Articles: opioid-analgesics.
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Mayo Clinic proceedings · Oct 2020
ReviewEnsuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations.
Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. ⋯ Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.
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This study aims to assess multimodal pain management and opioid prescribing practices in patients undergoing breast surgery. ⋯ There is need for a multidisciplinary approach to pain management with the use of enhanced recovery after surgery protocols as potential means to standardize perioperative regimens and mitigate opioid overprescription.
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The chronic use of opioids and glucocorticoids is associated with serious side effects. Moreover, both medications are related to poor long-term postoperative outcomes. ⋯ Chronic pre-operative use of opioids and glucocorticoids, together or individually, were associated with increased 90-day mortalities after noncardiac surgery, compared with opioid-naïve and glucocorticoid-naïve patients. Our results suggest that chronic pre-operative use of opioids and glucocorticoids should be managed carefully.
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Molecular pharmacology · Oct 2020
ReviewBidirectional Relationship between Opioids and Disrupted Sleep: Putative Mechanisms.
Millions of Americans suffer from opiate use disorder, and over 100 die every day from opioid overdoses. Opioid use often progresses into a vicious cycle of abuse and withdrawal, resulting in very high rates of relapse. Although the physical and psychologic symptoms of opiate withdrawal are well-documented, sleep disturbances caused by chronic opioid exposure and withdrawal are less well-understood. ⋯ SIGNIFICANCE STATEMENT: We review recent studies on the mechanisms linking opioids and sleep. Opioids affect sleep, and sleep affects opioid use; however, the biology underlying this relationship is not understood. This review compiles recent studies in this area that fill this gap in knowledge.