Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2015
ReviewFentanyl-induced hyperalgesia in acute pain management.
There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. ⋯ The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.
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J Pain Palliat Care Pharmacother · Jun 2015
Observational StudyPain indicators for persisting pain in hospitalized infants in a South African setting: an explorative study.
In the developing world, there is a high incidence of human immunodeficiency virus (HIV), gastroenteritis, pneumonia, meningitis, and other inflammatory diseases in infants, the conditions of which may induce persisting pain. The primary objective was to estimate the reliability and validity of the Touch Visual Pain (TVP) scale to measure persisting pain. This prospective observational study was performed in hospitalized 0-3-year-old infants in South Africa. ⋯ Two TVP items were not sensitive to assess pain or distress and were replaced in a revised TVP version. We conclude that our study identified sensitive and specific indicators of persisting pain in hospitalized children under the age of 3 years in a South African setting. Psychometric properties of the revised TVP need to be studied before its use in clinical practice can be recommended.
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J Pain Palliat Care Pharmacother · Jun 2015
Case ReportsFentanyl tolerance in the treatment of cancer pain: a case of successful opioid switching from fentanyl to oxycodone at a reduced equivalent dose.
Opioids are not generally deemed to have an analgesic ceiling effect on cancer pain. However, there have been occasional reports of tolerance to opioid development induced by multiple doses of fentanyl. The authors report a case of suspected tolerance to the analgesic effect of opioid, in which an increasing dose of fentanyl failed to relieve the patient's cancer pain symptoms, but opioid switching to oxycodone injections enabled a dose reduction to below the equivalent dose conversion ratio. ⋯ Despite the total daily dose of fentanyl reaching 5.6 mg (equivalent to 560 mg oral morphine), the analgesic effect was inadequate; thus, an urgent adjustment was necessary. Due to the moderate dose of fentanyl, the switch to oxycodone injection was done incrementally at a daily dose equivalent to 25% of the fentanyl injection. The total dose of oxycodone was replaced approximately 53.5% of the dose of fentanyl prior to opioid switching.
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J Pain Palliat Care Pharmacother · Jun 2015
Case ReportsImprovement in chronic low back pain in an obese patient with topiramate use.
The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. ⋯ Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences.
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Editor's Note The journal is delighted to introduce a new feature in this issue that focuses on the complex and multifaceted issue of managing pain and related symptoms while responsibly attending to minimizing substance abuse. How should the seemingly disparate disciplines of drug abuse and symptom control interact? Should these be two separate fields or should practitioners/investigators in one also be qualified in the other? Is that even feasible? We are honored to have two leading, academically based clinician scientists coordinating this new feature. Peggy Compton is Professor and Associate Dean for Academic Affairs at the School of Nursing & Health Studies, Georgetown University in Washington, DC. ⋯ Lipman, Editor ABSTRACT Abusers of prescription opioids represent two distinct populations: those who develop addiction via opioids prescribed for pain, and those for whom prescription opioids represent a primary drug of abuse. Regardless of the pathway to abuse, outcomes for patients with untreated opioid addiction are poor, and consideration of the contextual factors surrounding their problematic use is critical to effective treatment. Reviewed are patterns of prescription opioid abuse among particularly vulnerable populations in underserved rural communities, and in an effort to prevent problematic use, principles of responsible opioid prescription for chronic pain are outlined so as to decrease the risk for developing addiction.