Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2020
Case ReportsPhenytoin Cream for the Treatment of Sciatic Pain: Clinical Effects and Theoretical Considerations: Case Report.
Chronic sciatic pain is difficult to treat. Patients often suffer from considerable pain and are severely hampered in their everyday activities. Most pharmacologic analgesic treatments have disappointing effects, and often are limited due to adverse events. ⋯ Recently it has been documented that proximal nerve lesions are followed by small fiber pathology in the skin. This might be a responsible peripheral wind-up generator for the chronification of pain in sciatic nerve compression. Topical application of the broad-acting voltage-gated sodium channel blocker phenytoin could reduce neuropathic pain in our case completely, supporting a peripheral mechanism of action for phenytoin cream in sciatic pain.
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J Pain Palliat Care Pharmacother · Jun 2020
Pharmacogenetic Testing: The Ethics of Implementing in Clinical Practice for Chronic Pain Patients.
Chronic pain is a common and costly healthcare problem where standard of care often involves the use of opioids and patient response varies widely. Designing a treatment plan based upon an individual's genetic signature provides an individualized patient-centered care approach that can improve functional status, quality of life, and reduce adverse drug events (ADEs). This paper will discuss the ethical implications of pharmacogenetic (PGx) testing using the principlism framework of the four moral principles: beneficence, non-maleficence, autonomy, and justice. ⋯ Maximizing patient autonomy and beneficence during treatment promotes patient-centered care. Principlism supports PGx testing for patients experiencing chronic pain. Integrating PGx testing impact treatment plans and may improve the outlook for patients with chronic pain.
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J Pain Palliat Care Pharmacother · Jun 2020
Patient Experiences with Compounded Topical Pain Creams.
Topical pain therapy offers several potential advantages as an alternative or adjunct to oral analgesic therapy, including decrease in concurrent oral drug use, lower abuse potential, lower side effects and toxicity, and localized effects. A variety of drugs and cream bases designed to promote transdermal delivery allow for unlimited customization of compounded topical pain creams (CTPC) for specific patients. The purpose of this study was to understand why patients begin CTPC therapy, their perceptions of CTPC therapy, and their level of satisfaction with CTPC therapy. ⋯ The prescriber was the first person to suggest CTPC for most patients. The majority of patients had insurance coverage for the CTPC and paid an average of $24.41 out of pocket per prescription. Most patients were highly satisfied with all aspects of CTPC and were more satisfied with CTPC than other medications they had used for the medical condition previously.
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J Pain Palliat Care Pharmacother · Jun 2020
Randomized Controlled Trial Clinical TrialProphylactic Effects of Intravenous Dexamethasone and Lidocaine on Attenuating Hemodynamic-Respiratory and Pain Complications in Children Undergoing Cleft Palate Repair Surgery With General Anesthesia.
This study aimed to compare the prophylactic effects of intravenous (IV) dexamethasone and lidocaine on hemodynamic condition, respiratory complications, pain control, and vomit incidence following cleft palate repair surgery. This double-blind randomized controlled trial was carried out on 87 children assigned to three groups. Prior to anesthesia, subjects in groups D and L received 0.2 and 1 mg/kg IV dexamethasone and lidocaine, respectively. ⋯ Premedication with both IV dexamethasone and lidocaine provided similar stable hemodynamic and respiratory conditions during the surgical time. However, the use of dexamethasone developed more desirable effects on HR and SPO2 than administration of lidocaine during the recovery time. Both drugs significantly lessened postoperative pain compared to the placebo group at this time.
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J Pain Palliat Care Pharmacother · Jun 2020
Law, Culture, and Fear: A Qualitative Study of Health Professionals' Perceptions of Narcotic Use Related to Cancer Pain.
Studies have shown barriers to appropriate narcotic use in the Middle East have negatively impacted patient outcomes. This study aimed to explore health professionals' perspectives regarding opioid use for cancer patients in Qatar. Eight focus groups were conducted with physicians, pharmacists, and nurses. ⋯ Fear of prescribing for patient addiction and accusation of inappropriate prescribing by authorities were identified as health professional-related barriers. Facilitators included patient and provider education, as well as the availability of specialized teams to assess and treat cancer-related pain. Findings show narcotic utilization is not simply influenced by a single factor or subset of factors but by a multitude of factors that can be both independent and interrelated.