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Opioid Adverse Effect Management

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1. Randomised controlled trial: Non-opioid analgesia is as effective as opioid management in acute pain and supports a change in prescribing practice to help address the ‘opioid epidemic’

Randomised controlled trial: Non-opioid analgesia is as effective as opioid management in acute pain and supports a change in prescribing practice to help address the ‘opioid epidemic’ Non-opioid analgesia is as effective as opioid management in acute pain and supports a change in prescribing practice to help address the ‘opioid epidemic’ | Evidence-Based Nursing We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your (...) browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Non-opioid analgesia is as effective as opioid management

2018 Evidence-Based Nursing

2. Naloxegol (Moventig) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation

Naloxegol (Moventig) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation Prescrire IN ENGLISH - Spotlight ''Naloxegol (Moventig°) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation'', 1 October 2017 {1} {1} {1} | | > > > Naloxegol (Moventig°) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation Spotlight Every month, the subjects (...) in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight Naloxegol (Moventig°) and opioid-induced constipation. Its abdominal adverse effects are probably as troublesome as constipation FEATURED REVIEW Naloxegol tablets have been authorised in the European Union for adults with troublesome opioid-induced constipation despite laxative therapy. Does naloxegol relieve discomfort in these patients? What

2017 Prescrire

3. Supervised dosing with a long-acting opioid medication in the management of opioid dependence. (PubMed)

and take-home medication strategies is needed to support decisions on the relative effectiveness of these strategies. The trials should be designed and conducted with high quality and over a longer follow-up period to support comparison of strategies at different stages of treatment. In particular, there is a need for studies assessing in more detail the risk of diversion and safety outcomes of using supervised OST to manage opioid dependence. (...) Supervised dosing with a long-acting opioid medication in the management of opioid dependence. Opioid dependence (OD) is an increasing clinical and public health problem worldwide. International guidelines recommend opioid substitution treatment (OST), such as methadone and buprenorphine, as first-line medication treatment for OD. A negative aspect of OST is that the medication used can be diverted both through sale on the black market, and the unsanctioned use of medications. Daily supervised

2017 Cochrane

4. Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data. (PubMed)

Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data. Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes.Retrospective study (...) of administrative medical and pharmaceutical claims data.Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014-2015.A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1-30 and 31-90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities

2019 Pain Medicine

5. Managing opioid use disorder in primary care: PEER simplified guideline

, informed decision making with patients. ? Managing patients with OUD in primary care and offering long-term opioid agonist therapy can improve patient outcomes. Adding psychosocial interventions and avoiding punitive measures might also be helpful. All discussions of treatment should involve the patient’s preferences and values. ? Future randomized controlled trials should clarify the effects of pharmacologic treatments on morbidity, mortality, and social functioning (eg, employment); the management (...) that, similar to other chronic diseases, management of OUD be performed in primary care as part of the continuum of care for patients with OUD. Diagnosis of OUD The diagnostic criteria in the DSM-IV and DSM-5 are the Table 1. Estimated effects of treatments in opioid use disorder with GRADE rating of evidence TOPIC INTERVENTION VS CONTROL OUTCOME ESTIMATED BENEFIT, % FOLLOW-UP RANGE NNT OR NNH GRADE QUALITY OF EVIDENCE INTERVENTION CONTROL Primary care Primary care vs specialty care Treatment retention 86

2019 CPG Infobase

6. Nonopioid, Over-the-Counter Analgesics Can Be as or More Effective Than Prescription Medications Containing Opioids in the Pain Management of Post-Extraction Patients

