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Some further observations on the role of opioids, including advice to the primary clinician as they approach the prescribing decision.
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Managing pain in a world without opioids is a scenario that would harm some because there are truly, in my experience, individuals for whom the use of an opioid analgesic on a long-term basis, on a regular basis, made a huge difference in that person’s ability to function comfortably and maximally...
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The transdermal formulations of fentanyl and buprenorphine are for patients who have chronic pain. An important distinction is, with transdermal fentanyl the patient has to be opioid tolerant, on the equivalent of 60 mg of oral morphine a day for at least a week, whereas with transdermal...
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Most clinicians are already aware of one of the most common adverse effects, which is that of gastrointestinal side effects with NSAIDS and the importance of monitoring that goes with those medications. Newer concerns have recently arisen as far as the cardiovascular adverse effects of NSAIDS and...
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Postoperative pain in older adults is probably underappreciated, in the sense that many clinicians are hesitant to treat with opioids due to the risk of respiratory depression. However, what we’ve learned is that the inadequate use of opioids actually can lead to greater pain postoperatively in...
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Because patients in palliative care are often on so many medications, the clinical picture’s always changing. Their organ function changes, they have low protein stores sometimes that affects the way drugs interact, and many patients have different distributions of enzymes. A lot of the major drug...
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The common adverse effects of opioid therapy include nausea and vomiting, and, of course, constipation. Sedation, also, although this could be the result of pain-induced sleep deprivation, and now that you’re treating the pain, they’re catching up on their sleep. Generally, that gets better over the...
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When you go to the textbooks, historically speaking, there was no mention of pain associated with neuromuscular disorders. Most--including Charcot-Marie-Tooth (which is a hereditary neuropathy) amyotrophic lateral sclerosis, most forms of muscular dystrophy--conditions were described as painless and...
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Here are some tips that may be useful. I’m very fond of an Intensol. These are highly concentrated oral solutions of a medication. Morphine and oxycodone 20 mg/ml, methadone 10 mg/ml, haloperidol, Ativan, and dexamethasone all come as this highly concentrated oral solution. Even if someone is...
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Understanding the genetic underpinnings of the disease is really key to developing new drug targets and new therapies. Right now we have at least four autosomal dominant genes that have been identified to account for at least some of the rarest subtypes of migraine, and some genome-wide association...