Journal of opioid management
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pain physicians have few objective ways of determining which of their patients are drug abusers. Traditionally, these include psychological tests, physical examination, patient history, and urine drug testing. The traditional urine drug testing information provided to pain physicians mainly identifies patient compliance or drug diversion with qualitative information, that is, the patient is positive or negative for the presence of the drug in excreted urine. Although this information is useful for establishing compliance and identifying diversion, it is incomplete because it does not identify drug abuse. ⋯ application of a reference interval model allows identification of a patient population that excretes extremely high amounts of drug or its metabolite when compared with the rest of the population. Explanations for this high excretion include high dosage medication by prescription and drug abuse, determination of which can be done by the treating physician. The authors suggest that this patent-applied-for analytical model can become a potential tool to alert physicians to patients who may be abusing drugs.
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The administration of opioid analgesics via the intrathecal route is becoming more commonplace for a variety of chronic nonmalignant pathologic pain states. Despite this growing trend, there is very little information available to guide practitioners with regard to patient selection as well as intrathecal drug dosing paradigms. The authors describe the use of a protocol for patient selection, including pretrial preparation, as well as detailed very low-dose chronic intrathecal morphine dosing regimens to treat patients with refractory chronic nonmalignant pain.
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Multicenter Study
Long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray for breakthrough cancer pain in opioid-tolerant patients.
to assess the long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray (FPNS) in patients with breakthrough cancer pain (BTCP). ⋯ FPNS use for BTCP was associated with AEs, typical of opioids, with no evidence of nasal toxicity. A large proportion of BTCP episodes were treated with a single dose, and doses remained stable over the 4-month period.
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Randomized Controlled Trial
A double-blind, placebo-controlled study of dual-opioid treatment with the combination of morphine plus oxycodone in patients with acute postoperative pain.
animal and human studies suggest that coadministration of two opioids with different receptor binding properties may result in enhanced analgesia and fewer opioid-related adverse events (AEs). Q8003 (MoxDuo), an oral dual-opioid formulation with a fixed ratio (3:2) of morphine and oxycodone, was evaluated for analgesic effects and safety in the management of acute moderate to severe pain. ⋯ the 12/8 mg dose of Q8003, an immediate-release formulation, provided the optimal combination of analgesic efficacy and tolerability, with the 3/2 and the 6/4 mg doses being an effective alternative for treatment.
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The decision to prescribe opioid medications is complex. Physicians often struggle to balance the risks of medication diversion and abuse with the benefits of pain management. ⋯ Attendance at these workshops suggests that prescribers are interested in improving opioid prescribing practices and reducing patient risk. Presurvey data indicate that prescribers are knowledgeable about screening tools and they consider patient risk factors for misuse.