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1
Buck, Marcia L., and Jeffrey L. Blumer. "Opioids and Other Analgesics." Critical Care Clinics 7, no. 3 (July 1991): 615–37. http://dx.doi.org/10.1016/s0749-0704(18)30298-7.
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Pleuvry, Barbara J. "Opioids and other analgesics." Current Opinion in Anaesthesiology 5, no. 4 (August 1992): 527–28. http://dx.doi.org/10.1097/00001503-199208000-00011.
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&NA;. "Opioids and other analgesics." Current Opinion in Anaesthesiology 5, no. 4 (August 1992): 604–12. http://dx.doi.org/10.1097/00001503-199208000-00028.
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Sebel, Peter S. "Opioids and other analgesics." Current Opinion in Anaesthesiology 6, no. 4 (August 1993): 665–67. http://dx.doi.org/10.1097/00001503-199308000-00013.
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&NA;. "Opioids and other analgesics." Current Opinion in Anaesthesiology 6, no. 4 (August 1993): 748–55. http://dx.doi.org/10.1097/00001503-199308000-00030.
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&NA;. "Opioids and other analgesics." Current Opinion in Anaesthesiology 7, no. 4 (August 1994): B82–88. http://dx.doi.org/10.1097/00001503-199408000-00020.
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&NA;, &NA;. "Opioids and other analgesics." Current Opinion in Anaesthesiology 8, no. 4 (August 1995): B112—B119. http://dx.doi.org/10.1097/00001503-199508000-00021.
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&NA;, &NA;. "Opioids and other analgesics." Current Opinion in Anaesthesiology 9, no. 4 (August 1996): B119—B124. http://dx.doi.org/10.1097/00001503-199608000-00020.
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Matthew, Matthew T., and Patricia W. Nance. "Analgesics: Opioids, Adjuvants and Others." Physical Medicine and Rehabilitation Clinics of North America 10, no. 2 (May 1999): 255–73. http://dx.doi.org/10.1016/s1047-9651(18)30196-7.
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Oyler, PharmD, Douglas R., Kristy S. Deep, MD, and Phillip K. Chang, MD. "Opioid use in the acute setting: A survey of providers at an academic medical center." Journal of Opioid Management 14, no. 3 (July 2, 2018): 203–10. http://dx.doi.org/10.5055/jom.2018.0450.
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Objective: To examine attitudes, beliefs, and influencing factors of inpatient healthcare providers regarding prescription of opioid analgesics.Design: Electronic cross-sectional survey.Setting: Academic medical center.Participants: Physicians, advanced practice providers, and pharmacists from a single academic medical center in the southeast United States.Main Outcome Measures: Respondents completed survey items addressing: (1) their practice demographics, (2) their opinions regarding overall use, safety, and efficacy of opioids compared to other analgesics, (3) specific clinical scenarios, (4) main pressures to prescribe opioids, and (5) confidence/comfort prescribing opioids or nonopioids in select situations.Results: The majority of the sample (n = 363) were physicians (60.4 percent), with 69.4 percent of physicians being attendings. Most respondents believed that opioids were overused at our institution (61.7 percent); nearly half thought opioids had similar efficacy to other analgesics (44.1 percent), and almost all believed opioids were more dangerous than other analgesics (88.1 percent). Many respondents indicated that they would modify a chronic regimen for a high-risk patient, and use of nonopioids in specific scenarios was high. However, this use was often in combination with opioids. Respondents identified patients (64 percent) and staff (43.1 percent) as the most significant sources of pressure to prescribe opioids during an admission; the most common sources of pressure to prescribe opioidson discharge were to facilitate discharge (44.8 percent) and to reduce follow-up requests, calls, or visits (36.3 percent). Resident physicians appear to experience more pressure to prescribe opioids than other providers. Managing pain in patients with substance use disorders and effectively using nonopioid analgesics were the most common educational needs identified by respondents.Conclusion: Most individuals believe opioid analgesics are overused in our specific setting, commonly to satisfy patient requests. In general, providers feel uncomfortable prescribing nonopioid analgesics to patients.
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Reilly, Charles S. "EDITORIAL COMMENT: Opioids and other analgesics." Current Opinion in Anaesthesiology 8, no. 4 (August 1995): 315–16. http://dx.doi.org/10.1097/00001503-199508000-00007.
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Smith, Howard. "Peripherally-Acting Opioids." Pain Physician 2s;11, no. 3;2s (March 14, 2008): S121—S132. http://dx.doi.org/10.36076/ppj.2008/11/s121.
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Opioids are broad-spectrum analgesics with potent pain-relieving qualities but also with potential adverse effects related to both short-term and long-term therapy. Researchers have attempted to alter existing opioid analgesics, utilize different routes/ formulations, or combine opioid analgesics with other compounds in efforts to improve analgesia while minimizing adverse effects. Exogenous opioids, administered in efforts to achieve analgesia, work by mimicking the actions of endogenous opioids. Endogenous opioids and their receptors are located in the brain (supraspinal areas), spinal cord, and periphery. Although opioids and opioid receptors in the brain and spinal cord have received much attention over many years, peripheral endogenous opioid analgesic systems have only been extensively studied during the past decade. It has been known since 1990 that following injection into the rodent hindpaw, d-Ala2 , N-Me-Phe4 , Gly5 -ol-enkephalin (DAMGO) [a muopioid receptor agonist] probably exerts its antinociceptive effects locally, since the doses administered are too low to have an effect in the central nervous system (CNS). This notion has been supported by the observation that the quaternary compound morphine methyliodide, which does not as readily cross the bloodbrain barrier and enter the CNS, produced antinociception following intradermal administration into the hindpaw, but not when the same dose was administered systemically (subcutaneously at a distant site). With a growing appreciation of peripheral endogenous opioids, peripheral endogenous opioid receptors, and peripheral endogenous opioid analgesic systems, investigators began growing hopeful that it may be possible to achieve adequate analgesics while avoiding unwanted central untoward adverse effects (e.g. respiratory depression, somnolence, addiction). Peripherally-acting opioids, which capitalize on peripheral endogenous opioid analgesic systems, may be one potential future strategy which may be utilized in efforts to achieve potent analgesia with minimal side effects. Key words: Pain, opioids, immune cells, peripherally-acting opioids (PAO), leukocytes, inflammatory pain, peripheral analgesia
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Charalambous, Andreas, Marios Zorpas, Constantina Cloconi, and Yolanda Kading. "Healthcare professionals’ perceptions on the use of opioid analgesics for the treatment of cancer-related pain in Cyprus: A mixed-method study." SAGE Open Medicine 7 (January 2019): 205031211984182. http://dx.doi.org/10.1177/2050312119841823.
