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The Effect of Concurrent Use of Opioids and Gabapentin on Fall Risk in Older Adults. 同时使用阿片类药物和加巴喷丁对老年人跌倒风险的影响
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-06-10 DOI: 10.1080/15360288.2024.2358953
Jacob T Painter, Cheng Peng, Mary Burlette, Callie Clement, Lisa Luciani, Gohar Azhar, Lindsey Dayer

Falls pose a significant threat to older adults, resulting in injuries and mortality. Concurrently prescribed opioids and gabapentin for pain management may increase fall risks in older patients. This study aimed to estimate fall risks associated with the concurrent use of gabapentin and opioids, comparing them to opioid monotherapy in older adults. A retrospective case-control study of 1,813 patients aged 65-89 on chronic opioid therapy (2017-2020), excluding those with a fall history, analysis focused on the first fall occurrence. Logistic regression assessed the association between concurrent gabapentin and opioid use and fall events. Out of eligible patients, 122 (6.73%) experienced falls during opioid therapy, with 232 (12.80%) having concurrent gabapentin use. Concurrent use significantly increased fall risk (AOR = 1.73; 95% CI: 1.08-2.78). Being female, aged ≥81, and having more chronic conditions also increased risk. Mitigating fall risk in older adults requires education on prevention, exploring alternative pain management, and careful consideration of prescribing. Further research is crucial to understand adverse events linked to combined opioid and gabapentin use in the geriatric population.

跌倒对老年人构成重大威胁,会导致受伤和死亡。同时使用阿片类药物和加巴喷丁治疗疼痛可能会增加老年患者跌倒的风险。本研究旨在估算与同时使用加巴喷丁和阿片类药物相关的跌倒风险,并将其与老年阿片类药物单药治疗进行比较。该研究是一项回顾性病例对照研究,研究对象为1813名年龄在65-89岁之间、正在接受阿片类药物慢性治疗的患者(2017-2020年),排除了有跌倒史的患者,分析重点为首次跌倒发生情况。逻辑回归评估了同时使用加巴喷丁和阿片类药物与跌倒事件之间的关联。在符合条件的患者中,有 122 人(6.73%)在阿片类药物治疗期间发生过跌倒,其中 232 人(12.80%)同时使用了加巴喷丁。同时使用可明显增加跌倒风险(AOR = 1.73;95% CI:1.08-2.78)。女性、年龄≥81 岁和患有更多慢性疾病也会增加风险。要降低老年人的跌倒风险,就必须开展预防教育、探索替代性疼痛治疗方法并慎重考虑处方。要了解在老年人群中联合使用阿片类药物和加巴喷丁的不良反应,进一步的研究至关重要。
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引用次数: 0
Intravenous Ketamine for Cancer Pain: A Single-Center Retrospective Analysis Comparing Fixed-Rate Versus Weight-Based Dosing. 静脉注射氯胺酮治疗癌症疼痛:固定剂量与按体重给药的单中心回顾性分析比较。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI: 10.1080/15360288.2024.2374297
Leslie Siegel, Kyle Quirk, Gary Houchard, Sarah Ehrman, Eric McLaughlin, Omar Hajmousa, Maureen Saphire

Although weak evidence exists to support subanesthetic ketamine for cancer pain treatment, successful use may be hindered in the absence of standardized dosing guidance. We aimed to compare the success rates of intravenous ketamine fixed-rate versus weight-based dosing strategies for cancer pain treatment, and to assess patient characteristics that correlate with treatment success. We conducted a single-center retrospective review including non-critically ill adults with cancer pain who received subanesthetic ketamine for at least 24-h. All patients received fixed-rate ketamine; weight-based doses were retrospectively determined using total body weight. Treatment was considered successful if after reaching the maximum prescribed ketamine dose the patient had a 30% reduction in: baseline pain score, as-needed opioid use, or total morphine equivalent daily dose over a standardized 24-h. Of 105 included patients, 51 (48.6%) successfully responded to ketamine. Responders had lower fixed-rate ketamine doses compared to non-responders (median[IQR] 15 mg/hr[10-15] vs. 15 mg/hr[15-20], p = 0.043), but no difference in retrospectively calculated weight-based doses (0.201 ± 0.09 mg/kg/hr vs. 0.209 ± 0.08 mg/kg/hr, p = 0.59). Responders had higher daily opioid requirements at baseline compared to non-responders (p = 0.04). Though underpowered, our findings suggest that weight-based ketamine dosing may not convey additional benefit over fixed-rate dosing.

