Journal of Pain & Palliative Care Pharmacotherapy最新文献

Thoracic cancer pain, particularly due to lung malignancies, chest wall infiltration, or pancoast tumors, is often severe and multifactorial. When conventional systemic analgesics alone are inadequate, ultrasound-guided fascial plane blocks, such as the erector spinae plane block (ESPB), may provide rapid significant pain relief, particularly in outpatient settings. We report five cases of advanced thoracic malignancies with severe, refractory pain (Numerical Rating Scale [NRS] 8-10) despite optimized systemic analgesics. ESPB was performed using an in-plane ultrasound-guided technique at levels T4-T8 with a combination of local anesthetic and corticosteroid. All patients achieved significant pain relief (≥5-point reduction in NRS) and improved mobility immediately post-injection, with sustained pain control on reduced oral analgesic doses. During follow-up, one patient required a repeat block after one month, three maintained satisfactory analgesia with oral medications, and one patient was lost to follow-up. No procedural complications were observed. The erector spinae plane block appears to be a technically simple and effective regional analgesic technique for managing intractable thoracic cancer pain. Its rapid onset, opioid-sparing potential, and favorable safety profile make it a valuable adjunct in the palliative care of patients with advanced thoracic malignancy. Larger prospective studies are warranted to define optimal protocols and long-term efficacy.

Recurrent malignant ascites significantly impacts the quality of life in patients with advanced ovarian carcinoma, especially those in remote areas with limited healthcare access. Traditional management methods, including repeated paracentesis, present logistical and financial challenges. This case report describes a novel, low-cost method using a subcutaneously placed indwelling pigtail catheter for continuous ascites drainage. The approach provided symptom relief and minimized hospital visits, demonstrating its potential in palliative care.

Pain remains one of the most common reasons that individuals seek healthcare. Despite advances in pain care and an improved understanding of the harms associated with opioid use, there is still considerable reliance on opioid medications for treating both acute and chronic pain. With the implementation of guidelines emphasizing opioid risk mitigation strategies and non-pharmacologic treatments, healthcare providers increasingly engage in conversations with patients about opioid safety and alternative therapies. Pharmacists are highly accessible healthcare professionals who practice in a variety of settings and, therefore, often face conversations related to pain management and opioid use. Healthcare professionals in general receive limited training in pain care and empathetic communication, which can create barriers to effective patient-provider interactions. This publication aims to equip pharmacists with practical tools and strategies for managing difficult conversations related to pain management and opioid use. With the appropriate tools, pharmacists can work toward improving patient-provider relationships, enhancing patient outcomes, and creating a more supportive environment.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used medications that function by inhibiting cyclooxygenase enzymes. Although they are highly effective in managing pain and inflammation, their potential for increasing bleeding risks continues to be a concern. Due to the increased risk for bleeding complications following surgical procedures, the safety of perioperative NSAIDs is debated. The primary objective of this article is to examine literature published in the past 10 years focused on post-operative bleeding risks associated with perioperative NSAID use. A systematic search was designed to include randomized controlled trials, systematic review meta-analyses, and retrospective or prospective reviews examining post-operative bleeding events associated with perioperative NSAID use in adults. Following the screening process and review, 11 articles were included. The reviewed literature primarily examines post-operative bleeding incidence, blood loss, hemoglobin decline, and the frequency of hematomas or hemorrhages. Overall, the evidence suggests that perioperative NSAIDs have minimal impact on post-operative bleeding risk. COX-2 selective NSAIDs may be a safer alternative to nonselective NSAIDs, with some studies indicating a lower risk of post-operative bleeding following their use. Ultimately, the decision to use NSAIDs in the perioperative period should be tailored to the specific surgical procedure and individual patient factors.

