 373 DO - 10.3109/15360288.2010.523067 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Moyano, Figuers - 2010 - The Medical Consumption of Opioids in Colombia, 1997-2007.pdf ER - TY - JOUR T1 - Medication errors involving intravenous patient-controlled analgesia: results from the 2005-2015 MEDMARX database. A1 - Mohanty, Maitreyee A1 - Lawal, Oluwadolapo D A1 - Skeer, Margie A1 - Lanier, Ryan A1 - Erpelding, Nathalie A1 - Katz, Nathaniel Y1 - 2018/08// JF - Therapeutic advances in drug safety VL - 9 LA - eng IS - 8 SP - 389 EP - 404 DO - 10.1177/2042098618773013 N2 - BACKGROUND: The aim of this study was to determine the current magnitude and characteristics of intravenous patient-controlled analgesia (IV-PCA) errors, and to identify opportunities for improving the PCA modality. METHODS: We conducted a descriptive analysis of IV-PCA medication errors submitted to the MEDMARX database. Events were restricted to those occurring in inpatient hospital settings between 1 January 2005 and 31 December 2015. IV-PCA errors were classified by error category, cause of error, error type, level of care rendered, and actions taken. RESULTS: A total of 1948 IV-PCA errors were identified as potential errors (3.9%), nonharmful errors (89.5%), or harmful errors (6.7%) based on the National Coordinating Council for Medication Error Reporting and Prevention taxonomy for categorizing medication errors. Of these, 19.1% required a clinical intervention to address the deleterious effects of the error, indicating an underestimation of the risks associated with IV-PCA errors. The most frequent types of errors were improper dose/quantity (43.2%) and omission errors (19.9%). While human performance deficit was the leading cause of error (50.2%), other common causes included failure to follow procedure and protocol (42.2%) and improper use of the pump (22.7%). Although remedial actions were often taken to prevent error recurrence, actions were taken to rectify the systemic deficits that led to errors in only a minority of cases (11.8%). CONCLUSION: Preventable errors continue to pose unnecessary risks to patients receiving IV-PCA. Multimodal analgesic regimens and novel PCA systems that reduce human error are needed to prevent errors while preserving the advantages of PCA for the management of acute pain. ER - TY - JOUR T1 - Safety and tolerability of fentanyl iontophoretic transdermal system: Findings from a pooled data analysis of four clinical trials A1 - Minkowitz, Harold S. A1 - Yarmush, Joel A1 - Donnell, Malcolm T. A1 - Tonner, Peter H. A1 - Damaraju, C. V. A1 - Skowronski, Roman J. Y1 - 2010/05// KW - Fentanyl ITS KW - Pain management KW - Patient-controlled analgesia KW - Postoperative KW - Tolerability PB - J Opioid Manag JF - Journal of Opioid Management VL - 6 IS - 3 SP - 203 EP - 210 DO - 10.5055/jom.2010.0018 UR - https://pubmed.ncbi.nlm.nih.gov/20642249/ N2 - Acute postoperative pain remains inadequately managed. Although patient-controlled analgesia (PCA) represents a significant advance in postoperative pain management, drawbacks may include invasiveness and the potential for programming errors. The analysis presented here is based on pooled patient-level safety data from four multicenter, randomized, active-controlled trials that evaluated the safety and tolerability of the needle-free, preprogrammed fentanyl HCl iontophoretic transdermal system (ITS) versus morphine intravenous PCA for postoperative pain management; the results for patients who received fentanyl ITS are presented here. Adverse events (AEs), serious AEs, and clinically relevant respiratory depression were assessed across patient subpopulations categorized by age. A total of 1,288 patients, including 356 elderly (>65 years of age) patients, received fentanyl ITS following surgery. The most commonly reported AEs included nausea, fever, vomiting, headache, anemia, pruritus, and hypotension. The incidence of AEs was generally lower for elderly patients than for patients 65 years or younger. Application-site reactions were reported for 18.6 percent of patients using fentanyl ITS and were generally mild to moderate in severity. No cases of clinically relevant respiratory depression were reported for patients who received fentanyl ITS. The results demonstrate that fentanyl ITS is safe and well tolerated for postoperative pain management for patients overall and for subpopulations divided according to age. © 2010 Journal of Opioid Management, All Rights Reserved. ER - TY - JOUR T1 - Consumo de opioides en pacientes hospitalizados en un centro oncológico A1 - Milena, Ana A1 - Portillo, Antolinez A1 - Pablo, Pedro A1 - Sánchez, Pérez A1 - Margarita, Bilena A1 - Arteta, Molina A1 - López, David Y1 - 2017/// JF - Revista Colombiana de Cancerología VL - 21 IS - 4 SP - 194 EP - 201 ER - TY - JOUR T1 - Anticipating and Managing Opioid Side A1 - Martin, Caren Mchenry A1 - Forrester, Charles Samuel Y1 - 2013/// KW - abbreviations KW - adverse effect KW - ae KW - ags KW - american geriatrics society KW - beers criteria KW - central nervous system KW - chemoreceptor KW - cns KW - constipation KW - ctz KW - delirium KW - elderly KW - gastrointestinal KW - gi KW - medication KW - myoclonus KW - nausea KW - neurotoxicity KW - opioid KW - pain KW - receptor KW - respiratory depression KW - sedation KW - side effect KW - trigger zone KW - vomiting JF - The Consultatnt Pharmacist VL - 28 IS - 3 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Martin, Forrester - 2013 - Anticipating and Managing Opioid Side.pdf ER - TY - JOUR T1 - Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications A1 - Mangoni, A A1 - Jackson, S H D Y1 - 2003/// KW - ageing KW - pharmacodynamics KW - pharmacokinetics JF - British Journal of Clinical Pharmacology VL - 57 IS - 1 SP - 6 EP - 14 DO - 10.1046/j.1365-2125.2003.02007.x UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884408/pdf/bcp0057-0006.pdf L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Mangoni, D Jackson, Mangoni - 1365 - related changes in pharmacokinetics and pharmacodynamicsA Age-related changes in pharmacokinetics a.pdf ER - TY - JOUR T1 - Management of Opioid-Tolerant Patients with Acute Pain: Approaching the Challenges. A1 - Macintyre, Pamela E A1 - Roberts, Lindy J A1 - Huxtable, Christine A Y1 - 2020/01// KW - Acute Pain KW - Analgesics KW - Analgesics, Opioid KW - Animals KW - Drug Tolerance KW - Fentanyl KW - Humans KW - Pain Measurement KW - Preoperative Care KW - administration & dosage KW - adverse effects KW - drug therapy KW - methods JF - Drugs VL - 80 LA - eng IS - 1 SP - 9 EP - 21 DO - 10.1007/s40265-019-01236-4 N2 - For over two decades, dramatic increases in opioid prescriptions in the developed world, especially for long-term management of chronic noncancer pain, were accompanied by increases in patient harm. In recent years in the USA, opioid-related deaths rates have continued to increase despite falls in prescribing rates and deaths associated with prescription opioids. In large part, this is attributed to the growing availability of illicitly manufactured fentanyl. Increased opioid use, for medical and nonmedical reasons, has led to more opioid-tolerant patients requiring management of acute pain. The potential harms associated with long-term opioid use are now well known. What may be less well understood is that preoperative long-term opioid use is associated with increased perioperative complications including infection, readmissions, and greater healthcare utilisation and costs. Minimizing opioid use prior to surgery is a modifiable risk factor that could benefit both patient and healthcare system. Management of acute pain should include simple analgesics and adjuvants, with short-term opioid dose increases if needed and use of non-pharmacological strategies. Reported pain intensities may be high and titration of analgesia to function rather than pain scores is appropriate. Importantly, compared with opioid-naïve patients, opioid-tolerant patients may be at higher risk of opioid-induced ventilatory impairment when additional opioids are administered to manage new acute pain. For some patients, perioperative care may be best coordinated by a perioperative or post-discharge service with referral to multidisciplinary pain and addiction medicine services as indicated. Carefully planned and communicated discharge prescribing, with a weaning plan for additional opioids, is essential. ER - TY - JOUR T1 - Opioid Prescribing Patterns and Costs in a Large Group of Patients in Colombia A1 - Machado-alba, Jorge Enrique A1 - Gaviria-mendoza, Andres A1 - Vargas-, Camila A A1 - Gil-restrepo, Andrés Felipe A1 - Romero-zapata, Luis C A1 - Enrique, Jorge A1 - Gaviria-mendoza, Andres A1 - Vargas-, Camila A A1 - Machado-alba, Jorge Enrique A1 - Gaviria-mendoza, Andres A1 - Vargas-mosquera, Camila A A1 - Gil-restrepo, Andrés Felipe A1 - Romero-zapata, Luis C Y1 - 2017/// KW - chronic pain KW - drug KW - drug prescriptions KW - inappropriate KW - opioid analgesics KW - prescribing KW - prescriptions PB - Taylor & Francis JF - Journal of Pain & Palliative Care Pharmacotherapy VL - 31 IS - 1 SP - 57 EP - 65 DO - 10.1080/15360288.2016.1276504 UR - http://dx.doi.org/10.1080/15360288.2016.1276504 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Machado-alba et al. - 2017 - Opioid Prescribing Patterns and Costs in a Large Group of Patients in Colombia.pdf ER - TY - JOUR T1 - Can large surveys conducted on highly selected populations provide valid information on the epidemiology of common health conditions ? An analysis of UK Biobank data on musculoskeletal pain A1 - Macfarlane, Gary J A1 - Beasley, Marcus A1 - Smith, Blair H A1 - Jones, Gareth T A1 - Macfarlane, Tatiana V Y1 - 2015/// SN - 2049463715 DO - 10.1177/2049463715569806 ER - TY - JOUR T1 - The epidemiology of chronic pain A1 - Macfarlane, Gary J Y1 - 2016/// VL - 157 SP - 2158 EP - 2159 SN - 0000000000000 ER - TY - JOUR T1 - The United States opioid epidemic A1 - Lyden, Jennifer A1 - Binswanger, Ingrid A KW - Epidemiology KW - Opioids KW - Overdose DO - 10.1053/j.semperi.2019.01.001 N2 - The United States opioid epidemic is a nationwide public health crisis. Initially driven by increased consumption and availability of pharmaceutical opioids, an increasing number of opioid overdoses are now related to heroin and illicitly manufactured fentanyl and fentanyl analogs. Addressing this epidemic requires addressing the stigma associated with opioid use disorders and its treatment, improving access to efficacious treatment options, specifically methadone and buprenorphine, and reducing opioid overdose fatalities with distribution of the opioid antagonist and overdose reversal agent naloxone. ER - TY - JOUR T1 - Physical activity and exercise for chronic pain in adults : an overview of Cochrane Reviews ( Review ) A1 - Lj, Geneen A1 - Ra, Moore A1 - Clarke, C A1 - Martin, D A1 - La, Colvin A1 - Bh, Smith Y1 - 2017/// IS - 4 DO - 10.1002/14651858.CD011279.pub3.www.cochranelibrary.com ER - TY - JOUR T1 - An audit of intrathecal morphine analgesia for non-obstetric postsurgical patients in an adult tertiary hospital. A1 - Lim, P C A1 - Macintyre, P E Y1 - 2006/12// KW - Adult KW - Aged KW - Analgesics, Opioid KW - Anesthesia, Spinal KW - Australia KW - Drug Tolerance KW - Female KW - Humans KW - Intensive Care Units KW - Male KW - Medical Audit KW - Middle Aged KW - Morphine KW - Pain, Postoperative KW - Respiration Disorders KW - Retrospective Studies KW - administration & dosage KW - adverse effects KW - chemically induced KW - etiology KW - prevention & control KW - statistics & numerical data JF - Anaesthesia and intensive care VL - 34 LA - eng IS - 6 SP - 776 EP - 781 DO - 10.1177/0310057X0603400601 N2 - We conducted a retrospective audit of adult non-obstetric patients who had received a single dose of intrathecal morphine for postoperative analgesia. These patients were predominantly admitted to a regular postsurgical ward with strict hourly nursing observations, treatment protocols in place and supervision by an Acute Pain Service for the first 24 hours after intrathecal morphine administration. A total of 409 cases were examined for sedation score, incidence of respiratory depression and other side-effects, admission to the high dependency or intensive care unit and opioid-tolerance. Respiratory depression was defined as requiring treatment with naloxone (implying a sedation score of 3 irrespective of respiratory rate), or a sedation score of 2 with a respiratory rate less than six breaths per minute. The patients were predominantly elderly (57.2% were over the age of 70 years) and 84.8% had undergone vascular surgery. Of the total of 409 cases, only one case of respiratory depression was observed. A total of 77 patients were admitted to high dependency or intensive care unit for various reasons including management of postsurgical complications and patient co-morbidities. Our findings suggest that elderly patients who receive intrathecal morphine analgesia can be safely managed in a regular postsurgical ward. ER - TY - JOUR T1 - Past, Present, and Future of Drug–Drug Interactions A1 - Levy, René H. A1 - Ragueneau-Majlessi, Isabelle Y1 - 2019/// JF - Clinical Pharmacology and Therapeutics VL - 105 IS - 6 SP - 1286 EP - 1288 DO - 10.1002/cpt.1349 ER - TY - JOUR T1 - Under Treatment of Pain : A Prescription for Opioid Misuse among the Elderly? A1 - Levi-minzi, Maria A A1 - Surratt, Hilary L A1 - Kurtz, Steven P A1 - Mance, E Y1 - 2013/// KW - older adults KW - opioids KW - pain management KW - substance abuse JF - Pain Medicine VL - 14 IS - 11 SP - 1 EP - 17 DO - 10.1111/pme.12189.Under L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Levi-minzi et al. - 2013 - Under Treatment of Pain A Prescription for Opioid Misuse among the Elderly.pdf ER - TY - GEN T1 - A comprehensive review of opioid-induced hyperalgesia A1 - Lee, Marion A1 - Silverman, Sanford A1 - Hansen, Hans A1 - Patel, Vikram A1 - Manchikanti, Laxmaiah Y1 - 2011/03// KW - Adverse events KW - Chronic opioid therapy KW - Opioid sensitivity KW - Opioid tolerance KW - Opioid-induced hyperalgesia PB - Pain Physician JF - Pain Physician VL - 14 IS - 2 SP - 145 EP - 161 UR - https://pubmed.ncbi.nlm.nih.gov/21412369/ N2 - Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli. The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain. OIH appears to be a distinct, definable, and characteristic phenomenon that could explain loss of opioid efficacy in some patients. Findings of the clinical prevalence of OIH are not available. However, several observational, cross-sectional, and prospective controlled trials have examined the expression and potential clinical significance of OIH in humans. Most studies have been conducted using several distinct cohorts and methodologies utilizing former opioid addicts on methadone maintenance therapy, perioperative exposure to opioids in patients undergoing surgery, and healthy human volunteers after acute opioid exposure using human experimental pain testing. The precise molecular mechanism of OIH, while not yet understood, varies substantially in the basic science literature, as well as clinical medicine. It is generally thought to result from neuroplastic changes in the peripheral and central nervous system (CNS) that lead to sensitization of pronociceptive pathways. While there are many proposed mechanisms for OIH, 5 mechanisms involving the central glutaminergic system, spinal dynorphins, descending facilitation, genetic mechanisms, and decreased reuptake and enhanced nociceptive response have been described as the important mechanisms. Of these, the central glutaminergic system is considered the most common possibility. Another is the hypothesis that N-methyl-D-aspartate (NMDA) receptors in OIH include activation, inhibition of the glutamate transporter system, facilitation of calcium regulated intracellular protein kinase C, and cross talk of neural mechanisms of pain and tolerance. Clinicians should suspect OIH when opioid treatment's effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages. The treatment involves reducing the opioid dosage, tapering them off, or supplementation with NMDA receptor modulators. This comprehensive review addresses terminology and definition, prevalence, the evidence for mechanism and physiology with analysis of various factors leading to OIH, and effective strategies for preventing, reversing, or managing OIH. ER - TY - RPRT T1 - Latin-American guidelines for opioid use in chronic nononcologic pain A1 - Lara-solares, Argelia A1 - Zamora, Carlos Aguayo A1 - García, César Amescua A1 - Batista, João A1 - Garcia, Santos A1 - Berenguel, Rosario A1 - Sierra, Patricia Bonilla A1 - Kraychete, Campos A1 - Alberto, José A1 - Cantisani, Flores A1 - Guerrero, Carlos Y1 - 2017/// JF - Pain Management VL - 7 SP - 207 EP - 215 ER - TY - JOUR T1 - Socio-economic differences in the prevalence of acute , chronic and disabling chronic pain among ageing employees A1 - Laaksonen, Mikko A1 - Lahelma, Eero Y1 - 2005/// VL - 114 SP - 364 EP - 371 DO - 10.1016/j.pain.2004.12.033 ER - TY - JOUR T1 - OI-B-2 A1 - Kuehn, TJ A1 - Nassif, A A1 - Oswald, S A1 - …, C Modess - CliniCal A1 - 2010, undefined JF - researchgate.net UR - https://www.researchgate.net/profile/Jeffrey_Anderson/publication/295133906_PREDICTION_OF_ANTI-TNF_RESPONSE_IN_INFLAMMATORY_BOWEL_DISEASE_IBD_PATIENTS_USING_A_HAPLOTYPE_TAG-SNP_htSNP_METHOD/links/56d85ac508aee73df6cab93b/PREDICTION-OF-ANTI-TNF-RESPONSE-IN-INFLAMMATORY-BOWEL-DISEASE-IBD-PATIENTS-USING-A-HAPLOTYPE-TAG-SNP-htSNP-METHOD.pdf ER - TY - JOUR T1 - Remifentanil-acute