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Review, Journal: Effects of hydrocodone rescheduling on opioid use outcomes: A systematic review. (Pubmed Central) - Aug 8, 2021 Compared with ketamine, intrathecal morphine obtained better postoperative analgesia up to 12 hours after surgery, with a higher incidence of pruritus without any significant change in other variables. Hydrocodone rescheduling was associated with reductions in prescribing and use of HCPs but was also associated with increased prescribing and use of other opioids, both schedule II and nonschedule II.
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Clinical, Journal: Identifying Prevalence of and Risk Factors for Abnormal Urine Drug Tests in Cancer Pain Patients. (Pubmed Central) - Aug 8, 2021 However, given the methodological limitations, data should be interpreted with caution until more studies are available. This study demonstrates that oncologic pain patients are not a risk-free population for abnormal UDT, thus recommends a UDT with initial opioid prescriptions and annually thereafter, with more frequent tests for patients suspected to be at higher risk for misuse.
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Journal: The Effects of Botulinum Toxin A on Pain in Ischemic Vasospasm. (Pubmed Central) - Aug 8, 2021 Botulinum toxin type A administration also improved patient-reported disability for 6 months. Use of PPG testing to determine baseline perfusion deficit and capacity to improve after warm water immersion was helpful in consideration of BTX-A use.
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Journal: Factors associated with opioid-tapering success: A mixed methods study. (Pubmed Central) - Aug 8, 2021 Opioid tapering requires an individualized approach. Both clinical factors and personal circumstances should be considered when opioid tapering is being discussed as a possible solution for a patient.
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Clinical, Journal: Incidence and risk factors for prolonged postoperative opioid use following lumbar spine surgery: a cohort study. (Pubmed Central) - Aug 7, 2021 The altered phosphorylation patterns modulating the function of synaptic proteins may contribute to long-term neuroadaptations induced by drug use and withdrawal. In an analysis of pharmacy claims from a national insurance database, the authors identified incidence and predictors of long-term opioid use after elective lumbar spine surgery.
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Journal: The first 24 h: opioid administration in people with spinal cord injury and neurologic recovery. (Pubmed Central) - Aug 7, 2021 Since improving naloxone's affordability may increase access, whether naloxone's high cost is associated with low dispensing rates should be evaluated. These preliminary findings suggest that higher doses of opioids administered within 24 h of injury are associated with increased pain in the chronic phase of people with SCI.
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Journal: Carfentanil on the darknet: Potential scam or alarming public health threat? (Pubmed Central) - Aug 7, 2021 Antiviral treatment for HCV should be added to medical insurance coverage as soon as possible in Jiangsu Province. The availability of highly potent drugs such as Carfentanil on the darknet requires the urgent development of novel scientific methods and tools able to monitor and to predict such new threats, while informing policymaking and protecting the health and the security of citizens.
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Review, Journal: Liquorice for pain? (Pubmed Central) - Aug 6, 2021 In addition, they appear to have antidepressant actions and effects on morphine tolerance...Whether liquorice plant-derived compounds represent a novel class of analgesics is yet to be established. Having a host of bioactive compounds with a broad range of mechanisms of effect, liquorice is a plant that, in the future, may give rise to new therapies for pain.
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Preclinical, Journal: Modulation of anxiety behavior in gonadectomized animals. (Pubmed Central) - Aug 6, 2021 We review the effects of morphine and androgens on the modulation of anxiety behavior in gonadectomized animals...We then discuss the functional consequences of gonadectomy on anxiety behavior. Finally, we consider how the opioids and androgens may contribute to adaptive responses associated with anxiety.
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Review, Journal: Behavioral Sex Differences in Cocaine and Opioid Use Disorders: The Role of Gonadal Hormones. (Pubmed Central) - Aug 6, 2021 This vulnerability also translates to opioid use disorder, with females exhibiting stronger behavioral responses than males to drugs such as heroin and morphine...While there are far fewer studies on the role of ovarian hormones in opioid use disorder, the existing data suggest that ovarian hormones may not drive these behavioral effects in the same manner as in cocaine use disorder. This review highlights evidence that behavioral sex differences in substance use disorder might be driven by different mechanisms depending on drug class.
