Dissertations / Theses on the topic 'Opioid consumption'

Pain management is a critical part of the care of the surgical patient. This study sought to investigate the impact of cultural and linguistic diversity on analgesic administration practices and opioid consumption during postoperative period. A retrospective medical record audit of 278 English-speaking and non-English speaking surgical patients was carried out at four hospitals in Sydney's South West. No differences were found in the type of analgesia prescribed, the mode of analgesia, or the commencement of oral analgesia between the two groups. However, non-English speaking patients consumed less analgesia during the initial postoperative period than their English speaking counterparts. The importance of this difference was further examined within the context of a range of factors known to influence analgesia consumption. A model including sociodemographic and clinical factors - mode of administration of analgesia, gender, and language spoken -predicted 37% of total opioid consumption. Although mode of administration was the most important factor, being of non-English speaking background also contributed substantially. Pain assessment, inclusive of gender and cultural nuances is recommended. The need for further research into pain interpretation in specific linguistic and cultural groups is highlighted
Master of Science (Hons) (Health)

Thesis (MSc (Hons.)Health) -- University of Western Sydney, Macarthur, 2000.
"March 2000" "A thesis presented to the University of Western Sydney Macarthur in partial fulfilment of the requirements for the Degree of Master of Science (Hons) Health" Bibliography: leaves 90-101.

Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, May, 2020
"May 2020." Date of graduation confirmed by MIT Registrar Office. Cataloged from student-submitted PDF of thesis.
Includes bibliographical references (pages 49-50).
Improper consumption of prescription opioids is a massive public health issue in the United States currently. Here, we propose one approach of tackling this issue through using machine learning techniques to predict opioid consumption post discharge for surgical patients. Through the data collected from surgical patients at BIDMC, relevant features will be identified and used to predict if patients high, outlier consumption. Using logistic regression and gradient boosted decision trees, model performance were evaluated at AUCs of 0.7270 and 0.7289 respectively.
by Justin Yu.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science

Objectives: Electro-acupuncture (EA) has been demonstrated to be effective in reducing post-operative acute consumption of opioid-like medications (OLM) by previous studies. This effect has not been examined in patients with chronic pain. In this thesis, a randomised, double-blind, sham acupuncture-controlled study was reported. The trial aimed to evaluate the effect of EA in reducing OLM consumption in patients with chronic non-malignant pain. Methods: Thirty-five patients were recruited from a multidisciplinary pain management clinic in Melbourne. After a two-week baseline assessment, participants were randomly assigned to one of the two groups by a computer generated randomisation sequence: real EA (REA, n = 17) or sham EA (SEA, n = 18). The REA group received 2/100 Hz EA stimulation on two pairs of acupoints (Zusanli ST36 and Fenglong ST40 on one leg and Hegu LI4 and Quchi LI11 on one arm) and manual acupuncture on an additional five chosen acupoints for 30 minutes. The SEA group received superficial needling on non-acupoints without Deqi sensation or electrical stimulation. Both groups received treatment twice a week for six weeks. Participants were followed up for 12 weeks at intervals of four weeks. During the trial, participants were given clear instructions on how to reduce their OLM usage. A researcher telephoned the participants three times during the trial to encourage them to reduce OLM intake. The assessor, researcher and participants were blinded to treatment allocation. Outcome measures: The primary outcome measures included OLM consumption, related side effects, dosage of non-opioid analgesics and the intensity and unpleasantness of pain. These measures were recorded daily for two weeks before the intervention, six weeks during the treatment period and three times during the follow up period. Secondary outcome measures were depression and quality of life as assessed by the Beck Depression Inventory-II (BDI-II) and the Medical Outcome Study 36-Item Short Form (SF-36), respectively. Data were analysed with independent t-tests or analysis of variance (ANOVA) where appropriate and per protocol analysis was employed. Results: Nine participants withdrew from the study. At baseline, the two groups were comparable on all demographic characteristics and major outcome variables except for the average intensity of pain. During the treatment period, the reduction of OLM consumption was more rapid in the REA group (64%) than in the SEA (46%) (ANOVA, p less than 0.05). The effect was maintained for four weeks in the REA group. There were no differences in the improvement of all other measures between the two groups. The incidence of EA-related adverse events (AEs) per treatment was 21% and 10% in the REA and SEA groups, respectively. All AEs were minor. Over 90% of the participants were satisfied with the treatments given and would recommend EA to others. The blinding was successful. Conclusions: EA could be an effective and safe treatment for reducing OLM consumption for patients with chronic pain, and may be used as an adjunct therapy in chronic pain management. Further studies with larger sample sizes are warranted.

