Journal of Pain & Palliative Care Pharmacotherapy最新文献

{"title":"Peer Review Questions & Answers: How? Part III: Writing the Reviewer Report.","authors":"Laura Meyer-Junco","doi":"10.1080/15360288.2023.2271817","DOIUrl":"10.1080/15360288.2023.2271817","url":null,"abstract":"","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"265-267"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158197","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":"Oxycodone Extended-Release Capsule Utilization for Pain Management in a Cancer Palliative Care Clinic: A Retrospective Review.","authors":"Jordan Fortunato, Justin Kullgren, Gary Houchard, Jessica Hirsch, Nicole Shirilla, Meridith Bumb, Junan Li","doi":"10.1080/15360288.2023.2253248","DOIUrl":"10.1080/15360288.2023.2253248","url":null,"abstract":"<p><p>Xtampza ER™, an oxycodone extended-release capsule (OERC), was the first long-acting opioid to feature abuse-deterrent properties and various routes of administration without pharmacokinetic alterations. The primary objective of this study was to evaluate changes in reported pain scores after initiation of or rotation to OERC from a previous opioid.  Baseline scores were from patients' outpatient visits immediately before starting OERC and were compared to those at the next two follow-up visits. Secondary objectives identified variables that influenced pain scores. Methods included screening for cancer patients with outpatient OERC prescriptions seen in the palliative care clinic. Eighty-two charts were reviewed with 66 included. Overall mean pain scores at both follow-ups were lower than those at baseline (-0.7 ± 2.1; -1.1 ± 2.4). Results were statistically significant between first and second-reported pain scores versus baseline (<i>p</i> = 0.009; 0.012) but clinically insignificant, defined as <i>a</i> ≥ 2-point change in numeric pain scores. Most patients discontinued OERC at the first or second follow-up (35; 53%), and 12.1% of patients who started OERC were prescribed OERC at the end of the study. There were no significant variables identified to influence pain scores either statistically or clinically. Further studies are needed to determine the long-term efficacy and safety in cancer palliative-care patients.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"286-297"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10279171","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":"Mpox Pain Management and Topical Agents.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1080/15360288.2023.2276930","DOIUrl":"10.1080/15360288.2023.2276930","url":null,"abstract":"","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 4","pages":"270-271"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138445042","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":"Comparing Post-operative Opioid Consumption before and after a Patient-Controlled Analgesia Shortage: A Re-evaluation of Safety and Effectiveness.","authors":"Lena Zoma, Renee Alexander Paxton, Michelle Dehoorne, Christopher Giuliano","doi":"10.1080/15360288.2023.2250334","DOIUrl":"10.1080/15360288.2023.2250334","url":null,"abstract":"<p><p>This retrospective cohort study aimed to compare post-surgical opioid consumption before and after a PCA (patient-controlled analgesia) shortage. The study evaluated patients who received PCA <i>vs.</i> nurse-administered opioid analgesia (non-PCA). Two hundred and twenty-four patients ≥18 years who were initiated on analgesia within 24 h of surgery were included. The primary outcome was opioid consumption in average daily oral morphine milliequivalents (MME). The results showed that patients in the PCA group had increased MME consumption (162 ± 100.4 <i>vs.</i> 70.7 ± 52.8, <i>p</i> < 0.01), increased length of hospital stay (4.2 <i>vs.</i> 3.2 days, <i>p</i> < 0.01), and increased frequency of nausea (33 <i>vs.</i> 17.9%, <i>p</i> < 0.01). After controlling for confounding factors, the PCA group utilized significantly more opioids (84.6 MME/day, <i>p</i> < 0.01) than the non-PCA group. There was no difference in pain AUC/T (0.19 ± 0.07 <i>vs.</i> 0.21 ± 0.08, <i>p</i> = 0.07) and average opioid prescribing upon discharge (150 [77.5-360] <i>vs.</i> 90 [77.5-400], <i>p</i> = 0.64) between the PCA group and non-PCA group, respectively. These results question the routine use of PCA in post-operative patients due to the increased risk of opioid consumption, longer length of hospital stay, and higher incidence of nausea.