opioid tolerance and opioid-induced hyperalgesia: a systematic review. A1 - Kim, Sang Hun A1 - Stoicea, Nicoleta A1 - Soghomonyan, Suren A1 - Bergese, Sergio D Y1 - 2015/// KW - Acute Disease KW - Analgesics, Opioid KW - Drug Tolerance KW - Humans KW - Hyperalgesia KW - Pain Threshold KW - Piperidines KW - Remifentanil KW - adverse effects KW - chemically induced JF - American journal of therapeutics VL - 22 LA - eng IS - 3 SP - e62 EP - 74 DO - 10.1097/MJT.0000000000000019 N2 - The use of opioids may seem to be a double-edged sword; they provide straight analgesic and antihyperalgesic effects initially, but subsequently are associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) that have been reported in experimental studies and clinical observations. It has been suggested that opioids can induce an acute tolerance and hyperalgesia in dose- and/or time-dependent manners even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management in clinical anesthesia and in the intensive care units because of its rapid onset and offset. We reviewed articles analyzing AOT and/or OIH by remifentanil and focused on the following issues: (1) evidence of remifentanil inducing AOT and/or OIH and (2) importance of AOT and/or OIH in considering the reduction of remifentanil dosage or adopting preventive modulations. Twenty-four experimental and clinical studies were identified using electronic searches of MEDLINE (PubMed, Ovid, Springer, and Elsevier). However, the development of AOT and OIH by remifentanil administration remains controversial. There is no sufficient evidence to support or refute the existence of OIH in humans. ER - TY - JOUR T1 - High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study. A1 - Kim, Deokkyu A1 - Lim, Hyung-Sun A1 - Kim, Myung-Jong A1 - Jeong, WooJoo A1 - Ko, Seonghoon Y1 - 2018/12// KW - Adult KW - Aged KW - Analgesics, Opioid KW - Double-Blind Method KW - Drug Tolerance KW - Female KW - Fentanyl KW - Gastrectomy KW - Humans KW - Infusions, Intravenous KW - Male KW - Middle Aged KW - Pain, Postoperative KW - Postoperative Period KW - Prospective Studies KW - Remifentanil KW - administration & dosage KW - drug therapy KW - methods KW - therapeutic use JF - Journal of anesthesia VL - 32 LA - eng IS - 6 SP - 886 EP - 892 DO - 10.1007/s00540-018-2569-6 N2 - PURPOSE: The purpose of this study was to determine whether intraoperative infusion of remifentanil induces acute tolerance to opioids, and compare the postoperative pain and opioid consumption by the effect site concentrations of remifentanil. METHODS: One hundred and ninety-eight patients undergoing gastrectomy were randomly assigned to maintain target effect site concentrations of remifentanil at 0 (Group 1, n = 39), 2 (Group 2, n = 40), 4 (Group 3, n = 39), 8 (Group 4, n = 40), or 12 ng/ml (Group 5, n = 40) during operation. Postoperative pain intensities and fentanyl requirement were recorded at postoperative 2, 6, 24, and 48 h. RESULTS: Fentanyl requirement for postoperative 2 h was significantly greater in Group 5 compared to Group 1 (376 ± 116 vs. 283 ± 129 µg, P = 0.03). However, there were no differences in fentanyl requirements among the groups after postoperative 2 h. Also, total fentanyl consumption for 48 h was similar in all groups (Group 1; 3106 ± 629, Group 2; 2970 ± 705, Group 3; 3017 ± 555, Group 4; 3151 ± 606, and Group 5; 2984 ± 443 µg, P = 0.717). Pain scores at rest and during deep breathing were comparable in all groups at the time of each examination. CONCLUSION: Intraoperative infusion of remifentanil with 12 ng/ml of effect site concentration in patients undergoing gastrectomy increases early postoperative fentanyl requirement. Acute opioid tolerance would be developed by higher concentration of remifentanil than dosage of common anesthetic practice. ER - TY - JOUR T1 - Inappropriate opioid prescribing practices: A narrative review. A1 - Kim, Brian A1 - Nolan, Seonaid A1 - Beaulieu, Tara A1 - Shalansky, Stephen A1 - Ti, Lianping Y1 - 2019/08// KW - Analgesics, Opioid KW - Drug Prescriptions KW - Humans KW - Inappropriate Prescribing KW - Opioid-Related Disorders KW - Practice Patterns, Physicians' KW - adverse effects KW - etiology KW - prevention & control KW - statistics & numerical data JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VL - 76 LA - eng IS - 16 SP - 1231 EP - 1237 DO - 10.1093/ajhp/zxz092 N2 - PURPOSE: Results of a literature review to identify indicators of inappropriate opioid prescribing are presented. SUMMARY: While prescription opioids can be effective for the treatment of acute pain, inappropriate prescribing practices can increase the risk of opioid-related harms, including overdose and mortality. To date, little research has been conducted to determine how best to define inappropriate opioid prescribing. Five electronic databases were searched to identify studies (published from database inception to January 2017) that defined inappropriate opioid prescribing practices. Search terms varied slightly across databases but included opioid, analgesics, inappropriate prescribing, practice patterns, and prescription drug misuse. Gray literature and references of published literature reviews were manually searched to identify additional relevant articles. From among the 4,665 identified articles, 41 studies were selected for data extraction and analysis. Fourteen studies identified high-daily-dose opioid prescriptions, 14 studies identified coadministration of benzodiazepines and opioids, 10 studies identified inappropriate opioid prescribing in geriatric populations, 8 studies identified other patient-specific factors, 4 studies identified opioid prescribing for the wrong indication, and 4 studies identified factors such as initiation of long-acting opioids in opioid-naive patients as indicators of inappropriate opioid prescribing. CONCLUSION: A literature review identified various indicators of inappropriate opioid prescribing, including the prescribing of high daily doses of opioids, concurrent benzodiazepine administration, and geriatric-related indicators. Given the significant contribution of inappropriate opioid prescribing to opioid-related harms, identification of these criteria is important to inform and improve opioid prescribing practices among healthcare providers. ER - TY - JOUR T1 - Social risks for disabling pain in older people : A prospective study of individual and area characteristics A1 - Jordan, Kelvin P A1 - Thomas, Elaine A1 - Peat, George A1 - Wilkie, Ross A1 - Croft, Peter Y1 - 2008/// KW - cohort study KW - pain KW - residence characteristics KW - risk factors KW - social risks VL - 137 SP - 652 EP - 661 DO - 10.1016/j.pain.2008.02.030 ER - TY - JOUR T1 - Tobacco smoking in relation to pain in a national general population survey A1 - John, Ulrich A1 - Hanke, Monika A1 - Meyer, Christian A1 - Völzke, Henry A1 - Baumeister, Sebastian E A1 - Alte, Dietrich Y1 - 2006/// KW - general population KW - number of pain locations KW - pain intensity KW - smoking VL - 43 SP - 477 EP - 481 DO - 10.1016/j.ypmed.2006.07.005 ER - TY - JOUR T1 - Serotonin syndrome and opioids - What's the deal? A1 - Jhun, Paul A1 - Bright, Aaron A1 - Herbert, Mel Y1 - 2015/// PB - American College of Emergency Physicians JF - Annals of Emergency Medicine VL - 65 IS - 4 SP - 434 EP - 435 DO - 10.1016/j.annemergmed.2014.12.021 UR - http://dx.doi.org/10.1016/j.annemergmed.2014.12.021 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Jhun, Bright, Herbert - 2015 - Serotonin syndrome and opioids - What's the deal.pdf ER - TY - JOUR T1 - Potentially inappropriate medication related to weakness in older acute medical patients. A1 - Jensen, Line Due A1 - Andersen, Ove A1 - Hallin, Marianne A1 - Petersen, Janne Y1 - 2014/06// KW - Acute Disease KW - Aged KW - Aged, 80 and over KW - Cognition KW - Denmark KW - Female KW - Hand Strength KW - Hospitalization KW - Humans KW - Inappropriate Prescribing KW - Male KW - Muscle Weakness KW - Polypharmacy KW - Prevalence KW - Quality of Life KW - Socioeconomic Factors KW - epidemiology KW - statistics & numerical data JF - International journal of clinical pharmacy VL - 36 LA - eng IS - 3 SP - 570 EP - 580 DO - 10.1007/s11096-014-9940-y N2 - BACKGROUND: The use of potentially inappropriate medications (PIMs) is common in the older population. Inappropriate medications as well as polypharmacy expose older people to a greater risk of adverse drug reactions and may result in hospitalizations. OBJECTIVE: To evaluate the prevalence of PIMs among acutely hospitalized patients aged ≥65 years in an acute medical unit, and to investigate the relationship between use of PIMs and weakness. SETTING: This longitudinal observational study was undertaken in the Acute Medical Unit, Hvidovre Hospital, University of