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1.
Clin Pharmacol Ther ; 100(3): 275-86, 2016 09.
Article in English | MEDLINE | ID: mdl-27170195

ABSTRACT

An extended-release opioid analgesic (OxyContin, OC) was reformulated with abuse-deterrent properties to deter abuse. This report examines changes in abuse through oral and nonoral routes, doctor-shopping, and fatalities in 10 studies 3.5 years after reformulation. Changes in OC abuse from 1 year before to 3 years after OC reformulation were calculated, adjusted for prescription changes. Abuse of OC decreased 48% in national poison center surveillance systems, decreased 32% in a national drug treatment system, and decreased 27% among individuals prescribed OC in claims databases. Doctor-shopping for OC decreased 50%. Overdose fatalities reported to the manufacturer decreased 65%. Abuse of other opioids without abuse-deterrent properties decreased 2 years later than OC and with less magnitude, suggesting OC decreases were not due to broader opioid interventions. Consistent with the formulation, decreases were larger for nonoral than oral abuse. Abuse-deterrent opioids may mitigate abuse and overdose risks among chronic pain patients.


Subject(s)
Analgesics, Opioid/administration & dosage , Chemistry, Pharmaceutical/methods , Opioid-Related Disorders/epidemiology , Oxycodone/administration & dosage , Product Surveillance, Postmarketing , Drug Administration Routes , Humans , Opioid-Related Disorders/mortality , Practice Patterns, Physicians'/statistics & numerical data , Prescription Drug Diversion/statistics & numerical data , Prescription Drug Misuse/statistics & numerical data , Residence Characteristics , United States/epidemiology
2.
Clin J Pain ; 14(3): 187-8, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9758065
4.
J Law Med Ethics ; 26(4): 350-2, 263, 1998.
Article in English | MEDLINE | ID: mdl-11066894

ABSTRACT

Authors caution against possible unintended consequences of intractable pain treatment acts, suggesting that health care professionals look to the guidelines prepared by the Federation of State Medical Boards for an approach to this issue.


Subject(s)
Analgesics, Opioid/therapeutic use , Drug and Narcotic Control/legislation & jurisprudence , Pain/drug therapy , Public Policy , Risk Assessment , Social Control, Formal , Government Regulation , Humans , Pain, Intractable/drug therapy , Practice Guidelines as Topic , Professional Misconduct , United States
5.
Pain ; 63(1): 127-133, 1995 Oct.
Article in English | MEDLINE | ID: mdl-8577483

ABSTRACT

We present a revised taxonomic system for disorders previously called reflex sympathetic dystrophy (RSD) and causalgia. The system resulted from a special consensus conference that was convened on this topic and is based upon the patient's history, presenting symptoms, and findings at the time of diagnosis. The disorders are grouped under the umbrella term CRPS: complex regional pain syndrome. This overall term, CRPS, requires the presence of regional pain and sensory changes following a noxious event. Further, the pain is associated with findings such as abnormal skin color, temperature change, abnormal sudomotor activity, or edema. The combination of these findings exceeds their expected magnitude in response to known physical damage during and following the inciting event. Two types of CRPS have been recognized: type I, corresponds to RSD and occurs without a definable nerve lesion, and type II, formerly called causalgia refers to cases where a definable nerve lesion is present. The term sympathetically maintained pain (SMP) was also evaluated and considered to be a variable phenomenon associated with a variety of disorders, including CRPS types I and II. These revised categories have been included in the 2nd edition of the IASP Classification of Chronic Pain Syndromes.


Subject(s)
Causalgia/classification , Reflex Sympathetic Dystrophy/classification , Causalgia/diagnosis , Diagnosis, Differential , Humans , Neuralgia/physiopathology , Pain/physiopathology , Reflex Sympathetic Dystrophy/diagnosis
6.
Arch Phys Med Rehabil ; 76(2): 202-4, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7848079

ABSTRACT

In a previous report, we described heretofore undiscovered possibilities that neuropathic pain and spasticity may share some common pathophysiological mechanisms. Currently, systemically delivered local anesthetics are being used for the evaluation and treatment of neuropathic pain. We present a case describing the treatment of spasticity of spinal origin with continuous subcutaneous infusion of 0.75% bupivacaine in a patient who did not respond to traditional treatments and has become tolerant to intrathecal baclofen.


