Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2013
Multicenter StudyQuality of postoperative pain management in American versus European institutions.
Management of postoperative pain remains an important clinical problem throughout the world. Using the PAIN-OUT acute pain registry database to examine perioperative pain management in orthopedic surgery patients, we compared patient-reported outcomes (PROs) in a pooled sample obtained from four American hospitals (N = 473) with PROs in a pooled sample of 20 European institutions (N = 8799). Most American hospitals consistently assess acute pain in surgical patients due to Joint Commission accreditation guidelines. ⋯ Europeans also reported significantly less emotional discomfort, less interference of pain with activity and lower Least Pain. Nonetheless, 98.3% of American patients received opioids on the ward on the first postoperative day compared to 70.2% of European patients, and 41.1% received regional analgesia on the ward while 15.9% of European patients received regional analgesia (both small effect sizes). Overall, the results are clear in demonstrating much better pain control in the ensemble of European countries as compared to the United States.
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J Pain Palliat Care Pharmacother · Dec 2013
ReviewDemystifying analytical approaches for urine drug testing to evaluate medication adherence in chronic pain management.
This comprehensive review of analytical methods used for urine drug testing for the support of pain management describes the methods, their strengths and limitations, and types of analyses used in clinical laboratories today. Specific applications to analysis of opioid levels are addressed. ⋯ Analytical explanations for unexpected results are described. This article describes the scientific basis for urine drug testing providing information which will allow clinicians to differentiate between valid and questionable claims for urine drug testing to monitor medication adherence among chronic pain patients.
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J Pain Palliat Care Pharmacother · Dec 2013
Comparative StudyOnly modest long-term opioid dose escalation occurs over time in chronic nonmalignant pain management.
Clinical experience and the literature increasingly support differentiating chronic pain associated with malignant disease from chronic pain associated with nonmalignant conditions when defining optimal pharmacotherapy. The use of opioids for chronic nonmalignant pain has grown steadily despite the lack of a strong evidence base that can guide practice. A fundamental question is whether patients develop tolerance and need repeated dose escalations to sustain pain control. ⋯ Thirty percent of patients never changed doses during the course of treatment. In patients who never changed medications, the mean morphine equivalent 24-hour dose increased from beginning to end of opioid pharmacotherapy only by 1.4 fold, t = 25.73, Cohen's d = .427 and was independent of both age and gender. Comparison across extended release morphine, oxycodone, and fentanyl revealed that it was significantly greatest for patients using fentanyl and least for those using morphine.
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J Pain Palliat Care Pharmacother · Dec 2013
Mexican perspectives on adverse events in healthcare and pain management.
Adverse events due to medical staff errors are a leading cause of morbidity and mortality around the world. One important aspect of this serious public health issue is mismanagement of pain, particularly pain associated to acute coronary events or cancer. In recent years, there has been increased awareness among international heath care communities on the importance of recognizing and reducing the mistakes committed on a daily basis in practically all medical settings. ⋯ Rather than seeking to correct the root cause, the majority of situations are resolved on a case-by-case basis making it difficult to establish a cohesive prevention system. We suggest that future efforts should place emphasis on developing a uniform method of error detection and prevention, as well as improving and maintaining the patient-physician relationship. Medical education should be valued over litigation.