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Journal of Pain & Palliative Care Pharmacotherapy最新文献

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Caring is Healing: Finding Life Amid Pain and Suffering. 关怀即治愈:在痛苦中寻找生命。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-10-15 DOI: 10.1080/15360288.2024.2346389
Dalmacito A Cordero
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引用次数: 0
Music for Healing: A Careful Application of Music Therapy for the Sick. 音乐治病:为病人精心应用音乐疗法。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2024-10-15 DOI: 10.1080/15360288.2024.2389866
Dalmacito A Cordero
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引用次数: 0
Outcome Expectancies, Effects, and Mechanisms of Brief Training in Mindfulness Meditation vs. Loving-Kindness Meditation vs a Control Condition for Pain Management: A Randomized Pilot Study. 正念冥想与爱-善念冥想简短训练与疼痛管理对照条件的结果预期、效果和机制:随机试验研究
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 Epub Date: 2023-01-09 DOI: 10.1080/15360288.2022.2141944
Melissa A Day, Natasha Matthews, Jonathan N Davies, Claire Walker, Nicola Bray, Jeffrey Kim, Mark P Jensen

This study investigated the analgesic effects of a single session of mindfulness meditation (MM) and loving-kindness meditation (LKM) relative to a control. A total of 100 adults with chronic or current problematic pain completed a survey and were randomized to a 20-minute MM, LKM, or audiobook control. Co-primary outcomes of pain intensity and unpleasantness and mediators of mindfulness and self-compassion were assessed pre- and posttraining. Expectancies were assessed pretraining. Pain type (chronic vs current problematic) was a covariate. Relative to the control, higher expectancies were reported for MM and LKM (P < .001). MM (d = 0.41, P = .032) and LKM (d = 0.38, P = .027) had medium effects on pain intensity, with greater decreases than control (d = 0.05, P = .768). All conditions had small effects on unpleasantness. Mindful observing increased more within MM (d = 0.52, P = .022) and the control (d = 0.50, P = .011) than LKM (d = 0.12, P = .50); self-compassion increased more in LKM (d = 0.36, P = .042) than MM (d = 0.27, P = .201) and the control (d = 0.22, P = .249). The mediation models were nonsignificant. Pain type was a nonsignificant covariate. Overall, MM and LKM were associated with positive expectancies and small-medium pain intensity reductions, which did not differ by pain type. Although MM and LKM were associated with changes in theorized mediators, these changes did not underlie improvement.

本研究调查了单节正念冥想(MM)和慈爱冥想(LKM)相对于对照组的镇痛效果。共有 100 名患有慢性疼痛或目前有疼痛问题的成年人完成了调查,并被随机分配到 20 分钟的正念冥想、LKM 或有声读物对照组中。对疼痛强度和难受程度的共同主要结果以及正念和自我同情的中介因素进行了培训前和培训后评估。培训前对期望值进行了评估。疼痛类型(慢性疼痛与当前问题性疼痛)是一个协变量。与对照组相比,MM 和 LKM 的期望值更高(P < .001)。MM(d = 0.41,P = 0.032)和 LKM(d = 0.38,P = 0.027)对疼痛强度有中等程度的影响,比对照组(d = 0.05,P = 0.768)有更大的降低。所有条件对不愉快感都有微小影响。与 LKM(d = 0.12,P = .50)相比,MM(d = 0.52,P = .022)和对照组(d = 0.50,P = .011)的正念观察增加得更多;与 MM(d = 0.27,P = .201)和对照组(d = 0.22,P = .249)相比,LKM(d = 0.36,P = .042)的自我同情增加得更多。中介模型不显著。疼痛类型是一个不显著的协变量。总体而言,MM 和 LKM 与积极的预期和小到中等的疼痛强度降低有关,这在疼痛类型上没有差异。虽然 MM 和 LKM 与推测的中介因子的变化有关,但这些变化并不是改善的基础。
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引用次数: 0
Subcutaneous Bolus Infusions of Undiluted Levetiracetam for End-of-Life Patients: Two Cases. 为临终患者皮下注射未稀释的左乙拉西坦:两个病例
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-12 DOI: 10.1080/15360288.2024.2311379
Kenneth Skov, Astrid Lyager

