Search

Why you should read this article: • To update your knowledge of the latest guidance on managing chronic pain • To recognise the importance of reducing medicines use in chronic primary pain management • To consider which non-pharmacological interventions could be effective for people experiencing chronic pain Chronic pain can be debilitating and affects an increasing number of people in the UK due to an ageing population and the rising prevalence of comorbidities. Chronic pain can be primary, where it is not accounted for by another condition, or secondary, where it results from an underlying condition or injury. The National Institute for Health and Care Excellence has published updated guidance on the assessment and management of chronic pain in adults. This article explores the latest recommendations regarding medicines use in chronic primary pain and outlines appropriate non-pharmacological management strategies. It also discusses some of the barriers to implementing chronic pain management interventions, and provides advice for nurses caring for patients who are experiencing this type of pain. [ABSTRACT FROM AUTHOR]

"Burn This Night" by Alex Kenna is a gripping PI mystery that follows Kate Myles, a former LAPD officer struggling with addiction and custody issues. When Kate's former colleague contacts her about a DNA match to a cold case murder suspect, she is drawn into a web of secrets and lies. As Kate investigates the case, alternating with flashbacks that reveal the backstory of a tragic fire, the two narratives converge in an unexpected way. Fans of Lisa Unger will find this novel captivating. [Extracted from the article]

Does a potential interaction with antipyretics vary with different vaccine types (mRNA vs non-mRNA vaccines)? In its response, the manufacturer indicated the following:[7] Pre-vaccination: There are no robust clinical data on how pre-treatment use of antipyretics affects COVID-19 vaccine-induced antibody responses.[7] Post-vaccination: There is no clinical evidence that the use of antipyretics post-vaccination has a negative effect on COVID-19 vaccine efficacy.[7] During the Janssen COVID-19 Vaccine clinical trial program, antipyretics were recommended post-vaccination for symptom relief as necessary. [Extracted from the article]

Why you should read this article: • To understand the physiological properties of ketamine • To learn about the therapeutic uses of ketamine • To familiarise yourself with the nursing implications of ketamine use Ketamine is a synthetic drug with unique properties which started to be used therapeutically in humans in the 1970s and is now widely used in all fields of nursing. Ketamine acts on the central nervous system, primarily through inhibiting N-methyl-D-aspartate receptors. However, the precise understanding of its mechanisms of action remains elusive in many respects. Ketamine is frequently used as an anaesthetic in medical and surgical procedures and as an analgesic in children and adults. It is increasingly used in mental health settings to treat depression. It has potential to be used more often in areas such as palliative care and mental health care. This article reviews the physiological and pharmacological properties of ketamine, explores its main therapeutic uses, and considers the associated implications for nursing practice. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the complex issues in relation to managing pain in hospital patients with opioid use disorder • To recognise the stigma that may be experienced by patients with opioid use disorder • To consider strategies you could use in your practice to improve pain management in patients with opioid use disorder This article explores the challenges and barriers to the effective nursing management of pain in patients with a history of opioid use disorder. It also identifies recommendations for improving patient care and possible areas for further research. The author examined the relevant literature, which revealed that patients with opioid use disorder may experience stigmatisation by nurses; such negative attitudes are often in conflict with nurses' professional and ethical duties. This issue is compounded by a lack of knowledge and understanding of dependence, addiction and withdrawal. It was also identified that patients often recognise the effects of stigma and this can cause resentment, frustration and anxiety, in some cases leading to aggressive or disruptive behaviours that reinforce negative stereotypes of people who use opioids. A breakdown in the nurse-patient relationship can result in suboptimal pain management in this often-marginalised patient group. Therefore, effective pain management relies on a nurse-patient relationship that minimises anxiety, as well as multidisciplinary team collaboration. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experiences with injuries, pain management, and their perspectives on the use of cannabis as an alternative to pharmaceutical painkillers.

The article discusses how language can act as a barrier to and assist nurses in the United Kingdom (UK) in understanding the patient's pain experience. Topics covered include the personal nature of pain, the often suboptimal pain assessment, with severity often underestimated by healthcare professionals, and the possible influence of language in effective pain management. Also noted is the interchangeable use of the terms pain, discomfort and comfort.