The purpose of this non-experimental quantitative correlational study was to investigate the relationship between academic achievement and health in a national sample of college students using quantitative data analysis. Specifically, the researcher analyzed the relationship between three health-promoting behaviors (physical activity, strength training, and fruit and vegetable consumption), three negative health behaviors (cigarette, e-cigarette, and opioid use) and obesity with GPA. Cross-sectional data on student health collected from the American College Health Association’s National College Health Assessment II (ACHA-NCHA-II) and completed by 426,650 college students from 650 U.S. colleges during the semesters between 2015 and 2019 formed the foundation for this research. Nine research questions were addressed using a series of chi square tests. Results showed there was a significant positive relationship between health behaviors and grade average. Students who met the recommendations for fruit and vegetable consumption, moderate activity and vigorous physical activity were more likely to have GPAs than those who did not. Students who used cigarettes, opioids, or were obese were more likely to have GPAs.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
The endogenous opioids are involved in analgesia, thermoregulation and physiological responses to various stressful stimuli such as infection, psychological stress and hypoxia. The mu and kappa receptors in the hypothalamus play a role in endotoxin-induced fever and hypoxia-induced anapyrexia (opposite response to fever), respectively. In addition, periaqueductal gray (PAG), which express both mu and kappa receptors, is involved in defence and thermoregulatory responses. Thus, our hypothesis is that mu and kappa opioid receptors in the PAG modulate the restraint-induced fever in rats by activating and inhibiting this response, respectively. To this end, body temperature (Tb) and heat loss index (HLI; inference for heat conservation/loss) and oxygen consumption (VO ; inference for thermogenesis) of unanesthetized Wistar rats submitted or not to restraint stress, was monitored before and after intra-PAG microinjection of the selective mu opioid receptor antagonist (CTAP; 1 and 10 μg/ 100 nL/ animal), the selective kappa-opioid receptor antagonist (nor-BNI; 1 and 4 μg/ 100 nL/ animal), or vehicle (saline; 100nL/ animal). CTAP and nor-BNI did not change the Tb or the HLI of the animals in euthermia. During the restraint stress, Tb increased in all groups of animals. However, this effect was significantly lower in animals treated with CTAP, and significantly higher in animals treated with nor-BNI. No treatment affected HLI, but CTAP decreased thermogenesis and nor-BNI increased thermogenesis. The results indicate that the mu and kappa opioid receptors in the PAG of rats play a pyrogenic and antipyretic role, respectively, during fever induced by restraint stress and these receptors in PAG may not be essential for the maintenance of Tb during euthermia.
Os opióides endógenos estão envolvidos na analgesia, termorregulação e respostas fisiológicas a vários estímulos estressantes, como infecção, estresse psicológico e hipóxia. Os receptores mu e kappa no hipotálamo desempenham um papel na febre induzida por endotoxina e anapirexia induzida por hipoxia (resposta oposta à febre), respectivamente. Além disso, a substância cinzenta periaquedutal (PAG), que expressa ambos os receptores mu e kappa, está envolvida na defesa e respostas de termorregulação. Assim, nossa hipótese é que os receptores opióides mu e kappa na PAG modulam a febre induzida por contenção em ratos, ativando e inibindo esta resposta, respectivamente. Para este fim, a temperatura corporal (Tc) e o índice de perda de calor (IPC; inferência para a conservação/perda de calor) e o consumo de oxigênio (VO ; inferência para a termogênese) de ratos Wistar não anestesiados submetidos ou não ao estresse contenção, foi monitorado antes e depois microinjeção intra-PAG do antagonista seletivo do receptor opióide mu (CTAP; 1 e 10 μg/ 100 nL/ animal), antagonista seletivo do receptor opióide kappa (nor-BNI; 1 e 4 μg/ 100 nL/ animal) ou veículo (solução salina; 100 nL / animal). A microinjeção de CTAP ou nor-BNI não alterou a Tc ou IPC dos animais em eutermia. Durante o estresse de contenção, a Tc aumentou em todos os grupos de animais. No entanto, este efeito foi significativamente menor no grupo de animais tratados com CTAP, e significativamente maior em animais tratados com nor-BNI. Nenhum tratamento afetou o IPC, mas o CTAP diminuiu a termogênese e o nor-BNI aumentou a termogênese. Os resultados indicam que os receptores opióides mu e kappa na PAG de ratos desempenham um papel pirogênico e antipirético, respectivamente, durante a febre induzida pelo estresse de contenção e estes receptores na PAG podem não ser essenciais para a manutenção de Tc durante eutermia.

