Journal of Pain & Palliative Care Pharmacotherapy最新文献

The purpose of this study was to better characterize morphine equivalent daily dose (MEDD) equivalencies with buccal buprenorphine, and identify real-world efficacy and safety outcomes associated with the use of buccal buprenorphine for chronic pain at a local VA Medical Center. This study was a retrospective chart review of Computerized Patient Record System (CPRS) patient records with outpatient prescriptions for buccal buprenorphine (Belbuca^®). Overall, there was a high discontinuation rate of Belbuca^®: being 60% or greater across all different patient groups. These high attrition rates may potentially be result of failure to titrate to an optimal dose of Belbuca^® needed for adequate analgesia. Those fully rotated fared marginally better than those partially rotated in that those fully rotated discontinued at a lesser rate and less quickly than those who were partially rotated. From the results of this study, a local dosing scheme for Belbuca^® based on baseline MEDD was created for facility level guidance. The exact MEDD conversion ratio, however, for individual buprenorphine products as well as MEDD contributed by these products on a patient's overall opioid related risk compared to other full agonist opioids still remains unclear and further studies are warranted.

Chronic pancreatitis is a globally prevalent progressive disease, with pain affecting up to 90% of patients, significantly impairing quality of life and leading to high rates of disability, hospitalizations, and opioid dependence. Pain management is crucial in treating chronic pancreatitis, with endoscopic ultrasound-guided celiac plexus block (EUS-CPB) recognized as an interventional option. This systematic review and meta-analysis, following PRISMA guidelines, synthesized data from 12 studies (5 randomized control trials and 7 observational) on the efficacy of EUS-CPB in managing chronic pancreatitis pain. The overall analysis revealed a significant pain relief proportion of 0.64 (n=612) with moderate heterogeneity. Subgroup analyses revealed a proportion of 0.72 in RCTs and 0.59 in observational studies. Common complications included diarrhea and exacerbation of abdominal pain, with no reported mortality. Despite variations in efficacy due to study heterogeneity and patient differences, the findings suggest EUS-CPB as a safe and effective option, with effects lasting weeks to months. Recent studies have demonstrated the applicability of EUS-CPB across ethnically diverse and pediatric populations. However, limitations including small sample sizes and study variability highlight the need for personalized treatment approaches. Future larger randomized sham-controlled trials are recommended to better assess the duration of pain relief and impact on opioid use.

Bone pain is the commonest side-effect faced by cancer patients receiving granulocyte colony stimulating factor (G-CSF) therapy for the primary or secondary prevention of febrile neutropenia. We conducted a prospective quasi-experimental study at our setup to see the efficacy of dual histamine blockade (combined H1 and H2 receptor blockers) for preventing G-CSF-induced bone pain. Adult female patients with solid tumors who had received filgrastim for the primary prophylaxis of febrile neutropenia and met our inclusion criteria, were enrolled (n = 119). This population was analyzed for the development of significant bone pain 24 h after the administration of Filgrastim. Significant bone pain in our study was defined as emergence of new onset pain measuring ≥4 on 11-point Numerical rating scale (NRS) or at least ≥ 2-point increase in score when compared to the baseline pain (if any). Those patients who experienced significant bone pain (n = 47) were given Loratadine 10 mg and Famotidine 20 mg orally half an hour before the next filgrastim administration. Pain assessment was done 24 h after Filgrastim administration, using NRS and data was analyzed. The mean NRS score in our patients after administration of filgrastim was 6.87 ± 1.055. Most of these patients (n = 34 i.e 72%) experienced relief in bone pain after dual histamine blockade use. The mean NRS score following the use of dual antihistamines was 4.36 ± 1.870. The NRS score improved by a mean of 2.51 after using dual histamine blockade, which was statistically significant (p-value= 0.0005). We propose that dualhistamine blockade may prove to be an effective option for prophylaxis of G-CSF-induced-bone-pain. Randomized control trials on larger and more diverse patient populations are required to reinforce the findings.

Intravenous (IV) magnesium sulfate, a versatile electrolyte, plays a pivotal role across various medical domains. From cardiac care to obstetrics, gastrointestinal to pulmonary therapies, the impact is far-reaching among acute care services. Notably, in the postoperative phase of care, it shares intriguing similarities with ketamine as an NMDA receptor antagonist. This case series describes the difficulties experienced with postoperative analgesia in three patient cases with complex comorbidities and discusses the beneficial impact observed when magnesium was administered concomitantly with ketamine. Further research is necessary to outline the specific role, ideal population, and recommended bolus and infusion rate for optimal analgesic efficacy.

