Journal of Pain & Palliative Care Pharmacotherapy最新文献

{"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}

{"title":"Comparing National Methadone Equianalgesic Tools.","authors":"Raymond Y Wen,&nbsp;Kyle P Edmonds,&nbsp;Rabia S Atayee","doi":"10.1080/15360288.2023.2194873","DOIUrl":"https://doi.org/10.1080/15360288.2023.2194873","url":null,"abstract":"<p><p>Methadone is an effective analgesic with unique pharmacokinetic and pharmacodynamic variables. There is no national consensus on methadone equianalgesia tools. Our study aimed to compare methadone equianalgesic tools from various national institutions with the primary objective to summarize current practice and secondary objective to determine if a national consensus can be established. Out of 25 institutional methadone equianalgesic tools reviewed, 18 contained sufficient data and were included in this study. Fifteen (15) of the institution evaluated tools utilized a wide variety of dose-dependent modalities for methadone conversion with the hospice and palliative care (HAPC) Consensus method being the most common. Based on the variability of the equianalgesia tools evaluated in this study, we were unable to recommend a consensus methadone conversion method. Further trials exploring methadone equianalgesia beyond our study are needed.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"246-250"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139553","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":"Peer Review Questions & Answers: How?","authors":"Laura Meyer-Junco,&nbsp;Julie M Waldfogel,&nbsp;Nakia Duncan","doi":"10.1080/15360288.2023.2245738","DOIUrl":"https://doi.org/10.1080/15360288.2023.2245738","url":null,"abstract":"Peer review is a collaborative process among reviewers and the journal editor to assess the validity and significance of submitted manuscripts. Constructive comments from peer reviewers improve the scientific writing of authors and ultimately readers’ confidence in the integrity of the published article (1, 2). To support the growth of peer reviewers, the Journal of Pain and Palliative Care Pharmacotherapy (JPPCP) has created a Peer Review Q&A editorial series to serve as a comprehensive guide to the peer review process (3). In this installment How? Part II, we will focus on the peer review process for particular article types: case reports, systematic reviews, narrative reviews, and opinion pieces. For general tips on thinking like a peer reviewer and reviewing research articles specifically, check out the How? Part I editorial published in the Quarter 2 issue of 2023 (4).","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"209-212"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129328","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":"Retrospective Cohort Study of Safety Outcomes Associated with Opioid Rotations to Buprenorphine.","authors":"Neil K Shah,&nbsp;Michael W Chandler,&nbsp;Anne V Cetto,&nbsp;Lisa L Luciani,&nbsp;Jacob Painter,&nbsp;Danielle Bailey","doi":"10.1080/15360288.2023.2200412","DOIUrl":"https://doi.org/10.1080/15360288.2023.2200412","url":null,"abstract":"<p><p>The objective of this study was to understand the effect buprenorphine rotations have on respiratory risk and other safety outcomes. This was a retrospective observational study evaluating Veterans who underwent an opioid rotation from full-agonist opioids to buprenorphine products or to alternative opioids. The primary endpoint was change in the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD) score from baseline to six months post-rotation. Median baseline RIOSORD scores were 26.0 and 18.0 in the Buprenorphine Group and the Alternative Opioid Group, respectively. There was no statistically significant difference between groups in baseline RIOSORD score. At six months post-rotation, median RIOSORD scores were 23.5 and 23.0 in the Buprenorphine Group and Alternative Opioid Group, respectively. The difference in change in RIOSORD scores between groups was not statistically significant (<i>p</i> = 0.23). However, based on changes in RIOSORD risk class, an 11% and 0% decrease in respiratory risk was observed in the Buprenorphine and Alternative Opioid groups, respectively. This finding may be considered clinically significant given a change in risk was observed as predicted by RIOSORD score. Further research is needed to clarify the effect that opioid rotations have on respiratory depression risk and other safety outcomes.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"234-245"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139564","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":"Buprenorphine Inductions via Transdermal Patches for Opioid Use Disorder in the Inpatient Setting.","authors":"Hollie Porras,&nbsp;Elizabeth Johnson,&nbsp;Mariya Kotova,&nbsp;James Chenoweth,&nbsp;Daniel Colby","doi":"10.1080/15360288.2023.2222021","DOIUrl":"https://doi.org/10.1080/15360288.2023.2222021","url":null,"abstract":"<p><p>Buprenorphine inductions traditionally require an opioid-free period due to the risk of precipitated opioid withdrawal. Hospitalized patients with opioid use disorder and concurrent acute pain may be eligible for buprenorphine therapy. However, effective buprenorphine induction strategies in this patient population have not been well established. Investigators sought to review the completion of a low dose induction protocol that does not require an opioid-free period prior to buprenorphine initiation. Hospitalized patients who completed a 7-day low dose induction protocol via buprenorphine transdermal patches October 2021 - March 2022 were examined via retrospective chart review (N = 7). All seven patients completed the induction and were discharged on sublingual buprenorphine. Low dose transdermal buprenorphine provides a reasonable strategy for hospitalized patients on full agonist opioid therapy or those who have failed conventional buprenorphine induction strategies. Reducing barriers such as opioid abstinence is key to combating opioid use disorder.