Preliminary Validation for the "BJR method"-A Possible New Mathematical Approach to Methadone Conversion.
This article describes a novel approach to methadone conversion, with case studies providing preliminary validation. PMID: 31260376 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - July 2, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Referral Pattern to a Tertiary Care Cancer Pain Clinic in India.
Authors: Chatterjee A, Nimje G, Jain PN Abstract The study aimed to identify patterns of patient referral from oncology services, including pain severity, prior analgesics, impact of patient's literacy on referral, and adequacy of pain relief offered by the pain clinic. A retrospective analysis of pain clinic data from August 2014 to February 2015 at the Tata Memorial Hospital was carried out, wherein adult cancer patients referred for the first time to the pain clinic were included. Two thousand patients were included: 38.1% of the referred were at pretreatment stage, 28.8% advanced. Most referrals were from head ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - July 2, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Did I Hear You Right?
Authors: Jeba J Abstract As a palliative care physician I am constantly receiving wisdom from my interactions with patients and their families. The situation discussed in this article provides an example of a unique experience, with early requests for euthanasia that transitioned to aggressive end of life care later. Reflecting on this journey has enriched my professional life. PMID: 31237463 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 28, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Dexmedetomidine Use in a Case of Severe Cancer Pain.
Authors: Seymore RJ, Manis MM, Coyne PJ Abstract A 58-year-old male with chronic pancreatitis was seen by the palliative care service for pain and agitation related to a recent diagnosis of disseminated abdominal cancer. Increasing symptom burden, including pain and nausea, in the face of escalating doses of multiple opioid and sedative medications resulted in the addition of dexmedetomidine to successfully control his symptoms. Visceral sensitization related to his chronic pancreatitis likely increased his pain perception and required a multimodal approach to control his symptoms. PMID: 31242400 [PubMed - as s...
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 28, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Systematic Review of the Evidence Behind Use of Reduced Doses of Acetaminophen in Chronic Liver Disease.
Authors: Schweighardt AE, Juba KM Abstract Acetaminophen is among the most commonly used nonopioid analgesics, but significant variation exists in its prescribing practices for cirrhosis patients. Our primary objective was to describe the quality of evidence supporting or refuting the use of acetaminophen in patients with hepatic dysfunction. A comprehensive literature review of PubMed, Cochrane Library, Web of Science, and International Pharmaceutical Abstracts using the search terms "acetaminophen," "paracetamol," "chronic liver disease," "cirrhosis," and "hepatic dise...
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 19, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

UT Southwestern's Palliative Care Program: Measurable Patient Impact and Cost-savings.
Authors: Bird A, Leach S, Houck S, Robinson K, Lawson T Abstract The purpose of this analysis was to measure the impact of palliative care services on hospital charges in the 5 days prior to death-the most expensive time of a patient's life-and identify hospital service categories and patient financial classes yielding the highest savings from palliative care. The analysis population included UT Southwestern patients admitted to the hospital between October 1, 2013, and September 30, 2016. Palliative care patients were defined as any patient who received at least one completed palliative care order. In order to cre...
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 15, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

The Enigma of Low-Dose Ketamine for Treatment of Opioid-Induced Hyperalgesia in the Setting of Psychosocial Suffering and Cancer-Associated Pain.
We report the successful use of low-dose ketamine infusion for the treatment of opioid-induced hyperalgesia in a 38-year-old woman presenting with psychosocial suffering and high opioid requirement secondary to pain from a poorly differentiated neuroendocrine tumor. Over the course of a month, her opioid requirement escalated to the gram level of oral morphine equivalents, upon which she was hospitalized at University of California San Diego Health for an acute on chronic pain crisis. Despite use of patient-controlled analgesia, her pain level remained unchanged for nearly 2 days after initiation of a low-dose ketamine inf...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 29, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Implementation of a Clinical Pharmacist Service in the Hospice Setting: Financial and Clinical Impacts.
Authors: Richter C Abstract Hospice is a unique environment among all clinical fields of practice. Although every other specialty aims to work toward a curative goal or prevention of mortality, hospice completely redirects focus solely on pain and symptom management and sustaining the highest quality of life possible. Addition of a clinical pharmacist to the interdisciplinary group (IDG) is not common, but Haven: Advanced Illness Care added a clinical pharmacist to the team in 2017. Substantial financial impacts were made in the first year, and clinical impacts were well regarded by physicians and nurses. A cost sa...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 29, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

My Zentangled Spine.
