Opioid medications have several psychological and physical side effects. They can cause gastrointestinal issues like constipation and nausea. They impair recovery from injury and surgery by delaying healing. Opioids also negatively impact cognition and can cause respiratory depression by blocking the carbon dioxide feedback loop that regulates breathing. Long term opioid use leads to hypogonadism and decreased sex hormone production. It may also cause a condition called opioid-induced hyperalgesia, where the body becomes more sensitive to pain. Opioids are especially risky for the elderly and increase their risks of falls, fractures, and death. Prolonged use can also lead to brain changes and cause tolerance and withdrawal symptoms.
Fibromyalgia can be resolved by medical herbalismmorwenna2
A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).
Fibromyalgia can be resolved by medical herbalismmorwenna2
A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).
Many people suffer from alcoholism, which is an addiction to alcohol as a result of persistent indulgence of alcohol. Mainly, the affected person shows signs of mental illness or compulsive disorder. More so, the subject of finding the appropriate treatment is a major issue of concern.
The Opioid Crisis – Big Pharma Marketing and the dangers of extrapolation.Aaron Garner
NINTH ANNUAL ANN DAUGHERTY SYMPOSIUM (Tara Treatment Center)
FOR BASIC SCIENCE OF ADDICTION, TREATMENT AND RECOVERY
June 6th 2018 from 8am-4:30pm
Franklin College 101 Branigin Blvd. Franklin, IN 46131
This conference is a forum for professionals, policymakers, educators and the public from diverse disciplines interested in the biochemical, genetic, behavioral, and public health aspects of addiction.
Registar at:
https://crm.bloomerang.co/HostedDonation?ApiKey=pub_83aac092-878e-11e4-b8ac-0a8b51b42b90&WidgetId=1418240
Presentation By:
Jim Ryser, MA, LMHC, LCAC
Director, Chronic Pain and Chemical Dependence IU Health
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
Global Medical Cures™ | Prescription Drugs- Abuse & Addition
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
12Week IV, Discussion Post Care for the Client with a Subst.docxherminaprocter
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
12Week IV, Discussion Post Care for the Client with a Subst.docxRAJU852744
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
OBJECTIVES
--Describe and Discuss what is Pain Recovery
--Demonstrate the difference between Acute and Chronic Pain using case examples
--Explain the symbiotic relationship between Chronic Pain-Substance Abuse and Mental Health Disorders
--Identify and Recommend Multidisciplinary Treatment Options for the Behavioral HealthCare Field
12Week IV, Discussion Post Care for the Client with a Substlauvicuna8dw
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
12Week IV, Discussion Post Care for the Client with a Substdrennanmicah
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
Many people suffer from alcoholism, which is an addiction to alcohol as a result of persistent indulgence of alcohol. Mainly, the affected person shows signs of mental illness or compulsive disorder. More so, the subject of finding the appropriate treatment is a major issue of concern.
The Opioid Crisis – Big Pharma Marketing and the dangers of extrapolation.Aaron Garner
NINTH ANNUAL ANN DAUGHERTY SYMPOSIUM (Tara Treatment Center)
FOR BASIC SCIENCE OF ADDICTION, TREATMENT AND RECOVERY
June 6th 2018 from 8am-4:30pm
Franklin College 101 Branigin Blvd. Franklin, IN 46131
This conference is a forum for professionals, policymakers, educators and the public from diverse disciplines interested in the biochemical, genetic, behavioral, and public health aspects of addiction.
Registar at:
https://crm.bloomerang.co/HostedDonation?ApiKey=pub_83aac092-878e-11e4-b8ac-0a8b51b42b90&WidgetId=1418240
Presentation By:
Jim Ryser, MA, LMHC, LCAC
Director, Chronic Pain and Chemical Dependence IU Health
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
Global Medical Cures™ | Prescription Drugs- Abuse & Addition
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
12Week IV, Discussion Post Care for the Client with a Subst.docxherminaprocter
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
12Week IV, Discussion Post Care for the Client with a Subst.docxRAJU852744
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
OBJECTIVES
--Describe and Discuss what is Pain Recovery
--Demonstrate the difference between Acute and Chronic Pain using case examples
--Explain the symbiotic relationship between Chronic Pain-Substance Abuse and Mental Health Disorders
--Identify and Recommend Multidisciplinary Treatment Options for the Behavioral HealthCare Field
12Week IV, Discussion Post Care for the Client with a Substlauvicuna8dw
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
12Week IV, Discussion Post Care for the Client with a Substdrennanmicah
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
Pain management is a critical component to patient care. However, it is leading to opioid addiction at an alarming rate in the United States. For many patients, a paradigm shift is needed to go from pain management to pain recovery.