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"251-256"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10515231","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 Lidocaine and Morphine Gel Use for Malignant Wound Pain.","authors":"Ronakkumar Patel,&nbsp;Reuben O Mogoi,&nbsp;Sayed K Ali","doi":"10.1080/15360288.2023.2194870","DOIUrl":"10.1080/15360288.2023.2194870","url":null,"abstract":"Management of malignant wounds, especially from tumor infiltration, remains challenging especially in low-middle income country where resources, such as opioids, may be limited. Management of such wounds is also compounded by the use of intravenous or oral opioids that often might improve the pain, but result in various side effects. Our pharmacy department helped prepare a topical ointment that contained fixed amounts of both morphine and lidocaine specifically for use in malignant wounds. Ninety milligrams of 2% lidocaine gel was mixed with 80 mgs of oral morphine sulfate in a pestle until the mixture was consistent. Four to eight milliliters, depending on the size of the wound, was applied to a gauze and placed over the wound every 8 hours. Table 1 highlights the use of the ointment in select patients with malignant wound and improvement in pain scores over a 2 week period. About 5–10% of patient with metastatic cancer will go on to develop fungating wound that are often associated with pain as most common symptoms (1, 2). These wound share complex pathophysiological process compounded by the an inflammatory process that is often chronic in nature with stimulation of the skin afferent receptors, compression of the wound bed tissue, erosion of the blood and nerves surrounding the wound, resulting in various symptoms including pain that can often be difficult to manage (3). Even though topical agents have been used for pain management, data on the use of such agents in resource limited settings is non-existent. Compound lidocaine creams/gels have been shown to be safe to use in malignant wound managements. Application can reduce pain caused by the inflammatory process and also during the dressing process. The vasodilatory effects of lidocaine, resulting in increased blood flow, have been shown to help with wound healing (4). Lidocaine, also works by inhibiting the transmission of pain signals by blocking the voltage-gated sodium channels in nerve cells. This prevents the initiation and propagation of pain signals, resulting in pain relief (5). Application of such gels have been shown to offer long term relief, without associated systemic side effects and can also decrease the need and use of systemic opioids (3, 4). Topical morphine application to malignant wounds has also been showing to improve pain scores and quality of life, with fewer side effects and reduced need for systemic opioid therapy (6, 7). Topical morphine is thought to act on the peripheral opioid receptors that play a role in modulation of pain (6). In addition, normal, unaffected tissues contain silent opioid receptors that are activated soon after injury to the tissue. In fact, trauma, and inflammatory processes have been shown to increase the synthesis and transport of opioid receptors from the dorsal root ganglia to the peripheral sensory nerve endings (8). Opioid receptors have been found in skins","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"216-217"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125119","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":"Trends in Pain Medication Use in Patients With Type 2 Diabetes: NHANES 2005-2018.","authors":"Michelle Krichbaum,&nbsp;Neil Miransky,&nbsp;Alexandra Perez","doi":"10.1080/15360288.2023.2194868","DOIUrl":"https://doi.org/10.1080/15360288.2023.2194868","url":null,"abstract":"<p><p>The aim of this research was to compare pain medication use trends among adults with and without type 2 diabetes in the US. This cross-sectional study used data of adults with and without (type 2) diabetes from the National Health and Nutrition Examination Survey waves 2005-2018. Use of pain medication including opioids, prescription nonsteroidal anti-inflammatory drugs, gabapentinoids, serotonin norepinephrine reuptake inhibitors, skeletal muscle relaxants, and headache treatment agents was compared by diabetes status and within select social determinants of health and clinical factors. Adults with type 2 diabetes were twice as likely to be prescribed pain medications compared to those without a diabetes diagnosis (16.2% vs 8.6%). Females and those with a history of smoking or arthritis were more likely to be on pain medications. Opioid use was the most prevalent regardless of diabetes status, and use was twice as high among those with diabetes (10.8% vs 5.5%). Patients with type 2 diabetes in the US are twice as likely to be prescribed pain medications overall as well as opioids compared with those without diabetes. Clinical guideline recommendations are necessary to find pharmacologic and nonpharmacologic nociceptive pain management specific for patients with diabetes.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":"37 3","pages":"223-233"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10142540","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}