Orientador: Guilherme Antonio Moreira de Barros / Resumo: Introdução: A dor é uma experiência pessoal, subjetiva, que envolve aspectos sensitivos e culturais que podem ser alterados pelas variáveis socioculturais e psíquicas do indivíduo, do meio e, apesar de classificações diversas, geralmente relacionada ao sofrimento. No Brasil estudos indicam que, embora cerca de 50% dos pacientes portadores de dor estejam medicados, a maior parte deles está descontente com os resultados do tratamento. Em situação de dor aguda traumática, apenas 7% dos pacientes tem suas dores totalmente aliviadas e, em pacientes em vigência de dor de intensidade moderada a grande, somente 25% receberam opioides como parte de seu tratamento, apesar de recomendação da OMS de uso destes analgésicos, como descrito na escada analgésica. Objetivo: Compreender as razões da baixa prescrição dos opioides no tratamento da dor no Brasil, com ênfase aos entraves sociais, legais e burocráticos existentes. Métodos: Trata-se de um estudo epidemiológico, prospectivo, analítico observacional e transversal, aprovado pela Comissão de Ética em Pesquisa, e realizado a partir de questionário investigativo disponibilizado em plataforma online, com perguntas fechadas e abordagem quantitativa. Foram convidados a participarem do estudo, por meio de mensagens eletrônicas a médicos atuantes em território Nacional. Aqueles que concordaram em participar assinaram, eletronicamente, o Termo de Consentimento Livre e Esclarecido (TCLE) online. Para análise estatística foram realizados os teste... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Pain is a personal, subjective experience, involving sensitive and cultural aspects that can be altered by the socio-cultural and psychological variables of the individual, the environment and, despite different classifications, it is frequently related to suffering. In Brazil studies indicate that, although about 50% of pain patients are medicated, most of them are unhappy with the treatment outcomes. In situations of acute traumatic pain, only 7% of patients have their pain totally relieved and, in patients with moderate to severe pain, only 25% received opioids as part of their treatment, despite of the WHO recommendation to use these analgesics, as described on the analgesic ladder. Objective: To understand the reasons for the low prescription of opioids in the treatment of pain in Brazil, with emphasis on the existing social, legal and bureaucratic barriers. Method: This is a prospective, observational and cross-sectional epidemiological study, approved by the Research Ethics Committee, and carried out using an investigative questionnaire available on an online platform, with closed questions and a quantitative approach. Participants were invited to participate in the study, through electronic messages to medical doctors working in the national territory. Those who agreed to participate signed, electronically, the Free and Informed Consent Term (ICF) online. For statistical analysis, chi-square tests were performed followed by Z tests and Student's t tests.... (Complete abstract click electronic access below) / Doutor

Prescription drug abuse has been a growing problem in Indiana and around the nation for almost two decades. In recent years, prescription drug overdoses have pushed drug poisonings ahead of motor vehicle crashes as the leading cause of injury death. However, deaths due to overdoses of prescription drugs are only the tip of the iceberg when it comes to the much larger problem of abuse. This study has characterized prescription drug abuse in Indiana and taken an in-depth look at how it is and can be addressed both through organizational policies and state legislation. Opioid painkillers such as hydrocodone, oxycodone, and methadone are the most commonly abused prescription drugs, and most of these prescriptions are written by primary care physicians. Because more than 70% of Indiana’s family medicine residents will remain in the state to practice medicine following the conclusion of their residencies, it is worthwhile to take a look at how these residents are being educated during their training. St. Vincent’s Family Medicine Residency program in Indianapolis is one of several residency programs in Indiana training their residents on best practices of prescribing controlled substances. A review of residents’ prescribing patterns before and after training on the subject went into effect showed significant reductions in the number of opioid painkillers being prescribed, and showed the same reductions for alprazolam, a benzodiazepine anxiolytic.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: The purpose of this study is to investigate what post-operative analgesic agents if any, are provided by clinicians for their pediatric dental patients. The study will also evaluate the clinician's philosophy toward pain management in the child patient and look for trends in these philosophies, as well as trends in where they currently practice with regards to pain management and specific analgesic agents. Methods: An on-line survey (appendix A) was sent to gather data from board certified pediatric dentists. The American Board of Pediatric Dentistry (ABPD) website was used to obtain an e-mail directory of addresses of all registered ABPD members. This e-mail provided them with a link to an online survey site where they could access the survey. The online survey site used was surveymonkey.com. The survey was available on-line for 3 months. Mantel-Haenszel and chi-square tests were used to check the relationships of hours of patient care, years of experience, and region of the country with other items in the survey. Results: Responses were received from 210 (27%). The region distribution of the responders was compared to the region distribution of all pediatric dentists. The distributions were found to be similar (p=0.81 using a one-sample chi-square test). Conclusions: Ibuprofen and acetaminophen are recommended most frequently for over the counter (OTC) post-operative pain control by board certified pediatric dentists. Acetaminophen with codeine is prescribed most frequently for post-operative pain control by board certified pediatric dentists. The majority of board certified pediatric dentists adhere to the same philosophies with regard to post-operative pain management as taught in their respective post graduate programs.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

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.