OBJECTIVES
Describe and Discuss what is Pain Recovery
Identify the role Shame has with Chronic Pain
Demonstrate the difference between Acute and Chronic Pain using case examples
Explain the symbiotic relationship between Chronic Pain-Substance Abuse and Mental Health Disorders
Identify and Recommend Multidisciplinary Treatment Options for the Behavioral HealthCare Field
Discussion QuestionWhat you do think will be the market impact.docxelinoraudley582231
Discussion Question
What you do think will be the market impact(s) of the proposed increase in the federal minimum wage to $10 per hour?
a) Will the proposed increase help workers? And if so which part(s) of the labor market will be helped.
b) Which part(s) of the labor market will hurt by the proposed increase? How will they be hurt?
c) What will happen to the prices of goods and services produced with minimum wage labor?
3) What is your conclusion? Is this proposal a good idea or not? Explain why.
POST MUST BE BETWEEN 200-250 WORDS, APA FORMAT
Journal of Counseling & Development ■ Winter 2005 ■ Volume 83116
Trends
One of the most common disorders facing people today is
depression. By some estimates, roughly 10% to 25% of the
population experiences some form of depression. Accord-
ing to Murray and Lopez (1997), depression is the number
one cause of disability worldwide. It is clearly the most com-
mon disorder experienced by people who see mental health
practitioners (Gilroy, Carroll, & Murra, 2002). Also, it may be
the most common disorder of mental health workers them-
selves (Mahoney, 1997; Pope & Tabachnik, 1994), with re-
search suggesting that from one third to more than 60% of
mental health professionals had reported a significant epi-
sode of depression within the previous year. Depressing? Yes,
but there is hope and good news. Depression, by and large, is
a problem readily amenable to treatment, and there are many
successful approaches, many of which have empirical evi-
dence to support their efficacy. The bad news, however, is that
depression has been increasing in epidemic proportions. Data
reflect that depression is 10 times as prevalent now as it was in
1960! Seligman (2002) provided a provocative paradox on
depression. He stated that while every objective indicator of
well-being in the U.S. has been increasing, every indicator of
subjective well-being is decreasing.
Clearly, the importance of the current knowledge base on
depression is obvious. Counselors, from pre-K to adult men-
tal health workers, need to be well-versed on the current
state of treatment for depression. For counselors, it is quite
likely that for many of their clients, whether they present
with problems of mood disturbance or not, depression may
be involved. For professionals, who are at high risk for mood
disorders by the very nature of their work, the importance of
treatment and prevention in self-care is critical. Thus, this
topic has considerable value because it is quite likely that
counselors will work with clients with depression, and it is
quite likely, given the empirical evidence, that counselors
are experiencing or will be experiencing some form of de-
pression/mood disturbance themselves.
The article “Treatment and Prevention of Depression”
(Hollon, Thase, & Markowitz, 2002) reviews the current state
of research on various treatment modalities, comparing the
effectiveness of the more widely used approaches—psycho-
dynamic therapy.
Similar to The Psychological and Physical Side Effects of Pain Medications (20)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The Psychological and Physical Side Effects of Pain Medications
1. The Psychological and Physical
Side Effects of Pain Medications
BY: DONALD TEATER, M.D.
Medical Advisor, National Safety Council
2. 2 The Psychological and Physical Side-effects of Pain Medications
Overview
Opioid medications have been used for thousands of years to treat both pain and mental health
problems. In the past 20 years, a resurgence of opioid prescribing in the United States has risen
to unprecedented levels – increasing by more than 600% (Paulozzi & Baldwin, 2012). The United
States consists of 4.6% the world’s population and yet we consume 80% of the world’s opioids
(Solanki, Koyyalagunta, Shah, Silverman, & Manchikanti, 2011).This has been associated with
a concomitant increase in admissions for treatment of opioid dependence and opioid overdose
deaths (C. M. Jones, Mack, & Paulozzi, 2013). Though this increase in prescribing may be due to
multiple reasons, a major cause is the belief medical professionals hold that opioids are generally
safer than many alternatives including nonsteroidal anti-inflammatory medications (NSAIDs).
