The Evolving Role of Opioid Treatment in Chronic Pain Management

Opioids for chronic pain management have become increasingly controversial, yet many patients continue to be treated with high doses for prolonged periods of time. The miscon‐ ception between patients and providers alike is that these drugs can be taken without conse‐ quences. This liberalized thinking is far from the clinical practice of just two decades ago

Carbon and nitrogen stable isotope values in freshwater, brackish and marine fish bone collagen from Mesolithic and Neolithic sites in central and northern Europe

The aim of this research is to examine the isotopic characterisation of archaeological fish species as it relates to freshwater, brackish and marine environments, trophic level and migration patterns, and to determine intraspecies variation within and between fish populations in different locations within central and northern Europe. Carbon and nitrogen stable isotope analysis was undertaken on collagen extracted from 72 fish bone samples from eight Mesolithic and Neolithic archaeological sites in this region. Thirty-six (50%) of the specimens analysed produced results with acceptable carbon to nitrogen atomic ratios (2·9–3·6). The fish remains encompassed a wide spectrum of freshwater, brackish and marine taxa (n = 12), which were reflected in the δ13C values (−24·5 to −7·8‰). The freshwater/brackish fish (pike, Esox lucius; perch, Perca fluviatilis; zander, Sander lucioperca) had δ13C values that ranged from −24·2 to −19·3‰, whereas the brackish/marine fish (spurdog, Squalus acanthias; flatfish, Pleuronectidae; codfish, Gadidae; garfish, Belone belone; mackerel, Scomber scombrus) ranged from −14·9 to −9·4‰. Salmonidae, an anadromous taxon, and eel (Anguilla anguilla), a catadromous species, had carbon isotope values consistent with marine origin, and no evidence of freshwater residency (−12·7 to −11·7‰). The δ15N values had a range of 6·2‰ (6·5–12·7‰) indicating that these fish were on average feeding at 1·7 trophic levels higher than their producers in these diverse aquatic environments. These results serve as an important ecological baseline for the future isotopic reconstruction of the diet of human populations dating to the late Mesolithic and early Neolithic of the region

Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk

Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this shift within pain medicine, and an emphasis was placed on developing reliable and valid methods and measures of identifying those at risk for opioid misuse. Since that time, the evidence for the safety and effectiveness of chronic opioid therapy (COT) has not been established. Rather, the harmful, dose-dependent deleterious effects have become clearer, including addiction, increased risk of injuries, respiratory depression, opioid induced hyperalgesia, and death. Still, many individuals on low doses of opioids for long periods of time appear to have good pain control and retain social and occupational functioning. Therefore, we propose that the question, “Who is at risk of opioid misuse?” should evolve to, “Who may benefit from COT?” in light of the current evidence