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Review, Journal: Molecular mechanisms of opioid tolerance: From opioid receptors to inflammatory mediators (Review). (Pubmed Central) - Aug 5, 2021 The molecular mechanisms involved in the desensitization of the opioid receptors were briefly described, including their phosphorylation, internalisation and recycling. Subsequently, the effects of Toll like receptor 4/NOD-like receptor family pyrin domain containing 3-mediated proinflammatory responses in opioid tolerance were discussed, aiming in supporting the identification of novel therapeutic targets.
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[VIRTUAL] Post Discharge Narcotics are Unnecessary Following Radical Cystectomy () - Aug 5, 2021 - Abstract #AUA2021AUA_3242; We identified 107 patients, 32 discharged with a narcotic prescription (Mean Oral Morphine Equivalents Prescribed = 116) and 75 discharged without. There were no differences in sex (p=0.60), preoperative opioid use (p=0.21), or open vs. robotic approach (p=1.00). Patients discharged without opioids were significantly older than those discharged with an opioid prescription (p < 0.01). Patients can safely be discharged home without narcotics following cystectomy, regardless of robotic or open approach, reducing the incidence of opioid induced side effects as well as decreasing the risk of further perpetuating the opioid epidemic.
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[VIRTUAL] International Prescribing Rates of Opioids After Robotic Prostatectomy () - Aug 5, 2021 - Abstract #AUA2021AUA_2470; 145 participants from 21 countries completed the survey including the USA (56%), Greece (16%), Canada (9%), Israel (3.4%), Brazil (2%), the United Kingdom (2%), Germany (1.4%), and India (1.4%). 57% of respondents were attendings/consultants 32% residents, 10% fellows, and 2% advanced practice providers. The percentage of providers prescribing post-discharge opioids significantly differed between Canada, the United States, and other countries (85%, 63%, and 8%, respectively, p<0.0001). There was a significant difference between years of experience in those who provide opioids compared to those who do not (6.5 years vs 9.9 years, p= 0.001). The average oral morphine equivalents (OME) provided in those who did prescribe opioids was greatest in Canada but was not significantly different between groups (mean OME: Canada 41mg, USA 35mg, all others 33mg; p=0.82). Opioid prescriptions after prostatectomy are common in North America and uncommon in the rest of the world. Narcotic-free prostatectomies are still rare in North America and offer an opportunity for surgeons to decrease the pool of narcotics, and thus, reduce the risk of narcotic abuse.
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[VIRTUAL] Toradol (Ketorolac) to Reduce Ureteroscopy Symptoms Trial () - Aug 5, 2021 - Abstract #AUA2021AUA_2007; Ketorolac was not associated with an increase in complications. These findings show that intra-operative use of ketorolac effectively reduces narcotic requirements and should be considered independently or as part of a multimodal pain control protocol, unless otherwise contraindicated.
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[VIRTUAL] Support for minimizing narcotic requirement following urethroplasty () - Aug 5, 2021 - Abstract #AUA2021AUA_1193; Our preliminary analysis demonstrates decreased need for post-operative narcotic pain control with intra-operative nerve blocks. Further studies will focus on identifying patient factors predictive of narcotic requirement to build an algorithmic approach that would minimize narcotic use and ultimately addiction.
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Review, Journal: Emerging regulatory roles of opioid peptides, endogenous morphine, and opioid receptor subtypes in immunomodulatory processes: Metabolic, behavioral, and evolutionary perspectives. (Pubmed Central) - Aug 5, 2021 The significance of endogenous morphine's importance to evolution can be ascertained by the number of physiological tissues and systems that can be affected by this chemical messenger mechanism, which transcends pain. An integrated review is presented of opioid and opiate receptors, immunomodulation, and pain associated with inflammation, from an evolutionary perspective.
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