This white paper will show that opioid medications are, in fact, very dangerous and should be
used only after wise discernment and with great care.
Opiates are medications extracted from opium which comes from the poppy plant. The only true
opiates are morphine, codeine, and thebaine. Opioid medications, are derived from or produce
the same effect as opiates and include the semisynthetic opioids such as oxycodone, hydrocodone,
oxymorphone, hydromorphone and heroin as well as the entirely synthetic medications:
methadone, fentanyl, tapentadol and tramadol. The term opioids will be used throughout this
paper as it includes all of the medications of concern.
Opioid side effects
Opioid medications have multiple psychological and physical side effects. However, often,
medical providers do not fully consider the negative side effects when prescribing. Some of
the opioid side effects are as follows:
Gastrointestinal
• Constipation. Constipation frequently occurs when taking opioid medications.
Opioids slow down the normal peristaltic action of the intestines. Constipation may
occur in as many as 40-95% of people (Benyamin et al., 2008). There is a prescription
medication now that exclusively treats constipation secondary to opioid use.
• Nausea and vomiting. Nausea and vomiting are common side effects of opioid
medications and also occur because of the reduced peristaltic activity of the stomach
and small intestine. Nausea and vomiting may occur in 25% of people (Swegle
Logemann, 2006).
• Gastrointestinal bleeding. GI bleeding is commonly associated with NSAID medications
and may also occur from opioids. Solomon et al showed that in the elderly using opioids,
the incidence of upper gastrointestinal bleeding was 14 per 1000 patient years. This rate was
identical to those on NSAID medications (Solomon et al., 2010).
Impaired recovery from injury or surgery Opioids are often used to reduce pain
to enhance recovery from injury or surgery. It has been commonly believed that by reducing pain
in patients, they will resume activity more quickly and rehabilitative efforts will be more effective.
However, the literature has shown that this is not true. Opioids following an injury delay recovery
and increase the risk of permanent disability.
In a study of Workers Compensation claims for low back pain, Webster et al showed that even
after controlling for injury severity, increasing opioid doses correlated with increasing length
of disability. In other words, for those with equivalent injuries and levels of pain, those with no
opioids did better than those with higher dose opioid treatment. The same study showed that
opioids increased the risk of future back surgery (Webster, Verma, Gatchel, 2007).
A study by Franklin et al showed that opioids prescribed within 6 weeks of injury doubles the risk
of disability one year later (Franklin, Stover, Turner, Fulton-Kehoe, Wickizer, 2008). In this
study, after correcting for the severity of the pain, Franklin et al found that the use of opioids is
a major risk factor for future disability: an important finding that should be considered before
prescribing an opioid for acute pain.
About
the Council
Founded in 1913 and
chartered by Congress,
the National Safety
Council (nsc.org) is a
nonprofit organization
whose mission is to
save lives by preventing
injuries and deaths at
work, in homes and
communities, and on the
road through leadership,
research, education
and advocacy. NSC
advances this mission by
partnering with businesses,
government agencies,
elected officials and the
public in areas where
we can make the most
impact – distracted driving,
teen driving, workplace
safety, prescription
drug overdoses and
Safe Communities.
3. 3The Psychological and Physical Side-effects of Pain Medications
Opioids taken before and after surgery can affect recovery and outcome. Patients taking
opioids prior to back surgery have been shown to have worse outcomes with increased pain,
decreased function and increased depression (D. Lee et al., 2014).
Those taking opioids prior to total knee replacement also have worse outcomes (Zywiel,
Stroh, Lee, 2011)
Opioids used following surgery are known to delay recovery. Modern surgical and
postoperative procedures are designed to, among other things, reduce the use of opioids
to speed recovery. Excessive pain, however, also has an adverse effect on recovery. It is,
therefore, imperative to utilize a multimodal approach to pain relief and minimize the use
of oral and long-acting opioids (Varadhan, Lobo, Ljungqvist, 2010).
Cognitive impairment The effect of opioid medications on cognition is a
complicated topic, and the following summary should not be considered an extensive
review of the literature.
It is well known that larger doses of opioids are markedly impairing, leading to drowsiness,
lethargy, and even death. The data on the effects of doses commonly used for the outpatient
treatment of pain is more complex, because pain itself may compromise cognitive function.
