Pain management nursing : official journal of the American Society of Pain Management Nurses
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Addiction is a chronic, relapsing brain disease. It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress and learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brain structure and function. Over time, addictive substances can bring about a false fixed prediction error that cannot be rectified during learning. ⋯ Addiction can be treated and controlled, but not cured. Treatment of pain in individuals with addiction is a complex clinical challenge. Holistic assessment, interprofessional approaches, use of established guidelines, and non-pharmacological complementary modalities are needed.
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Randomized Controlled Trial
A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit.
Prospectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population. ⋯ I.
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The use and misuse of opioid pain medication is a public health problem that has extended to pregnant women. Assessing both the use and misuse of opioid pain medication had been limited. ⋯ The high rates of use and misuse of opioids in pregnant women underscores a critical need for screening for opioid use and misuse, particularly among White women. Pregnancy provides a unique window of opportunity to educate, screen, and provide treatment.
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Cannabis has been linked to reduced opioid use, although reasons for cannabis use among adults prescribed opioids are unclear. ⋯ Both studied populations have unmet health needs motivating them to use cannabis and commonly use cannabis for pain. Persistent pain participants were less likely to use cannabis for euphoric effects or withdrawal purposes. Nurses should assess for cannabis use, provide education on known risks and benefits, and offer options for holistic symptom management.
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The purpose of this study is to determine the types of content and to what extent that individual State Boards of Nursing (SBON) in the U.S. are providing information and education for nurses to mitigate prescription opioid misuse and diversion by patients and the public. ⋯ SBON have a responsibility to educate licensees to enable them to assist in the mitigation of opioid misuse and diversion. States have resources like PDMPs, opioid tool-kits, newsletters, announcements, and prescriber guidelines that need to be more numerous, of higher quality, and easier to access. SBON should be commended for the resources that they currently provide, but more can be done for nurses to aid in this endeavor. SBON are positioned to provide education and information for nurses to reduce opioid misuse, and diversion. The SBON websites need to have a link to their PDMP, opioid toolkit, OD treatment, and opioid prescribing guidelines readily accessible by nurses and especially APRNs.