Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Sep 2022
Evaluation of Guideline-Recommended Pain Management in Acute Sickle Cell Crisis and Its Effect on Patient Outcomes.
This was a retrospective, multi-site observational cohort of 233 encounters of patients with Sickle Cell Disease (SCD) who received analgesia for acute pain crisis related to SCD from January 1, 2019 to December 31, 2019. Patient encounters were categorized based on whether they received analgesia within guideline directed 60 minutes of emergency department (ED) arrival. The primary outcome was time to a pain score reduction of ≥30% on the numerical rating scale. ⋯ We found that patients with a history of substance use disorder documented in their chart were less likely to receive timely analgesia. Our study indicated that when patients with SCD received analgesia in accordance with guideline recommendations, pain goals were achieved faster with an improvement in outcomes. Providing optimal care can be difficult, but education and standardized policies may help mitigate this gap.
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J Pain Palliat Care Pharmacother · Sep 2022
Outpatient Opioid and Naloxone Prescribing Practices at an Academic Medical Center during the COVID-19 Pandemic.
While improving opioid safety has been a national priority, the coronavirus disease 2019 (COVID-19) pandemic has been associated with increased rates of opioid overdose. The present study characterized outpatient opioid and naloxone prescribing patterns during the COVID-19 pandemic. A retrospective chart review was conducted of adult patients receiving opioid therapy between August 2020 through October 2020 from outpatient clinics within a Texas health system. ⋯ Twenty-two (1.6%) patients were co-prescribed naloxone. In this study, naloxone was rarely prescribed for outpatients receiving opioid prescriptions during the COVID-19 pandemic. Health systems should continue to prioritize adherence to evidence-based clinical guidelines and increase access to naloxone.
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J Pain Palliat Care Pharmacother · Sep 2022
Pharmacist Opioid Dispensing Confidence in an Evolving Practice Landscape.
Pharmacists are increasingly called upon to make dispensing decisions when presented with prescriptions for opioids. Risk mitigation strategies have been implemented to assist pharmacists in making these decisions, but they have also increased the complexity of decision-making. The primary objective of this study was to describe change in pharmacist comfort levels with opioid prescription dispensing over the previous year. ⋯ When asked about information that may increase comfort in dispensing opioids, respondents noted diagnosis, morphine milligram equivalent, prior treatments, past medical history, drug monitoring program verification, and previous treatment trials with opioids. Comfort with dispensing opioids decreased over a 12-month period among pharmacists surveyed. Improved communication between prescriber and pharmacist, as well as enhanced access to patient health information, is critical to reduce barriers to care for patients.
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J Pain Palliat Care Pharmacother · Sep 2022
Case ReportsDexmedetomidine Continuous Infusion for Refractory Cancer Pain at End of Life: A Case Report.
Refractory cancer-related pain at end-of-life (EoL) is multifaceted and may require utilizing medications with different mechanism of actions beyond opioids. We report the successful use of dexmedetomidine in a 63-year old female with recurrent breast cancer and intractable left arm pain and swelling admitted to University of California, San Diego, Health (UC San Diego Health), palliative care unit. Patient's pain and agitation continued to persist and she declined clinically despite efforts to start methadone, continuous infusion opioids, continuous infusion lidocaine and intravenous chlorpromazine by the palliative care team. ⋯ She was able to have some lucid periods and interacting with her family. With the addition of dexmedetomidine to her pain regiment, the patient was able to peacefully die 5 days later. This case report highlights the clinical utility of demedetomidine in a palliative care unit for refractory pain at EoL.
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J Pain Palliat Care Pharmacother · Sep 2022
Validation of ICD-9 Codes for Identification of Chronic Overlapping Pain Conditions.
Chronic overlapping pain conditions (COPCs) are a collection of chronic pain syndromes that often co-occur and are thought to share underlying nociplastic pathophysiology. Since they can manifest as seemingly unrelated syndromes they have historically been studied in isolation. Use of International Classification of Diseases (ICD) codes in medical records has been proposed as a means to identify and study trends in COPCs at the population level, however validated code sets are needed. ⋯ Validated ICD-9 code sets were generated for 10 of the 11 COPCs evaluated. The majority had high levels of diagnostic accuracy, with all but one code set achieving ≥ 80% specificity, sensitivity, and predictive values. This code set may be used by pain researchers to identify COPCs using ICD-9 codes in administrative datasets.