Peripheral Neuropathy Associated with Hypereosinophilic Syndrome: A Clinical Therapeutic Success with Capsaicin 8% Patch.
Authors: Ruivo EFM, Gestosa SVS, Mulenas NME, Lares AMG Abstract Neuropathic pain is defined as a direct consequence of an injury or disease that affects the somatosensory system, which may affect 7 to 10% of the world population. Regardless of its origin, it is often described as disabling, chronic, difficult to treat and with a noticeable impact on patients' quality of life. This case report describes a patient with peripheral polyneuropathy associated with hypereosinophilic syndrome, a medical condition scarcely described in literature. Capsaicin 8% patches therapy, never mentioned before in the literature in su...
Source: Journal of Pain and Palliative Care Pharmacotherapy - April 1, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Improving Pain Management with Pharmacogenomics: A General Introduction.
This article introduces these concepts to assist the healthcare provider with incorporating PGx into practice to improve pain management. PMID: 32186418 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 19, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Healthcare Expenditures Associated with Persistent Opioid use Among Adults with Chronic Non-Cancer Pain Conditions: A Retrospective Cohort Study.
The objective of our study was to estimate the healthcare expenditures associated with persistent opioid use among adults with CNCP from both payer and patient perspectives. A retrospective cohort study using data from the Medical Expenditure Panel Survey (2012-2015) was undertaken. Patients with persistent, intermittent, and no opioid use in the baseline year were identified and their healthcare expenditures in the follow-up year were examined after controlling for potential confounders. In all, 7,286 adults with CNCP matching our inclusion criteria were identified: 14%, 16%, and 70% reported persistent, intermittent, and...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 19, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Attitudes toward and Barriers to Acetaminophen Use in the Chronic Pain Population: A Cross-Sectional Study.
Authors: Foo RMC, Hoff C, Sekhri NK, Weber G Abstract The use of acetaminophen is recommended in pain management, particularly acute pain management, to reduce opioid utilization and opioid related adverse drug events. Acetaminophen's role in chronic pain conditions is understudied. This cross-sectional study was performed in a pain management office to explore how chronic pain patients use acetaminophen. The final study sample included 100 patients. Current users of acetaminophen were most likely to report that a doctor had recommended acetaminophen to them (86.4%) compared to ever (66.7%) and never (55.6%) users (p
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 19, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

The Clinical Pharmacist's Role in Perioperative Surgical Pain Management.
Authors: Coulson EE, Kral LA Abstract The purpose of this quality improvement initiative was to demonstrate the value of having a clinical pain pharmacist in transitional perioperative pain management. Patients were referred to the pain pharmacist prior to elective surgery. The pharmacist worked with the patients to develop an individualized perioperative analgesic plan and provided education regarding surgery. The enrolled patients were followed throughout their surgical course by the pharmacist, and upon discharge the pharmacist conducted follow-up phone interviews approximately weekly for up to a month. This was...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 13, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Patient Experiences with Compounded Topical Pain Creams.
Authors: McPherson T, Fontane P, Bilger R Abstract Topical pain therapy offers several potential advantages as an alternative or adjunct to oral analgesic therapy, including decrease in concurrent oral drug use, lower abuse potential, lower side effects and toxicity, and localized effects. A variety of drugs and cream bases designed to promote transdermal delivery allow for unlimited customization of compounded topical pain creams (CTPC) for specific patients. The purpose of this study was to understand why patients begin CTPC therapy, their perceptions of CTPC therapy, and their level of satisfaction with CTPC the...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 3, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Pruritic Manifestation of Peripheral T Cell Lymphoma Effectively Managed with Mirtazapine: A Case Report.
We report a patient with diffuse, chronic pruritus secondary to peripheral T Cell Lymphoma (PTCL) who had same day response to mirtazapine after a litany of other agents were unsuccessful. PMID: 32118497 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 3, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Phenytoin Cream for the Treatment of Sciatic Pain: Clinical Effects and Theoretical Considerations: Case Report.
