Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Sep 2016
Deprescription in Advanced Cancer Patients Referred to Palliative Care.
In palliative care, drugs are considered futile if they do not have a short-term benefit in symptom control or quality of life. The authors examined pharmacotherapy prescribed for patients referred to palliative care to identify futile drugs. ⋯ Gastric protectants were prescribed futilely in 50% of cases (125/248), statins in 97% (69/71), antihypertensive agents in 27% (42/155), antidiabetic drugs in 1% (1/70), bisphosphonates in 27% (4/15), and antidementia drugs in 100% (9/9). This study reveals that many patients with advanced cancer continue to be treated with inappropriate drugs and points to the need for medical training in palliative care, drawing attention to the need for therapeutic review at each medical visit.
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Questions from patients about pain conditions and 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 fibromyalgia, the authors discuss symptoms, the use of opioids and naltrexone, other medication and nonmedication options, and managing expectations for treatment.
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J Pain Palliat Care Pharmacother · Sep 2016
Case ReportsChronic Cancer-Related Pain: Continuous Perineural Infusion of Local Anesthetics as Alternative to Systemic Analgesic Drugs.
Pain is a major concern for patients suffering from cancer. Although opioid drugs remain the gold standard for treatment of pain, little is known about the interest of continuous analgesia techniques as alternative. The aim of the present article is to detail the feasibility and to present the diversity of continuous perineural infusion of local anesthetic. ⋯ No infection was reported. In selected patients, continuous perineural infusion of local anesthetics appears to be an attractive alternative to parenteral opioids for cancer-related pain. Further investigation is warranted to better define the place of these techniques in the armamentarium of cancer-related pain treatment.
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J Pain Palliat Care Pharmacother · Sep 2016
Addressing the Challenge of Emergency Department Analgesia: Innovation in the Use of Opioid Alternatives.
The current epidemic of opioid toxicity and deaths has led clinicians and policy-makers to explore alternatives to opioids for management of moderate to severe pain. One environment in which opioid use has been questioned is the emergency department (ED). This commentary addresses the proposal for "opioid-free EDs" and discusses the risk-to-benefit ratios of opioid and alternative pharmacotherapy for acutely injured patients requiring analgesia. ⋯ Innovations in managing pain in the ED are needed. But excessive restriction on opioid pharmacotherapy in emergency medicine carries the risk of replacing overprescribing with underprescribing of opioids. The commentary supports the need to establish a core of evidence to support efforts to increase the use of nonopioid and nonpharmacologic modalities for those suffering from pain.
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J Pain Palliat Care Pharmacother · Sep 2016
Finding Peace Beyond the Pain: Sunder's Journey in the Hospice.
Dame Cicely Saunders revolutionized the concept of pain by coining the term "total pain", the sum of the physical, psychological, social, spiritual, emotional components that make up the total pain experience. Optimal pain relief may not be possible until all elements of the pain and suffering are addressed. This narrative describes the journey of Sunder in the hospice. ⋯ He stayed on by choice and found the peace he was looking for beyond his pain and sufferings, ably supported by the dedicated hospice team. He was able to live the last few months of his life as comfortably as was possible, and left this world in peace, with dignity. The narrative reiterates the belief that hospice, with its philosophy of active "total care" is an ideal place for addressing the concept of "total pain."