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Pain expert: Judge the opioid treatment, not the patient

With medications that carry significant risks, such as opioids, appropriate prescribing practices are critical to patient safety. One physician in Boston lives by a mantra that puts patients first: Judge the treatment, not the patient. We need to start re-conceptualizing chronic pain as a chronic disease, said Daniel P. Alford, MD, associate professor of medicine at the Boston University School of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program. “Acute pain is a symptom, and it’s life-sustaining—and you need to feel acute pain in order to survive,” Dr. Alford said. But “there is no advantage to chronic pain. Chronic pain really is a malfunctioning of the nervous system and requires, like other chronic diseases, a multimodal approach.” Assessing whether opioids are the appropriate course of treatment Many potential physical, psycho-behavioral, procedural and pharmacologic options exist for managing chronic pain. Dr. Alford follows a process that helps him to make the appropriate clinical judgment regarding whether or not opioids are an appropriate course of treatment for each individual patient: 1.  Determine whether the patient has a pain process that is likely to respond to opioid therapy. For a lot of chronic pain disorders, opioids are probably not the answer, Dr. Alford said. “For example, chronic migraine headaches, fibromyalgia and back pain … tend t...
Source: AMA Wire - Category: Journals (General) Authors: Source Type: news

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Authors: Kim CG Abstract Endoscopic full-thickness resection combined with laparoscopic surgery was recently developed. These procedures could be categorized as "Cut first and then suture" and "Suture first and then cut". "Cut first and then suture" includes laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR). Recent studies have demonstrated the safety and efficacy of LECS and LAEFR. However, these techniques are limited by the related exposure of the tumor and gastric mucosa to the peritoneal cavity and manipulat...
Source: Clinical Endoscopy - Category: Gastroenterology Tags: Clin Endosc Source Type: research
Conclusions: This study reveals a mutational profile and a distinct mutation signature of T:A>A:T transversion in early-stage HCC with HBV infection, which will enrich our understanding of genetic characteristics of the early-stage HCC. PMID: 29333154 [PubMed]
Source: Gastroenterology Research and Practice - Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
Eur Addict Res 2017;23:312 –313
Source: European Addiction Research - Category: Addiction Source Type: research
Conclusion: Compared to non-smokers, promoter-related deoxyribonucleic acid methylation of the ANP promoter was significantly elevated on days 7 and 14 of withdrawal in tobacco-dependent patients. Baseline methylation status of the ANP promoter was not significantly different from controls, arguing for an impaired regulation during withdrawal. Eur Addict Res 2017;23:306 –311
Source: European Addiction Research - Category: Addiction Source Type: research
The aim of this study was to evaluate the clinical value of PET and PET/CT in suspected recurrent cervical cancer. The recurrence of cervical cancer has a poor prognosis. Earlier intervention would lead to a better prognosis. PET and PET/CT were promising in early diagnosis of recurrence because they could detect the biological and molecular changes before the anatomical size changes occurred. However, few data concerning the clinical effect of PET and PET/CT were available. The database for PET (or positron emission tomography or FDG or fluorodeoxyglucose) AND cervical cancer (or cervical tumor or cervical neoplasm or cer...
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Review Article Source Type: research
Conclusion The SWMD20% and FV20 of FL using 20% of the maximum SPECT count as the threshold may be better predictors for the risk of RP.
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
Objective The aim of the study was to determine the fraction of administered activity that was excreted and retained by a small cohort of patients who each received treatment with radium-223 dichloride (223Ra). 223Ra is an α-emitting radionuclide that has been approved for use in the treatment of bone metastases that are secondary to castration resistant prostate cancer. Patients and methods Six patients received two weight-based administrations of 223Ra 6 weeks apart. Activity excreted in the urine and faeces during the first 48 h following each treatment was assessed by direct counting of the excreta. D...
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
Objective Radioiodine-131 is a radionuclide that is used for therapeutic purposes in hyperthyroidism and thyroid cancer. The aim of this study was to evaluate apoptotosis and proliferative changes in radioiodine-related kidney damage. Materials and methods Three groups (n=10/group) of rats were used as follows: the rats were in group 1 untreated, and the rats in groups 2 and 3 were treated once with oral radioiodine (111 MBq). The animals in group 2 were killed at the end of the seventh day and the rats in group 3 were killed at the end of the 10th week. The kidneys were removed and evaluated immunohistochemica...
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
Conclusion The results obtained suggest the potency of the [DTPA-(PABn)-Leu5]-DAG(1–5) as a new carrier of radionuclides in radiopharmacy.
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
Conclusion Excellent correlation has been found between two tested software reading platforms for all PET-derived metrics in a dual-reader analysis. Overall, the SULmax and SULpeak values had less bias and better precision compared with the MTV and TLG.
Source: Nuclear Medicine Communications - Category: Nuclear Medicine Tags: Original Articles Source Type: research
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