Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2007
Problems in studying the association between race and pain in outcomes research.
Variability in the pain experience and treatment among patients of different races or ethnicities has been well studied over the past half century. Despite a large body of evidence describing these differences, the importance of these differences on health and cost outcomes has not be evaluated by pharmacoeconomists and outcomes researchers. We examined the subject to identify potential reasons for the lack of pharmacoeconomics and outcomes research (PE/OR) evaluations by first, defining PE/OR, second, taking the position that race can be an important modifier of disease outcomes by pointing out some identified differences in drug responses due to biology, and third, describing how PE/OR researchers have looked at race in other disease states. Finally, we propose some theories for the lack of such evaluations in pain outcomes research including the limited availability of race and ethnicity data in secondary datasets, a lack of priority for public and private funding organizations to support this type of research, and the potential biases of researchers and funding organizations.
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J Pain Palliat Care Pharmacother · Jan 2007
ReviewPalliative care pharmacotherapy literature summaries and analyses.
Timely and important studies are reviewed and commentaries provided by leading palliative care clinicians. Symptoms and treatment side effects addressed in this issue are: cardiovascular risk due to NSAIDs or COX-2 inhibitors; prolongation of the QT interval due to methadone use; depression and its treatment with scopolamine; adverse drug reactions related to cardiovascular medications, and their association with ethnicity; and medication nonadherence in Medicare enrollees due to cost considerations.
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J Pain Palliat Care Pharmacother · Jan 2007
ReviewAdverse effects of opioids on the central nervous systems of palliative care patients.
Opioids, defined as drugs that stimulate opioid receptors, are primarily used in the treatment of moderate to severe pain. They induce central nervous system (CNS) adverse effects which can be divided into three groups. ⋯ The third group is of the direct toxic effects of opioids on neurons and includes myoclonus (perhaps), hyperalgesia and tolerance. This review addresses the incidence, possible mechanisms, and treatment of each of these groups of opioid-induced adverse effects.
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J Pain Palliat Care Pharmacother · Jan 2007
ReviewChronic administration of ketamine for analgesia.
Use of the dissociative anesthetic ketamine in subanesthetic doses has demonstrated efficacy in neuropathic pain. This article reviews the scientific and clinical literature on ketamine. ⋯ Studies of ketamine analgesia in postherpetic neuralgia, phantom pain, complex regional pain syndrome and cancer pain are reviewed. A range of administration methods for ketamine including neuroaxial administration are described.
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A commentary on the problem of tolerance to opioids is presented from the perspective of a person with chronic nonmalignant pain. The writer challenges the position of many clinicians and professional societies that tolerance to opioid analgesia usually is not a barrier to effective pain management. Implications for clinicians are presented.