Why you should read this article: • To understand the indications for epidural analgesia • To familiarise yourself with the complications associated with epidural analgesia • To improve your knowledge of the nursing care of people receiving epidural analgesia Epidural analgesia continues to have an important role in the management of acute pain in post-operative settings. Although its use in clinical practice has declined, it continues to demonstrate superior analgesia effect compared with parenteral opioids. However, despite these benefits, epidural analgesia requires additional monitoring to ensure the timely identification of significant complications, such as haematoma and abscess. This article details the nursing care and management of adults receiving epidural analgesia in post-operative settings. It also outlines the main complications that may occur and how these can be managed. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To refresh your knowledge of the mode of action, side effects and risks of opioids • To enhance your awareness of the safety implications associated with the use of prescribed opioids • To understand the role of the nurse in caring for and supporting patients who are taking opioids Opioids are powerful analgesics that are derived from the opium poppy plant. They are recognised as central in the management of acute pain and cancer pain, but concerns about long-term use have resulted in recommendations that they should be used with caution in the management of chronic pain. Opioids have associated side effects and risks, but these may be exaggerated and some healthcare professionals can be unnecessarily cautious and withhold the use of opioids, even in cases where these medicines may be beneficial. It is important that nurses understand the pharmacology, side effects and risks of opioids, so they can ensure these medicines are administered safely. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand patients' experience of post-operative pain • To develop an effective method of assessing patients' post-operative pain • To recognise the nurse's role in the management of post-operative pain While post-operative pain is a common and unavoidable consequence of surgery, evidence suggests that the levels of pain experienced by patients are unnecessarily high. In the past two decades, evidence has also indicated that nurses' knowledge of the assessment and effective management of pain is suboptimal. This article considers the elements required for an effective post-operative pain assessment, as well as examining the barriers that result in many patients' post-operative pain not being assessed. The article also provides an overview of the main pain management interventions available to nurses. [ABSTRACT FROM AUTHOR]

Problem/Condition: In 2017, a total of 70,237 persons in the United States died from a drug overdose, and 67.8% of these deaths involved an opioid. Historically, the opioid overdose epidemic in the United States has been closely associated with a parallel increase in opioid prescribing and with widespread misuse of these medications. National and state policy makers have introduced multiple measures to attempt to assess and control the opioid overdose epidemic since 2010, including improvements in surveillance systems. Period Covered: 2010-2016. Description of System: The Prescription Behavior Surveillance System (PBSS) was created in 2011. Its goal was to track rates of prescribing of controlled substances and possible misuse of such drugs using data from selected state prescription drug monitoring programs (PDMP). PBSS data measure prescribing behaviors for prescription opioids using multiple measures calculated from PDMP data including 1) opioid prescribing, 2) average daily opioid dosage, 3) proportion of patients with daily opioid dosages ≥90 morphine milligram equivalents, 4) overlapping opioid prescriptions, 5) overlapping opioid and benzodiazepine prescriptions, and 6) multiple-provider episodes. For this analysis, PBSS data were available for 2010-2016 from 11 states representing approximately 38.0% of the U.S. population. Average quarterly percent changes (AQPC) in the rates of opioid prescribing and possible opioid misuse measures were calculated for each state. Results and Interpretation: Opioid prescribing rates declined in all 11 states during 2010-2016 (range: 14.9% to 33.0%). Daily dosage declined least (AQPC: -0.4%) in Idaho and Maine, and most (AQPC: -1.6%) in Florida. The percentage of patients with high daily dosage had AQPCs ranging from -0.4% in Idaho to -2.3% in Louisiana. Multiple-provider episode rates declined by at least 62% in the seven states with available data. Variations in trends across the 11 states might reflect differences in state policies and possible differential effects of similar policies. Public Health Actions: Use of PDMP data from individual states enables a more detailed examination of trends in opioid prescribing behaviors and indicators of possible misuse than is feasible with national commercially available prescription data. Comparison of opioid prescribing trends among states can be used to monitor the temporal association of national or state policy interventions and might help public health policymakers recognize changes in the use or possible misuse of controlled prescription drugs over time and allow for prompt intervention through amended or new opioid-related policies. [ABSTRACT FROM AUTHOR]

