Opioid analgesia continues to be the primary pharmacologic intervention for managing acute pain and malignant pain in both hospitalized and ambulatory patients. The increasing use of opioids in chronic nonmalignant pain is more problematic. Opioid treatment is complicated with the risks raised by adverse effects, especially cognitive disturbance, respiratory depression but also the risk of tole...

Effective pain relief, especially at the end of life, is a primary ethical obligation based upon the principles of beneficence, nonmaleficence, patient autonomy, and particularly the concept of double effect. The pragmatic foundation of pain management begins with a complete assessment, which incorporates "WILDA" (words, intensity, location, duration, aggravating/alleviating factors) and consid...

Objective(s): This study explored the inter-relationship among nitric oxide, opioids, and KATP channels in the signaling pathway underlying remote ischemic preconditioning (RIPC) conferred cardioprotection. Materials and Methods: Blood pressure cuff was placed around the hind limb of the animal and RIPC was performed by 4 cycles of infla...

BACKGROUND In all recommended guidelines put forth for the treatment of cancer pain, opioids continue to be an important part of a physician's armamentarium. Though opioids are used regularly for cancer pain, there is a paucity of literature proving efficacy for long-term use. Cancer is no longer considered a "terminal disease"; 50% to 65% of patients survive for at least 2 years, and there are...

Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational d...

The medial septum/diagonal band region (MSDB), which provides a major cholinergic and GABAergic input to the hippocampus, expresses a high density of opioid receptors. Behaviorally, intraseptal injections of opioids produce deficits in spatial memory, however, little is known about the electrophysiological effects of opioids on MSDB neurons. Therefore, we investigated the electrophysiological e...

RATIONALE Opioids have become part of contemporary treatment in the management of chronic pain. However, chronic use of opioids has been associated with high prevalence of sleep apnea which could contribute to morbidity and mortality of such patients. OBJECTIVES The main aim of this study was to treat sleep apnea in patients on chronic opioids. METHODS Five consecutive patients who were ref...

Background: Over the past decade, prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase pregnancy complications. Opioid agonist pharmacotherapy (OAP) methadone or buprenorphine is recommended ACOG for management OUD. The objectives our study are to compare incidence complications among who at time their delivery used OAP, OAP plus any add...

BACKGROUND Pregabalin is a therapeutic drug for neuropathic pain that is associated with somnolence and dizziness. These adverse events are often experienced shortly after initiating pregabalin, and may lead to treatment discontinuation. The purpose of this study was to explore factors that influence the incidence of somnolence and dizziness induced by pregabalin, and to identify patients at hi...

Chronic nonmalignant pain requires evaluation and treatment different from acute pain. The pathophysiology is different, and there is commonly some degree of psychosocial dysfunction. Opioids tend to be much less effective as analgesics for chronic pain, and may increase the sensitivity to pain when given long-term. Because they are self-reinforcing, opioids may be sought and be reported to imp...