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"272-277"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10160704","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":"Potential Drug Interactions in Terminally-Ill Cancer Patients, a Report from the Middle East.","authors":"Hamed Mahzoni, Erfan Naghsh, Mehran Sharifi, Ayda Moghaddas, Mahnaz Momenzadeh, Azadeh Moghaddas","doi":"10.1080/15360288.2023.2253223","DOIUrl":"10.1080/15360288.2023.2253223","url":null,"abstract":"<p><p>This study aims to evaluate the epidemiology of potential drug interactions in terminally-ill cancer patients receiving exclusively supportive care. In this cross-sectional study, during a 6-month follow-up, we considered the medical record of terminally-ill cancer patients referred to palliative care at the cancer center in Isfahan, Iran. Potential drug-drug interactions (DDIs) were assessed by Lexi-Interact ver.1.1 online software. During the study period, 133 terminally-ill cancer patients were recruited. We detected 1678 DDIs with moderate or major severity levels. Among them, 330, 219, 32, 1075, and 51 interactions were categorized in B, C, D, and X drug interactions categories, respectively. One hundred and twenty-two patients (91.73%) encountered at least one potential drug-drug interaction during the end of life care. Mechanistically, most drug-drug interactions (64.5%) were pharmacodynamics. The most frequent pharmacological class of drugs responsible for DDIs were quetiapine (91 cases), oxycodone (87 cases), and sertraline (55 cases). Interaction between oxycodone and sertraline was found to be in the top 10 detected DDIs (13.7%). Our results showed that potentially moderate or major drug-drug interactions often occur among terminally-ill cancer patients and the clinical significance of DDIs should be considered meticulously in the palliative care cancer setting.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"278-285"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243800","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":"Systematic Review on Barriers to Access Opioid Analgesics for Cancer Pain Management from the Health Worker Perspective.","authors":"Josephine Fleckner, Katherine Pettus, Nandini Vallath, Tania Pastrana","doi":"10.1080/15360288.2023.2257674","DOIUrl":"10.1080/15360288.2023.2257674","url":null,"abstract":"<p><p>The increasing incidence of oncological diseases creates a corresponding need for effective cancer pain management (CPM). The lack of access to and availability of opioid analgesics in most countries leads to avoidable suffering. This systematic review aims to identify barriers to accessing opioids, as described in literature that reflects the perspective of health-care workers. A systematic literature search was performed in May 2018 and updated in December 2022, using search terms related to \"cancer pain,\" \"opioid analgesics,\" \"access,\" and \"health-care personnel.\" Medline, Embase, and PsycInfo were searched. Forty-two studies met the inclusion criteria. Principal barriers that have hindered licit access to medical opioids include regulatory, systemic, educational, patient-related, and societal. These barriers are rooted in a lack of adequate education about the importance and significance of appropriate CPM. Barriers were often mutually reinforcing. A interdisciplinary approach is required to overcome them. This research contributes to the important global health issue of unduly limited access to opioid analgesics. It provides interdisciplinary solutions in terms of guidelines to ensure that governments respect, protect, and fulfill the right to the highest attainable standard of health, which includes the relief of severe pain.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"324-335"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122722","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":"Atypical Withdrawal Symptoms after Abrupt Tramadol Discontinuation: A Case Report.","authors":"Caylee Sams, Serena Cheng","doi":"10.1080/15360288.2023.2261913","DOIUrl":"10.1080/15360288.2023.2261913","url":null,"abstract":"<p><p>Tramadol is a commonly utilized analgesic in the United States. One common misconception is that tramadol is safer than other opioid medications, or less likely to cause physical dependence. Given these misconceptions, the likelihood of patients experiencing withdrawal after discontinuation may be commonly overlooked as well. A 68-year old female patient with fibromyalgia was referred to a clinical pharmacy pain clinic for medication management. The patient was evaluated one month after abrupt discontinuation of tramadol 50 mg every 6 h for at least 10 years of use. She reports concerning symptoms of significant mucus production, fullness in chest and soreness in neck. Although tramadol is a Schedule IV Controlled Substance the risk of physical dependence and likelihood of patients experiencing withdrawal symptoms after abrupt cessation should not be diminished. Tramadol should not be considered a \"safer\" opioid therapy without potential of classic or atypical withdrawal symptoms, as well as risk of abuse, misuse or addiction.