OA most commonly affects the weight-bearing joints, including the knee and hip; OA can also affect the neck, lower back, feet, and hands.[156] OA symptoms typically develop gradually, and patients may present with an array of symptoms that may vary in degree of severity and clinical presentation. The degenerative joint disease osteoarthritis (OA) is the most prevalent form of arthritis, affecting more than 32.5 million adults in the United States and more than 7% of the world population, representing more than 500 million individuals globally.[12] According to the Global Burden of Disease Study 2019, OA is an ongoing public health concern, with projections continuing to increase due to the growing aging population and the ongoing obesity epidemic.[3] OA is one of the primary causes of pain and disability worldwide.[1-5] The pathogenesis of OA can be due to genetic, metabolic, or environmental factors, with the most common risk factors for OA including older age, women aged 50 or older, being overweight or obese, joint overuse or injury, and musculoskeletal abnormalities.[1-5 ]Some individuals also have a genetic susceptibility to developing OA.[1-5] Although there is no cure for OA, there are numerous measures that patients can employ to alleviate and/or minimize pain and to improve mobility and overall health-related quality of life. [Extracted from the article]

Why you should read this article: • To recognise the effects chronic pain can have on a person's life • To understand the range of management interventions available for chronic pain • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Chronic pain can have significant physical, psychological and social effects on a person's life, as well as on their families and friends. However, it is often not well-recognised or understood, which can lead to further harm. Therefore, an individualised, person-centred approach to chronic pain is essential to accurately assess pain and to develop an appropriate treatment plan. This article outlines the biomedical and psychosocial factors that can influence an individual's pain experience that should be considered as part of the assessment and management of chronic pain, and explores the assessment tools available to assist in this process. It also discusses the management options available for chronic pain, including neural blockade and analgesics, as well as non-pharmacological options such as psychological approaches, physical activity and exercise, and complementary and alternative therapies. [ABSTRACT FROM AUTHOR]

Dementia care has evolved over the years, with a rise in person-centred non-pharmacological interventions such as reminiscence therapy, reality orientation and validation therapy. While these nonpharmacological interventions are an important facet of dementia care, nurses also require up-to-date knowledge of the medicines used to manage the symptoms of dementia, including antidepressants, cognitive enhancers and analgesics. Nurses should also understand the effects of behaviour-modifying medicines such as antipsychotics, anxiolytics and hypnotics, which are often overused or inappropriately prescribed in people with dementia. This article discusses the use of all these medicines in dementia care. It also examines the effect of polypharmacy on people with dementia, as well as some of the challenges involved in medicines administration in this patient group, such as covert administration of medicines, polypharmacy and non-adherence. [ABSTRACT FROM AUTHOR]

The article discusses initial opioid analgesic prescriptions and refills in primary care of acute pain in the U.S. in 2014. Topics covered include the sufficiency of the more or less 7-day opioid analgesic prescription for most patients, which modifications based on the patient and condition, and the constant or decreasing probability of a refill with increasing initial prescription duration for individual conditions. Also noted is the overtreatment risk in a 7-day supply for some conditions.

Chronic pain affects a significant percentage of the population and is defined as pain that lasts beyond the point of healing. People presenting to hospital with acute illness may have underlying chronic pain that can be exacerbated by their presenting condition, even if this chronic pain is not the reason for their admission. While people may tolerate their usual medicine regimen under normal circumstances, small changes in their physical health can rapidly cause issues with their medication such as increased side effects. This article considers how nurses can improve the safety of people experiencing pain who have been admitted to hospital, and outlines when changes in their health might have implications for their prescribed analgesics. [ABSTRACT FROM AUTHOR]

The article reports on a study by Yoshihiro Yonekawa which analyzed opioid prescription patterns of retina specialists in the U.S. Based on data from the 2019 American Society of Retina Specialists directory Yonekawa found that male members were more likely to prescribe opioids but as a whole, members prescribe the drug at a lower rate. Between 201 and 2016, it was observed that there is a downward trend overtime. The highest prescriptions were written in Texas, Okalhoma, Idaho, among others.

The article reports that there is no link between hearing loss and opioids taken as prescribed, according to a study. There has been uncertainty on whether an opioid could damage hearing in isolation or only when in combination with other medications. Usually, no pre-drug baseline hearing test is available to determine actual change in cases of abuse. The study administered the Tinnitus Handicap Inventory to monitor participants for possible tinnitus.

