Journal of Pain & Palliative Care Pharmacotherapy最新文献

The aim of this work was to assess the effectiveness of full-spectrum cannabis (THC and CBD) extracts as adjuvants in the treatment of chronic pain. This is a prospective, open label, longitudinal study. Major cannabinoids were analyzed in herbal preparations using high performance liquid chromatography (HPLC). Subjects were included when chronic pain diagnosis criteria was met according to physicians' diagnosis. A patient stratification protocol was developed using a visual analogue scale to measure pain, a numerical scale for life quality parameters and a self-administered health survey. Eighty-eight patients aged between 35 and 88 years were included. A significant decrease in both pain and other life quality parameters was observed between time zero and subsequent time intervals, excepting the "appetite" variable. Overall, 51 individuals reported a decrease in pain, 38 a decrease in anxiety and 48 in insomnia, with "decrease" defined as symptom reduction of 50% or more between the first and last consultation. In addition, 23 subjects reduced or discontinued other analgesics and/or anti-inflammatory drugs during the trial. Adverse effects were mild and reversible. These results are consistent with previous studies, supporting effectiveness and safety of cannabis extracts as adjuvants in the treatment of chronic pain.

Low-dose naltrexone (LDN) has demonstrated mixed efficacy in treating fibromyalgia. This systematic review and meta-analysis aimed to evaluate the efficacy of LDN for fibromyalgia. We systematically searched electronic databases and gray literature from inception to May 2024. Included studies were clinical trials in humans published in English, reporting mean changes in pain scores and fibromyalgia symptom severity, comparing baseline to endpoint and LDN to placebo. Of 575 identified articles, eight met the eligibility criteria. In the LDN group, the Standardized Mean Difference (SMD) for pain decreased by 1.03 (95% confidence interval (CI): -1.25, -0.80; I² = 25%), and fibromyalgia symptom severity decreased by 1.02 (95% CI: -1.35, -0.69; I² = 52%) post-LDN treatment compared to the baseline. However, no significant differences in mean change in pain (SMD -0.50, 95% CI: -1.19, 0.19; I² = 91%) and fibromyalgia symptoms severity scores (SMD -0.67, 95% CI: -1.67, 0.34; I² = 95%) were observed between the LDN and placebo groups. Although LDN marginally reduced pain and symptom severity from baseline, these effects were not superior to placebo. This suggests that LDN may not provide significant clinical benefit over placebo in fibromyalgia management, warranting further research.

Chronic pancreatitis presents a formidable challenge in pain management, often leading to significant suffering and reduced quality of life for affected individuals. The intricate interplay of factors contributing to this pain, including inflammation and neural sensitization, has garnered increasing attention in recent research. Among the key players in this scenario are the transient receptor potential vanilloid 1(TRPV1) channels located in dorsal root ganglion (DRG) neurons. These channels, known for their role in pain perception, exhibit heightened sensitivity and altered expression patterns in the context of chronic pancreatitis. Sensitization of TRPV1 channels amplifies their response to various pain triggers, exacerbating the perception of discomfort. Furthermore, dysregulated expression of TRPV1 within DRG neurons contributes to the chronic pain phenotype associated with pancreatitis. Understanding the nuanced mechanisms governing TRPV1 modulation in DRG neurons promises to unlock novel therapeutic avenues for managing chronic pancreatitis pain. By targeting TRPV1 channels specifically in DRG neurons, researchers aim to develop treatments that alleviate pain while minimizing adverse effects, ultimately offering hope for improved outcomes and enhanced well-being for individuals grappling with this debilitating condition.

What do we already know about this topic?Significant obstacles to providing effective pain relief still exist despite major improvements in pain management strategies.How does this research contribute to the field?It highlights the necessity for a thorough comprehension of the complex nature of pain management, where nurses play a crucial role, in the context of patient care.What are the implications of this research for theory, practice, or policy?It highlights the need for healthcare organizations and educational institutions to give nurses priority in their ongoing training and education, with an emphasis on cultivating a holistic and compassionate approach to pain management.

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.