Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective

1996 ◽  
Vol 24 (4) ◽  
pp. 296-309 ◽  
Author(s):  
Russell K. Portenoy
Keyword(s):  
Psychosocial Functioning ◽  
Cumulative Risk ◽  
Opioid Therapy ◽  
Adverse Outcomes ◽  
The Public ◽  
The Past ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

During the past decade, debate has intensified about the role of long-term opioid therapy in the management of chronic nonmalignant pain. Specialists in pain management have discussed the issues extensively and now generally agree that a selected population of patients with chronic pain can attain sustained analgesia without significant adverse consequences. This perspective, however, is not uniformly accepted by pain specialists and has not been widely disseminated to other disciplines or the public. Rather, the more traditional perspective, which ascribes both transitory benefit and substantial cumulative risk to long-term opioid therapy, continues to predominate. According to this perspective, the inevitability of tolerance limits the possibility of sustained efficacy, and other pharmacological properties increase the likelihood of adverse outcomes, including persistent side-effects, impairment in physical and psychosocial functioning, and addiction. If accurate, these outcomes would indeed justify the withholding of opioid therapy for all but the most extreme cases of chronic nonmalignant pain.

Functional Outcomes in Patients with Chronic Nonmalignant Pain on Long-Term Opioid Therapy

Pain Practice ◽  
2008 ◽  
Vol 8 (5) ◽  
pp. 379-384 ◽  
Author(s):  
Amol Soin ◽  
Jianguo Cheng ◽  
Lora Brown ◽  
Sami Moufawad ◽  
Nagy Mekhail
Keyword(s):  
Functional Outcomes ◽  
Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Hospitable universities and integration of refugees: First responses from Austria and Poland

2017 ◽  
Vol 17 (2) ◽  
pp. 248-270 ◽  
Author(s):  
Daniel Kontowski ◽  
Madelaine Leitsberger
Keyword(s):  
Social Inclusion ◽  
Human Right ◽  
The Public ◽  
The Past ◽  
European Universities ◽  
Public Role ◽  
The Social ◽  
Academic Year

European universities responded in different ways to the ‘refugee crisis’ of 2015. Some subscribed to the agenda of higher education (HE) as a universal human right, while others stressed different long-term benefits of offering access to it. Yet, the unprecedented sense of moral urgency that guided immediate declarations of support and subsequent actions has largely remained unaddressed. With the crisis becoming a new reality for many countries, HE has a role to play in the social inclusion of refugees, even in countries that were not attractive destinations for refugees in the past. In this article, we provide an overview of the reasons why HE institutions supported refugees, and present the results of an empirical study of Poland and Austria during the 2015–2016 academic year. We then evaluate those first responses utilizing parts of Ager and Strang’s framework of integration, and discuss issues of institutional readiness, capabilities and the public role of HE stemming from this comparison. Our findings suggest that reasons such as acknowledgement of basic rights, or utilizing social capital are insufficient to explain and understand strong integrative support measures. We propose that refugee support by HE institutions is both better understood and promoted through the language of hospitality.

scholarly journals Chronic Use of Opioids for Nonmalignant pain: A Prospective Study

1997 ◽  
Vol 2 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Perry N Fuchs ◽  
Ann Gamsa
Keyword(s):  
Substance Abuse ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Intensity ◽  
Leisure Activities ◽  
Opioid Therapy ◽  
Social Activities ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.

scholarly journals Opioid Therapy for Chronic Nonmalignant Pain

1996 ◽  
Vol 1 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Russell K Portenoy
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Minimal Risk ◽  
Addiction Medicine ◽  
Nonmalignant Pain ◽  
Term Administration ◽  
Chronic Nonmalignant Pain ◽  
Physician Prescribing ◽  
Structured Approach

Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

The endocrine effects of long-term oral opioid therapy: A case report and review of the literature

2018 ◽  
Vol 7 (2) ◽  
pp. 145-154 ◽  
Author(s):  
Jennifer A. Elliott, MD ◽  
Erica Horton, DO ◽  
Eugene E. Fibuch, MD
Keyword(s):  
Case Report ◽  
Endocrine System ◽  
The United States ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Negative Effects ◽  
Opioid Administration ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

