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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
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A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
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Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
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An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures.

Justin M McLawhorn1, Matthew P Stephany1, William E Bruhn2

  • 1Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Journal of the American Academy of Dermatology
|November 23, 2019
PubMed
Summary
This summary is machine-generated.

Dermatologists developed opioid prescribing guidelines for common procedures. Most pain is managed with non-opioids, with few cases needing more than 15 opioid tablets.

Keywords:
Mohs micrographic surgerycosmetic dermatologydermatologic surgeryopioid guidelinesopioid overusepain managementpostoperative painpublic health

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Area of Science:

  • Dermatology
  • Pain Management
  • Public Health

Background:

  • Opioid overprescribing is a significant factor in the ongoing opioid crisis.
  • Variations in prescribing practices stem from a lack of procedure-specific guidelines.
  • Developing standardized guidelines is crucial for responsible opioid use.

Framework:

  • A modified Delphi method was employed, involving a panel of dermatologists.
  • Guidelines were formulated for opioid-naive patients undergoing common dermatologic procedures.
  • Consensus was reached on opioid dosage, defined as oxycodone 5-mg oral equivalents.

Implementation:

  • The study focused on developing consensus guidelines for common dermatologic procedures.
  • Recommendations were tailored for opioid-naive patients undergoing routine interventions.
  • A systematic discussion among experts ensured comprehensive guideline development.

Implications:

  • Expert consensus suggests most uncomplicated procedures require only non-opioid pain management.
  • No dermatologic scenario routinely necessitates more than 15 opioid tablets post-procedure.
  • These guidelines can form the basis for responsible postoperative pain management in dermatology.