Journal of opioid management
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Multicenter Study
Prevalence and characteristics of breakthrough pain in patients receiving opioids for chronic back pain in pain specialty clinics.
We sought to assess the prevalence and characteristics of breakthrough pain (BTP) in patients with chronic back pain. ⋯ These patients with opioid-treated chronic back pain commonly experienced BTP, which often had a rapid onset and a relatively short duration and was difficult to predict. Opioids were the mainstay of pharmacologic therapy, but nonopioid analgesics and adjuvant analgesics were commonly used.
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Randomized Controlled Trial Comparative Study
A comparison of oral midazolam, oral tramadol, and intranasal sufentanil premedication in pediatric patients.
This study was designed to evaluate the efficacy and safety of oral midazolam, tramadol drops, and intranasal sufentanil for premedication of pediatric patients. ⋯ Intranasal sufentanil and oral midazolam are more appropriate premedication options than tramadol drops in children.
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Comparative Study
Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients.
Psychopathology (depression, anxiety, somatization disorder) and substance abuse (opioid misuse and illicit drug use) are common in patients with chronic pain and present problems for public health and clinical management. Despite a body of literature describing various methods for identifying psychopathology, opioid misuse, and illicit drug use in chronic pain patients, the relationship between psychopathologies, substance abuse, and chronic pain has not been well characterized. ⋯ This study demonstrated that the presence of psychological features of depression and somatization disorder may be markers of substance abuse diathesis in chronic pain patients.
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To determine the level of urine drug test (UDT) interpretive knowledge of physicians who use these instruments to monitor adherence in their patients on chronic opioid therapy. ⋯ Physicians who employ UDT to monitor patients receiving chronic opioid therapy are not proficient in test interpretation. This study highlights the need for improved physician education; it is imperative for physicians to work closely with certified laboratory professionals when ordering and interpreting these tests.
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A patient was treated for several years with high doses of opioids for malignant pain. During a recent hospitalization, the patient's pain remained uncontrolled despite escalating doses of various opioids. ⋯ Methadone, because of its NMDA antagonist properties, offers an effective treatment for OIH. The use of methadone for analgesia is complex and should be undertaken only by practitioners who have appropriate experience.