Articles: opioid.
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More than one million people each year in the United States are diagnosed with cancer. Surgery is considered curative, but the perioperative phase represents a vulnerable period for residual disease to spread. Regional anesthesia has been proposed to reduce the incidence of recurrence by attenuating the sympathetic nervous system's response during surgery, reducing opioid requirements thus diminishing their immunosuppressant effects, and providing antitumor and anti-inflammatory effects directly through systemic local anesthetic action. In this article, we present a description of the perioperative period, a summary of the proposed hypotheses and available literature on the effects of regional anesthesia on cancer recurrence, and put regional anesthesia in context in regard to its potential role in reducing cancer recurrence during the perioperative period. ⋯ The benefits of regional anesthesia in reducing cancer recurrence have a sound theoretical basis and, in certain cancers, are supported by the existing body of literature. This article outlines the current state of our knowledge on the relationship between cancer progression and regional analgesia.
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The Opioid Compliance Checklist (OCC) is a self-report measure for chronic pain patients prescribed long-term opioid therapy. The original measure includes 'yes' or 'no' items that reflect the content of a typical opioid therapy agreement. The aim of the study was to assess the efficacy of the OCC for monitoring opioid adherence among chronic noncancer pain patients within primary care. One hundred seventy-seven chronic pain patients were recruited as part of a larger study from 8 primary care centers. All patients completed pre- and poststudy measures as well as the OCC once a month for 6 months. Patients were classified on the Drug Misuse Index on the basis of results of urine toxicology screens, physician misuse behavior ratings, and self-report questionnaire results. Patients treated in primary care reported fewer incidences of misuse compared with patients from pain specialty centers in the original study. Three items from the OCC were found to be most predictive of opioid misuse measured according to the area under the curve (AUC = .681) analyses, although use of the 8-item OCC seemed equally valid. By the end of the study the patients reported lower scores on the OCC (greater compliance with their opioid medication). Results of this study suggest that the psychometric parameters of the shortened 8-item OCC are not based solely on unique characteristics of the initial validation sample. The OCC seemed to be a reliable and valid screening tool to help detect current and future aberrant drug-related behavior and nonadherence among chronic pain patients in primary care. ⋯ The OCC is a brief 'yes' or 'no' questionnaire that reflects areas of compliance that are often included in an opioid therapy agreement. Repeated administrations of the OCC among patients who receive opioids for chronic pain can increase the chance of identifying those who misuse or are likely to misuse opioids.
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J Pain Symptom Manage · Apr 2016
Association Between Tobacco Use, Symptom Expression, Alcohol and Illicit Drug Use in Advanced Cancer Patients.
Limited knowledge exists examining the association between smoking status, symptom expression, and alcohol or illicit drug use. ⋯ In advanced cancer, patients who were former or current smokers were significantly more likely to have a history of CAGE positivity and illicit drug use compared with never smokers. Current smokers expressed significantly higher pain. A smoking history may be a marker of an increased risk of opioid misuse.
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Real-life data on laxative use in patients suffering from opioid-induced constipation (OIC) are very limited, and many OIC patients are only using over the counter laxatives to resolve their constipation. Our aim was to describe laxative utilization and quality of life in participants in Norway who ever experienced OIC. ⋯ Patients suffering from OIC with low quality of life and remaining symptoms despite use of two or more laxatives are a vulnerable patient group in need of optimized healthcare management, who also might benefit from more specific and innovative therapy.
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Take-home naloxone is increasingly provided to prevent heroin overdose deaths. Naloxone 0.4-2.0 mg is licensed for use by injection. Some clinicians supply improvised nasal naloxone kits (outside licensed approval). Is this acceptable? ⋯ The addictions treatment field has rushed prematurely into the use of improvised nasal naloxone kits. Evidence of adequate bioavailability and acceptable pharmacokinetic curves are vital preliminary steps, especially when effective approved formulations exist.