Subject(s)
Bupivacaine/therapeutic use , Paraplegia/drug therapy , Adult , Humans , Male , Muscle Spasticity/drug therapy , Treatment Outcome
8.
Can J Anaesth ; 40(10): 915-21, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8222029

ABSTRACT

The purpose of this study was to assess the cumulative incidence of substance use among anesthesiologists during training and practice, the effect of stress on drug use, and deterrent efficacy of institutional prevention programmes. The 260 anesthesiologists who had trained at the Medical College of Wisconsin between 1958-1988 were surveyed by mail regarding psychoactive substance use. Analysis of 183 responses focused on demographic and psychosocial factors. Substances used most frequently included: alcohol (91.6%), marijuana (30.8%) and cocaine (9.4%). Twenty-nine (15.8%) anesthesiologists were identified as being substance-dependent: 19 were alcohol-impaired; six were drug-impaired, and four were dependent on both alcohol and drugs. Impairment was more prevalent in anesthesiologists who had completed their training after 1975. Fifty-eight (32%) anesthesiologists had used illicit drugs to "get high"; 11 acknowledged daily use for two weeks or more, with eight admitting dependency. Substance abuse was more common in parents of impaired anesthesiologists (35.7%) than in unimpaired colleagues (8.1%; P < 0.001). The divorce rate for impaired anesthesiologists (24.1%) was greater than for unimpaired anesthesiologists (5.2%; P < 0.001). Increased stress during training was not reflected by increased substance use. Few recalled any drug counseling whatsoever. Seventy percent assessed hospital drug control policies as fair or poor. Younger respondents (born after 1951) were more critical of drug control programmes than their older cohort. Incidents of substance abuse were reported for both residents and faculty. Psychoactive substance abuse remains a serious problem among anesthesiologists.


Subject(s)
Anesthesiology , Psychotropic Drugs , Substance-Related Disorders/epidemiology , Adult , Alcoholism/epidemiology , Alcoholism/etiology , Alcoholism/prevention & control , Anesthesiology/education , Divorce/statistics & numerical data , Drug and Narcotic Control , Education, Medical, Continuing , Family Health , Female , Humans , Illicit Drugs , Life Change Events , Male , Middle Aged , Organizational Policy , Physician Impairment/psychology , Physician Impairment/statistics & numerical data , Prevalence , Psychotropic Drugs/classification , Retrospective Studies , Stress, Physiological/complications , Substance-Related Disorders/etiology , Substance-Related Disorders/prevention & control , Wisconsin/epidemiology
10.
Reg Anesth ; 17(5): 303-5, 1992.
Article in English | MEDLINE | ID: mdl-1419947

ABSTRACT

BACKGROUND AND METHODS: There is a growing awareness of the possibility of headache resulting from intracranial air secondary to identification of the epidural space by loss of resistance using air (LOR-A). Most reported cases have been attributed to subarachnoid air passage. A case is described of sudden headache following LOR-A. RESULTS: Various features of the case suggest that the passage of air to the head was subdural rather than subarachnoid. CONCLUSIONS: Recovery was uneventful.


Subject(s)
Air , Headache/etiology , Pneumocephalus/complications , Subarachnoid Space , Subdural Space , Adult , Female , Humans
12.
Arch Phys Med Rehabil ; 73(3): 300-1, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1543437

ABSTRACT

Dysesthetic pain after spinal cord injury is a common problem. The pathophysiology of this disorder is unclear and treatment modalities have been of inconsistent effectiveness. Various pharmacologic approaches have been advocated for treatment of chronic pain in spinal cord injury, including the use of either anticonvulsants or antidepressants. This case report describes the successful use of carbamazepine in conjunction with amitriptyline in the treatment of dysesthetic pain in a patient with spinal cord injury.


