The System Is Broken: A Qualitative Assessment of Opioid Prescribing Practices After Spine SurgeryTo elucidate factors that influence opioid prescribing behaviors of key stakeholders after major spine surgery, with a focus on barriers to optimized prescribing.
Prescription Opioid Epidemic and Trends in the Clinical Development of New Pain MedicationsTo evaluate trends in the clinical development of new pain and reformulated pain medications given the ongoing opioid crisis and the public health burden of inadequately controlled pain.
Spinal Stimulation for the Treatment of Intractable Spine and Limb Pain: A Systematic Review of RCTs and Meta-AnalysisTo synthesize the evidence regarding the effect of spinal stimulation (SS) vs medical therapy (MT) and the effect of newer SS technologies vs conventional SS on pain reduction in patients with intractable spine or limb pain.
Wide Variation in Opioid Prescribing After Urological Surgery in Tertiary Care CentersTo describe postoperative opioid prescribing practices in a large cohort of patients undergoing urological surgery.
A Before and After Analysis of Health Care Utilization by Patients Enrolled in Opioid Controlled Substance Agreements for Chronic Noncancer PainTo evaluate the impact of opioid controlled substance agreements (CSAs) enrollment on health care utilization.
Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care UtilizationTo examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.
Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based StudyTo determine what proportion of a geographically defined population who receive new opioid prescriptions progresses to episodic or long-term patterns of opioid prescribing and to explore the clinical characteristics associated with patterns of opioid prescribing.
Epidemiology of Emergency Department Visits for Opioid Overdose: A Population-Based StudyTo evaluate the rate of emergency department (ED) visits for opioid overdose and to examine whether frequent ED visits for opioid overdose are associated with more hospitalizations, near-fatal events, and health care spending.
Treatment Considerations for Patients With Neuropathic Pain and Other Medical ComorbiditiesThe efficacy of drugs for neuropathic pain has been established in randomized controlled trials that have excluded patients with comorbid conditions and those taking complex medications. However, patients with neuropathic pain frequently present with complex histories, making direct application of this evidence problematic. Treatment of neuropathic pain needs to be individualized according to the cause of the pain, concomitant diseases, medications, and other individual factors. Tricyclic antidepressants (TCAs), gabapentinoids, selective noradrenergic reuptake inhibitors, and topical lidocaine are the first-line choices; if needed, combination therapy may be used.
Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature UpdateThe Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel α2-δ ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances.
Chemical Dependency and the PhysicianAlthough the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic.
Development of Peripheral Opioid Antagonists: New Insights Into Opioid EffectsThe recent approval by the US Food and Drug Administration of 2 medications—methylnaltrexone and alvimopan—introduces a new class of therapeutic entities to clinicians. These peripherally acting μ-opioid receptor antagonists selectively reverse opioid actions mediated by receptors outside the central nervous system, while preserving centrally mediated analgesia. Methylnaltrexone, administered subcutaneously, has been approved in the United States, Europe, and Canada. In the United States, it is indicated for the treatment of opioid-induced constipation in patients with advanced illness (eg, cancer, AIDS) who are receiving palliative care, when response to laxative therapy has not been sufficient.
The Sickle Cell Crisis: A Dilemma in Pain ReliefSickle cell anemia is a progressive hemoglobinopathy producing chronic hemolytic anemia, microvascular thrombosis, ischemic pain, tissue infarction, decreased quality of life, and ultimately shortened life expectancy.1,2 In sickle cell anemia, valine is substituted for glutamic acid in the sixth amino acid of the β-globin chain. In a person who is homozygous, all hemoglobin is of the abnormal HbS type, and repeated episodes of sickling result in a less malleable molecule even at sites of normal atmospheric pressures of oxygen.
Chronic Noncancer Pain Rehabilitation With Opioid Withdrawal: Comparison of Treatment Outcomes Based on Opioid Use Status at AdmissionTo study differences in treatment outcomes between patients with chronic noncancer pain taking vs those not taking maintenance opioids at admission to a pain rehabilitation program.
Use of Opioids in the Treatment of Severe Pain in Terminally Ill Patients—Dying Should Not Be PainfulPain is a common symptom at the end of life. The vast majority of pain can be readily managed if simple principles of practice are followed. Chronic pain requires continuous analgesia, and severe pain requires use of strong analgesics, most commonly the opioids. In addition to drugs administered continually, short-acting medications must be available for “breakthrough” pain. This article reviews the principles of pain management in terminally ill patients, using a case-based demonstration.
An Overview of the Diagnosis and Pharmacologie Treatment of MigraineMigraine, an episodic headache disorder, is one of the most common complaints encountered by primary-care physicians and neurologists. Nevertheless, it remains underdiagnosed and undertreated. Rational migraine treatment necessitates an accurate diagnosis, identification and removal of potential triggering factors, and, frequently, pharmacologie intervention. Effective management also includes establishing realistic expectations, patient reassurance, and education. The choice of medication (abortive, symptomatic) for an acute attack depends on such factors as the severity of the attack, presence or absence of vomiting, time of onset to peak pain, rate of bioavailability of the drug, comorbid medical conditions, and side-effect profile.
Treatment of Cancer-Related Pain: When Orally Administered Medications FailTo summarize the available pain-relieving interventions other than oral medications for cancer-related pain.
Pathophysiology of PainTo review the pain pathways in the central and peripheral nervous system and the actions of drugs used to treat pain.
Use of Orally Administered Opioids for Cancer-Related PainTo summarize the important principles of opioid analgesia for cancer-related pain.
Management of Postoperative Pain: Influence of Anesthetic and Analgesic ChoiceImproved control of postoperative pain is being increasingly scrutinized yet concomitantly demanded by patients, physicians, and even the federal government. Our ever-increasing subspecialization in medicine has compartmentalized much of perioperative care and has created substantial difficulty for physicians in understanding the overall influence of other physicians' perioperative decisions, including control of pain. Clearly, intraoperative anesthetic management can affect patients' pain and perioperative course remote from the surgical procedure through modulation of analgesic and perioperative stress responses.