Re: interesting??
- From: "OldGoat" <oldgoatmail@xxxxxxxxxxxxxxxxxx>
- Date: Mon, 15 Sep 2008 21:41:15 -0400
Dear Terry,
Demerol explains a lot. It's about the shortest acting of the short acting
medicines. That's why you usually get it as a first line pain treatment in
an ER. They give you just enough relief to make an appointment with your
doctor. If I remember right, the PDR gives it a 2-4 hour half life. Not a
good choice for pain that's going to last any significant amount if time.
Just so you know, there's a lot longer lasting stuff out there--og
"tnt" <tnt@xxxxxxxxxx> wrote in message
news:Y-ydncSVBNzcZFPVnZ2dnUVZ_t3inZ2d@xxxxxxxxxxxxxxx
OG I take vicoden 5/500, Demerol 50 to 100, valium10's, and a joint pain
med. Yes I know it takes 1 hour for you to get full response from your
pills, and do time my pill taking when I'm in a bad way, so I don't over
do it. I love my times when I don't have to take anything I guess that's
why I don't thing of drug therapy that has you taking drugs all the time.
Terry
--
Not my way Not your way
Yahweh
"OldGoat" <oldgoatmail@xxxxxxxxxxxxxxxxxx> wrote in message
news:gamsd7$kud$1@xxxxxxxxxxxxxxxxxxxxxxxxxxxx
Hey Terry,
What's your doc got you taking? Just the medication, you don't have to
mention dose, just type of med and frequency. You probably mentioned it
already, I'm just too lazy to look at old posts.
There might be a better choice of medications for you, but the whole idea
of the long acting meds are to keep you medicated. It's a lot easier (not
to mention better for the patient) to prevent pain in the first place
than to stop it once you hurt. It keeps the medication level down by
preventing self-dosing. They don't want you looking in the bathroom
mirror crying "God, it hurt's. One more pill what the hell, I'm dying
now." So you take an early or extra pill, when if you'd have waited the
45 minutes for the full effects of the normal dose, you probably would
have found the extra pill unnecessary.
Sure, the flare up's are the job of the breakthrough/rescue medication,
but it's supposed to be rescue med + long acting med for flares, both
working together, not one working at a time.
Take care--og
"tnt" <tnt@xxxxxxxxxx> wrote in message
news:042dnV7-q9EAd1PVnZ2dnUVZ_hOdnZ2d@xxxxxxxxxxxxxxx
Unless I'm reading this wrong it seems like all the checking and
regulations are set for you having the same pain at the same time thing.
My med.'s say take 2 every 6 hours. Well unless I'm very different from
the rest of you my pain doesn't have schedule. I comes when it wants and
goes when It wants. Sometimes it stays for a few hours and sometimes for
a few days. I have to take meds every 6 hours ??? sometimes 3 hours???
sometimes every hour, till the monster lowers it ugly head. At times I
can get by with very little or no meds. At times it's a pain in the ass.
At times you want to cry. At times you want to scream. At times you
think you will die. At times you want to die. I want someone doc that
understands this. When the pain is gone or at a low level I can, I will,
I want to STOP taking drugs.
Terry
P.S. Why are the terms dependent and addicted group together?? Yes I I'm
dependent because I need relieve from the pain when I'm not in pain I
don't or want drugs. I HATE THEM!!
--
Not my way Not your way
Yahweh
.
Opioids May Be Useful for Chronic Noncancer Pain Management in Primary
Care CME/CE
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Disclosures
Release Date: October 12, 2007; Valid for credit through October 12,
2008
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)T for
physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for
physicians;
Nurses - 0.25 nursing contact hours (0.25 contact hours are in the area
of pharmacology)
October 12, 2007 - A review article in the October issue of the
Southern Medicine Journal indicates the proper administration of
opioids for chronic noncancer-associated pain management in the primary
care setting.
"Over the past decade, the pattern of chronic pain treatment in the
United States resembles a pendulum, swinging first in one direction and
then in the other, seeking only recently a modulated and more neutral
resting position," write Bruce Nicholson, MD, and Steven D. Passik,
PhD, from the Pain Specialists of Greater Lehigh Valley in Allentown,
Pennsylvania. "Since patients with chronic noncancer pain are a more
heterogeneous population than patients with chronic cancer pain, and
frequently have multiple comorbidities, the results of treatment with
opioid analgesics were, not surprisingly, more mixed than in tertiary
care cancer populations.... In order for the pendulum to attain a
modulated, more neutral resting position in which patients with chronic
noncancer pain receive adequate analgesia, it is essential to present
healthcare providers with necessary factual information to address
their clinical and medicolegal concerns."
Although opioids are considered to be the mainstay of chronic pain
management, their use is controversial for many primary care clinicians
concerned about dependence, abuse, addiction, and medicolegal issues
regarding state and federal regulatory authorities. Although these
concerns exist, opioids are thought to be effective and safe in
selected patients, and their use in this setting is consistent with
clinical practice guidelines and regulatory policy statements.
