Articles: opioid.
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Workers Compensation Board (WCB) recipients are a group commonly prescribed opioids. ⋯ Amongst low dose opioid claims, the WCB covers most opioids prescribed. Higher opioid dose WCB recipients are often prescribed opioids not covered by the WCB. Both opioids paid for and not paid for by the WCB are associated with post-claim opioid use.
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Editor's Note The journal is delighted to introduce a new feature in this issue that focuses on the complex and multifaceted issue of managing pain and related symptoms while responsibly attending to minimizing substance abuse. How should the seemingly disparate disciplines of drug abuse and symptom control interact? Should these be two separate fields or should practitioners/investigators in one also be qualified in the other? Is that even feasible? We are honored to have two leading, academically based clinician scientists coordinating this new feature. Peggy Compton is Professor and Associate Dean for Academic Affairs at the School of Nursing & Health Studies, Georgetown University in Washington, DC. ⋯ Lipman, Editor ABSTRACT Abusers of prescription opioids represent two distinct populations: those who develop addiction via opioids prescribed for pain, and those for whom prescription opioids represent a primary drug of abuse. Regardless of the pathway to abuse, outcomes for patients with untreated opioid addiction are poor, and consideration of the contextual factors surrounding their problematic use is critical to effective treatment. Reviewed are patterns of prescription opioid abuse among particularly vulnerable populations in underserved rural communities, and in an effort to prevent problematic use, principles of responsible opioid prescription for chronic pain are outlined so as to decrease the risk for developing addiction.
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J Pain Palliat Care Pharmacother · Jun 2015
Observational StudyA pilot evaluation of a hydromorphone dose substitution policy and the effects on patient safety and pain management.
Hydromorphone is a potent opioid analgesic commonly utilized in the hospital setting for the management of acute pain. Initial dose recommendations range from 0.1 to 2 mg of hydromorphone for opioid-naïve patients. This creates a challenge to optimally dose hydromorphone in opioid-naïve patients with the goals of avoiding opioid toxicities while also providing adequate pain management. ⋯ The primary outcome of the study was the incidence of opioid toxicity. The secondary outcome of the study was adequate pain management. The results of this study showed no difference in opioid toxicity; however, patients required less per day hydromorphone and other opioids while still adequately managing patients' pain.
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J Pain Palliat Care Pharmacother · Jun 2015
ReviewFentanyl-induced hyperalgesia in acute pain management.
There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. ⋯ The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.