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A study conducted at the Icahn School of Medicine at Mount Sinai has advanced our understanding of the mechanisms underlying oxycodone action that may be of value in the effort to separate the analgesic effects of opioids from their addictive properties. The protein RGS9-2 is known to control the...
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A research team from Indiana University, Bloomington has concluded that the presence of a variety of pre-existing behavioral and psychiatric conditions may be predictors of long-term opioid use, and further, that patients presenting with these conditions may be more likely to receive opioid...
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About 10 years ago I wrote a paper with Ken Kirsh and Howard Heit about how every stakeholder from the clinician to the patient, to the media, to law enforcement, regulators, could all work together to improve the state of affairs in pain management and the fate of people with pain. It was Ken Kirsh...
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Methadone is an outstanding analgesic. It has a long half-life which can be very tricky of course, but it gives the patient the flexibility of only having to take their analgesic twice a day. It also has multiple mechanisms of action over and above the other opioids. It’s a mu receptor agonist but...
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The existence of opioid induced hyperalgesia has been debated, but I believe that it does. It’s when a patient uses an opioid and over time develops not just tolerance but super tolerance. Tolerance is normal. You take a medicine, your body adjusts to that dose. The side effects will usually go away...
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When we think about the reward circuits in the brain, heavily dependent on dopamine and now more evidence to suggest the involvement of endogenous opioids, you can begin to recognize that from an evolutionary standpoint, we really do need those circuits. We need to be motivated to seek out things...
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A specialist in addiction medicine offers guidance in identifying opioid misuse and the appropriate means of withdrawing patients from long term opioid therapy. The longer term management and rehabilitation of these patients is also considered.
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The existence of opioid induced hyperalgesia as a side effect of chronic opioid therapy has been debated. A pain specialist offers his perspective on its reality and manifestations, and what the primary care clinician can do in response.
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Doctors Gourlay and Heit, specialists in the arena of pain and addition, explore some of the more common issues confronting the primary care clinician in the management of long-term opioid prescribing. The focus is on the challenges of the inherited patient. In part 2, we consider the issue of...
| Video
Doctors Gourlay and Heit, specialists in the arena of pain and addition, explore some of the more common issues confronting the primary care clinician in the management of long-term opioid prescribing. The focus is on the challenges of the inherited patient.