Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2015
Case ReportsManagement of severe pain due to lumbar disk protrusion.
Lumbar intervertebral disk protrusion can cause excruciating pain in severe cases, which can be exacerbated by activity such as sitting down and straining at stool. Acute sciatica due to disk rupture will improve within 1 to 3 months. ⋯ Severe cases can require opioid analgesia, however people taking opioids for pain relief frequently present with opioid-induced bowel dysfunction. The use of transforaminal steroid injections is a controversial issue and repeat steroid injections should be considered in light of the risk-benefit profile of the individual patient.
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Questions from patients about pain conditions, analgesic pharmacotherapy, and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question about benign fasciculation syndrome, the presentation, causes, treatment, and chances of developing amyotrophic lateral sclerosis will be discussed.
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J Pain Palliat Care Pharmacother · Mar 2015
Case ReportsPatient-tailored combinations of systemic and topical preparations for localized peripheral neuropathic pain: a two-case report.
This report describes two patients with peripheral neuropathic pain (PNP): a 43-year-old man with upper leg PNP and a 75-year-old woman with post herpetic neuralgia of the perineum and vagina. Pain was inadequately managed in both patients for a long time. ⋯ The second patient achieved optimal pain control with dipyrone (500 mg three times per day), pregabalin (150 mg twice a day), dextromethorphan (60 mg three times per day), plus topical compounds (10% ketamine, 0.3% clonidine, 5% diclofenac) in a penetrating enhancing gel. Notably, the individualized approach described herein was made possible through collaboration between a public health pain specialist and a private sector compounding pharmacist, highlighting the importance of such infrequent but, highly desirable collaborations.
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J Pain Palliat Care Pharmacother · Mar 2015
CYP2D6 phenotype-specific codeine population pharmacokinetics.
Codeine's metabolic fate in the body is complex, and detailed quantitative knowledge of it, and that of its metabolites is lacking among prescribers. We aimed to develop a codeine pharmacokinetic pathway model for codeine and its metabolites that incorporates the effects of genetic polymorphisms. We studied the phenotype-specific time courses of plasma codeine, codeine-6-glucoronide, morphine, morphine-3-glucoronide, and morphine-6-glucoronide. ⋯ The model also showed that about 39% of the MO formed from codeine was converted to morphine-6-glucoronide in extensive-metabolizer phenotypes, and about 58% was converted in ultrarapid-metabolizers. We conclude, a population pharmacokinetic codeine pathway model can be useful because beyond helping to achieve a quantitative understanding the codeine and MO pathways, the model can be used for simulation to answer questions about codeine's pharmacogenetic-based disposition in the body. Our study suggests that pharmacogenetics for personalized dosing might be most effectively advanced by studying the interplay between pharmacogenetics, population pharmacokinetics, and clinical pharmacokinetics.
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J Pain Palliat Care Pharmacother · Mar 2015
Temporomandibular disorders, headaches and chronic pain.
Temporomandibular disorders (TMDs) are a major cause of non-dental orofacial pain with a suggested prevalence of 3% to 5% in the general population. TMDs present as unilateral or bilateral pain centered round the pre-auricular area and can be associated with clicking and limitation in jaw movements. It is important to ascertain if there are other comorbid factors such as headaches, widespread chronic pain and mood changes. A biopsychosocial approach is crucial with a careful explanation and self-care techniques encouraged.