Journal of Pain & Palliative Care Pharmacotherapy最新文献

Ketamine is an analgesic used to manage neuropathic pain, but its use is limited by side effects and intravenous administration. Recently, the use of oral and nasal administration has expanded. However, no systematic review of randomized studies on its efficacy and safety. A search was conducted in PubMed, CINHAL, and Web of Science up to December 19, 2023. Randomized studies evaluating oral ketamine for managing any type of pain were included. Articles were assessed for quality using the ROB2 tool, and results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 1439 results. Six randomized studies were selected. The oral ketamine dose ranged from 0.5 to 10 mg/kg, up to a maximum of 400 mg/day. Three studies comparing oral ketamine with other analgesics found no differences between groups. Two studies compared oral ketamine to placebo; one showed a reduction in local anesthetic use and intraoperative pain, while the other found no difference. Adverse reactions were common, but their severity was not reported. Preliminary evidence suggests that oral ketamine may be considered in select patients with refractory chronic neuropathic pain. The potential use in outpatient settings warrants further high-quality studies.

Naltrexone is an opioid antagonist approved by the Food and Drug Administration (FDA) for alcohol use disorder and opioid use disorder. More recently, naltrexone has been used off-label at low doses of 4.5 mg daily for chronic pain due to fibromyalgia, neuropathy, complex regional pain syndrome, and multiple sclerosis. While several studies show the promise of low-dose naltrexone in treating chronic pain, most had small sample sizes and short-term follow up, which warrants additional investigation into the effectiveness of low-dose naltrexone. This medication use evaluation aimed to evaluate the effectiveness of low-dose naltrexone for chronic pain in Veterans through retrospective chart review. The average duration of low-dose naltrexone therapy was 123 days with approximately half of Veterans still taking it at the time of chart review. The average change in pain score from initiation to most recent visit was -0.83. Low-dose naltrexone was generally well-tolerated with 32% (13 of 41) of Veterans reporting adverse effects including vivid dreams, drowsiness, dizziness, and nausea. Low-dose naltrexone resulted in a small decrease in pain, although may be considered after a patient has failed multiple lines of therapy for additional pain control after a risk versus benefits discussion.

Treatment of chronic, non-cancer pain can be challenging in the presence of long-term opioid therapy (LTOT). Buprenorphine products can provide a unique option for chronic pain treatment due to the improved safety profile with a ceiling effect on respiratory depression. Drug manufacturers provide recommendations for conversion from full mu agonist to buprenorphine which typically includes tapering to lower morphine equivalent doses (MEDD). This study will attempt to compare if there is a difference in the ability of achieving buprenorphine maintenance therapy for chronic pain based on the starting opioid MEDD. This study's primary endpoint is the difference in ability to achieve buprenorphine maintenance therapy for chronic, non-cancer pain based on baseline MEDD (i.e., ≤30 MEDD vs >30 MEDD). Secondary endpoints will describe method of conversion to buprenorphine, difference in frequency of follow up and average time to achieve maintenance doses. There was no difference in ability to achieve buprenorphine maintenance doses between either group. Approximately 40% of patients in each group achieved maintenance doses regardless of baseline MEDD. Patients on higher MEDDs had the same likelihood of achieving buprenorphine maintenance therapy for chronic pain as those were at 30 MEDD and can be considered for buprenorphine therapy without tapering first.

For patients with an active or prior history of opioid use disorder (OUD), post-operative pain management following left ventricular assist device (LVAD) implantation can be challenging. It is imperative for an interdisciplinary team of specialists to collaborate to develop an individualized plan of care. Adopting multimodal analgesic strategies can minimize the risk of relapse and withdrawal. Here, we present a case of a multimodal analgesic plan using a bilateral parasternal perineural infusion and buprenorphine, a partial mu-opioid receptor agonist, for a patient who received an LVAD. Review of the total daily post-operative oral morphine equivalents (OME) trend revealed decreasing dependence on full mu-opioid receptor agonists as the dose of buprenorphine was increased. This illustrates that a primary buprenorphine strategy in conjunction with non-opioid analgesics can help manage post-LVAD pain in patients with OUD.

