Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2012
Methadone in the chronic pain patient with a substance use disorder.
Methadone, used both to treat opioid addiction and to manage chronic pain, is commonly prescribed as an opioid of choice for patients with chronic pain and comorbid substance use disorders. This practice apparently derives from the belief that because methadone is widely used in opioid addiction treatment programs, it is an excellent choice for the management of chronic pain in individuals with substance use disorders. However, chronic pain and addiction treatment contexts are vastly different. ⋯ Methadone is a uniquely complex opioid, responsible for a disproportionate percentage of opioid-related morbidity and mortality. Its use in high-risk patients should not be a reflexive choice. Rather, it should be employed only after careful consideration of relative risks and benefits.
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Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. Topics addressed in this issue pertain to epidural injection for painful central lumbar stenosis and epicondolysis.
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Opioid-induced constipation is described, including features, mechanism, and management of the disorder. The role of various categories of laxatives including suppositories and the use of a peripherally acting μ-opioid receptor antagonist are discussed.
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Over the past three decades, health professionals have recognized that continued mismanagement of pain affect approximately one third of all hospitalized patients as well as many ambulatory patients. Various measures have been taken to correct this problem, including the development of pain management guidelines and standards by governments, medical associations, accrediting bodies, and international organizations. However, these issues remain problems with no clear solution. This commentary reflects the opinions of two practicing Mexican pain management physicians on these issues as they pertain to clinicians managing pain in Mexico today.