. It reduces the need for the over-prescribing of opioids, which can be potentially harmful for the patient and lead to misuse of the drug. Applicability These studies show an acetaminophen-NSAID combination is as effective in postoperative pain management as codeine without the risk of developing opioid dependence or adverse drug effects of the patient. Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) Keywords Opioids, Analgesics, Acetaminophen, NSAIDs, Ibuprofen, Postoperative, Drug (...) Nonopioid, Over-the-Counter Analgesics Can Be as or More Effective Than Prescription Medications Containing Opioids in the Pain Management of Post-Extraction Patients UTCAT3212, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Nonopioid, Over-the-Counter Analgesics Can Be as or More Effective Than Prescription Medications Containing Opioids in the Pain Management of Post-Extraction Patients Clinical Question For a post

2017 UTHSCSA Dental School CAT Library

7. Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines

are the evidence-based guidelines regarding the use of alpha2-adrenergic agonists for the treatment of patients who are reducing or discontinuing opioids or opioid substitution therapy? Key Message Alpha2-adrenergic agonists were found to be more effective than placebo for managing withdrawal, however less effective than buprenorphine and potentially similar to methadone. Hypotension was a common adverse effect with clonidine specifically. Evidence comparing alpha2-adrenergic agonists to non-medicinal support (...) Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Alpha2-Adrenergic Agonists for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of Clinical Effectiveness

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

8. A Novel Opioid-Sparing Pain Management Protocol Following Total Hip Arthroplasty: Effects on Opioid Consumption, Pain Severity, and Patient-Reported Outcomes. (PubMed)

A Novel Opioid-Sparing Pain Management Protocol Following Total Hip Arthroplasty: Effects on Opioid Consumption, Pain Severity, and Patient-Reported Outcomes. Opioid prescriptions and subsequent opioid-related deaths have increased substantially in the past several decades. Orthopedic surgery ranks among the highest of all specialties with respect to the amount of opioids prescribed. We present here the outcomes of our opioid-sparing pain management pilot protocol for total hip arthroplasty (...) (THA).A retrospective study was conducted to assess outcomes before and after the implementation of an opioid-sparing pain management protocol for THA. Patients were divided into 2 cohorts for comparison: (1) traditional pain management protocol and (2) opioid-sparing pain management protocol. The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, pain severity using a Visual Analog Scale, and inpatient morphine milligram equivalents (MMEs) per day were compared between the 2

2019 Journal of Arthroplasty

9. Management of opioid use disorders: a national clinical practice guideline

found no significant difference among buprenor- phine–naloxone, methadone and a 2 -adrenergic agonists in terms of severity of withdrawal symptoms, adverse effects, withdrawal completion and, importantly, of the poor sustained abstinence rates in the absence of linkage to long-term addiction treat- ment. 69–71 If withdrawal management is offered as part of an imme- diate transition to psychosocial or residential treatment, then, among available pharmacologic approaches used for withdrawal management (...) requirement for accessing opioid agonist treatment (strong recommendation; moderate- quality evidence). In 2011, a Cochrane review of 35 RCTs compared the effect of adding psychosocial treatment interventions to standard opioid agonist treatment programs that included clinician-led medical management and counselling. 73 The authors found, based on moderate- and high-quality evidence, that ancillary psychosocial treatment did not confer additional benefits in terms of retaining individuals in treatment

2018 CPG Infobase

10. Parenteral opioids for maternal pain management in labour. (PubMed)

Parenteral opioids for maternal pain management in labour. Parenteral opioids (intramuscular and intravenous drugs including patient-controlled analgesia) are used for pain relief in labour in many countries throughout the world. This review is an update of a review first published in 2010.To assess the effectiveness, safety and acceptability to women of different types, doses and modes of administration of parenteral opioid analgesia in labour. A second objective is to assess the effects (...) ).There was limited information on adverse effects and harm to women and babies. There were few results that clearly showed that one opioid was more effective than another. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids

