Abstract:
OBJECTIVE:There is a need to identify safe and effective opioid-sparing multimodal alternative treatment strategies and approaches, including topical analgesics, for opioid-experienced chronic pain patients to mitigate the risk of addiction, misuse, and abuse of opioids. METHODS:This subset analysis from a prospective, observational study evaluated changes in opioid use, other concurrent medication use, and pain severity and interference in opioid-experienced patients (OEP) treated with topical analgesics for chronic pain with measures obtained at baseline and 3- and 6- month follow-up. RESULTS:The 3-month opioid-experienced patient (3-month OEP) group included 121 patients who completed baseline and 3-month follow-up assessments; 27 opioid-experienced patients completed baseline and 6-month follow-up assessments (6-month OEP). Demographic characteristics, and mean pain severity and interference scores were similar between groups at baseline. After treatment with topical analgesics, 49% of patients in the 3-month and 56% of patients in the 6-month group reported they had completely discontinued use of opioids. In addition, 31% of patients at the 3-month assessment and 30% at the 6-month assessment reported that they were no longer taking any pain medication. Other concurrent medications decreased by 65% after 3 months, and 74% after 6 months. There were statistically significant decreases from baseline in pain severity and interference scores within the 3- (CI:0.7-1.4, 1.4-2.2) and 6-month (CI:0.7-2.4 (severity); CI:1.2-3.5 (interference)) OEP groups. CONCLUSIONS:Opioid use and other concurrent medications decreased among opioid-experienced chronic pain patients after 3- and 6- months of treatment with topical analgesics. Pain severity and interference scores also decreased. The topical analgesics were reported to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Gudin JA,Brennan MJ,Harris ED,Hurwitz PL,Dietze DT,Strader JDdoi
10.1080/00325481.2018.1414551subject
Has Abstractpub_date
2018-01-01 00:00:00pages
42-51issue
1eissn
0032-5481issn
1941-9260journal_volume
130pub_type
杂志文章abstract::Preview Hereditary hemochromatosis, once believed to be rare, is now known to affect 1 in 250 to 300 people of northern European descent. Untreated, the disorder can have serious complications, but for patients in whom it is discovered and treated early, the prognosis is good. In this guide to diagnosis and management...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945914
更新日期:1994-11-01 00:00:00
abstract::Ingested ethylene glycol is readily absorbed and metabolized into toxic metabolites that can cause CNS depression, cardiopulmonary failure, and renal failure. Thorough history taking, physical examination, and laboratory testing are essential for diagnosis. Careful differential diagnosis is important because symptoms ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.1999.10.1.734
更新日期:1999-10-01 00:00:00
abstract::Symptomatic treatment of transient insomnias is advisable, for without treatment these sleep disorders may become persistent. The drugs of choice are the benzodiazepine hypnotics, which have minimal side effects when used for short periods in properly selected patients. The three such drugs currently available in the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698665
更新日期:1984-07-01 00:00:00
abstract::In acutely injured patients, recognition of profound shock may be difficult initially. Ensuring adequate oxygenation, restoring intravascular volume, and controlling ongoing blood loss are key principles of treatment in these patients. Additionally, an appreciation for and recognition of the possible adverse consequen...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injec...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698794
更新日期:1984-11-15 00:00:00
abstract::Regular aerobic exercise has significant cardiovascular benefits, including a reduction in incidence of and mortality from coronary artery disease--probably because of positive effects on blood lipid levels and blood pressure. Aerobic exercise can also be an important adjunct to a weight-loss program. Many persons who...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700983
更新日期:1991-07-01 00:00:00
abstract::In this article, Drs Kerr and Yan describe four cases--two handled the wrong way and two the right way--to help you frame a set of criteria that will work for you in suspecting, testing for, diagnosing, and treating pulmonary embolism in ambulatory patients. In addition, Dr Kerr uses his legal expertise to provide sug...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1992.11701345
更新日期:1992-05-15 00:00:00
abstract::Many patients who present with acute or chronic diarrhea do not have an important organic disease. Most have functional diarrhea. The history, clinical examination, and initial laboratory studies should lead to a provisional diagnosis with respect to organic or functional origin and help define whether the disease aff...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11704504
更新日期:1989-12-01 00:00:00
abstract::Ultraviolet (UV) radiation is a notorious environmental carcinogen. Acute and chronic UV radiation exposure increase the risk for skin cancer. Protecting oneself from both UVA and UVB radiation with broad-based sunscreen can prevent certain skin cancers, their precursors, and photoaging. Although sun protection factor...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.07.2315
更新日期:2011-07-01 00:00:00
abstract::Patient Notes are indexed alphabetically and by subject. The number immediately following the title is the number of the Patient Note, and the number in parentheses is the date of publication. This index includes all 82 Patient Notes published so far, from February 1, 1988, through this issue. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1993.11701589
更新日期:1993-01-01 00:00:00
abstract::The recent resurgence of rheumatic fever reported in eight locations in the United States after years of decline has several noteworthy characteristics. Most patients were children of families in high- to middle-income brackets with ready access to medical care. In four of the outbreaks, the majority of patients were ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701445
更新日期:1992-09-01 00:00:00
abstract::Emergency physicians are usually the first to see patients with injuries to oral and facial tissues. Because many of these patients may have life-threatening neurologic injuries, secondary oral and perioral problems may be overlooked initially. These injuries, however, have a profound potential for causing lifelong di...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700566
更新日期:1989-02-01 00:00:00