Therefore, studies evaluating the effect of opioids on cognitive abilities compared to
healthy controls may not be representative of their effect on people in pain. However, as
opioids impair cognitive abilities in healthy people (Cherrier, Amory, Ersek, Risler, Shen,
2009) and people in pain experience cognitive impairment, it is reasonable to assume that
those with pain who are on opioids likely have some cognitive impairment. At least one
prospective study has demonstrated that those with chronic pain on opioid therapy have
cognitive deficits including reduced spatial memory capacity and impaired performance in
working memory assessment (Schiltenwolf et al., 2014).
Respiratory depression Opioids adversely affect the respiratory system. Carbon
dioxide (CO2) levels in the blood stimulate our respiratory drive. As breathing slows
down, CO2 levels increase, which stimulates the brainstem to increase the respiratory rate.
Low oxygen levels do not stimulate breathing so sensitivity to CO2 levels is an important
function of nerve cells in the brainstem. Opioids block that feedback loop. When an
individual overdoses on an opioid, the high levels of opioid will decrease alertness and
induce sleep. During sleep, it is the CO2 feedback loop that keeps people breathing but
when blocked by the high levels of an opioid, breathing slows or stops and the person who
has overdosed literally suffocates.
Don Teater, MD
Medical Advisor,
National Safety Council
Donald Teater is responsible
for advising National Safety
Council advocacy initiatives
to reduce deaths and injuries
associated with prescription
drug overdoses. Teater is
a patient advocate who
specializes in psychiatric
services and opioid
dependence treatment. Prior to
joining NSC, Teater practiced
primary care medicine in North
Carolina. At present, along
with his role at NSC, Teater
treats opioid dependence at
Meridian Behavioral Health
Services and Mountain Area
Recovery Center, along with
volunteer work in the field.
Teater is certified by the
American Board of Family
Medicine and completed
his MD degree at the Ohio
State University College of
Medicine. Currently, Teater
is enrolled in the Masters
of Public Health program at
the UNC Chapel Hill Gillings
School of Global Public Health.
CO2 feedback is blocked
and breathing slows or stops,
causing suffocation.
Opioids will decrease alertness and induce sleep.
They also block the CO2 feedback loop resulting
in decreased breathing and suffocation.
CO2 stimulate respiratory
drive. Increased CO2
levels signal the
brainstem to increase the
respiratory rate.
BLOCK
X
X
X
CO2
The effect of opioids on the respiratory system
4. 4 The Psychological and Physical Side-effects of Pain Medications
This is also problematic for individuals with lung disease or sleep apnea. People with chronic
lung disease often need elevated carbon dioxide levels to stimulate them to breathe more deeply.
Taking opioids will blunt this response, causing people with lung disease to breathe slower and
therefore have low oxygen levels.
Sleep apnea is similar as people periodically stop breathing at night until their carbon
dioxide levels get high enough to stimulate their brain to signal them to gasp for breath.
When opioids interfere with this response the effect can be life threatening. Opioids have
been shown to worsen the apnea episodes in those with sleep apnea (Jungquist, Flannery,
Perlis, Grace, 2012).
Endocrine – hypogonadism Chronic use of opioid medications can lead to several
endocrine abnormalities. The most significant abnormality is a decrease in the production of
gonadotropin releasing hormone (GNRH). This is the chemical that stimulates our body to
produce sex hormones (estrogen and testosterone). A decrease in GNRH lowers sex hormone
levels for both men and women. These low hormone levels will occur in over 50% of people on
chronic opioid therapy (Reddy, Aung, Karavitaki, Wass, 2010). Persistent low sex hormone levels
produce multiple symptoms, which may include “loss of libido, infertility, fatigue, depression,
anxiety, loss of muscle strength and mass, alteration of gender role, osteoporosis, and compression
fractures and, in men, impotence, and, in females, menstrual irregularities, galactorrhea and
infertility”(Katz, 2005). Another study found sex hormone levels were 30-70% lower in women on
chronic opioid therapy compared to those who were not on opioids (Daniell, 2008).
Hyperalgesia Opioid-induced hyperalgesia (OIH) is another side effect of the use of opioid
medications. Opioid hyperalgesia is a phenomenon where the body develops an increased
sensitivity to pain secondary to opioid use (hyper – over or excess, algesia – sensitivity to pain).
