Opioid rotation is a common and necessary clinical practice in the management of chronic non-cancer pain to improve therapeutic efficacy with the lowest opioid dose. When dose escalations fail to achieve adequate analgesia or are associated with intolerable side effects, a trial of a new opioid should be considered. Much of the scientific rationale of opioid rotation is based on the wide interi...

Background and Objective: Opioid use disorder is an evolving crisis, 17.2% of postsurgical patients continue to fill opioid prescription one year after surgery. Preclinical studies suggest perioperative use, defined here as opioids used in the setting operative pain, may be linked inferior oncologic outcomes. If this were true, minimization strategies for surgical reduce opioid-related deaths m...

PURPOSE This study investigated the patterns of opioid co-prescription with benzodiazepine and other concomitant medications among opioid users. Opioid dose in each type of co-prescription was also examined. PATIENTS AND METHODS This cross-sectional study was conducted among opioid users receiving concomitant medications at an outpatient tertiary hospital setting in Malaysia. Opioid prescript...

A 36-year-old female presented with a 3-day history of increasing shortness of breath, cough with purulent sputum, haemoptysis, pleuretic chest pain, nausea, vomiting and rigors. The patient was an intravenous drug user (IVDU) who smoked 20 cigarettes per day and denied drinking alcohol. Her only past medical history was of mild asthma, for which salbutamol was taken as needed. On examination, ...

A male intravenous drug abuser who was infected with hepatitis B and C, presented with a slowly progressive hemiplegia. Contrast enhanced computerized tomography of the head showed a solitary ring-enhanced mass with surrounding edema. Clinically brain tumor was suspected but a brain biopsy confirmed cerebral toxoplasmosis. An HIV test was not considered until the result of brain biopsy. He also...

This report discusses the issues involved in the diagnosis and management of tetanus. A 29-year-old female with a history of illicit drug use presented with progressive tetany secondary to an abscess on her forearm from subcutaneous injections. She was managed in the intensive care unit for 29 days and was discharged to the ward. The main issue in her management was control of tetanic episodes ...

abstract background and objective: pain relief during labour is an important determinant of a women’s birth experience. there are numerous pain relief techniques which can be used either with or without pain medication. the aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. methods: after obtaining informed con...

the catastrophic effects of opioids use on public health and the economy are documented clearly in numerous studies. repeated morphine administration can lead to either a decrease (tolerance) or an increase (sensitization) in its behavioral and rewarding effects. morphine-induced sensitization is a major problem and plays an important role in abuse of the opioid drugs. studies reported that mor...