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2024: Putting the Our in Journal.
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2025-03-14 DOI: 10.1080/15360288.2024.2453775
Laura Meyer-Junco
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引用次数: 0
Intrathecal Baclofen Pump Refill-Related Cardiac Arrest: A Case Report. 鞘内巴氯芬泵再充相关心脏骤停1例报告。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-28 DOI: 10.1080/15360288.2024.2433639
Mohammad Aldalahmeh, Elie Bou Sanayeh, Waleed Sadiq, Chapman Wei, Michel Chalhoub

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.

我们报告一例45岁男性患者,有多发性硬化症合并痉挛和截瘫的病史,他出现精神状态改变和II型呼吸衰竭,需要插管,同一天他的鞘内巴氯芬泵由他的疼痛医生重新填充。入院后不久,患者在2小时内出现4次心脏骤停,直至泵内容物被抽吸,患者病情稳定。本病例报告强调了警惕和及时识别鞘内巴氯芬中毒的重要性,这可能导致危及生命的毒性和停药。
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引用次数: 0
Pain-Induced Delirium in Patient with Dementia: A Case Report and Narrative Review. 痴呆患者的疼痛性谵妄:1例报告及叙述回顾。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-28 DOI: 10.1080/15360288.2024.2433198
Julia Dian Christiani Adi Santoso, Erikavitri Yulianti

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.

疼痛管理是姑息治疗的标志;然而,在晚期痴呆和谵妄(急性精神错乱状态)的病例中,疼痛通常被低估。我们报告一例66岁女性严重痴呆患者,因行为改变和睡眠障碍而住院。精神错乱、迷失方向、注意力不集中和躁动的症状在夜间最为严重。病人从未抱怨过疼痛。仔细检查发现谵妄叠加在痴呆上,并伴有痴呆、肩周炎、骨关节炎、牙痛和老年综合征等行为和心理症状。给予美金刚5mg, q.12 h,多奈哌齐10mg, haloperidol 1mg, q.12 h,劳拉西泮1mg, q.8 h(如有必要),对乙酰氨基酚500mg, q.8 h,甲基强的松龙4mg, q.8 h,并给予社会心理支持,症状得到改善。疼痛常表现为神经精神症状,导致不适当使用抗精神病药物。精确的疼痛评估和有效的治疗是必要的,特别是在晚期痴呆症中。低估和治疗不足的痴呆疼痛可能导致谵妄和痴呆的进展。今后的研究应强调全面的多维度疼痛评估和总疼痛,以更好地管理晚期痴呆患者的疼痛,从而进一步提高姑息治疗患者的心理健康和生活质量。
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引用次数: 0
Family Caregivers in Palliative Care Therapeutic Management: An Integrative Review. 姑息治疗管理中的家庭照顾者:一项综合综述。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-28 DOI: 10.1080/15360288.2024.2433204
Dora Margarida Fragoso Santos, Patrícia Silva-Pereira

In palliative care, family caregivers are partners of multidisciplinary teams in the continuity of care at home. Effective therapeutic management provides optimal relief of distressing symptoms. It requires the acquisition of specific knowledge and care, but it also involves decision-making with ethical implications that increase the stress and burden on caregivers. The themes identified reflect the tangled dynamics of managing therapeutic regimens in the complexity of being a family caregiver. Therapeutic management relates to effective symptom management, which requires tasks and skills. This management is filled with uncertainties, fears, and emotions that arise from the complexity, responsibility, and weight represented by managing therapeutic regimens. Family caregivers are presented as coordinating elements within the healthcare system. The role of family caregivers is multidimensional, with numerous tasks and skills needed to support their relatives. Therapeutic management is more than just administering medications and needs to keep up with growing and fluctuating needs.

在姑息治疗中,家庭照护者是多学科团队在家庭照护连续性方面的合作伙伴。有效的治疗管理提供了最佳的缓解痛苦的症状。它需要获得特定的知识和护理,但它也涉及涉及伦理的决策,增加了照顾者的压力和负担。确定的主题反映了在作为家庭照顾者的复杂性中管理治疗方案的纠结动态。治疗管理涉及到有效的症状管理,这需要任务和技能。这种管理充满了不确定性、恐惧和情绪,这些情绪来自于管理治疗方案所代表的复杂性、责任和重量。家庭照顾者是医疗保健系统中的协调要素。家庭照顾者的作用是多方面的,需要许多任务和技能来支持其亲属。治疗管理不仅仅是给药,还需要跟上不断增长和波动的需求。
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引用次数: 0
Evaluating the Impact of Buprenorphine on Depressive Symptoms Among Veterans with Chronic Pain. 评估丁丙诺啡对慢性疼痛退伍军人抑郁症状的影响。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-22 DOI: 10.1080/15360288.2024.2427877
Anne V Cetto, Michael W Chandler, Neil K Shah, Lisa L Luciani, Jacob Painter

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.