Excessive and compulsive ethanol drinking is one of the most serious public health issues. Therefore, it is vital to increase the knowledge about risks and protection for alcohol use disorders (AUD) to optimize prevention and treatment strategies. Ethanol consumption commonly initiates during adolescence when extensive neuronal maturation and development also occurs. Early exposure to ethanol is a risk factor for AUD, but the effects of adolescent drinking and the basis for the individual susceptibility to AUD are not fully understood. The interactions between genotype and environmental factors determine the individual risk for AUD and this thesis aimed to examine the environmental impact. The specific aims were to investigate 1) how early-life conditions affect adolescent voluntary ethanol drinking, behavioural profiles, endogenous opioids and response to treatment with an opioid antagonist (naltrexone), and 2) whether alterations detected in the offspring may be mediated by variations in maternal behaviour. A rodent maternal separation (MS) model was used to mimic a protective and risk-inducing early-life environment, respectively, with the use of 15 min (MS15) or 360 min (MS360) of daily MS. The main findings were 1) the MS360, but not the MS15 rats, responded to naltrexone following adolescent ethanol drinking; all adolescent rats had a high voluntary ethanol intake independent of early environmental conditions whereas in the adult groups the MS360, but not the MS15 rats, increased their ethanol intake and preference over time; adolescent ethanol exposure resulted in higher dynorphin levels in hippocampus and higher Met-enkephalin-Arg6Phe7 in the amygdala, independently of rearing conditions, 2) behavioural profiling using the multivariate concentric square field™ test showed: the young MS360 rats had increased risk assessment and risk taking behaviour compared to the young MS15 rats; the young MS15 rats increased, whereas the young MS360 rats decreased, their risk assessment and risk taking behaviour over time; differences in pup-retrieval strategies where the MS360 dams retrieved some pups into a safe area but as compared to MS15 rats they left more pups in a risk area; increased risk assessment behaviour in the MS360 dams immediately after weaning. Taken together, early-life environmental conditions alter adult but not adolescent drinking, the response to naltrexone, and behaviour in dams and offspring. Adolescent rats consumed more ethanol independent of rearing conditions and displayed increased opioid levels in brain areas related to cognition and addiction.