Tramadol is a synthetic opioid with a central effect from the aminocyclohexanol group, which has two main mechanisms of action, including as a weak agonist of opioid receptors and as a norepinephrine and serotonin reuptake inhibitor. The present study presents a review based on clinical trials designed in 2023. In July 2023, six international databases, including Medline/PubMed, ProQuest, Scopus, EMBASE, Google Scholar, and ISI (Web of Science), were searched and 58 articles were included in the study. The results of most studies showed that tramadol can be used as an analgesic drug, although in some studies it was shown that tramadol is not therapeutically superior in reducing pain compared to other treatments. Also, complications related to this treatment have been reported in some studies. Physicians should consider these factors to prevent drug toxicity, poor pain relief, use disorder in patients, and unpredictable complications. It should be noted that there is not enough evidence to support the long-term effectiveness of tramadol, but this argument also extends to nonopioid and other types of opioid analgesics, and the lack of long-term trials is due to regulatory and ethical issues. Although opioids can cause addiction when used for a long time, tramadol has a reasonable safety profile. According to the patient's condition and the clinical judgment of the medical professional, tramadol can be prescribed for patients, but the consequences of its use must be considered and a personalized treatment algorithm should be selected if the benefits outweigh the risks of the drug.

This cohort study aims to assess the outcomes of fibromyalgia patients enrolled in the UK Medical Cannabis Registry prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). A cohort study of fibromyalgia patients treated with oils (Adven^®, Curaleaf International, UK), dried flower (Adven^®, Curaleaf International, UK) or both CBMPs was performed. Primary outcomes were changes from baseline at 1, 3, 6 and 12 months in validated patient-reported outcome measures. Secondary outcomes included descriptive analysis of adverse events. One hundred and forty-eight participants were treated with oils (n = 77; 52.03%), dried flower (n = 14; 9.46%) or both (n = 57; 38.51%). Improvements in the generalized anxiety disorder-7 questionnaire, single-item sleep quality scale, fibromyalgia symptom severity score and EQ-5D-5L Index values were observed at each follow up period compared to baseline (p < 0.050). Thirty-six (24.32%) patients experienced 648 adverse events. Improvements were observed across all primary outcomes with no differences observed across different formulations of CBMPs. Adverse events were reported by one-quarter of participants and were more likely to reported by cannabis naïve patients. This present work through focusing on a homogeneous group of CBMPs can help inform randomized controlled trials after observing signals of improvement associated with a specific cultivar of CBMPs.

Buprenorphine has demonstrated benefit for acute and chronic pain and various psychiatric disorders. However, many studies evaluating buprenorphine's effect on psychiatric conditions are not specific to the chronic pain population. This retrospective study was conducted to assess the impact of buprenorphine on depressive symptoms in patients with chronic pain at a Veterans Affairs healthcare facility. Adults with chronic pain started on any formulation of buprenorphine or traditional opioid (non-buprenorphine opioid) with at least two depression screenings between May 1, 2016 and November 1, 2021 were included. The primary outcome was change in depressive symptoms, measured by Patient Health Questionnaire-9 (PHQ-9), from baseline to 6-18 months after starting therapy. Secondary outcomes included changes in Columbia-Suicide Severity Rating Scale and mental health services utilization. Twenty-one patients were included. Median baseline PHQ-9 in the buprenorphine and traditional opioid groups were 14 and 13, respectively. Median change in PHQ-9 was -5 in the buprenorphine group and -1.5 in the traditional opioid group. Compared to traditional opioids, buprenorphine was associated with a greater reduction in depressive symptoms among Veterans with chronic pain. Although this reduction met the threshold for clinically significant improvement, further investigation is needed to evaluate the clinical relevance of these findings.

We present the case of a 45-year-old male with a history of multiple sclerosis complicated by spasticity and paraplegia, who developed altered mental status and type II respiratory failure requiring intubation on the same day his intrathecal baclofen pump was refilled by his pain physician. Shortly after admission, the patient experienced cardiac arrest four times within two hours until the pump contents were aspirated, and the patient was stabilized. This case report emphasizes the significance of vigilance and prompt recognition of intrathecal baclofen poisoning, which can lead to life-threatening toxicities and withdrawals.

Pain management is the hallmark of palliative care; however, pain is commonly underassessed in cases of advanced dementia and delirium (acute confusional state). We present a case of a 66-year-old female patient with severe dementia who was hospitalized because of behavioral changes and sleep disturbance. Symptoms of confusion, disorientation, inattention, and agitation were most severe at night. The patient never complained of any pain. Thorough examination revealed delirium superimposed on dementia with behavioral and psychological symptoms of dementia, frozen shoulder, osteoarthritis, tooth pain, and geriatric syndrome. Treatment with tablets memantine 5 mg q.12 h, donepezil 10 mg q.day, haloperidol 1 mg q.12 h, lorazepam 1 mg q.day (if necessary), acetaminophen 500 mg q.8 h, and methylprednisolone 4 mg q.8 h, along with psychosocial support, improved her symptoms. Pain often manifests as neuropsychiatric symptoms, resulting in inappropriate use of antipsychotics. Precise pain assessment and effective treatment are imperative, particularly in advanced dementia. Underassessed and undertreated pain in dementia may lead to delirium and progression of dementia. It is paramount for future studies to emphasize comprehensive multidimensional pain assessment and total pain to better manage pain in advanced dementia, which will further enhance psychological well-being and quality of life in palliative care.