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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

Impact of palliative treatment on survival in sinonasal malignancies
ConclusionIn this study we identify the impact of palliative treatment modalities on survival in sinonasal cancer. Palliative surgery was shown to have the highest 1Y ‐OS and M‐OS compared with other palliative treatment modalities.
Source: International Forum of Allergy and Rhinology - September 19, 2019 Category: Allergy & Immunology Authors: Nicole I. Farber, Roman Povolotskiy, Richard D. Bavier, Julia Riccardi, Jean Anderson Eloy, Wayne D. Hsueh Tags: ORIGINAL ARTICLE Source Type: research

Aromatherapy improves nausea, pain, and mood for patients receiving pediatric palliative care symptom-based consults: A pilot design trial.
Abstract OBJECTIVE: The role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure. METHODS: The 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathin...
Source: Palliative and Supportive Care - August 18, 2019 Category: Palliative Care Authors: Weaver MS, Robinson J, Wichman C Tags: Palliat Support Care Source Type: research

Intrathecal Injection of Gadobutrol: A Tale of Caution.
We report a case of an intrathecal gadobutrol injection resulting in neurotoxic manifestations.A 60-year-old female with a history significant for lumbar post-laminectomy syndrome and intrathecal drug delivery implantation was admitted for lumbar fusion and kyphoplasty. Postoperatively, the patient had escalating pain medication requirements. A pump and intrathecal catheter contrast study was completed to assess the integrity and proper placement of the intrathecal catheter. Due to patient.s allergy to iodinated contrast, the physician requested gadolinium contrast dye. Unknown to the staff was that Magnevist had recently ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - May 12, 2017 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Nebulized Fentanyl for Dyspnea in a Hospice Patient with True Allergy to Morphine and Hydromorphone.
Authors: Wahler RG, Smith DB, Mulcahy KB Abstract An 86-year-old white female was admitted to hospice care with lung cancer. Even with optimal medical management, she suffered from dyspnea and required opioid therapy. However, the patient had a true morphine and hydromorphone allergy. She was administered nebulized fentanyl for symptomatic relief of dyspnea with good effect and she did not experience any allergic response. PMID: 28287363 [PubMed - in process]
Source: Journal of Pain and Palliative Care Pharmacotherapy - March 15, 2017 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

Paracetamol: pharmacology, prescribing and controversies
Indications and mechanism of action Paracetamol (internationally known as acetaminophen) is the most common medicine encountered in paediatric practice. It is used widely by parents and health professionals and it has analgesic and antipyretic effects. Its short-term safety and efficacy are well established and it is readily available for purchase over the counter. Its mechanism of action is not fully understood but it is known to inhibit prostaglandin synthesis and is highly selective for cyclooxygenase enzymes in the central nervous system. It also has a weak anti-inflammatory action. An understanding of its pharmacology...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Moriarty, C., Carroll, W. Tags: Editor's choice, Immunology (including allergy), Pain (neurology), Child health, Infant health, Neonatal health, Pain (palliative care), Rheumatology, Poisoning, Occupational and environmental medicine Research in practice Source Type: research

NSAIDs or paracetamol for short-term treatment of mild to moderate knee pain in early osteoarthritis: are they equivalent?
Commentary on: Verkleij SP, Luijsterburg PA, Willemsen SP, et al.. Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care. Br J Gen Pract 2015;65:e530–7. Context Management of osteoarthritis (OA) in primary care is often pharmacologically dominated with paracetamol and oral non-steroidal anti-inflammatory drugs (NSAIDs) both very commonly used.1 Current evidence-based guidelines recommend both agents, starting with paracetamol. This is because NSAIDs have a serious side effect profile and paracetamol is generally a lot safer (though perhaps not without pro...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Conaghan, P. G. Tags: Clinical trials (epidemiology), General practice / family medicine, Immunology (including allergy), Pain (neurology), Pain (palliative care), Degenerative joint disease, Drugs: musculoskeletal and joint diseases, Musculoskeletal syndromes, Osteoarthritis, Source Type: research

No difference in pain, swelling or function with NSAIDs compared with paracetamol for soft tissue injury
Commentary on: Jones P, Dalziel SR, Lamdin R, et al. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev 2015;7:CD007789. Implications for practice and research Paracetamol may be the first choice of treatment for soft tissue injuries because of less adverse events and similar efficacy as non-steroidal anti-inflammatory drugs (NSAIDs). Additional randomised controlled trials (RCTs) are required to determine if there is a difference in return to function or adverse effects between non-selective and COX-2 selective NSAIDs versus paracetamol. F...
Source: Evidence-Based Nursing - December 15, 2015 Category: Nursing Authors: van den Bekerom, M. P. J. Tags: Pain management, Immunology (including allergy), Pain (neurology), Pain (palliative care), Pain (anaesthesia), Complementary medicine, Drugs: musculoskeletal and joint diseases, Trauma, Injury Source Type: research

Paediatric pain-related conditions impact healthcare expenditures
The objectives of this study, therefore, are twofold: (1) to assess the impact of paediatric pain-related conditions on national healthcare expenditures and (2) to compare incremental healthcare expenditures associated with paediatric pain-related conditions relative to asthma, ADHD and obesity in children. Methods This cross-sectional study linked two large, nationally representative databases: the 2007 National Health Interview Survey (NHIS) and 2008 Medical Expenditure Panel Survey (MEPS)....
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Torio, C. Tags: Palliative care, Health policy, Epidemiologic studies, Immunology (including allergy), Headache (including migraine), Pain (neurology), Obesity (nutrition), Child and adolescent psychiatry, Asthma, Health economics, Health service research, Health educati Source Type: research

