Journal of opioid management
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Randomized Controlled Trial Comparative Study
Comparison of transdermal fentanyl with codeine/paracetamol, in combination with radiotherapy, for the management of metastatic bone pain.
Radiotherapy (R/T) is frequently used for palliative treatment of painful bone metastases; however, complete alleviation of pain is not always achieved. This study was designed to evaluate pain management outcomes and quality of life (QoL) measures in cancer patients with metastatic bone pain receiving a combination of R/T and either transdermal therapeutic fentanyl (TTS-F) patches or codeine/paracetamol. A total of 460 palliative care patients with bone metastases who received R/T were enrolled in this prospective, open-label study. ⋯ Both treatments were generally well tolerated, with constipation as the most common side effect followed by sleep disturbances and nausea. The overall frequencies of side effects were higher in the codeine/paracetamol group. The results therefore indicate that TTS-F offers more effective pain relief than codeine/paracetamol, in combination with R/T, in patients with metastatic bone pain, obtaining complete treatment satisfaction matched by improvements in their QoL.
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Opioid contracts are widely used to manage opioid prescribing in the treatment of pain conditions, but they are not well studied. A notable gap in our knowledge of opioid contracts involves the factors that determine their use. As an initial inquiry, this study evaluated the responses of a Web-based survey of trainees and faculty in an academic medical training context to determine correlates of opioid contract use. ⋯ The factors associated with opioid contract use found in this study suggest there are significant prescriber-specific determinants of the use of the tool, including training level, medical specialty, and risk appraisals. Opioid contracts' effects on mastery and comfort of the physician with prescribing opioids suggest that they may play an important role in facilitating appropriate pain management with opioids. Further study is needed to elucidate environmental and patient-specific factors that may influence opioid contract use.
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Hydromorphone, one of the oldest and most potent of opioids, is an effective alternative to morphine. With a variety of routes of administration, it has an efficacy similar to that of morphine. ⋯ The manufacturer and the FDA have articulated a plan to minimize unskillful prescribing and abuse/diversion through education, supply-chain integrity, and surveillance. It is anticipated that Palladone will be a valuable addition to the limited armamentarium of extended-release opioids.