Authors: Russell AL, Kopsky DJ, Hesselink JMK Abstract Chronic sciatic pain is difficult to treat. Patients often suffer from considerable pain and are severely hampered in their everyday activities. Most pharmacologic analgesic treatments have disappointing effects, and often are limited due to adverse events. New treatments are therefore needed. Surprisingly we found fast pain reduction after applying topical phenytoin cream at the painful dermatome in a 55-year-old patient suffering from sciatic pain due to pathology of a disc. This patient was treatment resistant for 13 years. Prescribing topical analges...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 3, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Chemotherapy-Induced Peripheral Neuropathy: Causative Agents, Preventative Strategies, and Treatment Approaches.
Authors: Kachrani R, Santana A, Rogala B, Pawasauskas J Abstract Chemotherapy-induced peripheral neuropathy (CIPN) is a chronic symptom associated with chemotherapy treatment. Symptoms and severity vary based on chemotherapeutic agent used and dose. At present, effective options for the prevention and treatment of CIPN are inadequate and clinical guidance is limited. Unknown mechanism of action, lack of efficacy in many traditional neuropathic pain medications, and inconsistent evidence in regard to drug therapy have further complicated evaluation of therapeutic options. Twenty-five studies were identified and eval...
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 3, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Multi-Centered Case Series Highlighting the Clinical Use and Dosing of Lidocaine and Mexiletine for Refractory Cancer Pain.
Authors: Atayee RS, Naidu D, Geiger-Hayes J, Saphire ML, Hausdorff J, Edmonds KP Abstract Lidocaine infusion for pain control has been used for years. While some centers transition from continuous infusion lidocaine to oral mexiletine, there are no published studies to guide this conversion in pain and palliative care settings. This is a retrospective case series of 10 cancer patients across four institutions, with attention to dosing of both agents, and subsequent decrease in morphine-equivalent daily dosing (MEDD). The mean age was 55 years (range 34-78). The mean bolus dose of lidocaine was 1.6 mg/...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 25, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Law, Culture, and Fear: A Qualitative Study of Health Professionals' Perceptions of Narcotic Use Related to Cancer Pain.
This study aimed to explore health professionals' perspectives regarding opioid use for cancer patients in Qatar. Eight focus groups were conducted with physicians, pharmacists, and nurses. An eight-question topic guide framed discussions and targeted contextual barriers and cultural beliefs. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis was used to identify the following themes: narcotic use process, patient-related factors, and healthcare professional-related factors. Laws and regulations were identified as major barriers to appropriate narcotic access, prescribing, and administration. Gove...
Source: Journal of Pain and Palliative Care Pharmacotherapy - February 25, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Prophylactic Effects of Intravenous Dexamethasone and Lidocaine on Attenuating Hemodynamic-Respiratory and Pain Complications in Children Undergoing Cleft Palate Repair Surgery With General Anesthesia.
This study aimed to compare the prophylactic effects of intravenous (IV) dexamethasone and lidocaine on hemodynamic condition, respiratory complications, pain control, and vomit incidence following cleft palate repair surgery. This double-blind randomized controlled trial was carried out on 87 children assigned to three groups. Prior to anesthesia, subjects in groups D and L received 0.2 and 1 mg/kg IV dexamethasone and lidocaine, respectively. Moreover, group C received placebo in a similar condition. The outcome variables were recorded prior to the surgery and then every 15 minutes during the surgical and r...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 12, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Nebulized Fentanyl for Dyspnea: A Retrospective Chart Review.
Authors: Higgins EA, Young AM, Cain J, Dulin JD, Miller MM, Overstreet AN, Vaughan L, Coyne PJ Abstract Nebulized fentanyl is well established for analgesia but its use for dyspnea requires further investigation. The aim of our study was to determine the effectiveness of nebulized fentanyl in treating patients with dyspnea and to determine if there were harmful side effects described by patients or their providers. We used a convenience sample of patients from July 1 2014 to July 1 2018 and performed a retrospective chart review. We found that 360 doses of nebulized fentanyl were given to 73 patients during that ti...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 12, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Pharmacogenetic Testing: The Ethics of Implementing in Clinical Practice for Chronic Pain Patients.
