Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2014
ReviewDisrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.
Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. ⋯ The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.
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J Pain Palliat Care Pharmacother · Jun 2014
Case ReportsA case of severe low back pain after surgery.
The etiology of chronic back pain is often unknown but can include failed spinal surgery. Pain can often be of mixed type and it is important to evaluate pain mechanisms. Comorbid factors often contribute to pain chronicity. ⋯ Other rehabilitative procedures such as physiotherapy, exercise therapy, and good sleep hygiene may have a profound impact on patient quality of life. Spinal cord stimulation may be an effective option for some patients with failed spinal surgery syndrome. A case of severe low back pain after surgery in a 45-year-old man is presented to illustrate this.
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J Pain Palliat Care Pharmacother · Jun 2014
Clinical TrialA transit compartment model unmasks OxyContin's reflective pharmacokinetics from urine measurements in humans.
The absorption pattern of orally administered OxyContin (OXC) reflected in urine indicates that its appearance into systemic circulation undergoes transit absorption delays. The authors developed an OXC transit-delay compartment model that identified a new source of oxycodone hydrochloride (OC): the rate of appearance of OC due to OXC tablet dissolution in transit through the gastrointestinal (GI) tract (R(a)(GI)), which is due to disintegration of OXC's AcroContin delivery system. R(a)(GI) is independent of the biphasic dissolution and release of OC from the delivery system. The authors conclude that an OXC transit-delay compartment model can be of value in the interpretation of OXC pharmacokinetics.