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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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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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Analgesia and Pain Management01:25

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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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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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Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
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Opioid Taper Practices Among Clinicians.

Amelia L Persico1,2, Jeffrey J Bettinger2,3, Erica L Wegrzyn2,4

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Journal of Pain Research
|October 28, 2021
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This summary is machine-generated.

Clinicians report discomfort tapering high-dose opioids, with many citing CDC guidelines. This highlights a need for evidence-based opioid tapering guidelines and further education for pain management specialists.

Keywords:
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Area of Science:

  • Pain Management
  • Pharmacology
  • Clinical Practice Guidelines

Background:

  • Opioid dose tapers are common for opioid switching or discontinuation.
  • Lack of a universal standard of care poses risks like withdrawal and inadequate pain control.

Purpose of the Study:

  • Examine clinician practices and rationale for opioid tapering.
  • Assess comfort levels, methods, and rationale across different morphine milligram equivalent (MME) levels.
  • Determine the need for a standardized care approach.

Main Methods:

  • An electronic survey was distributed to clinicians via professional networks.
  • Data collected included provider type, comfort with tapering at various MME, tapering methods, rationale, and withdrawal management.
  • Statistical analysis used Pearson's Chi squared and Fisher's exact tests.

Main Results:

  • 149 clinicians (physicians, NPs, pharmacists, PAs) participated; 55% were pain specialists.
  • No significant difference in comfort levels was found across provider types.
  • Nearly 50% cited the 2016 CDC guidelines as their rationale for tapering.

Conclusions:

  • Over 50% of surveyed pain specialists were uncomfortable tapering opioids above 120 MME/day.
  • This indicates a need for enhanced education and consensus guidelines for opioid tapering.
  • Current tapering practices are influenced by low-quality evidence, underscoring the need for high-quality evidence-based guidelines.