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Objectives: Pain is considered the most common and debilitating symptom reported by patients affected by cancer, and opioids are at the front line for its effective management. However, the appropriate use of opioids can be limited by healthcare professionals’ perceptions on opioids. Therefore, the aim of this study was to explore their perceptions on the use of opioids medication. Methods: This was a study of sequential mixed-method design conducted in Cyprus. As part of the quantitative phase of the study, the Barriers to Opioid Analgesic Availability Test questionnaire was completed by 73 physicians randomly selected. In the qualitative phase, 28 healthcare professionals working in primary and secondary healthcare centers participated in two focus groups. They were asked to express their perceptions on the use of opioid analgesics for the treatment of cancer-related pain. Data were analyzed according to Colaizzis’ seven-stage phenomenological analysis. Results: The quantitative analysis showed that 69.85% of physicians acknowledge opiophobia as a main barrier to appropriate pain relief but also explicitly for cancer pain which is not adequately managed (45.19%). In terms of opioids availability, physicians stated that moderate to severe problems in opioids availability were mainly caused by their reluctance to prescribe opioids (49.3%) followed by the laws/regulations in place (41.08%). The qualitative analysis yielded the following six main themes: inadequate training of healthcare professionals in the use of opioid analgesics, inadequate patient/caregivers’ awareness of opioid analgesics, opiophobia in healthcare professionals, opiophobia of patients/caregivers, poor management of opioid analgesics by healthcare professionals and patients/caregivers, and ineffective pain relief with opioids. Conclusions: The lack of appropriate education is a significant barrier to opioids use in Cyprus. This is compounded by the attitudes and phobias of both healthcare professionals and the general public. In addition, there are barriers to opioid availability and unsatisfactory cancer pain relief.
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Smith, Howard S. "Opioids and Neuropathic Pain." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES93—ES110. http://dx.doi.org/10.36076/ppj.2012/15/es93.
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Opioids are broad spectrum analgesics that may be beneficial to alleviate the intense perception of algesia in patients suffering with pain. They have been one of the most controversial analgesics, in part because of their potential for addiction. Opioids or any currently available analgesic will not provide effective analgesia for every patient with chronic neuropathic pain (NP), but overall opioids are considered to be a second or third line class of analgesics that may provide reasonable analgesia to some patients with chronic NP. Although opioids may alleviate chronic NP, overall, NP tends to be less opioid responsive than nociceptive pain. The mechanisms that may contribute to neuropathic pain may simultaneously also contribute to diminishing the antinociceptive properties of opioids for neuropathic pain. Some of these mechanisms may also contribute to analgesic tolerance and/or opioid-induced hyperalgesia. Hyperalgesia consequently to nerve insult and opioidinduced analgesic tolerance, may both involve the N-methyl-D-aspartate (NMDA) receptor and share part of intracellular events producing a state of neural hyperexcitation. Conversely, opioid therapy may contribute to nociceptive processes that may be involved in neuropathic pain such as opioid-induced cholecystokinin release. Furthermore, within NP, peripheral NP appears to be the most opioid responsive, followed by spinal NP while supraspinal NP tends to be the least responsive to opioids. Although, there is no robust evidence that any specific opioid agent is better than any other opioid at effectively treating NP, it is conceivable that some opioids/opioid-like analgesic agents may be particularly well suited to alleviate NP in certain patients suffering from neuropathic pain. Key words: Pain, neuropathic, opioids, oxycodone, methadone, buprenorphine, tramadol, tapentadol
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Elsesser, Karin, and Thomas Cegla. "Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy." Scandinavian Journal of Pain 17, no. 1 (October 1, 2017): 87–98. http://dx.doi.org/10.1016/j.sjpain.2017.07.005.
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AbstractBackground and aimsRecent studies reveal high prevalence rates of patients receiving long-term opioids. However, well designed studies assessing effectiveness with longer than 3 months follow-up are sparse. The present study investigated the outcomes of long-term opioid therapy compared to nonopioid treatment in CNCP patients with respect to measures of pain, functional disability, psychological wellbeing, and quality of life (QoL).MethodsThree hundred and thirty three consecutive patients at our pain clinic were included and divided into patients with continuous opioid treatment for at least 3 months (51%) and patients receiving nonopioid analgesics (49%). Further, outcome of different doses of opioid (<120 mg vs. >120 mg morphine equivalents) and differences between high and low potency opioids were examined.ResultsThe opioid and nonopioid groups did not differ with regard to pain intensity or satisfaction with analgesic. Patients with continuous opioids treatment reported higher neuropathic like pain, longer duration of pain disorder, lower functional level, wellbeing, and physical QoL in comparison to patients receiving nonopioid analgesics. Higher opioid doses were associated with male gender, intake of high potency opioids and depression but there were no differences with regard to pain relief or improvement of functional level between high and low doses. Similarly, patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief. Overall, remaining level of pain, functional disability and poor QoL were quite high irrespective of the analgesic used or opioid dosing.ConclusionsIn the long-term no clear advantage of opioid vs. non-opioid analgesics could be revealed. In terms of remaining pain intensity, functional disability and quality of life, treatment with pain medication proved insufficient. Additionally, with higher doses of opioids the benefit to risk relationship becomes worse and patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief.ImplicationsOur results raise questions about the long-term effectiveness of analgesic treatment regimens irrespective of analgesics type employed and call for more multidisciplinary treatment strategies.
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Fortune, Shanna, and Jennifer Frawley. "Optimizing Pain Control and Minimizing Opioid Use in Trauma Patients." AACN Advanced Critical Care 32, no. 1 (March 15, 2021): 89–104. http://dx.doi.org/10.4037/aacnacc2021519.
