Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2006
Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation.
There has been intense interest in the problem of prescription drug abuse on the parts of health professionals, law enforcement, the media, and the general public. Clinicians not only need to know how to assess risk but also what drugs are being diverted most in their region. We conducted a prospective survey of prescription drug abusers entering a treatment facility in central Kentucky. ⋯ The most commonly abused drugs were hydrocodone-containing formulations (78%) and oxycodone-containing products (69%), while products containing methadone (23%) or fentanyl (7%) were abused much less frequently. Most respondents (91%) stated that they had purchased prescription opioids from a street dealer at least once and the majority (80%) had altered the delivery system of the prescription drug by chewing, snorting, or using i.v. administration. Implications for pain management are discussed, focusing on the need for clinicians treating chronic pain to more thoroughly assess patients for their risk of abuse and addiction before starting an opioid regimen.
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J Pain Palliat Care Pharmacother · Jan 2006
Evidence-based pain management and palliative care in Issue One for 2006 of The Cochrane Library.
The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2608 complete reviews, 1592 protocols of reviews and 5859 one page summaries of systematic reviews published in the general medical literature. ⋯ This edition of the Library contains 83 new reviews of which the three have potential relevance for practitioners in pain and palliative medicine. These address opioids for the management of breakthrough (episodic) pain in cancer patients, perioperative ketamine for acute postoperative pain, and superficial heat or cold for low back pain.
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Controlled-release oxycodone (OxyContin) is commonly used for pain relief in terminal cancer. This opioid may be considered as a treatment option for patients who prefer oral pain control, but who are unwilling to take oral morphine sulphate or cannot tolerate its side effects. However, little is documented about the use of high doses of this drug in terminal cancer patients. ⋯ Survival was not related to OxyContin doses (Log Rank test, p = 0.12; Breslow test, p = 0.37). We conclude that the use of high dose OxyContin for terminal cancer pain management is safe, efficient, and unrelated to shorter survival times. The results suggest that health care professionals may use higher OxyContin doses, when indicated, to enable better pain relief and quality end-of-life care.
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The concept of opioid equianalgesia, limitations in current dose conversion systems, equianalgesic dose tables, and computer assisted dose conversions are discussed. Conversions for methadone, fentanyl and hydromorphone are described.