Journal of Pain & Palliative Care Pharmacotherapy最新文献

Prescription opioid risk mitigation is paramount to patient and community safety. Postoperative pain management prescriptions can lead to excess opioids in the home with many patients being unaware of proper disposal. The purpose of this initiative was to evaluate pharmacist impact on opioid safety outcomes in perioperative surgical pain management patients. Select patients scheduled to undergo total knee arthroplasty or total hip arthroplasty at a single Veterans Affairs Health Care System were contacted perioperatively by a clinical pharmacist to provide education on pain management and prescription opioid risk mitigation. Outcomes measured included patient interest in a naloxone prescription and medication disposal envelopes, level of pain control, quantity of opioids used, method of disposal or planned disposal of remaining opioids, and patient satisfaction. Twenty-seven patients were included in the initiative. Twenty patients (74%) expressed interest in a naloxone prescription and 13 patients (48%) expressed interest in a medication disposal envelope. During the postsurgery assessment, 20 patients reported having excess opioid tablets. Of those, 4 patients (20%) reported proper disposal of excess opioids, and 16 patients (80%) had not yet disposed of their excess opioids. Pharmacist involvement in perioperative pain management could promote prescription opioid risk mitigation through targeted education and the proffering of tools such as naloxone and medication disposal options.

Opioid prescribing following orthopedic surgeries, such as total hip arthroplasties (THA) and total knee arthroplasties (TKA), is a critical focus area given the risks of dependence, adverse effects, and overprescribing. This single-center, retrospective quality improvement study evaluated postoperative opioid prescribing patterns among 142 opioid-naïve Veterans discharged from the Kansas City Veterans Affairs Medical Center (KCVAMC) following THA or TKA between September 2023 and September 2024. Patients who underwent TKA received higher inpatient and discharge morphine equivalent daily doses (MEDD) than THA patients, despite similar pain scores. Notably, 11% of patients were discharged with opioids despite no inpatient opioid use in the 24-h period immediately preceding discharge. The findings from this study reveal inconsistent prescribing and documentation practices, highlighting opportunities to improve care. Recommendations include implementing a standardized multimodal analgesia discharge order set with guideline-concordant opioid quantities, encouragement of non-opioid analgesic use, and inclusion of a naloxone prescription.

IV Methadone may be used post-procedurally to manage pain; however, it carries risks of respiratory depression and QTc prolongation. The purpose of this study is to compare safety profiles of multiple doses of intravenous (IV) methadone and IV hydromorphone in post-procedural patients. The primary outcome was incidence of respiratory event, defined as oxygen saturation (O₂Sat) less than 90%, respiratory rate less than 8 breaths per minute (bpm), increased supplemental oxygen, or naloxone administration within 24 h of IV methadone or hydromorphone. Secondary outcomes included incidence of QTc prolongation and additional opioid, benzodiazepine, or ketamine doses. After exclusion assessment, 154 patients met inclusion criteria. Patients were grouped by receiving methadone (n = 85) or hydromorphone (n = 69). The primary outcome occurred 111 times in the methadone group and 40 times in the hydromorphone group (p < 0.0001). Among patients who had a respiratory event, patients who received methadone had more respiratory events compared to those who received hydromorphone (IRR: 2.25, 95% CI (1.56-3.32), p < 0.0001). Patients who received methadone also received more opioid and ketamine doses (p < 0.0001). Post-procedural methadone may be unsafe due to increased incidence of respiratory events, possible because of methadone's long half-life causing drug accumulation.

End-stage liver disease (ESLD) is associated with a high symptom burden, poor prognosis, and limited access to curative disease. Despite growing evidence supporting the role of palliative care (PC), its integration into the routine management of ESLD remains limited and inconsistent. To synthesize the current evidence on the role of palliative care in ESLD, emphasizing its impact on quality of life and including strategies for symptom control and effective clinical integration. A narrative review with a systematic approach was conducted. PubMed, Scopus, Embase, and SciELO were searched for English- and Spanish-language studies published between 2015 and 2025. Studies were selected based on methodological rigor and relevance to PC interventions in ESLD. Key barriers to PC implementation include misconceptions about its use being limited to terminal phases, lack of referral criteria, and insufficient coordination between specialties. Evidence shows that early PC involvement improves symptom control (pain, dyspnea, pruritus, encephalopathy), decreases avoidable hospitalizations, and facilitates shared decision-making. Early and structured integration of palliative care into ESLD management is essential. Health systems should prioritize interdisciplinary care models, establish clear referral criteria, and promote a care approach focused on patient well-being, autonomy, and dignity.

This retrospective chart review aimed to evaluate the effectiveness of methadone for cancer-induced bone pain (CIBP) in inpatient and outpatient settings. The primary objective of this study was to analyze the change in pain scores utilizing the numeric rating scale (NRS) after 28 days of receiving methadone therapy compared to previous failed opioids trialed. Secondary objectives included assessing the daily total morphine milliequivalent (MME) of breakthrough opioid medications required, change in Eastern Cooperative Oncology Group (ECOG) and Palliative Performance Scale (PPS) scores before and after the initiation of methadone. Twenty-seven patients with CIBP received at least twenty-eight days of methadone between January 2020 and August 2024. Reported pain scores utilizing the NRS prior to the initiation of methadone and after at least twenty-eight days of methadone therapy were 7 (IQR 5,8) and 4 (IQR 4,5) respectively (p = 0.013). Reported amount of breakthrough MME prior to methadone and after twenty-eight days of methadone were 90 MME and 31 MME respectively (p = 0.021). No change was seen in ECOG or PPS scores before [1.0 ± 1.02]; (70% (IQR 60%,80%]) and after [1.5 ± 0.831]; (70% (IQR 60%,80%)) methadone, respectively (p = 0.104); (p = 0.855). Methadone demonstrated effectiveness in reducing pain and the amount of breakthrough medication needed in patients with CIBP.

Management of chronic pain syndromes represent significant challenges to clinicians. Fluphenazine was shown to attenuate mechanical allodynia in rat neuropathic pain models via antagonism of voltage gated sodium channels and has been identified as a candidate drug for chronic pain. We present a 66 year old man with treatment-refractory chronic pain syndrome. Right ischial pain developed over time as a result of his years practicing as a dentist sitting on a stool with a tilted seat pan. Imaging and neurologic investigations led to a presumed diagnosis of chronic microtears of the sacrotuberous ligament. The patient failed to respond to multiple modes of therapy. Prescribed medications included amitriptyline, celecoxib, duloxetine, gabapentin, muscle relaxants, opioids, and quetiapine. Procedures included facet and trigger point injections, platelet-rich plasma injections, and prolotherapy. Nonpharmacologic modalities included acupuncture, chiropractic therapy, osteopathic manipulation therapy, physical therapy, and psychotherapy. He then underwent an outpatient, nine-month course of oral fluphenazine, in which his pain was controlled successfully, resulting in resumption of normal sleep and daily activities per the patient. This case suggests fluphenazine as a monotherapy for refractory chronic pain.