scholarly journals Opioid Induced Hyperalgesia, a Research Phenomenon or a Clinical Reality? Results of a Canadian Survey

2020 ◽  
Vol 10 (2) ◽  
pp. 27
Author(s):  
Grisell Vargas-Schaffer ◽  
Suzie Paquet ◽  
Andrée Neron ◽  
Jennifer Cogan
Keyword(s):  
Chronic Pain ◽  
Nmda Antagonist ◽  
Treatment Modalities ◽  
Clinical Test ◽  
Physician Practice ◽  
Clinical Tests ◽  
Opioid Rotation ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Age Range

Background: Very little is known regarding the prevalence of opioid induced hyperalgesia (OIH) in day to day medical practice. The aim of this study was to evaluate the physician’s perception of the prevalence of OIH within their practice, and to assess the level of physician’s knowledge with respect to the identification and treatment of this problem. Methods: An electronic questionnaire was distributed to physicians who work in anesthesiology, chronic pain, and/or palliative care in Canada. Results: Of the 462 responses received, most were from male (69%) anesthesiologists (89.6%), in the age range of 36 to 64 years old (79.8%). In this study, the suspected prevalence of OIH using the average number of patients treated per year with opioids was 0.002% per patient per physician practice year for acute pain, and 0.01% per patient per physician practice year for chronic pain. Most physicians (70.2%) did not use clinical tests to help make a diagnosis of OIH. The treatment modalities most frequently used were the addition of an NMDA antagonist, combined with lowering the opioid doses and using opioid rotation. Conclusions: The perceived prevalence of OIH in clinical practice is a relatively rare phenomenon. Furthermore, more than half of physicians did not use a clinical test to confirm the diagnosis of OIH. The two main treatment modalities used were NMDA antagonists and opioid rotation. The criteria for the diagnosis of OIH still need to be accurately defined.

scholarly journals Conservative management, a preferred first line method for treatment of epistaxis.

2019 ◽  
Vol 26 (11) ◽  
pp. 1998-2002
Author(s):  
Muhammad Awais Javed
Keyword(s):  
Cold Water ◽  
Nasal Packing ◽  
Treatment Modalities ◽  
Chi Square ◽  
Conservative Method ◽  
Number Of Patients ◽  
Chi Square Test ◽  
Number Of Treatment ◽  
Medical University ◽  
Age Range

Epistaxis is defined as hemorrhage from nose where source of bleeding is inside the nose. There are many factors which can precipitate epistaxis. A number of treatment modalities are used for its treatment, conservative measures and nasal packing being the commonest method of treatment. Conservative method is an effective method of treatment and avoids potential complications of nasal packing. Objectives: To assess efficacy of conservative mode of treatment for epistaxis. Study Design: Prospective study. Settings: Department of Otorhinolaryngology, E.N.T. Unit-I, Allied Hospital/ Faisalabad Medical University, Faisalabad. Period: Three months i.e. from 16-10-2018 to 15-01-2019. Sample Size: 60. Material and Method: Procedure: 60 patients were enrolled according to inclusive and exclusive criteria. Conservative measures were applied to patients including cold water gargles, nasal pinching and Trotter’s method. Patients were observed for control of epistaxis and number of patients noted in whom conservative measures were not successful and nasal packing was done. No patient among the sample needed the surgical intervention due to failed conservative measures or nasal packing. Frequency and percentage calculated for data and chi-square test applied and level of <0.05 taken significant. Results: 60 patients enrolled with age range from 5-75 years and mean age as 39.53 years. Out of 60 patients, 38 were male and 22 were females. Out of 60 patients, 42 patients (70%) were treated successfully using conservative measures and 18 patients (30%) were treated with nasal packing. Conclusion: Based upon results of this study, it is concluded that conservative method of treatment of epistaxis is an effective and safe method and avoids potential complications which can occur due to nasal packing.