Notre objectif était d’optimiser la prise en charge de la douleur aiguë sévère en médecine d’urgence. La titration morphinique intraveineuse qui fait actuellement référence doit se moderniser pour répondre aux nouveaux enjeux de la pratique en même temps que l’on doit garantir une balance bénéfice risque inchangée dans la lutte contre l’oligoanalgésie. Le travail décrit dans cette thèse, constitue une première étape d’évaluation d’une alternative nébulisée à la titration morphinique, à travers 3 études cliniques (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH) et l’étude de son contexte dans la littérature. Des travaux chez le volontaire sain ont permis d’établir un mode opératoire avec une technique aérosol simple et accessible, de courte durée (5 min), que l’on peut répéter en titration (toutes les 10 min). Sa faisabilité est en voie d’être confirmée à grande échelle dans une étude multicentrique clinique et sa non-infériorité en termes d’efficacité est en cours d’évaluation. Des données pharmacologiques chez le volontaire sain et chez les patients confirment une concentration sanguine en morphine proche des concentrations efficaces observées en intraveineux (1 à 120 ng/ml dans CLIN-AEROMORPH), ce qui est déjà un résultat positif démontré par nos travaux. Par ailleurs, sur le plan de son éligibilité, nos données observationnelles et de simulation de décision, associées aux données médico-économiques que nous avons analysées dans la littérature, suggèrent la nécessité de baser son indication autrement que sur la simple évaluation par EVA/EN à l’accueil. Dans ce travail nous montrons que la pratique des praticiens témoigne aujourd’hui de leur manque d’adhésion au déclenchement systématique de la prescription d’opiacés Iv titrés par l’autoévaluation de la douleur sévère (de 6 à 20% de respect des critères SFMU, 61% de réinterprétation des scores EVA/EN). Si la titration aérosol est uniquement proposée en starter de la titration morphinique sans moderniser les algorithmes de décision de prescription opiacée dans les protocoles d’urgences, il est probable que cette nouvelle proposition thérapeutique ne résoudra qu’une partie de la problématique actuellement posée. Une prise en charge pharmacologique la plus individualisée possible est plus que jamais pertinente, avec une prescription ciblée de la titration morphinique selon la typologie du patient, en plus d’une priorisation par typologie douloureuse. En développant un « modèle douleur » original chez le volontaire sain, nous avons d’ailleurs mis en lumière des profils de patients « hyperesthésiques » et « endurants », sur le plan neurophysiologique et biochimique, qui sont sûrement retrouvés en pratique clinique quotidienne. L’ensemble de ces éléments doivent donc être pris en compte pour améliorer la prise en charge de la douleur en médecine d’urgence, avec une vision plus systémique, et davantage d’études dédiées, utilisant des méthodes d’évaluation innovantes mêlant critères quantitatifs robustes et qualitatifs exhaustifs
Our goal was to optimize the management of severe acute pain in emergency medicine. Intravenous morphine titration, which is currently the referent method, must be modernised to meet the new challenges of practice while at the same time, we must keep guaranteeing an unchanged risk-benefit balance in the fight against oligoanalgesia. Our work, described in this thesis, has been a cornerstone for the evaluation of a nebulized alternative solution to emergencies through 3 clinical studies, (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH), and study of its contextualisation in literature. Work in healthy volunteers allowed us to establish a simple and accessible procedure for aerosol, of short duration (5 min), which can be repeated in titration procedures (every 10 min). Its feasibility is likely to be confirmed on our multicentre clinical study at a large scale and its efficacy, by a non-inferiority design of study is being evaluated. Pharmacological data in healthy volunteers and in patients confirm a blood morphine concentration close to the effective blood concentrations observed by intravenous administration (CLIN-AEROMORPH: 1-20 ng/ml), which is already a positive result demonstrated by our work. Moreover, regarding eligibility, our observational study, combined to a experiment about decision mechanisms, combined with the analysis of medico-economic data in literature, suggest the need to base its indication on more than just the simple VAS/NRS assessment at triage. In this work we showed that emergency practitioners’ practice today underlines their lack of adherence to the systematic initiation of intravenous morphine titration by patient self-assessment of severe pain (compliance with SFMU criteria 6 to 20%, re-assessment of VAS/NRS scores 61%). If nebulized morphine titration is only proposed as a starter for morphine titration without modernising the algorithms for opiate prescription decision in emergency protocols, it is likely that this new therapeutic proposal will only solve part of the current problem. Targeted pharmacological management, as individualised as possible, is more relevant than ever, with prescription of morphine titration according to the patient's typology, in addition to prioritisation by pain typology. By developing an original pain model in healthy volunteers, we have also highlighted profiles of "pain sensitive" and "enduring" patients, according to neurophysiological and biochemical data, that are certainly represented in daily clinical practice. Therefore, all these components should be taken into account to improve pain management in emergency medicine, with a more systemic vision and more dedicated studies using innovative evaluation methods, combining robust quantitative criteria with comprehensive qualitative criteria

