Profile: randie griffith |
| ABC@home member since | 10 Aug 2009 |
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Opioid use by patients in an orthopedics spine clinic Concerns regarding the efficacy, toxicity, tolerance, dependence, and abuse of opioids have limited pain medication their use for patients with chronic spine pain. Opioids were prescribed for 152 of the 230 patients, for / 3 months (long-term [LTO]) in 58, and none in 72 (no opioid [NTO]). Abuse behaviors were not more frequent in those with or without a history of abuse/addiction. Because of the phenolic hydroxyl group a change of pH after alkaline pain medication hair digestion (by adding excess orthophosphoric acid) was necessary for the detection of delta 9-tetrahydrocannabinol (delta 9-THC), cannabinol (CBN) and cannabidiol (CBD) by HS-SPME. The results provide objective data from patients with well-defined spine diagnoses to challenge the position that opioid treatment is inappropriate for chronic nonmalignant pain. Clomethiazole, a compound hydrolysed in alkali, was measured by HS-SPME after extraction with aqueous buffer. Medications prescribed were codeine, oxycodone, propoxyphene, Tramadol pain medicine ( Generic Ultram ), morphine, meperidine, fentanyl, or hydroxycodone, either alone or in combination. Opioids significantly reduced the back pain severity score from 8.3 /- 1.5 to 4.5 /- 2.2 (mean /- SD). This study provides data on the efficacy, toxicity, tolerance, and abuse or addiction behaviors with opioid therapy in a large cohort of patients in an orthopedics spine clinic. Opioid use and stability of the daily dose over 3 years were derived from arthritis medicine computerized pharmacy records. This study provides clinical evidence to support and protect physicians treating patients with chronic musculoskeletal diseases, who may be reluctant to prescribe opioids because of possible sanctions from regulatory agencies. HS-SPME coupled with the hydrolysis of the hair matrix by drugstore 4% sodium hydroxide in the presence of excess sodium sulphate and of a suitable internal standard proved to be a convenient one-step method for the measurement of many lipophilic basic drugs such as nicotine, amphetamine derivatives, local anaesthetics, phencyclidine, tramadol ketamine, methadone, diphenhydramine, Tramadol ( Generic Ultram ), tricyclic antidepressants and phenothiazines. Detection limits were between 0.05 and 1.0 ng/mg. There was no significant increase from the mean /- SD initial opioid dosage of 5.0 /- 12.2 30-mg codeine equivalents per day (30 mg oral codeine 5 mg oral morphine) to the mean peak dosage of 7.9 /- 12.5 and the mean recent dosage of 4.3 /- 6.3, suggesting that tolerance to opioid analgesia did not appear to occur pain meds in these patients. Dosage escalations of 2 30-mg codeine equivalents occurred 19 times in 17 LTO patients and was due to worsening of the underlying painful condition, complications of spine surgery, or unrelated surgical or medical problems in all but 3 of them (5%). Nevertheless, the detection limits were such that only CBN could be detected in hair of a consumer. Patients were intervie to determine the efficacy, frequency, and types of side effects and instances of obtaining opioids from sources outside the Veterans Affairs system. Cocaine could not be detected by HS-SPME. These recoveries decreased considerably if larger sample amounts were used, perhaps due to increased drug solubility in the aqueous phase or to elevated viscosity in the presence of dissolved hair proteins. The application of HS-SPME to hair samples from several forensic and clinical cases is described. The detection limit was 0.5 ng/mg. Use of headspace solid-phase microextraction (HS-SPME) in hair analysis for organic compounds.Headspace solid phase microextraction (HS-SPME) has advantages of high purity of the extract, avoidance of organic solvents and simple technical manipulation and can be used in combination with gas chromatography-mass spectrometry (GC-MS) in the hair analysis of a number of drugs. The purpose of this study was to replicate our previous study in another large cohort of patients with nonmalignant pain due to well-defined spinal diseases. More important, it will benefit patients by permitting them to receive these effective, safe medications.. Mild side effects (most commonly, constipation and sedation) were reported by 58% of the opioid-treated patients but rarely caused them to stop taking the medication. Pain severity (0-10 scale) was not different in patients with different spinal pathologies. In our previous study of rheumatology clinic patients, opioid analgesics were found to be highly effective, produced only mild side effects, and had few instances of opioid abuse. Opioid use was studied in 230 orthopedics spine clinic patients by retrospective analysis of prescriptions for 3 years and cross-sectional analysis of efficacy and toxicity by patient interviews. These 3 patients also displayed other abuse behaviors. From spiked 10-mg hair samples absolute recoveries between 0.04 and 5.7% were found. Medical records, operative reports, and radiographic studies were revie to determine the reason for dosage escalations and to detect instances of abuse or addiction behaviors. Interviews were completed in 72 STO, 50 LTO, and 45 NTO patients. | |
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