Journal of pain & palliative care pharmacotherapy
-
A case of nerve injury pain is discussed to address whether it is more likely complex regional pain syndrome or neuropathic pain.
-
J Pain Palliat Care Pharmacother · Jun 2013
Prescribers and pharmacists requests for prescription monitoring program (PMP) data: does PMP structure matter?
Prescription monitoring programs (PMPs) have been purported to be an effective tool to combat prescription drug abuse. However, utilization rates of PMP data by health care providers (e.g., prescribers and pharmacists) is relatively low. The objectives of the study were to describe (1) PMP utilization (e.g., requested reports) by prescribers, pharmacists, and law enforcement for active state PMPs; (2) PMP utilization by health care providers with and without online access; (3) average annual operational costs for PMPs from 2008 to 2009; and (4) PMP requests based on PMP housing authority (law enforcement vs. non-law enforcement [e.g., board of pharmacy]). ⋯ In law enforcement-governed PMPs, health care provider utilization was lower compared with PMPs under health or pharmacy boards. Prescriber request rates were higher than pharmacists and online access for providers (e.g., prescribers and pharmacists) resulted in higher request rates per 100,000 population. More research is needed to determine other factors that may be associated with PMP utilization by prescribers and pharmacists.
-
J Pain Palliat Care Pharmacother · Jun 2013
The importance of putting pain on the curricula in medical schools in Europe.
Pain continues to be underdiagnosed and undertreated in Europe. A lack of training in pain medicine among clinicians has been identified as a barrier to optimal pain management. Except for clinicians entering specialized training in pain medicine or a related field, inadequate or nonexistent pain management training is the norm in Europe. A multidisciplinary group of experts, including representatives from the European Federation of IASP (International Association for the Study of Pain) Chapters (EFIC), is launching a pan-European initiative aimed at raising the profile and importance of undergraduate pain education.
-
J Pain Palliat Care Pharmacother · Jun 2013
Do we have clarity on the therapeutic levels of morphine and its metabolites: seeking answers for the dilemma?
In spite of numerous investigations and decades of research, there is still a void in the complete understanding of the therapeutic action of morphine due to the complex nature of its pharmacokinetic/metabolic disposition coupled with elusive pharmacodynamics. This commentary attempts to collate current information on this very important topic and provide perspective to further tease out the relationship between morphine and its metabolites to its purported clinical effect. Similar to numerous acute therapies that need a close vigil for therapy optimization, postoperative pain management with morphine is a challenge due to its extreme intrasubject variability, a fragile therapeutic index, and complex pharmacology interlinked with formation and transport of active metabolite(s). ⋯ Moreover, the intravenous titration option used in the study provided a clean collection of pharmacokinetic surrogate data of morphine along with its metabolites without the issue of absorption and/or oral bioavailability setback if morphine was given by oral route. However, the various pharmacokinetic surrogates used in this study was found insufficient to distinguish the clinical effects. Given the complicated pharmacokinetic and pharmacodynamic profiles of morphine and its metabolites (6MG and 3MG), this commentary provides some thoughts to seek answers for this interesting dilemma.
-
The number of patients taking long-term opioid therapy for pain is increasing, with opioid use no longer being confined to advanced cancer patients. Challenges to peri- and postoperative pain management in chronic pain patients include complex existing drug regimens and problems arising from tolerance to opioid analgesia. Postoperatively, individualized, multimodal pain therapy involving a round-the-clock regimen of nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, paracetamol, and regional blocks should be used. Other considerations may include patients receiving opioids by intrathecal drug delivery systems, spinal cord stimulator (SCS), and potential substance abusers.