碩士
臺北醫學大學
護理學研究所
95
Pain is the most prevalent symptom in the majority of patients with cancer during hospitalization. Many of patients have not received adequate pain treatments.Inadequate pain management may compromise well being of the patients; therefore, pain control must be one of the priorities in caring for cancer patients. This study explored opioid analgesics consumption and related factors in hospitalized cancer patients . Cross-sectional design is used in is study . Hospitalized cancer patients using opioid drugs registered in the“2004 National Health Insurance Research Database” are selected as the study population. There are totally 163,780 cases. Descriptive analysis, t test, one-way ANOVA, and multiple regression analysis are used for data analysis. Rsults from this study indicate that pethidine is the most commonly used opioid for hospitalized cancer patients, with oral morphine being the second. The total morphine equivalent doses consumed annually by hospitalized cancer patients sum up to 45, 160,418mg. Because of the modest sample size, we present the DDD (defined daily dose) by per thousand patients. In this way, the hospitalized cancer patients of 2004 consumed 25.3 DDDs/thousand/day of morphine. The results of ANOVA show that patient, physician, and hospital characteristics significantly influence the opioid consumption (P <0.001). The result of multiple regression analysis also reveals that predictive factors affect the opioid usage (P<0.001). Hopefully this survey may serve the medical personnel and institutions as reference to cancer pain management, in order to improve life quality by relieving cancer pain timely and effectively for patients with cancer.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

The goal of this dissertation was two fold: 1) To relate dopamine responses in the ventral striatum to ethanol preference and consumption, and 2) to investigate the role of the mu opioid receptors in this ethanol induced dopamine release in the ventral striatum. First a two bottle choice experiment established that a substrain of C57BL/6 mice (C57BL/6NCrl) had significantly less preference for and consumption of ethanol than a second substrain of mouse based on the same background (C57BL6/J). The C57BL/6 strain has been extensively used in alcohol drinking studies and is well known for it’s propensity to consume alcohol over water. To determine if differences in ventral striatal dopamine response vii could contribute to this variability in drinking behavior, we characterized the dopamine response in both substrains of mice after intraperitoneal injections of 1.0, 2.0 or 3.0 g/kg ethanol or saline. We found that the acute intraperitoneal ethanol injections in naïve mice caused a significant elevation in dopamine in both substrains at all three doses with a significant difference between substrains at the two highest alcohol doses. Therefore, ethanol induced dopamine release in the ventral striatum may contribute to ethanol preference and consumption. Next, we investigated the effect of acute intraperitoneal ethanol injections on naïve mu opioid receptor knockout mice and in mice pretreated with a mu opioid receptor antagonist. The mice used were all established on the C57BL/6J background. We found that ventral striatal dopamine response was similar in these mice after 1.0, 2.0 and 3.0 g/kg intraperitoneal ethanol injections compared to appropriate controls. As both gene deletion and pharmacological blockade of the mu opioid receptor did not affect ethanol stimulated dopamine release, it points to the conclusion that this receptor may not play a significant role in ethanol induced ventral striatal dopamine release.
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Supervised Injection Facilities (SIFs) for the medical supervision of illicit drug use exist in Europe, Canada, and Australia to reduce infectious disease transmission, overdose deaths, and other harms of drug use. They have been shown to reduce rates of needle sharing by 69% and local overdose mortality by 35% without increasing rates of drug use or related crime. In light of increasing rates of illicit opioid use and overdose death in Massachusetts, the Massachusetts Medical Society recently endorsed opening a SIF in Boston. This thesis proposes a study of the Boston SIF with the hypothesis that higher SIF utilization will be associated with decreased incidence of fatal overdose, HIV seroconversion, and HCV seroconversion during the study period. I propose evaluating this hypothesis prospectively by following clients of the SIF at 6 month intervals and comparing the rates of overdose death and HIV or HCV seroconversion among frequent and infrequent clients of the SIF. Based on data reported from previous SIFs and projections of the population of people who inject drugs (PWID) in Boston, a study with this design should detect a significant difference in these three primary endpoints between people using the SIF frequently and those using it infrequently within five years. A positive finding would confirm the efficacy of SIFs in harm reduction and secondary prevention for Opioid Use Disorder (OUD), potentially leading to broader adoption in other hotspots of opioid use in the United States.