Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2011
Capsaicin 8% topical patch (Qutenza)--a review of the evidence.
Qutenza is a high-potency capsaicin (8%) topical patch, labeled for treating pain associated with postherpetic neuralgia (PHN). Qutenza decreases pain sensation by reducing transient receptor potential vanilloid 1 (TRPV1) expression and decreasing the density of epidermal nerve fibers in the application area. Systemic absorption from Qutenza is low. ⋯ Prior to application, pretreat the affected area with a topical anesthetic to reduce application site pain. Some patients may require systemic analgesics during and after treatment for treatment-associated pain. Applications of Qutenza can be repeated no sooner than once every 3 months, as needed.
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J Pain Palliat Care Pharmacother · Jan 2011
Distinct relations among plasma concentrations required for different pharmacological effects in oxycodone, morphine, and fentanyl.
Several clinical reports showed that adverse effect profiles are not the same in morphine, oxycodone, and fentanyl. The authors investigated whether the relationship between plasma concentrations for antinociceptive effect and for various pharmacological effects differed among oxycodone, morphine, and fentanyl under controlled experimental setting using animal models. Oxycodone induced constipation and an antinociceptive effect in a similar concentration-dependent manner, whereas morphine required approximately 9-fold higher plasma concentration for antinociceptive effect compared with that for constipation when 50% effective plasma concentration (EC(50)) levels were compared. ⋯ Respiratory inhibition was observed even at higher plasma concentrations in all three opioids, and the differences in the EC(50) values compared with those for antinociceptive effects were 234.5-fold (oxycodone), 233.1-fold (morphine), or 104.2-fold (fentanyl). These results showed that oxycodone, morphine, and fentanyl exhibited unique patterns of plasma concentrations required for different pharmacological effects. The different adverse effect profiles observed in a clinical setting appear to be resulted from, at least in part, distinct intrinsic pharmacological profiles among these μ-opioid receptor agonists.
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Recent passage of a House Bill in the state of Washington led to a commentary on whether mandates for urine drug testing of pain patients represented a breach of the Fourth and Fourteenth Amendment rights of patients. Issues over true consent to such tests and potential view of warrantless searches were discussed. The authors address these concerns in a broader context of risk management and stratification efforts, along with discussion about the need for a tailored approach in this arena and consideration of cost burden for such tests. Finally, the argument is made that social justice issues need to be considered (along with issues of autonomy, beneficence, and nonmaleficence).
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A young man with acute maxillofacial injuries and a tracheotomy in intense pain was denied pain relief for several days. Intermittent suctioning of the trachea was agonizing. He became psychologically affected to such an extent that he was totally focused on his pain and suffering and unable to make intelligent decisions regarding his future treatment. ⋯ A doctor called in to counsel him found that pain was his predominant problem and treated it. The patient was magically transformed to a sensible person, now thinking straight and promptly consenting for surgery. The author, a doctor himself, learned from this experience what a devastating experience pain can have on the person, that one should look for pain to find it, that most of the time pain can be relieved by simple means, and that relief from pain changes the whole attitude of the sufferer.
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J Pain Palliat Care Pharmacother · Jan 2011
Multicenter Study Clinical TrialMethylnaltrexone for opioid-induced constipation in patients with advanced illness: a 3-month open-label treatment extension study.
Methylnaltrexone is a methylated form of the mu-opioid antagonist naltrexone that blocks peripheral effects of opioids without affecting centrally mediated analgesia. The authors conducted a 3-month open-label extension trial of methylnaltrexone in patients with advanced illness and opioid-induced constipation (OIC). Following completion of a 2-week double-blind (DB) trial, 82 patients with OIC who did not respond to laxatives received subcutaneous (SC) methylnaltrexone as needed for up to 3 months. ⋯ There were minimal changes in pain scores and opioid withdrawal symptoms. Adverse events included abdominal pain and nausea, mostly mild or moderate in severity. SC methylnaltrexone administered PRN (as needed) for up to 3 months continued to rapidly induce laxation in advanced illness patients with OIC.