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An Older Man with Clonus, Rigidity, Hyperreflexia, and Hand Tremors. 一位老年男性伴有阵挛、僵直、反射亢进和手部震颤。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-28 DOI: 10.1080/15360288.2024.2443013
Olga Abel, Yan Press

Serotonin toxicity (ST) is a preventable, life-threatening condition caused by serotonergic agents. It typically arises from combined drug use that affects serotonin's release and metabolism. While often presenting with mild symptoms that may be overlooked or misdiagnosed, severe toxicity is associated with significant mortality. The older population is particularly at risk due to altered drug pharmacokinetics, a tendency for multiple drug use, and symptom overlap with common neurodegenerative conditions. The case study discusses an older patient with prolonged ST developed with the use of several serotonergic drugs for postherpetic neuralgia. It emphasizes the challenges of polypharmacy in older patients, offering insights into the serotoninergic potential of multiple medicines commonly used in older adults, the pathophysiology, proper diagnosis and differential diagnoses, and management strategies of ST. Accurate diagnosis requires heightened vigilance from healthcare professionals regarding potential drug interactions and familiarity with the specific clinical criteria. Regular revision and adjustment of medications in older patients and preference for the non-pharmacological treatment of chronic pain are essential for preventing ST. This case report is a convenient way for many healthcare professionals to update their knowledge about ST, its diagnosis and management.

血清素毒性(ST)是由血清素能药物引起的一种可预防的、危及生命的疾病。它通常是由影响血清素释放和代谢的联合用药引起的。虽然通常表现为可能被忽视或误诊的轻微症状,但严重毒性与显著死亡率相关。由于药物药代动力学改变、多种药物使用的趋势以及与常见神经退行性疾病的症状重叠,老年人群尤其处于危险之中。病例研究讨论了一个老年患者与长期ST发展与使用几种血清素能药物带状疱疹后神经痛。它强调了老年患者多药治疗的挑战,提供了对老年人常用的多种药物的血清素能潜力、病理生理学、正确诊断和鉴别诊断以及st的管理策略的见解。准确的诊断需要医疗保健专业人员对潜在的药物相互作用提高警惕,并熟悉具体的临床标准。老年患者对药物的定期调整和调整以及对慢性疼痛的非药物治疗的偏好是预防ST的必要条件。本病例报告为许多医疗保健专业人员提供了一个方便的方法来更新他们对ST、ST的诊断和管理的知识。
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引用次数: 0
Safety of Naldemedine for Opioid-Induced Constipation - A Systematic Review and Meta-Analysis. 纳德美定治疗阿片类药物引起的便秘的安全性:一项系统综述和荟萃分析。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-19 DOI: 10.1080/15360288.2024.2427324
Bastian Wobbe, Maximilian Gerner, Claus-Henning Köhne

Naldemedine is a peripheral acting µ-opioid receptor antagonist approved by the Food and Drug Administration to treat opioid-induced constipation. Concerns about side effects like opioid withdrawal prevent its widespread use, especially for cancer patients. We performed this systematic review and meta-analysis to evaluate existing safety data of naldemedine treating opioid-induced constipation following the PRISMA guidelines. We searched PubMed and the Cochrane Library on April 16th 2024 to identify studies evaluating naldemedine treatment among patients with opioid-induced constipation. Our analysis found no differences between groups comparing naldemedine therapy with placebo-control for treatment-emergent adverse events (OR = 1.06; 95%-CI: 0.91-1.24), serious adverse events (OR = 1.02; 95%-CI: 0.76-1.38). We found no increased risk for opioid withdrawal, while an increased risk for gastrointestinal disorders (OR = 2.08; 95%-CI: 1.72-2.51), particularly higher incidences of diarrhea (OR = 2.44; 95%-CI: 1.81-3.29) and abdominal pain (OR = 3.31; 95%-CI: 2.16-5.06) were found. In the cancer subgroup, treatment-emergent and serious adverse events were more frequent. However, no increased risk for opioid withdrawal was observed. This analysis confirms naldemedine's overall safety in treating opioid-induced constipation, with manageable gastrointestinal side effects. However, the higher adverse events in cancer patients require further investigation to ensure safe use in this population.

