Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Sep 2015
ReviewThe US Congressional "Decade on Pain Control and Research" 2001-2011: A Review.
In 2000, the United States Congress proclaimed the decade commencing January 1, 2001, as the "Decade of Pain Control and Research." This review examines the progress, setbacks, and controversies in public policy, pain education, advocacy, ethics, and the law through this decade. Critical developments including the rise and fall of the consensus on the doctrine of balance in opioid policies, the respective roles of federal and state bodies, the surge of and response to the diversion and abuse of prescription medication, initiatives in education and advocacy, and reforms to state pain policies and laws shall be examined.
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We hypothesize that there is a tissue store of methadone content in humans that is not directly accessible, but is quantifiable. Further, we hypothesize the mechanism by which methadone content is sustained in tissue stores involves methadone uptake, storage, and release from tissue depots in the body (recycling). Accordingly, we hypothesize that such tissue stores, in part, determine plasma methadone levels. ⋯ We predict 39 ± 13% to 83 ± 6% of methadone's tissue stores "spillover" into the circulation. Our results indicate that there exists a large quantifiable tissue store of methadone in humans. Our results support the notion that methadone in humans undergoes tissue uptake, storage, release into the circulation, reuptake from the circulation, and re-release into the circulation, and that spillover of methadone from tissue stores, in part, maintain plasma methadone levels in humans.
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J Pain Palliat Care Pharmacother · Sep 2015
Differential Consequences of Tramadol in Overdosing: Dilemma of a Polymorphic Cytochrome P450 2D6-Mediated Substrate.
Tramadol is a centrally acting opioid analgesic that is prone to polymorphic metabolism via cytochrome P450 (CYP) 2D6. The generation of the active metabolite, O-desmethyltramadol, which occurs through the CYP 2D6 pathway, significantly contributes to the drug's activity. ⋯ Depending on the individual subject's CYP 2D6 status, one may see excessive miotic-related toxicity driven by the excessive availability of O-desmethyltramadol or one may manifest mydriatic-related toxicity driven by the excessive availability of tramadol. This report provides pharmacokinetic perspectives in situations of tramadol overdosing.
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J Pain Palliat Care Pharmacother · Sep 2015
ReviewEfficacy and Safety of Oral or Nasal Fentanyl for Treatment of Breakthrough Pain in Cancer Patients: A Systematic Review.
Formulations of fentanyl that use buccal, sublingual, or nasal transmucosal routes of administration have been developed for the treatment of BTP in opioid-tolerant patients with cancer. The purposes of this analysis were to identify and review published data describing the efficacy and safety of different oral or nasal transmucosal fentanyl formulations for treatment of cancer-related BTP, based on a critical analysis of scientific literature. ⋯ Nevertheless, further progress in standardizing methodology, definitions, and criteria used both in research and in clinical practice is needed in order to generate quality information allowing a better understanding of the comparable efficacy of available formulations of fentanyl. A more rigorous assessment of long-term safety is also needed to establish a balance between benefits and risks of the available options.
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Up to 80% of nursing home residents may be experiencing pain; however, in many cases their pain is not diagnosed and/or treated. People with moderate to severe dementia may have impaired communication, and this can impact on their self-report of pain. Drug treatment should be used cautiously. --This report is adapted from paineurope 2015; Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com , at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.