Papers by Jane Ballantyne
Hospital Medicine Clinics, 2016
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Expert Opinion on Drug Safety, 2015
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Textbook of Addiction Treatment: International Perspectives, 2014
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Current Psychiatry Reports, 2012
Substance use disorders are a large public health problem in the United States. Over the past dec... more Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders. Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.
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Suffering and Bioethics, 2014
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Current rheumatology reports, 2013
The recent increase in the number of patients taking opioids chronically for pain has not yielded... more The recent increase in the number of patients taking opioids chronically for pain has not yielded the expected benefits in reduction of symptoms and improved function. Chronic pain patients typically respond well initially to opioid medications, but regular use is associated with adverse psychological and physical effects. Patients with significant psychiatric comorbidity and substance use issues are more likely to stay on opioids and to receive higher doses. In the common rheumatological conditions of fibromyalgia and osteoarthritis, opioid treatment is of limited benefit because of lack of efficacy and prominent side effects. Chronic opioid therapy may be more usefully regarded as a form of comfort care, reserved for those patients who have exhausted other treatments and prospects of recovery.
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Journal of Clinical Anesthesia, 1993
To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-co... more To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-controlled analgesia (PCA) in postoperative patients by analyzing data from published comparative trials. Meta-analyses of 15 randomized control trials. Seven hundred eighty-seven adult patients (aged 16 to 65) undergoing various operative procedures. Either PCA or conventional analgesia for postoperative pain control. Data were extracted on analgesic efficacy, analgesic use, patient satisfaction, length of hospital stay, and side effects. Meta-analyses of the data showed the following: (1) greater analgesic efficacy when PCA was used, with a mean additional benefit of 5.6 on a scale of 0 to 100 (SED, 2.2; p = 0.006); (2) a nonsignificant trend toward reduced analgesic use in PCA patients, based on a count of trials finding in one direction or the other (p = 0.092); (3) a 42% difference in the proportion of patients expressing satisfaction over dissatisfaction (SED, 20%; p = 0.02), with PCA being preferred; (4) a nonsignificant trend toward shortening of length of hospital stay with PCA use (mean, 0.15 days, SED, 0.13; p = 0.24); (5) no significant differences in the occurrence of any side effect. Patient preference strongly favors PCA over conventional analgesia. Patients using PCA also obtain better pain relief than those using conventional analgesia, without an increase in side effects. Favorable effect of PCA upon analgesic usage and length of hospital stay did not in the initial trials attain statistical significance. Nonetheless, the favorable trends in the mean effect sizes for both outcomes argue that further studies of both outcomes should be performed to determine whether the favorable impact of PCA upon either may become statistically significant if larger numbers of patients are enrolled.
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Best Practice & Research Clinical Anaesthesiology, 2006
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Anesthesia & Analgesia, 2006
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Anesthesia & Analgesia, 1998
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Acute Pain, 2003
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Page 1. 520 Part IV: Pain Conditions 38. 39. 40. phantom limb pain: comprehensive therapy with sp... more Page 1. 520 Part IV: Pain Conditions 38. 39. 40. phantom limb pain: comprehensive therapy with spinal cord and thalamic stim-ulation. Stereotact Funct Neurosurg 2001;77:159162. 32. Microsurgical junctional DREZ coagulation for treatment of deafferentation syndromes. ...
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Http Dx Doi Org 10 1089 Jpm 2006 9 50, Jan 23, 2006
The attitudes, beliefs, and experience of physicians will influence how they view the use of opio... more The attitudes, beliefs, and experience of physicians will influence how they view the use of opioids for chronic nonterminal pain. To survey pain specialists and primary care providers (PCPs) to obtain their opinion and attitude on aberrant drug-taking behaviors. We surveyed three physician groups, mailing 250 surveys followed by two followups. The survey consisted of (1) questions about beliefs in the effectiveness of long-term opioid therapy and successful and unsuccessful outcomes and (2) a ratings section for possible indicators of unsuccessful long-term opioid treatment. In total 147 questionnaires (82 PCPs, 65 pain specialists) were returned. Pain specialists reported a greater number of patients undergoing long-term opioid therapy compared to nonpain specialists. Opinion regarding the effectiveness of long-term opioid therapy among all physicians was mixed but there was no significant difference between pain specialists and PCPs. There was agreement among physicians with regard to highly aberrant behaviors being indicators of failed long-term opioid therapy. The ratings of the following indicators showed differences between each group: no improvement in pain control, not being able to return to work, and a deterioration in relationships with others. Physicians reported increases or decreases in function to be the most important successful or unsuccessful outcome, respectively. This preliminary survey showed consensus among physicians that highly aberrant behaviors indicate a failure of chronic opioid therapy. However, when considering less egregious behaviors, it would appear a physician's experience and the number of patients they had taking opioids influenced their opinion.
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The New England journal of medicine, Jan 26, 2015
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Journal of opioid management
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Pain, Jan 22, 2015
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Pain, 2016
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Expert Opinion on Drug Safety, 2015
Pain management with opioids is a fundamental element of palliative medicine. Since the risks of ... more Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted. This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff. Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.
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Stannard/Evidence-Based Chronic Pain Management, 2010
Page 1. 194 CHAPTER 16 Postsurgical pain syndromes Fred Perkins and Jane Ballantyne National Anes... more Page 1. 194 CHAPTER 16 Postsurgical pain syndromes Fred Perkins and Jane Ballantyne National Anesthesia Service, United States Department of Veteran Affairs, White River Junction, VT, USA Background ... Callesen et al. ...
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The Laryngoscope, 1979
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Papers by Jane Ballantyne