Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2020
Population Pharmacokinetics of Methadone after Oral Administration in Japanese Patients with Cancer-Related Pain.
Methadone tablets were approved for use in Japan in March 2013. The metabolism of methadone is complex and executed mainly by the cytochromes, CYP3A4 and CYP2B6. The aim of this study was to evaluate the pharmacokinetics of methadone upon oral administration in Japanese patients who experienced cancer-related pain. ⋯ A population pharmacokinetic analysis was evaluated using the Phoenix® NLMETM software. Based on this, the ALBI (albumin-bilirubin) score was identified as a significant factor that could be used to assess variations in the serum concentration of methadone, which was then incorporated into the following final model formula: clearance (L/h) = 5.38 × (ALBI score/-2.139)1.88. The results of these pharmacokinetic parameters suggested that, in clinical use, the dose of methadone should be reduced if liver function declined in patients with cancer-related pain.
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J Pain Palliat Care Pharmacother · Sep 2020
Healthcare Expenditures Associated with Persistent Opioid use Among Adults with Chronic Non-Cancer Pain Conditions: A Retrospective Cohort Study.
Persistent opioid use in adults with chronic non-cancer pain (CNCP) conditions may lead to high economic burden due to adverse events associated with opioids. The objective of our study was to estimate the healthcare expenditures associated with persistent opioid use among adults with CNCP from both payer and patient perspectives. A retrospective cohort study using data from the Medical Expenditure Panel Survey (2012-2015) was undertaken. ⋯ Moreover, persistent opioid use was associated with high out-of-pocket burden compared to no opioid use (adjusted odds ratio, 1.44; 95% confidence interval, 1.09-1.89). Our study shows that both payers and patients bear the brunt of economic burden of persistent opioid use. Alternative cost-effective strategies for pain management for this group of patients are needed.
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J Pain Palliat Care Pharmacother · Sep 2020
ReviewChemotherapy-Induced Peripheral Neuropathy: Causative Agents, Preventative Strategies, and Treatment Approaches.
Chemotherapy-induced peripheral neuropathy (CIPN) is a chronic symptom associated with chemotherapy treatment. Symptoms and severity vary based on chemotherapeutic agent used and dose. At present, effective options for the prevention and treatment of CIPN are inadequate and clinical guidance is limited. ⋯ For treatment of CIPN, pharmacological agents duloxetine and topical combination product containing baclofen, amitriptyline, and ketamine have data supporting use. Early stage trials have shown initial promise for non-pharmacological therapies Scrambler Therapy and Photobiomodulation. Significant research is required as CIPN symptoms can lead to decreased quality of life, chemotherapy dose reduction, and discontinuation of drug therapy.
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J Pain Palliat Care Pharmacother · Sep 2020
Attitudes toward and Barriers to Acetaminophen Use in the Chronic Pain Population: A Cross-Sectional Study.
The use of acetaminophen is recommended in pain management, particularly acute pain management, to reduce opioid utilization and opioid related adverse drug events. Acetaminophen's role in chronic pain conditions is understudied. This cross-sectional study was performed in a pain management office to explore how chronic pain patients use acetaminophen. ⋯ Patients who were recommended taking acetaminophen by a physician were 3.60 times as likely (95% CI 1.58, 8.25) to be a current or ever user of acetaminophen as compared to those who did not receive such a recommendation from their physician. There were no significant differences between current, ever, and never users on their knowledge of the maximum daily dose of acetaminophen of 4 g (p = .925). The study suggests that patients are often unaware of acetaminophen's role in the treatment of their chronic pain.