Too Much of a Good Thing? Treating the Emerging Syndrome of Opioid-Induced Hyperalgesia

2008 ◽  
Vol 21 (2) ◽  
pp. 165-168 ◽  
Author(s):  
Robert Leonard ◽  
Helen Kourlas
Keyword(s):  
Chronic Pain ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Opioid Therapy ◽  
Medical Subject Headings ◽  
Opioid Rotation ◽  
Seek Health Care ◽  
Aspartate Receptor ◽  
Opioid Induced Hyperalgesia ◽  
Very High

Pain is the primary reason individuals seek health care, and chronic pain is the leading cause of disability. Patients with chronic pain often require treatment with strong analgesics, including opioids. Mounting evidence shows that very high opioid doses or rapidly escalating doses may lead to a paradoxical syndrome of increasing pain that is nonresponsive to opioid therapy. A review of the published literature describing the phenomenon of opioid-induced hyperalgesia was conducted, and management strategies were reviewed. A systematic search of PubMed using Medical Subject Headings terms to narrow search criteria identified 3 treatment strategies. The strategies evaluated in this literature review include opioid rotation, coadministration of N-methyl-D-aspartate receptor antagonists, and coadministration of opioid antagonists. Further research is needed to draw conclusive recommendations. As of now, the safest and most effective treatment strategy showing the best evidence involves the use of opioid rotation.

Retrospectieve praktijkanalyse van tapentadol met vertraagde afgifte bij patiënten met chronische pijn refractair aan sterke opioïden

2021 ◽  
Author(s):  
L. Brullot ◽  
G. Hans ◽  
P.J. Germonpré ◽  
D. Mesotten ◽  
T. Vanneste ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Daily Practice ◽  
Prolonged Release ◽  
Refractory Pain ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Secondary Endpoints ◽  
Strong Opioids ◽  
Numeric Scale

Retrospective practice analysis of tapentadol prolonged release in patients with chronic pain refractory to strong opioids Tapentadol is a strong opioid with mixed antinociceptive analgesia and inhibition of the descending pain pathway, tested for the management of different types of chronic refractory pain. In daily practice, tapentadol prolonged release (tapentadol PR) is reserved for patients who already received strong opioids with unsatisfactory pain control or severe side effects, or patients who experienced opioid-induced hyperalgesia. The data of patients treated with tapentadol PR in 3 pain centers in Flanders (Belgium) were analyzed. The primary endpoint was the number of patients who continued the tapentadol PR treatment 6 weeks after it started. The secondary endpoints were pain reduction, global perceived effect (GPE) and side effects. Six weeks after the start of the treatment, 83% of the patients continued the therapy. The median reduction in pain score was 2 points on a numeric scale from 0-10. The GPE showed an improvement of 25% to 30% in 52% of the patients. The mean duration of the tapentadol PR treatment was 6.5 months. Only 24% of the patients stopped the treatment because of side effects and 34% due to an unsatisfactory result. Tapentadol PR is a possible addition in the therapeutic arsenal for the treatment of patients with severe chronic pain.

New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

scholarly journals Characteristics of Osteoporosis & Osteoporotic Fractures in Korea Based on Health Insurance Review and Assessment (HIRA) Database: 2009–2017

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 324
Author(s):  
Ho-Seok Oh ◽  
Sung-Kyu Kim ◽  
Hyoung-Yeon Seo
Keyword(s):  
Health Insurance ◽  
Age Groups ◽  
Osteoporotic Fractures ◽  
Prescription Data ◽  
Diagnostic Codes ◽  
Number Of Patients ◽  
Upper And Lower Extremities ◽  
Fractures Of The Spine ◽  
And Gender ◽  
Age Range

To investigate the incidence and characteristics of osteoporosis and osteoporotic fractures in Korea, we used the Health Insurance Review and Assessment Service (HIRA) database. Patients over 50 years old, who were diagnosed or treated for osteoporosis and osteoporotic fractures in all hospitals and clinics, were analyzed between 1 January 2009 and 31 December 2017 by using the HIRA database that contains prescription data and diagnostic codes. These data were retrospectively analyzed by decade and age-specific and gender-specific incidents in each year. We also evaluated other characteristics of patients including medication state of osteoporosis, primary used medical institution, regional-specific incidence of osteoporosis, and incidence of site-specific osteoporotic fractures. The number of osteoporosis patients over 50 years old, as diagnosed by a doctor, steadily increased from 2009 to 2017. The number of osteoporosis patients was notably greatest in the 60′s and 70′s age groups in every study period. Patients undergoing treatment for osteoporosis increased significantly (96%) from 2009 to 2017. Among the patients diagnosed with osteoporosis, the proportion who experienced osteoporotic fracture increased gradually (60%) from 2009 to 2017. The number of patients with osteoporotic fractures of the spine and hip was highest in the 70 to 90 age range, and the number of patients with osteoporotic fractures in the upper and lower extremities was highest in the 50 to 70 age range. Understanding the trends of osteoporosis in Korea will contribute to manage the increased number of patients with osteoporosis and osteoporotic fractures.

