Journal of Pain & Palliative Care Pharmacotherapy最新文献

{"title":"Suzetrigine (Journavx) as a Non-Opioid Adjuvant for Cancer-Associated Pain: A Case Series.","authors":"Anil Desai","doi":"10.1080/15360288.2026.2753457","DOIUrl":"https://doi.org/10.1080/15360288.2026.2753457","url":null,"abstract":"<p><p>Opioids remain central to managing cancer-associated pain (CAP) but are often limited by constipation, nausea, sedation, and concerns about maladaptive use amid the ongoing opioid epidemic. Suzetrigine (Journavx), a first-in-class, non-opioid, selective NaV1.8 sodium channel inhibitor, was approved by the U.S. Food and Drug Administration in January 2025 for moderate-to-severe acute pain; its role in chronic pain syndromes such as CAP has not been established. This case series describes two patients with CAP of differing pathophysiology started on suzetrigine as an off-label adjuvant analgesic. An 80-year-old man with radicular pain from metastatic prostate cancer to bone, who had declined opioid therapy, had an Edmonton Symptom Assessment Scale (ESAS) pain score that fell from 4/10 at baseline to 1-2/10 over approximately six months, with benefit first reported after three weeks. A 63-year-old man with severe oxaliplatin-associated chemotherapy-induced peripheral neuropathy on a multidrug regimen had an ESAS pain score that improved from 9/10 to 4/10 over three weeks, during which he self-discontinued duloxetine and substantially reduced his gabapentin and oxycodone use. Neither patient experienced adverse reactions. These anecdotal cases suggest suzetrigine may have potential as an opioid- and adjuvant-sparing analgesic across more than one CAP pain phenotype, supporting further prospective study outside its currently approved acute-pain indication.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical Diclofenac Patches Versus Oral Diclofenac for Postoperative Dental Pain: A Systematic Review.","authors":"Maryam Altuhafy, Diya Kamdar, Junad Khan","doi":"10.1080/15360288.2026.2740065","DOIUrl":"https://doi.org/10.1080/15360288.2026.2740065","url":null,"abstract":"<p><p>Postoperative pain is common following dental procedures, and the route of administration may influence analgesic efficacy and tolerability. This review compared topical diclofenac patches with oral diclofenac tablets for postoperative dental pain. The patches evaluated in the included studies are local topical therapies that release diclofenac into and near the skin at the application site; they should not be interpreted as systemic transdermal delivery systems. Indexed databases, including PubMed, EMBASE, Ovid, Scopus, ISI Web of Knowledge, and the Cochrane Library, were searched through August 2024. Fourteen studies met the eligibility criteria for qualitative synthesis, and risk of bias was assessed using the Cochrane Risk of Bias tool for interventions. Some studies reported early postoperative pain relief and fewer gastrointestinal complaints with topical diclofenac patches than with oral tablets; however, findings were heterogeneous and not consistently significant, and the overall risk of bias was high. Accordingly, the available evidence does not establish superior efficacy of topical diclofenac patches over oral diclofenac. The apparent analgesic effects at dental sites distant from patch placement require mechanistic clarification and confirmation in standardized, high-quality trials.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-62"},"PeriodicalIF":1.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three Years of Bidirectional, Home-Based Opioid Route Management in Advanced Cervical Cancer with Coexisting Causes of Route Failure: A Case Report.","authors":"Takao Arai","doi":"10.1080/15360288.2026.2746625","DOIUrl":"https://doi.org/10.1080/15360288.2026.2746625","url":null,"abstract":"<p><p>Oral administration is preferred for cancer pain, and when it fails the switch to a parenteral or transdermal route is usually made once and in one direction. We describe a woman with recurrent cervical cancer managed at home for approximately three years in whom several causes of route failure coexisted-short bowel syndrome with a stoma (impairing enteral absorption of sustained-release opioids), profound cachexia (impairing subcutaneous absorption), and recurrent indwelling-device infections (threatening vascular access)-so that the opioid route had to be changed repeatedly and in both directions. Delivery moved from oral, to continuous subcutaneous patient-controlled analgesia (PCA), to an existing central venous port when subcutaneous absorption failed, back to oral hydromorphone, then to transdermal and transmucosal fentanyl when tablets were recovered undissolved from the stoma, and finally back to intravenous PCA with hydromorphone and ketamine as bony metastatic pain emerged. Each transition followed an identifiable event and was accomplished at home through physician-pharmacist-visiting-nurse collaboration, including home therapeutic drug monitoring. Analgesia and an active quality of life were largely maintained. When multiple causes of route failure coexist, opioid route selection cannot be a single fixed decision; a flexible, bidirectional and anticipatory approach to route management is central to home-based palliative care.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Use of a Systemic Diclofenac Patch for Cancer Pain: A Retrospective Analysis of Prescription Patterns at a Single Japanese University Hospital.","authors":"Shinya Kajiura, Shingo Chikaoka, Yuta Yagi, Nobukazu Ryu, Yurika Nakayama, Miho Sakumura, Yuko Ueda, Iori Motoo, Takayuki Ando, Ichiro Yasuda, Atsushi Kato, Ryuji Hayashi","doi":"10.1080/15360288.2026.2738697","DOIUrl":"https://doi.org/10.1080/15360288.2026.2738697","url":null,"abstract":"<p><p>Real-world evidence on systemic diclofenac patch use in cancer pain is limited. We described prescribing patterns in oncology practice. In this single-center retrospective descriptive study, we reviewed consecutive patients with cancer who received a systemic diclofenac patch (75 mg per patch) for cancer-related pain at a Japanese university hospital (<i>n</i> = 48). The usual regimen was two 75-mg patches once daily (150 mg/day); one patient started one 75-mg patch/day. Among 48 patients, 35 (73%) retained oral medication intake and 32 (67%) were receiving ongoing anticancer therapy at patch initiation. Gastroprotective agents were co-prescribed in 31 patients (65%), any acetaminophen in 29 (60%; scheduled acetaminophen in 28 [58%]), and opioids in 28 (58%). Transdermal fentanyl-containing regimens were observed in 9 patients (19%), whereas strict all-transdermal scheduled baseline analgesia was identified in 3 (6%). No recipient had documented clinically apparent gastrointestinal bleeding or symptomatic peptic ulcer during available follow-up. The systemic diclofenac patch was prescribed to selected patients with cancer-related pain in routine Japanese practice and was commonly incorporated into multimodal analgesic regimens. These findings describe prescribing patterns and chart-documented observations only; prospective studies with standardized outcomes are needed to clarify effectiveness, safety, and patient-centered impact.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dronabinol for Neuropathic Pain in Palliative Care.","authors":"Garner Boogaerts, Asti Rego, Heather Freeman, Steven Baumrucker, Saima Rashid","doi":"10.1080/15360288.2026.2718824","DOIUrl":"https://doi.org/10.1080/15360288.2026.2718824","url":null,"abstract":"<p><p>Neuropathic pain, characterized by dysfunction in the somatosensory system, is prevalent among palliative care patients, often resulting from conditions such as cancer, neurodegenerative diseases, and diabetes. Effective management of neuropathic pain is crucial for enhancing patient comfort and quality of life. This review explores the efficacy of dronabinol, a synthetic delta-9-tetrahydrocannabinol (THC), in managing neuropathic pain in palliative care. A comprehensive review of neuropathic pain mechanisms, treatment options, and the role of the endocannabinoid system was conducted. Clinical evidence supporting use of dronabinol for neuropathic pain was analyzed, including its pharmacological action, safety profile, and potential advantages over traditional analgesics. Dronabinol modulates pain pathways through CB1/CB2 receptor activation, reducing nociceptive transmission and neuroinflammation. Clinical studies indicate that dronabinol provides modest analgesic effects, improves associated symptoms such as nausea and sleep disturbances, and exhibits opioid-sparing potential. Dronabinol may represent a potential therapeutic option for neuropathic pain in palliative care. Its reported multimodal effects, generally favorable safety profile, and possible role in reducing opioid requirements should be considered potential advantages; however, these findings are supported by limited and heterogeneous evidence. Further research is needed to better define optimal dosing, assess long-term safety, and compare its efficacy with established treatments for neuropathic pain.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-11"},"PeriodicalIF":1.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Progress of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: Mechanisms, Efficacy, and Clinical Practice.","authors":"Yu-Hui Zheng, Ren-Shu Li, Zheng Wang, Rui Pan","doi":"10.1080/15360288.2026.2731925","DOIUrl":"https://doi.org/10.1080/15360288.2026.2731925","url":null,"abstract":"<p><p>Knee osteoarthritis (KOA) affects approximately 28% of adults older than 45 years in China. About 20% to 30% of patients experience neuropathy-like pain features (burning, shooting pain, allodynia) that respond poorly to conventional nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or hyaluronic acid. Platelet-rich plasma (PRP) has emerged as a promising autologous biologic for KOA. This narrative review summarizes the mechanisms, clinical efficacy, and practical considerations of PRP for KOA, with emphasis on its unique ability to relieve neuropathy-like pain through central immunomodulation. PRP exerts effects via tissue repair (growth factors: TGF-β, PDGF, VEGF), pain relief, and immunomodulation. Unlike conventional treatments targeting only inflammatory pain, preclinical evidence suggests that PRP modulates spinal microglial M1→M2 polarization, potentially reducing central sensitization. Clinically, leukocyte-poor PRP is superior to leukocyte-rich PRP. PRP combined with hyaluronic acid provides 6 to 12 months of efficacy. Optimal platelet concentration ranges from 600 to 900 × 10⁹/L, with a minimum of 3.5 × 10⁹ platelets per injection. PRP offers a unique advantage over existing non-operative KOA treatments by relieving neuropathy-like pain through central immunomodulation-a mechanism not shared by NSAIDs, corticosteroids, or hyaluronic acid. For patients with KOA and neuropathy-like pain features that respond poorly to conventional analgesics, PRP represents a promising therapeutic candidate that warrants further dedicated clinical trials.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-14"},"PeriodicalIF":1.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Pharmacist Support for Complex Palliative Pharmacotherapy and Home Infusion in Advanced Heart Failure: A Case Report.","authors":"Hiroshi Suzuki, Makiko Mori, Yusuke Hattori, Akari Koizumi, Taiki Murakami, Katsuya Yamauchi","doi":"10.1080/15360288.2026.2736029","DOIUrl":"https://doi.org/10.1080/15360288.2026.2736029","url":null,"abstract":"<p><p>Advanced heart failure (HF) may require complex palliative pharmacotherapy, including continuous home infusion of inotropes, diuretics, and opioids, together with careful management of infusion devices, injectable-drug quality, compatibility, and symptom monitoring. However, practical reports describing community pharmacist involvement in such care remain limited, particularly from the pre-discharge phase. We report a case of end-of-life pharmacotherapy and home infusion for advanced HF supported by an interdisciplinary team. A 76-year-old man with stage D HF and inotrope dependence chose home-based care after repeated hospitalizations for decompensated HF. Before discharge, the community pharmacist contributed to device-operation training, aseptic compounding procedures, cassette-exchange scheduling, and contingency planning for continuous dobutamine infusion. During home care, the pharmacist coordinated cassette preparation and exchange, proposed a lightweight disposable pump for high-dose continuous furosemide infusion, implemented light protection for furosemide, supported lumen separation to avoid incompatibility with dobutamine, and prepared a morphine cassette for continuous subcutaneous infusion. Home infusion was continued until the patient died peacefully at home on Day 45. This case highlights the multifaceted role of community pharmacists in supporting complex palliative pharmacotherapy and home infusion for advanced HF.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregabalin Modified-Release Formulations: Clinical Differences Beyond Adherence.","authors":"Antonio Alcántara Montero","doi":"10.1080/15360288.2026.2734030","DOIUrl":"https://doi.org/10.1080/15360288.2026.2734030","url":null,"abstract":"","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-3"},"PeriodicalIF":1.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective Uptake of Oral Extended-Release Hydromorphone After Formulary Listing in Cancer Care.","authors":"Shinya Kajiura, Shingo Chikaoka, Ryuji Hayashi","doi":"10.1080/15360288.2026.2731928","DOIUrl":"https://doi.org/10.1080/15360288.2026.2731928","url":null,"abstract":"","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-4"},"PeriodicalIF":1.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tizanidine Withdrawal Syndrome: Clinical Manifestations and Management Strategies. Case Series.","authors":"Emad AlAttar, Farook AlRawi, Samaira Rafique","doi":"10.1080/15360288.2026.2719866","DOIUrl":"https://doi.org/10.1080/15360288.2026.2719866","url":null,"abstract":"<p><p>Tizanidine, an imidazole derived α2 adrenergic agonist, is widely prescribed for spasticity and chronic musculoskeletal pain. Abrupt discontinuation can precipitate withdrawal syndromes characterized by sympathetic overactivity. Although pharmacologically plausible, this phenomenon is potentially underreported in clinical practice. We describe four patients with diverse comorbidities who developed acute tizanidine withdrawal. All cases were directly observed at a single tertiary care center and identified during routine inpatient clinical practice over a defined timeline. Case 1 was a 24 year old female admitted with empagliflozin induced diabetic ketoacidosis who experienced hypertensive crisis and tachycardia following abrupt cessation of chronic high dose tizanidine. Case 2 was a 29 year old female with Crohn's disease who developed tremors, anxiety, and autonomic instability after reducing her regimen from 40 mg nightly to 16 mg daily. She had self-discontinued her last dose prior to presentation. Case 3 was a 29 year old female with recurrent pancreatitis, resistant hypertension, and an adrenal incidentaloma who presented with severe hypertension and tremors after discontinuing both tizanidine and diazepam. Symptoms began within approximately 24 h of abrupt cessation. Case 4 was a 42 year old male with asthma, hypertension, anxiety disorder, bariatric surgery, methamphetamine use, and more than ten prior admissions specifically for tizanidine withdrawal, who presented with palpitations, tremors, vomiting, and hypertensive crisis after abrupt dose reduction. In all cases, reintroduction of tizanidine followed by a structured tapering regimen resulted in clinical stabilization. These cases highlight the clinical significance of tizanidine withdrawal, its diverse presentations, and the importance of cautious tapering. Patient education on avoiding abrupt discontinuation is essential, particularly for individuals with psychiatric comorbidities or prior withdrawal episodes. Awareness of this underrecognized syndrome is critical to prevent misdiagnosis and ensure safe prescribing practices.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}