Authors: Fredrikson KM, Fasolino T Abstract Chronic pain is a common and costly healthcare problem where standard of care often involves the use of opioids and patient response varies widely. Designing a treatment plan based upon an individual's genetic signature provides an individualized patient-centered care approach that can improve functional status, quality of life, and reduce adverse drug events (ADEs). This paper will discuss the ethical implications of pharmacogenetic (PGx) testing using the principlism framework of the four moral principles: beneficence, non-maleficence, autonomy, and justice. Beneficence...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 9, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

A Systematic Review of the Effectiveness of Oral Baclofen in the Management of Hiccups in Adult Palliative Care Patients.
Authors: Adam E Abstract Hiccup is a recognised symptom amongst the palliative care population. It can be debilitating, with significant impact on quality of life. The pathophysiology is poorly understood and the list of aetiological factors is extensive. The current treatment recommendations are based on a small body of evidence and there remains uncertainty regarding optimal management. The aim of this study was to systematically review the evidence for oral baclofen in the management of hiccups in adult palliative care patients. A search was conducted using MEDLINE, Embase, the Cochrane library and CINAHL, as we...
Source: Journal of Pain and Palliative Care Pharmacotherapy - January 9, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Efficacy and Safety of Intraperitoneal Local Anesthetics in Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis.
Authors: Abdelhakim AM, Elghazaly SM, Lotfy A Abstract Intraperitoneal local anesthetics have been increasingly used nowadays. However, they are not routinely given in laparoscopic appendectomy and a lot of controversies are found about their administration in this procedure. The goal of this study is to review effectiveness and safety of intraperitoneal local anesthetics in laparoscopic appendectomy. We conducted a computer search of four authentic databases. We included randomized controlled trials (RCTs) which compared intraperitoneal local anesthetics versus control group in laparoscopic appendectomy. Data were...
Source: Journal of Pain and Palliative Care Pharmacotherapy - December 29, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Sustainable access to appropriate opioids for palliative care patients in Australia-preventing the need for crisis management.
Authors: Reed K Abstract The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst a...
Source: Journal of Pain and Palliative Care Pharmacotherapy - December 13, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Calcitonin Gene-Related Peptide (CGRP) Antagonists and Their Use in Migraines.
Authors: Henson B, Hollingsworth H, Nevois E, Herndon C Abstract Migraine is highly prevalent and associated with a large socio-economic burden in the United States. Current preventive medications have variable efficacy and their use is often limited by intolerable side effects. Calcitonin gene-related peptide (CGRP) has been identified as an integral part of migraine pathophysiology. There are currently seven CGRP antagonists under investigation, all of which are undergoing or have completed phase 3 clinical trials. Three of the investigated CGRP antagonists are approved for use within and outside of the United St...
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 26, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Analyzing and Benchmarking Global Consumption Statistics for Opioid Analgesics 2015: Inequality Continues to Increase.
Authors: Scholten W, Christensen AE, Olesen AE, Drewes AM Abstract Many countries around the world have a very low per capita consumption of opioid analgesics, which is probably related to absence or inadequate management of moderate and severe pain for large parts of their populations. We conducted a longitudinal observational study with opioid analgesic consumption data for all countries from 2000-2015, to assess 2015 per capita consumption data for strong opioid analgesics and to investigate the hypothesis that inequality decreased over the years 2000-2015. We based our study on the official statistics kept by t...
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 23, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Doctors and Nurses' Knowledge and Attitudes Towards Pediatric Pain Management: An Exploratory Survey in a Children's Hospital.
This study aimed to evaluate doctors and nurses' knowledge of pain treatment and the use of opioids in children, before and after the implementation of Law 38/2010, that represented an important step in guaranteeing patients' rights to gain access to appropriate services for pain control and palliative care in Italy and in establishing the obligation of specific training programs in this matter for health professionals. An ad hoc questionnaire was developed and administered before (investigation A) and after (investigation B) the issuance of the Law. In B both doctors and nurses showed a slight but significant increase in ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 8, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Ketamine: When Delirium and Desperation Call for a Hero.
Authors: Moazam C, Hirst J, Mesarwi P, Atayee RS Abstract The use of ketamine in palliative care is becoming more common for challenging symptom management, namely cancer related pain and psychiatric conditions. However, there is much that remains unstudied and uncertain about ketamine's clinical utility. In this case we examine a young cancer patient who was struggling with challenging neuropathic pain and significant existential anguish in the setting of metastatic pancreatic cancer and delirium. Despite concerns regarding baseline delirium we successfully used ketamine to better manage neuropathic pain, decrease...
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 8, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Opioid Rotation to Methadone for Refractory Cancer Pain: A Case Series.
Authors: Khoo SY, Aziz FA, Nambbiar P Abstract Methadone has been increasingly used in the treatment of refractory cancer pain with different conversion methods and ratios described. A retrospective chart review of patients on methadone for cancer pain was conducted to assess its use as the primary opioid, focusing on pain characteristics, opioid rotation indication, previous analgesics, adverse effects and final methadone dose in comparison with the pre-rotation Morphine Equivalent Daily Dose (MEDD). Eight patients were rotated to methadone due to refractory moderate-severe cancer pain and achieved good pain relie...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 24, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Clinical Manifestations and Diagnostic Evaluation of Opioid Allergy Labels - A Review.
Authors: Kalangara J, Potru S, Kuruvilla M Abstract While opioids represent one of the most common medication allergy labels, these labels are often unsubstantiated in clinical practice. The removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain. The current approach to patients with pseudo-allergy to opioids is switching to an alternative opioid with less histamine release. Thus, allergy labels to relatively lower potency opioids such as codeine may be feasibly result in the prescription of stronger medications like fentanyl that would otherwise not be indic...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 24, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Society of Pain And Palliative Care Pharmacists (SPPCP) Position Statement on the Proposed Change of Naloxone to Over-the-Counter (OTC) Status.
Authors: DiScala S, Fudin J, Coulson E, Lodl E, Kral L, Herndon C PMID: 31644358 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 24, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Hospital Opioid Requirements Following Continuation Versus Discontinuation of Buprenorphine for Addiction - A Retrospective Cohort Study.
Authors: Houchard G, Kullgren J, Saphire M, Porter K, Abel S Abstract Evidence guiding inpatient management of buprenorphine is lacking-this retrospective cohort study evaluated the clinical impact of hospital continuation versus discontinuation of buprenorphine at an academic medical center. The primary outcome was inpatient oral morphine equivalents (OME). Secondary outcomes included patient pain levels, functional assessment, and hospital length of stay. One hundred thirty-one patients (74 continued buprenorphine, 57 discontinued) were included in the analysis. Median OME were significantly lower among patients ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 17, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

The Use of Propofol for Continuous Deep Sedation at the End of Life: A Definitive Guide.
Authors: Bodnar J Abstract The anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. The manner in which it is dosed and administered in each environment varies, tailored to the specific task at hand. Because the use of propofol in end-of-life care is uncommon, providers may lack practical experience, and resources that are specific to this specialized application are not comprehensive and largely based on dosing and administration as it is done on the intensive care unit. The purpose of ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 16, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden.
Authors: Oderda GM, Senagore AJ, Morland K, Iqbal SU, Kugel M, Liu S, Habib AS Abstract Opioid-induced respiratory depression (OIRD) and postoperative nausea and vomiting (PONV) are challenging, resource-intensive, and costly opioid-related adverse events (ORAEs). Utilizing the Premier Healthcare Database, we identified patients> 18 years old, who underwent at least one surgical procedure of interest (i.e., cardiothoracic/vascular, general/colorectal, obstetric/gynecologic, orthopedic, or urologic), and received at least one dose of intravenous morphine, hydromorphone, or fentanyl for acute postoperative ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 16, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Pearls for opioid use in seriously ill patients.