Analgesics represent a large group of medicines which is used for suppresing subjectively perceived pain. Analgesics can be divided into two large groups, opioids and non-opioids. Some of the non-opioids can be used as anti-inflammatory and/or antipyretics as well. All non-opioids influence metabolism of prostaglandins. Diverse group of non-opioid analgesics is available in Czech pharmacies as prescription medicines or for sale over the counter. The aim of this work is mainly to assess the toxicity of over-the-counter analgesics and to find out the frequency of fatal intoxications caused by these analgesics in the Czech Republic and abroad. A list of peroral over-the-counter analgesics was created. A partial analysis of data from medical judicial departments of regional hospitals in the Czech Republic was performed in order to obtain total number of deaths caused by overdosing with these drugs. Using ÚZIS the number of deaths was extracted from information system Deceased. These logged deaths were caused only by acute intoxication with analgesics and were chosen on basis of precisely defined combinations of diagnostic codes (MKN10). Results were then expanded by similar enumeration from the National register of hospitalized, by which we specified the amount of intoxications where patients survived. Overall case report was evaluated from processed information. The number of deaths caused by analgesics and commonly misused addictive substances were compared by which the second hypothesis was clarified. The data was obtained from Annual reports about substance misuse and 6 years were compared in total. Identified risk of analgesic in Czech Republic was compared with registered cases of overdosing in world. Data used for comparing were gained from analysis of world literature. During the years 2006 ? 2011, 53 deaths and 2024 hospitalizations in the Czech Republic were caused by acute intoxication as a result of overdosing with mentioned medication. Our first hypotesis can be confirmed on the basis of these numbers, and therefor it can be said that over-the-counter medicines used for suppressing pain can cause death. On the basis of analysis of world literature a certain risk is seen in fact that these analgesics ? mainly paracetamol ? are often linked with suicides. For instance in United Kingdom thousands of cases of self-harm are caused by overdosing with paracetamol. In USA 16 500 deaths are thought to be caused by NSAIDS and 1600 acute liver failure incidents are caused by overdosing with paracetamol annualy. Illegal drugs caused 253 intoxications during the years 2006 -2011 compared to 53 cases of deaths caused by overdosing by analgesics. Annual reports about substance misuse report that deaths caused by illegal drugs are more common than deaths caused by over-the-counter analgesics in the Czech Republic. There remains a question: What percentage of analgesics intoxications, where patient survived or not, is caused only by over-the-counter analgesics without any other cause.

published_or_final_version / Anaesthesiology / Master / Master of Philosophy

Thesis (M.S.)--Massachusetts Institute of Technology, Alfred P. Sloan School of Management, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND DEWEY. / Bibliography: leaves 155-156. / by Joseph J. Beshel. / M.S.

