Journal of Pain & Palliative Care Pharmacotherapy最新文献

{"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":"The Role of Health Coaching in Pain and Palliative Care Pharmacy Practice.","authors":"Lee A Kral","doi":"10.1080/15360288.2023.2268039","DOIUrl":"https://doi.org/10.1080/15360288.2023.2268039","url":null,"abstract":"<p><p>Whole-person care is essential in the management of patients with chronic pain and serious illness. Pain, suffering, and comfort do not fall under typical chronic disease management and cannot be boxed nicely into algorithms of evidence-focused, biomarker-based goal achievement like hypertension or diabetes. Current therapies, including surgical, interventional, and analgesic modalities may be only marginally effective, and have brought with them questionable practices, high cost, and an opioid epidemic. Patient-focused goals are gaining favor, and exploration of methods to enhance this approach include health coaching. In the setting of pain management, this would include pain coaching. This commentary will highlight the role of health coaching in the setting of chronic disease and pain management, and the pharmacists' qualifications and potential contributions to health and pain coaching.</p>","PeriodicalId":16645,"journal":{"name":"Journal of Pain & Palliative Care Pharmacotherapy","volume":" ","pages":"1-6"},"PeriodicalIF":1.1,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49678570","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}