Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Jun 2022
ReviewPharmacotherapy in Cachexia: A Review of Endocrine Abnormalities and Steroid Pharmacotherapy.
Cachexia is a state of increased metabolism associated with high morbidity and mortality. Dysregulation of cytokines and hormone activity causes reduced protein synthesis and excessive protein breakdown. various treatments are available, depending on the primary disease and the patient's state. Besides pharmacological treatment, crucial is nutritional support as well as increasing physical activity. ⋯ Estrogen analogs, progesterone analogs, testosterone analogs, Selective Androgen Receptor Modulators (SARM), Angiotensin-Converting-Enzyme Inhibitors (ACEI), Nonsteroidal anti-inflammatory drugs (NSAIDs), thalidomide, melatonin, Growth Hormone Releasing Peptide-2 (GHRP-2) may play important role in wasting syndrome treatment as well. However, for the usage of some of them, evidence-based recommendations are not available. This review highlights current therapeutic options for cachexia with a specific focus on steroid therapy.
-
J Pain Palliat Care Pharmacother · Jun 2022
Predictors of Opioid Resistance: An Investigation in Cancer Pain.
Appropriate use of opioid analgesics according to the World Health Organization pain relief ladder has provided pain relief to many patients with cancer pain. However, a proportion of patients fail to achieve sufficient pain relief and develop opioid resistance. Individual risk factors may relate to opioid resistance. ⋯ Age, neuropathic pain, and alkaline phosphatase were extracted as significant factors for opioid resistance (p < 0.05). A resistance score was created from these factors and classified into binary values, the sensitivity was 80.6% and the negative predictive value was 91.6%. The findings suggest that the resistance score could be a sensitive predictor of opioid resistance before opioid initiation.
-
J Pain Palliat Care Pharmacother · Jun 2022
Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay.
To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. ⋯ Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.
-
J Pain Palliat Care Pharmacother · Jun 2022
Comparison of Current Post-Graduate Pain Management and Palliative Care Pharmacy Residency Programs.
Post-graduate pharmacy residency training in pain management and palliative care is continuing to increase in availability. It is expected that there will be further expansion in the need for specialty trained pain and palliative care pharmacists as the population continues to age and prevalence of pain increases; however, descriptions of current post-graduate year 2 pain management and palliative care residencies are limited. The purpose of this survey is to collect program information and compare baseline characteristics of the currently available programs. ⋯ Approximately 33% of residency program directors had completed a post-graduate year two residency in pain management and palliative care, and the majority of responding programs were funded by the Department of Veterans Affairs. The characteristics of responding programs illustrates the diversity of current post-graduate pain management and palliative care residency opportunities. The results of this survey help evaluate these opportunities and will provide valuable information as this specialty continues to progress.