Evaluation attempt of own body sensing amongst persons with and without scoliosis

2021 ◽  
pp. 1-6
Author(s):  
Elżbieta Szczygieł ◽  
Agata Gigoń ◽  
Izabela Cebula Chudyba ◽  
Golec Joanna ◽  
Golec Edward
Keyword(s):  
Idiopathic Scoliosis ◽  
Sensory Integration ◽  
Head Position ◽  
Clinical Test ◽  
Spine Deformity ◽  
Functional Tests ◽  
Body Proportion ◽  
Average Value ◽  
Age Range

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a common structural spine deformity affecting 2%–4% of adolescents. Due to the unknown cause of idiopathic scoliosis, its therapy is a long-term and often unsatisfactory process. In the literature, it is often suggested that problems related to the feeling of one’s own body are caused by AIS. OBJECTIVE: The aim of this study was to assess the feeling of one’s own body among children with and without scoliosis on the example of feeling the head position, pelvis shape and balance. METHOD: The research included 62 children: 30 with scoliosis and 25 without diagnosed scoliosis with an age range between 11 to 19 years. The minimum scoliosis value was 7∘ and the maximum was 53∘. The average value was 25∘. During the study, three functional tests were used: Cervical Joint Position Error Test (CJPET), Clinical Test of Sensory Integration on Balance (CTSIB) and Body proportion demonstration test (BPDT). RESULTS: The results of the tests showed statistically significant differences (CJPET p= 3.54* 10-14, CTSIB p= 0.0376, BPDT p= 0.0127). However, none of the studies showed a correlation between the results of people with scoliosis and the value of their Cobb angles.

scholarly journals POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 921.2-922
Author(s):  
M. Yasmine ◽  
K. Maatallah ◽  
H. Ferjani ◽  
W. Triki ◽  
D. Ben Nsib ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Approach ◽  
Cross Sectional Study ◽  
Treatment Modalities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Standard Assessment ◽  
Number Of Patients ◽  
Cervicogenic Dizziness ◽  
No Gold Standard

Background:The treatment of patients presenting with cervicogenic dizziness (CGD) may be challenging. Indeed, there is no consensual treatment approach for CGD, nor is there no gold-standard assessment for diagnosis.Objectives:Our study aimed to assess the management of CGD by rheumatologists versus otorhinolaryngologists.Methods:We conducted a cross-sectional study including Tunisian doctors dealing with CGD. Rheumatologists (RTO) and otorhinolaryngologists (ORL) were invited to answer a questionnaire via google form about CGD daily management. Outcomes of interest were treatment modalities.Results:The study included 30 RTO and 32 ORL. Most of the doctors (RTO, vs ORL) were females (88.3%, vs 56.3%), aged between 35 and 45 (43.3%, vs 62.5%), and worked at a private practice (33.3%, vs 59.4%). The number of patients diagnosed with CGD by RTO was as follows: 1-2 per year (33.3%), 1-2 per month (18.8%), 1-2 per week (20%), less than one patient a year (10%) and none in 3.3% of cases. The number of patients diagnosed with CGD by ORL was as follows: 1-2 per year (50%), 1-2 per month (33.3%), 1-2 per week (6.2%), less than one patient a year (15.7%) and none (9.4%). Most patients presenting with CGD were females in both groups (93.1%, vs 82.8% respectively) with a mean age between 36 and 65 (79.3%, vs 82.1%). Most of the respondents declared treating patients with CGD (93.1%, vs 79.1%). Regarding treatment modalities, physical therapy was the most prescribed in both specialties (81.5% and 48.3%, respectively). Only RTO (18.5%) prescribed manual therapy. Concerning medical treatment, anti-inflammatory were the most prescribed drugs in both groups (92.6, and 34.5%, respectively). Sixty-seven percent of RTO prescribed anti-vertigo medication. Interestingly, it was the least prescribed drug by ORL (6.9%). Only RTO (59.3%) prescribed Muscle relaxants.Conclusion:Despite the disparities in the management of CGD, physical therapy remains the first prescribed treatment by Tunisian doctors. Further studies are needed to establish a consensus to treat CGD.Disclosure of Interests:None declared

scholarly journals Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Mohamed El-Begermy ◽  
Marwa Mohamed El-Begermy ◽  
Pretty O. Afifi
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
Fat Graft ◽  
Cartilage Graft ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hearing Outcomes ◽  
Age Range

Abstract Background This study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults. In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes. Results The success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing. Conclusions Inlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

Sign in / Sign up

Export Citation Format

Share Document