丁丙诺啡对急性和慢性疼痛以及各种精神疾病都有疗效。然而,许多评估丁丙诺啡对精神疾病影响的研究并不针对慢性疼痛人群。这项回顾性研究旨在评估丁丙诺啡对退伍军人事务医疗机构中慢性疼痛患者抑郁症状的影响。研究纳入了在 2016 年 5 月 1 日至 2021 年 11 月 1 日期间开始使用丁丙诺啡或传统阿片类药物(非丁丙诺啡阿片类药物)任何剂型且至少接受过两次抑郁症筛查的慢性疼痛成人患者。主要结果是抑郁症状从基线到开始治疗后 6-18 个月的变化,以患者健康问卷-9(PHQ-9)进行测量。次要结果包括哥伦比亚自杀严重程度评定量表和心理健康服务利用率的变化。共纳入 21 名患者。丁丙诺啡组和传统阿片类药物组的 PHQ-9 基线中位数分别为 14 和 13。丁丙诺啡组和传统阿片类药物组的PHQ-9中位数变化分别为-5和-1.5。与传统阿片类药物相比,丁丙诺啡对慢性疼痛退伍军人抑郁症状的缓解作用更大。虽然这种减少达到了临床显著改善的临界值,但仍需进一步调查以评估这些发现的临床意义。
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引用次数: 0
Longitudinal Evaluation of the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression in Patients with Cancer. 纵向评估癌症患者用药过量或严重阿片类药物引起呼吸抑制的风险指数。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-22 DOI: 10.1080/15360288.2024.2427876
Phap Nguyen, Ngozi A Okoroma, Kenny K Ngo, Parker K Kaleo, Eric J Roeland, Joseph D Ma

The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based screening tool to determine an individual's risk of opioid-induced respiratory depression (OIRD) or overdose. Chronic opioid use and changes in a patient's clinical status and/or medication regimen may impact OIRD or overdose risk. This study evaluated longitudinal CIP-RIOSORD scores over three consecutive visits. Data for eighty patients with cancer encompassed two-hundred and forty visits. Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores (mean ± SD) were 16.6 ± 15.4, 20.3 ± 15.7, and 19.1 ± 15.1 at visits 1, 2, and 3, respectively. Visit 1 CIP-RIOSORD scores were similar compared to visit 2 and visit 3 (p = 0.14-0.31). CIP-RIOSORD intraindividual variability was low to moderate; the median (range) coefficient of variation was 22.3% (0-173%). Beyond a baseline OIRD/overdose risk assessment, reevaluation of such risk using the CIP-RIOSORD does not to be performed at each palliative care visit.

商业保险健康计划过量或严重阿片类药物引起的呼吸抑制风险指数(CIP-RIOSORD)是一种循证筛查工具,用于确定个人患阿片类药物引起的呼吸抑制(OIRD)或过量的风险。长期使用阿片类药物以及患者临床状态和/或用药方案的改变可能会影响 OIRD 或用药过量风险。本研究评估了连续三次就诊的纵向 CIP-RIOSORD 评分。八十名癌症患者的数据涵盖了二百四十次就诊。大多数患者是患有转移性胃肠癌的白种女性。第 1、2 和 3 次就诊时,CIP-RIOSORD 评分(平均值 ± SD)分别为 16.6 ± 15.4、20.3 ± 15.7 和 19.1 ± 15.1。第 1 次就诊时的 CIP-RIOSORD 评分与第 2 次和第 3 次就诊时相似(p = 0.14-0.31)。CIP-RIOSORD 的个体内部变异性从低到中等;变异系数的中位数(范围)为 22.3% (0-173%)。除了基线OIRD/用药过量风险评估外,在每次姑息关怀就诊时,无需使用CIP-RIOSORD对此类风险进行重新评估。
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引用次数: 0
Implementation of Pharmacist Driven Gabapentinoid Titration for Diabetic Peripheral Neuropathy in a Primary Care Setting. 在基层医疗机构实施由药剂师驱动的加巴喷丁胺滴定法治疗糖尿病周围神经病变。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-22 DOI: 10.1080/15360288.2024.2421527
Emma Eibye, Julie M Waldfogel, Patricia A Ross, Callan Banks, Joshua Chou, Katharine Russo, Jessica Merrey