Naldemedine是一种外周作用的微阿片受体拮抗剂,经美国食品和药物管理局批准用于治疗阿片类药物引起的便秘。对阿片类药物戒断等副作用的担忧阻止了它的广泛使用,尤其是对癌症患者。我们按照PRISMA指南进行了这项系统回顾和荟萃分析,以评估纳尔地美定治疗阿片类药物引起的便秘的现有安全性数据。我们于2024年4月16日检索PubMed和Cochrane图书馆,以确定评估naldemedine治疗阿片类药物引起的便秘患者的研究。我们的分析发现,在治疗后出现的不良事件方面,两组间比较纳尔地米定治疗与安慰剂对照无差异(OR = 1.06;95%-CI: 0.91-1.24),严重不良事件(OR = 1.02;95% ci: 0.76—-1.38)。我们发现阿片类药物戒断的风险没有增加,而胃肠道疾病的风险增加(OR = 2.08;95%-CI: 1.72-2.51),特别是腹泻的发生率较高(OR = 2.44;95% ci: 1.81-3.29)和腹痛(OR = 3.31;95%-CI: 2.16-5.06)。在癌症亚组中,治疗后出现的严重不良事件更为频繁。然而,没有观察到阿片类药物戒断的风险增加。该分析证实了纳尔地美定治疗阿片类药物引起的便秘的总体安全性,胃肠道副作用可控。然而,癌症患者较高的不良事件需要进一步调查,以确保在这一人群中安全使用。
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引用次数: 0
Intravenous Magnesium Sulfate as an Adjunct to Intravenous Ketamine for Acute Pain: A Case Series. 静脉注射硫酸镁辅助静脉注射氯胺酮治疗急性疼痛:一个病例系列。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-13 DOI: 10.1080/15360288.2024.2441794
Nathan Smith, Sanny Juresic, Kia Lor, Carrie Schmidt, Annie Bell Howrigon, Oludare Olatoye

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.

静脉注射硫酸镁是一种多功能电解质,在各个医疗领域都发挥着举足轻重的作用。从心脏护理到产科,从胃肠道治疗到肺部治疗,它对急症护理服务的影响是深远的。值得注意的是,在术后护理阶段,氯胺酮作为一种 NMDA 受体拮抗剂,与氯胺酮有着惊人的相似之处。本系列病例描述了三例合并症复杂的患者在术后镇痛中遇到的困难,并讨论了在氯胺酮同时使用镁时观察到的有益影响。有必要开展进一步研究,以概述镁的具体作用、理想人群、推荐的栓剂和输注速度,从而达到最佳镇痛效果。
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引用次数: 0
Deafferentation in Pain Medicine: A Narrative Review of Mechanisms and Management. 疼痛医学中的神经传入障碍:机制和管理的叙述性回顾。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-12 DOI: 10.1080/15360288.2024.2432640
Usama Ahmed, Mohjir Baloch

Deafferentation is an umbrella term that includes several clinical conditions. The exact mechanism is not yet known, and the different clinical conditions do not necessarily share common pathophysiology. It includes both non-painful and painful conditions, including cancer pain conditions. Clinical presentation can be immediate or delayed, sometimes years after the causative lesion. Patients experience neuropathic pain symptoms in an area of abnormal or absent sensation. Laboratory tests show denervation and loss of function. Pain management strategies can be directed toward alleviating symptoms rather than eradication. The site of origin of the pain can help decide the treatment modalities to be tried. Gabapentinoids, antidepressants, and sodium channel blockers can be used. This type of pain is typically opioid-nonresponsive, but some patients may benefit. Neuronal destructive procedures are indicated for brachial plexus avulsion injuries. Spinal cord stimulation, dorsal root entry zone rhizotomy, deep brain thalamic stimulation, and motor cortex stimulation have been suggested for the management of the complex clinical conditions under the umbrella of deafferentation.

失音是一个总括术语,包括多种临床症状。确切的机制尚不清楚,不同的临床病症不一定具有共同的病理生理学。它包括非疼痛性和疼痛性疾病,包括癌痛疾病。临床表现可立即出现,也可延迟出现,有时在致病病变发生后数年才出现。患者会在感觉异常或感觉缺失的区域出现神经病理性疼痛症状。实验室检查显示神经支配和功能丧失。疼痛治疗策略可以以缓解症状而非根除疼痛为目标。疼痛的起源部位有助于决定应尝试的治疗方式。可使用加巴喷丁类药物、抗抑郁药和钠离子通道阻滞剂。这类疼痛通常对阿片类药物无反应,但有些患者可能会从中受益。神经元破坏程序适用于臂丛神经撕脱伤。脊髓刺激、背根进入区根切术、脑丘脑深部刺激和运动皮层刺激已被建议用于治疗去神经支配的复杂临床症状。
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引用次数: 0
Medicinal Cannabis: A Potential Tool for Managing Chronic Pain and Mental Health in Asia. 药用大麻:在亚洲管理慢性疼痛和心理健康的潜在工具。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-11 DOI: 10.1080/15360288.2024.2436975
John Patrick C Toledo
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引用次数: 0
Case Report: Buprenorphine for Palliation in a Patient with End Stage Renal Disease. 病例报告:丁丙诺啡对终末期肾病患者的缓解作用。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-05 DOI: 10.1080/15360288.2024.2435425
Sing Ping Chow, Scott Donelenko, Chris Coppock