Pain is an important part of our body’s defense system, warning us of current or impending
damage or injury. As opioids decrease our brain’s sensitivity to pain signals coming from the rest
of the body, our brain begins to compensate by increasing our recognition of and sensitivity to
pain. The pain neurons going to the brain actually change to make them more responsive to pain
and increase our perception of pain. This change is called neuroplasticity of the nerve cell. Many
mechanisms are believed to be involved in these changes (M. Lee, Silverman, Hansen, Patel,
Manchikanti, 2011). The result of this change is that after opioid levels decrease, our pain fibers
are more sensitive than before consuming the opioid which results in an increase in pain.
Though the frequency of opioid-induced hyperalgesia is unknown, it is believed to be fairly
common, and significant. Even after IV use of remifentanil (a very short acting opioid that is
given intravenously) during surgery, postoperative patients had more pain and needed more
opioids compared to those who did not receive this medication (Kim, Stoicea, Soghomonyan,
Bergese, 2014).
Patients who are on opioids for pain prior to orthopedic surgery have higher levels of pain and
higher opioid needs after surgery suggesting OIH (D. Lee et al., 2014; Zywiel et al., 2011).
Opioid hyperalgesia presents clinically with increasing pain in a patient on opioids. Unfortunately,
increasing pain can also mean disease progression or the development of tolerance to the current
opioid dose. For these conditions, opioid doses are usually increased. In contrast, the treatment
of opioid hyperalgesia is the decrease or discontinuation of opioids. Even experts in pain
management may have difficulty recognizing and treating this complication appropriately.
Opioid use in the elderly A number of organizations have made recommendations for
the treatment of pain in the elderly, many supporting the use of opioids because of concerns
regarding side effects of the NSAID medications. The American Geriatric Society’s pain
treatment recommendations state the following:
Nonselective NSAIDs and COX-2 selective inhibitors may be considered
rarely, and with extreme caution, in highly selected individuals.” Whereas their
recommendation for opioids states: “All patients with moderate to severe pain,
pain-related functional impairment, or diminished quality of life due to pain
should be considered for opioid therapy. (Ferrell, Argoff, Epplin, 2009. pg
1341 and 1342).
5. 5The Psychological and Physical Side-effects of Pain Medications
In fact, the use of opioids in the elderly is very risky. Solomon et al reviewed Medicare
claims in Pennsylvania and New Jersey from 1999 through 2005. They evaluated medical
outcomes in individuals who were taking one of three classes of medication: a nonselective
NSAID, a COX-2 inhibitor NSAID (these are a special type of NSAID that do not have as
many stomach complications. The only one available today is celecoxib – Celebrex®), and an
opioid for pain. Their findings were remarkable. They found that compared to those taking
a nonselective NSAID, those taking opioids experienced:
• A greater risk of having a cardiovascular event
• Equal rates of GI bleeding
• Four times as many fractures
• 68% greater risk for being hospitalized for an adverse drug event
• 87% greater risk of dying during the study period.
These were indeed surprising results but clearly showed that the opioid pain medications
are very risky in the elderly; they should be used with extreme caution and only after
extensive consideration and discussion regarding the likelihood of an adverse event
(Solomon et al., 2010).
Solomon et al also showed that the risk of falls in the elderly taking opioids for pain
increased by 64% compared to those taking NSAIDs. The risk of fracture of the humerus
(the bone in the upper arm) was nine times greater for those on opioids. The risk of
fracture of the hip was 3 times greater for those on opioids (Solomon et al., 2010). In a
more recent study, Rolita et al showed that the risk of fall and fracture in the elderly was 3-4
times greater in those on opioid pain medications for control of the pain of osteoarthritis
compared to those taking NSAIDs (Rolita, Spegman, Tang, Cronstein, 2013). This is
important because complications of hip fracture are a leading cause of death in elderly
women, and up to half of elderly adults hospitalized for hip fracture never return to their
previous level of function (Tinetti Williams, 1997).
Brain Changes A number of studies have shown that significant changes to the brain
that can occur with the use of opioid medications to treat pain. Younger et al showed that
when individuals with chronic low back pain were administered oral morphine daily for
1 month, they had significant changes in the volume of several critical areas of the brain
(some got bigger and some got smaller) compared to those who received placebo. Even after
stopping the morphine and measuring for up to 4.7 months later, these changes persisted
(Younger et al., 2011).
