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Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Management Briefs eBrief-no160 -- Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no160 -- Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Health Services Research & Development Management eBrief (...) no. 160 » Issue 160 October 2019 The report is a product of the VA/HSR&D Evidence Synthesis Program. Evidence Brief: Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Acutepain management in patients with opioid use disorder (OUD) can be challenging due to several factors including increased pain sensitivity and higher opioid tolerance. Use of medications for OUD (MOUD) including methadone, buprenorphine/naloxone, or naltrexone adds to the complexity of acutepain management
Treatment for AcutePain: An Evidence Map Treatment for AcutePain: An Evidence Map Technical Brief Number 33 RTechnical Brief Number 33 Treatment for AcutePain: An Evidence Map Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0000-81 Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Victoria (...) A. Nelson, M.Sc. Shellina Scheiner, PharmD, B.C.G.P. Mary L. Forte, Ph.D., D.C. Mary Butler, Ph.D., M.B.A. Sanket Nagarkar, D.D.S., M.P.H. Jayati Saha, Ph.D. Timothy J. Wilt, M.D., M.P.H. AHRQ Publication No. 19(20)-EHC022-EF Oct ober 2019 ii Key Messages Purpose of review The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acutepain. We map the evidence for several acutepain
Chest Pain – Possible Acute Coronary Syndrome American College of Radiology End User License Agreement ACR Appropriateness Criteria is a registered trademark of the American College of Radiology. By accessing the ACR Appropriateness Criteria®, you expressly agree and consent to the terms and conditions as described at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/TermsandConditions.pdf Personal use of material is permitted for research, scientific and/or information purposes only. You (...) Criteria ® Clinical Condition: Chest Pain Suggestive of Acute Coronary Syndrome Radiologic Procedure Rating Comments RRL* Tc-99m SPECT MPI rest and stress 8 This procedure is appropriate for intermediate-to-high likelihood for coronary artery disease. There is abundant literature available on clinical utility. ???? Arteriography coronary 8 This procedure is the gold standard and is invasive. ??? Tc-99m SPECT MPI rest only 7 In the setting of ongoing chest pain, this procedure has a high negative
Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines (...) Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Last updated: May 7, 2019 Project Number: RC1109-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness of multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings? What is the cost-effectiveness
Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Last updated: June 14, 2019 Project Number: RA1039-000 Product Line: Research Type: Drug Report (...) Type: Reference List Result type: Report Question What is the clinical effectiveness of prescribing opioids in smaller quantities for patients with acutepain? What are the evidence-based guidelines associated with opioid prescribing for patients with acutepain? Key Message One systematic review of guidelines, two non-randomized studies, and four evidence-based guidelines were identified regarding smaller quantity opioid prescribing for acutepain. Files Rapid Response Reference List Published
Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness | CADTH.ca Find the information you need Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Last updated: August 16, 2019 (...) Project Number: RB1357-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical utility of acutepain assessment by multidisciplinary pain consult teams in an inpatient setting? What is the cost-effectiveness of acutepain assessment by multidisciplinary pain consult teams in an inpatient setting? Key Message No relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non
Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating AcutePain in the Emergency Department: A Randomized Controlled Trial Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for the management of acutepain, with ibuprofen being one of the most frequently used oral analgesics in the emergency department (ED). We compare the analgesic efficacy of oral ibuprofen at 3 different doses for adult ED patients with acute pain.This was a randomized, double-blind trial (...) comparing analgesic efficacy of 3 doses of oral ibuprofen (400, 600, and 800 mg) in adult ED patients with acutepainful conditions. Primary outcome included difference in pain scores between the 3 groups at 60 minutes.We enrolled 225 subjects (75 per group). The difference in mean pain scores at 60 minutes between the 400- and 600-mg groups was -0.14 (95% confidence interval [CI] -0.67 to 0.39); between the 400- and 800-mg groups, 0.14 (95% CI -0.65 to 0.37); and between the 600- and 800-mg groups
Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Comparative Effectiveness Review Number 220 R Comparative Effectiveness Review Number 220 Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 (...) analgesics as treatment of moderate to severe acutepain in the prehospital setting. Key Messages • As initial therapy in the prehospital setting: o Nonsteroidal anti-inflammatory drugs provide similar pain relief to opioids and may cause fewer overall side effects and less drowsiness. o Acetaminophen may provide similar pain relief to opioids, and may cause fewer side effects overall and less dizziness. o Ketamine may provide similar pain relief to opioids. Ketamine may cause more dizziness or overall