Copenhagen, Denmark. METHOD: Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included. Patients were interviewed at admission and at a follow-up visit 30 days after discharge. Data included information about medications, social status, functional status, cognitive status, handgrip strength, health-related quality of life, visual acuity, days of hospitalization, and comorbidities, and was prospectively collected. Polypharmacy was defined as regular use of 5 or more drugs. The Charlson Comorbidity Index was used to categorize comorbidities. MAIN OUTCOME MEASURE: The prevalence of PIMs and the association with PIMs and functional status handgrip strength, HRQOL, comorbidities, social demographic data and vision. RESULTS: Seventy-one patients (55 % men) with a median age of 78.7 years participated. The median number of medications was eight per person. Eighty percent were exposed to polypharmacy. PIMs were used by 85 % of patients, and PIMs were associated with low functional status (p = 0.032), low handgrip strength (p = 0.006), and reduced health-related quality of life (p = 0.005), but not comorbidities (p = 0.63), age (p = 0.60), sex (p = 0.53), education (p = 0.94), cognition (p = 0.10), pain (p = 0.46), or visual acuity (p = 0.55). CONCLUSIONS: Use of PIMs was very common among older people admitted to an acute medical unit. The use of PIMs is associated with low functional status, low handgrip strength, and reduced health-related quality of life. ER - TY - JOUR T1 - Racial and Socioeconomic Disparities in Disabling Chronic Pain: Findings from the Health and Retirement Study A1 - Janevic, Mary R A1 - Mclaughlin, Sara J A1 - Heapy, Alicia A A1 - Thacker, Casey A1 - Piette, John D Y1 - 2017/// PB - The American Pain Society JF - Journal of Pain DO - 10.1016/j.jpain.2017.07.005 UR - http://dx.doi.org/10.1016/j.jpain.2017.07.005 ER - TY - JOUR T1 - Use of Methadone to Reverse Opioid Escalation in a Patient With Surgical Pain. A1 - Jaffar, Muhammad A1 - Cunningham, Gwin A1 - Chandler, Michael A1 - Webb, Thomas Y1 - 2018/03// KW - Abdominal Pain KW - Acute Pain KW - Aged KW - Analgesics, Opioid KW - Dose-Response Relationship, Drug KW - Drug Tolerance KW - Humans KW - Male KW - Methadone KW - Pain, Postoperative KW - administration & dosage KW - adverse effects KW - drug therapy KW - etiology JF - Journal of pain & palliative care pharmacotherapy VL - 32 LA - eng IS - 1 SP - 10 EP - 14 DO - 10.1080/15360288.2018.1463344 N2 - Acute pain is a prevalent issue for patients recovering from surgical procedures. Methadone has been recognized as a unique option for treatment of surgical pain due to its multiple mechanisms of analgesia and its potential to decrease tolerance to other opioids. Studies of methadone use in postoperative settings are sparse in part due to safety concerns, such as complex pharmacokinetics, risk of respiratory depression, and association with arrhythmias. In this case study of a 70-year-old male with postsurgical abdominal pain, methadone utilization over a period of 9 days resulted in patient-reported analgesia and aided in de-escalating overall opioid use. More studies are needed to develop guidance on how methadone can be used to relieve pain following surgical procedures. ER - TY - JOUR T1 - A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Postoperative Analgesia: A Multicenter Study of Opioid-Induced Adverse Reactions A1 - Hutchison, Rob A1 - Chon, Eun Hae A1 - William Tucker, Jr A1 - Gilder, Richard A1 - Moss, Janet A1 - Daniel, Phyllis Y1 - 2010/// KW - Patient controlled analgesia KW - adverse reactions KW - fentanyl KW - hydromorphone KW - intravenous delivery KW - morphine JF - Hospital Pharmacy VL - 41 IS - 7 SP - 659 EP - 663 SN - 0022-3069 (Print)\n0022-3069 (Linking) DO - 10.1055/s-0029-1245435 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Hutchison et al. - 2010 - A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Post.pdf N2 - Toxoplasma gondii (T. gondii) is one of the most common opportunistic infections affecting the central nervous system (CNS) in AIDS patients. Disease results from a reactivation of a latent infection in the brain resulting in a severe and necrotizing encephalitis. In this study we infected a primary culture from human fetal brain with T. gondii and studied the behavior of both the active and latent stages in this culture system. We found that the active (tachyzoite) stage of T. gondii can infect both astrocytes and neurons. However, a higher percentage of astrocytes were infected than neurons. Additionally, astrocytes were found to support more replication of T. gondii than did neurons. Both astrocytes and neurons also supported the cyst stage, found in the latent infections. These data indicate that astrocytes are the host cells supporting most of the replication of T. gondii in the brain in reactivated infections, but both host cell types may be able to support the cyst stage in latent infections. However, evidence indicates that cysts formed in astrocytes may be distinct from neuronal cysts. These findings may have relevance to reactivation of latent T. gondii infections in AIDS patients. ER - TY - JOUR T1 - Polypharmacy among inpatients aged 70 years or older in Australia. A1 - Hubbard, Ruth E A1 - Peel, Nancye M A1 - Scott, Ian A A1 - Martin, Jennifer H A1 - Smith, Alesha A1 - Pillans, Peter I A1 - Poudel, Arjun A1 - Gray, Leonard C Y1 - 2015/04// KW - Aged KW - Aged, 80 and over KW - Australia KW - Female KW - Health Status Indicators KW - Hospitalization KW - Humans KW - Male KW - Odds Ratio KW - Patient Admission KW - Patient Discharge KW - Polypharmacy KW - Prospective Studies JF - The Medical journal of Australia VL - 202 LA - eng IS - 7 SP - 373 EP - 377 DO - 10.5694/mja13.00172 N2 - OBJECTIVES: To investigate medication changes for older patients admitted to hospital and to explore associations between patient characteristics and polypharmacy. DESIGN: Prospective cohort study. PARTICIPANTS AND SETTING: Patients aged 70 years or older admitted to general medical units of 11 acute care hospitals in two Australian states between July 2005 and May 2010. All patients were assessed using the interRAI assessment system for acute care. MAIN OUTCOME MEASURES: Measures of physical, cognitive and psychosocial functioning; and number of regular prescribed medications categorised into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and hyperpolypharmacy (≥ 10 drugs). RESULTS: Of 1220 patients who were recruited for the study, medication records at admission were available for 1216. Mean age was 81.3 years (SD, 6.8 years), and 659 patients (54.2%) were women. For the 1187 patients with complete medication records on admission and discharge, there was a small but statistically significant increase in mean number of regular medications per day between admission and discharge (7.1 v 7.6), while the prevalence of medications such as statins (459 [38.7%] v 457 [38.5%] patients), opioid analgesics (155 [13.1%] v 166 [14.0%] patients), antipsychotics (59 [5.0%] v 65 [5.5%] patients) and benzodiazepines (122 [10.3%] v 135 [11.4%] patients) did not change significantly. Being in a higher polypharmacy category was significantly associated with increase in comorbidities (odds ratio [OR], 1.27; 95% CI, 1.20-1.34), presence of pain (OR, 1.31; 1.05-1.64), dyspnoea (OR, 1.64; 1.30-2.07) and dependence in terms of instrumental activities of daily living (OR, 1.70; 1.20-2.41). Hyperpolypharmacy was observed in 290/1216 patients (23.8%) at admission and 336/1187 patients (28.3%) on discharge, and the proportion of preventive medication in the hyperpolypharmacy category at both points in time remained high (1209/3371 [35.9%] at admission v 1508/4117 [36.6%] at discharge). CONCLUSIONS: Polypharmacy is common among older people admitted to general medical units of Australian hospitals, with no clinically meaningful change to the number or classification (symptom control, prevention or both) of drugs made by treating physicians. ER - TY - JOUR T1 - Prescribing opioids in older people A1 - Huang, Allen R. A1 - Mallet, Louise Y1 - 2013/// KW - Analgesics KW - Elderly KW - Frail KW - Older adults KW - Older people KW - Older persons KW - Opiate KW - Opioids KW - Side-effects PB - Elsevier Ireland Ltd JF - Maturitas VL - 74 IS - 2 SP - 123 EP - 129 SN - 1873-4111 (Electronic)\r0378-5122 (Linking) DO - 10.1016/j.maturitas.2012.11.002 UR - http://dx.doi.org/10.1016/j.maturitas.2012.11.002 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Huang, Mallet - 2013 - Prescribing opioids in older people.pdf N2 - People are living to older age. Demographic pressures are driving change. Opiate analgesics are the most powerful known pain relievers. Persistent pain, both cancer and non-cancer types is frequent in older adults. The use of opioid analgesics is appropriate