Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2020
ReviewSustainable access to appropriate opioids for palliative care patients in Australia-preventing the need for crisis management.
The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst actively avoiding unintended suffering restricted access can cause. ⋯ Compulsory palliative care education in undergraduate medical, nursing and allied health tertiary courses. Adequate, consistent stock of evidence based opioids for palliative care in community pharmacies and residential aged care facilities. These recommendations provide the regulatory guidance required to ensure persons with life limiting illness have continued access to safe and effective medication that can relieve suffering.
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J Pain Palliat Care Pharmacother · Mar 2020
Analyzing and Benchmarking Global Consumption Statistics for Opioid Analgesics 2015: Inequality Continues to Increase.
Many countries around the world have a very low per capita consumption of opioid analgesics, which is probably related to absence or inadequate management of moderate and severe pain for large parts of their populations. We conducted a longitudinal observational study with opioid analgesic consumption data for all countries from 2000-2015, to assess 2015 per capita consumption data for strong opioid analgesics and to investigate the hypothesis that inequality decreased over the years 2000-2015. We based our study on the official statistics kept by the International Narcotics Control Board, built on data submitted by governments annually. ⋯ Inequality of adequacy of consumption between low- and highly-developed countries increased from 2000 to 2015. The world needs 1867 tonnes ME for treating pain with opioids analgesics at an adequate level (actual use: 365 tonnes or 19.5% of the global need). We concluded that in 2015, almost 6.5 billion people lived in countries where opioid analgesic consumption was low, very low, or extremely low.
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J Pain Palliat Care Pharmacother · Sep 2019
ReviewThe Use of Propofol for Continuous Deep Sedation at the End of Life: A Definitive Guide.
The anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. The manner in which it is dosed and administered in each environment varies, tailored to the specific task at hand. Because the use of propofol in end-of-life care is uncommon, providers may lack practical experience, and resources that are specific to this specialized application are not comprehensive and largely based on dosing and administration as it is done on the intensive care unit. The purpose of this review is to provide an evidence and experienced based reference for the specific use of propofol for end of life sedation.
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J Pain Palliat Care Pharmacother · Sep 2019
ReviewClinical Manifestations and Diagnostic Evaluation of Opioid Allergy Labels - A Review.
While opioids represent one of the most common medication allergy labels, these labels are often unsubstantiated in clinical practice. The removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain. The current approach to patients with pseudo-allergy to opioids is switching to an alternative opioid with less histamine release. ⋯ The low likelihood of true reactivity, combined with the conceivable clinical relevance of an opioid allergy label, calls for further characterization of this label in populations with acute or chronic pain diagnoses. Future directions should include larger prospective studies with systematic evaluation and classification of opioid allergy labels to determine future viability of opioid use. AbbreviationsEHRelectronic health recordNMBAneuromuscular blocking agentIgEimmunoglobulin EMCmast cellGPCRG-protein coupled receptorMRGPRX2mas-related G-protein receptorQAIquaternary ammonium ionsSCARsevere cutaneous adverse reactionAGEPacute generalized exanthematous pustulosisSDRIFEsymmetrical drug-related intertriginous and flexural exanthemaBATbasophil activation testingDPTdrug provocation testing.
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J Pain Palliat Care Pharmacother · Sep 2019
Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden.
Opioid-induced respiratory depression (OIRD) and postoperative nausea and vomiting (PONV) are challenging, resource-intensive, and costly opioid-related adverse events (ORAEs). Utilizing the Premier Healthcare Database, we identified patients > 18 years old, who underwent at least one surgical procedure of interest (i.e., cardiothoracic/vascular, general/colorectal, obstetric/gynecologic, orthopedic, or urologic), and received at least one dose of intravenous morphine, hydromorphone, or fentanyl for acute postoperative pain. The incidence of OIRD and PONV using ICD-9 codes, factors influencing these AEs, length of stay (LOS) and related costs were analyzed. ⋯ Increased odds of PONV were associated with younger age, female sex, and major disease severity. When respiratory depression or nausea/vomiting was present versus absent, LOS was significantly longer, and hospital costs were higher. In this analysis, OIRD and PONV were more prevalent than previously reported, were associated with identifiable risk factors, and had substantial effects on resource utilization and costs.