Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Aug 2013
Observational StudyTapentadol prolonged release for severe chronic pain: results of a noninterventional study involving general practitioners and internists.
This noninterventional, prospective study investigated the administration of tapentadol prolonged release (PR; the dosage form described in this article is commercially available in Germany as Palexia retard; Grünenthal GmbH, Aachen) for severe chronic pain in routine clinical practice over a 3-month period. Effectiveness analyses included data from 3134 patients; 1331 received World Health Organization (WHO) Step III pretreatment. A total of 97.8% of patients received long-term analgesic pretreatment (42.5% with strong opioids). ⋯ Significant decreases in pain-related impairment of daily activities and improvements in quality of life (descriptive P value ≤.001) were observed with tapentadol PR with good tolerability. Tapentadol PR was effective for various pain indications in patients previously receiving strong opioids (67.2% achieved clinically relevant pain relief). Tapentadol PR can be considered an alternative therapy to classical opioids for treatment of severe chronic pain.
-
J Pain Palliat Care Pharmacother · Aug 2013
Estimates of charges associated with emergency department and hospital inpatient care for opioid abuse-related events.
The economic burden of prescription opioid abuse is substantial; however, no study has estimated the monetary burden of hospital services (emergency department [ED] and inpatient) using a single, nationally representative database. We sought to estimate total and average (adjusted for demographic and clinical factors) charges billed for opioid abuse-related events, and magnitude of difference in charges between ED visits resulting in inpatient admission to the same hospital and treat-and-release ED visits in the United States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). ⋯ Compared with events covered by private insurance, mean charges for Medicare- and Medicaid-covered events were higher (t = 28.14, P < .001; t = 6.42, P < .001, respectively), whereas self-paid events had significantly lower charges (t = -11.14, P < .001). ED visits resulting in subsequent inpatient admission had approximately 6 times higher charges than treat-and-release visits. This study provides estimates of differences in hospital costs of opioid abuse by insurance status, resulting in a better understanding of the economic burden of opioid abuse on the health care system.
-
J Pain Palliat Care Pharmacother · Aug 2013
Randomized Controlled TrialA new model for using quantitative urine testing as a diagnostic tool for oxycodone treatment and compliance.
We conducted a prospective, randomized, cross-sectional study to develop and validate a new model to predict oxycodone in urine that can be used to help evaluate whether patients are complying with their oxycodone dosing regimens. We studied 20 patients: eight black women, two white women, six black men, and four white men; ages 48 ± 10 years (mean ± SD); weight 97 ± 32 kg. Pain levels before treatment averaged 9.5 ± 0.9 out of 10. ⋯ One patient was 35% below the prediction; the other was 51% above. Our model accurately predicts oxycodone in urine (±10% for 90% of the patients). The model appears clinically useful for evaluating the results of a quantitative urine test, since it objectively discriminates between (1) a "normal" patient complying with their oxycodone dosing regimen, and (2) a patient who may require genetic testing to distinguish between unusual metabolism or abuse.
-
Chronic pelvic pain is a common, multifactorial complaint that affects both women and men, causing disability and frustration for patients. The exact aetiology remains unknown, although several theories have been proposed. Assessment should be undertaken with care and compassion, while considering the sensitive nature of the area. ⋯ Novel treatment approaches have been investigated for specific clinical scenarios. The more severe CPP cases are best managed using a multidisciplinary approach. Management requires good integration and knowledge of all pelvic organ systems and including musculoskeletal, neurologic and psychological mechanisms.
-
J Pain Palliat Care Pharmacother · Aug 2013
Case ReportsManaging musculoskeletal pain in an elderly woman.
Musculoskeletal conditions are common and a major cause of chronic pain; more than nine million people in the UK are affected by arthritis alone. Successful treatment of pain can lead to increased physical activity with consequent improvement of muscle tone around the affected joints. In older patients with multiple comorbidities, fewer therapeutic approaches or surgical interventions tend to be indicated. Where opioid therapy is unsuccessful, possible strategies include opioid rotation and/or changing route of administration.