This study was conducted to assess participant understanding of medication-overuse headache (MOH) by adults in the US. It was conducted using an 18 item, descriptive questionnaire which addressed demographic information, frequency and severity of headaches, type of headaches experienced, medication use frequency, perceived risk for MOH of specific medications, and knowledge of the term "medication-overuse or rebound headache." Descriptive statistics and Mann-Whitney U tests were used in analyzing data. The study included 329 (n = 329) participants. Almost half of respondents were between the ages 18 and 30 years old [155/329 (47.1%)]. The most common type of headache diagnosis reported was tension-type headache [144/329 (43.8%)]. About 10% (31/329) of survey respondents reported chronic daily headache, or headache that is present on at least 15 days per month. Of the survey respondents, 26.7% (88/329) had never heard of the term "medication-overuse headache." A significant number of participants who reported overusing various medications also reported that they had never heard of the term "medication-overuse headache." This study shows that many of the respondents, including some who use analgesics or abortive medications for headaches, were not familiar with MOH. Furthermore, it suggests that patients may benefit from further education on this condition.

This case report details a successful transition of a patient with cancer-related pain from long-term methadone therapy to sublingual buprenorphine using a micro-induction protocol in an outpatient setting. The transition involved initiating low-dose transdermal buprenorphine while gradually tapering methadone, followed by the introduction of sublingual buprenorphine. This approach resulted in a smooth conversion without clinically evident withdrawal symptoms and led to improved pain control, reduced adverse effects, and enhanced functional status. A gradual transition from methadone to buprenorphine represents a safe and effective outpatient strategy for managing cancer-related pain. Future research should focus on refining micro-induction protocols and exploring precision medicine in opioid transitions.

Suzetrigine is a novel non-opioid analgesic for treating moderate to severe acute pain. Clinical trials for postoperative pain demonstrated that the most common side effects were headache and constipation. Since it became commercially available in March of 2025, there have been no case reports of unanticipated problems. However, the wider use of this first-in-class drug outside of clinical trials may lead to reports of additional side effects, interactions, or intolerances. We present the case of a patient experiencing paresthesia following administration of suzetrigine for refractory postoperative pain.

Opioids continue to be relied on to treat postoperative pain and continue to result in harms ranging from pruritis to overdose. The partial agonist opioid buprenorphine was synthesized in the 1960s as result of a search for a safe and effective opioid analgesic. While formulations of buprenorphine are approved for the treatment of pain, it is more commonly known as a medication for opioid use disorder. However, there is increasing interest in employing buprenorphine as a front-line perioperative opioid analgesic. We review the continued reliance on full agonist opioids and associated harms, highlight key efficacy and safety advantages of buprenorphine compared to usual care opioids, and describe the evolution of our consideration of buprenorphine for acute perioperative pain management. We then describe the process by which we worked within our institution to arrive at a twice daily buccal film and describe the clinical pathway ultimately implemented, providing details on training of staff, order set development, and surgical populations included. Buprenorphine presents a promising opportunity to reduce opioid harms while potentially improving pain outcomes after surgery. Our experience suggests that the buccal formulation possesses unique advantages for perioperative administration. Future directions will inform buprenorphine's impact on key pain and opioid-related outcomes.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune-mediated disorder with neuropsychiatric manifestations, frequently following herpes simplex virus (HSV) encephalitis. The management of associated behavioral disturbances is challenging, complicated by poor response and tolerability to antipsychotics. This case report describes the use of oral phenobarbital for refractory behavioral disturbances in a patient with concurrent anti-NMDA and HSV encephalitis. A 65-year-old female with a two-year history of anti-NMDAR and HSV encephalitis presented with severe behavioral disturbances, including paranoia, insomnia, hypersexuality, compulsive behaviors, and aggression. Disease-modifying therapies, including IV acyclovir, IV immunoglobulin, prednisone, and rituximab, were ineffective. Multiple psychotropic medications, including fluoxetine, quetiapine, olanzapine, and trazodone, failed to relieve behavioral symptoms. Given previous ineffective pharmacotherapies, oral phenobarbital was initiated at 30 mg every 12 hours and later titrated to 60 mg every 12 hours. Four weeks after phenobarbital dose escalation, behavioral improvements were observed, with reductions in obsessive behaviors, elopement, and insomnia. After 20 weeks of phenobarbital therapy, notable improvements in agitation, redirection, and verbal aggression were documented. No adverse effects were reported. This case suggests that low-dose oral phenobarbital may be a viable option for managing refractory behavioral disturbances in patients and improving quality of life with anti-NMDAR and HSV encephalitis.