Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2017
Case ReportsIntrathecal Injection of Gadobutrol: A Tale of Caution.
In the field of interventional pain medicine a radiocontrast agent is commonly used in conjunction with fluoroscopy. Limited work has been published regarding the use of gadolium based contrast agents (GBCA) in the intrathecal space. We report a case of an intrathecal gadobutrol injection resulting in neurotoxic manifestations. ⋯ Less than five minutes after the injection of gadobutrol, the patient reported spastic pain of the lower extremities. There is a lack of evidence as it relates to the use of GBCA specifically gadobutrol in the intrathecal space. The use of gadobutrol in the intrathecal space should be used with caution.
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J Pain Palliat Care Pharmacother · Jun 2017
Case ReportsPain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.
Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. ⋯ By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.
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Palliative care provides holistic care to individuals in life-threatening or life-limiting conditions. This narrative describes the journey of Kanchan. A strong lady and a doting mother, she came to the hospital by choice, in immense pain and with swelling. ⋯ Kanchan was able to benefit from physiotherapy to reduce the risk of lymphoedema after surgery for breast cancer. Her narrative illustrates how she found comfort and relief, ably supported by the dedicated hospital team. Although a chance encounter led her to the hospital, her story emphasizes the need for greater awareness about palliative services to ensure early intervention.
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J Pain Palliat Care Pharmacother · Jun 2017
Editorial Historical ArticleMedical Cannabis for Pain: Anecdote or Evidence.
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J Pain Palliat Care Pharmacother · Jun 2017
ReviewOral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis.
Osteoarthritis (OA) is one of the most common causes of joint pain in the United States and non-steroidal anti-inflammatories (NSAIDs), such as Diclofenac sodium, which is currently available in two main routes of administration; oral and topical distribution have been established as one of the standard treatments for OA. Generally, oral NSAIDs are well tolerated; however our narrative review suggests that the topical solution had a better tolerability property than oral Diclofenac sodium, especially due to side effects of gastrointestinal bleeding with the utilization of the oral format. ⋯ Most studies reviewed comparing oral versus topical solution of Diclofenac sodium revealed comparable efficacy, with minimal side effects utilizing the topical route. The key point of this narrative review is to help clinicians that currently must decide between very inexpensive diclofenac oral presentations and expensive topical presentations especially in the elderly population and the pros and cons of such decision-making process.