Pain medicine : the official journal of the American Academy of Pain Medicine
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To examine the risk of developing aberrant behaviors that might lead to a substance use disorder (addiction) when prescribing opioids for the relief of chronic noncancer pain in primary care settings. ⋯ This prospective study suggests that patients without a recent or prior history of substance use disorder who were prescribed primarily short-acting opioids in low doses for chronic noncancer pain have a low risk for developing a substance use disorder. This finding supports the importance of prescreening patients being considered for opioid therapy and that prescription of opioids for noncancer pain may carry a lower risk of abuse in selected populations such as in private, community-based practices.
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Observational Study
Sedative Prescriptions Are Common at Opioid Initiation: An Observational Study in the Veterans Health Administration.
Concurrent use of sedatives, especially anxiolytics, and opioids is associated with increased risk of medication-related harms. To the extent that multiple prescribers are involved, approaches to influence patterns of coprescribing will differ from those to influence prescribing within a single drug class. ⋯ One in five patients newly prescribed opioids also had a sedative prescription. Less than half of patients with concurrent opioid and benzodiazepine prescriptions received these from the same provider. Efforts to reduce concurrent opioid and sedative prescribing will require addressing care coordination.
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Case Reports
Spinal Cord Injury During Attempted Cervical Interlaminar Epidural Injection of Steroids.
Interlaminar cervical epidural injections are commonly performed in the practice of interventional pain medicine. Injury to the spinal cord following injection into the substance of the cord is a known complication of this procedure, but it has rarely been reported and illustrated in the literature. ⋯ By recognizing the potential complications of a procedure, and by describing means of avoiding those complications, practice guidelines serve to reduce the risk, and thereby the incidence of complications. Deviation from established best practice guidelines reinstates risks of complications that can be avoided.