Journal of Pain & Palliative Care Pharmacotherapy最新文献

Objectives: Intrathecal opioids may not be effective for severe refractory pain associated with cancer. Intrathecal ketamine may be effective in reducing pain in these cases, however, there is legitimate concern regarding ketamine neurotoxicity. We present our experience using intrathecal ketamine in 17 consecutive patients in one clinic, as well as, a case report of one patient who received intrathecal ketamine for 36 wk.

Materials and methods: A retrospective case review included all patients treated with intrathecal ketamine at one center. The primary outcome was dosing required to change pain intensity and signs of neurotoxicity.

Results: Seventeen patients received intrathecal ketamine, data was available on 11. Mean ketamine concentration was 794 mcg/ml. Mean basal dose was 341 mcg/day. All 11 experienced pain reduction. One experienced auditory hallucinations.

Conclusion: This study provides more data supporting the safety and efficacy of intrathecal ketamine in this population. While neurotoxicity is a concern, our experience has been positive.

Opioid Use Disorder (OUD) imposes significant burdens on healthcare systems, leading to increased costs and utilization. Limited real-world data exist on the healthcare resource use, charges, and impact of medications for OUD (MOUD). This study aimed to characterize healthcare use and costs in treated and untreated OUD patients. Adult patients diagnosed with OUD from January 2017, until April 2022, with at least 1 year of follow-up within the University of Utah Healthcare System (UHealth) were included. Patients were identified using ICD codes and data was extracted from electronic health record data system. Of 6,059 OUD patients, 3,474 (57%) received MOUD. Treated patients were younger (median age: 38.7 vs. 50.9 years), more often male (53% vs. 46%), and insured by Medicaid (40%). MOUD initiation was highest in emergency medicine (32%) and psychiatry (25%). Adjusted all-cause charges were similar for treated and untreated patients ($11,192.23 vs. $14,744.20, p = 0.964). Treated mothers had lower rates of spontaneous abortions/miscarriages (6% vs. 16%, p < 0.0005). The initiation of MOUD is influenced by demographic and clinical factors. While treatment with MOUD did not significantly impact all-cause healthcare charges, improvement in clinic outcomes such as improved maternal and newborn health outcomes were observed.

Chronic postsurgical pain (CPSP) is a debilitating condition that affects up to 50% of patients after procedures like inguinal herniorrhaphy, significantly impairing quality of life. This case report describes a 63-year-old male who experienced refractory CPSP for 5 years following inguinal hernia repair. The patient reported persistent pain despite multiple pharmacological treatments, including amitriptyline, gabapentin, and codeine, as well as nerve blocks and nonpharmacological interventions like acupuncture. Periodic intravenous ketamine infusions (30 mg every 30 days) were introduced, resulting in substantial pain relief, improved mobility, and enhanced functionality. Ketamine, a noncompetitive NMDA receptor antagonist, has shown promise in modulating central sensitization in chronic pain, with minimal adverse effects at low doses. This case aligns with the 2018 consensus guidelines on ketamine use in chronic pain and contributes to the growing body of evidence supporting its efficacy in CPSP management. While this therapy demonstrated remarkable clinical benefits, further research is essential to establish optimal protocols and long-term outcomes for ketamine use in chronic postoperative pain.

Cancer-associated cachexia-anorexia syndrome (CACS) significantly affects patients' quality of life, leading to weight loss, muscle wasting, and reduced treatment response. This prospective study aimed to evaluate effectiveness of olanzapine versus mirtazapine in managing CACS. Primary objective was to assess their impact on body weight and appetite, while the secondary objective focused on psychological distress and sleep. A total of 152 patients were randomly allocated into two groups of 76 patients each. Group O received Tablet Olanzapine 5 mg/day orally; Group M received Tablet Mirtazapine 15 mg/day orally at bed time. All patients were assessed by using Simplified Nutritional Appetite Questionnaire (SNAQ) score and weight at time of first visit then follow-up visit at 2nd and 4th weeks. At 2nd week, the mean change in SNAQ score was 3.14 in Group M compared to 2.04 in Group O (p = 0.035). By the 4th week, it was 3.86 in Group M and 2.87 in Group O (p = 0.006). Weight changes increased from 45.57 to 46.81 kg in Group M and from 45.97 to 46.90 kg in Group O by 4th week (p ≥ 0.5). Both mirtazapine and olanzapine significantly increased appetite without notable weight gain. Mirtazapine showed stronger effects on appetite, sleep, anxiety, and depression.