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Adverse effects of opioids and the ongoing crisis of opioid abuse have prompted providers to reduce prescribing opioids and increase use of multiple nonpharmacologic therapies, nonopioid analgesics, and co-analgesics for pain management in trauma patients. Nonopioid agents, including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, central α2 agonists, and lidocaine, can be used as adjuncts or alternatives to opioids in the trauma population. Complementary therapies such as acupuncture, virtual reality, and mirror therapy are modalities that also may be helpful in reducing pain. Performing pain assessments is fundamental to identify pain and evaluate treatment effectiveness in the critically ill trauma patient. The efficacy, safety, and availability of opioid-sparing therapies and multimodal pain regimens are reviewed.
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Efjestad, Anne Sverdrup, Hege Ihle-Hansen, Vidar Hjellvik, Knut Engedal, and Hege Salvesen Blix. "Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors." PLOS ONE 16, no. 9 (September 20, 2021): e0243804. http://dx.doi.org/10.1371/journal.pone.0243804.
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Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.
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BIGELOW, GEORGE E. "Human drug abuse liability assessment: opioids and analgesics." Addiction 86, no. 12 (December 1991): 1615–28. http://dx.doi.org/10.1111/j.1360-0443.1991.tb01756.x.
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Dmytriiev, Dmytro, A. Andriiets, E. Andriiets, V. Bankivsky, and S. Yatsenko. "Management of pain treatment in the early postoperative period. Practice of using ketorolac. A clinical case." Pain medicine 5, no. 3 (November 4, 2020): 18–26. http://dx.doi.org/10.31636/pmjua.v5i3.3.
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The current strategy of rational perioperative analgesia involves reducing the use of opioid analgesics and preventing associated side effects. Today it is known that the use of opioid analgesics can further lead to the development of hyperalgesia. Opioid-induced hyperalgesia is an adaptive response of the body in response to exogenous administration of opioids, the mechanisms of development of which are associated with the activation of the central glutamatergic system and the release of spinal dinorphins. In contrast, gabapentin, NSAIDs, and ketamine have opioid-preserving properties, reducing the number of opioid-associated side effects. Hyperalgesia is a condition that underlies the formation of chronic pain and develops regardless of the degree of postoperative wound repair.
For the treatment of pain in the postoperative period, the main group of treatment agents are opioid analgesics, which are prescribed to 60% of patients. However, with severe pain, there is a need for opioids in doses that exceed the standard recommended. It is known that the tactics of increasing the dose of opioid analgesics leads to an increase in the frequency of adverse reactions: severe sedation, respiratory depression, nausea, vomiting, intestinal paresis, dysfunction of the biliary and urinary systems, hallucinations. In order to reduce side effects, the doctor reduces the dose of opioids, which is accompanied by inadequate analgesia.
Given the above, clinicians prescribe additional drugs of other drug groups that can enhance the analgesic effect of opioids. An important aspect is the ability to reduce the dose of opioids.
Our data and data of other authors. Until recently, NSAIDs were rarely used in intensive care units, mainly in mild to moderate pain.
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Dodhia, S., S. Patel, G. Beghal, K. Pandey, and C. Hopkins. "A study of the use of post-operative opioid analgesics following rhinology surgery in 35 patients." Journal of Laryngology & Otology 133, no. 12 (November 14, 2019): 1050–52. http://dx.doi.org/10.1017/s0022215119002251.
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AbstractObjectiveOpioid analgesics are often prescribed following rhinology surgery. This study aimed to evaluate whether the quantity of opioid analgesics prescribed is justified.MethodsPatients were asked about their pain management post-operatively. Parameters recorded included: current pain (using a 10-point Likert scale); type of operation; the opioid analgesics prescribed; and the quantity of opioid tablets taken and other methods of pain relief used.ResultsThirty-five patients were successfully contacted. The median pain score at one week post-operation was 1 (interquartile range, 0–3). Of these 35 patients, 16 were prescribed opioids, whilst 19 were not. Patients prescribed opioids took a median of 8 tablets (interquartile range, 0.8–10.5) out of the 28 tablets prescribed.ConclusionThe study shows that the quantity of post-operative opioid analgesics prescribed does not compare with the amount consumed by patients to relieve pain, resulting in a surplus of opioid medication which has the potential to be abused.
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Nguyen, Thi Ngoc Mai, Dana Clarissa Laetsch, Li-Ju Chen, Walter Emil Haefeli, Andreas D. Meid, Hermann Brenner, and Ben Schöttker. "Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany." European Journal of Clinical Pharmacology 76, no. 12 (July 10, 2020): 1695–707. http://dx.doi.org/10.1007/s00228-020-02954-5.
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Abstract Purpose Chronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany. Methods A cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63–89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations. Results One out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration. Conclusions A significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults.
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Reset, Askild, Svetlana Skurtveit, Kari Furu, and Eva Skovlund. "Effect of the market withdrawal of dextropropoxyphene on use of other prescribed analgesics." Scandinavian Journal of Pain 18, no. 4 (October 25, 2018): 667–74. http://dx.doi.org/10.1515/sjpain-2018-0103.