We present two cases, in which end-of-life patients were inadvertently treated with bolus infusions of undiluted subcutaneous levetiracetam. The patients were treated for three and four days respectively. In both cases, the course of treatment was uneventful. Especially, no seizures, nor local irritation was observed. Administration of undiluted subcutaneous levetiracetam as intermittent bolus infusions by hand holds alluring properties for end-of-life patients. Amongst others reducing patient discomfort, increasing freedom of movement, and accessibility to essential seizure prophylaxis by eliminating the need for a syringe driver, thereby helping accommodate many patients wish to die in their own home. However, pharmacokinetics, efficacy, and safety, including the optimum dilution and administration time of the subcutaneous preparation remains to be determined in clinically controlled trials.

我们介绍了两个病例,其中临终患者无意中接受了未经稀释的皮下注射左乙拉西坦的治疗。患者分别接受了三天和四天的治疗。两个病例的治疗过程都很顺利。尤其是没有观察到癫痫发作,也没有观察到局部刺激。对临终患者而言,以间歇性栓剂输注的方式进行未稀释的皮下注射左乙拉西坦具有诱人的特性。其中包括减少病人的不适感,增加行动自由,以及通过消除对注射器驱动器的需求来获得必要的癫痫预防,从而帮助满足许多病人在自己家中去世的愿望。然而,药代动力学、疗效和安全性,包括皮下注射制剂的最佳稀释度和给药时间,仍有待临床对照试验来确定。
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引用次数: 0
Frequency of Myoclonus and its Countermeasures in Terminally Ill Patients with Cancer: A Single-Center Retrospective Study. 癌症晚期患者肌阵挛的发生频率及其对策:单中心回顾性研究
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-09 DOI: 10.1080/15360288.2024.2345326
Yoshihiro Yamamoto, Hiroaki Watanabe, Norio Watanabe, Yasuyuki Asai, Motozumi Ando, Masami Kawahara, Yuko Deguchi, Takuya Odagiri

Myoclonus is a relatively rare involuntary movement that is often observed in palliative care settings and that can cause patient distress. The purpose of this study is to investigate the occurrence of myoclonus and countermeasures against it in terminally ill patients with cancer diagnosed by palliative care specialists at Komaki City Hospital, Japan. We retrospectively reviewed patients with terminal cancer who received palliative care consultations between January 2018 and May 2019 and who were diagnosed with myoclonus by palliative care specialists, using electronic medical records. Patient demographics, time from onset of myoclonus to death, daily opioid use, countermeasures, and outcome of myoclonus were assessed. Of 360 patients examined during this period, 45 (12.5%) were diagnosed with myoclonus. Median age was 71 (range, 43-88) years; median time from onset of myoclonus to death was 8 days (range, 0-56); opioid usage was present in 39 patients (morphine, oxycodone, and fentanyl: n = 6, 21, and 12, respectively); and median oral morphine equivalent at onset of myoclonus was 60 mg (range, 12-336 mg). Myoclonus treatment was administered to 21 patients (opioid dose reduction, opioid switching, and others: n = 14, 3, and 4, respectively). Myoclonus is a common complication in patients with terminal cancer.

肌阵挛是一种相对罕见的不自主运动,在姑息治疗环境中经常可以观察到,并会给患者带来痛苦。本研究旨在调查由日本小牧市医院姑息治疗专家诊断的癌症晚期患者肌阵挛的发生情况和应对措施。我们利用电子病历对2018年1月至2019年5月期间接受姑息治疗会诊并被姑息治疗专家诊断为肌阵挛的晚期癌症患者进行了回顾性研究。评估了患者的人口统计学特征、肌阵挛发病至死亡的时间、每日阿片类药物的使用情况、对策以及肌阵挛的预后。在此期间接受检查的 360 名患者中,有 45 人(12.5%)被确诊为肌阵挛。中位年龄为 71 岁(43-88 岁);从肌阵挛发病到死亡的中位时间为 8 天(0-56 天);39 名患者使用了阿片类药物(吗啡、羟考酮和芬太尼:分别为 6、21 和 12);肌阵挛发病时的中位口服吗啡当量为 60 毫克(12-336 毫克)。21 名患者接受了肌阵挛治疗(减少阿片类药物剂量、更换阿片类药物及其他:人数分别为 14、3 和 4)。肌阵挛是癌症晚期患者常见的并发症。
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引用次数: 0
Lidocaine Infusion: An Analgesic Option for Checkpoint Inhibitor Arthritis: A Case Report. 利多卡因输注:检查点抑制剂关节炎的镇痛选择:病例报告。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1080/15360288.2024.2345334
Lana Ferguson, Stacey Hooper