Authors: Watson J PMID: 31066637 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Editorial: Opioids 2019 & Beyond?
Editorial: Opioids 2019 & Beyond? J Pain Palliat Care Pharmacother. 2018 Jun - Sep;32(2-3):61-62 Authors: Jackson KC PMID: 31066638 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Comparison of haloperidol, non-haloperidol antipsychotics, and no pharmacotherapy for the management of delirium in an inpatient geriatric palliative care population.
Authors: Felton MA, Jarrett JB, Hoffmaster R, D'Amico FJ, Sakely H, Pruskowski J Abstract Antipsychotics are frequently used for treatment of delirium, although little evidence exists that they improve delirium outcomes. Our objective was to evaluate haloperidol (HAL) compared to non-haloperidol antipsychotics (NHAP) or no pharmacologic treatment (NP) in the management of delirium in older adults under the care of a palliative care consult service across a large, integrated health care system. A retrospective chart review examined data from September 2014-September 2015. All hospitalized patients ≥65 years old w...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Patient Counseling Guidelines for the Use of Cannabis for the Treatment of Chemotherapy-Induced Nausea/Vomiting and Chronic Pain.
Authors: Makary P, Parmar JR, Mims N, Khanfar NM, Freeman RA Abstract The use of cannabis medications has grown in recent years for the symptomatic relief of chemotherapy-induced nausea/vomiting (CINV) and chronic pain (cancer-related and non-cancer-related). As states legalize the use of cannabis, it is important for pharmacists and other health care professionals to be aware of how to counsel patients receiving prescriptions for cannabis medications. The aim of this study was to develop patient counseling guidelines for the use of cannabis products in treatment of CINV and chronic pain. A literature search was pe...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Home Hospice, Not Hospital.
Authors: Majeed MH Abstract In December 2017, my mother was diagnosed with an end-stage pancreatic cancer. In the following weeks, she had to be taken to the emergency room frequently due to worsening infections, electrolyte imbalance, and vertigo, which often led to delirium. The doctors treating her were well qualified but lacked education and training about palliative and end-of-life care issues, which was reflected in their clinical practice. They kept treating her medical conditions as if she could be cured; no one recommended comfort measures only. After much deliberation and with some degree of hesitation, I...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 6, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

The Efficacy of Vitamin C in the Prevention of Complex Regional Pain Syndrome After Distal Radius Fractures: A Synthesis.
Authors: Keef T, Keef S Abstract The current recommendation is to use daily doses of vitamin C to prevent the occurrence of the complex regional pain syndrome (CRPS) following a distal radius fracture. The study is a synthesis of the four primary studies that examine this issue. These studies have been previously examined in the meta-analysis literature. The incidence of CRPS is lower in patients treated with the vitamin C protocol compared with the control. The significance of the difference varies from P = .02 to P = .13. Our analysis points to the fact that the relative efficacy of vi...
Source: Journal of Pain and Palliative Care Pharmacotherapy - April 19, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Comparison of Parenteral Opioid Dosing in Adult Sickle Cell Disease Patients With Vaso-occlusive Crisis.
Authors: Shah SP, Twilla JD, Kemp L, Phelps GL, Reaves A Abstract Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. The main objective of this study is to evaluate whether outcomes differ in patients with VOC based on pain management treatment modality. A retrospective review of admissions with a primary diagnosis...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 23, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Laxative Use in Inpatients on Oxycodone/Naloxone Prolonged Release and Oxycodone Prolonged Release for Cancer and Non-cancer Pain.
CONCLUSION: This retrospective study of hospital inpatients with cancer and non-cancer pain found that laxative use was not reduced in those on combined oxycodone/naloxone compared to oxycodone alone, suggesting that despite the interpretations of the clinical trials in the phase IV setting, the addition of naloxone had no effect on reducing laxative use. PMID: 30735070 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Ketamine-Induced Diabetes Insipidus.