THE NEUROPATHY SPECTRUM IN WALDENSTRoM'S MACROGLOBULINAEMIA
We present 5 cases illustrating an extended diversity of PNS involvement in WM with implications for treatment and outcome. Cases A 73 year-old man (IgM WM) developed progressively disabling tremor with stable WM. Neurophysiology was demyelinating with disproportionate DMLs; anti-MAG antibodies were strongly positive. He was treated with DRC with symptom stabilisation. A 64 year-old woman (IgM) with typical anti-MAG neuropathy developed severe episodic foot pain and ulceration. Skin biopsy confirmed leucocytoclastic vasculitis. She was treated with DRC but died from sepsis. A 43 year-old man (IgM WM) with rapidly progress...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 14, 2015 Category: Neurosurgery Authors: Carr, A., Jaunmuktane, Z., Brandner, S., Kothari, J., Blake, J., D'Sa, S., Lunn, M. Tags: Immunology (including allergy), Pain (neurology), Hospice, Radiology, Vascularitis Thur 21, Parallel session 5: Therapeutics Source Type: research

Sugar and warmth additively decrease pain in newborns getting vaccines
Commentary on: Gray L, Garza E, Zageris D, et al. Sucrose and warmth for analgesia in healthy newborns: an RCT. Pediatrics 2015;135:e607–14. Context Sucrose as an analgesic has been well studied in the newborn and infant population undergoing brief noxious stimuli such as vaccines or heel sticks.1 Providing additional, non-pharmacological, therapeutic options to create a synergy with the sucrose has been considered in other studies.2 Breast feeding, which supplies the sweetness of sugar (breast milk) and skin-to-skin contact, has been thought to provide radiant body heat.3 4 The authors of this study draw on their pr...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Harrington, J. W. Tags: Liver disease, Clinical trials (epidemiology), Immunology (including allergy), Hepatitis and other GI infections, Vaccination / immunisation, Pain (neurology), Childhood nutrition, Pain (palliative care), Drugs: musculoskeletal and joint diseases, Hepatit Source Type: research

American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014
This American guideline updates previous 2006 recommendations providing guidance for primary care and specialist clinicians for treating children of 2 years and older with acute otitis externa (AOE): a diffuse inflammation of the external ear canal±pinna and tympanic membrane.1 2 Key points: what should I be doing? Distinguish diffuse AOE from other causes of otalgia and otorrhoea, for example, dermatitis (inflammatory, contact, allergic), viral infections, furunculosis and referred pain from other sites Appropriately assess pain and treat with analgesia such as non-steroidal anti-inflammatories. There are no s...
Source: Archives of Disease in Childhood - Education and Practice - July 17, 2015 Category: Pediatrics Authors: Prentice, P. Tags: Oncology, Journalology, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Otitis, Pain (neurology), Child health, Pain (palliative care), Sexual health, Dermatology, Ear, nose and throat/otolaryngology, Competing interests (ethics), Tr Source Type: research

Implementing a training and accreditation scheme for tta (to take away) pre-pack dispensing
Conclusion The training and accreditation programme has allowed for the implementation of a safe dispensing and checking process for TTA prepacks by medical and nursing staff. The next step is to audit the process.
Source: Archives of Disease in Childhood - May 18, 2015 Category: Pediatrics Authors: Betmouni, R., Gillani, N. Tags: Immunology (including allergy), Drugs: infectious diseases, Pain (neurology), Pain (palliative care), Unwanted effects / adverse reactions, Pain (anaesthesia), Screening (epidemiology), Screening (public health) Short Papers Source Type: research

TRPV1, CGRP and SP in scalp arteries of patients suffering from chronic migraine. Some like it hot! Chronic migraine increases TRPV1 receptors in the scalp
The transient receptor potential vanilloid type-1 receptor (TRPV1) is a non-selective, ligand-gated cation channel expressed in small sensory neurons.1 It responds to noxious heat, protons and capsaicin and it is preferentially expressed in small sensory neurons.2 3 Trigeminal nociceptive neurons contain glutamate, substance P (SP) and calcitonin gene-related peptide (CGRP). TRPV1 receptors evoke CGRP release; inhibition prevents and reverses central sensitisation. BoNT/A has analgesic effects on capsaicin-evoked pain. It is effective in chronic migraine treatment.4 BoNT/A decreases TRPV1-positive neurons in the rat trigem...
Source: Journal of Neurology, Neurosurgery and Psychiatry - March 13, 2015 Category: Neurosurgery Authors: Silberstein, S. D. Tags: Immunology (including allergy), Drugs: CNS (not psychiatric), Headache (including migraine), Pain (neurology), Pain (palliative care), Pain (anaesthesia), Drugs: musculoskeletal and joint diseases Editorial commentaries Source Type: research

How safe is paracetamol?
Paracetamol is the most widely used medicine in children, in hospital and in the community. In most countries it is available over the counter and as a prescribed medicine. It is used as an analgesic and an antipyretic. Pain has historically been undertreated in children, especially in preverbal children. In contrast, fever is overtreated, especially in high-income countries. Concerns have been raised regarding the safety of paracetamol in relation to the development of liver toxicity and possible long-term effects in the development of asthma. Exposure to paracetamol in pregnancy or infancy has been linked with an increas...
Source: Archives of Disease in Childhood - December 15, 2014 Category: Pediatrics Authors: Star, K., Choonara, I. Tags: Liver disease, Open access, ADC Drug Therapy, Immunology (including allergy), TB and other respiratory infections, Pain (neurology), Pregnancy, Reproductive medicine, Adolescent health, Child health, Pain (palliative care), Unwanted effects / adverse reac Source Type: research

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