Journal of pain & palliative care pharmacotherapy
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Opioids are the cornerstone of pain management; however, their use is associated with a variety of adverse drug events (ADEs) ranging from nausea and vomiting to urinary retention and respiratory depression. The purpose of this review is to describe the frequency and cost associated with different types of opioid-related ADEs to better understand their economic impact. A search of studies published in journals from 1946 to December, 2013, was conducted using MEDLINE and EMBASE. ⋯ Data reflect a substantial economic burden of opioid-related ADEs resulting in high hospital costs, prolonged hospital stays, and substantial health care resource usage. Nausea, vomiting, and constipation are frequent and increased costs occur in all types of pain (surgical, nonsurgical, cancer, noncancer) in both inpatients and outpatients. Given the large economic burden of opioid-related ADEs, prevention rather than treatment may be the most effective strategy.
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Pain may adversely affect cognition through its effects on mood and sleep, and chronic pain has been associated with brain atrophy. Studies suggest that chronic pain is undertreated in cognitively impaired people. ⋯ This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.
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Evidence supporting the efficacy of long-term opioid therapy for chronic noncancer pain is scarce. However, weak evidence suggests that those who are able to continue opioids long-term experience clinically significant pain relief. ⋯ This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.
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J Pain Palliat Care Pharmacother · Sep 2014
Comparative StudyClinicians' perspective on the use of immunoassay versus definitive laboratory quantitation methodologies for medication monitoring.
Treating chronic pain is complicated. Primary care doctors and others are called on to treat the vast majority of patients with pain, to do so in brief visits and to do it safely. This is a tall order, but it is possible to do it well when the proper tools are employed to aid the clinician in diagnosing and monitoring the patient. ⋯ When medically necessary, it makes sense to seek definitive testing from the laboratory to confirm results of immunoassay tests with chromatographic testing and/or when there is the possibility of a false negative in the office. These "false negatives" are extremely common, with patients using nonprescribed opioids and illicit medications often go undetected if one were to stop at the office-based result. These patients are in danger of addiction and overdose, and this added information is crucial in efforts to treat pain and avoid these complications.