Other studies have shown that there are neuronal changes that occur with opioid use. These
begin to occur early after opioid initiation and affect our response to opioids and the
behavior associated with that response. These neuroplastic changes can begin as early as 24
hours after exposure to morphine (Dacher Nugent, 2011).
Tolerance and withdrawal Tolerance occurs when the body has developed
physiologic (both neuroplastic and chemical) changes that result in decreased
effectiveness of the medicine necessitating a higher dose to get the same effect.
Withdrawal is the unpleasant symptoms that develop upon decrease or discontinuation
of that medicine. Brain changes and measurable withdrawal symptoms can occur after
one dose of opioid medication (Rothwell, Thomas, Gewirtz, 2012). In clinical practice,
withdrawal symptoms can occur after five to seven days of opioid medication (Anand
et al., 2010). Withdrawal symptoms may consist of myalgia (muscle pain), chills, sweats,
anxiety, increased pain, rapid heartbeat, dilated pupils, yawning, diarrhea and nausea.
Withdrawal is extremely unpleasant and can be relieved by taking another opioid dose.
Tolerance and withdrawal are not considered addiction. Tolerance occurs because of the
physiologic changes resulting from exposure to opioids. Withdrawal is the unpleasant
physical and emotional symptoms that occur upon withdrawal of the opioid after tolerance
has developed.
6. 6 The Psychological and Physical Side-effects of Pain Medications
Addiction According to the American Society of Addiction Medicine:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related
circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social
and spiritual manifestations. This is reflected in an individual pathologically pursuing reward
and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in
behavioral control, craving, diminished recognition of significant problems
with one’s behaviors and interpersonal relationships, and a dysfunctional
emotional response. Like other chronic diseases, addiction often involves
cycles of relapse and remission. Without treatment or engagement in
recovery activities, addiction is progressive and can result in disability or
premature death. (American Society of Addiction Medicine, 2011)
Addiction is not a moral weakness but is a complex disease in which genetic predisposition,
exposure to opioids, social stress, and mental health status all play a role. Some individuals
believe that they were essentially addicted after their first dose – even if prescribed by a
medical provider (Doe, 2012).
Death There is one factor that is often not considered when prescribing opioid pain
medications – the overall increase in deaths. Opioids account for more deaths than any
other medication. More than 16,000 people die every year from opioid overdose, which
compares to about 3000 from upper GI bleeding from NSAID medications. Because of
the illicit use of these medications, we have a situation that is unique to the opioids and
other controlled substances, many of those who die are collateral deaths; these individuals
were never prescribed the medication that killed them (C. Jones, Paulozzi, Mack, 2014). The
medical ethical principle of non-maleficence (do not harm) now extends beyond the exam room:
the interaction between a physician and his/her patient may adversely affect the life and health of
someone else who is not a part of the medical decision.
Opioids may lead to an increase in deaths that are frequently attributed to other causes.
Opioid abuse often progresses to intravenous use, which may result in HIV or hepatitis C
infections. Impairment from opioid medications may lead to unintentional death by motor
vehicle crashes or workplace safety incidents. Opioid use may also lead to falls and increase
mortality rates in the elderly.
It is also important to realize that the risk of death is markedly increased when opioids are taken
with benzodiazepine medications. The combination of opioids and benzodiazepines are the
leading cause of overdose deaths when multiple medications are involved (Calcaterra, Glanz,
Binswanger, 2013). Despite this danger, benzodiazepines are prescribed to about 30% of people
on chronic opioid therapy (Nowak, Abou-Nader, Stettin, 2014).
Side effects to society Unintentional death is one of many significant societal side
effects related to the prescription of opioid medications. The diversion of opioid medications and
the crime associated with that diversion are a significant problem for law enforcement and the
public in many areas of our country. The sheriff in one North Carolina county in the southern
Appalachian Mountains believes that the abuse of opioid medications accounts for at least 80%
of the crime in his area (Christopher, 2014). Initially, the Appalachian Mountains and rural
America were hard-hit but now the problem is pervasive in all areas of our society.
Opioids contribute to increased medical costs for patient care when used instead of non-opioid
treatment of pain (White, Tao, Talreja, Tower, Bernacki, 2012). Furthermore, treatment of
those who are abusing or addicted to opioids is costly (Birnbaum et al., 2011).