Joint arthroplasty for shoulder, hip and knee joints is a widely performed surgical intervention in orthopedics practice. Early postoperative complications include pain, delirium and cognitive dysfunction, urinary retention, sleep disturbance, anxiety and others. Melatonin is a sleep-inducing hormone successfully tried for management of many painful conditions, postoperative sleep disturbance, and postoperative delirium. This systematic review aimed to critically analyze the randomized clinical studies on the therapeutic effects of perioperative melatonin administration in patients submitted to joint arthroplasty. It was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eight articles were progressed to final analysis. The effect of melatonin administration on postoperative pain and sleep quality was assessed by six studies while its effect on delirium was assessed by two studies. In conclusion, the present review found variable degrees of success of melatonin administration for management of postoperative pain, sleep disturbance and delirium. However, based on published studies, use of melatonin for management of these conditions lacks robust clinical evidence.

Various invasive and non-invasive treatment modalities have been performed for the treatment of Myofascial pain dysfunction syndrome (MPDS). Topical agents may be effective with minimal disadvantages, and can be the first line of non-invasive treatment option in the management of MPDS. This systematic review was done to evaluate the safety and effectiveness of topical agents and patches in the management of pain associated with MPDS as a non-invasive management option. According to PRISMA guidelines, the PubMed, Embase, Web of science and Cochrane engine databases were searched for clinical trials which were published till July 2023. A total of 5 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed. Topical agents in forms of ointment, gels and patches was found to improve the pain symptoms along with better quality of life and range of motion in patients with MPDS. This systematic review showed that topical interventions provide a non-invasive option for pain management in MPDS, demonstrating efficacy compared to placebo with a favorable safety profile. However, direct comparisons with invasive methods are limited and further studies directly comparing topical and invasive interventions are needed before establishing them as a first-line treatment.

Cancer pain (CP) is a prevalent condition with limited pharmacotherapeutic options. Cannabis-based medicinal products (CBMPs) have shown analgesic effects, but their efficacy in CP remains contentious. This study aims to evaluate the change in patient-reported outcome measures (PROMs) and adverse events (AEs) in CP patients treated with CBMPs. A case series was conducted using prospectively collected clinical data from the UK Medical Cannabis Registry. Primary outcomes were the changes in the Brief Pain Inventory (BPI), pain visual analogue scale (Pain-VAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7), Patient Global Impression of Change (PGIC) and Single-Item Sleep Quality Scale (SQS) questionnaires from baseline to 1, 3, and 6 months. AEs were recorded and graded. p < 0.050 was considered statistically significant. One hundred and sixty-eight participants were included. CBMPs were associated with improvements in all pain-specific PROMs at all follow-up periods (p < 0.050). Improvements in GAD-7, SQS, and EQ-5D-5L index scores were also observed (p < 0.050). Twenty-nine AEs (17.26%) were reported by five patients (2.98%), mostly mild-to-moderate (72.41%). Although the observational design means causality cannot be established, the findings support the development of future randomized controlled trials into CP management with CBMPs.

This study compares the efficacy of hydrodilatation (HD) alone with intra-articular corticosteroid injection (ICI) in treating frozen shoulder (FS). A total of 48 patients with FS were randomly assigned to two groups: 24 patients received HD treatment, while the other 24 patients received ICI treatment. HD involved 20 mL 0.9% normal saline solution with 3 mL 2% lidocaine, and ICI included 1 mL of 40 mg/mL methylprednisolone acetate with 1 mL 2% lidocaine and 3 mL normal saline. Outcome measures included Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) at baseline, two-, four-, and eight-week follow-ups. Both treatments demonstrated significant improvement in the VAS, SPADI, and passive ROM, when between-times comparison was conducted in each group at all follow-up points over the eight-week study period (p < 0.001). However, no significant differences were found in between groups comparison at study end (p > 0.05), with no significant interaction between groups and times (p > 0.05). Absolute changes from baseline to eight-week follow-up were not significantly different between HD and ICI (p > 0.05). In the short term, HD alone demonstrates strong efficacy in managing FS, matching the effectiveness of ICI.