Articles: analgesics.
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Review
Persistent pain, long-term opioids, and restoring trust in the patient-clinician relationship.
The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis. Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician. For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust. ⋯ To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes. PERSPECTIVE: Erosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.
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Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery. ⋯ This paper reviews advancements in perioperative pain management for cardiac surgery patients, emphasising the shift from high-dose opioids to multimodal analgesia and regional anaesthetic techniques, and highlighting the role of multidisciplinary transitional pain services.
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Pain is a common presenting symptom to consultant physicians, both in the hospital and in the clinic or rooms. Biologically, pain serves as warning of tissue damage. But this is no longer the case when pain is present for months or years, especially when it has been fully investigated. ⋯ The response to the so-called 'opioid epidemic' has led to a renewed focus on how chronic pain should be managed. The aim of this article is to update fellows and trainees on the assessment and management of chronic pain in adult medical patients. In particular, we address the role of pharmacotherapy post-opioid epidemic (primarily antidepressants and anticonvulsants in neuropathic pain), the place of interventional procedures and the nature and effectiveness of pain self-management training in people with chronic pain, many of whom have had pain for a year or more and failed other treatments.
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Review
[Osteoarthritis: Degenerative changes or adaptive changes? Brief pain advice in primary care].
Osteoarthritis is a degenerative joint disease and is the most common joint problem worldwide. It is considered a serious disease due to the presence of pain and reduced functional capacity. Moreover, there are no disease-modifying drugs or curative treatment at present; the basic or first-line treatment is non-pharmacological, based on education and physical exercise. ⋯ In short, osteoarthritis is part of the normal aging process of the population. As with low back pain, it is proposed to apply a salutogenic model of health, paying special attention to the terms used when informing and advising patients. It is proposed a review of the main causes, effectiveness and prognosis of osteoarthritis treatment, in order to provide brief educational advice to patients.
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Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence. ⋯ Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.