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Abstract Background and aims Dextropropoxyphene (DXP) is a synthetic opioid that was prescribed worldwide for mild to moderate pain. It was withdrawn from the European market in 2009. In this study we aim to investigate the effect of the market withdrawal of dextropropoxyphene in Norway on overall use of opioids and other analgesics at an individual level. Methods Data were collected from the nationwide Norwegian Prescription Database (NorPD). It covers all prescription of drugs from 01 January 2004 from Norwegian pharmacies dispensed to individuals outside institutions. The study period was divided in two 2-year periods from 01 September 2008 to 31 August 2010, and from the market withdrawal of DXP on 01 September 2010 to 31 August 2012. We included every individual that filled at least one prescription of dextropropoxyphene in the first 2-year period in our study population. In this study dextropropoxyphene, codeine and tramadol are defined as “weak opioids”, and all other opioids are termed “strong opioids”. Results Nine thousand one hundred and seventy-one individuals were included in our study population. Four thousand two hundred and ninety filled a prescription of DXP only once and were classified as “single users”, 2,990 were users with prescriptions of up to 200 defined daily doses (DDD) over the first 2-year period, or “sporadic users”, and 1,886 were classified high users with over 200 DDDs over a 2-year period. After the market withdrawal 8,392 continued to be prescribed analgesics or benzodiazepines. In the single user group, the proportion of users of weak opioids decreased from 69.5% to 57.6%, whereas the proportion of users of strong opioids was unchanged. Among the sporadic user group, the proportion of users of weak opioids went from 69.7% to 71.0%, the proportion using tramadol from 39.1% to 43.9%, and the users of strong opioids from 25.8% to 31.3%. In the high user group, there was an increase in the number of users of strong opioids from 37.8% to 51.4%. The amount of strong opioids prescribed in the high user group increased from a mean of 262.5 DDD to a mean of 398.3 DDD in the following 2 years. The amount of tramadol increased in all groups and was 3 times as high in the high user group after market withdrawal of DXP. Conclusions Our study showed that the withdrawal of DXP lead to an increase in prescription of other analgesics. The proportion of users increased in all three groups and so did the prescribed amount of other analgesics. Both the proportion of users of other opioids and the amount prescribed increased considerably. However, 1 in 10 earlier users of DXP stopped using prescribed analgesics altogether in the following 2 years. The increase in use among earlier high users of DXP was most striking. Implications This study documents markedly increased prescriptions of other opioids after withdrawal of dextropropoxyphene due to its high risk of serious complications. However, consequences of the increased use of opioids among earlier high users of DXP such as changes in risk of poisonings, accidental deaths and suicides remain to be investigated.
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Atluri, Sairam. "Assessment of the Trends in Medical Use and Misuse of Opioid Analgesics from 2004 to 2011." Pain Physician 2;17, no. 2;3 (March 14, 2014): E119—E128. http://dx.doi.org/10.36076/ppj.2014/17/e119.
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Background: The epidemic of medical use and abuse of opioid analgesics is linked to the economic burden of opioid-related abuse and fatalities in the United States. Multiple studies have estimated the extent to which prescription opioid analgesics contribute to the national drug abuse problem; studies also assessing the trends in medical use and abuse of opioid analgesics have confirmed the relationship between increasing medical use of opioids and increasing fatalities. The available data is limited until 2002.. Study Design: Retrospective analysis of data from 2004 to 2011 from 2 databases: Automation of Reports and Consolidated Orders System (ARCOS) for opioid use data and Drug Abuse Warning Network (DAWN) for drug misuse data. Objective: To determine the proportion of drug abuse related to opioid analgesics and the various trends in the medical use and abuse of 8 opioid analgesics commonly used to treat pain: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. Methods: The data obtained from DAWN is a nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main outcome measure was the identification of trends in the medical use and misuse of opioid analgesics from 2004 to 2011. Results: From 2004 to 2011, there was an increase in the medical use of all opioids except for a 20% decrease in codeine. The abuse of all opioids including codeine increased during this period. Increases in medical use ranged from 2,318% for buprenorphine to 35% for fentanyl, including 140% for hydromorphone, 117% for oxycodone, 73% for hydrocodone, 64% for morphine, and 37% for methadone. The misuse increased 384% for buprenorphine with available data from 2006 to 2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263% for oxycodone, 146% for morphine, 107% for hydrocodone, 104% for fentanyl, 82% for methadone, and 39% for codeine. Comparison of opioid use showed an overall increase of 1,448% from 1996 to 2011, with increases if 690% from 1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more dramatically: 4,680% from 1996 to 2011, with increases of 1,372% from 1996 through 2004 and 245% from 2004 to 2011. The number of patients seeking rehabilitation for substance abuse also increased 187% for opioids, whereas it increased 87% for heroin, 40% for marijuana, and decreased 7% for cocaine. Limitations: Limitations of this assessment include the lack of data from 2003, lack of data available on meperidine, and that the aggregate data systems used in the study did not identify specific formulations or commercial products. Conclusion: The present trend of continued increase in the medical use of opioid analgesics appears to contribute to increases in misuse, resulting in multiple health consequences. Key words: Medical use of opioids, inappropriate use of opioids, abuse of opioids, opioid-related fatalities, Automation of Reports and Consolidated Orders System (ARCOS), Drug Abuse Warning Network (DAWN), International Narcotics Control Board (INCB)
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Darke, Andrew C., and John H. Stewart. "Efficacy and Abuse Potential of Opioid Analgesics and the Treatment of Chronic Noncancer Pain." Pain Research and Management 4, no. 2 (1999): 104–9. http://dx.doi.org/10.1155/1999/352469.
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While the role of opioid analgesics has been established in the treatment of cancer pain, reservations persist about appropriate use in patients with chronic noncancer pain. Recent evidence from controlled clinical trials supports the effectiveness of opioids for treating noncancer pain of varying etiologies. The safety of opioids in noncancer patients has been an area of controversy because of confusion between physical dependence, which develops in all patients receiving opioids chronically, and addiction, which is a behavioural diagnosis that is rarely made in patients appropriately treated with opioids for pain. Abuse by secondary recipients of opioids is well documented and arises as a result of diversion by primary recipients, double-doctoring, forgery and theft. The frequency of forgery and theft of different opioids appears to be largely related to the corresponding number of legitimate prescriptions. While it is legitimate medical practice to prescribe opioid analgesics to patients with chronic noncancer pain, there is clear evidence that prescribing is affected by concerns of regulatory sanctions. Recent guidelines, including most recently comprehensive guidelines issued by the Canadian Pain Society, should help to reduce inappropriate undertreatment because of such concerns.
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Smith, MD, Wally R., Donna K. McClish, PhD, Bassam A. Dahman, PhD, James L. Levenson, MD, Imoigele P. Aisiku, MD, MSCR, Vanessa de A. Citero, MD, Viktor E. Bovbjerg, PhD, MPH, John D. Roberts, MD, Lynne T. Penberthy, MD, MPH, and Susan D. Roseff, MD. "Daily home opioid use in adults with sickle cell disease: The PiSCES project." Journal of Opioid Management 11, no. 3 (May 1, 2015): 243. http://dx.doi.org/10.5055/jom.2015.0273.
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Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.Objective: To report on home opioid use among adults with SCD.Design: Cohort study.Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.