End stage renal disease (ESRD) is known to be associated with pain, malaise and decreased quality of life. Pain management in the setting of dialysis is particularly challenging from a pharmacologic standpoint given altered pharmacokinetics of pain medications. Buprenorphine, a partial mu opioid receptor agonist, demonstrates superior safety profile compared to full mu opioid receptor agonists. In this case report, we demonstrated buprenorphine buccal film (Belbuca) as a safe and effective opioid treatment option for pain palliation in a dialysis dependent patient. Future studies may be warranted with larger sample size and longer follow up period to study the effect of buprenorphine in the setting of hemodialysis and non-dialysis dependent ESRD population.

终末期肾病(ESRD)与疼痛、不适和生活质量下降有关。考虑到疼痛药物的药代动力学改变,从药理学角度来看,透析患者的疼痛管理尤其具有挑战性。丁丙诺啡是一种部分阿片受体激动剂,与全阿片受体激动剂相比,具有更高的安全性。在本病例报告中,我们证明丁丙诺啡颊膜(Belbuca)是一种安全有效的阿片类药物治疗方案,用于缓解透析依赖患者的疼痛。未来的研究可能需要更大的样本量和更长的随访时间来研究丁丙诺啡在血液透析和非透析依赖ESRD人群中的作用。
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引用次数: 0
Outpatient Patient Controlled Analgesia (PCA) for the Palliative Care Patient. 姑息治疗病人的门诊病人控制镇痛(PCA)。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1080/15360288.2024.2383415
Jacob T Painter, Kennede McLeroy-Charles, Heather Moore, Sarah Harrington, Lindsey E Dayer

This study explores the under-researched domain of patient-controlled analgesia (PCA) for cancer pain management in adult outpatients, focusing on the transition from patient-controlled analgesia pumps (PCA pump) to oral medications. While existing literature primarily addresses the use of PCA in inpatient settings, this descriptive study investigates the initiation of outpatient PCA in palliative care patients. The retrospective chart review includes data from all admissions between July 1, 2014, and December 31, 2020. Among the 49 identified patients, 41 were admitted for cancer-related pain, with an indication for PCA such as insufficient pain relief, highly fluctuating pain, or inadequate response to other routes. Of these patients, 13 were successfully transitioned from outpatient PCA to oral opioids. The study underscores the effective use of PCA as a transitional tool following a pain crisis that necessitates inpatient admission. Future research avenues could explore healthcare utilization, length of stay, and required outpatient resources, such as home visits or telehealth, for optimal PCA use in outpatient settings.

本研究探讨了患者自控镇痛(PCA)在成人门诊患者癌症疼痛治疗中的应用,重点关注从患者自控镇痛泵(PCA 泵)到口服药物的过渡。现有文献主要论述了在住院环境中使用 PCA 的情况,而本描述性研究则调查了姑息治疗患者在门诊开始使用 PCA 的情况。回顾性病历审查包括 2014 年 7 月 1 日至 2020 年 12 月 31 日期间所有入院患者的数据。在已确认的 49 名患者中,有 41 人因癌症相关疼痛入院,有 PCA 适应症,如疼痛缓解不足、疼痛波动大或对其他途径反应不佳。在这些患者中,有 13 人成功地从门诊 PCA 过渡到了口服阿片类药物。这项研究强调,在出现疼痛危机而必须住院治疗时,可有效使用 PCA 作为过渡工具。未来的研究途径可以探索医疗保健利用率、住院时间和所需的门诊资源(如家访或远程医疗),以便在门诊环境中优化 PCA 的使用。
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引用次数: 0
Methadone for Pain Management in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Review. 美沙酮用于化疗引起的周围神经病变的疼痛治疗:回顾性综述。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-30 DOI: 10.1080/15360288.2024.2383423
Christiane Boen, Julia Ridley, Philippa Hawley

