Abstract:
:This article first reviews the evidence for and against chronic opioid therapy. Evidence supporting the opioid responsiveness of chronic pain, including neuropathic pain, includes multiple randomized trials conducted over months (up to 8 months). Observational studies are conducted for longer, and many also support opioid analgesic efficacy. Concerns have arisen about loss of efficacy with prolonged use, possibly related to tolerance or opioid-induced hyperalgesia. Mechanisms of tolerance and opioid-induced hyperalgesia are explored. Evidence on other important outcomes such as improvement in function and quality of life is mixed, and is less convincing than evidence supporting analgesic efficacy. It is clear from current evidence that many patients abandon chronic opioid therapy because of the unacceptability of side effects. There are also concerns about toxicity, especially when opioids are used in high doses for prolonged periods, related to hormonal and immune function. The issue of addiction during opioid treatment of chronic pain is also explored. Addiction issues present many complex questions that have not been satisfactorily answered. Opioid treatment of pain has been, and remains, severely hampered because of actual and legal constraints related to addiction risk. Pain advocacy has focused on placing addiction risk into context so that addiction fears do not compromise effective treatment of pain. On the other hand, denying addiction risk during opioid treatment of chronic pain has not been helpful in terms of providing physicians with the tools needed for safe chronic opioid therapy. Here, a structured goal-directed approach to chronic opioid treatment is suggested; this aims to select and monitor patients carefully, and wean therapy if treatment goals are not reached. Chronic opioid therapy for pain has not been a universal success since it was re-established during the last two decades of the twentieth century. It is now realized that the therapy is not as effective or as free from addiction risk as was once thought. Knowing this, many ethical dilemmas arise, especially in relation to patients' right to treatment competing with physicians' need to offer the treatment selectively. In the future, we must learn how to select patients for this therapy who are likely to achieve improvement in pain, function and quality of life without interference from addiction. Efforts will also be made in the laboratory to identify opioids with lower abuse potential.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Ballantyne JCdoi
10.1097/01.smj.0000223946.19256.17subject
Has Abstractpub_date
2006-11-01 00:00:00pages
1245-55issue
11eissn
0038-4348issn
1541-8243journal_volume
99pub_type
杂志文章,评审abstract::Like all types of farming, raising tobacco has many hazards that may lead to injury, disability, or death. Burley tobacco farming is a multistep process that is not highly mechanized. An 8-year emergency department surveillance system in Kentucky identified 674 injury cases related to the production of burley tobacco....
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2002-08-01 00:00:00
abstract::Anorexia nervosa has been associated with various hematologic and immunologic abnormalities, including characteristic bone marrow changes, red cell acanthocytosis, leukopenia, complement deficiencies, and defective bactericidal activity of granulocytes. Dietary and psychogenic factors may play a role in these abnormal...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198308000-00018
更新日期:1983-08-01 00:00:00
abstract::Chemonucleolysis and lumbar laminectomy after unsuccessful chemonucleolysis are now common and accepted surgical procedures that require precise perioperative management based on a thorough understanding of the pathophysiology of chymopapain-induced anaphylaxis and the herniating nucleus pulposus syndrome. Preoperativ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198612000-00019
更新日期:1986-12-01 00:00:00
abstract::Most exercise programs designed for healthy persons older than 65 emphasize fitness development, but the maintenance of functional capacity and quality of life are equally important. The basic guidelines for frequency, intensity, and duration of training and the mode of activity recommended by the American College of ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:The incidence of prostate cancer in black men is estimated to be 30% to 50% higher than among age-matched white men, and black men have a twofold higher mortality rate. To determine whether racial differences exist in men with similarly staged disease, we compared clinical and pathologic features in black an...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-04-01 00:00:00
abstract::A woman with chronic hemoptysis as her only complaint had extensive testing and did not respond to antibiotic therapy. Radiologic examination of the sinuses identified a mass which, on surgical exploration, was found to be the result of a fungus, Pseudallescheria boydii. Although this fungus is known to be a cause of ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199507000-00021
更新日期:1995-07-01 00:00:00
abstract::The vast majority of acute iron toxicity cases occur in children less than 5 years of age. Moreover, clinical hepatic injury is uncommon with most symptoms stemming from the intestinal tract (eg, nausea, vomiting, diarrhea). Therefore, physicians, particularly those who do not routinely treat pediatric patients, are o...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000152546.05519.FE
更新日期:2005-02-01 00:00:00
abstract::A 64-year-old female patient presented with acute cerebellar ataxia. After ruling out vascular, infectious, metastatic, demyelinating, and medication etiologies, a paraneoplastic origin for her illness was determined. A renal mass was discovered and found to be renal cell carcinoma. Her symptoms resolved after a radic...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e31816bea80
更新日期:2008-05-01 00:00:00
abstract::We have presented three patients in whom a striking desquamating perineal rash developed within the first five days of a febrile illness. Such a rash should raise the suspicion for Kawasaki syndrome even when all criteria are not present. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198807000-00039
更新日期:1988-07-01 00:00:00
abstract:OBJECTIVE:This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. METHODS:Mail surveys were used to obtain data from 350 randomly sel...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000066811.53167.2E
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Human immunodeficiency virus (HIV) seroprevalence surveys help determine the extent of HIV and the need for routine HIV counseling and testing. We sought to describe trends in five south Georgia hospitals and compare two protocols for conducting anonymous HIV surveys. METHODS:From 1993 to 1997, each hospita...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2001-04-01 00:00:00
abstract::Despite recent pharmacologic advances in the prevention and treatment of osteoporosis, the disease remains incurable. Effective disease management ultimately lies in the hands of the individual patient, who must take responsibility for key health behaviors related to bone health. One behavior modification strategy tha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-200406000-00007
