Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2021
Predictive Factors of Opioid-Induced Nausea in Cancer Patients.
Approximately 30% of patients experience nausea after initiation of opioid therapy, which can lead to poor quality of life. We aimed to identify risk factors for opioid-induced nausea at the initiation of opioid therapy by conducting a retrospective review of medical records of patients diagnosed by palliative care specialists with solid cancer and pain at the lesion site at Showa University Hospital between June 2005 and June 2011. The primary endpoint was the development of nausea grade ≥1 according to the Common Terminology Criteria for Adverse Events version 4.0 within 48 hours of initiation of opioid therapy. ⋯ Furthermore, 22.4% had opioid-induced nausea. Age (odds ratio (OR) 1.74; 95% confidence interval (CI), 1.13-2.69), edema (OR 5.83; 95% CI, 1.22-28.19), and gastrointestinal cancer (OR 2.61, 95% CI 1.07-6.36) were significantly associated with opioid-induced nausea. Prophylactic antiemetics were found to be ineffective.
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J Pain Palliat Care Pharmacother · Mar 2021
ReviewRethinking Docusate's Role in Opioid-Induced Constipation: A Critical Analysis of the Evidence.
Opioid induced constipation (OIC) is a predictable and preventable adverse effect of opioid use. Docusate is often utilized for OIC prophylaxis and treatment because of its low cost, easy accessibility and tolerability. However, the costs of docusate use may not outweigh the benefits given limited reported efficacy. ⋯ The majority of guidelines or CR that endorsed the use of docusate for OIC prophylaxis or treatment did not cite primary evidence to support their recommendations. The inclusion of docusate in major guidelines and CR for OIC management is weakly evidence based, though docusate use is still widely recommended. Institutions and health care providers should consider careful evaluation of OIC protocols and/or algorithms to ensure integration of evidence-based therapy and reduce unnecessary drug use and associated costs, which may include removal of docusate.
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J Pain Palliat Care Pharmacother · Mar 2021
Low-Dose Ketamine Infusion as Adjuvant Therapy during an Acute Pain Crisis in Pediatric Patients.
Recent studies in pediatric patients have suggested that ketamine, an N-methyl-D-aspartate receptor (NMDA) antagonist, given at sub-anesthetic doses can effectively decrease pain scores, provide analgesic effects, and in some cases, reduce opioid requirements. Our study aims to assess impact of low-dose ketamine on reducing pain scores and total opioid requirements during an acute pain crisis in pediatric patients. From November 2016 to December 2018, eight patients between the ages of 2 and 17 years admitted to the pediatric intensive care unit (PICU) were treated with LDK infusions to manage severe, opioid-refractory, acute pain crises. ⋯ Hallucination was reported in one patient which resolved upon dose reduction. LDK infusion could be considered as an adjuvant therapy to optimize pain control in pediatric patients experiencing acute pain crises. Further investigation with a larger patient population is warranted to establish the effects of LDK on pain improvement and reducing total opioid requirements.
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J Pain Palliat Care Pharmacother · Mar 2021
Case ReportsManagement of Malignant Chylothorax with Subcutaneous Octreotide Treatment.
There are currently limited published case reports and clinical studies looking at octreotide as a potential therapeutic agent for treating surgery- and malignancy-related chylothorax in adult patients. Few case reports have shown that low-dose subcutaneous octreotide can be used to treat malignant chylothorax. ⋯ This case also highlights the importance of understanding the pharmacotherapeutic effects of octreotide when managing malignant chylothorax as it may help to benefit patients by improving symptoms, quality of life, and length of hospital stay. Further prospective studies are warranted to further evaluate the role of octreotide in the management of malignant chylothorax.
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J Pain Palliat Care Pharmacother · Mar 2021
Strategies for Rotation between Gabapentinoids in the Inpatient Setting.
Guidance and evidence to support best practices in rotating between gabapentinoids is lacking. This retrospective cohort study was performed to describe and evaluate strategies for rotation. Patients rotated while admitted from June 1st, 2014 to April 25th, 2020 at a large, academic medical center were included. ⋯ Post hoc analysis of patients with normal renal function (eGFR ≥ 50 mL/min/1.73 m2) found that those who were successful were more likely to have used a direct switch strategy (p = 0.048). There were no differences in adverse effects. These findings suggest that either strategy is reasonable for gabapentinoid rotation in the inpatient setting.