Articles: opioid.
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Curr Pain Headache Rep · May 2017
ReviewTechniques to Optimize Multimodal Analgesia in Ambulatory Surgery.
Ambulatory surgery has grown in popularity in recent decades due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. We review common approaches to multimodal analgesia. ⋯ A multimodal approach can help reduce perioperative opioid requirements and improve patient recovery. Analgesic options may include NSAIDs, acetaminophen, gabapentinoids, corticosteroids, alpha-2 agonists, local anesthetics, and the use of regional anesthesia. We highlight important aspects related to pain management in the ambulatory surgery setting. A coordinated approach is required by the entire healthcare team to help expedite patient recovery and facilitate a resumption of normal activity following surgery. Implementation and development of standardized analgesic protocols will further improve patient care and outcomes.
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To examine encounter-level factors associated with opioid dose increases during patients' first year on opioid therapy for chronic pain. ⋯ Most opioid prescriptions were written without face-to-face encounters. One quarter of dose increases contained no documented prescribing rationale. Documented encounter-level factors were not significantly associated with overall opioid dose escalation.
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Human psychopharmacology · May 2017
Multicenter StudyImpact of synthetic cannabinoids on the duration of opioid-related withdrawal and craving among patients of addiction clinics in Kazakhstan: A prospective case-control study.
The aim of the study was to prospectively assess whether regular use of synthetic cannabinoids (SCs) affects the duration of opioid-related withdrawal and craving symptoms in patients undergoing drug detoxification treatments. ⋯ This is the first study to assess the impact of SCs on the course of opioid withdrawal and craving symptoms. The results (a) suggest that patients with opioid use disorder in combination with regular use of SCs exhibit a significantly longer duration of opioid withdrawal and craving symptoms, (b) add to the accumulating evidence showing clinical and molecular cross talks between cannabinoids and opioids, and (c) underline novel harmful effects of SCs.
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Pharmacoepidemiol Drug Saf · May 2017
Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment.
To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients. ⋯ For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population-level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended. Copyright © 2017 John Wiley & Sons, Ltd.
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Int. J. Drug Policy · May 2017
Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan.
This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. ⋯ Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries.