Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Nov 2024
Intrathecal Baclofen Pump Refill-Related Cardiac Arrest: A Case Report.
We present the case of a 45-year-old male with a history of multiple sclerosis complicated by spasticity and paraplegia, who developed altered mental status and type II respiratory failure requiring intubation on the same day his intrathecal baclofen pump was refilled by his pain physician. Shortly after admission, the patient experienced cardiac arrest four times within two hours until the pump contents were aspirated, and the patient was stabilized. This case report emphasizes the significance of vigilance and prompt recognition of intrathecal baclofen poisoning, which can lead to life-threatening toxicities and withdrawals.
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J Pain Palliat Care Pharmacother · Nov 2024
Pain-Induced Delirium in Patient with Dementia: A Case Report and Narrative Review.
Pain management is the hallmark of palliative care; however, pain is commonly underassessed in cases of advanced dementia and delirium (acute confusional state). We present a case of a 66-year-old female patient with severe dementia who was hospitalized because of behavioral changes and sleep disturbance. Symptoms of confusion, disorientation, inattention, and agitation were most severe at night. ⋯ Precise pain assessment and effective treatment are imperative, particularly in advanced dementia. Underassessed and undertreated pain in dementia may lead to delirium and progression of dementia. It is paramount for future studies to emphasize comprehensive multidimensional pain assessment and total pain to better manage pain in advanced dementia, which will further enhance psychological well-being and quality of life in palliative care.
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J Pain Palliat Care Pharmacother · Nov 2024
Family Caregivers in Palliative Care Therapeutic Management: An Integrative Review.
In palliative care, family caregivers are partners of multidisciplinary teams in the continuity of care at home. Effective therapeutic management provides optimal relief of distressing symptoms. It requires the acquisition of specific knowledge and care, but it also involves decision-making with ethical implications that increase the stress and burden on caregivers. ⋯ Family caregivers are presented as coordinating elements within the healthcare system. The role of family caregivers is multidimensional, with numerous tasks and skills needed to support their relatives. Therapeutic management is more than just administering medications and needs to keep up with growing and fluctuating needs.
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J Pain Palliat Care Pharmacother · Nov 2024
Evaluating the Impact of Buprenorphine on Depressive Symptoms Among Veterans with Chronic Pain.
Buprenorphine has demonstrated benefit for acute and chronic pain and various psychiatric disorders. However, many studies evaluating buprenorphine's effect on psychiatric conditions are not specific to the chronic pain population. This retrospective study was conducted to assess the impact of buprenorphine on depressive symptoms in patients with chronic pain at a Veterans Affairs healthcare facility. ⋯ Median change in PHQ-9 was -5 in the buprenorphine group and -1.5 in the traditional opioid group. Compared to traditional opioids, buprenorphine was associated with a greater reduction in depressive symptoms among Veterans with chronic pain. Although this reduction met the threshold for clinically significant improvement, further investigation is needed to evaluate the clinical relevance of these findings.
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J Pain Palliat Care Pharmacother · Nov 2024
Implementation of Pharmacist Driven Gabapentinoid Titration for Diabetic Peripheral Neuropathy in a Primary Care Setting.
Previous studies suggest that patients with diabetic peripheral neuropathy (DPN) frequently do not receive the minimum effective doses of a gabapentinoid according to guidance from national organizations. There is opportunity to assess the implementation of pharmacist intervention for patients not meeting minimum effective gabapentinoid dosing for DPN. This prospective, single site quality improvement project was conducted at a primary care clinic and included patients with DPN prescribed a gabapentinoid by their primary care provider (PCP) at a dose lower than minimum effective dosing. ⋯ No patients were able to meet the minimum effective dose. The majority of patients declined pharmacist services due to neuropathy being controlled on the current gabapentinoid dose. This study supports the ability for pharmacists to assess patient specific factors for adequate dosing, titration, and deprescribing recommendations for analgesic medications in diabetic peripheral neuropathy.