in the treatment of moderate to severe persistent pain. The challenge of prescribing opioids in older adults is to understand the factors involved in making appropriate choices and monitoring the beneficial effects of pain relief while managing the side-effects. This article will review the current concepts, evidence and controversies surrounding opiate use in the elderly. An approach is outlined which involves: pain assessment, screening for substance abuse potential, deciding whether you are able to treat your patient without help, starting treatment, monitoring effectiveness of pain control and managing opioid-Associated side-effects. The goal of pain management using opioids is the attainment of improved function and quality of life. © 2012 Elsevier Ireland Ltd. ER - TY - JOUR T1 - Opioid analgesic prescribing in Australia: a focus on gender and age. A1 - Hollingworth, Samantha A A1 - Gray, Paul D A1 - Hall, Wayne D A1 - Najman, Jake M Y1 - 2015/06// KW - Adolescent KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Analgesics, Opioid KW - Australia KW - Child KW - Databases, Factual KW - Female KW - Humans KW - Inappropriate Prescribing KW - Male KW - Middle Aged KW - Practice Patterns, Physicians' KW - Sex Factors KW - Young Adult KW - epidemiology KW - prevention & control KW - statistics & numerical data KW - therapeutic use JF - Pharmacoepidemiology and drug safety VL - 24 LA - eng IS - 6 SP - 628 EP - 636 DO - 10.1002/pds.3767 N2 - PURPOSE: The use of prescription opioid analgesics has been increasing over the last few decades in Australia. In particular, oxycodone and fentanyl have increased substantially. We examined the gender and age trends in the prescribing of subsidised opioid analgesics in the Australian population for non-palliative care indications. METHODS: We analysed the Medicare Australia and Drug Utilisation Sub-Committee databases for prescription data from 2002 to 2009 in 10-year age groups and by gender. Prescriptions were converted to Defined Daily Doses (DDD)/1000/day using Australian Bureau of Statistics population data. RESULTS: Overall use increased progressively in 2002-2009 from 12.95 to 16.08 DDD/1000 population/day (average annual increase 3.4%). Codeine was the most widely used agent followed by tramadol then oxycodone. Dispensed use increased in those aged in their 20s and 30s to plateau between 30 and 59 years for the three most preferred analgesics. The peak use of higher dose formulations of oxycodone was seen in males from 40 years. The highest dose formulation of tramadol was preferred in those aged up to approximately 70 years. CONCLUSIONS: Reasons for increased use may include increased prevalence of people with cancer and use for acute pain. The overall benefit and risk in this escalation of opioid use are difficult to determine; however, the increasing risk of tolerance, dependence, overdose and drug diversion suggests to clinicians and policy makers that this escalation may not be in the best interest of all Australians. ER - TY - BOOK T1 - Opiodes en la práctica médica A1 - Hernandez Castro, John Jairo A1 - Moreno Benavides, Carlos Y1 - 2009/// PB - Asociación Colombiana para el Estudio del Dolor ET - Guadalupe SP - 250 EP - 250 CY - Bogotá D.C SN - 9789589904015 ER - TY - JOUR T1 - Management of Expected and Unexpected Opioid-related Side Effects A1 - Harris, Juan-diego Y1 - 2008/// KW - cardiopulmonary side effects KW - gastrointestinal side KW - hyperalgesia KW - ntolerable side effects along KW - opioid rotation KW - opioids KW - s13 KW - s8 KW - sedation KW - with inadequate analgesia JF - The Clinical Jounal of Pain VL - 24 IS - 4 SP - 8 EP - 13 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Harris - 2008 - Management of Expected and Unexpected Opioid-related Side Effects.pdf ER - TY - JOUR T1 - Adverse events involving intravenous patient-controlled analgesia. A1 - Hankin, Cheryl S A1 - Schein, Jeff A1 - Clark, John A A1 - Panchal, Sunil Y1 - 2007/07// KW - Analgesia KW - Analgesia, Patient-Controlled KW - Analgesics, Opioid KW - Device Approval KW - Equipment Safety KW - Humans KW - Infusion Pumps KW - Medication Errors KW - Pain KW - adverse effects KW - drug therapy KW - epidemiology KW - instrumentation JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists VL - 64 LA - eng IS - 14 SP - 1492 EP - 1499 DO - 10.2146/ajhp060220 N2 - PURPOSE: This article systematically characterizes aspects of all Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) reports associated with i.v. patient-controlled analgesia (PCA) postoperative use during a two-year index period. METHODS: Intravenous PCA represents a well-accepted and satisfactory means of acute pain treatment; case reports and large case series have described the occurrence of i.v. PCA-related adverse drug events (ADEs). MAUDE data files were downloaded, and all records pertaining to i.v. PCA devices were extracted for the two-year period from January 1, 2002, through December 31, 2003. Medical device events were categorized by their reported cause, including patient-related event, device safety event, operator error, and adverse reactions to opioids. Because there was not sufficient information to grade the certainty of each reported cause, all reported causes were graded "possible," except for device safety events that were confirmed on inspection by the manufacturer. RESULTS: There were 2009 individual i.v. PCA-related MAUDE medical device events reported during the two-year period. Of these events, 1590 (79.1%) were classified as possible device safety events, 131 (6.5%) as possible operator error, 25 (1.2%) as possible adverse reactions to opioids, 12 (0.6%) as possible patient-related events, and 235 (11.7%) as indeterminate. CONCLUSION: Manufacturer-confirmed device malfunction was a major cause of reported ADE with i.v. PCA infusion pumps while operator errors were more likely to be associated with more serious adverse outcomes than device safety problems. To reduce the incidence of these problems, potential vulnerabilities in the design and manufacture of i.v. PCA pumps must be identified and addressed. ER - TY - JOUR T1 - Thalamic Atrophy Associated With Painful Osteoarthritis of the Hip Is Reversible After Arthroplasty A Longitudinal Voxel-Based Morphometric Study A1 - Gwilym, Stephen E A1 - Filippini, Nicola A1 - Douaud, Gwenaelle A1 - Carr, Andrew J A1 - Tracey, Irene Y1 - 2010/// VL - 62 IS - 10 SP - 2930 EP - 2940 DO - 10.1002/art.27585 ER - TY - JOUR T1 - Overuse of opioids for acute migraine in an Australian emergency department. A1 - Gunasekera, Lakshini A1 - Akhlaghi, Hamed A1 - Sun-Edelstein, Christina A1 - Heywood, John A1 - Sanders, Lauren Y1 - 2020/10// JF - Emergency medicine Australasia : EMA VL - 32 LA - eng IS - 5 SP - 763 EP - 768 DO - 10.1111/1742-6723.13504 N2 - OBJECTIVE: Acute migraine is associated with significant personal, economic and work-related disability. Management guidelines advise the use of simple analgesia, triptans, chlorpromazine and anti-emetics based on severity, with avoidance of opioids. We aimed to determine consistency of prescribing patterns in our ED with national guidelines. METHODS: We performed a retrospective cohort analysis of migraine presentations (ICD-10-AM G439) between 2012 and 2016. Exclusion criteria included migraine without headache, other primary headaches and secondary headaches. Demographic and prescribing data were extracted from medical records. Results have been reported as proportions. RESULTS: Of 4769 headache presentations, the application of exclusion criteria led to a total of 744 patients who received a migraine diagnosis (G439). Most were female (558/744, 75%), young (mean age 36.4 years) and had a self-reported migraine history (558/744, 75%). There were 54 different medications prescribed. Paracetamol was more frequently prescribed (385/744, 52%) than aspirin (134/744, 18%). Opioid prescription occurred in nearly half of all presentations (345/744, 46%). Similar opioid prescriptions were also observed in those with a documented history of migraines (253/558, 45%). A minority of patients received triptans (51/744, 7%). Overall, a quarter of patients (189/744, 25%) received no guideline-recommended medications. CONCLUSION: We observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications were infrequently used and opioid use was common. Factors influencing prescribing patterns require further investigation in order to improve rates of guideline recommended treatment. ER - TY - JOUR T1 - Opioid tolerance--a predictor of increased length of stay and higher readmission rates. A1 - Gulur, Padma A1 - Williams, Libby A1 - Chaudhary, Sanjay A1 - Koury, Katharine A1 - Jaff, Michael Y1 - 2014/// KW - Analgesics, Opioid KW - Drug Tolerance KW - Hospitalization KW - Humans KW - Length