Articles: opioid.
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Anesthesiology clinics · Dec 2014
ReviewPerioperative management of the opioid tolerant patient for orthopedic surgery.
The prevalence of opioid use in the North America and some countries of the European Union has resulted in an increase in the number of patients who may exhibit opioid tolerance when requiring postoperative pain management. The approach to postoperative pain control in these patients is different from the strategies used in opioid-naïve patients. Better understanding of the cellular mechanisms of opioid tolerance in animals has resulted in the transfer of these concepts from the basic research to the clinical arena. This article presents new developments in opioid tolerance and how this knowledge can be applied to clinical practice.
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J Pain Symptom Manage · Dec 2014
Randomized Controlled TrialMindfulness-oriented recovery enhancement ameliorates the impact of pain on self-reported psychological and physical function among opioid-using chronic pain patients.
Chronic pain impacts one-third of the U.S. population, and its effects are debilitating for individuals and costly to the medical system. Although opioids are commonly prescribed to address chronic pain, they confer risk for misuse and addiction in some patients and may not fully restore life function-particularly with regard to psychosocial factors. Because of the multiplicity of impacts that chronic pain may have on daily functioning, broad-spectrum behavioral interventions are needed. ⋯ Findings demonstrate preliminary efficacy of MORE as a treatment for pain-related functional impairments and suggest that effects may be more pronounced and durable for aspects of psychological function.
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Multicenter Study
Clinical and genetic factors related to cancer-induced bone pain and bone pain relief.
The study objective was to evaluate whether there are clinical or genetic differences between patients with cancer-induced bone pain (CIBP) and patients with non-CIBP, and, in the CIBP group, in those with good versus poor opioid response. ⋯ Patients with CIBP who were taking opioids had a clinical profile slightly different from that of the non-CIBP group. However, no specific genetic pattern emerged for CIBP versus non-CIBP or for responsive versus nonresponsive patients with CIBP.
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Clinical pediatrics · Dec 2014
Acute pediatric musculoskeletal pain management in North America: a practice variation survey.
Children's musculoskeletal (MSK) injury pain remains poorly managed. This survey of pediatric emergency physicians and orthopedic surgeons assessed analgesia administration practices and discharge advice for children with acute MSK pain; 683 responses were received. Ibuprofen was the most commonly reported analgesic used in the emergency department (52%) and at discharge (68%). ⋯ Younger physicians and recent graduates chose acetaminophen and codeine more than older and more experienced colleagues, who preferred ibuprofen and non-codeine containing opioid compounds (P < .001 and .006, respectively). Orthopedic surgeons reported less ibuprofen use than pediatric emergency physicians (P < .001). Choice of analgesic agents is heterogeneous among physicians and is influenced by pain severity, child's age, and physician characteristics.
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Opioids can suppress testosterone in men, which can lead to extensive morbidity. Identifying risk factors for androgen deficiency in men using daily opioids could improve monitoring and safety. ⋯ Use of long-acting opioids is a key risk factor in the development of androgen deficiency. Dose was significantly associated with androgen deficiency, but more so for men on short-acting than on long-acting opioids.