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C., Muraleemohan, Pratiksha Shetty, Satadru Roy, and B. Rajendra Prasad. "Opioids in the World of Oral and Maxillofacial Surgery- A Review." Journal of Health and Allied Sciences NU 08, no. 03 (September 2018): 029–33. http://dx.doi.org/10.1055/s-0040-1708760.
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AbstractPain control is one of the most difficult challenges in medicine and a key facet of disease management. The isolation of Morphine by Friedrich Sertürner in 1804 added an essential pharmacological tool in the treatment of pain and spawned the discovery of a new class of drugs known collectively as Opioid analgesics. To date, Morphine and other opioids remain essential analgesics for alleviating pain. However, their use is plagued by major side effects, such as analgesic tolerance (diminished pain-relieving effects), hyperalgesia (increased pain sensitivity), and drug dependence. Despite the potential side effects, opioids remain the pharmacological cornerstone of modern pain therapy. Opioids are particularly effective for treating acute moderate-to-severe pain after surgery or trauma. Just like other disciplines of Medicine, pain management is an integral part in Oral and Maxillofacial Surgery. The wide domain of diseases and the procedures involved in treating them, require profound analgesia for sound patient management. In order to achieve that , Opioid analgesics play a vital role for providing long term pain free period, thus enjoying a widespread use in this field. Critical to the employment of Opioid therapy are proper patient evaluation and use of comprehensive management strategies. If certain criteria are followed, administration of oral opioids may be a successful means of decreasing the patient's debilitating chronic pain to tolerable levels, enabling an improvement in the quality of life and return to function. This article is an attempt to review the commonly used opioids and their extensive application in routine maxillofacial surgery practice.
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Haddox, DDS, MD, J. David. "Opioids with abuse-deterrent properties: A regulatory and technological overview." Journal of Opioid Management 13, no. 6 (December 7, 2017): 397. http://dx.doi.org/10.5055/jom.2017.0417.
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Three concurrent public health problems coexist in the United States: endemic nonmedical use/misuse of opioid analgesics, epidemic overdose fatalities involving opioid analgesics, and endemic chronic pain in adults. These intertwined issues comprise an opioid crisis that has spurred the development of formulations of opioids with abuse-deterrent properties and label claims (OADP). To reduce abuse and misuse of prescription opioids, the federal Food and Drug Administration (FDA) has issued a formal Guidance to drug developers that delineates four categories of testing to generate data sufficient for a description of a product's abuse-deterrent properties, along with associated claims, in its Full Prescribing Information (FPI). This article reviews the epidemiology of the crisis as background for the development of OADP, summarizes the FDA Guidance for Industry regarding abuse-deterrent technologies, and provides an overview of some technologies that are currently employed or are under study for incorporation into OADP. Such technologies include physical and chemical barriers to abuse, combined formulations of opioid agonists and antagonists, inclusion of aversive agents, use of delivery systems that deter abuse, development of new molecular entities and prodrugs, and formulation of products that include some combination of these approaches. Opioids employing these novel technologies are one part of a comprehensive intervention strategy that can deter abuse of prescription opioid analgesics without creating barriers to the safe use of prescription opioids. The maximal public health contribution of OADP will probably occur only when all opioids have FDA-recognized abuse-deterrent properties and label claims.
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Chen, Xianwen, Lisong Yang, Xueli Liu, He Zhu, Fei Yu, Carolina Oi Lam Ung, Hao Hu, Waisin Chan, Honghao Shi, and Sheng Han. "Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data." Medicina 57, no. 5 (May 6, 2021): 451. http://dx.doi.org/10.3390/medicina57050451.
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Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was “NSAIDs + opioids” (55.92%), followed by “NSAIDs only” (17.85%), and “NSAIDs + Opioids + Non-opioid central analgesics” (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method.
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Hays, Helen, and Mary Ann Woodroffe. "Use of Methadone in Treating Chronic Noncancer Pain." Pain Research and Management 4, no. 1 (1999): 23–27. http://dx.doi.org/10.1155/1999/343209.
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Chronic, noncancer pain is often very difficult to treat. Opioids continue to be the most effective analgesics in relieving severe pain, and recently their long-term use has gained wider acceptance because patients report benefits related to improved comfort and/or enhanced function. There is no best choice of opioids, but rather analgesics are chosen according to individual needs and response. It may be beneficial to trial various opioids because of the possibility that opioid responsiveness may vary from drug to drug. The authors' clinical experiences using oral methadone and the switchover process from the previously used opioid to methadone are reported. This potent analgesic has a wide variation in elimination half-life and clearance. Consequently, there are inherent risks, such as severe sedation, in using opioid equianalgesic charts when switching to methadone from alternate opioids. Therefore, it is imperative that treatment be individualized, and that practitioners be familiar with prescribing opioids and have a good understanding of their pharmacokinetics. The authors' experiences are with an out-patient population, and the gradual changeover process that they use demonstrate safety without loss of pain control. This method may also be useful in those suffering terminal illness.
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Connolly, Irene, Carolyn Zaleon, and Marcos Montagnini. "Management of Severe Neuropathic Cancer Pain." American Journal of Hospice and Palliative Medicine® 30, no. 1 (April 13, 2012): 83–90. http://dx.doi.org/10.1177/1049909112443586.
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Neuropathic cancer pain is common, very disabling and difficult to treat. It can be related to tumor invasion of neural structures and neuronal damage by surgery, chemotherapy and radiation therapy. Adjuvant analgesics are often used with opioids to control neuropathic pain in cancer patients. Methadone, a synthetic opioid with multiple mechanisms of action, is gaining increasing importance as an effective agent in the treatment of cancer related neuropathic pain. This case illustrates the challenges of managing severe pain in a patient with head and neck cancer while undergoing anti-tumor treatment. A review of the adjuvant analgesics and opioids, particularly methadone, in the management of neuropathic pain is also included.
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Rodriguez-Monguio, Rosa, Mahim Naveed, and Enrique Seoane-Vazquez. "Predictors of shortages of opioid analgesics in the US: Are the characteristics of the drug company the missing puzzle piece?" PLOS ONE 16, no. 3 (March 31, 2021): e0249274. http://dx.doi.org/10.1371/journal.pone.0249274.