of Stay KW - Massachusetts KW - Pain KW - Patient Readmission KW - Retrospective Studies KW - Risk Adjustment KW - drug therapy KW - epidemiology KW - pharmacology KW - statistics & numerical data KW - therapeutic use JF - Pain physician VL - 17 LA - eng IS - 4 SP - E503 EP - 7 N2 - The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to be a challenge amongst health care providers, there is little in the literature that has studied opioid tolerance as a predictor of outcomes. We conducted a review on all admissions to Massachusetts General Hospital over a period of 6 months, from January 2013 to June 2013, and identified opioid tolerant patients at admission using the FDA definition of opioid tolerance. To compare risk adjusted groups, we placed opioid tolerant patients and control patients into groups determined by expected length of stay of less than 2 days, 2 to 5 days, 5 to 10 days, and greater than 10 days. Opioid tolerant patients were then compared to the control for outcomes measures including observed length of stay and readmission rates. Our results show that all opioid tolerant patients have a significantly longer length of stay and a greater 30 day all cause readmission rate than the control group (P < 0.01). This trend was found in the first 3 risk adjusted groups, but not in the fourth group where expected length of stay was greater than 10 days. The opioid tolerant population is at risk given the poorer outcomes and higher health care costs associated with their care. It is imperative that we identify opportunities for improvement and delineate specific pathways for the care of these patients. ER - TY - JOUR T1 - Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. A1 - Guignard, B A1 - Bossard, A E A1 - Coste, C A1 - Sessler, D I A1 - Lebrault, C A1 - Alfonsi, P A1 - Fletcher, D A1 - Chauvin, M Y1 - 2000/08// KW - Analgesia, Patient-Controlled KW - Analgesics, Opioid KW - Anesthetics, Inhalation KW - Colectomy KW - Desflurane KW - Drug Tolerance KW - Female KW - Hemodynamics KW - Humans KW - Intraoperative Period KW - Isoflurane KW - Male KW - Middle Aged KW - Morphine KW - Pain Measurement KW - Pain, Postoperative KW - Piperidines KW - Remifentanil KW - administration & dosage KW - adverse effects KW - analogs & derivatives KW - drug effects KW - drug therapy JF - Anesthesiology VL - 93 LA - eng IS - 2 SP - 409 EP - 417 DO - 10.1097/00000542-200008000-00019 N2 - BACKGROUND: Rapid development of acute opioid tolerance is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement. METHODS: Fifty adult patients undergoing major abdominal surgery were randomly assigned to two anesthetic regimens: (1) desflurane was kept constant at 0.5 minimum alveolar concentrations and a remifentanil infusion was titrated to autonomic responses (remifentanil group); or (2) remifentanil at 0.1 microg. kg-1. min-1 and desflurane titrated to autonomic responses (desflurane group). All patients were given a bolus of 0.15 mg/kg morphine 40 min before the end of surgery. Morphine was initially titrated to need by postanesthesia care nurses blinded to group assignment. Subsequently, patients-who were also blinded to group assignment-controlled their own morphine administration. Pain scores and morphine consumption were recorded for 24 postoperative h. RESULTS: The mean remifentanil infusion rate was 0.3 +/- 0.2 microg. kg-1. min-1 in the remifentanil group, which was significantly greater than in the desflurane group. Intraoperative hemodynamic responses were similar in each group. Postoperative pain scores were significantly greater in the remifentanil group. These patients required morphine significantly earlier than those in the desflurane group and needed nearly twice as much morphine in the first 24 postoperative h: 59 mg (25-75% interquartile range, 43-71) versus 32 mg (25-75% interquartile range, 19-59; P < 0.01). CONCLUSIONS: Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia. ER - TY - JOUR T1 - Opioids for chronic noncancer pain: A meta-analysis of effectiveness and side effects A1 - Furlan, Andrea D. A1 - Sandoval, Juan A. A1 - Mailis-Gagnon, Angela A1 - Tunks, Eldon Y1 - 2006/// JF - Cmaj VL - 174 IS - 11 SP - 1589 EP - 1594 SN - 1488-2329 (Electronic) 0820-3946 (Linking) DO - 10.1503/cmaj.051528 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Furlan et al. - 2006 - Opioids for chronic noncancer pain A meta-analysis of effectiveness and side effects.pdf N2 - BACKGROUND Chronic noncancer pain (CNCP) is a major health problem, for which opioids provide one treatment option. However, evidence is needed about side effects, efficacy, and risk of misuse or addiction. METHODS This meta-analysis was carried out with these objectives: to compare the efficacy of opioids for CNCP with other drugs and placebo; to identify types of CNCP that respond better to opioids; and to determine the most common side effects of opioids. We searched MEDLINE, EMBASE, CENTRAL (up to May 2005) and reference lists for randomized controlled trials of any opioid administered by oral or transdermal routes or rectal suppositories for CNCP (defined as pain for longer than 6 mo). Extracted outcomes included pain, function or side effects. Methodological quality was assessed with the Jadad instrument; analyses were conducted with Revman 4.2.7. RESULTS Included were 41 randomized trials involving 6019 patients: 80% of the patients had nociceptive pain (osteoarthritis, rheumatoid arthritis or back pain); 12%, neuropathic pain (postherpetic neuralgia, diabetic neuropathy or phantom limb pain); 7%, fibromyalgia; and 1%, mixed pain. The methodological quality of 87% of the studies was high. The opioids studied were classified as weak (tramadol, propoxyphene, codeine) or strong (morphine, oxycodone). Average duration of treatment was 5 (range 1-16) weeks. Dropout rates averaged 33% in the opioid groups and 38% in the placebo groups. Opioids were more effective than placebo for both pain and functional outcomes in patients with nociceptive or neuropathic pain or fibromyalgia. Strong, but not weak, opioids were significantly superior to naproxen and nortriptyline, and only for pain relief. Among the side effects of opioids, only constipation and nausea were clinically and statistically significant. INTERPRETATION Weak and strong opioids outperformed placebo for pain and function in all types of CNCP. Other drugs produced better functional outcomes than opioids, whereas for pain relief they were outperformed only by strong opioids. Despite the relative shortness of the trials, more than one-third of the participants abandoned treatment. ER - TY - JOUR T1 - Chronic and acute pain and pain management for patients in methadone maintenance treatment. A1 - Eyler, Elizabeth C H Y1 - 2013/01// KW - Acute Pain KW - Analgesics KW - Catastrophization KW - Chronic Pain KW - Drug Tolerance KW - Female KW - Humans KW - Methadone KW - Opiate Substitution Treatment KW - Opioid-Related Disorders KW - Pain Management KW - Pain Threshold KW - Pregnancy KW - Pregnancy Complications KW - Self Medication KW - complications KW - drug effects KW - drug therapy KW - psychology KW - therapeutic use JF - The American journal on addictions VL - 22 LA - eng IS - 1 SP - 75 EP - 83 DO - 10.1111/j.1521-0391.2013.00308.x N2 - BACKGROUND AND OBJECTIVES: Many individuals receiving methadone maintenance treatment (MMT) for opioid addiction also require treatment for acute or chronic pain, and the presence of pain is known to have a negative impact on patient health and function. However, effective pain management in this population is complicated by many factors, including heightened pain sensitivity, high opioid tolerance, illicit substance use, and variable cross-tolerance to opioid pain medications. This article reviews the recent literature on acute and chronic pain among, and pain treatment of, patients receiving MMT for opioid addiction and discusses the implications for effective pain management. Acute pain management among women maintained on methadone during and after labor and delivery is also discussed, as well as common concerns held by patients and providers about appropriate pain management strategies in the context of methadone maintenance and addiction treatment. METHODS: One hundred nine articles were identified in a PubMed/MEDLINE electronic database search using the following search terms: methadone, methadone maintenance, methadone addiction, pain, pain management, chronic pain, and acute pain. Abstracts were reviewed for relevance, and additional studies were extracted from the reference lists of articles identified in the original search. RESULTS: The pain sensitivity and pain responses of MMT patients differ significantly from those of patients not maintained on opioids, and few data are available to guide patient care. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Rigorous studies are needed to identify and evaluate effective pain management approaches for this unique patient population and to improve patient treatment outcomes. ER - TY - JOUR T1 - Guideline for opioid therapy and chronic noncancer pain A1 - Dc, Jason W Busse A1 - Craigie, Samantha A1 - Juurlink, David N A1 - Buckley, D Norman A1 - Wang, Li A1 - Couban, Rachel J A1 - Mist, M A A1 - Agoritsas, Thomas A1 - Akl, Elie A A1 - Dds, Alonso Carrasco-labra A1 - Bes, Lynn Cooper A1 - Cull, Chris A1 - Bruno, R A1 - Pt, Costa A1 - Mph, Joseph W Frank A1 - Grant, Gus A1 - Llb, A B Y1 - 2017/// VL - 189 IS - 18 SP - 659 EP - 666 DO - 10.1503/cmaj.170363 ER - TY - CHAP T1 - Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit A1 - Darnall, Beth D. A1 - Colloca, Luana Y1 - 2018/01// KW - Catastrophizing KW - Chronic pain KW - Evidence-based KW - Expectations KW - Nocebo KW - Opioids KW - Pain KW - Patient-centered KW - Placebo KW - Treatment PB - Academic Press Inc. JF - International Review of Neurobiology VL - 139 SP - 129 EP - 157 SN - 9780128154168 DO - 10.1016/bs.irn.2018.07.022 UR - /pmc/articles/PMC6175287/?report=abstract UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175287/ N2 - Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically. ER - TY - JOUR T1 - Short-term side effects associated with opioids for acute pain A1 - Daoust, R A1 - Paquet, J A1 - Cournoyer, A A1 - Piette, E A1 - Morris, J A1 - Justine, L A1 - Castonguay, V A1 - Lavigne, G A1 - Williamson, D A1 - Chauny, J.-M. A1 - Holland, C Y1 - 2019/// KW - adult KW - adverse drug reaction KW - chronic pain KW - cohort analysis KW - conference abstract KW - constipation KW - controlled study KW - dizziness KW - dose response KW - drowsiness KW - drug therapy KW - emergency ward KW - female KW - follow up KW - human KW - incidence KW - laxative KW - major clinical study KW - male KW - morphine KW - nausea and vomiting KW - opiate KW - oxycodone KW - physician KW - prescription KW - prospective study KW - short course therapy KW - side effect KW - weakness JF - Academic Emergency Medicine VL - 26 LA - English SP - S130 EP - S130 CY - R. Daoust, Université De Montréal, Hôpital du Sacré-Coeur De Montréal, DO - 10.1111/acem.13756 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627698460&from=export UR - http://dx.doi.org/10.1111/acem.13756 N2 - Background: Opioid side effects are common when treating chronic pain. However, the rate of opioid side effects for acute pain has rarely been examined, particularly in the post emergency department (ED) setting. The objective of this study was to evaluate the short- term incidence of opioid induced side effects (constipation, nausea/vomiting, diz z iness, and drowsiness) in patients discharged from the ED with an opioid prescription. Methods: This was a prospective cohort study of patients aged ≥18 years that visited the ED for an acute pain condition (≤ 2 weeks) and were discharged with an opioid prescription. Patients completed a 14- day diary assessing daily pain medication use and side effects. Results: Median age of the 386 patients included was 54 years; 50% were women. During the 2-week follow-up, 80% of patients consumed at least one dose of opioids. Among the patients who used opioids, 79% (95%CI:75-83) reported any side effects compared to 38% for non-users. Adjusting for age, sex, and pain condition, patients who used opioids were more likely to report constipation (OR:7.5; 95%CI:3.1-17.9), nausea/vomiting (OR:4.1; 95%CI:1.8-9.5), dizziness (OR:5.4; 95%CI: 2.2-13.2), drowsiness (OR:4.6; 95%CI:2.5-8.7), and weakness (OR:4.2; 95%CI:1.6-11.0) compared to non-users. A dose response effect was observed for constipation but not for the other side effects. Nausea/vomiting (OR:2.0; 95%CI:1.1-3.6) and dizziness (OR:1.9; 95%CI:1.1-3.4) were more often associated with oxycodone compared to morphine. Conclusion: Similar to chronic pain, opioid side effects are highly prevalent during short-term treatment for acute pain. Physicians should inform patients about those side effects and systematically prescribe laxatives. ER - TY - JOUR T1 - Enhancing Patient Compliance in the Elderly A1 - Cramer, Joyce A. Y1 - 1998/// JF - Drugs & Aging VL - 12 IS - 1 SP - 7 EP - 15 DO - 10.2165/00002512-199812010-00002 UR - http://link.springer.com/10.2165/00002512-199812010-00002 ER - TY - JOUR T1 - Constipation in Elderly Patients with Noncancer Pain : Focus on Opioid-Induced Constipation A1 - Chokhavatia, Sita A1 - John, Elizabeth S A1 - Bridgeman, Mary Barna A1 - Dixit, Deepali Y1 - 2016/// PB - Springer International Publishing JF - Drugs & Aging VL - 33 IS - 8 SP - 557 EP - 574 DO - 10.1007/s40266-016-0381-2 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Chokhavatia et al. - 2016 - Constipation in Elderly Patients with Noncancer Pain Focus on Opioid-Induced Constipation.pdf ER - TY - JOUR T1 - Extended-Release Dinalbuphine Sebacate Versus Intravenous Patient-Controlled Analgesia with Fentanyl for Postoperative Moderate-to-Severe Pain: A Randomized Controlled Trial A1 - Chang, Tsung-Kun A1 - Huang, Ching-Wen A1 - Su, Wei-Chih A1 - Tsai, Hsiang-Lin A1 - Ma, Cheng-Jen A1 - Yeh, Yung-Sung A1 - Chen, Yen-Cheng A1 - Li, Ching-Chun A1 - Cheng, Kuang-I. A1 - Su, Miao-Pei A1 - Wang, Jaw-Yuan Y1 - 2020/12// PB - Springer Science and Business Media LLC JF - Pain and Therapy VL - 9 IS - 2 SP - 671 EP - 681 DO - 10.1007/s40122-020-00197-x N2 - INTRODUCTION: Post-operative pain control remains unsatisfactory in patients after laparotomy. This study aimed to evaluate the efficacy, safety, and quality of life with a single dose of extended-release dinalbuphine sebacate (ERDS) pre-operatively to intravenous patient-controlled analgesia (PCA) with fentanyl in patients undergoing laparotomy. METHODS: This was a prospective, open-label, randomized controlled study. Of 110 randomized patients, 107 completed all assessments. The area under the curve (AUC) of visual analogue scale (VAS) from baseline to 48 h after surgery, VAS throughout 7 days after surgery, post-operative analgesics use, quality of life, satisfaction, and safety were evaluated. RESULTS: The AUC of VAS from baseline to 48 h after surgery were 118.6 [97.5% confidence interval (CI) 95.6-141.6] in ERDS group and 176.13 (97.5% CI 150.8-201.4) in PCA group, which showed the non-inferiority because the upper limit of the 97.5% CIs of ERDS group was lower than the lower limit of PCA group (P < 0.001), but also had superiority in favor of ERDS group (P < 0.001). ERDS group reported a significant reduction in VAS pain intensity at 4, 24, 32, 72, 120, and 144 h after surgery, and better quality of life (P < 0.05). The safety profile was comparable between ERDS and PCA groups. CONCLUSIONS: In patients undergoing laparotomy, a single dose of dinalbuphine sebacate was superior to intravenous PCA with fentanyl on lower pain intensity and better quality of life. TRIAL REGISTRATION: NCT03296488. ER - TY - JOUR T1 - Ethnic differences in pain and pain management A1 - Campbell, Claudia M A1 - Edwards, Robert R VL - 2 IS - 2012 SP - 219 EP - 230 ER - TY - JOUR T1 - Associations among gender , coping patterns and functioning for individuals with chronic pain : A systematic review A1 - C, Nina El-shormilisy Mphil A1 - Strong, Jenny A1 - Boccthy, Moccthy A1 - Meredith, Pamela J A1 - Hons, B A A1 - Strong, J A1 - Meredith, P J Y1 - 2015/// VL - 20 IS - 1 SP - 48 EP - 56 ER - TY - JOUR T1 - Analgésicos opioides en pacientes hospitalizados A1 - Buitrago, Claudia Liliana A1 - Rodríguez, Carlos Hernan A1 - Ibarra, Nestor Alfredo A1 - Velásquez, Andres Felipe A1 - Molina, Bilena Margarita Y1 - 2014/// JF - Repertorio de Medicina y Cirugia VL - 23 IS - 4 SP - 276 EP - 282 ER - TY - JOUR T1 - Prospective association of serum opioid levels and clinical outcomes in patients with cancer pain treated with intrathecal opioid therapy A1 - Brogan, SE A1 - Sindt, JE A1 - Analgesia, CM Jackman - … & A1 - 2020, undefined JF - ingentaconnect.com UR - https://www.ingentaconnect.com/content/wk/ane/2020/00000130/00000004/art00056 ER - TY - JOUR T1 - Pain and use of alcohol to manage pain : prevalence and 3-year outcomes among older problem and non-problem drinkers A1 - Brennan, Penny L A1 - Schutte, Kathleen K A1 - Moos, Rudolf H A1 - Brennan, Penny A1 - Park, Menlo A1 - Brennan, Penny L Y1 - 2005/// SP - 777 EP - 786 DO - 10.1111/j.1360-0443.2005.01074.x ER - TY - JOUR T1 - Management of Opioid Analgesic Overdose A1 - Boyer, Edward W Y1 - 2012/// JF - New England Journal of Medicine VL - 376 SP - 146 EP - 55 DO - 10.1056/NEJMra1202561 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Boyer - 2012 - Management of Opioid Analgesic Overdose.pdf ER - TY - JOUR T1 - Opioid Complications and Side Effects A1 - Benyamin, Ramsin