Revue médicale suisse
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Revue médicale suisse · Jun 2015
Review[Clinical pharmacology of medical cannabinoids in chronic pain].
In Switzerland, medical cannabinoids can be prescribed under compassionate use after special authorization in justified indications such as refractory pain. Evidence of efficacy in pain is limited and the clinical benefit seems to be modest. Their drug-drug interactions (DDI) profile is poorly documented. Cytochromes P450 (CYP) 2C9 and 3A4 are involved in the metabolism of tetrahydrocannabinol and cannabidiol, which implies possible DDI with CYP450 inhibitor and inducer, such as anticonvulsivants and HIV protease inhibitors, which may be prescribed in patients with neuropathic pain.
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Revue médicale suisse · Jun 2015
Review[The use of transdermal opioids in patients in oncological remission suffering from chronic pain].
Today, oncological patients in remission are becoming more numerous and about a third have chronic pain from various etiologies. In the objective of a comprehensive management plan for chronic pain in these patients, therapeutic goals, conditions and terms of prescription of opioids in the long-term should be discussed. ⋯ It provides increased comfort in selected patients in whom oral administration is difficult or a polypharmacy troublesome. Risks/benefits of a prescription of opioids in the treatment of chronic pain in patients in oncological remission should be re-evaluated and included in a multimodal support.
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The lack of clear recommendations makes optimal pain management difficult in patients with hepatic function impairment. This article reviews the evidence on commonly used analgesics (paracetamol, NSAIDs, opiates). ⋯ Glucuronoconjugated opiates should be preferred but all must be used carefully because of the risk of side effects. Dosage reduction and/or increased dose interval are often required.
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Mindfulness based therapies are nowadays widely spread. During the last decades, several approches and specific programs have been scientifically challenged and developped. ⋯ It also has a favorable impact when dealing with craving. Currently, the scientific research has come to promissing conclusions as far as craving and relapse prediction are concerned.