Pain medicine : the official journal of the American Academy of Pain Medicine
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Multicenter Study Comparative Study
Source of drugs for prescription opioid analgesic abusers: a role for the Internet?
There has been a sharp increase in the abuse of prescription opioid analgesics in the United States in the past decade. It has been asserted, particularly by several governmental and regulatory agencies, that the Internet has become a significant source of these drugs which may account to a great extent for the surge in abuse. We have studied whether this is correct. ⋯ The assertion that the Internet has become a dangerous new avenue for the diversion of scheduled prescription opioid analgesics appears to be based on no empirical evidence and is largely incorrect.
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Review
Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options.
To facilitate the clinician's understanding of the basis and treatment of painful diabetic neuropathy (PDN). ⋯ A better understanding of the peripheral and central mechanisms resulting in PDN is likely to promote the development of more targeted and effective treatment.
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Traditionally, opioids have been the cornerstone of therapy for patients suffering from cancer pain, regardless of the potential to develop opioid tolerance. In chronic pain patients who experience worsening pain despite increasing doses of opioids, the clinical role of opioid-induced hyperalgesia is gaining more recognition. ⋯ Opioid-induced hyperalgesia might be considered in a patient who has no evidence of disease progression, who is on clinically reasonable doses of opioids, and whose pain escalates as opioid doses are increased. A reduction of opioids and the addition of a low-dose N-methyl-D-aspartate receptor antagonist may provide a favorable clinical outcome in those patients who have failed to benefit from opioid rotation and other adjunctive pain treatments.
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Comparative Study
Physicians charged with opioid analgesic-prescribing offenses.
To provide a "big picture" overview of the characteristics and outcomes of recent criminal and administrative cases in which physicians have been criminally prosecuted or charged by medical boards with offenses related to inappropriate prescribing of opioid analgesics. ⋯ Criminal or administrative charges and sanctions for prescribing opioid analgesics are rare. In addition, there appears to be little objective basis for concern that pain specialists have been "singled out" for prosecution or administrative sanctioning for such offenses.
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Principle-based ethical theory is currently available to guide health care professionals in clinical decision-making when they face ethical dilemmas. These principles include respect for autonomy (RA), nonmaleficence (NM), beneficence (B), and distributive justice. It is, however,unknown which principles, if any, guide physicians and nurses in this decision-making. The goal of our study was to explore how anesthesiologists, surgeons, nurses, and nurse anesthetists reason in the face of a moral dilemma. ⋯ Anesthesiologists tend to transfuse Jehovah’s Witness patients more than did the others. Together with surgeons, they explicitly justify their decision-making less frequently when compared with nurses and nurse anesthetists. Further education in ethical theory is appreciated and needed.