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Palliative Care
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Pain is a common symptom for patients with incurable malignancy and other life-limiting conditions. To best manage this symptom, it is necessary to identify the likely cause of the pain. Exclude any emergencies requiring specific management, such as spinal cord compression, bowel obstruction or bone fracture. Non-opioids (e.g. ibuprofen) and opioids (e.g. tramadol and morphine) should be prescribed, as required, to initiate and maintain pain control. Table 12.1.1 lists the characteristics of different types of pain and treatment options.
More Complex Patients
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Patients on long-term opioid therapy may have developed a tolerance to the drug, meaning that higher doses are required in order to obtain good analgesia. Opioid-induced hyperalgesia (OIH) might also be present, which will have the opposite effect, and increased doses will not improve pain relief. For the definitions of each see Table 15.4, and for more information on tolerance and OIH, see Chapter 4. After continuous exposure to an opioid, some degree of tolerance is probably seen after seven to ten days.
Disenchantment with current pain management
Published in Stephen Buetow, Rethinking Pain in Person-Centred Health Care, 2020
Opioid use carries health risks, including accidental and non-accidental overdoses, stimulating treatment of opioid-use disorder.116 The global pharmaceutical industry is profiting from treating effects of the opioid epidemic it helped to create. However, prescription opioids are generally safe when taken as prescribed and without other central nervous system depressants. Prescription opioids carry a low risk of overdose events, both non-fatal and, in particular, fatal.109 Nonetheless, risks of opioid misuse and addiction vary widely between studies, depending on variables like the definitions used, study population and prescriber.117 In carefully selected populations with persistent pain, the incidence of addiction reported is below 5 per cent.118 Yet, many clinicians struggle to balance the therapeutic value of opioid prescribing against a risk of serious harms.119
Current and emerging pharmacotherapies for opioid dependence treatments in adults: a comprehensive update
Published in Expert Opinion on Pharmacotherapy, 2022
Jonna M. Leyrer-Jackson, Amanda M. Acuña, M. Foster Olive
The ability of opioids to induce feelings of intense pleasure and euphoria, while also producing negative-reinforcing effects via pain relief, are largely rooted in their neurobiological effects on the central and peripheral nervous systems. Chronic pain conditions vastly increase the risk for opioid misuse and OUD development [14]. Individual susceptibility or resilience to the development of OUD is influenced by genetic and epigenetic factors [15], as well as developmental factors, such as age of opioid use initiation, as discussed in the next section. Still, there are profound societal and environmental influences that can confer susceptibility to development of OUD. These include a history of incarceration or early life adversity, low socioeconomic status, unstable housing, employment, and family structure, economic stagnation, social despair, and race and ethnicity-based disparities in treatment access [16,17]. Specifically, individuals who have childhood trauma or perceived stress are more likely to abuse opioids and develop an OUD [18]. Trauma in the form of sexual abuse and assault particularly increases prescription opioid use and misuse in both men and women in adulthood [19]. Interestingly, females are more likely to report prescription opioid use and abuse than men, although the reasons behind this are not well understood [20]. In section 9 we highlight sex differences in OUDs, which provides additional insight into this topic.
Against the Current: Exploring the Experiences of Five Fathers With a History of Substance Use
Published in Occupational Therapy in Mental Health, 2021
Paige Garramone, Laurie Knis-Matthews, Penina Brandeis, Megan Kret, Lukasz Sliwa, Arielle Leva
Opioids are a class of drugs often used to relieve pain. They include prescription opioids (i.e. oxycodone [OxyContin], hydrocodone [Vicodin], morphine and methadone), fentanyl, and heroin (Centers for Disease Control & Prevention [CDC], 2017). Opioid use has become an epidemic in the United States, with over 2.4 million people meeting the DSM-5 (American Psychiatric Association [APA], 2013) criteria for severe opioid use disorder (Jones et al., 2015). On October 24, 2018, the President signed H.R.6: Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act to include occupational therapy as a non-pharmacological pain management treatment (American Occupational Therapy Association [AOTA], 2018). This legislation will promote access to occupational therapy services for adults, including fathers with a substance use disorder, as it requires the Centers for Medicare & Medicaid Services (CMS) to analyze best practices, payment and coverage for pain management services. State Medicaid plans will now be directed to provide coverage for non-pharmacological treatment and management of pain, often a component of substance abuse treatment, which includes occupational therapy (Parsons, 2018). This law emphasizing non-pharmacological treatment options comes at a key time to fight this epidemic.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Opioids are a class of drugs used in a medical setting to treat acute and chronic pain. They include alkaloids from poppy seeds (codeine and morphine), semisynthetic opioids (oxycodone, hydromorphone and oxymorphone), synthetic phenylpiperidines (meperidine and fentanyl) and synthetic pseudopiperidines (methadone). It is estimated that up to 8 million Americans use opioid medications for chronic pain [20]. Lifetime self-reported misuse of opioid analgesics is 14% in persons 12 years and over [21]. These statistics help elucidate the magnitude of the current opioid crisis we are facing. Studies show that the opioid crisis has worsened over the past several decades, with mortality having quadrupled between 2000 and 2014 in opioid driven hospitalizations [22]. Most opioid-related hospitalizations are a direct result of opioid use such as intoxication, and others due to resulting traumatic injuries, injection site infections, and endocarditis. Unfortunately, these patients have been shown to be less compliant with follow up recommendations, resulting in recurrent ER visits and hospitalizations [3].