abstract::In the past decade, significant progress has been made in the understanding and treatment of Alzheimer's disease. Modest success has been achieved using new drugs in treatment of mild symptoms of the disease. Vitamin E, estrogen, and NSAIDs may slow the progression of Alzheimer's disease, but their routine use is not ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.10.15.746
更新日期:1999-10-15 00:00:00
abstract::Management of pain syndromes clearly requires a multidimensional approach and involves social, psychologic, and somatic factors. At the Behavioral Medicine/Pain Therapy Center of Jewish Hospital, St Louis, most patients significantly increase social and physical activity using the combined approach outlined. A majorit...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697831
更新日期:1983-05-01 00:00:00
abstract::Acute urinary retention often is secondary to obstruction of the bladder or distal genitourinary system, which may be induced by any of a number of medical or surgical conditions. Treatment varies according to the cause. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11715998
更新日期:1982-02-01 00:00:00
abstract::Contrary to popular belief, hypoglycemia is an infrequently encountered condition and its presence is questionable until confirmed by appropriate tests. In ambulatory patients, blood glucose levels obtained during intake of a normal diet are more reliable than those obtained during a glucose tolerance test. If the blo...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11700028
更新日期:1987-11-01 00:00:00
abstract::Venous thromboembolism is a serious and, often, asymptomatic complication of hip surgery. A reliable screening test is needed to detect thrombi early to prevent death from pulmonary emboli. Noninvasive screening tests were ineffective in our study of 453 patients. We recommend early use of ventilation/perfusion lung s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699529
更新日期:1986-09-15 00:00:00
abstract::Primary carcinoid tumor of the thymus is a rare, slow-growing neoplasm occurring most commonly in middle-aged men. The usual clinical manifestations are those of a mediastinal mass, although in asymptomatic patients, the diagnosis may be suggested by a routine chest roentgenogram. Excision is the most common treatment...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698575
更新日期:1984-01-01 00:00:00
abstract::Evaluation of the suicidal patient involves careful consideration of risk factors, including attention to subtle clues from the history, and mental status examination. The most urgent decision for the physician to make is whether or not to insist on hospitalization. If the need for inpatient care is uncertain, a "no s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699432
更新日期:1986-06-01 00:00:00
abstract::Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the ava...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2009.11.2069
更新日期:2009-11-01 00:00:00
abstract::This case report describes prolongation of a patient's prothrombin time and partial thromboplastin time possibly due to coadministration of warfarin and an overdose of an acetaminophen-propoxyphene combination analgesic. Patients receive warfarin for many indications, and concomitant use of an analgesic agent is commo...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700233
更新日期:1988-04-01 00:00:00
abstract::Physicians need to be aware that women and mothers are capable of sexually abusing children and need to watch for signs that a mother may be at risk for perpetrating abuse or that a child may have been abused. Posttraumatic stress disorder, attention-deficit hyperactivity disorder, secondary enuresis and encopresis, n...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-07-01 00:00:00
abstract::The association of depression and erectile dysfunction (ED) has been firmly established, but it may be difficult to distinguish between cause and effect--whether ED causes the depression or the depression causes ED--in an individual patient. In most patients who have major depression, successful reversal of the depres...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.5.15.2000.suppl5.29
更新日期:2000-05-01 00:00:00
abstract::Although low-dose oral corticosteroid therapy cannot be considered remittive, it has earned a place in the therapeutic armamentarium for rheumatoid arthritis. Major clinical trials of a group using corticosteroid compared with a control group have not been done since the 1950s. One of these three large trials showed s...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章,评审
doi:10.1080/00325481.1987.11700016
更新日期:1987-10-01 00:00:00
abstract::Anemia of chronic disease (ACD) is a prevalent condition commonly observed in patients with chronic infections, cancer, trauma, and inflammatory disorders. In this article, Dr Andrews examines new research findings that enhance the understanding of the pathophysiologic mechanisms of ACD. After a brief review of iron h...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.11.2004.suppl36.250
更新日期:2004-11-01 00:00:00
abstract::A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiograp...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716219
更新日期:1982-10-01 00:00:00
abstract::Abdominal aortic aneurysms are believed to result from several factors, one probably being inflammation that leads to dilatation, plaque deposition, and degeneration of the arterial wall. Most of these aneurysms are asymptomatic, but abdominal or back pain, shock, and a pulsatile abdominal mass indicate rupture. Initi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.08.651
更新日期:1999-08-01 00:00:00
abstract::In the Western world, diabetes is the biggest cause of peripheral neuropathy, usually distal symmetric polyneuropathy but some times another polyneuropathy or a focal neuropathy. In addition, hypothyroidism and acromegaly can cause carpal tunnel syndrome and other sensory complaints. A complete blood cell count, nerve...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.09.318
更新日期:1997-09-01 00:00:00
abstract::Hair analysis has important uses in screening for metal intoxication and exposure to environmental pollutants, as well as applications in forensic medicine. In addition, hair analysis has been hailed as the new "in" tool for diagnosis of nutritional deficiencies and chronic diseases, but data to support these applicat...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716248
更新日期:1982-11-01 00:00:00
abstract::Providing medical care for patients with mental disabilities may be challenging and financially unappealing because of the need for extra time and effort. Nonetheless, primary care physicians can meet the medical needs of these patients and benefit from working with a team approach that fosters open communication and ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.1999.11.776
更新日期:1999-11-01 00:00:00