Problem: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important health-related behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels. Reporting Period Covered: September 2016--December 2017. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority healthrelated behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991--2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available). Results: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10--24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor's prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexual identity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. Interpretation: Most high school students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that some subgroups of students defined by sex, race/ethnicity, grade in school, and especially sexual minority status have a higher prevalence of many health-risk behaviors that might place them at risk for unnecessary or premature mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime). Public Health Action: YRBSS data are used widely to compare the prevalence of health-related behaviors among subpopulations of students; assess trends in health-related behaviors over time; monitor progress toward achieving 21 national health objectives; provide comparable state and large urban school district data; and take public health actions to decrease health-risk behaviors and improve health outcomes among youth. Using this and other reports based on scientifically sound data is important for raising awareness about the prevalence of health-related behaviors among students in grades 9--12, especially sexual minority students, among decision makers, the public, and a wide variety of agencies and organizations that work with youth. These agencies and organizations, including schools and youth-friendly health care providers, can help facilitate access to critically important education, health care, and high-impact, evidence-based interventions. [ABSTRACT FROM AUTHOR]

Effective management of acute and chronic pain is an important aspect of nursing practice. Relieving patients' pain requires nurses to have an understanding of the latest evidence-based approaches, which will enable them to assess pain, implement appropriate management strategies and monitor their effectiveness. This article outlines the developments in evidence-based guidelines and recommendations for the pharmacological management of acute and chronic pain, including migraine, and in the use of analgesics such as opioids. It also discusses pain management in specific groups such as children and young people, and older people. [ABSTRACT FROM AUTHOR]

The article focuses on fentanyl problem in the U.S. Fentanyl is a powerful synthetic opioid that has been on the market since the 1960s and is used medically to manage pain. Exposure to small quantities can cause serious negative health effects. Fentanyl can suppress respiration and cause death more than other opioids

The article discusses the impact of opioid abuse on public libraries and librarians. Emphasis is given to topics such as the administration of the drug Narcan by library staff to reverse the effects of opioid overdose, the monitoring of public restrooms in libraries, and the installation of boxes for the disposal of needles.

Pain management nurse specialists provide nursing expertise and advice for patients, enabling them to carry out their day-to-day activities and functions without being limited by pain. [ABSTRACT FROM AUTHOR]

The article describes two cataract surgery cases and evaluates different regimens for the management of preoperative inflammation. The first case involves a 68-year-old diabetic patient with cataracts and an unremarkable ocular history who underwent routine cataract surgery while the second case involves a 73-year old patient who underwent cataract surgery and minimally invasive glaucoma surgery (MIGS) for primary open-angle glaucoma.

Chronic pancreatitis is a complex inflammatory condition characterised by irreversible damage to the pancreas. This article explores the pathophysiology of this condition and its effects on pancreatic function. It outlines the causes and presenting features of chronic pancreatitis, as well as its effect on patients' quality of life and the changes to their lifestyle that are likely to be required. Chronic pancreatitis cannot be cured; therefore, treatment aims to control pain, manage problems associated with malabsorption, and assess and manage long-term complications that may develop, such as insulin dependence. [ABSTRACT FROM AUTHOR]

The article discusses the rampant prescription of opioids to treat chronic pain, and the efforts of health care providers in the U.S. to reduce prescription of opioids which can cause death and addiction to its patients. Topics discussed include the Opioid Safety Initiative of Veterans Health Administration, the National Pain Strategy of the U.S. Department of Health & Human Services, and the emphasis on management for pain treatment. Alternative methods of managing pain are also provided.

Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these ofen require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic [ABSTRACT FROM AUTHOR]

A liquid chromatography-mass spectrometry (LC-MS) method has been developed for simultaneous quantification of buprenorphine and its three metabolites, namely norbuprenorphine, buprenorphine glucuronide, and norbuprenorphine glucuronide. Chromatographic separation was achieved on a Cl 8 column with a gradient of acetonitrile over ammonium acetate buffer (25 mM, pH 6.6). The method run time was 7.5 min. Quantification was performed by selected ion monitoring of [M+H]+ ions of norbuprenorphine glucuronide (590), norbuprenorphine (414), buprenorphine glucuronide (644), and buprenorphine (468). Naloxone (328) (328 ng/mL) was used as an internal standard. The samples were processed by protein precipitation and extraction recovery was >95% with minimal observed matrix effects (<11%). Linear calibration curves were obtained over a range of 25 or 100 ng/mL to 4000 ng/mL, depending on the analyte. The lower limit of quantitation for buprenorphine and norbuprenorphine was 25 ng/mL and for buprenorphine glucuronide and norbuprenorphine glucuronide it was 100 ng/mL. The intraday and interday precision and accuracy determinations were <15% coefficient of variation and <15% bias, respectively. The method was successfully applied to in vitro enzymatic metabolism studies of buprenorphine. [ABSTRACT FROM AUTHOR]

This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. [ABSTRACT FROM AUTHOR]

The article offers a guidelines from the U.S. Centers for Disease Control and Prevention (CDC) that provides recommendations for primary care clinicians who are prescribing opioids for chronic pain beyond active cancer treatment, palliative care and end-of-life care. It mentions that the guideline aims to improve communication between clinicians and patients on the risks and benefits of opioid therapy for chronic pain, improve safety and effectiveness of pain treatment.

The article discusses the opioid epidemic affecting hospitals in the U.S. Topics covered include the guidelines for managing opioids in the emergency department (ED), the health systems that are taking a concentrated approach to ensuring opioids are prescribed properly and the need for hospitals to facilitate easy communication between ED physicians, primary care doctors and clinicians at outpatient facilities.

The article discusses the issue of overcoming adherence challenges and avoiding the use of opioids in cataract surgery. It notes the problem of opioid-involved overdoses and misuse linked to the length of time when opioids is prescribed for acute pain and people continuously taking the drug. Another issue is the difficulty among cataract surgery patients to adhere to complex postoperative drop regimens and one solution to this is the use of Dextenza, a dexamethasone intracanalicular insert.

Information about the Public Library Association (PLA) 2018 Conference that took place in Philadelphia, Pennsylvania on March 20-24 is presented. Topics discussed at the event include the development of relationships with libraries abroad, the diversity and inclusion in library professionals and the creation of summer reading program to reach more kids. The event featured several professionals including Cynthia Thornley, Renee DiPilato and Steve Pemberton.

Encourage patients with continual, severe, or recurring pain to seek additional care from their primary health care providers, especially if pain worsens or they see no signs of progress after using nonprescrip- tion analgesics. Nonprescription analgesics, and pharmacists can help them choose the correct OTC products. [Extracted from the article]

Pain is a multifaceted experience with physical, psychological, social and spiritual components. Dementia, which is often accompanied by impaired communication, complicates the assessment and treatment of pain. Although older people with dementia share the same age-related pathology as other older people, they do not experience the same access to pain relief as their cognitively-unimpaired counterparts. Tools have been developed to enhance self-reporting of pain by people with dementia and the objective observation of non-verbal signs of pain. The first step, however, is awareness that pain might be present and can be responsible for otherwise unexplained distress and behaviour change. Recognition of pain should trigger the appropriate and timely use of pain assessment tools. Pharmaceutical and non-pharmaceutical measures to relieve pain should be used as appropriate. Evaluation of the efficacy of these methods is needed on an ongoing basis. People living with dementia deserve to be listened to, no matter how they choose to express pain, and to have their pain minimised effectively and efficiently. [ABSTRACT FROM AUTHOR]

