Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2024
An Older Man with Clonus, Rigidity, Hyperreflexia, and Hand Tremors.
Serotonin toxicity (ST) is a preventable, life-threatening condition caused by serotonergic agents. It typically arises from combined drug use that affects serotonin's release and metabolism. While often presenting with mild symptoms that may be overlooked or misdiagnosed, severe toxicity is associated with significant mortality. ⋯ Accurate diagnosis requires heightened vigilance from healthcare professionals regarding potential drug interactions and familiarity with the specific clinical criteria. Regular revision and adjustment of medications in older patients and preference for the non-pharmacological treatment of chronic pain are essential for preventing ST. This case report is a convenient way for many healthcare professionals to update their knowledge about ST, its diagnosis and management.
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J Pain Palliat Care Pharmacother · Dec 2024
ReviewSafety of Naldemedine for Opioid-Induced Constipation - A Systematic Review and Meta-Analysis.
Naldemedine is a peripheral acting µ-opioid receptor antagonist approved by the Food and Drug Administration to treat opioid-induced constipation. Concerns about side effects like opioid withdrawal prevent its widespread use, especially for cancer patients. We performed this systematic review and meta-analysis to evaluate existing safety data of naldemedine treating opioid-induced constipation following the PRISMA guidelines. ⋯ However, no increased risk for opioid withdrawal was observed. This analysis confirms naldemedine's overall safety in treating opioid-induced constipation, with manageable gastrointestinal side effects. However, the higher adverse events in cancer patients require further investigation to ensure safe use in this population.
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J Pain Palliat Care Pharmacother · Dec 2024
Intravenous Magnesium Sulfate as an Adjunct to Intravenous Ketamine for Acute Pain: A Case Series.
Intravenous (IV) magnesium sulfate, a versatile electrolyte, plays a pivotal role across various medical domains. From cardiac care to obstetrics, gastrointestinal to pulmonary therapies, the impact is far-reaching among acute care services. ⋯ This case series describes the difficulties experienced with postoperative analgesia in three patient cases with complex comorbidities and discusses the beneficial impact observed when magnesium was administered concomitantly with ketamine. Further research is necessary to outline the specific role, ideal population, and recommended bolus and infusion rate for optimal analgesic efficacy.
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J Pain Palliat Care Pharmacother · Dec 2024
ReviewDeafferentation in Pain Medicine: A Narrative Review of Mechanisms and Management.
Deafferentation is an umbrella term that includes several clinical conditions. The exact mechanism is not yet known, and the different clinical conditions do not necessarily share common pathophysiology. It includes both non-painful and painful conditions, including cancer pain conditions. ⋯ This type of pain is typically opioid-nonresponsive, but some patients may benefit. Neuronal destructive procedures are indicated for brachial plexus avulsion injuries. Spinal cord stimulation, dorsal root entry zone rhizotomy, deep brain thalamic stimulation, and motor cortex stimulation have been suggested for the management of the complex clinical conditions under the umbrella of deafferentation.