1,721,007 research outputs found
The impact of long-term maintenance treatment with buprenorphine on complex psychomotor and cognitive function
No full textIntroduction: Despite the fact that buprenorphine is effective, well tolerated and due to its pharmacological profile a very safe drug, the impact of long-term buprenorphine substitution therapy on complex psychomotor and cognitive function predicting driving ability is not yet clear. Therefore, a prospective comparison between patients receiving sublingual buprenorphine and a control group of untreated, healthy volunteers was performed. Methods: Treated and untreated subjects were matched for age and sex, with three control subjects selected for every buprenorphine patient. Patients using unreported drugs were included in the intention-to-treat (HT) analysis; the remaining patients were analysed as the per-protocol (PP) group. The test battery comprised the assessment of: performance during stress, visual orientation, concentration, attention, vigilance and reaction time. The primary endpoint was defined as the sum of the relevant scores of the tests after z-transformation of the individual scores. Results: 30 patients with sublingual buprenorphine treatment (7.7 +/- 3.9 mg per day) were matched to 90 controls. 19 patients were excluded from the PP-analysis because of additional unreported drug intake. Significant non-inferiority could be demonstrated for the PP-group (p < 0.05) as well as for the HT-group (p < 0.001). Conclusion: Patients receiving a stable dose of sublingual buprenorphine showed no significant impairment of complex psychomotor or cognitive performance as compared to healthy controls. However intake of illicit drugs as well as the lack of social reliability are major problems in this specific patients group. Despite of the absence of a relevant impact of the drug on driving ability, those patients do not seem to be qualified for getting their driving license. (C) 2011 Elsevier Ireland Ltd. All rights reserved
Use of controlled release opioids in perioperative pain therapy - A standpoint on a new warning advice in literature on controlled release opioids
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Empfehlung zur Klassifikation schmerztherapeutischer Einrichtungen in Deutschland
No full textOn behalf of the German chapter of the International Association for the Study of Pain (IASP) recommendations for German pain treatment services have been developed for the first time. The criteria were based on the IASP recommendations but adapted to the specific German situation. According to the structure and process criteria four different levels of pain treatment services can be distinguished. The aim of the recommendations is to serve as a guide for future development and implementation of pain therapy and quality assurance
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Practicability, safety, and efficacy of a “German model” for opioid conversion to oral levo-methadone
No full textAn algorithm to convert from any other opioid to oral levo-methadone was developed in Germany, the German model of levo-methadone conversion (GMLC). According to this GMLC, the pre-existing opioid is stopped, then titration of oral levo-methadone is initiated with a starting dose of 5 mg orally q 4 h (plus prn q 1 h). If necessary, levo-methadone dose is increased (pain) or decreased (side effects) by 30% q 4 h (plus prn q 1 h). After 72 h, the achieved single dose is maintained, but the dosing interval increases twofold to q 8 h (plus prn q 3 h). The aim of this study was to obtain information about the practicability, safety, and efficacy of the GMLC in clinical routine. A retrospective, systematic chart review of levo-methadone conversions for the treatment of pain in inpatient palliative care was performed. Fifty-two patients were analyzed. The dosing interval was increased correctly after 72 h as demanded by the GMLC in 60% of patients. In 85% of the patients, opioid medication with levo-methadone could be maintained until the end of the inpatient stay. In three patients (6%), levo-methadone administration had to be stopped due to side effects. No serious adverse events could be detected during opioid rotation. Pain intensity was reduced significantly (p < 0.001) after conversion concerning mean (NRS 0.9; range 0-4) and maximum pain over the day (NRS 3.9; range 0-10). The presented study indicates that the GMLC provides a practical and reasonably safe approach to perform opioid rotation to levo-methadone in a palliative care setting
Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice
No full textBACKGROUND
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain.
AIM
Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain.
DESIGN
First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life.
DATA SOURCES
The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts.
RESULTS
Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased.
CONCLUSION
Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use
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