Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2002
Removing meperidine from the health-system formulary--frequently asked questions.
Meperidine is FDA-approved for relieving moderate to severe pain and has been widely used since its introduction in the 1930s. However, the drug is no longer considered a first-line analgesic. Many clinicians recommend that meperidine be removed from health-systems or that its use be restricted, due to concerns about adverse reactions, drug interactions, and normeperidine neurotoxicity. ⋯ The Drug Information Service developed this document to help pharmacists respond to prescribers' questions and to alleviate the prescribers' concerns about these changes. Information is provided comparing meperidine with other opioids, including dosage equivalency, pharmacodynamics, pharmacokinetics, cost, adverse effects, and drug interactions. Where available, alternatives to meperidine are suggested for various indications.
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J Pain Palliat Care Pharmacother · Jan 2002
Case ReportsPain relief from baclofen analgesia in a neuropathic pain patient who failed opioid and pharmacotherapy: case report.
A case report and discussion of a 64-year-old white female who presented with uncontrolled pain in several body areas despite massive oral controlled release morphine use is presented. Her pain was not associated with much spasticity. This patient responded remarkably to intrathecal baclofen even after the opioid was tapered and discontinued. The potential usefulness of baclofen in seemingly opioid-resistant chronic pain is discussed.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesia issues in palliative care: bone pain, controlled release opioids, managing opioid-induced constipation and nifedipine as an analgesic.
Some recent literature relevant to analgesia in palliative care is reviewed. Reports on clinical use of bisphosphonates for bone pain in cancer, controlled release opioids, selection of laxatives for opioid-induced constipation and the calcium channel blocker nifedipine as an analgesic are described.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesic issues in palliative care gastroesophageal reflux pain and chronic non-cancer pain management.
Brief literature reviews and commentary on gastroesophageal reflux disease associated pain management with rectal dosage forms and beliefs about use of opioids in non-cancer pain are presented. Relevant references including the model guidelines of the Federation of State Medical Boards of the United States on the use of opioids in non-cancer pain are cited.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewCan patients taking opioids drive safely? A structured evidence-based review.
A structured evidence-based literature review was completed to determine if there was epidemiological evidence of an association of opioid use and intoxicated driving, motor vehicle accidents (MVA) and MVA fatalities; to rate the quality of this research evidence according to Agency for Health Care Policy and Research (AHCPR) type of evidence and strength and consistency of the evidence rating scales; and according to this evidence determine whether patients taking opioids can drive safely. Relevant references were located from Medline, Psychological Abstracts, Science Citation Index and the National Library of Medicine Data Query databases by appropriate subject headings. A manual search was also performed utilizing the reference lists of the retrieved articles. ⋯ The evidence in this review indicates that opioids do not appear to be associated with intoxicated driving, MVA and MVA fatalities, and consistently indicated that opioids are not associated with MVA. Although the comparison of point prevalence rates to the point prevalence may be problematic, the results of this systematic review support the contention that patients taking opioids may be allowed to drive. As in all clinical decisions, this determination should be individualized according to clinical factors.