Articles: opioid.
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Pain is the presenting symptom in 20 to 30% of patients with autosomal dominant polycystic kidney disease (ADPKD) and occurs in 50 to 60% of patients at some stage of the disease process, but its frequency increases with age and size of the cysts. Back pain is caused by kidney enlargement as well as rupture, hemorrhage, or infection of cysts. Other causes of pain include nephrolithiasis and urinary tract infections (UTIs). Analgesic options for patients with ADPKD include transcutaneous electrical nerve stimulation (TENS), spinal cord stimulation, low-dose opioids, and local anesthetics.
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Worldviews Evid Based Nurs · Dec 2014
Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients.
Adverse events related to opioid-induced unintended advancing sedation and respiratory depression in hospitalized patients are occurring with increased frequency, and these adverse events can have a negative impact on quality and cost outcomes. ⋯ Nurse executives and nurse managers assume accountability for ensuring that patient care is aligned with the best evidence, practices, and regulatory mandates. The framework presented in this paper can help prevent opioid-induced advancing sedation and respiratory depression, and assist nurse leaders in implementation strategies to guide policies and practice.
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The objective of this study is to estimate the prevalence and impact of prescription opioid abuse and tampering among US adults. ⋯ Tampering with opioid medications to get high is associated with substantial loss of productivity and health care use. Technologies that reduce users' ability to tamper may reduce the burden of opioid abuse on the health care system.
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Pharmacoepidemiol Drug Saf · Dec 2014
The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping").
This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. ⋯ The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed.
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Breathlessness is a key symptom in chronic obstructive pulmonary disease (COPD) with prognostic implications on health status and survival. Since most conditions underlying chronic refractory breathlessness in COPD are not modifiable, the use of opioids and benzodiazepines has been proposed to relieve it. However, respiratory depression is a known adverse event of these drugs, and concerns have been raised on their use in patients with chronic respiratory failure. ⋯ Recent observations favor the use of lower doses of opioids (≤30 mg oral morphine equivalents/day) for reduction of symptoms in those patients with severe COPD receiving long-term oxygen therapy. Low dose opioids are not associated with an increased risk of hospital admission or death in cohorts of COPD patients on long term oxygen therapy. On the contrary, benzodiazepines and opioids at higher doses might increase mortality.