尽管有微弱的证据支持将麻醉下氯胺酮用于癌痛治疗,但由于缺乏标准化的剂量指导,成功使用氯胺酮可能会受到阻碍。我们旨在比较静脉注射氯胺酮固定剂量与基于体重的剂量策略治疗癌症疼痛的成功率,并评估与治疗成功率相关的患者特征。我们进行了一项单中心回顾性研究,研究对象包括接受麻醉下氯胺酮治疗至少 24 小时的非重症成人癌痛患者。所有患者都接受了固定剂量的氯胺酮;根据总重量回顾性地确定了基于体重的剂量。在达到氯胺酮的最大处方剂量后,如果患者的基线疼痛评分、阿片类药物的按需使用量或吗啡当量日总剂量在标准的24小时内减少了30%,则认为治疗成功。在纳入的 105 名患者中,有 51 人(48.6%)对氯胺酮成功产生了反应。与无反应者相比,有反应者的氯胺酮固定剂量较低(中位数[IQR] 15 mg/hr[10-15] vs. 15 mg/hr[15-20], p = 0.043),但回顾性计算的基于体重的剂量没有差异(0.201 ± 0.09 mg/kg/hr vs. 0.209 ± 0.08 mg/kg/hr,p = 0.59)。与无应答者相比,有应答者的基线阿片类药物日需求量更高(p = 0.04)。我们的研究结果表明,基于体重的氯胺酮剂量可能不会比固定剂量带来更多益处。
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引用次数: 0
Advancing Patient Care Through Clinical Research.
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2025-03-14 DOI: 10.1080/15360288.2024.2415803
Julie M Waldfogel, Chris Herndon
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引用次数: 0
The Foreigner. 外国人
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-25 DOI: 10.1080/15360288.2024.2383463
Tarek Zieneldien
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引用次数: 0
Navigating the Postoperative Management of Remifentanil-Induced Hyperalgesia: A Case Report. 瑞芬太尼诱发的术后痛感处理指南:病例报告。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-09 DOI: 10.1080/15360288.2024.2400901
Nathan T Smith, Ryan Fernholz, Sanny Juresic

Opioid induced hyperalgesia in the postoperative setting presents a significant challenge for clinicians managing postoperative pain in opioid tolerant patients. Remifentanil is a fentanyl analog frequently utilized in anesthesia for its favorable pharmacokinetic profile. However, as described in the case report, it may also increase the risk of postoperative hyperalgesia. Management of postoperative pain in the setting of hyperalgesia should be approached in a stepwise fashion, emphasizing therapy options with analgesic effects achieved outside of the opioidergic system while maintaining a neutral opioid balance.

术后阿片类药物引起的痛觉减退给临床医生处理阿片类药物耐受患者的术后疼痛带来了巨大挑战。Remifentanil 是一种芬太尼类似物,因其良好的药代动力学特征而经常用于麻醉。然而,如病例报告所述,它也可能增加术后痛觉过敏的风险。对于术后痛觉减退情况下的疼痛治疗应采取循序渐进的方式,强调在阿片肽能系统外实现镇痛效果的治疗方案,同时保持阿片类药物的中性平衡。
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引用次数: 0
Shared Decision-Making and Collaborative Care Models for Pain Management: A Scoping Review of Existing Evidence. 疼痛管理的共同决策与合作护理模式:现有证据范围综述》。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-12 DOI: 10.1080/15360288.2024.2400925
Elise Omaki, Megan Fitzgerald, Diksha Iyer, Wendy Shields, Renan Castillo

This article aims to summarize the existing evidence on shared decision-making and collaborative care models for acute and chronic pain management. We searched the PubMed database for articles published between 1980 and 2023 and scanned included articles' references to identify additional sources. Two reviewers independently screened titles and abstracts. Studies met inclusion criteria if they implemented or evaluated shared decision-making or collaborative care interventions in patients with acute or chronic pain. A total of 690 articles were reviewed, with 32 full text articles meeting inclusion criteria. Most studies assessed changes in prescription opioid quantities and patient-reported pain levels. Secondary measures generally included patient satisfaction, 30-day refill rate, and use of non-opioid analgesics. Shared decision-making and collaborative care models are promising interventions to improve pain management. These interventions are effective at reducing opioid consumption among acute and chronic pain patients without compromising patient-reported pain levels. There is further research needed to evaluate how shared decision-making and collaborative care interventions impact patient-centered outcomes such as patient satisfaction, quality of life, and patient-provider communication.