Private businesses and industry lose a significant amount of money from the prescribing of
prescription opioids. Opioid pain medications increase the cost of Workers Compensation and
increase disability (Franklin, Rahman, Turner, Daniell, Fulton-Kehoe, 2009; White et al., 2012).
Even more problematic is the loss of worker productivity. A study in 2011 estimated that there
was $55.6 billion in societal costs including $25 billion in workplace related costs secondary to
opioid abuse (Birnbaum et al., 2011).
Morphine Milligram
Equivalent (MME)
is a convenient way
to compare opioids
of different strengths.
Oxycodone, for
example, is about 50%
more potent than
morphine so 1 mg
of oxycodone is
equal to 1.5 mg
of morphine and
therefore is said to be
1.5 MME. 5 mg of
oxycodone = 7.5 MME.
$55.6 billion cost per
year in 2007. 301 million
citizens in 2007. $184.72
per person. 700 MME/
person (Paulozzi
Baldwin, 2012). Calculates
to 26 cents per MME.
7. 7The Psychological and Physical Side-effects of Pain Medications
Every single prescription results in significant cost to society. Using the estimation of $55.6
billion per year for the societal cost of opioids, equals about 26 cents/morphine milligram
equivalent (MME). A bottle of 20 Percocet (5mg) tablets would total 150 MME with a cost to
society of about $39 (150 x .26).
Another significant cost to society is the marked increase in heroin use over the past few years.
A recent study by the CDC showed of 28 states surveyed, heroin deaths doubled from 2010 to
2012 (Rudd et al., 2014). Four out of five heroin users started with prescription drugs (Muhuri,
Gfroerer, Davies, 2013). Typically, individuals will start misusing opioid pain pills, and when
their habit becomes unaffordable (commonly $100-200 per day) they change to heroin, a cheaper
alternative that produces the same effect (Mars, Bourgois, Karandinos, Montero, Ciccarone,
2014). Heroin trafficking is becoming a major driver of crime in many communities. The IV use
of heroin is leading to increasing rates of Hepatitis C.
Side effects of other pain
medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) Medical providers are
always cautious when prescribing NSAID medications. This caution is appropriate as these
medications can have several adverse reactions that can be life-threatening. Unfortunately,
our fear of NSAID-related side effects contributes to our overprescribing of opioids. An
examination of these side effects reveal that NSAIDs can be utilized safely – with caution.
Gastrointestinal side effects of NSAIDs NSAIDs are known to cause upper
gastrointestinal irritation and bleeding. Approximately 3200 people die every year from GI
bleeds secondary to the use of NSAIDs (Tarone, Blot, McLaughlin, 2004). However, with
some caution, NSAIDs can be used as a first or second line agent for pain. Lower doses of
NSAIDs are less likely to cause GI bleeding. 200 mg of ibuprofen taken four times a day
has the pain-relieving efficacy of 10 mg of morphine four times a day (Bandolier, 2007)
and a side effect rate similar to placebo (Rainsford, Roberts, Brown, 1997). If there
is significant concern for GI complications, NSAIDs can be taken with a proton pump
inhibitor (PPI) such as omeprazole (Prilosec®) to greatly decrease the risk of bleeding.
Celecoxib may also be taken to reduce the risk of bleeding. Taking celecoxib with a PPI has
a bleeding risk that is similar to placebo (Chan et al., 2007; Roth, 2012). Celecoxib now
comes in a generic formulation and is getting much more affordable for patients.
Renal side effects of NSAIDs NSAIDs may also have a detrimental effect on
kidney function. Medical providers are rightfully worried about recommending NSAIDs
to anyone with an elevated creatinine. (Creatinine is a blood test that measures kidney
function.) This detrimental effect is worse with some NSAIDs than it is with others. The
renal effects of NSAIDs are dose-related. Lower doses are safer. The 200 mg dose of
ibuprofen is very safe and can be used for a short duration even for those with moderate or
severe renal insufficiency and acute pain (Nderitu, Doos, Jones, Davies, Kadam, 2013).
Cardiac side effects of NSAIDs NSAIDs do have significant cardiac effects and
should be used with caution in those with coronary artery disease. They appear to increase
the risk of cardiovascular events in those with known heart disease and those at high risk
for heart disease (Bhala et al., 2013). NSAIDs also interfere with aspirin, clopidogrel, and
other blood thinners (Lamberts et al., 2014) and they should be used only after a thorough
discussion of risks and benefits when there are no better options. Opioids also increase
the risk of cardiac events and death and are not an appropriate alternative in the elderly
(Solomon et al., 2010). Acetaminophen may be the safest pain reliever for those with known
cardiac disease or those at risk.