Previous studies suggest that patients with diabetic peripheral neuropathy (DPN) frequently do not receive the minimum effective doses of a gabapentinoid according to guidance from national organizations. There is opportunity to assess the implementation of pharmacist intervention for patients not meeting minimum effective gabapentinoid dosing for DPN. This prospective, single site quality improvement project was conducted at a primary care clinic and included patients with DPN prescribed a gabapentinoid by their primary care provider (PCP) at a dose lower than minimum effective dosing. Pharmacists assessed patient-reported pain ratings, adverse effects, and renal function for appropriate dosing and titrated to minimum effective dosing based on clinical judgment. All patients that were followed through week 13 had a clinically significant improvement in pain. No patients met a 50% reduction in patient-reported pain rating scales on guidance-directed minimum effective dosing. No patients were able to meet the minimum effective dose. The majority of patients declined pharmacist services due to neuropathy being controlled on the current gabapentinoid dose. This study supports the ability for pharmacists to assess patient specific factors for adequate dosing, titration, and deprescribing recommendations for analgesic medications in diabetic peripheral neuropathy.

以往的研究表明,糖尿病周围神经病变(DPN)患者经常无法按照国家组织的指导获得最小有效剂量的加巴喷丁胺。现在有机会评估药剂师对未达到加巴喷丁诺类药物治疗 DPN 最低有效剂量的患者进行干预的实施情况。该前瞻性单点质量改进项目在一家初级保健诊所开展,包括初级保健提供者(PCP)开出的剂量低于最低有效剂量的加巴喷丁类药物的 DPN 患者。药剂师对患者报告的疼痛评分、不良反应和肾功能进行评估,以确定合适的剂量,并根据临床判断将剂量调整到最低有效剂量。所有随访至第 13 周的患者的疼痛均有明显的临床改善。在指导性最低有效剂量下,没有患者的患者报告疼痛评分量表达到减少 50%的要求。没有患者能够达到最低有效剂量。大多数患者拒绝了药剂师的服务,原因是目前的加巴喷丁诺剂量可以控制神经病变。这项研究证明,药剂师有能力评估患者的具体因素,以便为糖尿病周围神经病变患者提供适当的镇痛药物剂量、滴定和停药建议。
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引用次数: 0
Cannabis-Based Treatments for Fibromyalgia: Implications for the Philippines' Medical Cannabis Legalization. 基于大麻的纤维肌痛治疗方法:菲律宾医用大麻合法化的启示。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-11-20 DOI: 10.1080/15360288.2024.2426604
John Patrick C Toledo
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引用次数: 0
The Effectiveness of Tramadol in Pain Relief in Chronic Diseases: A Review Based on Clinical Trials. 曲马多缓解慢性病疼痛的疗效:基于临床试验的综述
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-10-23 DOI: 10.1080/15360288.2024.2411239
Kosar Seidmohammadi, Hoda Haghshenas, Sara Moghaddam, Hossein Kargar Jahromi, Hamed Delam

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.

曲马多是一种由氨基环己醇基团合成的具有中枢效应的阿片类药物,其主要作用机制有两种,包括作为阿片受体的弱激动剂以及去甲肾上腺素和五羟色胺再摄取抑制剂。本研究基于 2023 年设计的临床试验进行综述。2023 年 7 月,研究人员检索了 Medline/PubMed、ProQuest、Scopus、EMBASE、Google Scholar 和 ISI(Web of Science)等六个国际数据库,共收录了 58 篇文章。大多数研究结果表明,曲马多可作为镇痛药物使用,但也有一些研究结果表明,与其他治疗方法相比,曲马多在减轻疼痛方面并不具有治疗优势。此外,一些研究还报告了与该疗法相关的并发症。医生应考虑这些因素,以防止药物毒性、疼痛缓解效果不佳、患者用药紊乱以及不可预测的并发症。需要注意的是,目前还没有足够的证据支持曲马多的长期有效性,但这一论点也适用于非阿片类和其他类型的阿片类镇痛药,缺乏长期试验是由于监管和伦理问题。虽然长期使用阿片类药物会导致成瘾,但曲马多的安全性是合理的。根据患者的病情和专业医务人员的临床判断,可以为患者开具曲马多处方,但必须考虑到使用该药物的后果,并在利大于弊的情况下选择个性化的治疗算法。
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引用次数: 0
Correction. 更正。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-10-21 DOI: 10.1080/15360288.2024.2419784
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引用次数: 0
期刊
Journal of Pain & Palliative Care Pharmacotherapy
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