Evidence Brief - Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted Treatment Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted Treatment Health Services Research & Development Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted (...) Treatment to the ESP Report RSS feed Prepared by: Evidence Synthesis Program (ESP) Coordinating Center Portland VA Health Care System Portland, OR Mark Helfand, MD, MPH, MS, Director Recommended Citation: Veazie S, Mackey K, Bourne D, Peterson K. Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-Assisted Treatment. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans
Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (...) (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM.In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain.To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture (...) on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS.A randomized prospective double-blinded trial.Assiut University Hospitals, Orman Cardiology Hospital.Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough
Efficacy and safety of loxoprofen sodium topical patch for the treatment of pain in patients with minor acute traumatic limb injuries in Brazil: a randomized, double-blind, noninferiority trial Posttraumatic injury pain is commonly treated with oral nonsteroidal anti-inflammatory drugs. However, oral nonsteroidal anti-inflammatory drugs cause several adverse events, with topical formulations arising as an important alternative. Therefore, we aimed at evaluating the efficacy and safety (...) of loxoprofen patch (LX-P) in the treatment of patients with posttraumatic pain. This phase III, randomized, double-blind, noninferiority study enrolled Brazilian patients aged 18 to 65 years diagnosed with lower and upper limb posttraumatic injury who were experiencing moderate or severe pain. Patients were assigned to active LX-P or to loxoprofen tablet (LX-T), and pain intensity was measured based on a visual analog scale score variation after 7 days of treatment. Data on clinical symptoms, rescue
Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? - 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 AcutePain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department (...) of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: December 11, 2018 Expand all Collapse all Article Outline Take-Home Message In adult emergency department (ED) patients with acutepain, low-dose intravenous ketamine (0.3 to 0.5 mg/kg) may provide pain relief within 10 minutes that is similar to that of single-dose intravenous morphine (0.1 mg/kg). Methods Data Sources A medical librarian searched MEDLINE, EMBASE, Scopus, Cochrane
Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal painAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological (...) , and analytical data were collected.We studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD
Chronic use of tramadol after acutepain episode: cohort study. To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids.Observational study of administrative claims data.United States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018.Opioid-naive patients undergoing elective surgery.Risk of persistent opioid use after discharge for patients treated with tramadol alone (...) =0.013).People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acutepain as for other short acting opioids.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http
Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain Subdissociative-dose ketamine (SDDK) is used to treat acutepain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 (...) minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.A total of 106
Transition from acute to chronic pain after surgery. Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause (...) of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions
Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emergency Department We compare the efficacy and safety of intravenous lidocaine with that of hydromorphone for the treatment of acute abdominal pain in the emergency department (ED).This was a randomized, double-blind, clinical trial conducted in 2 EDs in the Bronx, NY. Adults weighing 60 to 120 kg were randomized to receive 120 mg of intravenous lidocaine or 1 mg of intravenous hydromorphone. Thirty (...) minutes after administration of the first dose of the study drug, participants were asked whether they needed a second dose of the investigational medication to which they were randomized. Patients were also stratified according to clinical suspicion of nephrolithiasis. The primary outcome was improvement in pain scores of 0 to 10 between baseline and 90 minutes. An important secondary outcome was need for "off-protocol" parenteral analgesics, including opioids and nonsteroidal anti-inflammatory
Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury (...) . Design. A pilot randomized controlled trial (RCT) with two parallel groups.A supraregional level 1 trauma center.Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities.More than 80% of eligible patients agreed to participate
APOLLO-1: a randomized placebo and active-controlled phase III study investigating oliceridine (TRV130), a G protein-biased ligand at the micro-opioid receptor, for management of moderate-to-severe acutepain following bunionectomy Oliceridine is a novel G protein-biased µ-opioid receptor agonist designed to provide intravenous (IV) analgesia with a lower risk of opioid-related adverse events (ORAEs) than conventional opioids.APOLLO-1 (NCT02815709) was a phase III, double-blind, randomized (...) trial in patients with moderate-to-severe pain following bunionectomy. Patients received a loading dose of either placebo, oliceridine (1.5 mg), or morphine (4 mg), followed by demand doses via patient-controlled analgesia (0.1, 0.35, or 0.5 mg oliceridine, 1 mg morphine, or placebo). The primary endpoint compared the proportion of treatment responders through 48 hours for oliceridine regimens and placebo. Secondary outcomes included a composite measure of respiratory safety burden (RSB