Bone healing There is concern among physicians treating trauma that NSAIDs may
delay healing after fracture, an appropriate concern since inflammation is an important
8. 8 The Psychological and Physical Side-effects of Pain Medications
component of bone healing. Reduction of inflammation may impair the healing process.
Some studies have confirmed that NSAIDs may have a small negative effect on healing but
others have questioned this (Carley, 2005). Opioids may also have a negative effect on bone
healing. As discussed previously, opioids decrease GNRH causing hypogonadism which is
associated with decreased healing after fracture (Brinker, O’Connor, Monla, Earthman,
2007). Animal studies have also shown that opioids impair healing after fracture (Chrastil,
Sampson, Jones, Higgins, 2013). These studies have not yet been done in humans.
The final answer on the effect of NSAIDs still eludes us. While some reviewers believe that
NSAIDs should be used with great caution after fracture (Geusens, Emans, De Jong, Van Den
Bergh, 2013), others believe that NSAIDs are safe and have little or no effect on fracture healing
(Kurmis, Kurmis, O’Brien, Dalen, 2012; Taylor, Lindblad, Kolber, 2014).
Acetaminophen Acetaminophen is likely the safest of all of the medications used for
pain and is approximately as strong as the oral opioids (Gaskell, Derry, Moore, McQuay,
2009; Toms, McQuay, Derry, Moore, 2008), providing acceptable pain relief (Toms et
al., 2008). While acetaminophen can cause liver damage when used in higher doses for
prolonged periods of time, it is more likely to cause liver damage in individuals who are
ingesting other liver-toxic drugs (alcohol in particular). For those with a healthy liver, 4000
mg per day or less is generally considered safe.
Risks and benefits
With an estimated 100 million people in the United States suffering from pain it is appropriate
for treatment of pain to be a major health concern for our country (IOM, 2011). In an effort to
improve pain treatment, medical providers have markedly increased their prescribing of opioids;
consequently there has been a marked increase in abuse, overdose, and death.
There are potential side effects with all medications used to treat pain. For the past 20 years,
medical professionals have had great concern regarding the side effects of NSAID medications
and acetaminophen while largely ignoring the side effects of opioid medications. All medications
must be used only after careful consideration and balancing of their risks and benefits. The NSC
white paper, Evidence for the Efficacy of Pain Medications (nsc.org/painmedevidence), detailed
why opioids are not more effective than NSAIDs for pain relief. Given that fact, along with the
side effects described in this paper, it is very seldom that the benefit is worth the risk.
Conclusion
After considering the side effects of various pain medications in this paper, the evidence is
clear that opioids are dangerous medications that should only be used with great caution
when all other options have failed. In select circumstances, opioids may be used first-line
for brief periods of time.
Loss of family and community
Lifelong disability
Dependence/Addiction
Serious adverseevents
Overdosemorbidity
Mortality
Effectiveness
9. 9The Psychological and Physical Side-effects of Pain Medications
Call to Action
With this evidence of the opioid side effect profile and the knowledge of their limited
effectiveness in relieving pain (Teater, 2014), the following actions are recommended:
• Medical providers should re-evaluate their prescribing habits. Opioids should be used
rarely, only when indicated, and for a few days.
• Dental providers should rarely prescribe opioids and limit the prescription to 1-2 days.
• Public agencies, insurance companies, and pharmacy benefit managers should put
restrictions on the use of these medications.
- As tolerance and withdrawal can occur within 5 days of starting opioid therapy,
any prescription over 5 days should require prior approval (Honey, Benefield,
Miller, Johnson, 2014).
- Routine dental procedures, back pain, headaches, fibromyalgia and injuries that
do not require hospitalization should require preapproval (Franklin, 2014).
• Insurance companies should develop mechanisms to facilitate non-drug treatment of
pain including appropriate physical therapy and counseling.
• Everyone on chronic opioid treatment should have periodic evaluation to assess the
risk of opioid-related side effects.
We need to change the paradigm of how we treat pain in this country. In the process, we
will reduce the suffering from pain, save money, and save lives.
10. 10 The Psychological and Physical Side-effects of Pain Medications
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