The negative effects of long-term opioid administration on the body’s endocrine system have been known for decades.1,2 These effects have been observed and studied with the use of intrathecal opioids and in heroin addicts.3-9 However, they have also been noted to occur with the use of oral opioids, especially in those patients who require chronic opioids for the management of nonmalignant and cancer-associated pain.2,10-13 Epidemiologic data in recent years suggest that up to five million men with chronic nonmalignant pain suffer from opioid-induced androgen deficiency (OPIAD) in the United States.14 Therefore, it is important to understand the physiologic impact of chronic opioid administration in patients. In view of the increasing use of opioids for chronic pain, we must anticipate the potential occurrence of hypogonadism during chronic opioid therapy and monitor patients accordingly. If symptoms of endocrine dysfunction are recognized during chronic opioid therapy, appropriate evaluation, treatment, and follow-up should be instituted. This article describes a case report of a patient who suffered from a clinically significant testosterone deficiency and osteoporosis related to the use of long-term oral opioids for chronic nonmalignant pain. It also includes a review of the existing literature regarding OPIAD and provides recommendations regarding the evaluation and management of OPIAD.

E-Projects Challenges in India – Role of Human Resource Management and Technology

2018 ◽  
Vol 6 (8) ◽  
pp. 263
Author(s):  
Ramnik Kaur
Keyword(s):  
Developing Countries ◽  
Public Administration ◽  
Paradigm Shift ◽  
Successful Implementation ◽  
The Public ◽  
Government Services ◽  
The Past ◽  
The Government ◽  
Traditional Approaches

E-governance is a paradigm shift over the traditional approaches in Public Administration which means rendering of government services and information to the public by using electronic means. In the past decades, service quality and responsiveness of the government towards the citizens were least important but with the approach of E-Government the government activities are now well dealt. This paper withdraws experiences from various studies from different countries and projects facing similar challenges which need to be consigned for the successful implementation of e-governance projects. Developing countries like India face poverty and illiteracy as a major obstacle in any form of development which makes it difficult for its government to provide e-services to its people conveniently and fast. It also suggests few suggestions to cope up with the challenges faced while implementing e-projects in India.

Impact of FII’s and FDI’s on Indian Stock Market

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Dr. Kamlesh Kumar Shukla
Keyword(s):  
Stock Market ◽  
Financial Markets ◽  
Global Economy ◽  
Short Term ◽  
Earnings Growth ◽  
The Past ◽  
Bull Market ◽  
Indian Stock Market

FIIs are companies registered outside India. In the past four years there has been more than $41 trillion worth of FII funds invested in India. This has been one of the major reasons on the bull market witnessing unprecedented growth with the BSE Sensex rising 221% in absolute terms in this span. The present downfall of the market too is influenced as these FIIs are taking out some of their invested money. Though there is a lot of value in this market and fundamentally there is a lot of upside in it. For long-term value investors, there’s little because for worry but short term traders are adversely getting affected by the role of FIIs are playing at the present. Investors should not panic and should remain invested in sectors where underlying earnings growth has little to do with financial markets or global economy.

Approaches to Supporting Local and Community Development

2018 ◽  
Author(s):  
Liesel Mack Filgueiras ◽  
Andreia Rabetim ◽  
Isabel Aché Pillar
Keyword(s):  
Large Scale ◽  
Mining Company ◽  
The Sustainable Development ◽  
Social Partnership ◽  
The Public ◽  
Mining Investment ◽  
The Social ◽  
Corporate Social

Reflection about the role of community engagement and corporate social investment in Brazil, associated with the presence of a large economic enterprise, is the major stimulus of this chapter. It seeks to present how cross-sector governance can contribute to the social development of a city and how this process can be led by a partnership comprising a corporate foundation, government, and civil society. The concept of the public–private social partnership (PPSP) is explored: a strategy for building a series of inter-sectoral alliances aimed at promoting the sustainable development of territories where the company has large-scale enterprises, through joint efforts towards integrated long-term strategic planning, around a common agenda. To this end, the case of Canaã dos Carajás is introduced, a municipality in the State of Pará, in the Amazon region, where large-scale mining investment is being carried out by the mining company Vale SA.

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