1/34. drug-seeking behavior in urolithiasis in the noncontrast computed tomography era: 2 cases.Symptomatic urolithiasis is usually treated with narcotic pain management. This leads to the potential for use of its symptoms for personal gain. Historically, the typical presentation of a narcotic-seeking "stone patient" was a history of radiolucent stones and an intravenous contrast allergy. With the increased use of non-contrast-enhanced computed tomography to evaluate patients suspected of having acute urolithiasis, we have seen a change in the strategy of narcotic-seeking patients. We report 2 patients with pelvic calcifications on non-contrast-enhanced computed tomography feigning symptoms of urolithiasis to receive narcotic drugs.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/34. Chronic pain management: evaluating the use of opioids.A patient with chronic pain who is on multiple medications raises important questions for the case manager. Is the patient's underlying problem actually pain, or is it addiction? Has the patient been thoroughly evaluated? Does the patient have a coordinated management plan, or are several physicians independently writing prescriptions and recommending treatment? How can the case manager facilitate appropriate management?- - - - - - - - - - ranking = 6keywords = pain (Clic here for more details about this article) |
3/34. myocardial infarction associated with methadone and/or dihydrocodeine.chest pain and myocardial infarction occurring in young people with angiographically normal coronary arteries is well documented. Opiates have a cardioprotective effect and are used in acute heart attacks. We described a 22-year-old opioid addicted male patient who suffered a myocardial infarction following the consumption of methadone and dihydrocodeine.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
4/34. Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. methods: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.- - - - - - - - - - ranking = 3.4120840741133keywords = pain, abdominal pain (Clic here for more details about this article) |
5/34. A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs.The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.- - - - - - - - - - ranking = 8keywords = pain (Clic here for more details about this article) |
6/34. Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets.Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. CASE SERIES: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. CONCLUSIONS: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/34. Complications of intranasal prescription narcotic abuse.The abuse of drugs via an intranasal route is an increasingly prevalent pattern of behavior. In the past year, a number of patients received care at our institution for complications resulting from the previously unreported phenomenon of intranasal prescription narcotic abuse. This report describes the clinical manifestations of this form of drug abuse in 5 patients. Their symptoms consisted of nasal and/or facial pain, nasal obstruction, and chronic foul-smelling drainage. Common physical findings were nasal septal perforation; erosion of the lateral nasal walls, nasopharynx, and soft palate; and mucopurulent exudate on affected nasal surfaces. In addition, 2 of the 5 patients had invasive fungal rhinosinusitis, which appears to be a complication unique to intranasal narcotic abuse.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/34. Slow metabolism and long half life of methadone in a patient with lung cancer and cirrhosis.In a patient on methadone maintenance treatment, admitted for lung cancer suspicion, a slight decrease in pain dose response to morphine have necessitated adjustments of methadone treatment founded on clinical check-up and methadone assay. plasma methadone concentrations were 4 fold higher than mean plasma concentration for control population at the same dose. half-life was above 70 hours and clearance and metabolic index were strongly decreased. In this patient, daily dose methadone occurred in progressive accumulation and neuro-physiological tolerance without clinical incidence, except decrease in morphine effectiveness compared to our knowledge. Cancer, cirrhosis and adjuvant therapy contributions (fluconazole, omeprazole) to this original methadone kinetic are discussed. methadone and morphine dose clinical adjustments are described. However, the main objective of this case report is focused on plasma methadone assay contribution to therapeutic adjustment of the interval dose in a single patient with a complex clinical situation.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/34. Successful use of oral methadone after failure of intravenous morphine and ketamine.We describe an opioid-tolerant patient with severe acute pain which was unrelieved by morphine and ketamine via intravenous patient-controlled analgesia, but almost totally relieved by methadone. In the previous 24 hours, 509 mg of intravenous morphine and 769 mg of ketamine had been used and this was replaced by 200 mg of oral methadone. This implies that the success of methadone in morphine tolerant patients chiefly involves factors other than its role as an N-methyl-D-aspartate receptor antagonist, and that methadone should be considered as a replacement for morphine when the N-methyl-D-aspartate antagonist ketamine has proved ineffective.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/34. Ethical perspectives: opioid treatment of chronic pain in the context of addiction.The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.- - - - - - - - - - ranking = 8keywords = pain (Clic here for more details about this article) |
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