Articles: opioid-analgesics.
-
Observational Study
Poorer Physical and Mental Health Status Are Associated with Subsequent Opioid Prescriptions: a U.S. National Study.
How physical and mental health status relate to receipt of opioid prescription remains unclear, creating uncertainty in minimizing opioid harms while avoiding pain under-treatment. ⋯ In a nationally representative U.S. sample, both poorer physical and mental health status independently predicted receiving more opioid prescriptions received in a subsequent year, as well as receiving ≥ 6 prescriptions during the year. Our findings may contribute to a more nuanced picture of the drivers of opioid prescription.
-
Int J Obstet Anesth · Feb 2020
Review Meta AnalysisAdverse side effects and route of administration of opioids in combined spinal-epidural analgesia for labour: a meta-analysis of randomised trials.
Studies report an increased risk of maternal and fetal adverse side effects when combined spinal-epidural, rather than standard epidural, analgesia is provided for labour and delivery. Intrathecal opioids used with local anaesthetic in combined spinal-epidural analgesia may be a cause. It is not known whether this is due to the addition of opioid to local anaesthetic in the intrathecal space only or due to concomitant administration into the intrathecal and epidural spaces. ⋯ For combined spinal-epidural techniques, the administration of opioids in combination with local anaesthetic, particularly when used in both the intrathecal and epidural space, should be carefully considered.
-
Nurses who care for hospitalized patients are responsible for ensuring adequate pain management is provided in a safe manner. The clinical challenge is balancing the effective control of the patient's pain with the side effects of administering opioids. The aim of this literature review is to explore the evidence on how nurses assess for opioid-induced sedation and advancing respiratory depression and how they integrate those data in their critical thinking skills when deciding to administer opioids for pain. ⋯ This review revealed a lack of evidence between how nurses assess for opioid induced advancing sedation and excessive respiratory depression, and the impact, including the adverse events associate with acute pain management.
-
Addiction is a chronic, relapsing brain disease. It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress and learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brain structure and function. Over time, addictive substances can bring about a false fixed prediction error that cannot be rectified during learning. ⋯ Addiction can be treated and controlled, but not cured. Treatment of pain in individuals with addiction is a complex clinical challenge. Holistic assessment, interprofessional approaches, use of established guidelines, and non-pharmacological complementary modalities are needed.