Patients with chronic, noncancer-associated moderate to moderately
severe pain typically require a controlled-release formulation of a
long-acting opioid or opioid combination drug product that will offer
sustained pain relief, as well as better sleep quality, compliance, and
sometimes quality of life. These drugs allow around-the-clock
administration, resulting in constant systemic drug levels and
decreased potential for end-of-dose failure.
In treating patients with chronic, moderate to moderately severe pain,
immediate-release opioid formulations should be used to provide
analgesia when breakthrough pain occurs.
Before starting patients on long-term opioid therapy, it is essential
to identify patients who may have difficulties in managing opioids or
who will develop dependence, abuse, or addiction. Careful screening
with validated questionnaires can be helpful in this regard. Although
these patients should not be denied treatment with opioids, focused
monitoring and case management are crucial.
The 4 A's are a useful mnemonic for ongoing monitoring: analgesia,
activities of daily living, adverse effects, and aberrant drug-related
behaviors. Healthcare providers should be able to distinguish between
the physical and psychological effects of opioids and to classify
patients with low, moderate, or high risk for substance abuse and/or
addiction based on careful screening. Based on their risk category,
patients should be monitored for the 4 A's at appropriate intervals.
Clinicians must thoroughly document all aspects of patient care.
Aberrant drug-taking behaviors, which are probably more predictive of
addiction-related outcomes, are selling prescription drugs;
prescription forgery; stealing or borrowing another patient's drugs;
injecting an oral formulation; obtaining prescription drugs from
nonmedical sources; concurrent abuse of related illicit drugs; multiple
episodes of unsanctioned dose escalations; and recurrent prescription
losses.
Aberrant drug-taking behaviors, which are probably less predictive of
addiction-related outcomes, are aggressive complaining about the need
for higher doses; drug hoarding during periods of reduced symptoms;
requesting specific drugs; unapproved use of a drug to treat another
symptom; obtaining similar drugs from other medical sources; reporting
psychic effects not intended by the clinician; and 1 to 2 episodes of
unsanctioned dose escalations.
Specific areas requiring clinician documentation include history of
medication use, pain complaints, and substance abuse or addiction;
screening tool assessments, such as Screener and Opioid Assessment for
Patients with Pain (SOAPP) or the Opioid Risk Tool (ORT); pain
score/intensity; physical examination; results of diagnostic testing;
diagnosis and clinical indication for prescribing opioids; and assumed
and/or hypothesized pathology.
The treatment plan should document treatments, both pharmacologic (type
of medication, dosage, quantity, and date prescribed) and
nonpharmacologic (physical therapy, exercise, behavioral therapy,
and/or lifestyle changes as indicated). Treatment goals and anticipated
time course should be recorded, as well as compliance measures, such as
urine drug screens, pill, or patch counts.
Other essential parts of the medical record are informed consent,
including discussion of risks and benefits, and agreement for
treatment, which should delineate the patient's responsibilities and
clinic policies. Periodic review should include pain score/intensity
and perceived analgesia from current medications; physical,
occupational, and overall functioning; family and social relationships;
mood; sleep patterns; adverse events and their severity; aberrant
drug-taking behaviors; medication flow chart; and consultations and
referrals as indicated to provide appropriate and comprehensive care.
Because the adverse effects of opioid therapy can usually be predicted,
prevented, or treated, concern about adverse effects should not prevent
opioid treatment of chronic pain. However, early recognition of adverse
effects and aggressive management is an essential component of opioid
treatment.
Typical adverse effects of opioids include constipation, nausea,
vomiting, sleepiness, cognitive dysfunction, and respiratory distress.
Except for constipation, most adverse effects resolve as tolerance
develops. Constipation should be managed with use of both a stimulant
laxative and stool softener.
When there are neuropsychological adverse effects, direct dose
reduction may be helpful. Adding a nonopioid analgesic may facilitate
dose reduction. When the opioid dose is carefully titrated, respiratory
depression seldom occurs. Tolerance to the respiratory depressant
effect usually develops during long-term administration of opioid
treatment.
"Primary care physicians are skilled at managing comorbidities in their
patients, yet they face a dilemma when it comes to managing chronic
pain because the pharmacologic treatment of choice, opioid analgesics,
are controlled drugs," the authors write. "Given the privileged nature
of their relationship with patients, primary care physicians should
feel secure in their responsibility to provide appropriate analgesia
for patients with chronic pain. Concerns regarding abuse potential
should not impede appropriate medical use of opioids."
Abbott Laboratories funded medical writer Rachelle Weiss, PhD, to
assist the authors with manuscript preparation.
Southern Med J. 2007;100:1028-1036.
Clinical Context
.
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