Pain Management

Pain Management

Barriers to Availability of Legal Opioid Analgesics in the US

(Barriers to Availability of Legal Opioid Analgesics in the US) "The most common reason cited as a barrier to opioid availability was low demand (93.1%). However, this did not vary by opioid analgesic sufficiency, pharmacy racial composition, pharmacy type, level of zip code urbanization, level of opioid analgesic supply, median age, household income, or proportion of residents ?65 years old. The fear that patients might use opioid analgesics for illicit purposes was the second most prevalent barrier identified (8.5%).

Prescription Opioid Overdose

(Prescription Opioid Overdose) "Among patients who are prescribed opioids, an estimated 80% are prescribed low doses (<100 mg morphine equivalent dose per day) by a single practitioner (7,8), and these patients account for an estimated 20% of all prescription drug overdoses (Figure 3). Another 10% of patients are prescribed high doses (?100 mg morphine equivalent dose per day) of opioids by single prescribers and account for an estimated 40% of prescription opioid overdoses (9,10). The remaining 10% of patients are of greatest concern.

Oxycodone Production Quotas

(Oxycodone Production Quotas) "Until 2011, the DEA had increased the quota for oxycodone every year since 2002101 with the exception of 2008, when the quota remained unchanged from 2007.102 In 2010, the quota for oxycodone available for sale was 105,500,000 grams.103 In 2002, the quota for oxycodone available for sale was 34,482,000 grams, which means that over that eight-year period, the DEA permitted a 206% increase in the oxycodone quota.104 The DEA decreased the quota to 98,000,000 grams in 2011.105 OxyContin

Global Medical Opiate Shortage

(Global Medical Opiate Shortage) "We determined per capita need of strong opioids for pain related to three important pain causes for 188 countries. These needs were extrapolated to the needs for all the various types of pain by using an adequacy level derived from the top 20 countries in the Human Development Index. By comparing with the actual consumption levels for relevant strong opioid analgesics, we were able to estimate the level of adequacy of opioid consumption for each country.

Global Lack of Pain Relief

(Global Lack of Pain Relief) "Current estimates suggest that upward of 80% of the world’s population lacks access to basic pain relief [6]. Paradoxically, those 80% are mostly in poorer countries, and their need for pain relief is heightened by a relative absence of curative care such as surgery, or treatment for both communicable and non-communicable diseases causing pain (e.g., HIV/AIDS, cancer)[7]."

Prevalence of Neuropathic Pain

(Prevalence of Neuropathic Pain) "Neuropathic pain (NP) is defined as pain caused by a lesion or disease of the central or peripheral somatosensory nervous system.[1] NP affects between 5% and 10% of the US population [2] and examples include diabetic neuropathy, complex regional pain syndrome, radiculopathy, phantom limb pain, HIV sensory neuropathy, multiple sclerosis-related pain, and poststroke pain.[3]"

Global Pain Growth Projection

(Global Pain Growth Projection) "In the future, the global need for pain medicine will increase rapidly. In developed and developing countries, the world’s population is aging, resulting in an increase of the prevalence of chronic, painful conditions and cancer. By 2025, there will be 1.2 billion people over the age of 60, which is double the current estimate of 600 million.14 Future demand for such care is also expected to rise due to the dramatically expanding prevalence of HIV/AIDS in several parts of the world.

International Law and the "Central Principle of Balance"

(International Law and the "Central Principle of Balance") "In 1998, WHO [World Health Organization], in cooperation with its collaborating center at the University of Wisconsin, elaborated the concept of the 'Central Principle of Balance' in order to guide the development of national drug regulatory policies pursuant to the Single Convention.64 According to WHO, 'The Central Principle of Balance' represents the dual imperative of preventing the abuse, trafficking, and diversion of narcotic drugs while, at the same time, ensuring medical availability.

Pain Contracts

(Pain Contracts) "Another control strategy that has gained traction is opioid 'contracts' or 'treatment agreements' between health care providers and patients, under which medication use by highrisk patients is closely monitored. In a study of a primary are clinic’s use of such contracts, three-fifths of patients adhered to the agreement (with a median follow-up of 23 months) (Hariharan et al., 2006).

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