A1 - Trescot, Andrea M A1 - Datta, Sukdeb A1 - Buenaventura, Ricardo A1 - Adlaka, Rajive A1 - Sehgal, Nalini A1 - Glaser, Scott E A1 - Vallejo, Ricardo Y1 - 2008/// JF - Pain Physician IS - 11 SP - 105 EP - 120 L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Benyamin et al. - 2008 - Opioid Complications and Side Effects.pdf ER - TY - JOUR T1 - Prescription Drug Monitoring Programs Are Associated With Sustained Reductions in Opioid Prescribing By Physicians A1 - Bao, Yuhua A1 - Pan, Yijun A1 - Taylor, Aryn A1 - Radakrishnan, Sharmini A1 - Luo, Feijun A1 - Alan, Harold A1 - Schackman, Bruce R Y1 - 2017/// JF - Health Affairs (Milwood) VL - 35 IS - 6 SP - 1045 EP - 1051 DO - 10.1377/hlthaff.2015.1673.Prescription L1 - file:///Users/santiagopabon/Library/Application Support/Mendeley Desktop/Downloaded/Bao et al. - 2017 - Prescription Drug Monitoring Programs Are Associated With Sustained Reductions in Opioid Prescribing By Physicians.pdf ER - TY - JOUR T1 - Opioid analgesia: Perspective on right use and utility A1 - Ballantyne, J C Y1 - 2007/// KW - aggression KW - arthritis KW - cancer pain KW - chronic pain KW - clinical decision making KW - clinical trial KW - codeine KW - community care KW - constipation KW - controlled clinical trial KW - criminal law KW - cultural factor KW - drive KW - drug dependence KW - drug dose comparison KW - drug dose escalation KW - drug efficacy KW - drug exposure KW - drug legislation KW - drug megadose KW - drug safety KW - drug tolerability KW - drug utilization KW - drug withdrawal KW - employment status KW - estrogen blood level KW - euphoria KW - evidence based medicine KW - female infertility KW - genetic predisposition KW - human KW - hydrocortisone blood level KW - hyperalgesia KW - hypogonadism KW - ibuprofen KW - immune deficiency KW - levorphanol KW - libido disorder KW - long term exposure KW - low drug dose KW - male infertility KW - medical ethics KW - methadone KW - morphine KW - narcotic analgesic agent KW - nausea KW - neuropathic pain KW - oxycodone KW - paracetamol KW - patient care KW - patient right KW - patient selection KW - placebo KW - pruritus KW - quality of life KW - race difference KW - randomized controlled trial KW - respiration depression KW - review KW - risk benefit analysis KW - sedation KW - short course therapy KW - side effect KW - social psychology KW - social status KW - testosterone blood level JF - Pain Physician VL - 10 LA - English IS - 3 SP - 479 EP - 491 CY - J.C. Ballantyne, Massachusetts General Hospital Pain Center, 15 Parkman Street, Boston, MA 02114, United States UR - https://www.embase.com/search/results?subaction=viewrecord&id=L46971301&from=export N2 - The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the "principle of balance" may justify that "...efforts to address abuse should not interfere with legitimate medical practice and patient care." Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients' function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients' rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of "producing good for the patient and protecting from harm," so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. ER - TY - JOUR T1 - The Assessment of Pain in Older People : UK National Guidelines A1 - Authors, Contributing Y1 - 2018/// SP - 1 EP - 22 DO - 10.1093/ageing/afx192 ER - TY - JOUR T1 - Subcutaneous methylnaltrexone for treatment of acute opioid-induced constipation: phase 2 study in rehabilitation after orthopedic surgery. A1 - Anissian, Lucas A1 - Schwartz, Harry W A1 - Vincent, Kevin A1 - Vincent, Heather K A1 - Carpenito, Jennifer A1 - Stambler, Nancy A1 - Ramakrishna, Tage Y1 - 2012/02// KW - Aged KW - Analgesics, Opioid KW - Constipation KW - Double-Blind Method KW - Female KW - Humans KW - Injections, Subcutaneous KW - Male KW - Middle Aged KW - Naltrexone KW - Narcotic Antagonists KW - Orthopedic Procedures KW - Pilot Projects KW - Quaternary Ammonium Compounds KW - Rehabilitation KW - Treatment Outcome KW - administration & dosage KW - adverse effects KW - analogs & derivatives KW - chemically induced KW - drug therapy KW - methods JF - Journal of hospital medicine VL - 7 LA - eng IS - 2 SP - 67 EP - 72 DO - 10.1002/jhm.943 N2 - BACKGROUND: Methylnaltrexone has been shown to be effective for treating opioid-induced constipation (OIC) in chronic settings, but its effects on acute OIC have not been studied. OBJECTIVE: To assess safety and efficacy of subcutaneous methylnaltrexone in patients with acute OIC after orthopedic procedures. DESIGN: Double-blind, randomized, parallel-group, placebo-controlled, hypothesis-generating phase 2 study. SETTING: Sixteen US hospitals and rehabilitation facilities. PATIENTS: Adult patients with acute OIC after orthopedic surgical procedure, expected to require opioids for at least 7 days postrandomization. INTERVENTIONS: Patients received once-daily subcutaneous methylnaltrexone 12 mg or placebo for up to 4 or 7 days. MEASUREMENTS: All endpoints were exploratory and included the percentage of patients achieving laxation within 2 and 4 hours of first dose and time to laxation. RESULTS: Thirty-three patients received at least 1 dose of study drug (methylnaltrexone, n = 18; placebo, n = 15). Within 2 and 4 hours, significantly more patients receiving methylnaltrexone achieved laxation (2 hours: 33.3% vs 0%, P = 0.021; 4 hours: 38.9% vs 6.7%, P = 0.046) compared with placebo. Time to laxation was significantly shorter with methylnaltrexone (median = 15.8 hours) versus placebo (median = 50.9 hours), P = 0.0197. The most common adverse events related to the gastrointestinal tract. Pain scores remained stable and were similar to those of placebo, and signs and symptoms of opioid withdrawal did not emerge in patients receiving methylnaltrexone. CONCLUSIONS: Methylnaltrexone was generally well tolerated and was active in inducing laxation in this study of patients experiencing acute OIC following orthopedic surgery. ER - TY - RPRT T1 - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) A1 - American Psychiatric Association Y1 - 2013/// UR - www.appi.org ER - TY - JOUR T1 - Are Inhaled Systemic Therapies a Viable Option for the Treatment of the Elderly Patient? A1 - Allen, Stephen Y1 - 2008/// JF - Drugs & Aging VL - 25 IS - 2 SP - 89 EP - 94 DO - 10.2165/00002512-200825020-00001 UR - http://link.springer.com/10.2165/00002512-200825020-00001 ER - TY - JOUR T1 - Adapting clinical guidelines to take account of multimorbidity A1 - Alderson, Phil A1 - Mcmurdo, Marion E T Y1 - 2012/// VL - 6341 IS - October SP - 1 EP - 5 DO - 10.1136/bmj.e6341 ER - TY - JOUR T1 - Opiate Intoxication Caused by Epidural Infusion of Morphine: A Case Report of a Near Fatal Medication Error. A1 - Akkerman, Ronald D L A1 - Nguyen, Thi M D A1 - Dekkers, Angela J E A1 - de Haas, Jan A M Y1 - 2020/03// KW - Aged KW - Analgesia, Epidural KW - Coma KW - Humans KW - Male KW - Medication Errors KW - Middle Aged KW - Morphine KW - Respiratory Insufficiency KW - administration & dosage KW - adverse effects KW - chemically induced KW - methods JF - Pain practice : the official journal of World Institute of Pain VL - 20 LA - eng IS - 3 SP - 321 EP - 324 DO - 10.1111/papr.12837 N2 - INTRODUCTION: Epidural infusion of local anesthetics with opioids is widely used for pain control during the perioperative-and peripartum-periods. Selection of the opioid, appropriate dosing, and follow-up by the acute pain service are critical in providing safe postoperative epidural analgesia. CASE REPORT SUMMARY: A 71-year-old man was scheduled for a parastomal hernia repair with midline laparotomy. The parastomal hernia was a complication from a previously performed colectomy for ulcerative colitis. Preoperatively, the patient received a lower thoracic epidural catheter. The epidural infusate (0.2% ropivacaine with 0.5 µg/mL sufentanil) was prepared and double-checked by holding area nurses. The fact that the right prescription medication label partially covered a morphine label went unnoticed. The intraoperative phase was characterized by stable parameters. Postoperatively, it was not possible to demonstrate an epidural nerve block. No pain was reported, and the patient could be transferred to the ward. The patient developed coma and delayed respiratory depression after discharge to the surgical ward, requiring intensive care unit admission and naloxone administration. Analysis of the syringe content revealed the presence of morphine (1 mg/mL). DISCUSSION: Color-coded prefilled syringes combined with the use of an epidural specific syringe connector to prevent cross-connections should become standard practice. In addition, delayed respiratory depression should be considered after epidural administration of morphine. 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