Problem/Condition: Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/ tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of > 100 morphine milligram equivalents (MMEs) per day. Period Covered: 2013. Description of System: The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. population. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. Results: In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines. Prescribing rates by drug class varied widely by state: twofold for opioids, fourfold for stimulants, almost twofold for benzodiazepines, and eightfold for carisoprodol, a muscle relaxant. Rates for opioids and benzodiazepines were substantially higher for females than for males in all states. In most states, opioid prescribing rates peaked in either the 45--54 years or the 55--64 years age group. Benzodiazepine prescribing rates increased with age. Louisiana ranked first in opioid prescribing, and Delaware and Maine had relatively high rates of use of long-acting (LA) or extended-release (ER) opioids. Delaware and Maine ranked highest in both mean daily opioid dosage and in the percentage of opioid prescriptions written for > 100 MMEs per day. The top 1 % of prescribers wrote one in four opioid prescriptions in Delaware, compared with one in eight in Maine. For the five states whose PDMPs collected the method of payment, the percentage of controlled substance prescriptions paid for in cash varied almost threefold, and the percentage paid by Medicaid varied sixfold. In West Virginia, for 1 of every 5 days of treatment with an opioid, the patient also was taking a benzodiazepine. Multiple-provider episode rates were highest in Ohio and lowest in Louisiana. Interpretation: This report presents rates of population-based prescribing and behavioral measures of drug misuse in the general population that have not been available previously for comparison among demographic groups and states. The higher prescribing rates for opioids among women compared with men are consistent with a higher self-reported prevalence of certain common types of pain, such as lower back pain among women. The trend in opioid prescribing rates with age is consistent with an increase in the prevalence of chronic pain with age, but the increasing prescribing rates of benzodiazepines with age is not consistent with the fact that anxiety is most common among persons aged 30^4 years. The variation among states in the type of opioid or benzodiazepine of choice is unexplained. Most opioid prescribing occurs among a small minority of prescribers. Most of the prescriptions by top-decile prescribers probably are written by general, family medicine, internal medicine, and midlevel practitioners. The source of payment varied by state, for reasons that are unclear. Persons who are prescribed opioids also are commonly prescribed benzodiazepine sedatives despite the risk for additive depressant effects. Public Health Actions: States can use their prescription drug monitoring programs to generate population-based measures for the prescribing of controlled substances and for behaviors that suggest their misuse. Comparing data with other states and tracking changes in these measures over time can be useful in measuring the effect of policies designed to reduce prescription drug misuse. [ABSTRACT FROM AUTHOR]

The articles discusses the importance of oral medicines for restoring health and protecting vision. It states that oral antibiotics are prescribed to eradicate bacterial pathogens. Topics include challenges in pain medications, use of painkiller analgesia for corneal abrasion, and use of steroids for short-term purpose. The subject sulfur-allergies and its medication are discussed.

Problem/Condition: At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosis of human immunodeficiency virus (HIV) infection. Approximately one in four of the estimated HIV infections diagnosed in 2011 were attributed to heterosexual contact. Heterosexuals with a low socioeconomic status (SES) are disproportionately likely to be infected with HIV. Reporting Period: June–December 2010. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, injecting drug users, and heterosexuals at increased risk for HIV infection. Data for NHBS are collected in rotating cycles in these three different populations. For the 2010 NHBS cycle among heterosexuals, men and women were eligible to participate if they were aged 18-60 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported engaging in vaginal or anal sex with one or more opposite-sex partners in the 12 months before the interview. Persons who consented to participate completed an interviewer-administered, standardized questionnaire about HIV- associated behaviors and were offered anonymous HIV testing. Participants were sampled using respondent-driven sampling, a type of chain-referral sampling. Sampling focused on persons of low SES (i.e., income at the poverty level or no more than a high school education) because results of a pilot study indicated that heterosexual adults of low SES were more likely than those of high SES to be infected with HIV. To assess risk and testing experiences among persons at risk for acquiring HIV infection through heterosexual sex, analyses excluded participants who were not low SES, those who reported ever having tested positive for HIV, and those who reported recent (i.e., in the 12 months before the interview) male-male sex or injection drug use. This report summarizes unweighted data regarding HIV-associated risk, prevention, and testing behaviors from 9,278 heterosexual men and women interviewed in 2010 (the second cycle of NHBS data collection among heterosexuals). Results: The median age of participants was 35 years; 47% were men. The majority of participants were black or African American (hereafter referred to as black) (72%) or Hispanic/Latino (21%). Most participants (men: 88%; women: 90%) reported having vaginal sex without a condom with one or more opposite-sex partners in the past 12 months; approximately one third (men: 30%; women: 29%) reported anal sex without a condom with one or more opposite-sex partners. The majority of participants (59%) reported using noninjection drugs in the 12 months before the interview; nearly one in seven (15%) had used crack cocaine. Although most participants (men: 71%; women: 77%) had ever been tested for HIV, this percentage was lower among Hispanic/ Latino participants (men: 52%; women: 62%). Approximately one third (34%) of participants reported receiving free condoms in the 12 months before the interview; 11% reported participating in a behavioral HIV prevention program. Interpretation: A substantial proportion of heterosexuals interviewed for the 2010 NHBS heterosexual cycle reported engaging in behaviors that increase the risk for HIV infection. However, HIV testing was suboptimal among the overall sample, including among groups disproportionately affected by HIV infection (i.e., blacks and Hispanics/Latinos). Public Health Action: Increasing coverage of HIV testing and other HIV prevention services among heterosexuals at increased risk is important, especially among groups disproportionately affected by HIV infection, such as blacks and Hispanics/Latinos. The National HIV/AIDS Strategy for the United States delineates a coordinated national response to reduce infections and HIV- related health disparities among disproportionately affected groups. NHBS data can guide national and local planning efforts to maximize the impact of HIV prevention programs. [ABSTRACT FROM AUTHOR]