This report describes the use of subcutaneous lidocaine infusion to manage complex pain associated with checkpoint inhibitor inflammatory arthritis. In addition, the safe administration of lidocaine in the home setting is described. A 49-year-old man with metastatic melanoma to lung, right axilla and posterior chest wall on regular pembrolizumab developed checkpoint inhibitor inflammatory arthritis. Pain associated with this was unresponsive to simple analgesia, escalating opioids and adjuvant analgesics. Lidocaine infusion was used on separate occasions (inpatient unit and home setting) to gain rapid and sustained control of inflammatory pain. Inflammatory pain responded well to 2 mg/kg/h lidocaine infusion over 4 days with sustained response between infusions of up to 6 wk. Resulting in improved mobility, functional status, and overall quality of life. Lidocaine infusion should be considered as an option for analgesic management of checkpoint inhibitor inflammatory arthritis in patients for whom usual treatment is ineffective, and as an opioid-sparing intervention.

本报告介绍了使用皮下注射利多卡因来控制与检查点抑制剂炎症性关节炎相关的复杂疼痛。此外,还介绍了在家庭环境中安全使用利多卡因的方法。一名 49 岁的男子患有转移性黑色素瘤,肺部、右腋窝和后胸壁均有转移,定期服用彭博利珠单抗后出现了检查点抑制剂炎症性关节炎。与此相关的疼痛对简单镇痛、阿片类药物升级和辅助镇痛药均无反应。为了快速、持续地控制炎性疼痛,在不同的场合(住院病房和家庭环境)分别使用了利多卡因输注。在 4 天内输注 2 毫克/千克/小时利多卡因后,炎性疼痛得到了很好的控制,两次输注之间的反应持续时间长达 6 周。从而改善了活动能力、功能状态和整体生活质量。对于常规治疗无效的检查点抑制剂炎症性关节炎患者,利多卡因输注应被视为镇痛治疗的一种选择,同时也是一种节省阿片类药物的干预措施。
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引用次数: 0
Initial Experiences With Integration of Palliative Medicine and Specialist Pain Services in a Tertiary Cancer Care Center in India. 印度一家三级癌症护理中心整合姑息医学和疼痛专科服务的初步经验。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-01 DOI: 10.1080/15360288.2024.2320379
Anuja Damani, Arunangshu Ghoshal, Raghu Thota, Parmanand N Jain

Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient outcomes. A prospective assessment was carried out within a collaborative clinic, uniting the realms of pain management and palliative medicine. Anonymized patient information was scrutinized to grasp the advantages of this amalgamation and identify strategies to address any inherent deficiencies. Furthermore, an illustrative case study was delineated, spotlighting the collaborative dynamics at a systemic level. During the period spanning from November 2020 to June 2021, a total of 43 patients received consultations at this collaborative clinic. Each patient was exposed to a comprehensive pain management regimen, with the most frequently conducted procedure being an intercostal nerve block, which was administered in 9.30% of cases. For the provision of effective pain relief within the palliative care context, the confluence of joint consultations from cancer pain specialists emerges as a requisite measure. This approach carries the promise of optimizing pain control and augmenting the quality of palliative care.

疼痛管理是姑息关怀的一个重要方面。某些令人痛苦的疼痛可以通过介入止痛方法得到明显缓解,这就需要疼痛专家的专业知识。我们的观点是将这两个方面结合起来,建立一种共生关系,从而提高病人的治疗效果。我们在一家合作诊所内开展了一项前瞻性评估,将疼痛管理和姑息医学结合起来。对匿名患者信息进行了仔细研究,以了解这种融合的优势,并找出解决任何固有缺陷的策略。此外,还对一个案例进行了说明性研究,突出了系统层面的合作动力。在 2020 年 11 月至 2021 年 6 月期间,共有 43 名患者在该合作诊所接受了诊治。每位患者都接受了全面的疼痛治疗方案,其中最常进行的手术是肋间神经阻滞,占 9.30% 的病例。为了在姑息治疗中有效缓解疼痛,癌症疼痛专家的联合会诊是一项必要的措施。这种方法有望优化疼痛控制,提高姑息治疗的质量。
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引用次数: 0
Alpha Alert: Utilization of Transdermal Clonidine for Refractory Agitation. 阿尔法警报:利用透皮氯硝安定治疗难治性躁动。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.1080/15360288.2024.2327868
Samantha Grable, Gary Houchard, Zach Rossfeld