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"321-323"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41105901","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":"Accidental Administration of Mega-Dose-Morphine Intrathecally.","authors":"Evangelia Samara,&nbsp;Agathi Karakosta,&nbsp;Vasilios Tsionaras,&nbsp;Petros Tzimas","doi":"10.1080/15360288.2023.2219666","DOIUrl":"10.1080/15360288.2023.2219666","url":null,"abstract":"Dear Editor, Intrathecal opioid administration is a common practice in major abdominal surgery, to facilitate postoperative pain management and lower total opioid consumption (1). We report a case of accidental administration of mega-dose-morphine intrathecally. A 64-year-old patient of 84 kg weight and 172 cm height presented to the OR to undergo an elective sigmoidectomy due to malignancy. His medical record was significant for Paget’s disease under no medication. For his postoperative analgesia, an intrathecal administration of ropivacaine 15 mg and morphine 100 mcg in total volume of 3 ml was planned, using an atraumatic needle of 25 G. Immediately after, anesthesia induction was facilitated with propofol 2 mg/kg, fentanyl 250 mcg and rocuronium 0.6 mg/kg. Anesthesia was maintained with sevoflurane. The procedure lasted for two hours and was uneventful. Toward the end, medication syringes were checked prior to discard, to discover that, instead of 100 mcg, 1 mg of morphine had been administered due to wrong dilution. The standard practice is to dilute 1 ampule (10 mg) in 10 ml syringe and then aspirate 1 ml and perform a second dilution in another 10 ml syringe. In this case, the second dilution was omitted. The patient was easily recovered from anesthesia and transferred to PostAnesthesia Care Unit (PACU), where he was started on naloxone drip 0.5 mcg/kg/h, under monitoring and continuous O2 administration via nasal canula. 8 h later, he was transferred to general ward under close monitoring for 24 h. The analgesic result was excellent, with the patient reporting pain on Numerical Rate Scale (NRS) equal to 0 for the first 24 h, with the naloxone drip withdrawn afterwards. Notably, the patient did not experience any of the commonest opioid related adverse events, i.e., respiratory depression, somnolence and nausea (2). Similar intrathecal morphine doses have been described in the literature, followed by naloxone infusion, to override the adverse events of morphine. Rebel et al. have reported 10-fold higher doses of naloxone than the one used in our case, with sustained analgesic results (3). The combination of opioid agonist-antagonist has been used even per os, to alleviate the nausea and constipation in managing both acute and chronic pain (4). To conclude, incorrect dosage administration, attributed to human factor, is common. A thorough checking of the dugs must always precede their administration and local protocols to manage such an unfortunate event should be established.","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"221-222"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10140096","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":"Checking Each Other's Math: Is It Possible Without a Single Standard for Opioid Dose Equivalence?","authors":"Kyle P Edmonds,&nbsp;Rabia S Atayee","doi":"10.1080/15360288.2023.2240303","DOIUrl":"10.1080/15360288.2023.2240303","url":null,"abstract":"For the last decade or more, there has been a proliferation of guidance, policies, and protocols on opioid prescribing that rely on oral morphine equivalents (OME) or morphine equivalent daily doses (MEDD) (1–4). Almost exclusively, this guidance has presumed that OME calculations are standardized and predictable, while those of us who do the work of specialist palliative care on a daily basis know that not to be true. Some experts are encouraging us to dispense with the concept of “equianalgesia” altogether and instead adopt conversion tables as our primary clinical decision aides (5). Few studies have examined the safety and efficacy of opioid dosing decision aids. As such, the tool we use at University of California San Diego Health (6) is different from tools used at other institutions across the country or in widely utilized online calculators such as MD CalcTM. Given this fact, we teach our rotating learners that they should advocate for use of one equianalgesic tool at their institution, choosing a method of equianalgesic calculation that makes sense to them and stick with it. This may minimize intraand inter-tool variability in their clinical decisions and also facilitate direct comparison among colleagues/ teams using other decision tools. Results","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"213-215"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10216041","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":"Response to Demarest et al.","authors":"Jessica Otte,&nbsp;Robin Love","doi":"10.1080/15360288.2023.2201271","DOIUrl":"10.1080/15360288.2023.2201271","url":null,"abstract":"We read with interest the article “Comprehensive Diagnosis and Management of Malignant Bowel Obstruction: A Review” (1). Malignant bowel obstructions (MBO) are common in the palliative care context yet can be challenging to manage because of the sparse evidence base. Even though we must often practice with a paucity of randomized-controlled trials (RCTs) to guide us, an understanding of pharmacology and the best available evidence can help us navigate. Unfortunately, the article by Demarest et al. did not capture common clinical controversies in palliative management of MBO, omitting some key contributions of evidence and did not disclose uncertainty where it is present. Several statements are at issue:","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"218-220"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10496127","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}