Think twice before tapering opioids in some patients

Bill is a 58-year-old male with a history of head and neck cancer as well as chronic low back pain who presents to his new primary care doctor for a routine checkup and visit for a medication refill. He works in construction and has been on chronic opioid therapy after his cancer — with a stable dose of 15 mg of oxycodone for over five years. At his new primary care visit, after a few meet and greet pleasantries, his new primary care doctor discusses his current medication regimen with him — ibuprofen 400mg TID and oxycodone 15mg BID. His physician expresses significant concern with his medication regimen, telling Bill that “it’s against the rules” to continue prescribing opioids for him — despite the fact that he’s been on this dose for several years. She prescribes an oxycodone taper for him and requests he return to her office in two weeks for a re-evaluation. Bill, not wanting to be a problem, takes his taper as prescribed for the first few days. However, as he’s been on opioids for over five years, he begins feeling sick — nausea, vomiting, malaise, and irritability. He tries to go back to his old dose but runs out of oxycodone. While trying to work at a construction site, Bill is having trouble completing his tasks and drops a few expensive objects. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Oncology/Hematology Source Type: blogs

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Publication date: September 2018Source: Nano Energy, Volume 51Author(s): Jun Li, Lei Kang, Yanhao Yu, Yin Long, Justin J. Jeffery, Weibo Cai, Xudong WangAbstractImplantable nanogenerator (i-NG) has shown great promises for enabling self-powered implantable medical devices (IMDs). One essential requirement for practical i-NG applications is its long-term bio-compatibility and bio-safety. This paper presents a systematic study of polydimethylsiloxane (PDMS) and PDMS/Parylene-C packaged polyvinylidene fluoride (PVDF) NGs implanted inside female ICR (Institute of Cancer Research) mice for up to six months. The PVDF NG had a st...
Source: Nano Energy - Category: Nanotechnology Source Type: research
Publication date: Available online 21 July 2018Source: Seminars in Cell &Developmental BiologyAuthor(s): Jiayun Hou, Xiangdong WangAbstractPolycomb group proteins (PcG) play important roles in the maintenance of DNA sequencing and multi-dimensional organization of genome. The main PcG complexes are consisted of Polycomb repressive complex 1 and 2, of which the diversity is dependent upon target gene sequences and functions. The present review initially explores the mechanism-based relationship and functional roles of PcG proteins in the interplay between epithelial mesenchymal transition (EMT) and chromatin dynamics in...
Source: Seminars in Cell and Developmental Biology - Category: Cytology Source Type: research
In this study, we found that overexpression of nicotinamide nucleotide transhydrogenase (NNT) was associated with shorter overall and disease free survival in gastric cancer. The NNT is considered a key antioxidative enzyme based on its ability to regenerate NADPH from NADH. Knockdown of NNT caused significantly NADPH reduction, induced high levels of ROS and significant cell apoptosis under oxidative stress conditions such as glucose deprival and anoikis. In vivo experiments showed that NNT promoted tumor growth, lung metastasis and peritoneal dissemination of gastric cancer. Moreover, intratumoral injection of NNT siRNA ...
Source: Redox Biology - Category: Biology Source Type: research
Publication date: Available online 21 July 2018Source: Chemico-Biological InteractionsAuthor(s): Bharath Kumar VelmuruganAbstractThe psychoactive properties of cannabinoids are well known and there has been a continuous controversy regarding the usage of these compounds for therapeutic purposes all over the world. Their use for medical and research purposes are restricted in various countries. However, their utility as medications should not be overshadowed by their negative physiological activities. This review article is focused on the therapeutic potential and applications of phytocannabinoids and endocannabinoids. It h...
Source: Chemico Biological Interactions - Category: Biochemistry Source Type: research
Publication date: September 2018Source: Journal of Science and Medicine in Sport, Volume 21, Issue 9Author(s): R. Johnston, R. Cahalan, M. O’Keeffe, K. O’Sullivan, T. ComynsAbstractObjectivesTo determine the associations between training load, baseline characteristics (e.g. age or previous injury) and rate of musculoskeletal injury and/or pain specifically within an Endurance Sporting Population (ESP).DesignProspectively registered systematic review.MethodsEight electronic databases were searched by two independent reviewers. Studies were required to prospectively monitor both (i) training loads and (ii) muscul...
Source: Journal of Science and Medicine in Sport - Category: Sports Medicine Source Type: research
ConclusionsImpingement-type bony morphology was related to cartilage defects, but not labral tear. Hip pain was not associated with pathology or bony morphology. Longitudinal studies are warranted to determine if bony features, such as cam morphology, acetabular retroversion or anteversion, are precursors to symptomatic hip joint injury or osteoarthritis.
Source: Journal of Science and Medicine in Sport - Category: Sports Medicine Source Type: research
In this month ’s first feature article, Silva’s group report that a 16 week in-classroom standing desk intervention reduced sitting time without an increase in sedentary behaviour out of school time. In the second featured article, Tsikopoulos and colleagues report the results of a network meta-analysis on in terventions to enhance dynamic balance in individuals with chronic ankle instability. In the third feature article Mayes, Smith and Cook suggest that impingement related bony morphology is not related to pain in professional dancers’ hips.
Source: Journal of Science and Medicine in Sport - Category: Sports Medicine Authors: Tags: Editorial Source Type: research
Publication date: Available online 21 July 2018Source: International Journal of Nursing SciencesAuthor(s): Dalia Salah El-Deen, Naglaa F.A. YoussefAbstractObjectiveTo investigate the effect of cryotherapy application before versus after subcutaneous anticoagulant injection (SCAI) on pain intensity and hematoma formation.MethodsA quasi-experimental design was utilized. A convenient sample of 105 adult patients, who were admitted to one of the biggest teaching hospitals in Cairo and receiving SCAI, were recruited over a period of six months. Patients were randomly allocated into three groups: A Control group who received the...
Source: International Journal of Nursing Sciences - Category: Nursing Source Type: research
BOWEL cancer symptoms include stomach pain, a change in bowel habits, and finding blood in your stool. You could reveal your risk of cancer by thinking about how often you use the toilet. How many toilet trips counts as a ‘normal’ amount?
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
Publication date: Available online 21 July 2018Source: Seminars in Cancer BiologyAuthor(s): Jinsong LiuAbstractLife starts with a zygote which is formed via fusion of haploid sperm and egg. The formation of blastomere via cleavage division (nuclear division without increase in cell size) is the first step in the embryogenesis after zygote. The blastomeres are responsible to reprogram parental genome to new embryonic genome for generation of pluripotent stem cells which then differentiate via Waddington’s epigenetic landscape to give a birth for a new life. Multiple authors over the past century and a half have propos...
Source: Seminars in Cancer Biology - Category: Cancer & Oncology Source Type: research
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