Authors: Kral L, Ku J, Kematick BS, Fudin J Abstract Opioids are often the foundation of pain management in seriously ill patients. Unfortunately, even experienced providers carry with them information that they consider "fact", when this information is not based on scientific evidence, but on "myth". Several topics were elicited based on common beliefs and misconceptions in clinical practice. These were identified via a survey of pharmacist pain and palliative care providers. Pearls from these topics were chosen that were based on evidence and would have the greatest bearing on clinical practic...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 10, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Use of Dexmedetomidine for Postoperative Pain Management Following Spine Fusion Surgery in a Highly Opioid-Tolerant Patient.
Authors: Wu J, Ku SC, Ko AL Abstract A 51-year-old man with metastatic renal cell carcinoma whose fentanyl requirement was 3000-4000 µg/h in inpatient hospice presented for a thoracic (T) vertebral 4-10 posterior spinal fusion for a lytic T7 compression fracture. He underwent total intravenous (IV) anesthesia with propofol, remifentanil, and ketamine; liposome bupivacaine was locally infiltrated at the end of the case. Following extubation on postoperative day (POD) 1, he had severe pain refractory to high-dose IV fentanyl patient control analgesia and ketamine infusion. His pain dramatically improved ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 31, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Pain Management in Children With Cancer Using World Health Organization Guidelines at a Tertiary Cancer Center in Rural India.
Authors: Biji MS, Vinayagamoorthy V, Jithin TK, Raghavan V, Selvaraj K, Duraisamy K, Shringarpure K, Abhinaa SS, Deenathayalan VP, Mehta K, Rathi P, Mathews L Abstract Management of cancer pain among children is a difficult process due to the way they perceive pain, their dependence on parents, complexity of assessment, and limited availability of safe analgesics. Pain among children with cancer is still a less explored problem in India. This descriptive study was carried out in a tertiary cancer center to explore the characteristics of pain and its management among the children with cancer. We analyzed children di...
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 28, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Drug Enforcement Administration Rescheduling of Hydrocodone Combination Products Is Associated With Changes in Physician Pain Management Prescribing Preferences.
This study explored how HCP rescheduling and associated administrative barriers may have affected physician treatment of acute (aNCP) and chronic (cNCP) noncancer pain. To this end, physician members of the Texas Medical Association completed a self-administered online questionnaire. Pharmacotherapy treatment plan was measured with two questions asking physicians whether they were more likely to recommend HCPs, acetaminophen/codeine (APAP/codeine), nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, or other agents for the treatment of aNCP and cNCP. Two Likert-scaled items were used to assess administrative burden. I...
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 28, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Trigeminal Neuralgia: Medical Management and Surgical Options.
Authors: Green TH, Girgis F 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 trigeminal neuralgia, its diagnosis, medical therapies, surgical procedures, and treatment outcomes will be discussed. PMID: 31369323 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 3, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Transformation.
Authors: PMID: 31290722 [PubMed - in process] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - July 12, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Analysis of Inpatient Hospice Pharmacist Interventions Within a Veterans Affairs Medical Center.
Authors: Basri DS, DiScala SL, Brooks AT, Vartan CM, Silverman MA, Quellhorst J Abstract Clinical pharmacy interventions have been shown to improve medication therapy, prevent undesirable side effects, and improve patients' clinical outcomes in a number of settings; however, limited data exist to characterize clinical pharmacy specialist (CPS) providers' interventions in an inpatient hospice Veteran Affairs (VA) setting. The primary objective of this quality improvement (QI) project was to quantify the number and types of pharmacy interventions implemented from the Pharmacists Achieve Results with Medications Docum...
Source: Journal of Pain and Palliative Care Pharmacotherapy - July 12, 2019 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

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