This report suggests that the patient likely experienced a medication-induced DI, which was successfully resolved through proper identification of the causative agent, removal, and subsequent treatment with desmopressin. Causality assessment between ketamine and DI was determined using the Naranjo Adverse Drug Reaction Probability Scale-a total score of 7 was achieved and thus identified the adverse drug reaction as probable. Clinicians should be aware of the possibility that ketamine may be contributory in a patient with unexplained DI. PMID: 30702377 [PubMed - as supplied by publisher] (Source: Journal of Pain and Pa...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Natural Language Processing-Identified Problem Opioid Use and Its Associated Health Care Costs.
This study utilized electronic health record (EHR) data to identify chronic opioid therapy (COT) patients with problem opioid use (POU) and compared costs with those for COT patients without POU. This study utilized EHR and claims data from an integrated health care system. Patients received COT (≥70 days' supply in ≥1 calendar quarter, 2006-2012). Natural language processing (NLP) identified notations of opioid addiction, abuse, misuse, or overuse, and manual validation was performed. Cases had evidence of POU (index = first POU notation), and controls, sampled 9:1, did not. Health care resource utiliz...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Opioid-Sparing Effects of Topical Ketamine in Treating Severe Pain From Decubitus Ulcers.
Authors: Skavinski KA Abstract Pain from pressure ulcers can severely impact a patient's quality of life. Evidence-based treatment of ulcer-related pain typically relies on systemic opioids with limiting side effects. Literature exists on the use of topical ketamine for neuropathic pain, but not for tissue injury in general and for decubitus ulcer pain specifically. Ketamine has a number of actions including blocking of the glutamate NMDA ionophore in the periphery. Preclinical evidence suggests that NMDA receptors located on peripheral sensory afferent terminals may play a role in initiating pain signaling in infl...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Adverse Drug Reactions in Palliative Care.
This study sought to identify ADRs in palliative care, assess their severity and preventability, and identify specific medications most commonly involved. This retrospective cohort study included patients who received a consult by the hospital's palliative care service over a 1-year period. Records were reviewed to identify ADR occurrences, causative and resulting events, and variables used to determine preventability and severity. Of the 430 patients who met inclusion criteria, 247 patients experienced an ADR (57.4%). In total, 440 ADRs were documented, with 45.7% of patients experiencing more than one. Patients with repe...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 25, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Public Policy: An Analgesia for Opioid Diversion.
In conclusion, appropriate policies and guidelines are necessary to support the entire health care body in executing a coordinated approach and exercising vigilance to better manage the opioid diversion problem. PMID: 30676178 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 25, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

The Association of Joint Pain and Dipeptidyl Peptidase-4 Inhibitor Use Among U.S. Adults With Type-2 Diabetes Mellitus.
Authors: Rai P, Zhao X, Sambamoorthi U Abstract The purpose of this study was to examine the association of dipeptidyl peptidase-4 inhibitors (DPP4Is) with joint pain in adults with type 2 diabetes mellitus (T2DM). This was a retrospective cross-sectional study design, pooling data from the 2012 and 2014 Medical Expenditure Panel Survey. The sample consisted of 4,559 T2DM patients older than 40 years with (n = 3,224) or without joint pain (n = 1,335). Chi-square test and logistic regression were used to describe association of DPP4I use with joint pain. Among adults with T2DM, 70....
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 25, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Elevated Transaminases with Topical Diclofenac: A Case Report.
Authors: Daniels AM, Gibbs LM, Herndon CM Abstract Drug-induced liver injury (DILI) has been described with numerous nonsteroidal anti-inflammatory drugs (NSAIDs). Oral diclofenac has been associated with DILI more frequently than other NSAIDs and requires periodic monitoring of liver transaminases and judicious consideration of clinical signs and symptoms of hepatotoxicity. Here we describe a case in which elevated liver transaminases in a 79-year-old female returned to normal following discontinuation of topical diclofenac 1% gel. Using a widely accepted drug reaction causality instrument, a rating of "defin...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 17, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate Intravenous Acetaminophen Versus Placebo in Patients Undergoing Robotic-Assisted Laparoscopic Prostatectomy.