Chemotherapy-Induced Peripheral Neuropathy (CIPN) refers to damage of peripheral nerve fibers due to the use of neurotoxic chemotherapy to treat various cancers. It occurs in more than 30% of patients and only duloxetine has currently been identified to show limited efficacy in symptomatic treatment of CIPN. Opioids have traditionally been used to treat cancer pain, and there is evidence for their use in treatment of peripheral neuropathic pain from other causes. With a similar mechanism of action to duloxetine, methadone has rationale for treating neuropathic pain. This study is a retrospective chart review to evaluate the outcomes of using methadone for CIPN pain. Out of 31 patients, 65% felt that methadone was an effective treatment, 19% felt that it was ineffective, and 16% felt that it was partially or temporarily effective. These results suggest that analgesic response to methadone varies between patients, but that it has a potential role in painful CIPN. Its advantages for long-term use include low cost and lack of metabolites. Potential risks include a long half-life, drug interactions, and potential for QT prolongation at high doses. Prospective studies should be conducted to evaluate the role of methadone in CIPN pain management more comprehensively.

化疗诱发的周围神经病(CIPN)是指由于使用神经毒性化疗来治疗各种癌症而导致的周围神经纤维损伤。30%以上的患者会出现这种情况,目前只有度洛西汀在对症治疗 CIPN 方面显示出有限的疗效。阿片类药物历来被用于治疗癌痛,也有证据表明它们可用于治疗其他原因引起的周围神经痛。美沙酮的作用机制与度洛西汀相似,因此具有治疗神经病理性疼痛的合理性。本研究是一项回顾性病历审查,旨在评估使用美沙酮治疗 CIPN 疼痛的效果。在 31 名患者中,65% 认为美沙酮是一种有效的治疗方法,19% 认为无效,16% 认为部分有效或暂时有效。这些结果表明,不同患者对美沙酮的镇痛反应各不相同,但美沙酮对 CIPN 疼痛有潜在作用。长期使用美沙酮的优点包括成本低和不产生代谢物。潜在风险包括半衰期长、药物相互作用以及大剂量时可能导致 QT 延长。应开展前瞻性研究,更全面地评估美沙酮在 CIPN 疼痛治疗中的作用。
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引用次数: 0
Opioid Medication Errors in Patients Followed by Home Palliative Care Support Teams in the Community of Madrid. 马德里社区居家姑息关怀支持团队随访患者的阿片类药物用药错误。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-05 DOI: 10.1080/15360288.2024.2369542
María Consuelo Fernández Gómez, Genoveva Díaz Sierra, María Del Carmen Peinado Cañaveras, María Antonia Berrocal Higuero, Cristina de Miguel Sánchez

The presence of comorbidities and complex drug regimens makes palliative care patients more susceptible to opioid medication errors. Most of the studies conducted so far have mainly focused on patients admitted to hospitals or hospice facilities. During this study, we examined the frequency of medication errors with opioids and the causes and consequences for patients, followed by home palliative care teams. Errors occurred in 39% of patients (n = 378) and 27% of all prescribed opioids (n = 708). Of the 148 (39%) patients with error/s in the opioid/s prescribed, in 55% the patient and/or the caregiver were involved in the error; in 26% the health care providers were involved. An association was found between the presence of error in the prescribed opioid and the level of patient education, p = .038, and with the number of days of follow-up, p < .001. Considering their formulation, the prescribed opioids were associated with medication error, type of error, and cause of the error. The study demonstrated an association between the route of administration and error p < .004, and type of error p < .001.

由于存在合并症和复杂的用药方案,姑息治疗患者更容易出现阿片类药物用药错误。迄今为止进行的大多数研究主要集中在医院或临终关怀机构收治的患者身上。在这项研究中,我们研究了阿片类药物用药错误的发生频率,以及对患者造成的原因和后果,并对居家姑息关怀团队进行了跟踪调查。39%的患者(n = 378)和27%的阿片类药物处方(n = 708)发生了错误。在处方阿片类药物出错的 148 名患者(39%)中,55% 的患者和/或护理人员与错误有关;26% 的患者和/或护理人员与错误有关。研究发现,阿片类药物处方中是否存在错误与患者教育水平(P = .038)和随访天数(P P P
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引用次数: 0
Teaching People About Pain: A Path to Healing Beyond Medication. 教导人们关于疼痛:一条超越药物治疗的道路。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-12-11 DOI: 10.1080/15360288.2024.2436979
Jeff Clyde G Corpuz
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引用次数: 0
期刊
Journal of Pain & Palliative Care Pharmacotherapy
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