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Background Shortages of opioid analgesics are increasingly common, interfere with patient care and increase healthcare cost. This study characterized the incidence of shortages of opioid analgesics in the period 2015–2019 and evaluated potential predictors to forecast the risk of shortages. Methods This was an observational retrospective study using the US Food and Drug Administration (FDA) drug shortages data. All FDA approved opioids were included in the study. Opioid analgesics were identified using the FDA National Drug Codes (NDC) and classified according to the Drug Enforcement Administration (DEA) schedule. We conducted Least Absolute Shrinkage and Selection Operator logistic regression analysis to assess direction of the association between risk of shortage and potential predictors. We used multivariable penalized logistic regression analysis to model predictors of shortages. We split the dataset into training and validation sets to evaluate the performance of the model. Findings The FDA approved 8,207 unique NDCs for opioid analgesics; 3,017 (36.8%) were in the market as of April 30, 2019 and 91(3.0%) of them were listed as in shortage by the FDA. All NDCs in shortage were schedule II opioids; 86 (94.5%) were injectable and 84 (92.3%) generics. There were 418 companies with at least one opioid NDC listed by the FDA. Three companies accounted for more than 4 in 5 of the schedule II active injectable opioids. For each unit increase in the number of prior instances of shortages of a company, the likelihood of an NDC shortage for that company increased by 3.4%. For each unit increase in number of NDCs marketed by a company, the odds of an NDC shortage for that company decreased by 1%. Conclusions In the period 2015–2019, shortages of opioid analgesics disproportionally impacted schedule II and injectable opioids. The risk of shortage of opioid analgesics significantly increased with the incidence of previous instances of shortages of a manufacturing company and decreased with the number of NDCs marketed by a company. The characteristics of the manufacturing company, rather than the number of companies, might be the missing piece to the complex puzzle of drug shortages in the US.
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Stepanović-Petrović, Radica, and Maja Tomić. "Opioids and adjuvant analgesics in current treating of pain." Arhiv za farmaciju 68, no. 6 (2018): 1009–20. http://dx.doi.org/10.5937/arhfarm1806009s.
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Stepanović-Petrović, Radica, and Maja Tomić. "Opioids and adjuvant analgesics in current treating of pain." Arhiv za farmaciju 69, no. 1 (2019): 1009–20. http://dx.doi.org/10.5937/arhfarm1901009s.
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Wilkins, Matthew. "Nonopioid analgesics as effective as opioids for acute pain?" Evidence-Based Practice 23, no. 2 (February 2020): 6–7. http://dx.doi.org/10.1097/ebp.0000000000000695.
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Bromm, B., and E. Scharein. "Comparative evaluation of different analgesics: Opioids, nsaids and others." Pain 41 (January 1990): S20. http://dx.doi.org/10.1016/0304-3959(90)92178-s.
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Herrera-Gómez, Francisco, Eduardo Gutierrez-Abejón, Ignacio Ayestarán, Paloma Criado-Espegel, and F. Javier Álvarez. "The Trends in Opioid Use in Castile and Leon, Spain: A Population-Based Registry Analysis of Dispensations in 2015 to 2018." Journal of Clinical Medicine 8, no. 12 (December 5, 2019): 2148. http://dx.doi.org/10.3390/jcm8122148.
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Opioids are driving-impairing medicines (DIM). To assess the evolution and trends of opioid analgesics use between 2015 and 2018 in Castile and Leon (Spain), a population-based registry study was conceived. The length of opioid use and its concomitant use with other DIMs were studied. Analyses were done considering age and gender distributions. Adjusted consumption for licensed drivers is also presented. Of the 5 million dispensations recorded between 2015 and 2018, opioid analgesics were dispensed to 11.44% of the general population and 8.72% of vehicle drivers. Increases among daily users (2.6 times higher) and chronic users (1.5% higher) were noted, supporting the overall increase in opioid use (1.5%). The use of multiple drugs including other DIMs was a common finding (mean ± SD, 2.54 ± 0.01). Acute use (5.26%) and chronic use (3.20%) were also frequent. Formulations combining opioid analgesics with nonopioid analgesics were preferred. The use of opioids increased in Spain between 2015 and 2018. Concomitant use with other DIMS especially affects women and the elderly. Frequent use of opioid analgesics with other DIMs is a serious problem for drivers and increases the risk of accidents. Promoting safe driving should be a main objective of health authorities, to be achieved by developing and implementing educational activities for healthcare professionals and patients.
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Zimecki, Michał. "Potential impact of obligatory use of opioids in invasive procedures on interpretation of experimental data." Postępy Higieny i Medycyny Doświadczalnej 72 (February 16, 2018): 52–57. http://dx.doi.org/10.5604/01.3001.0010.8709.
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Application of opioids as an analgesic drug is a common practice in the prevention of pain in patients and experimental animals in highly invasive procedures. Very recently, new legal regulations were implemented that broaden the application of analgesics in procedures where pain relievers have not been previously obligatory. However, in light of hitherto studies, the application of opioids has adverse effects on the condition of animals in experiments. Harmful effects of opioids include: lower intake of water and food, weight loss, increased mortality, susceptibility to infection by experimental pathogens and chemicals inducing pathological changes. The above listed actions, induced by opioids, may significantly affect interpretation of experimental data. The aim of this article is to review selected studies in animal models, mainly on the application of morphine and buprenorphine, including the mechanism of opioid action. Alternative methods of analgesia, involving other types of pain relievers, such as non-steroid anti-inflammatory drugs, are also described. Since opioids significantly affect the values of investigated parameters, some experimental procedures should be probably modified in order to lower the detrimental effects of this class of pain relievers. In consequence, new protocols would probably consider the application of lower doses of compounds or pathogens required for the induction of defined, experimentally induced disease states. A wider application of analgesics, of a different mechanism of action than opioids, would also be an alternative.
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Mathews, Leya Meriam. "Management of pain using transdermal patches." Asian Journal of Pharmaceutical and Clinical Research 9, no. 6 (November 1, 2016): 32. http://dx.doi.org/10.22159/ajpcr.2016.v9i6.13775.
