Reducing opioid analgesic deaths in America: what health providers can do.

BACKGROUND: Available data have shown steady increases of drug overdose deaths between 1992 and 2011. We review evidenced-based recommendations provided by a few prominent North American pain societies and suggest ways on how health providers might help reduce opioid analgesic deaths by implementing these practices. OBJECTIVE: To identify health care providers' roles in reducing opioid analgesic deaths. STUDY DESIGN: A comprehensive review of current literature. METHODS: The review included relevant literature identified through searches of MEDLINE, Cochran reviews, and Google Scholar, PubMed and EMBASE from January 1998 to January 2014. The level of evidence was classified as I (good), II (fair), and III (limited) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). RESULTS: Several practices such as too high doses overall, giving too high doses to opioid naive patients, too fast opioid titration, insufficient use and knowledge of urine drug testing, not updating knowledge of drug metabolism/interactions, and inadequate patient monitoring are associated with higher risks of opioid analgesic deaths. Suboptimal risk stratification of patients, rotation practices, and use of opioids analgesics in chronic noncancer pain are also associated factors. LIMITATIONS: There were a paucity of good evidence studies which show recommendations reduce death. CONCLUSION: Providers should be aware of all associated factors with opiate analgesic deaths and apply the available evidence in reducing opioid analgesic deaths.

Postbariatric surgery neuropathic pain (PBSNP): case report, literature review, and treatment options.

OBJECTIVE: This study is aimed at facilitating clinician understanding of factors associated with postbariatric surgery neuropathic pain (PBSNP) and discussing the evidence base for management options. DESIGN: A case report and systematic literature review. METHODS: A search was conducted of PubMed, MEDLINE, Google Scholar, EMBASE, Psych Info, and Cochrane Database of Reviews for articles published between 1985 and 2013 on neuropathy, pain, and pharmacokinetics associated with postbariatric surgery. RESULTS: The epidemiology of PBSNP has not been well established, and current therapeutic options are not evidence based. Available data indicate up to 33% incidence of pain in patients with neuropathy after bariatric surgery, resulting in significant decreases in quality of life and increases in health care costs. Pathophysiologic mechanisms underlying PBSNP are unclear, and the natural course is variable, with some patients experiencing spontaneous improvement when nutritional deficiency is identified and corrected. Early identification of nutritional deficiency along with glycemic and lipid control may prevent or partially reverse postsurgical neuropathy and modulate PBSNP. CONCLUSIONS: A better understanding of the peripheral and central mechanisms resulting in PBSNP is likely to promote the development of targeted and effective treatments.