The objective of this study was to determine the impact of intravenous (IV) acetaminophen when added to the perioperative analgesic regimen for robotic-assisted laparoscopic prostatectomy (RALP) on hospital length of stay (LOS), postoperative pain scores, and opioid consumption. In this prospective, randomized, double-blind, placebo-controlled trial, a total of 86 patients undergoing RALP were prospectively enrolled and randomly assigned to receive either 1 g IV acetaminophen (study group; n = 43) or IV placebo (n = 43) within 15 minutes following the induction of anesthesia and pr...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 17, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Things to Consider When Completing an Advance Directive.
Authors: Laramie LC, Smolinski KM Abstract Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In response to a question about advance directives for a patient experiencing chronic pain, the authors discuss the importance of having legal documents in place. PMID: 30624123 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 11, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Cost and Quality Analysis of Utilizing a Rectal Catheter for Medication Administration in End-of-Life Symptom Management.
Authors: Latuga NM, Gordon M, Farwell P, Farrell MO Abstract Technology that can improve the ability to provide quick symptom control while decreasing the cost and burden of care could help hospice agencies deal with current hospice industry challenges. This paper describes how the use of a new rectal medication delivery technology at a large hospice in western New York has improved patient care and nursing efficiency while at the same time decreasing the cost of care. PMID: 30596459 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 1, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Case of Opioid-Induced Hyperalgesia.
This report aims to increase awareness of OIH, a clinical phenomenon which remains poorly understood and probably under recognised. PMID: 30592628 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - December 31, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Retrograde Intrathecal Drug Delivery: A Report of Three Cases for the Management of Cancer-Related Sacropelvic Pain.
We report three cases of sacral and pelvic pain resistant to oral medications successfully managed with intraspinal drug delivery through a catheter placed at the intrathecal sacral space to deliver low doses of bupivacaine and fentanyl with local effects. PMID: 30589369 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - December 29, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Preliminary Study of Pain Relieving Dressings for Older Adults With Chronic Leg Ulcers From the Provider's Perspective: A Qualitative Study.
Authors: Docking R, Boateng J, Catanzano O, Schofield P Abstract Prevalence of leg ulcers increases with age due to an increase in risk factors, including immobility and venous disease. With an increasingly aging population, therefore, the number of older adults with leg ulcers is increasing. Older adults with leg ulcers experience frequent pain and discomfort, and yet pain in this population is poorly managed. The aim of this study was to explore the feasibility of the use of analgesic dressings in older adults with leg ulcers, including their perception of current pain management, feasibility of an analgesic dres...
Source: Journal of Pain and Palliative Care Pharmacotherapy - December 29, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Treatment for Refractory High Ileostomy Output.
We present a case where the glucagon-like peptide 2 (GLP-2) analog teduglutide was used successfully to decrease high ostomy output due to short bowel syndrome in a patient not entirely dependent on parenteral nutrition. Short bowel syndrome is known to decrease quality of life and is associated with high health care costs. Although use has been limited by cost, teduglutide appears to be a treatment option for palliative care practice if patients suffer from short bowel syndrome. PMID: 30395777 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 6, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Comment on Gressler et  al.: Serotonin Syndrome in Tapentadol Literature: Systematic Review of Original Research.
Comment on Gressler et al.: Serotonin Syndrome in Tapentadol Literature: Systematic Review of Original Research. J Pain Palliat Care Pharmacother. 2018 Oct 31;:1-2 Authors: Radic T, Stollenwerk A, Elling C PMID: 30380966 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 2, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Intravenous Chlorpromazine for the Short-Term Treatment of Insomnia in End-Stage Cancer Patients With Difficulty in Oral Administration.
The objective of the study was to evaluate effectiveness and safety of intravenous chlorpromazine for the short-term treatment of insomnia in end-stage cancer patients. Insomnia occurs as one of distressing symptoms in 70% of end-stage cancer patients. End-stage cancer patients often have difficulty in oral administration because of disease progress. We retrospectively evaluated 30 end-stage cancer patients with difficulty in oral administration who received intravenous chlorpromazine for the short-term treatment of insomnia. A primary end point was sleep quality based on St. Mary's Hospital Sleep Questionnaire 3 days afte...
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 2, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Pain Scale.
Authors: Bugni C PMID: 30383501 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 2, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Interstitial Cystitis: An Update on the Disease Process and Treatment.