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2018 Cochrane

11. Opioid Use Disorder - Diagnosis and Management in Primary Care

theme_10_collection theme_10_frontend Sports, Recreation, Arts & Culture theme_8_collection theme_8_frontend theme_8_collection theme_8_frontend Taxes & Tax Credits theme_14_collection theme_14_frontend theme_14_collection theme_14_frontend Tourism & Immigration Search default_collection default_frontend Section Navigation Opioid Use Disorder - Diagnosis and Management in Primary Care Effective Date: June 1 st , 2018 Recommendations and Topics Scope This guideline presents recommendations for the diagnosis (...) and management of opioid use disorder (OUD) in primary care with a focus on induction and maintenance of buprenorphine/naloxone (Suboxone®) opioid agonist treatment (OAT) for adults and youth ≥ 12 years. OUD can be effectively treated with buprenorphine/naloxone in primary care and is not contingent on having access to counselling or inpatient detox. Free online training and in-person preceptorships with experienced buprenorphine/naloxone prescribers are available through the to all primary care

2018 Clinical Practice Guidelines and Protocols in British Columbia

12. American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation

results from the specific effects of opioids, it differs mechanistically from other forms of constipation, and therefore, medical management of this disorder deserves dedicated attention. x 8 Camilleri, M., Drossman, D.A., Becker, G. et al. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil . 2014 ; 26 : 1386–1395 | | | Opioid-induced bowel dysfunction refers to the set of gastrointestinal adverse (...) effects associated with opioid therapy, including constipation, gastroesophageal reflux disease, nausea and vomiting, bloating, and abdominal pain. x 9 Pappagallo, M. Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg . 2001 ; 182 : 11S–18S | | | | | , x 10 Drewes, A.M., Munkholm, P., Simren, M. et al. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction—recommendations of the Nordic Working Group. Scand J Pain . 2016 ; 11 : 111–122

2019 American Gastroenterological Association Institute

13. Buprenorphine for managing opioid withdrawal. (PubMed)

Buprenorphine for managing opioid withdrawal. Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment.To assess the effects of buprenorphine versus tapered doses of methadone, alpha2-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal, in terms of the intensity of the withdrawal syndrome experienced, duration and completion of treatment, and adverse effects.We (...) and methadone having similar capacity to ameliorate opioid withdrawal, without clinically significant adverse effects. The meta-analyses that were possible support a conclusion of no difference between buprenorphine and methadone in terms of average treatment duration (mean difference (MD) 1.30 days, 95% confidence interval (CI) -8.11 to 10.72; N = 82; studies = 2; low quality) or treatment completion rates (risk ratio (RR) 1.04, 95% CI 0.91 to 1.20; N = 457; studies = 5; moderate quality).Relative

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2017 Cochrane

14. A Guideline for the Clinical Management of Opioid Use Disorder

purpose of pain control, though moderate evidence of efficacy • Reversing effects of overdose can be challenging due to pharmacology of buprenorphine References 1. Maremmani I, Gerra G. Buprenorphine-based regimens and methadone for the medical management of opioid dependence: selecting the appropriate drug for treatment. Am J Addict 2010;19:557–68. 2. Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine (...) A Guideline for the Clinical Management of Opioid Use Disorder 1 A Guideline for the Clinical Management of2 THIS IS A BLANK PAGE3 About the British Columbia Centre on Substance Use & the Canadian Research Initiative in Substance Misuse The BC Centre on Substance Use ( BCCSU) is a new provincially networked resource with a mandate to develop, implement and evaluate evidence-based approaches to substance use and addiction. The BCCSU’s focus is on three strategic areas including research

2017 Clinical Practice Guidelines and Protocols in British Columbia

15. Opioid Adverse Effect Management

Opioid Adverse Effect Management Opioid Adverse Effect Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Opioid Adverse (...) Effect Management Opioid Adverse Effect Management Aka: Opioid Adverse Effect Management , Opioid Adverse Effect , Narcotic Side Effect , Opioid-Induced Nausea , Opioid-Induced Constipation From Related Chapters II. Indications III. Approach: Pearls Many Opioid Adverse Effects are predictable and can be prophylaxed Consider intolerance as an opportunity to transition back to IV. Adverse Effects: Constipation Begin regime concurrently with s See Sample protocol solution ( ) and Peristaltic stimulant