The article offers suggestions for optometrists to address patients who search for prescription painkillers. Topics discussed include recognition of the drug-seeking behavior of patients by optometrists, prescription of a controlled substance to reduce risk of addiction, harm or death, and several charts related to prescribing schedules in the U.S. INSETS: A Brief History of US Drug Laws;Tools to Combat Drug-Seeking Behavior.

The article offers information on Butrans (buprenorphine) Transdermal System CIII and its position among prescription analgesics. Topics discussed include misconceptions on the need for a modified registration number from the U.S. Drug Enforcement Agency (DEA) to prescribe Butrans and the use of opioid and non-opioid supplemental analgesics in combination with Butrans therapy. Also mentioned are the limitations on the use and available dosage strengths of Butrans.

Pain is common in patients with cancer and may be caused by the disease itself or treatments. Part 1 of this article identified the causes and types of cancer pain to inform assessment and management of pain, which will be discussed in this article. Barriers to pain management and the non-medical prescribing role of the advanced practice nurse in treating patients with cancer pain will be explored. [ABSTRACT FROM AUTHOR]

The article provides tips for pharmacists on how to answer queries from customers regarding cold and influenza, including their symptoms, treatment, and prevention strategies. Considered the best strategy in preventing the common cold is regular and thorough hand-washing. For multiple symptoms relief, simple analgesics, such as paracetamol or ibuprofen, is suggested. Meanwhile, annual seasonal influenza vaccination is the recommended preventative strategy for this infection.

Several tables are presented that offer information on the frequency of pharmacist recommendations for over the counter (OTC) brands under the eyes, ears, nose, throat (EENT) category including the ear pain reliever Similasan Earache Relief, ear wax remover Debrox and snore aid Breathe Right.

Phantom limb pain is common in patients who have amputations. This article outlines the different theories that explain the pathophysiology of phantom limb pain, including peripheral, spinal and central mechanisms. Treatment options are targeted at addressing these mechanisms, combining analgesic techniques with physical and psychological rehabilitation. [ABSTRACT FROM AUTHOR]

Obesity is a growing public health problem. This article provides an overview of the health implications associated with obesity. It describes laparoscopic Roux-en-Y gastric bypass surgery, an invasive intervention for the management of obesity. Strategies for achieving effective pain management following this procedure are discussed. [ABSTRACT FROM AUTHOR]

Procedural pain in adults is not well documented in the literature. This article provides practical advice for healthcare professionals on how to assess and manage pain in these patients. Pain management strategies for common procedures, such as removing a chest drain and redressing a leg ulcer, are detailed. Procedural pain in adults needs thorough assessment and treatment requires careful planning. Fast-acting and short-acting analgesics may provide the most convenient method of managing procedural pain. The possible presence of different types of pain, such as chronic and neuropathic pain, may need to be addressed when managing procedural pain in adults. [ABSTRACT FROM AUTHOR]

The main focus of this article, part of a series on pain, is to describe the abnormal patterns that occur in persistent and neuropathic pain states. It provides an overview of the adjuvant medications available to treat this type of pain when it does not respond to conventional methods. Treatments described require the input of pain specialists; however, the purpose of this article is to encourage nurses to assess pain accurately and to identify symptoms of neuropathic pain, thereby improving patient outcomes. [ABSTRACT FROM AUTHOR]