Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewCan patients taking opioids drive safely? A structured evidence-based review.
A structured evidence-based literature review was completed to determine if there was epidemiological evidence of an association of opioid use and intoxicated driving, motor vehicle accidents (MVA) and MVA fatalities; to rate the quality of this research evidence according to Agency for Health Care Policy and Research (AHCPR) type of evidence and strength and consistency of the evidence rating scales; and according to this evidence determine whether patients taking opioids can drive safely. Relevant references were located from Medline, Psychological Abstracts, Science Citation Index and the National Library of Medicine Data Query databases by appropriate subject headings. A manual search was also performed utilizing the reference lists of the retrieved articles. ⋯ The evidence in this review indicates that opioids do not appear to be associated with intoxicated driving, MVA and MVA fatalities, and consistently indicated that opioids are not associated with MVA. Although the comparison of point prevalence rates to the point prevalence may be problematic, the results of this systematic review support the contention that patients taking opioids may be allowed to drive. As in all clinical decisions, this determination should be individualized according to clinical factors.
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J Pain Palliat Care Pharmacother · Jan 2002
Case ReportsMyofascial pain response to topical lidocaine patch therapy: case report.
This is a case from a preliminary open trial to assess the efficacy of topically applied lidocaine patches as an alternative to trigger point injections for myofascial pain. We describe one case in this report that had a dramatic response to the lidocaine patch. Her pain relief increased, pain intensity decreased, and functional capacity increased. ⋯ The response to other patients has varied. The true clinical utility cannot be obtained from this one report, but only after the data have been analyzed from this initial trial. If the data are promising, a randomized, double-blind, crossover trial is planned.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesia issues in palliative care: bone pain, controlled release opioids, managing opioid-induced constipation and nifedipine as an analgesic.
Some recent literature relevant to analgesia in palliative care is reviewed. Reports on clinical use of bisphosphonates for bone pain in cancer, controlled release opioids, selection of laxatives for opioid-induced constipation and the calcium channel blocker nifedipine as an analgesic are described.
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J Pain Palliat Care Pharmacother · Jan 2002
Comparative StudyPatient-specific factors affecting patient-controlled analgesia dosing.
A study was conducted to evaluate the effect of characteristics patients' gender, age, weight, height, and body surface area, as well as the concurrent or recent use of opioids, ethanol and tobacco, on opioid dose requirements during administration of patient-controlled analgesia (PCA). Data were collected retrospectively from the medical records of 150 patients who underwent open cholecystectomies during an 18 month period at one institution. ⋯ The results of the study demonstrate that during the first 48 hours of PCA therapy, patient age, height, weight, body surface area, gender, smoking, alcohol use, and preoperative opioid use may have significant influence on opioid analgesic use (p < 0.05). The data support the hypothesis that patient-specific factors may contribute to the variability observed in patients' PCA analgesic dose requirements, and these factors should be considered when selecting a proper demand (bolus) dose for PCA therapy.