Articles: opioid.
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Objectives. Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QoL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. ⋯ The mean morphine dose during the spinal trial was 11.28 mg/day, 7.92 mg/day at pump implantation, and 16.32 mg/day at one-year follow-up. Conclusions. Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QoL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side-effects with systemic administration of analgesics.
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This article provides an overview of central issues in chronic nonmalignant pain management with a focus on prescribing opioid analgesics. Definitions are provided for terminology regarding pain and addiction. ⋯ Nonopioid treatments are reviewed. A standardized approach to chronic nonmalignant pain reduces stigma and improves patient care, therefore, an algorithm is presented for management of chronic nonmalignant pain.
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This investigation evaluated the efficacy of nalbuphine in treating postoperative opioid-induced pruritus (Pr) in pediatric patients. ⋯ La nalbuphine iv à 50 µg·kg(-1) n'est pas efficace pour traiter le prurit postopératoire induit par les opioïdes chez des patients pédiatriques. Le score modifié à l'EAC et la DIPr devront être étudiés plus à fond.
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Study Design. A retrospective design comparing three matched groups was used to evaluate the application of a multidimensional approach to outcomes analysis using a variety of disease-specific and generic outcome measures to assess three treatments for failed back surgery syndrome. Objective. The objective of this study was to explore the use of a multidimensional analysis of outcomes to compare and contrast the effects of three different treatments: 1) intrathecal therapy using an implantable drug administration system (DAS), 2) standard medical therapy emphasizing the use of oral opioids (OO), and 3) residential pain and rehabilitation program (RPRP) for the treatment of chronic low back pain. Summary of Background Data. The incidence of low back pain in patients with prior back surgery remains significant. ⋯ No one treatment emerged as the most effective across all of the disease-specific and generic measures. However, patients in the DAS group tended to report greater improvement. Overall, although generally "satisfied" with treatment, they were generally "satisfied" with treatment despite continuing to report significant levels of pain, disability, and impaired QoL.
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The administration of intrathecal drugs has been shown to be efficacious in the treatment of both cancer pain and noncancer pain in patients who do not respond well to conventional treatment, in those who are unable to tolerate side-effects of opioids, and in those who constantly require significant increases in drug dosing. Although morphine represents the "drug of choice" for intrathecal administration, the use of alternative drugs (e.g., bupivacaine, clonidine, and hydromorphone) appears promising for intrathecal therapy of pain in patients who are unresponsive to morphine, those who cannot tolerate its side-effects, and those patients with neuropathic pain. This study analyzes results of studies published from 1990 to 2005 in order to evaluate the efficacy of intraspinal therapy.