Articles: opioid.
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Management of osteoarthritis should be based on a combination of non-drug and drug treatments targeted towards prevention, modifying risk and disease progression. Obesity is the most important modifiable risk factor, so losing weight in addition to land- and water-based exercise and strength training is important. While paracetamol can be tried, guidelines recommend non-steroidal anti-inflammatory drugs as first-line treatment for osteoarthritis. ⋯ Fish oil has not been found to reduce the structural progression of knee arthritis. Surgical interventions should be avoided in the first instance, with arthroscopic procedures not showing benefit over sham procedures or optimised physical and medical therapy. Joint replacement surgery should be considered for severe osteoarthritis.
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Observational Study
Dose-response relationship between methadone dose and adherence to antiretroviral therapy among HIV-positive people who use illicit opioids.
For HIV-positive individuals who use illicit opioids, engagement in methadone maintenance therapy (MMT) can contribute to improved HIV treatment outcomes. However, to our knowledge, the role of methadone dosing in adherence to antiretroviral therapy (ART) has not yet been investigated. We sought to examine the relationship between methadone dose and ART adherence among a cohort of people who use illicit opioids. ⋯ Among HIV-positive individuals in methadone maintenance therapy, those receiving higher doses of methadone (≥ 100 mg/day) are more likely to achieve ≥ 95% adherence to antiretroviral therapy than those receiving lower doses.
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Develop a risk index to estimate the likelihood of life-threatening respiratory depression or overdose among medical users of prescription opioids. ⋯ RIOSORD performed well in identifying medical users of prescription opioids within the Veterans' Health Administration at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated.
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Morphine and other opioid analgesics are potent pain-relieving agents routinely used for pain management in patients with cancer. However, these drugs have recently been associated with a worse relapse-free survival in patients with surgical cancer, thus suggesting that morphine adversely affects cancer progression and relapse. ⋯ Our studies further demonstrate that morphine, administered in the presence or absence of surgery-induced tissue damage, neither facilitates de novo metastatic dissemination nor promotes outgrowth of minimal residual disease after surgery. Together, these findings indicate that opioid analgesics can be used safely for perioperative pain management in patients with cancer and emphasize that current standards of "good clinical practice" should be maintained.
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An implantable drug delivery system (IDDS) provides an alternate route of opioid administration for patients with chronic pain. We collected data on systemic opioid use before and after IDDS implantation; patients who successfully discontinued systemic opioids; and physician support of discontinuation. ⋯ IDDS can provide significant and lasting pain relief and an alternate route of delivery compared with systemic opioids with their associated side-effects. We demonstrated that systemic opioid elimination could be accomplished after IDDS implantation in the majority of cases through appropriate patient selection, monitoring, and participation.