Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Mar 2013
The use of prescription monitoring programs to reduce opioid diversion and improve patient safety.
An increase in the prescribing of opioids in an effort to improve management of chronic pain has led to enhanced availability of controlled substances for diversion and abuse. Evidence suggests that the use of prescription monitoring programs (PMPs) may help curtail this growing public health issue. ⋯ This paper describes current data on the effect of prescription monitoring programs on reducing abuse and diversion of controlled substances. It also offers suggestions on how PMPs may be incorporated into practice and clinical decision-making to ensure appropriate pain management and patient safety.
-
J Pain Palliat Care Pharmacother · Mar 2013
Clinical TrialPilot study of human recombinant hyaluronidase-enhanced subcutaneous hydration and opioid administration for sickle cell disease acute pain episodes.
The objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. ⋯ Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial.
-
J Pain Palliat Care Pharmacother · Mar 2013
Effect of opioid-related adverse events on outcomes in selected surgical patients.
This retrospective study utilized a large, national hospital database to assess the impact of opioid-related adverse events (ORADE) on patient outcomes following selected surgical procedures known to require postoperative pain control. ⋯ Patients exhibiting a documented ORADE had greater overall costs, longer hospitalizations, and increased likelihood for readmission. These results highlight the economic impact associated with opioid use for postsurgical pain management.
-
J Pain Palliat Care Pharmacother · Mar 2013
ReviewAssessment of extended-release opioid analgesics for the treatment of chronic pain.
Approximately 3.8 million patients annually receive extended-release (ER) or long-acting opioid prescriptions in the outpatient setting, around half of which are written by primary care physicians. Compared with short-acting, immediate-release (IR) formulations, ER and oral long-acting opioid analgesics are associated with clinical advantages, such as extended periods of time during which drug plasma levels are within the therapeutic range, decreased peak-to-trough fluctuations, and prolonged analgesia over the dosing period. Additionally, ER opioids offer a more convenient, less frequent dosing regimen to chronic pain patients who are often taking several concomitant medications. ⋯ Putative abuse-deterrent formulations have also recently been introduced to impede physical manipulation of these formulations, or reduce the harm resulting from such behavior. Such formulations may represent an incremental advance to reduce non-oral forms of abuse. This article reviews the pharmacokinetic profiles and abuse-deterrent features of newer ER opioid analgesics for the treatment of moderate to severe chronic pain.
-
The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.