本文旨在总结有关急慢性疼痛管理的共同决策和协作护理模式的现有证据。我们在 PubMed 数据库中检索了 1980 年至 2023 年间发表的文章,并扫描了收录文章的参考文献以确定更多来源。两名审稿人独立筛选了标题和摘要。如果研究针对急性或慢性疼痛患者实施或评估了共同决策或协作护理干预措施,则符合纳入标准。共审查了 690 篇文章,其中 32 篇全文符合纳入标准。大多数研究评估了阿片类药物处方量的变化和患者报告的疼痛程度。次要衡量指标一般包括患者满意度、30 天再用药率以及非阿片类镇痛药的使用情况。共同决策和协作护理模式是很有希望改善疼痛管理的干预措施。这些干预措施能有效减少急性和慢性疼痛患者的阿片类药物用量,同时又不影响患者报告的疼痛水平。还需要进一步研究,以评估共同决策和协作护理干预如何影响以患者为中心的结果,如患者满意度、生活质量和患者与医护人员的沟通。
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引用次数: 0
A Utilization Review of Patients That Respond to Low-Dose Naltrexone (LDN) for Chronic Pain at a Single Institution. 一家机构对低剂量纳曲酮(LDN)治疗慢性疼痛患者的使用情况回顾。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-06-05 DOI: 10.1080/15360288.2024.2358941
Joshua Pogue, Diane Johnson, Andrew Burch

Studies have demonstrated the benefits of LDN for various pain indications. This review describes the utilization of and response to LDN in patients with chronic pain within the William S. Middleton Memorial Veterans Hospital (Madison VA). This was a retrospective, single center, chart review of patients that were prescribed LDN for chronic pain. The primary outcome, change in subjective pain report via numeric rating scale (NRS), was analyzed through Wilcoxon Signed Rank Test and descriptive statistics. A total of 136 participants were included. Patients had an average pain score of 7.1 per NRS at baseline. At the initial follow up visit, participants had an average pain of 6.4 (p < 0.001). Additionally, 17.1% of patients had a greater than or equal to 30% pain reduction from baseline. At subsequent follow up, patients reported an average pain of 5.5 (p < 0.0001) per NRS. At the end of the study, 31.6% of patients were maintained on LDN at an average dose of 3.8 mg. This retrospective review demonstrated that LDN may be an effective modality for some chronic pain indications. Reported pain scores were significantly lower at initial follow up compared to baseline for the total population, and for patients with fibromyalgia (FM) specifically.

研究表明,LDN 对各种疼痛适应症都有益处。本综述介绍了威廉-米德尔顿退伍军人纪念医院(麦迪逊退伍军人医院)的慢性疼痛患者对 LDN 的使用情况和反应。这是对开具 LDN 治疗慢性疼痛的患者进行的一次回顾性、单中心、病历审查。通过 Wilcoxon Signed Rank Test 和描述性统计分析了主要结果,即通过数字评分量表(NRS)得出的主观疼痛报告的变化。共纳入 136 名参与者。基线时,患者的 NRS 平均疼痛评分为 7.1 分。在首次随访时,参与者的平均疼痛程度为 6.4(p < 0.001)。此外,17.1% 的患者疼痛较基线减轻了 30%。在随后的随访中,患者报告的 NRS 平均疼痛程度为 5.5(p < 0.0001)。研究结束时,31.6% 的患者仍在服用 LDN,平均剂量为 3.8 毫克。这项回顾性研究表明,LDN 可能是治疗某些慢性疼痛的有效方法。与基线相比,初次随访时所有患者的疼痛评分明显降低,尤其是纤维肌痛(FM)患者。
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引用次数: 0
Effectiveness and Safety of Sublingual Fentanyl in the Treatment of Breakthrough Cancer Pain in Older Patients with Cancer: Results from a Retrospective Observational Study. 舌下含服芬太尼治疗老年癌症患者突破性癌痛的有效性和安全性:一项回顾性观察研究的结果。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-08 DOI: 10.1080/15360288.2024.2385680
Jordi Guitart-Vela, Ángela Magrone, Gloria González, Jordi Folch

The study assessed sublingual fentanyl citrate (SFC) effectiveness and safety for breakthrough cancer pain (BtCP) in older patients. A multicenter, retrospective, observational study was conducted in three subgroups of cancer patients aged over 65 years with BtCP. The reports were collected by 20 oncologists across 12 hospitals. The primary goal was to measure changes in BtCP intensity with SFC treatment over 30 days; secondary objectives included pain relief onset and adverse events. A total of 127 patients with long-term cancer (mean: 3.3 years) were recruited. All of them had BtCP, mostly of mixed origin (62.5%). A significantly lower dose was needed in the high-age group at the final visit compared to baseline (212.90 ± 200.45 mcg vs. 206 ± 167.08 mcg; p = 0.000). Pain intensities at the beginning of the flare and at 30 min after SFC administration were significantly lower when the last and first visits were compared (1.9 vs. 2.3, p = 0.000; and 6.2 vs. 6.8 p = 0.006, respectively). The onset of analgesia was significantly more rapid for half of the patients ≥75 years, compared with 65-69 and 70-74 age groups. SFC appears then to be effective, well-tolerated, and safe to treat BtCP in older cancer patients.