Authors: Daniels AM, Schulte AR, Herndon CM Abstract Interstitial cystitis (IC) is a chronic pain disorder of the bladder that is often underdiagnosed and mistreated. The difficulties in diagnosis stem from numerous theories regarding pathophysiology and etiology, including the breakdown of the glycosaminoglycan (GAG) layer, altered permeability of the urothelium, uroinflammation, and neural up-regulation. Dysfunction of the bladder increases the struggle for proper treatment and continues to prove difficult for health care providers to correctly diagnose and manage IC. If diagnosed and/or managed inappropriately, ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 15, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Opioid and Benzodiazepine Relative Use in Breast Cancer Patients Before, During, and After Curative Chemotherapy.
Authors: Yau WH, Roeland EJ, Revta C, Ale-Ali A, Ma JD PMID: 30204508 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 13, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Identifying Patterns of Delirium in Hospitalized Patients on Dexamethasone Using a Chart Abstraction Tool.
Authors: Chang JT, Atayee RS, Edmonds KP Abstract Delirium is a neuropsychiatric syndrome that can occur in hospitalized patients, including in palliative care settings. The aim of this study is to describe patterns of delirium in patients receiving dexamethasone at the request of an inpatient palliative consultation team by using a modified chart abstraction tool. This retrospective study analyzed patterns of delirium development in adult hospitalized patients receiving opioids for cancer-related pain and initiated on dexamethasone with recommendation from the palliative care team. Primary end point described patt...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 13, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Ensuring and Restoring Balance on Access to Controlled Substances for Medical and Scientific Purposes: Joint Statement from Palliative Care Organizations.
This report presents examples of unbalanced systems and a joint statement from global and regional palliative care organizations to promote development of balanced systems for optimal public health outcomes. Although nonmedical use of controlled substances poses a risk to society, the system of control is not intended to be a barrier to their availability for medical and scientific purposes, nor to interfere in their legitimate medical use for patient care. As representatives of palliative care organizations, we urge heads of state to act and to take measures to ensure and restore balanced systems in their countries and ca...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 12, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Prescription Drug Monitoring Programs: Relationships Among Program Awareness, Use, and State Mandates.
Authors: Williams KS, Magalotti S, Schrouder K, Knox M, Feldman L, Ujwal D, Lynch D Abstract The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. The current study used a self-report survey instrument that was administered to 223 participant physicians. The goal of the study was to compare awareness and use of the PDMP in a state that mand...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 12, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A New Editor-in-Chief.
Authors: Jackson K PMID: 29799322 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 31, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Low-Dose Ketamine Infusion for Adjunct Management during Vaso-occlusive Episodes in Adults with Sickle Cell Disease: A Case Series.
This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs). Patients were treated with a continuous-infusion of low-dose ketamine (up to 5 µg/kg/min) after insufficient pain control with opioid analgesic therapy. Outcomes studied included impact on opioid analgesic use, a description of ketamine dosing strategy, and an analysis of adverse events due to opioid or ketamine analgesia. Descriptive statistics are provided. During ketamine infusion, patients experienced a lower reported pain score (mean numeric rating scale ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 25, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Provider Perspectives on Topical Analgesics.
Authors: Smith MA, Cho K, Rodgers P Abstract Topical analgesics are effective and alternative means to systemic therapy, often minimizing the adverse drug effects and complications of systemic analgesic use. Despite the number of available topical analgesics, there is little direction provided in practice guidelines on their appropriate use and little is known about patterns of their prescribing. To begin understanding these knowledge gaps, we sought provider perspectives on topical analgesic use at a large academic medical center. This electronic survey seeks to explore the perceptions and prescription patterns of...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 24, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Successful Improvement of Pain Symptomatology in a Suspected Case of Cramp-Fasciculation Syndrome via Interventional Pain Treatment.
Authors: Gupta A, First L, Swain CA Abstract Peripheral nerve hyperexcitability (PNH) syndromes are a rare set of neuromuscular disorders that include cramp-fasciculation syndrome (CFS) and Isaacs syndrome (IS). Successful treatment of these diseases has been achieved with antiepileptic medications; however, chronic pain symptoms can persist. We provide a case report of a 25-year-old female who has suffered from painful severe muscle spasms and fasciculations since childhood. With CFS as our working diagnosis, a treatment regimen using interventional pain techniques, including sympathetic chain blocks, ketamine inf...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 19, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Use of Methadone to Reverse Opioid Escalation in a Patient With Surgical Pain.