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Transdermal delivery is a non-invasive route of drug administration through the skin surface that can deliver the drug at a predetermined rate across the dermis to achieve a local or systemic effect. It is potentially used as an alternative to oral route of drugs and hypodermic injections. Analgesics are mostly used for various diseases as most of them are associated with severe or mild pain .The use of analgesics as a pain relief patch is now being used commonly. A transdermal analgesic or pain relief patch is a medicated adhesive patch used to relieve minor to severe pain. Currently, the patches are available for many Opioids , Non opioids analgesics. Local anesthetics and antianginal drugs. The drugs include Fentanyl, Buprenorphine ketoprofen, diclofenacepolamine , piroxicam , Capsaicin ,Nitroglycerine and Lignocaine . They are available as both matrix and reservoir patches. This review explores the various drugs used to manage pain and their route of administration in terms of frequency, complications and effects
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Van Rensburg, R., and H. Reuter. "An overview of analgesics: opioids, tramadol, and tapentadol (Part 2)." South African Family Practice 61, no. 2 (April 29, 2019): 16–23. http://dx.doi.org/10.4102/safp.v61i2.5001.
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Pain can be caused by several mechanisms, and the development of chronic pain (also known as pain chronification) is a complex and often unpredictable process. Opioids, tramadol, and tapentadol provide pharmacological solutions to chronic pain of cancer or non-cancer origins, particularly if central sensitization is present. It may also be indicated for short-term use in acute pain. Despite large studies and meta-analyses of opioids for a variety of pain conditions, the evidence for its clinical effectiveness is still unclear. This is, however, mostly due to significant heterogeneity and bias between studies assessed. The dual analgesic mechanisms of tramadol and tapentadol appear to be effective options for pain relief, with an overall lower incidence of opioid-related adverse effects. Tapentadol has an analgesic effect comparable to the strong opioids, which appears to be mediated by its greater mu opioid receptor activity and more selective noradrenaline reuptake inhibition. Tramadol produces less analgesia than tapentadol, but it is also associated with reduced opioid-related adverse effects and dependence. The opioids and tramadol may be significantly affected by polymorphisms of CYP2D6, while this effect is lessened with tapentadol.
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Brooks, Elaine, Susan H. Freter, Susan K. Bowles, and David Amirault. "Multimodal Pain Management in Older Elective Arthroplasty Patients." Geriatric Orthopaedic Surgery & Rehabilitation 8, no. 3 (August 8, 2017): 151–54. http://dx.doi.org/10.1177/2151458517720297.
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Background: Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. Objective: We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed. Methods: One hundred fifty-eight patients, 70 years and older, admitted to tertiary care for elective arthroplasty were prospectively assessed postoperative days 1–3. Patients received either traditional postoperative analgesia (acetaminophen plus opioids) or a multimodal pain protocol (acetaminophen, opioids, gabapentin, celecoxib), depending on surgeon preference. Self-rated pain, postoperative delirium, and time to achieve standby-assist ambulation were compared, as were total opioid doses and analgesic costs. Results: Despite receiving significantly more opioid analgesics (traditional: 166.4 mg morphine-equivalents; multimodal: 442 mg morphine equivalents; t = 10.64, P < .0001), there was no difference in self-rated pain, delirium, or mobility on postoperative days 1–3. Costs were significantly higher in the multimodal group ( t = 9.15, P < .0001). Knee arthroplasty was associated with higher pain scores than hip arthroplasty, with no significant difference in opioid usage. Conclusion: A multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.
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Davison, Sara N. "Clinical Pharmacology Considerations in Pain Management in Patients with Advanced Kidney Failure." Clinical Journal of the American Society of Nephrology 14, no. 6 (March 4, 2019): 917–31. http://dx.doi.org/10.2215/cjn.05180418.
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Pain is common and poorly managed in patients with advanced CKD, likely due to both under and over prescription of appropriate analgesics. Poorly managed pain contributes to patients’ poor quality of life and excessive health care use. There is tremendous variability within and between countries in prescribing patterns of analgesics, suggesting that factors other than patient characteristics account for these differences. This article discusses the pharmacologic management of acute and chronic pain in patients with advanced CKD, and the role analgesics, including opioids, play in the overall approach to pain management.
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Wampole, Chelsea R., and Kathryn E. Smith. "Beyond Opioids for Pain Management in Adult Critically Ill Patients." Journal of Pharmacy Practice 32, no. 3 (March 7, 2019): 256–70. http://dx.doi.org/10.1177/0897190019834479.
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Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators. Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.
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Boland, Jason W., Victoria Allgar, Elaine G. Boland, Mike I. Bennett, Stein Kaasa, Marianne Jensen Hjermstad, and Miriam Johnson. "The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study." European Journal of Clinical Pharmacology 76, no. 3 (December 21, 2019): 393–402. http://dx.doi.org/10.1007/s00228-019-02801-2.
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Abstract Purpose Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making. Methods Secondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death. Results Date of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6–49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 24% co-analgesics. Opioid-use was associated with decreased survival in the multivariable model (HR = 1.59 (95% CI:1.38–1.84), p < 0.001). An exploratory subgroup analysis of those with C-reactive protein (CRP) measures (n = 219) indicated higher CRP was associated with poorer survival (p = 0.001). In this model, the strength of relationship between survival and opioid-use weakened (p = 0.029). Conclusion Opioid-use and survival were associated; this relationship weakened in a small sensitivity-testing subgroup analysis adjusting for CRP. Thus, the observed relationship between survival and opioid-use may partly be due to tumour-related inflammation. Larger studies, measuring disease activity, are needed to confirm this finding to more accurately judge the benefits and risks of opioids in advanced progressive disease.
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Hashimoto, MPharm, Momoyo, Kazuki Aogaki, BPharm, Chikako Numata, PhD, Kensuke Moriwaki, PhD, Yoshinobu Matsuda, MD, Ryouhei Ishii, MD, PhD, Ikuko Tanaka, BPharm, and Yoshiaki Okamoto, PhD. "Factors influencing the prescribed dose of opioid analgesics in cancer patients." Journal of Opioid Management 16, no. 4 (July 1, 2020): 247–52. http://dx.doi.org/10.5055/jom.2020.0578.
