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When I Control the Pain, I Control My Life: Opioids and Opioid-Containing Analgesic Medication in the Management of Chronic Intractable Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
Drug-seeking behavior Acquisition from nonmedical sourcesAltered prescriptionsHoarding and/or selling drugsIgnoring negative impact and influences of the drugManipulation of the physician to get more drugMultiple excuses to get more drugMultiple therapists and multiple pharmaciesStrong desire for the drug for other than medical useUse of additional drugs, most commonly alcohol
Characteristics Of Dependence On And Abuse Of Psychoactive Drugs
Published in S.J. Mulé, Henry Brill, Chemical and Biological Aspects of Drug Dependence, 2019
Drug dependence may be defined in scientific terminology as follows: Repeated use of psychoactive drugs leading to a conditioned pattern of drug-seeking behavior. A characteristic, predictable and reproducible syndrome is associated with each drug (or drug type). It may be modified or reinforced by drug-induced physical and/or pathological components. The intensity of response varies with the nature and amount of the drug and the method, frequency, and duration of administration.
Cauda equina syndrome
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Jasmin Stefani, Luis M. Tumialán
A 24-year-old man who works at a hardware store presented to the emergency department after he lifted a 50-pound bag of cement and felt a “pop” in his back. He reported debilitating axial back pain without radiculopathy. His physical examination was limited by his pain, and a test of his motor skills against confrontation was likewise difficult to perform. The patient reported no bowel or bladder issues. Plain radiographs were negative for abnormal findings, and the patient was discharged with narcotic pain medication and was instructed to follow up with his primary care provider. On two subsequent occasions, he returned to the emergency department, but his assessments were unremarkable and he was discharged. The treating physician noted a concern about potential drug-seeking behavior.
Genetic and epigenetic studies of opioid abuse disorder – the potential for future diagnostics
Published in Expert Review of Molecular Diagnostics, 2023
Sarah Abdulmalek, Gary Hardiman
Similar transcriptional changes have been reported in the VTA. Upregulation of Tet1 in conjunction with downregulation of Dnmt1 and the corresponding increase of 5-hmC and decrease of 5-mC expressions were observed in the rats’ VTA following repeated i.p. administration of oxycodone [84]. Repeated exposure to oxycodone altered synaptic associated genes in the VTA in the same manner reported from hippocampal tissues. Hypomethylation of exon 1 and exon 2 of Syp and Psd95, respectively, corresponded with transcriptional increase in mRNA levels [84]. Heroin self-administration also resulted in global DNA methylation changes in the NAc. Rats trained to self-administer heroin showed hypomethylation of the Gamma-aminobutyric acid type A receptor subunit D (GABRD) concomitant with an increase in the levels of mRNA [85]. Interestingly, these changes were only displayed by rats who self-administer heroin and not by heroin yoked groups who received the same dose of heroin at the same time their counterparts made the decision to self-administer the drug [85]. These results suggest a novel therapeutic target to tackle drug-seeking behavior and, also, suggest a pivotal role of the process of decision-making on the severity of dependence.
Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses
Published in International Journal of Forensic Mental Health, 2021
PRN for a severely ill group of patients with individual medication histories. Both patients and nurses saw forensic psychiatric patients as a unique group when it came to participation in PRN. Patients identified themselves as severely ill forensic patients who needed the strongest medications. One patient described this group as “the most difficult patients in Finland.” One nurse added that “our patients have special needs with PRN.” Nurses also thought patients’ illnesses made it difficult for them to participate in PRN decisions and to even understand the meaning of PRN. Patient participation was connected to medication history. Patients had favorite drugs and those they disliked, or they were either keen or avoidant toward medication in general. Some patients with a history of substance misuse avoided PRN because they associated it with addictive behavior. Nurses connected such history to drug-seeking behavior and saw requests as a habit, and patients could feel stigmatized as misusers. Nurses described trying to optimize PRN use to match medication needs by encouraging drug-avoidant patients and inhibiting drug-seeking patients.
Addressing Racism in Medicine Requires Tackling the Broader Problem of Epistemic Injustice
Published in The American Journal of Bioethics, 2021
Brandon del Pozo, Josiah D. Rich
Given these definitions and examples, we can see how epistemic injustice helps characterize certain instances of racism in medicine. It may explain why physicians systematically discount complaints of pain and discomfort by Black patients, and do less to treat them (Meghani, Byun, and Gallagher 2012). There is evidence that physicians dismissed these complaints as drug-seeking behavior, ironically sparing some patients from the initial analgesic wave of the current opioid crisis (Frakt and Monkovic 2019). It also helps explain why medical professionals and institutions have for decades downplayed the urgency of combatting sickle cell disease in the Black community. Correcting this requires presuming that patients are accurately articulating something about themselves, and realizing that ethnocentric viewpoints can deprive us of critical evidence.