Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2013
Clinical TrialPilot study of human recombinant hyaluronidase-enhanced subcutaneous hydration and opioid administration for sickle cell disease acute pain episodes.
The objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. ⋯ Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial.
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J Pain Palliat Care Pharmacother · Mar 2013
ReviewAssessment of extended-release opioid analgesics for the treatment of chronic pain.
Approximately 3.8 million patients annually receive extended-release (ER) or long-acting opioid prescriptions in the outpatient setting, around half of which are written by primary care physicians. Compared with short-acting, immediate-release (IR) formulations, ER and oral long-acting opioid analgesics are associated with clinical advantages, such as extended periods of time during which drug plasma levels are within the therapeutic range, decreased peak-to-trough fluctuations, and prolonged analgesia over the dosing period. Additionally, ER opioids offer a more convenient, less frequent dosing regimen to chronic pain patients who are often taking several concomitant medications. ⋯ Putative abuse-deterrent formulations have also recently been introduced to impede physical manipulation of these formulations, or reduce the harm resulting from such behavior. Such formulations may represent an incremental advance to reduce non-oral forms of abuse. This article reviews the pharmacokinetic profiles and abuse-deterrent features of newer ER opioid analgesics for the treatment of moderate to severe chronic pain.
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J Pain Palliat Care Pharmacother · Mar 2013
Effect of opioid-related adverse events on outcomes in selected surgical patients.
This retrospective study utilized a large, national hospital database to assess the impact of opioid-related adverse events (ORADE) on patient outcomes following selected surgical procedures known to require postoperative pain control. ⋯ Patients exhibiting a documented ORADE had greater overall costs, longer hospitalizations, and increased likelihood for readmission. These results highlight the economic impact associated with opioid use for postsurgical pain management.
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The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.
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J Pain Palliat Care Pharmacother · Mar 2013
Personalized medicine--one size fits one: tailoring pain therapy to individuals' needs.
Personalized medicine can be defined as the tailoring of therapies to defined subsets of patients based on their likelihood to respond to therapy or their risk of adverse events. This medical model is more established in oncology but personalized pain therapy is showing potential promise. ⋯ Research using quantitative sensory testing is seeking to identify phenotypic subgroups of neuropathic pain patients with different underlying pain mechanisms. Imaging studies have suggested that genetic, environmental, mood, and injury-specific factors combine to produce a unique cerebral pain "signature." The search for central nervous system (CNS) biomarkers for chronic pain is ongoing.