Opioid analgesia after discharge from hospital
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2014
The risk of long-term use of an opioid initially prescribed to manage acute pain in the short term may correlate better with psychological factors such as depression rather than duration of the pain. In hospital it is known that the combination of opioid with any sedative medication will increase the risk of opioid-induced ventilatory impairment. This combination has also been shown to increase the risk of death in patients with chronic noncancer pain and those using opioids for nonmedical purposes. The effects of opioid medication on driving and driving risks have been studied in detail and many countries have guidelines relating to driving and opioid medications. The intensity of acute pain both in and after discharge from hospital is likely to vary according to the degree of activity, and should decrease as the patient recovers. Therefore, the dose of opioid that is to be needed by the patient may vary within each day and should be decreasing with time overall.
Naloxone Use in the Opioid Epidemic
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Drug overdose deaths continue to rise in the United States. Two out of three overdose deaths involve an opioid, which includes prescription opioids, heroin, and synthetic opioids such as fentanyl. Naloxone is thought to be a competitive antagonist of the mu-, kappa-, and delta-receptors, inhibiting both the toxic and clinical effects of opioids, making it an effective antidote for opioid overdoses. Access to naloxone has been increasing in recent years. Between 2017 and 2018, naloxone prescriptions doubled from 270,000 prescriptions written in 2017 to 556,000 prescriptions written in 2018. The opioid crisis was created by multiple factors, and it will take a concerted effort from multiple disciplines, including healthcare professionals, legislators, and the general public, to address it effectively. Wider access to naloxone is an important component to help fight opioid deaths and ensure that this crisis does continue in the future.
The Opioid Crisis and Relief
Eldo E. Frezza in The Moral Distress Syndrome Affecting Physicians, 2020
In this chapter, the authors talk about: the stress of prescribing opioids, the opioid epidemic, expenditure on the opioid crisis, opioid abuse, physicians left alone with increasing patient demands and the need for state and federal rules and a database. Every time a patient looks suspicious, they should be placed automatically in the database for controlled substances to prevent medicine shopping. While instead, the patient should be informed of the opioid abuse. Stress and burnout among practicing physicians may play a role in the opioid epidemic. Scenarios like this raise the possibility that physician burnout may be playing a role in the opioid epidemic. “Having a database that can be shared between different pharmacies, hospitals, and doctors’ offices is essential nowadays. Lots of patients in the past were ‘doctor shopping’ to get more drugs from a different office.
Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service
Published in Canadian Journal of Pain, 2018
Hance Clarke, Saam Azargive, Janice Montbriand, Judith Nicholls, Ainsley Sutherland, Liliya Valeeva, Sherif Boulis, Kayla McMillan, Salima S. J. Ladak, Karim Ladha, Rita Katznelson, Karen McRae, Diana Tamir, Sheldon Lyn, Alexander Huang, Aliza Weinrib, Joel Katz
ABSTRACT Background The perioperative period provides a critical window to address opioid use, particularly in patients with a history of chronic pain and presurgical opioid use. The Toronto General Hospital Transitional Pain Service (TPS) was developed to address the issues of pain and opioid use after surgery. Aims To provide program evaluation results from the TPS at the Toronto General Hospital highlighting opioid weaning rates and pain management of opioid-naïve and opioid-experienced surgical patients. Methods Two hundred fifty-one high-risk TPS patients were dichotomized preoperatively as opioid naïve or opioid experienced. Outcomes included pain, opioid consumption, weaning rates, and psychosocial/medical comorbidities. Results Six months postoperatively, pain and function were significantly improved. Opioid-naïve and opioid-experienced patients reduced consumption by 69% and 44%, respectively. Forty-six percent and 26% weaned completely. Consumption at hospital discharge predicted weaning in opioid-naïve patients. Pain catastrophizing, neuropathy, and recreational drug use predicted weaning in opioid-experienced patients. Conclusions The TPS enabled almost half of opioid-naïve patients and one in four opioid-experienced patients to wean. The TPS successfully targets perioperative opioid use in complex pain patients.
Opioid-induced hyperalgesia and tolerance: understanding opioid side effects
Published in Expert Review of Clinical Pharmacology, 2008
Jay S Grider, William E Ackerman
Opioid-induced pain or opioid tolerance should be considered when opioid therapy fails to provide expected analgesic effects or when there is unexplainable pain exacerbation following opioid treatment. As a result, an increase in the opioid dosage may not be the solution to ineffective opioid therapy for chronic pain management. A decrease in the opioid mass may actually provide pain relief in many instances. At one time, it was anticipated that opioid-induced pain was related to upregulation of NMDA receptors with a downregulation of mu receptors. However, there is growing evidence to suggest the opioid receptor-based hyperalgesic mechanism may be directly modulated by the NMDA receptor. Furthermore, the mechanism that causes opioid tolerance may be the same mechanism that causes opioid-induced pain. Current evidence suggests that opioid-induced pain sensitivity could be prevented by interrupting the cellular and molecular changes associated with the development of opioid tolerance. Continued research may lead the way to a new period in which patients prone to opioid-induced pain could be identified, allowing one to tailor pharmacologic pain therapy to each patient.
Opioids in chronic non-cancer pain
Published in Expert Opinion on Pharmacotherapy, 2011
Bob Kwok Bun Chan, Lee Ka Tam, Chun Yin Wat, Yu Fai Chung, Siu Lun Tsui, Chi Wai Cheung
Introduction: The use of chronic opioid therapy for chronic non-cancer pain is growing and is now accepted as an effective treatment modality. Areas covered: Although there are guidelines and reviews for chronic opioid therapy for chronic non-cancer pain patients, physicians may still have concerns and be reluctant to prescribe strong opioids for chronic non-cancer pain. Common issues and concerns when prescribing opioid for chronic pain management are reviewed and discussed. The literature search was done using Medline with key words ‘chronic non-cancer pain’, ‘chronic opioid therapy’, ‘effectiveness’, ‘opioid tolerance’, ‘opioid-induced hyperalgesia’, ‘adverse effect’, ‘opioid dependency’, ‘addiction’, ‘monitoring’, ‘opioid contract’ and various combinations with these key words. Studies from 1990 – 2010 have been included. This article helps readers to update, clarify and understand the common concerns when using opioid for chronic non-cancer pain. Clinical effectiveness and adverse effects with chronic opioid therapy, opioid tolerance and opioid-induced hyperalgesia, opioid dependency and addiction, monitoring during chronic opioid use, and opioid contact are discussed in detailed. Expert opinion: Not much strongly positive data supports the long-term use of opioids for pain relief, and the evidence for an improvement in functional activity is inconclusive. With careful selection of patients, meticulous prescription and monitoring protocol, chronic non-cancer pain patients who are likely to benefit from potent opioids should not be prevented from obtaining this treatment.
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