该研究评估了枸橼酸芬太尼舌下含服(SFC)治疗老年患者突破性癌痛(BtCP)的有效性和安全性。这项多中心、回顾性、观察性研究针对患有突破性癌痛的 65 岁以上癌症患者的三个亚组进行。报告由 12 家医院的 20 位肿瘤专家收集。研究的首要目标是测量 BtCP 在接受 SFC 治疗 30 天内的强度变化;次要目标包括疼痛缓解的开始时间和不良事件。共招募了 127 名长期癌症患者(平均 3.3 年)。所有患者都患有 BtCP,其中大部分为混合型(62.5%)。与基线相比,高年龄组在最后一次就诊时所需剂量明显降低(212.90 ± 200.45 微克 vs. 206 ± 167.08 微克;p = 0.000)。最后一次就诊与第一次就诊相比,发作初期和服用 SFC 后 30 分钟的疼痛强度明显降低(分别为 1.9 vs. 2.3,p = 0.000;6.2 vs. 6.8,p = 0.006)。与 65-69 岁和 70-74 岁年龄组相比,≥75 岁的半数患者的镇痛起效明显更快。由此看来,用 SFC 治疗老年癌症患者的 BtCP 是有效、耐受性好且安全的。
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引用次数: 0
Antidepressant Efficacy in Managing Nonspecific Chronic Lower Back Pain Among Older Adults: A Review. 抗抑郁药在治疗老年人非特异性慢性腰背痛中的疗效:综述。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-12 DOI: 10.1080/15360288.2024.2384961
Krzysztof Wilczyński, Adam Mazurski, Kornela Kotucha

This review evaluates the use of antidepressants in older patients for the treatment of nonspecific chronic lower back pain (LBP), emphasizing age-related physiological changes and common degenerative conditions in this age group. We conducted a comprehensive search targeting studies on antidepressant use in older patients with LBP. Selective serotonin reuptake inhibitors, while effective for mood regulation, show limited benefits for LBP. Serotonin-norepinephrine reuptake inhibitors, particularly duloxetine, demonstrate potential in managing LBP, though further research is needed to confirm these findings. Tricyclic antidepressants have shown potential for pain relief, with limited evidence for LBP, but have a substantial side effect profile, including cardiotoxicity, weight gain, and severe anticholinergic effects. The evidence for trazodone in the treatment of LBP is limited. When prescribing new medications for older adults, it is crucial to carefully consider the patient's overall health, potential drug interactions, and sensitivity to side effects, ensuring that the benefits of treatment outweigh the risks. This review underscores the need for further research to understand the long-term effects and benefits of antidepressants in older patients with LBP, aiming to balance pain relief, mood stabilization, and minimized side effects.

本综述评估了老年患者使用抗抑郁药治疗非特异性慢性下背痛(LBP)的情况,强调了与年龄相关的生理变化以及该年龄组常见的退行性病变。我们针对患有下背痛的老年患者使用抗抑郁药的研究进行了全面检索。选择性血清素再摄取抑制剂虽然能有效调节情绪,但对枸杞多糖症的疗效有限。血清素-去甲肾上腺素再摄取抑制剂,尤其是度洛西汀,显示出治疗枸杞痛的潜力,但还需要进一步的研究来证实这些发现。三环类抗抑郁药具有缓解疼痛的潜力,但用于枸杞痛的证据有限,但副作用较大,包括心脏毒性、体重增加和严重的抗胆碱能作用。曲唑酮治疗枸杞痛的证据有限。在为老年人开具新药处方时,必须仔细考虑患者的整体健康状况、潜在的药物相互作用以及对副作用的敏感性,确保治疗的益处大于风险。本综述强调了进一步研究的必要性,以了解抗抑郁药物对老年椎间盘突出症患者的长期影响和益处,从而在缓解疼痛、稳定情绪和减少副作用之间取得平衡。
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引用次数: 0
Memory with the Malady. 带着弊病的记忆
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-28 DOI: 10.1080/15360288.2024.2393843
Dalmacito Cordero
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引用次数: 0
期刊
Journal of Pain & Palliative Care Pharmacotherapy
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