Journal of opioid management
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The Opioid Manager (OM) is a point-of-care paper tool for physicians, which summarizes the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. To evaluate the efficacy of the OM, there is a need to better understand how physicians are using the OM, and how it is relevant to their practice. ⋯ Overall, the OM was viewed positively for improving pain management practices but further work is required to refine the tool's potential.
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Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data supporting basic strategies for addressing aberrant opioid-related behaviors. Risk reduction strategies were identified via a review of available guidelines. ⋯ Similarly, preliminary evidence suggests that although recent regulatory and legal efforts may reduce misuse, they also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination in an attempt to minimize the risk of abuse in opioid treatment patients. Physicians must critically evaluate their opioid prescribing and not only increase their efforts to prevent substance abuse but also not compromise pain management in patients who benefit from it.
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To understand primary care providers (PCPs)' experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain. ⋯ Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.
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Observational Study
Transdermal opioids for cancer pain control in patients with renal impairment.
As guidelines for opioid use in renal-impaired patients with cancer are limited, the authors sought to assess the efficacy, safety, and tolerability, of transdermal buprenorphine for moderate/severe cancer pain in renal-impaired outpatients. ⋯ Transdermal buprenorphine, in outpatients with cancer and renal impairment, is as effective, safe, and tolerable as fentanyl in patients without such impairment. These results add further evidence to the notion that buprenorphine, with its peculiar pharmacokinetics, may be an appropriate choice for opioid treatment in patients with renal impairment.