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-04-30Bitstream added on 2014-06-13T20:28:37Z : No. of bitstreams: 1 albuquerque_vb_me_araca.pdf: 508052 bytes, checksum: f5bfe0202134876e0b52b05728bc52f8 (MD5) / A utilização da anestesia local peridural tem alcançado grande ênfase nos últimos anos, sobretudo com a utilização de opióides. O presente trabalho teve como objetivo investigar a utilização da ropivacaína isolada ou em associação a diferentes opióides, na anestesia peridural de cadelas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Participaram do estudo duplamente encoberto 32 cadelas sadias, adultas, de diferentes raças, pesando entre seis e 15 kg e pré-medicadas com acepromazina (0,05mg/kg, IM) associada ao midazolam (0,2mg/kg, IM), distribuídas em quatro grupos distintos: Grupo 1: ropivacaína: 0,3 mL/kg; Grupo 2: ropivacaína + morfina (0,1 mg/kg); Grupo 3: ropivacaína + butorfanol (0,1 mg/kg); e Grupo 4: ropivacaína + tramadol (0,5 mg/kg) administrados pela via peridural. Em cada momento experimental foram mensurados: freqüência cardíaca; freqüência respiratória; pressão arterial sistólica; temperatura retal; pressão parcial dos gases sangüíneos (arterial); pH sangüíneo; além da avaliação não-paramétrica do grau de sedação, grau de sangramento e de relaxamento muscular seguindo tabelas de escores. Os dados foram submetidos à ANOVA e comparados pelos testes de Kruskal-Wallis, Friedman, Dunn e Tukey (p< 0,05). Concluiu-se que a utilização da ropivacaína isolada ou associada à morfina, ao butorfanol ou ao tramadol pela via peridural não promoveu depressão cardiorrespiratória ou alterações hemodinâmicas significativas, sendo que a ropivacaína associada ao butorfanol permitiu a realização de OSH em cadelas. / The use of epidural local anesthesia has been reaching great emphasis for the last years, overcoat with the opioids using. This research ained the use of ropivacaine with or without association the different opioids, for epidural anesthesia biches submitted the elective ovariosalpingohisterectomy (OSH). 32 bitches tool part is this double-blind study, adult, different breed, weighing between 6 and 15kg and pré-medicated with acepromazine (0.05mg/kg, IM) associated to the midazolam (0.2mg/kg, IM), distributed in for different groups: Group 1: ropivacaine: 0.3 mL/kg; Group 2: ropivacaine + morphine (0.1 mg/kg); Group 3: ropivacaine + butorphanol (0.1 mg/kg); and Group 4: ropivacaine + tramadol (0.5 mg/kg) administered epidural. The following parameters were studied: heart frequency; breathing frequency; systolic arterial pressure; rectal temperature; blood gas partial pressures (arterial); blood pH; besides non-parametric of sedation grade, bleeding grade and muscular relaxation following tables scores. The results were submitted by ANOVA and compared by Kruskal-Wallis, Friedman, Dunn and Tukey test (p< 0.05). It was conclude that the use of only ropivacaine or associated with morphine, with butorphanol or tramadol for the epidural administration didn't promote depression cardiorrespiratory or significant hemodinamycs alterations and the ropivacaine associated to the butorphanol allowed OSH in bitches accomplishment.

Problematic painkiller use is a large and increasing problem worldwide, leading to serious physical, psychological and social consequences. Existing research indicates that accessibility of painkillers and psychological factors could have a role in problematic painkiller use. To clarify, accessibility refers to ease of obtaining painkillers, whilst psychological factors refer to individual-level processes and meanings that influence mental states (Upton, 2013). However, there have been few studies conducted, and these studies have focused mainly on either clinical samples or women with childbirth pain. Hence, the role among the general population is less clear. The aim of the present thesis was therefore to focus on the role of accessibility and psychological factors in problematic painkiller use among the general population. Three studies were conducted: one study compared the general population of the UK (N = 295) and Egypt (N = 420) regarding the role of accessibility of painkillers and psychological factors, including attitudes and beliefs towards pain, painkillers, self-medication and alternative methods of pain relief; another study was a multi-national comparison of these variables among the general population of more countries including Germany (N = 217), USA (N = 146), Australia (N = 93) and China (N = 76); another study focused on the role of psychological factors over time among the UK general population (N = 529), specifically attitudes and beliefs towards painkillers, as well as pain catastrophising, pain acceptance, pain self-efficacy and alexithymia. In these studies, the role of accessibility and psychological factors was investigated using online surveys, with participants aged 18 years or over, who experienced pain in the last month, used over-the-counter (OTC) or prescription painkillers in the last month, and were residents of the countries concerned. An additional study was conducted to develop 14-item versions of the Survey of Pain Attitudes-Brief (SOPA-B-14) and the Pain Medication Attitudes Questionnaire (PMAQ-14), which also tested the validity of these scales. Results Accessibility of painkillers and psychological factors predicted problematic painkiller use. However, there were several differences between the countries regarding the particular role of these factors. In the longitudinal study of the UK general population, changes in psychological factors were found over time, but attitudes and beliefs about withdrawal from painkillers was the only psychological factor that predicted problematic painkiller use over time. In addition, testing the validity of the SOPA-B-14 and PMAQ-14 showed that these scales were valid. The present research provided understanding regarding the role of accessibility and psychological factors in problematic painkiller use among the general population, and the role of psychological factors over time. Based on this understanding, interventions focusing on accessibility and psychological factors should be developed to reduce problematic painkiller use, but tailored to the particular factors that were predictors for each country. The present research also developed a valid SOPA-B-14 and PMAQ-14, therefore these scales can be used rather than the full versions to make assessment easier.