Nalbuphine's mixed agonist-antagonist activity has historically limited use. This study evaluated the impact of utilizing nalbuphine during admission during a parenteral opioid shortage. A single-center retrospective chart review was performed between January 2018 and June 2018 to compare outcomes between those who received nalbuphine and those who received morphine. The primary outcome was average pain score during admission. Secondary outcomes included: change in parenteral opioid, change in dose, and opioid prescription at discharge. In total, 138 patients, 47 in the nalbuphine group and 91 in the morphine group, were included. Average pain score during admission was 3.97 and 4.13 for nalbuphine and morphine, respectively (p = 0.695). There was no statistically significant change in average pain control on day 1, 2, or last day between groups. In opioid-tolerant patients who inadvertently received nalbuphine, average pain scores were higher compared to the nalbuphine opioid-naïve group, admission (p = 0.003), day 1 (p < 0.001), day 2 (p = 0.016), and last day (p = 0.007). No differences were observed based on sex. No difference in pain scores was observed. Nalbuphine resulted in less pain control in opioid-tolerant patients. Nalbuphine may represent an alternative first-line parenteral opioid in the acute care setting.

This article aims to summarize evidence regarding subcutaneously administered anesthetics and analgesics and their effects on pain management. Searches were conducted in September 2023 by a paired review in the MEDLINE database via the Virtual Health Library (BVS) and SCOPUS via Elsevier. Study selection was independently performed by two researchers according to inclusion criteria: primary studies, published in any language, and without temporal restriction. Duplicates, irrelevant studies, and those outside the research scope were excluded, with discrepancies resolved by a third reviewer. The final sample for the review comprised 45 articles, predominantly clinical trials with eligible patients, published between 1982 and 2022. Key drug classes identified in the evaluation of subcutaneous administration for pain management included amide and amino-amide anesthetics, opioids, and adjuvant agents (such as anti-inflammatory drugs, antihypertensives, and catecholamines). Primary advantages noted were reduced postoperative opioid use, effective analgesic control in postoperative settings, adjuvant efficacy in intraoperative settings and invasive exams, fewer cognitive side effects compared to other anesthesia types, decreased coughing, and shorter hospitalization and ambulation times. Disadvantages included subcutaneous bupivacaine's poor adjuvant performance when combined with general anesthesia, tissue necrosis associated with tumescent anesthesia technique, and ambiguity regarding postoperative respiratory function.

Fistulae can severely impact a patient's quality of life, causing physical pain and excessive malodorous discharge. Beyond the physical symptoms, they also impose significant psychological and social burdens. This report presents a unique case involving the intravenous administration of a single dose of infliximab to a terminally ill patient with rectal adenocarcinoma complicated by severe enterocutaneous fistulae in the genital, subscrotal, and gluteal regions. This home-based intervention not only improved the patient's quality of life but also alleviated caregiver burdens and facilitated the timely completion of end-of-life tasks.

Hematopoietic stem cell transplantation is one of the important treatment modalities for a wide range of malignant and nonmalignant hematological disorders, as well as congenital and acquired disorders of the immune system. Through bone marrow transplantation, candidates face unique challenges throughout the treatment process, which can be accompanied by high physical and psychological burdens. To address the challenges, emerging interventions, such as supportive and palliative care, have shown significant potential for improving quality of life, enhancing overall well-being, alleviating pain, and reducing patient symptoms. The integration of supportive and palliative care in all types of bone marrow transplantation has become increasingly crucial throughout all phases of transplantation, including pre-, during, and post. Therefore, there has to be a specialized team available that can provide complete care, from diagnosis to post-transplantation. Supportive and palliative care requires collaboration for their shared efforts in meeting the special needs of the patients, increasing their quality of life, hope, mood, and well-being. Accordingly, supportive and palliative care, as an integral part of the transplant process, provides patients comprehensive care that addresses their physical, emotional, and psychological well-being.