Abstract:
:The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system-depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Gudin JA,Mogali S,Jones JD,Comer SDdoi
10.3810/pgm.2013.07.2684subject
Has Abstractpub_date
2013-07-01 00:00:00pages
115-30issue
4eissn
0032-5481issn
1941-9260journal_volume
125pub_type
杂志文章,评审abstract:OBJECTIVES:Lorcaserin is a selective 5-HT2C (5-hydroxytryptamine 2C) receptor agonist indicated for weight management. Here, we assess the impact of lorcaserin on progression from prediabetes to type 2 diabetes (T2D) and on reversion from prediabetes to euglycemia. METHODS:This is a post hoc analysis of pooled data fr...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2016.1178590
更新日期:2016-05-01 00:00:00
abstract::Diabetic foot infections (DFIs) are a commonly encountered medical problem. They are associated with an increased frequency and length of hospitalization and risk for lower-extremity amputation. Furthermore, they have substantial economic consequences. Patients with diabetes mellitus are particularly susceptible to fo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.03.2541
更新日期:2012-03-01 00:00:00
abstract::Although the link between cigarette smoking and its cardiovascular effects is well established, the mechanisms through which smoking raises blood pressure remain to be clarified. Possible mechanisms include nicotine-induced peripheral and central sympathetic nervous system stimulation, persisting levels of nicotine in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1996.11.114
更新日期:1996-11-01 00:00:00
abstract::With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usuall...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.06.1114
更新日期:2000-06-01 00:00:00
abstract::Type 2 diabetes, which is increasing in prevalence, is a multifaceted disease that presents a challenge to the primary care physician. In this article, Drs Flemmer and Vinik review the significant findings of several important clinical trials and present a method of comprehensive staged management to improve the quali...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.5.1.1064
更新日期:2000-05-01 00:00:00
abstract::Most patients with type 2 diabetes present with comorbid overweight or obesity. Reaching and maintaining acceptable glycemic control is more difficult in overweight and obese patients, and these conditions are associated with increased risk for cardiovascular and other diseases. Glycemic management for these patients ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.05.2148
更新日期:2010-05-01 00:00:00
abstract::The stress treatment program at Ochsner, New Orleans, provides participants with knowledge of necessary skills and opportunities for rehearsal and practice within the setting. In addition, the modalities chosen reinforce what Lazarus and Opton described as "perceived control," which was found to be as instrumental as ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698991
更新日期:1985-05-01 00:00:00
abstract::The goals of therapy for congestive heart failure (CHF) are to improve quality of life and to prolong it. Improvement in patients with CHF can only be realized, however, if a multidisciplinary healthcare team can provide effective management in both the inpatient and outpatient settings. Inhibition of compensatory mec...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.01.143
更新日期:1997-01-01 00:00:00
abstract::Hyponatremia (serum sodium <135 mEq/L) is a common electrolyte disorder in community or hospitalized patients. Serum sodium levels should be corrected at a proper rate in patients with hyponatremia, since overcorrection of serum sodium levels is related to devastating neurologic consequences, such as the osmotic demye...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1186488
更新日期:2016-06-01 00:00:00
abstract::Varicose veins are a common problem that still presents a major challenge to the physician and the patient. Complete surgical removal of the malfunctioning veins has proved to be the most effective management for significant varicosities, although several nonsurgical methods are available for mild cases or those not s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715178
更新日期:1979-06-01 00:00:00
abstract::Preview Back pain can be a symptom of any number of problems, most commonly mechanical, or structural, in nature. Among the nonmechanical causes is ankylosing spondylitis, an inflammatory disease that involves the spine and sometimes other joints and extra-articular organs. Dr Escalante explains how to differentiate t...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1993.11945685
更新日期:1993-07-01 00:00:00
abstract::In scarcely more than 30 years, the People's Republic of China has progressed from limited health care available only to a privileged few to a countrywide system providing basic services to one fifth of the world's population. The author gives his impressions of the current situation, based on a recent visit. :There ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1981.11715824
更新日期:1981-08-01 00:00:00
abstract::Measurement of cerebrospinal fluid (CSF) lactate is a useful test when properly applied to the appropriate clinical situation and can offer information other CSF parameters cannot provide. Except for Gram's stain of CSF, lactate level is the most important CSF parameter in the early differentiation of viral (aseptic) ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11716403
更新日期:1990-10-01 00:00:00
abstract::Because of the broad range of physiologic problems and the many potential sources of complications, liver transplantation patients require contributions from virtually the complete spectrum of medical science. The evolving specialty of liver transplantation has eagerly assimilated advances in surgical techniques, anes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704566