2018 FP Notebook

16. Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain?

details of data abstraction were not reported. The primary outcome was change in mean pain score at 10 minutes or closest point to 10 minutes with available data. The secondary outcome of adverse events was not predefined, but all adverse events reported in the individual trials were recorded. The difference in change in visual analog scale or numeric rating scale score between ketamine and opioids was meta-analyzed with random-effects models. Results were reported with 95% confidence intervals (...) Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages e47–e49 Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department

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2019 Annals of Emergency Medicine Systematic Review Snapshots

17. Alpha₂-adrenergic agonists for the management of opioid withdrawal. (PubMed)

Alpha₂-adrenergic agonists for the management of opioid withdrawal. Withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment.To assess the effectiveness of interventions involving the use of alpha2-adrenergic agonists compared with placebo, reducing doses of methadone, symptomatic medications, or an alpha2-adrenergic agonist regimen different to the experimental intervention, for the management of the acute phase of opioid withdrawal (...) extent as clonidine, but is otherwise similar to clonidine.Clonidine and lofexidine are more effective than placebo for the management of withdrawal from heroin or methadone. We detected no significant difference in efficacy between treatment regimens based on clonidine or lofexidine and those based on reducing doses of methadone over a period of around 10 days, but methadone was associated with fewer adverse effects than clonidine, and lofexidine has a better safety profile than clonidine.

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2016 Cochrane

18. Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery. (PubMed)

Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery. Radical surgery for colorectal cancer, associated with moderate to severe postoperative pain, needs multimodal analgesia with opioid for analgesia. Despite considerable advancements, the psychological implications and other side effects with opioid remain substantially unresolved. This study aimed to investigate the impact on mood, side (...) flurbiprofen axetil 50 mg 30 min before the end of surgery and wound infiltration with 10 ml of 0.75% ropivacaine at the end of surgery. The primary endpoint was mood changes at 48 and 96 h after surgery. The secondary endpoints were the incidence of opioid-related adverse effects, recovery results and patient satisfaction after surgery.Seventy-two patients completed the study finally. There were no significant differences between the two groups with respect to preoperative parameters, surgical

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2018 BMC Anesthesiology

19. Management of Opioid Therapy (OT) for Chronic Pain

) with the aim of ensuring opioids are used in a safe, effective, and judicious manner. The goals of the OSI related to such topics as increased education, monitoring, use of safe and effective prescribing and management methods, tool development, collaboration, and use of alternative pain treatment. The OSI uses the Veterans Health Administration (VHA’s) electronic health record to identify patients who may be high-risk for adverse outcomes with use of opioids and providers whose prescribing practices do (...) presidential memorandum of October 2015 mandated that executive departments and agencies shall, to the extent permitted by law, provide training on the appropriate and effective prescribing of opioid medications to all employees who are health care professionals and who prescribe controlled substances as part of their federal responsibilities and duties. The DoD Opioid Prescriber Safety Training Program, launched accordingly, includes modules on pain management and opioid prescribing safety, the recent

2017 VA/DoD Clinical Practice Guidelines

20. Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care. (PubMed)

and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone. The other was published in 2008, Issue 4 on mu-opioid antagonists (MOA) for OIBD. In this updated review, we only included trials on MOA (including methylnaltrexone) for OIBD in people with cancer and people receiving palliative care.To assess the effectiveness and safety of MOA for OIBD in people with cancer and people receiving palliative care.We searched (...) and extracted data. The appropriateness of combining data from the trials depended upon sufficient homogeneity across the trials. Our primary outcomes were laxation, impact on pain relief, and adverse events. Impact on pain relief was a primary outcome because a possible adverse effect of MOAs is a reduction in pain relief from opioids. We assessed the evidence on these outcomes using GRADE.We identified four new trials for this update, bringing the total number included in this review to eight. In total

2018 Cochrane

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