Authors: Jaffar M, Cunningham G, Chandler M, Webb T Abstract Acute pain is a prevalent issue for patients recovering from surgical procedures. Methadone has been recognized as a unique option for treatment of surgical pain due to its multiple mechanisms of analgesia and its potential to decrease tolerance to other opioids. Studies of methadone use in postoperative settings are sparse in part due to safety concerns, such as complex pharmacokinetics, risk of respiratory depression, and association with arrhythmias. In this case study of a 70-year-old male with postsurgical abdominal pain, methadone utilization over a...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 18, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Prescribing Trends of Palliative Care Team's Use of Dexamethasone for Cancer-Related Pain.
Authors: Barghi K, Edmonds KP, Ajayi TA, Atayee RS Abstract Opioids are first-line therapy for cancer-related pain. In addition, corticosteroids are commonly utilized as adjuvant analgesics for pain and other symptoms in the oncology setting with limited supporting data. A retrospective analysis was conducted evaluating adult hospitalized patients receiving opioids who received once-daily dexamethasone on the recommendation of a specialty palliative care team during their hospitalization from January 1, 2015, to January 1, 2016. Primary end point was to describe prescribing patterns of dexamethasone in this patient...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 9, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Case Report: Utility of Ketamine, Lidocaine, and Mexiletine as Nonopioid Adjuvants in Complex Cancer-Associated Pain.
Authors: Hakim RC, Edmonds KP, Atayee RS Abstract Ketamine, lidocaine, and mexiletine are potential nonopioid adjuvant medications for the use of refractory cancer-related pain, particularly when opioids are demonstrating limited objective benefit. This is a case report of a single patient admitted to a large academic medical center in the United States. The patient is a 43-year-old woman with a history of Crohn's disease complicated by rectal squamous cell carcinoma and complex, progressive, and intractable pelvic and rectal pain. Over the course of hospitalization, her pain demonstrated limited opioid responsiven...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 9, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Systematic Reviews Published in the Cochrane Library April-May 2017.
This report attempted to identify all relevant reviews published in the 2 months to May 31, 2017. Eight reviews have been identified that have potential relevance for practitioners in pain and palliative medicine. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. PMID: 29381131 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Writhing.
Authors: Haroutounian S PMID: 29381132 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Gabapentin for Cough in Cancer.
Authors: Razzak R, Waldfogel JM, Doberman DJ, Feliciano JL, Smith TJ Abstract Cough is a common problem among cancer patients, especially lung cancer patients. Gabapentin has been shown to be effective in reducing cough number and severity in patients with idiopathic refractory cough. The authors report here the successful use of gabapentin at usual doses to treat cough in cancer patients, including two with lung cancer, with minimal side effects. Gabapentin may be a useful addition to the symptom management toolbox for palliation of cancer symptoms. PMID: 29381133 [PubMed - in process] (Source: Journal of Pain...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 1, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Serotonin Syndrome in Tapentadol Literature: Systematic Review of Original Research.
This study aimed to review the literature and identify methodological issues that could lead to inaccurately reported rates of serotonin syndrome associated with tapentadol use. A systematic review of English articles using MEDLINE, Cochrane Controlled Trials Register, and Scopus was performed. Additional studies were identified by cross-referencing article bibliographies. Original research that examined the safety of tapentadol in patients with nonconfounding indications were examined. In total, 22 studies met inclusion criteria. There were 13 randomized clinical trials, 7 open-label trials, and 2 observational studies. A...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 18, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Urinary Retention and Medication Utilization on a Palliative Care Unit: A Retrospective Observational Study.
Authors: Bergstra TG, Gutmanis I, Byrne J, Faulds C, Whitfield P, McCallum S, Shadd J Abstract Urinary retention is a common problem at end-of-life that may be a result of medications used to control other symptoms. To determine whether use of retention-causing drugs was associated with catheterization for urinary retention among palliative care unit (PCU) patients, the authors reviewed charts of 91 consecutively admitted patients to a hospital-based PCU. Utilization of eight classes of retention-causing medications (opioids, antidopaminergics, benzodiazepines, anticholinergics, antidepressants, calcium channel ant...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 18, 2018 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research