Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2015
Case ReportsAmbulatory continuous interscalene blocks for cancer pain.
Continuous peripheral nerve blocks are used in the management of pain following surgical procedures. They can also be used in patients with cancer-related pain, to improve sleep quality, reduce opioid requirements and their side effects. We describe two cancer patients in whom interscalene brachial plexus catheters were used on an outpatient basis, allowing them to travel, decrease their opioid use, and improve their ability to perform routine activities.
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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
Case ReportsTreat the whole patient and be aware of drug interactions.
The case of an elderly male with bilateral shoulder pain is presented. The pain had been successfully treated years earlier with surgery, but a repeat rotator cuff procedure when the pain recurred was not effective. ⋯ Cardiovascular and renal risks of NSAOIDs are discussed as are potential toxicities of tramadol and too rapid withdrawal from it. Drug interactions of medications used are described.
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The neurobiology of pain and analgesia exhibits plasticity in different pain states. Animal models allow the study of the pathways, neuronal plasticity, and pharmacology that reflect the pains many patients have. Inherited pain disorders may also indicate the pain-related roles of gene products. ⋯ Pain remains a subjective experience, and the search for objective measures or biomarkers of pain has so far not yielded definitive results. However, rational, mechanistic explanations for pain states are emerging, and a number of potential treatment targets that have recently been revealed by animal models of clinical pain conditions are beginning to be translated to the patient. This article outlines some of the major recent developments in preclinical and clinical pain science that have the potential to shape the development of new treatments for pain.
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J Pain Palliat Care Pharmacother · Mar 2015
New DEA rules expand options for controlled substance disposal.
Prescription drug abuse and overdose are rapidly growing problems in the United States. The United States federal Disposal of Controlled Substances Rule became effective 9 October 2014, implementing the Secure and Responsible Drug Disposal Act of 2010 (Disposal Act). These regulations target escalating prescription drug misuse by reducing accumulation of unused controlled substances that may be abused, diverted or accidentally ingested. ⋯ Retail pharmacies and hospitals or clinics with an onsite pharmacy may also place and maintain collection receptacles at long-term care facilities. The Act and Rule are intended to increase controlled substance disposal methods and expand local involvement in collection of unused controlled substances. Potential barriers to participating in controlled substance collection include acquisition of suitable collection receptacles and liners, lack of available space meeting the necessary criteria, lack of employee time for verification and inventory requirements, and program costs.