Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesic issues in palliative care gastroesophageal reflux pain and chronic non-cancer pain management.
Brief literature reviews and commentary on gastroesophageal reflux disease associated pain management with rectal dosage forms and beliefs about use of opioids in non-cancer pain are presented. Relevant references including the model guidelines of the Federation of State Medical Boards of the United States on the use of opioids in non-cancer pain are cited.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewKetamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration.
Ketamine is a parenteral anesthetic agent that provides analgesic activity at sub-anesthetic doses. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with opioid receptor activity. Controlled studies and case reports on ketamine demonstrate efficacy in neuropathic and nociceptive pain. ⋯ Use of this drug by the oral, intranasal, transdermal, rectal, and subcutaneous routes has been reported with analgesic efficacy in treating nociceptive and neuropathic pain. Ketamine also has been reported to produce opioid dose sparing and good patient acceptance. A transdermal formulation is currently under patent review in Brazil and an intranasal formulation is currently undergoing phase I/II clinical trials.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewWhat is the most effective therapy for preventing NSAID-induced gastropathy?
Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity is associated with morbidity and mortality, and given the very wide use of NSAIDs, is problematic and costly to society. Several options are now available to minimize gastrointestinal toxicity from NSAIDs. ⋯ The effectiveness of these strategies to minimize NSAID-induced gastrointestinal toxicity is summarized. In addition, their associated adverse effect profiles and costs are compared.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesia issues in palliative care: bone pain, controlled release opioids, managing opioid-induced constipation and nifedipine as an analgesic.
Some recent literature relevant to analgesia in palliative care is reviewed. Reports on clinical use of bisphosphonates for bone pain in cancer, controlled release opioids, selection of laxatives for opioid-induced constipation and the calcium channel blocker nifedipine as an analgesic are described.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewOpioid treatment of chronic pain in patients with addiction.
Patients with a history of drug or alcohol addiction may present to physicians with pain complaints. The medical literature is weak on the treatment of pain with opioids in patients in recovery or active addiction. This is because inconsistent criteria were used to define addiction and the types of chronic pain. ⋯ A way to distinguish between these conditions is by giving the patient appropriate pain medication and observing the pattern of behavior to determine which is causing the drug-seeking behavior. Safe prescribing of medications with abuse potential includes use of a medication agreement, setting goals with the patient, giving appropriate amounts of pain medication, monitoring with pill counts and drug screens, and careful documentation. Even patients with a history of addiction can benefit from opioid pain medications if monitored appropriately.