Journal of opioid management
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Randomized Controlled Trial
Oral naltrexone to enhance analgesia in patients receiving continuous intrathecal morphine for chronic pain: a randomized, double-blind, prospective pilot study.
Years' worth of observations suggest that morphine has both inhibitory and excitatory actions, and that selective blockade of excitatory effects by low doses of opioid antagonists (e.g., naltrexone) may paradoxically enhance morphine analgesia. The purpose of this pilot study was to evaluate and compare the analgesic efficacy and safety of two different low doses of oral naltrexone given in addition to chronic intrathecal morphine infusions in patients with chronic nonmalignant pain (CNMP). ⋯ 1) Patients with chronic pain who received oral naltrexone 100 microg BID in addition to their chronic intrathecal morphine infusions demonstrated the greatest improvement (p = 0.07) in their daily pain scores. Because of the small sample size, the results did not reach traditional levels of significance. 2) Side effects were common, minor, and similar across treatment groups. 3) No serious adverse events were recorded. 4) No evidence of opioid antagonist toxicity or opioid withdrawal was observed.
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Randomized Controlled Trial
Analgesic effects of lornoxicam after total abdominal hysterectomy.
The authors investigated, in a randomized, placebo-controlled, double-blinded study, the efficacy and safety of lornoxicam on pain after abdominal hysterectomy and on tramadol consumption in patients. Fifty patients were randomized to receive either oral placebo or lornoxicam 8 mg one hour before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50 percent N2O/O2 with a fresh gas flow of 2 L/min (50 percent N2O in O2) and fentanyl (2 microg/kg). ⋯ There was difference in the incidence of nausea between the groups (p = 0.047). The number of patients and the doses of antiemetics given during the first 24 hours after surgery in lornoxicam group were less than those in placebo group (p = 0.003, p = 0.034, respectively). In conclusion, a single oral dose of lornoxicam given preoperatively enhanced the analgesic effect of tramadol, decreasing tramadol consumption and side effects, and shortened the length of hospitalization.
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To investigate the effect of once-a-day extended release of morphine sulfate AVINZA (A-MQD) on polysomnographic measures of sleep in a population of chronic osteoarthritic pain patients with sleep difficulties. ⋯ A-MQD was an effective treatment for pain, and this study treatment was associated with improvement of both objective and subjective sleep parameters in participants with chronic osteoarthritic pain.
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We addressed the prevalence of opioid dependence (OD) in spine surgery patients and its correlation with length of stay (LOS) as the most important determinant of hospital cost. ⋯ Chronic pain and prolonged use of opioids raise the prevalence of OD in spine surgery patients to 20 percent. The lack of effect of OD on LOS after surgical intervention means that efforts to decrease LOS by trying to satisfy patients' craving for opioids will not be fruitful. Older, African-American LDF patients with a lengthy history of pain and multiple spine surgeries in the past are the most likely to stay longer in hospital.