Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2012
CommentAre opioid risk evaluation and mitigation strategies (REMS) interrupting your sleep?
The article entitled "Risk Evaluation and Mitigation Strategies (REMS) for Extended-Release and Long-Acting Opioid Analgesics: Considerations for Pain and Palliative Care Practice" that appears in this issue of the journal addresses the important new Food and Drug Administration (FDA) REMS program. This commentary expands on themes introduced by Dr. Gudin, projects future directions for REMS, and discusses possible benefits, limitations, and risks associated with the extended-release long-acting opioid REMS.
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J Pain Palliat Care Pharmacother · Jun 2012
Population pharmacokinetics of transdermal fentanyl in patients with cancer-related pain.
Determining the appropriate dose of transdermal fentanyl (TDF) for the alleviation of cancer pain requires determining the factors causing variations in serum fentanyl concentration after TDF treatment. The objective of this study was to identify these factors and incorporate them into a formula that can be used to predict serum fentanyl concentration after application of a TDF patch. ⋯ Based upon this evaluation, Child-Pugh Score and use of a cytochrome P450 3A4 (CYP3A4) inducer were identified as the most significant factors in variations in serum fentanyl concentration and incorporated into the following Final Model formula: CL(fenta) (L/h) = 3.53 × (15 - Child-Pugh Score) × (1 + 1.38 × use or no use of CYP3A4 inducer). Bootstrap evaluation of the Final Model revealed a high convergence rate, suggesting that the model formula is a reliable and useful tool for determining TDF dose for the alleviation of cancer pain.
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J Pain Palliat Care Pharmacother · Jun 2012
International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices in Palliative Care.
The objective of this study was to identify, through a consensus process, the essential practices in primary palliative care. A three-phase study was designed. Phase 1 methods included development of a working group; a literature review; development of a baseline list of practices; and identification of levels of intervention. ⋯ The working group (WG) arranged the resulting practices in four categories: Physical care needs, Psychological/Emotional/Spiritual care needs, Care Planning and Coordination, and Communication. The IAHPC List of Essential Practices in Palliative care may help define appropriate primary palliative care and improve the quality of care delivered globally. Further studies are needed to evaluate their uptake and impact.
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In conjunction with World Cancer Day 2012, three leading pain and palliative care organizations developed a statement on access to analgesics to provide freedom from pain as a human right. Numerous other professional organizations subsequently signed this manifesto calling upon governments, the pharmaceutical industry, and health institutions to make available immediate-release morphine at affordable prices for all in need of pain relief. This report is reprinted with permission of the originating organizations. For more information see: http://palliumindia.org/manifesto/.
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All India Institute of Medical Sciences, New Delhi, receives patients from all over India. This narrative describes the suffering of cancer patients who are unable to access pain relief and palliative care at their native places and have to repeatedly travel long distances to get morphine-all because of lack of awareness and availability of palliative care in North India, and the restrictions on availability of morphine due to stringent, outdated narcotic regulations.