Defining an Opioid Sparing Treatment Pathway for Chronic Abdominal Pain of Somatic and Visceral Origin: A Case Series.
We present a treatment algorithm for chronic abdominal pain using a combination of interventional therapy using transversus abdominis plane (TAP) blocks along with post injection medical management for treatment of somatic and visceral pain. This is a case series of 4 patients presenting with diverse causes of chronic abdominal pain were treated with the treatment algorithm defined below. Patients received either bilateral or unilateral TAP blocks based on pain location using a combination of 0.25% bupivicaine 10ml, 40mg triamcinolone, and clonidine 50 mcg by a single physician upon admission to our acute care hospital. Fo...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 25, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Clinical Tolerability and Safety of Tramadol in Hospitalized Patients.
Authors: Mohan N, Edmonds KP, Ajayi TA, Atayee RS Abstract Tramadol is a schedule IV, monoaminergic and μ-opioid-receptor analgesic with unique pharmacology properties. Though it is well established and widely utilized, there is little guidance on tramadol's place in therapy, including tolerability, safety and monitoring guidelines. Retrospective chart review of 250 patients who received oral tramadol during their hospitalization from January 1, 2018 to December 31, 2018. Of the 250 patients, 10.8% had cancer as their primary diagnosis while 8.8% were admitted for hematologic reasons. 79.1% of patients had acute...
Source: Journal of Pain and Palliative Care Pharmacotherapy - October 6, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Intravenous Ketamine Administered as Patient Controlled Analgesia and Continuous Infusion for Central Pain Syndrome.
We report a case of using ketamine as a patient-controlled analgesia (PCA) for the treatment of CPS. A 58-year-old male with CPS presented with severe generalized body pain refractory to multiple pharmacological interventions. He was started on a basal infusion rate at 0.3 mg/kg/h with a ketamine PCA bolus of 10 mg with a 10-minute lockout period. Over the next 7 days, the basal infusion rate was titrated up to 2.1 mg/kg/h relative to the number of times the patient pressed the PCA. At the end of the trial, the patient reported 0/10 pain with lightheadedness on the first day being the only side ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 23, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Palliative and Supportive Care Prescribing Considerations Around QT Prolongation Risk in the Context of COVID-19 (Coronavirus Disease 2019) Management.
Authors: Wong A, Keith C, Gregory H, Liew D Abstract COVID-19 brings with it unprecedented challenges in clinical management. An important component of care is the provision of safe and effective symptom control. Given the emerging literature reporting on the risk of QT prolongation and arrhythmias associated with COVID-19 disease and experimental therapies, we highlight some considerations for the prescribing of palliative care medications in this context. Based on the experience gained from palliative care referrals at our institution prior to and during the COVID-19 pandemic, and in collaboration with our clinic...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 23, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Evaluation of a Pharmacist Managed Telephone Pain Clinic for Neuropathy Treatment.
Authors: Dumpit JR, McGuire CD, Wang FY, Crandall B, Chen TC Abstract Pain is prevalent in our society, affecting more than a quarter-million U.S. adults and leading to poor patient outcomes. At the Veteran's Affairs San Diego Healthcare System (VASDHS), a Telephone Pain Clinic (TPC) was developed to improve these outcomes. The purpose of this study was to evaluate the effectiveness of TPC in improving neuropathic pain. A retrospective cohort study was conducted at the VASDHS comparing pre- and post- self-rated Numeric Rating Scale (NRS-11), an 11-point scale from 0 to 10 with 0 equaling no pain and 10 equaling mos...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 16, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Comparing Effectiveness of Gabapentin and Pregabalin in Treatment of Neuropathic Pain: A Retrospective Cohort of Palliative Care Outpatients.
This study demonstrates that pregabalin may afford better tolerability and lower pill burden compared to gabapentin. PMID: 32924715 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 16, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Population Pharmacokinetics of Methadone after Oral Administration in Japanese Patients with Cancer-Related Pain.
Authors: Kokubun H, Takigawa C, Chihara S, Hara S, Uezono Y Abstract Methadone tablets were approved for use in Japan in March 2013. The metabolism of methadone is complex and executed mainly by the cytochromes, CYP3A4 and CYP2B6. The aim of this study was to evaluate the pharmacokinetics of methadone upon oral administration in Japanese patients who experienced cancer-related pain. The concentration of the drug in blood samples was measured in 25 patients undergoing methadone therapy, and the factors leading to variations were investigated. A population pharmacokinetic analysis was evaluated using the Phoenix®...
Source: Journal of Pain and Palliative Care Pharmacotherapy - September 2, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Opioid Stewardship: Building on Antibiotic Stewardship Principles.
Authors: Uritsky TJ, Busch ME, Chae SG, Genord C Abstract The opioid stewardship model is born out of the antimicrobial stewardship model, and thus there are many shared characteristics. Both opioid stewardship and antimicrobial stewardship are based on the principle that there is an indication for a particular medication in the right patient at the right time. As antimicrobial stewardship is in a later stage of development, looking at the two in parallel can lead to interesting learning and development opportunities for opioid stewardship. Two requirements of antimicrobial stewardship that need to be applied to op...
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 13, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Acetaminophen in Patients Receiving Strong Opioids for Cancer Pain.
In this study of cancer patients receiving strong opioids, acetaminophen use was not associated with improved pain control or reduced opioid utilization, but was associated with a greater LOS. PMID: 32744914 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - August 5, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Effect of Antipsychotics and Non-Pharmacotherapy for the Management of Delirium in People Receiving Palliative Care.
Authors: Lee KY, Tan ECK, Hanrahan JR, Chircop C, Michael F, Ong JA Abstract Evidence to support the use of antipsychotic medications for the management of delirium symptoms remains limited. The primary objective of this study was to compare the effect of antipsychotic and non-antipsychotic treatments for delirium symptoms among palliative care inpatients. Secondary outcomes were use of midazolam and overall survival. This involved retrospective analysis of medical records (November 2018 to April 2019) for adult palliative care patients diagnosed with delirium at an Australian tertiary hospital. NuDESC was used to ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - July 31, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Adding Fuel to the Fire!
Authors: Jeba J PMID: 32527187 [PubMed - as supplied by publisher] (Source: Journal of Pain and Palliative Care Pharmacotherapy)
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 14, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Changes in Pain Medication Profile among Patients Admitted to Specialized Home Palliative Care in Relation to Referral Source: An Exploratory Study.
Authors: Berthold D, Carrasco AJP, Brachvogel S, Sibelius U, Eul B, Dumitrascu R, El-Awad U, Maeder LJ, Hauch H Abstract Pain is a common symptom leading to referrals to specialized home palliative care (SHPC) services and is known to affect patients' quality of life. To date, little is known about the impact of referral source on its management. To assess changes to pain medication profile in the course of SHPC and to identify potential differences in relation to referral source. This exploratory study is a retrospective analysis of 501 electronic medical records of a SHPC team in Germany. This included the assess...
Source: Journal of Pain and Palliative Care Pharmacotherapy - June 11, 2020 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

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 7, 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 7, 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