Cases reported "Opioid-Related Disorders"

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1/2. Successful use of oral methadone after failure of intravenous morphine and ketamine.

    We describe an opioid-tolerant patient with severe acute pain which was unrelieved by morphine and ketamine via intravenous patient-controlled analgesia, but almost totally relieved by methadone. In the previous 24 hours, 509 mg of intravenous morphine and 769 mg of ketamine had been used and this was replaced by 200 mg of oral methadone. This implies that the success of methadone in morphine tolerant patients chiefly involves factors other than its role as an N-methyl-D-aspartate receptor antagonist, and that methadone should be considered as a replacement for morphine when the N-methyl-D-aspartate antagonist ketamine has proved ineffective.
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ranking = 1
keywords = acute pain
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2/2. acute pain and opioid seeking behaviour.

    BACKGROUND: acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. general practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.
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ranking = 2
keywords = acute pain
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