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The dose of opioids prescribed for cancer pain does not always correlate with the actual pain severity. However, there is little evidence to explain this observation. In the present study, we sought to determine factors that influence the dose of opioid analgesics. A total of 227 patients who were administered opioids between August 2012 and May 2016 and later expired within the Department of Palliative Care at Ashiya Municipal Hospital were included, and the following variables were examined: age, sex, type of cancer, Verbal Rating Scale before and after the administration of the maximum prescribed dose of opioids, type of opioids and route of administration, blood test results, pain severity, and use of adjuvants. Data were analyzed using step-wise multiple linear regression. Median of the maximum prescribed dose of opioids, expressed in oral morphine equivalent, was 68.6, 60.0, and 39.2 mg for patients aged 65, 65-74, and ≥75 years, respectively. Step-wise multiple linear regression analysis further demonstrated that an increase in age by 1 year decreased the maximum prescribed dose of opioids by 0.98-fold (p = 0.006). Other factors that influenced the maximum prescribed dose of opioids included the use of analgesic adjuvants (1.91-fold, p = 0.001), oral administration (0.54-fold, p = 0.016), and elevated level of bilirubin (0.95-fold by 0.1 mg/dL increase, p = 0.013). Opioids examined in the study are metabolized in the liver by cytochromes P450 or by glucuronidation. Thus, if reduced drug metabolism causes the reduction in the maximum prescribed dose of opioids, liver function may contribute to this effect. Based on our findings that old age is associated with a lower prescribed dose of opioids, future studies should examine additional variables included in laboratory tests in more detail and measure hepatic blood flow to determine the cause of this association.
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Brill, S., G. M. Gurman, and A. Fisher. "A history of neuraxial administration of local analgesics and opioids." European Journal of Anaesthesiology 20, no. 9 (July 11, 2005): 682–89. http://dx.doi.org/10.1017/s026502150300111x.
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Brill, S., G. M. Gurman, and A. Fisher. "A history of neuraxial administration of local analgesics and opioids." European Journal of Anaesthesiology 20, no. 9 (September 2003): 682–89. http://dx.doi.org/10.1097/00003643-200309000-00002.
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Yeung, Celine, Alex Kiss, Sarah Rehou, and Shahriar Shahrohki. "66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S47. http://dx.doi.org/10.1093/jbcr/irab032.070.
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Abstract Introduction Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns. Methods A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers. Results On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p < 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p < 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01). Conclusions The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.
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Guarnieri, PhD, MPH, Michael. "Buprenorphine blood concentrations: A biomarker for analgesia." Journal of Opioid Management 17, no. 7 (August 1, 2021): 15–20. http://dx.doi.org/10.5055/jom.2021.0638.
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Opioids, the frontline drugs for postsurgical analgesia, have been linked to diversion and abuse with lethal consequences. The search for safe analgesics with less harm potential has been decades long. However, clinical trials for safe opioid and nonopioid analgesics have relied on subjective pain reports, which are biased by placebo effects that increase the complexity of trials to develop new therapies to manage pain.Research in opioid naïve animals and humans demonstrates that blood concentrations of opioids that effectively saturate the morphine opioid receptor are tightly linked with patient reports and quantitative sensory tests for analgesia. Opioid drug concentrations can predict clinical responses.This report reviews preclinical and clinical evidence correlating buprenorphine pharmacokinetics with analgesia. More than 30 years of data confirm buprenorphine blood concentrations can be an objective biomarker of analgesia for moderate to severe acute postoperative pain.
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Jirarattanaphochai, Kitti, and Surachai Jung. "Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials." Journal of Neurosurgery: Spine 9, no. 1 (July 2008): 22–31. http://dx.doi.org/10.3171/spi/2008/9/7/022.
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Object The authors undertook this meta-analysis to assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in addition to opioid analgesics on perioperative pain management in lumbar spine surgery. Methods The authors searched MEDLINE, Excerpta Medica (EMBASE), The Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine (AMED), and Science Citation Index Expanded databases. In addition, they manually searched key journals and their references. They included randomized trials comparing the use of NSAIDs in addition to opioid analgesics versus opioid analgesics alone after posterior lumbar discectomy, laminectomy, or spinal fusion. Two independent reviewers performed an assessment of the quality of the methods. Results Seventeen studies comprising 400 patients who received NSAIDs in addition to opioid analgesics and 389 patients receiving opioid analgesics alone were included. Patients receiving NSAIDs in addition to opioid analgesics had lower pain scores and consumed fewer opioids than the group receiving opioid analgesics alone. There was no difference in the incidence of adverse effects. Conclusions This meta-analysis provides evidence that the addition of NSAIDs to opioid analgesics in lumbar spine surgery provided better pain control than opioid analgesics alone.
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Bressler, Linda R. "Cancer Pain Management in Ambulatory Patients." Journal of Pharmacy Practice 8, no. 6 (December 1995): 260–68. http://dx.doi.org/10.1177/089719009500800602.
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Pain, by definition, is a subjective phenomenon. The subjective component in chronic pain due to cancer is very important. Opioid analgesics are the mainstay of treatment for cancer pain. Their use should be optimized to provide adequate pain relief. Optimal use includes understanding the concepts of tolerance, physical dependence, and psychological dependence. None of these should limit or inhibit pain management. Optimal use also includes familiarity with the clinical use of opioids. Regular use is generally preferred over “prn” use. Increased parenteral versus oral effectiveness of opioids, secondary to a high first-pass effect, is an important consideration when routes of administration must be altered. Familiarity with approximate equianalgesic doses allows for conversion from one opioid to another. Such conversion might help increase the convenience, increase the efficacy, or decrease the adverse effects of an opioid regimen. Knowledge of durations of action of opioids helps in the selection of dosing intervals to facilitate continuous pain relief. Morphine is the most common opioid chosen for cancer pain management, but others may be equally effective. Follow-up assessments with subsequent alterations are as important as the initial selection of drug, dose, and dosing interval. Adjuvant analgesics, such as nonsteroidal antiinflammatory drugs, anticonvulsants, or antidepressants, may enhance pain relief, especially in certain pain syndromes (eg, metastatic bone pain, neuropathic pain). These agents are usually used in addition to opioids.