Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2020
Comparing Effectiveness of Gabapentin and Pregabalin in Treatment of Neuropathic Pain: A Retrospective Cohort of Palliative Care Outpatients.
Gabapentin and pregabalin are often considered first line treatment options for various neuropathic pain conditions. The purpose of this retrospective cohort study was to compare clinically meaningful pain reduction and other relevant outcomes among patients prescribed either gabapentin or pregabalin at the University of Arkansas for Medical Sciences (UAMS) Palliative Care Clinic (PCC). The primary endpoint was a significant improvement in pain within six months of initiating either gabapentin or pregabalin. ⋯ The average number of pills per day by a patient in the gabapentin group was 1.8 pills higher than the pregabalin group which was statistically significant (p = 0.01). The results of this analysis support the notion that there is no significant difference in meaningful pain reduction with gabapentin versus pregabalin. This study demonstrates that pregabalin may afford better tolerability and lower pill burden compared to gabapentin.
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J Pain Palliat Care Pharmacother · Dec 2020
LetterPalliative and Supportive Care Prescribing Considerations Around QT Prolongation Risk in the Context of COVID-19 (Coronavirus Disease 2019) Management.
COVID-19 brings with it unprecedented challenges in clinical management. An important component of care is the provision of safe and effective symptom control. Given the emerging literature reporting on the risk of QT prolongation and arrhythmias associated with COVID-19 disease and experimental therapies, we highlight some considerations for the prescribing of palliative care medications in this context. Based on the experience gained from palliative care referrals at our institution prior to and during the COVID-19 pandemic, and in collaboration with our clinical pharmacology colleagues, we outline some general prescribing principles which may assist with weighing the risks and benefits of prescribing symptomatic medications in and beyond the current pandemic.
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J Pain Palliat Care Pharmacother · Dec 2020
Acetaminophen in Patients Receiving Strong Opioids for Cancer Pain.
The mainstay of treatment in advanced cancer pain is opioids; however, non-opioid medications such as acetaminophen continue to be included in guidelines despite a lack of clear, convincing evidence for their use. The aim of our study was to determine if acetaminophen improves pain control or reduces opioid utilization in hospitalized patients receiving strong opioids for cancer pain managed by the palliative care consult service (PCCS). We carried out at single-center retrospective cohort study of 194 adult cancer patients seen by the PCCS and who received strong opioids. ⋯ There was no difference between groups in achieving a 30% reduction in pain (35.8% vs. 35.4%, adjusted odds ratio 0.87, 95% confidence interval [CI] 0.46 to 1.63). Acetaminophen was associated with a longer LOS (8 days vs. 6 days, adjusted relative risk 1.67, 95% CI 1.30 to 2.15). In this study of cancer patients receiving strong opioids, acetaminophen use was not associated with improved pain control or reduced opioid utilization, but was associated with a greater LOS.
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J Pain Palliat Care Pharmacother · Dec 2020
Evaluation of a Pharmacist Managed Telephone Pain Clinic for Neuropathy Treatment.
Pain is prevalent in our society, affecting more than a quarter-million U. S. adults and leading to poor patient outcomes. At the Veteran's Affairs San Diego Healthcare System (VASDHS), a Telephone Pain Clinic (TPC) was developed to improve these outcomes. ⋯ At discharge, pain medications that were increased were use of serotonin and norepinephrine reuptake inhibitors (SNRIs), pregabalin, and capsaicin. Management by the TPC showed promise and trends toward reducing pain experienced by patients with diabetic neuropathy, fibromyalgia, or postherpetic neuralgia. The TPC also may be more effective in maximizing evidenced-based pharmacotherapy for neuropathic pain, suggesting expertise by pharmacist clinical specialists.
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J Pain Palliat Care Pharmacother · Dec 2020
Clinical Tolerability and Safety of Tramadol in Hospitalized Patients.
Tramadol is a schedule IV, monoaminergic and μ-opioid-receptor analgesic with unique pharmacology properties. Though it is well established and widely utilized, there is little guidance on tramadol's place in therapy, including tolerability, safety and monitoring guidelines. Retrospective chart review of 250 patients who received oral tramadol during their hospitalization from January 1, 2018 to December 31, 2018. ⋯ The longer that patients were on tramadol and the more doses they received during their inpatient stay, the greater risk of a severe drug-drug interaction (p < 0.05; R 0.29). In hospitalized patients, the risk of major and severe drug-drug interactions with tramadol increased with dose and duration. Hospital medicine, bone marrow transplant, and emergency medicine teams predominantly used tramadol.