Subject(s)
Amitriptyline/therapeutic use , Carbamazepine/therapeutic use , Pain/drug therapy , Spinal Cord Injuries/physiopathology , Adult , Female , Humans , Pain/physiopathology , Spinal Cord Injuries/rehabilitation
13.
Reg Anesth ; 17(2): 78-83, 1992.
Article in English | MEDLINE | ID: mdl-1581263

ABSTRACT

BACKGROUND AND OBJECTIVE: Though cervical paratracheal injections for the purpose of sympathetic block are customarily referred to as stellate ganglion blocks, there is no documentation of the actual site of local anesthetic action. The objective of this study is to test whether solution travels to the stellate ganglion during injections commonly used to anesthetize it. METHODS: In eight volunteers, magnetic resonance imaging was used to delineate the distribution of 15 ml saline injected by an anterior paratracheal technique at the sixth and seventh cervical vertebral levels. RESULTS: Injectate was not delivered to the stellate ganglion but rather passed anterior to it. CONCLUSIONS: The findings suggest that sympathetic neural block during stellate ganglion block may take place at sites other than the stellate ganglion.


Subject(s)
Autonomic Nerve Block , Stellate Ganglion , Adult , Cervical Vertebrae , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Sodium Chloride/administration & dosage , Sodium Chloride/pharmacokinetics , Solutions , Stellate Ganglion/anatomy & histology , Trachea
14.
J Clin Anesth ; 4(1): 45-7, 1992.
Article in English | MEDLINE | ID: mdl-1540369

ABSTRACT

We describe the first case report of an epidural autologous blood patch used for the treatment of a durocutaneous fistula caused by a surgical dural tear. The epidural blood patch cured the patient's headache and was followed by a sequelae of back pain that responded to conservative therapy.


Subject(s)
Dura Mater/injuries , Fistula/therapy , Headache/therapy , Laminectomy/adverse effects , Skin Diseases/therapy , Adult , Blood , Female , Fistula/etiology , Headache/etiology , Humans , Injections, Epidural , Skin Diseases/etiology
15.
Can J Anaesth ; 38(6): 767-71, 1991 Sep.
Article in English | MEDLINE | ID: mdl-1914062

ABSTRACT

While Horner's syndrome is a rare but occasionally reported side-effect of epidural block administered for labour, trigeminal nerve palsy has been described only once. The cases described in this report confirmed the benign nature of these neurological complications of epidurally administered anaesthetics which were not detrimental to fetal viability. The complications may be attributed to extensive cephalad spread of local anaesthetic, sometimes via unexplained routes and with surprisingly selective targeting effect (unilateral trigeminal nerve palsy). The atypical and unusually high cephalad spread of local anaesthetic in pregnant women at term is believed to be due to pregnancy-related altered anatomy and physiology of the epidural space.


Subject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Facial Paralysis/etiology , Horner Syndrome/etiology , Trigeminal Nerve , Adult , Anesthetics, Local/adverse effects , Bupivacaine/adverse effects , Female , Humans , Pregnancy , Procaine/adverse effects , Procaine/analogs & derivatives
16.
J Cancer Educ ; 4(2): 113-6, 1989.
Article in English | MEDLINE | ID: mdl-2641326

ABSTRACT

Lack of appropriate physician education is one of several reasons for the recognized deficits in cancer pain management. This article describes the educational role of a weekly meeting, "Cancer Pain Rounds," attended by a multidisciplinary team of health professionals skilled in cancer pain management and student physicians caring for inpatients with cancer. Educational benefits occur in three spheres including factual information concerning assessment, treatment, and attitude issues, legitimization of the cancer pain problem, and role modeling. This type of educational experience will hopefully improve cancer pain management.


Subject(s)
Education, Medical , Medical Oncology/education , Neoplasms , Pain Management , Teaching/methods , Analgesia/methods , Attitude of Health Personnel , Humans , Patient Care Team
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