Alpha-2 agonists are under-recognized for their class effects yet offer potential benefit in specialty palliative care via decreasing sympathetic output, inducing sedation, and modulating pain. Especially in clinical contexts where agitation predominates and patients are intolerant of oral medication route, transdermal medication delivery is advantageous. We report a case of agitated behaviors in setting of mixed Alzheimer/vascular-type dementia limiting hospital discharge to nursing facility that were ameliorated with transdermal clonidine. We suggest palliative clinicians routinely conceptualize the seemingly disparate alpha-2 agonists as a class for effective symptom palliation especially as new clinical evidence becomes available.

α-2受体激动剂的类药物效应未得到充分认识,但它通过减少交感神经输出、诱导镇静和调节疼痛,为专业姑息治疗提供了潜在的益处。特别是在临床上,当患者以躁动为主且不耐受口服药物时,透皮给药具有优势。我们报告了一例阿尔茨海默病/血管性痴呆混合型患者的躁动行为,患者出院后转入护理机构,经皮氯硝安定可改善患者的躁动行为。我们建议姑息治疗临床医生将看似不同的α-2受体激动剂作为一类有效缓解症状的药物,尤其是当新的临床证据出现时。
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引用次数: 0
Commentary: Is Polyethylene Glycol Toxicity From Intravenous Methocarbamol Fact or Fiction? 评论:静脉注射甲氧苄啶引起的聚乙二醇中毒是事实还是虚构?
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1080/15360288.2024.2345322
Emilie Chan, Coleton Waggoner, Paul M Boylan

Methocarbamol is an antispasmodic muscle relaxant and was the fourth most-prescribed muscle relaxant by volume in the United States in 2021. Intravenous (IV) methocarbamol contains the excipient, polyethylene glycol (PEG), which has been implicated in metabolic acidosis and nephrotoxicity. Intravenous methocarbamol was first approved by the US Food and Drug Administration in 1959 and at that time the IV methocarbamol prescribing information warned of PEG-associated adverse drug events in patients living with renal impairment; however, the manufacturer acknowledged data were lacking to objectively support this claim. Clinicians prescribing and dispensing IV methocarbamol may encounter the warning for PEG-associated metabolic acidosis and nephrotoxicity without knowing the potential risks, or lack thereof, supporting or disavowing this phenomenon. This commentary debates the merits supporting and arguments refuting PEG-associated metabolic acidosis and nephrotoxicity in patients treated with IV methocarbamol.

甲氧卡马酚是一种解痉肌肉松弛剂,2021 年在美国肌肉松弛剂处方量排名第四。静脉注射(IV)甲氧卡摩尔含有赋形剂聚乙二醇(PEG),它与代谢性酸中毒和肾毒性有关。1959 年,美国食品和药物管理局首次批准了静脉注射甲氧卡莫司,当时,静脉注射甲氧卡莫司的处方信息警告肾功能受损的患者会出现与 PEG 相关的药物不良事件;但是,制造商承认缺乏客观支持这一说法的数据。临床医生在开具和配发静脉注射甲氧沙林胺醇时,可能会遇到 PEG 相关代谢性酸中毒和肾毒性的警告,而不了解支持或否定这一现象的潜在风险或缺乏风险。本评论就支持和反驳静脉注射甲氧卡莫醇患者 PEG 相关代谢性酸中毒和肾毒性的优点进行了辩论。
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引用次数: 0
Yay, or Nay? Over-the-Counter Naloxone Nasal Spray. 赞成,还是反对?非处方纳洛酮鼻腔喷雾剂。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-21 DOI: 10.1080/15360288.2024.2317149
Miranda Hetrick
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引用次数: 0
期刊
Journal of Pain & Palliative Care Pharmacotherapy
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