Articles: opioid.
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Pharmacoepidemiol Drug Saf · May 2018
Patterns of opioid initiation at first visits for pain in United States primary care settings.
The primary objective of this study was to characterize variation in patterns of opioid prescribing within primary care settings at first visits for pain, and to describe variation by condition, geography, and patient characteristics. ⋯ In 2014, nearly half of all patients filling opioid prescriptions received more than 7 days' of opioids in an initial prescription. Policies limiting initial supplies have the potential to substantially impact opioid prescribing in the primary care setting.
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Palliative Care (PC) is an evolving oncology subspecialty in the Middle East (ME). Justified opioid use is an integral part of palliative care. Often, morphine consumption is taken as a quality indicator of palliative care services, but is it a reliable indicator to reflect the status of palliative care in current Middle East setting? We need to understand that data on morphine consumption, represent the amount distributed of morphine per person in a country and does not refer the actual justified amount utilization of opioids. ⋯ There is an urgent and essential need to work for comprehensive and integrated palliative care programs encompassing the subspecialties. It must include and care for local perspectives of psychological, social, spiritual, and religious issues in PC in addition to pain management. There remains a need for health education for population, advocacy for policy makers, and a political will at the appropriate levels to meet these challenges.
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Repeated stimulation of mu-opioid receptors (MORs), by an MOR-selective agonist DAMGO induces type II priming, a form of nociceptor neuroplasticity, which has 2 components: opioid-induced hyperalgesia (OIH) and prolongation of prostaglandin-E2 (PGE2)-induced hyperalgesia. We report that intrathecal antisense knockdown of the MOR in nociceptors, prevented the induction of both components of type II priming. Type II priming was also eliminated by SSP-saporin, which destroys the peptidergic class of nociceptors. ⋯ Inhibitors of Src and mitogen-activated protein kinase (MAPK) also only attenuated OIH. Inhibitors of matrix metalloproteinase, which cleaves EGF from membrane protein, markedly attenuated the expression, but did not prevent the induction, of prolongation of PGE2 hyperalgesia. Thus, although the induction of prolongation of PGE2-induced hyperalgesia at the peripheral terminal of peptidergic nociceptor is dependent on Src, FAK, EGFR, and MAPK signaling, Src, FAK, and MAPK signaling is only partially involved in the induction of OIH.