更新日期:1990-02-01 00:00:00
abstract::The best treatment for adenocarcinoma of the prostate depends on the patient's age, general medical condition, life expectancy, and willingness to accept such side effects as impotence. Radical prostatectomy or full-dose radiation therapy are usually curative when cancer is confined to the gland. The technique of pros...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1988.11700490
更新日期:1988-11-15 00:00:00
abstract::The fact that atopic dermatitis is such a common medical problem underlies the need for better understanding of the basic disease processes and the development of new therapeutic approaches. Infection is now recognized as an important exacerbating factor, and the role of inflammatory and immunologic mediators is recei...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698671
更新日期:1984-07-01 00:00:00
abstract::Inhaled corticosteroids (ICSs) belong to the armament for treatment of chronic obstructive pulmonary disease (COPD) and as such, they are widely used in real life. This is a narrative review on evidence-based papers published in the English language listed in Medline between 1990 and March 2016 discussing ICS applicat...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1186487
更新日期:2016-06-01 00:00:00
abstract::Systolic hypertension, especially isolated systolic hypertension (ISH) is very common in older subjects aged ≥ 65 years and is a major risk factor for cardiovascular disease (CVD), strokes, heart failure (HF) and chronic kidney disease (CKD). It is also, directly and linearly related with these complications irrespect...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1433434
更新日期:2018-03-01 00:00:00
abstract::Pain is one of the most common problems for cancer patients, and its management is often hindered by barriers created by patients and physicians alike. By avoiding potential barriers and understanding the principles of pain management and drug selection and titration provided here by Dr Hartmann and colleagues, physic...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2000.03.959
更新日期:2000-03-01 00:00:00
abstract::What clinical circumstances call for aggressive treatment of jaundice in newborns? Is cessation of breast-feeding necessary to help bring down the high bilirubin concentration? When should phototherapy be started--and stopped? The authors address these and other questions in this thorough guide to differential diagnos...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-03-01 00:00:00
abstract::By being aware of which patients are at high risk for ingestion or insertion of foreign bodies, physicians can be on the lookout for objects in the gastrointestinal tract and ready to institute initial care. Esophageal foreign bodies and other objects that increase the chance of perforation or obstruction may require ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1992.11701481
更新日期:1992-10-01 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::When patients have a clear understanding of the etiology and pathophysiology of Parkinson's disease, management is easier for the physician and the patient is better able to cope with the disease. Patients also should be made aware of the proper use of antihistamines and anticholinergics that control tremor, as well a...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715531
更新日期:1980-09-01 00:00:00
abstract:OBJECTIVES:We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons. METHOD:...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2018.1491779
更新日期:2018-08-01 00:00:00
abstract::Many drugs with which to treat reversible obstructive airway disease are available. Beta-adrenergic aerosols are the first line of defense; these are followed, when necessary, by either timed-release theophylline or oral beta-adrenergics. Often, a combination of these drugs must be used to achieve effective relief of ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699911
更新日期:1987-07-01 00:00:00
abstract::Gastroesophageal reflux is not synonymous with sliding hiatus hernia. It should be approached as a condition dependent on the intrinsic strength of the lower esophageal sphincter rather than on the presence of a hiatus hernia. The patient's account of symptoms is probably the most important means of diagnosis, but in ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1975.11713946
更新日期:1975-01-01 00:00:00
abstract::Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. Physicians sh...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.09.15.1238
更新日期:2000-09-15 00:00:00
abstract::Despite cervical cancer being considered a preventable disease, it still remains the second most common malignancy in women worldwide, with a higher incidence in underdeveloped countries. Human papillomavirus (HPV) is considered the causative agent of cervical cancer. The major mechanisms through which HPV contributes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2008.11.1928
更新日期:2008-11-01 00:00:00
abstract::While more remains to be learned about the natural history of deep vein thrombosis and pulmonary embolism, better information is now available on which to base decisions about diagnosis and treatment. Several retrospective and prospective studies have placed the value of lung scanning, venography, and pulmonary angiog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699336
更新日期:1986-03-01 00:00:00
abstract::In the face of deficiencies in our present system of introducing new drugs, clinicians must be committed to monitoring patients carefully. They must not be caught up in the hyperbole and excitement of the latest new drug, but instead should allow the crucible of time to teach them and the rest of the medical community...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697799
更新日期:1983-03-01 00:00:00