更新日期:2004-06-01 00:00:00
abstract::We report the case of an 18-year old man with hemolytic-uremic syndrome (HUS) having a classic clinical presentation and diagnostic renal pathology without evidence of microangiopathic hemolytic anemia (MAHA) by peripheral blood smear. Indirect evidence of hemolysis was suggested by mild anemia, elevation of serum lac...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199603000-00018
更新日期:1996-03-01 00:00:00
abstract::The aim of this project was to review the course of infants referred for consideration of extracorporeal membrane oxygenation (ECMO) to identify maximal ventilator settings that, when exceeded, did not provide clinical benefit to the patient. These settings might then be used in defining failure of conventional mechan...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199706000-00009
更新日期:1997-06-01 00:00:00
abstract::A patient ingested a massive amount of an oral theophylline preparation and recovered. The paucity of central nervous system manifestations may have been related to the presence of fulminant diarrhea with expulsion of the tablets per rectum. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197808000-00027
更新日期:1978-08-01 00:00:00
abstract::Diagnostic peritoneal lavage (DPL) is an established procedure in evaluation of trauma victims but is less well established for use in patients suspected of having acute intra-abdominal disease. Twenty-six seriously ill patients at our institution who had DPL for acute intra-abdominal disease form the basis of this re...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199004000-00015
更新日期:1990-04-01 00:00:00
abstract::Recent investigations of outbreaks of Salmonella enteritidis gastroenteritis among humans, especially in the northeastern United States, implicate grade A shell chicken eggs as the likely vehicle of transmission. In April 1991 we investigated an outbreak of S enteritidis infections after a wedding anniversary celebrat...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199312000-00005
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:In recent years, more and more discussions have arisen with regard to the role of (partially) hydrolyzed formulas as standard feedings for infants with a high risk to have allergy. METHODS:This review is based on an extensive overview of the literature dealing with the subjects of allergy prevention and hyd...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199712000-00002
更新日期:1997-12-01 00:00:00
abstract::The diagnosis of granular acute lymphoblastic leukemia (ALL) can be problematic as the cytoplasmic granules found in many blast cells may mimic those seen in acute myelogenous leukemia (AML). This rare variant of B-cell ALL is more commonly diagnosed in children, but may occur in adults. We report a case of granular B...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000231247.33762.f3
更新日期:2006-08-01 00:00:00
abstract::Thirty-four cases of meningococcal disease were identified in a retrospective survey of nine US Army posts in the southeastern United States from June 1977 to August 1979. Group B organisms predominated in dependents and civilian communities surrounding two of the posts, while active-duty personnel had a greater varie...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198102000-00007
更新日期:1981-02-01 00:00:00
abstract:OBJECTIVE:To determine the association of utilization of health maintenance tables (HMTs) as a provider reminder tool within the electronic medical record with the completion of women's preventive health services. METHODS:Guidelines from the US Preventive Services Task Force and the Advisory Committee on Immunization ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000001160
更新日期:2020-10-01 00:00:00
abstract::The rapid increase in the use of helicopters for hospital transport during the 1980s is the culmination of several hundred years of military medical innovation. Mass battefield casualties spurred both technologic and medical changes necessary for today's sophisticated helicopter systems in use worldwide, particularly ...
journal_title:Southern medical journal
pub_type: 历史文章,杂志文章
doi:10.1097/00007611-198907000-00022
更新日期:1989-07-01 00:00:00
abstract::Brown recluse spider bites may result in extensive soft tissue injury, causing months of disability. We have described a patient who had a series of extensive surgical debridements after envenomation. Despite skin grafting, persistent cutaneous lesions and extensive satellitosis progressed to involve the entire lower ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199002000-00029
更新日期:1990-02-01 00:00:00
abstract::The value of splenoportography in evaluating patients with portal hypertension was assessed. The technic was found to be useful in estimating portal-venous pressure, ruling out portal vein thrombosis, evaluating the superior mesenteric and portal veins as to their suitability for shunt procedures, and defining anatomy...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197710000-00017
更新日期:1977-10-01 00:00:00
abstract::Systemic lupus erythematosus presents various clinical manifestations. The coexistence of systemic lupus erythematosus and celiac sprue has been rarely reported. We present a patient who had systemic lupus erythematosus with malabsorption demonstrating characteristic clinical and pathologic findings of celiac sprue (g...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199506000-00018
更新日期:1995-06-01 00:00:00
abstract::A new era in the treatment of immune-mediated inflammatory disorders has begun with the clinical availability of anticytokine therapy. Biological agents that are currently available include 3 agents that decrease the activity of tumor necrosis factor-alpha (infliximab, adalimumab, etanercept) and an interleukin-1 rece...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.SMJ.0000153119.37032.8B
更新日期:2005-02-01 00:00:00
abstract::The Pelorus Stereotactic Surgical System is a relatively new, commercially available device that can be used to perform computed tomography (CT)-guided stereotactic brain biopsy. It has been promoted as being a relatively simple and inexpensive system that is more rapid, less cumbersome, and generally easier to use th...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199307000-00008
更新日期:1993-07-01 00:00:00
abstract::Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneu...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-06-01 00:00:00
abstract::I have described two patients who had recurrent spontaneous myoclonic jerking in the alcohol withdrawal state. These movements were distinguishable clinically and electroencephalographically from partial seizures and epilepsia partialis continua. The jerking did not respond to anticonvulsants but resolved as the withd...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198308000-00028
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:This study was performed to examine the effect of stress on pregnancy outcome in women who underwent assisted reproductive technology (ART) procedures. METHODS:In a controlled clinical study of healthy volunteers in an academic research environment, stress was measured subjectively by administering patient ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000054567.79881.E9
更新日期:2003-06-01 00:00:00