Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge.

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge. Anesth Analg. 2017 Dec;125(6):2113-2122 Authors: Monitto CL, Hsu A, Gao S, Vozzo PT, Park PS, Roter D, Yenokyan G, White ED, Kattail D, Edgeworth AE, Vasquenza KJ, Atwater SE, Shay JE, George JA, Vickers BA, Kost-Byerly S, Lee BH, Yaster M Abstract BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), an...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Chronic pain is a silent epidemic Chronic pain is a significant public health burden, but one that is not talked about enough. In 2011, the Institute of Medicine estimated that approximately 100 million Americans suffer from chronic pain. But chronic pain is not just a national problem. The 2016 World Health Organization (WHO) Global Burden of Disease report named back pain as the leading cause of years lived with disability (YLD), or more simply stated, years not being able to live your best life. Chronic pain is a complex dis...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pain Management Primary Care Source Type: blogs
AbstractPurpose of ReviewWith the rise of the opioid epidemic, anesthesiologists will find themselves faced with opioid-addicted patients more frequently. Addiction to opioids may also occur concurrently with abuse of other non-opioid medications. Our review article seeks to outline an armamentarium of pain management strategies in the perioperative period for these patients with addiction to opioid and non-opioid medications.Recent FindingsStatistics from the CDC demonstrate a shocking increase in opioid prescription rates and opioid-related deaths. Furthermore, opioid-addicted patients have notoriously undertreated pain ...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The opioid epidemic has reached a tipping point. Overdose deaths involving prescription opioids have quadrupled since 1999, as safer pain management practices must be a national priority. Everyone in health care needs to be aware of the potential dangers and become part of the solution. That means partnering with patients and families on pain management expectations; education on safe use, storage and disposal of opioids; and prevention of misuse and abuse after discharge. Clinicians throughout a patient’s full continuum ...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Hospital-Based Medicine Surgery Source Type: blogs
Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medicat...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research
Providers face many challenges when faced with pain management. Pain is complex, difficult to understand, diagnose, and especially enigmatic to manage. The discovery of non-opioid agents for pain management has become particularly important considering the on-going opioid epidemic. This review is focused on revisiting Ketamine, an agent that has historically been used for anesthesia in new ways to manage pain. Ketamine has unique pharmacologic properties that may prevent the development of pain as well as reduce chronic pain.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Review Source Type: research
Providers face many challenges when faced with pain management. Pain is complex, difficult to understand and diagnose, and especially enigmatic to manage. The discovery of nonopioid agents for pain management has become particularly important considering the ongoing opioid epidemic. This review is focused on revisiting ketamine, an agent that has historically been used for anesthesia, in new ways to manage pain. Ketamine has unique pharmacologic properties that may prevent the development of pain as well as reduce chronic pain.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Review Source Type: research
Ever since the institution of pain as the fifth vital sign, there has been a rising opioid epidemic in the United States, with Americans now consuming 80% of the global opioid supply while representing only 5% of the world ’s population. Surgeons are tasked with the duty of both managing patients’ pain in the perioperative period and following responsible prescribing behaviors. Several articles have been published with the goal of evaluating opioid use after upper extremity surgery, risk factors for opioid misuse/ abuse, the impact of anesthetic type, and the role of multimodal pain management regimens.
Source: The Journal of Hand Surgery - Category: Surgery Authors: Tags: The hand surgery landscape Source Type: research
Purpose of review Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence. In ...
Source: Current Opinion in Critical Care - Category: Nursing Tags: NEUROSCIENCE: Edited by Marek A. Mirski Source Type: research
PMID: 29401077 [PubMed - as supplied by publisher]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
This study questions the effectiveness of standard therapies (SQ insulin, IV fluids) in lowering blood glucose in type II DM patients who present to the ED with hyperglycemia but are otherwise well-appearing. Across 566 such encounters there was only an association with modest blood sugar reductions while significantly increasing the ED length of stay (in regards to IV fluid administration). Prior work from this group (https://www.ncbi.nlm.nih.gov/pubmed/27353284) questioned the value of lowering the blood sugar at all in well-appearing hyperglycemic type II diabetics. Add this to a lack of significant reduction and it may...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Education Emergency Medicine R&R in the FASTLANE Toxicology and Toxinology clinical critical care EBM literature recommendations research and reviews Source Type: blogs
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