Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2019
Case ReportsPreliminary Validation for the "BJR method"-A Possible New Mathematical Approach to Methadone Conversion.
Methadone has been effectively utilized in the palliative care setting as a second-line agent for pain management in cancer patients with refractory pain, or in those who cannot tolerate other opioid medications. The lack of reliable dosing ratios, substantial interindividual variability in methadone pharmacodynamics, the potential for extensive drug interactions, and the high potency of methadone compared with other opioids all pose significant barriers to the use of this drug in routine practice. This article describes a novel approach to methadone conversion, with case studies providing preliminary validation.
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J Pain Palliat Care Pharmacother · Mar 2019
Referral Pattern to a Tertiary Care Cancer Pain Clinic in India.
The study aimed to identify patterns of patient referral from oncology services, including pain severity, prior analgesics, impact of patient's literacy on referral, and adequacy of pain relief offered by the pain clinic. A retrospective analysis of pain clinic data from August 2014 to February 2015 at the Tata Memorial Hospital was carried out, wherein adult cancer patients referred for the first time to the pain clinic were included. Two thousand patients were included: 38.1% of the referred were at pretreatment stage, 28.8% advanced. ⋯ Pain scores were lower in the literate group, and this group were referred significantly earlier than the illiterate. Literacy could therefore hold the key to better awareness and compliance with pain management. Our findings demonstrate that pain as yet does not receive a much needed priority even at a tertiary care cancer centre.
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J Pain Palliat Care Pharmacother · Mar 2019
Trigeminal Neuralgia: Medical Management and Surgical Options.
Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In response to a question about trigeminal neuralgia, its diagnosis, medical therapies, surgical procedures, and treatment outcomes will be discussed.
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J Pain Palliat Care Pharmacother · Dec 2018
Meta AnalysisA Systematic Review of the Evidence Behind Use of Reduced Doses of Acetaminophen in Chronic Liver Disease.
Acetaminophen is among the most commonly used nonopioid analgesics, but significant variation exists in its prescribing practices for cirrhosis patients. Our primary objective was to describe the quality of evidence supporting or refuting the use of acetaminophen in patients with hepatic dysfunction. A comprehensive literature review of PubMed, Cochrane Library, Web of Science, and International Pharmaceutical Abstracts using the search terms "acetaminophen," "paracetamol," "chronic liver disease," "cirrhosis," and "hepatic disease" for studies describing changes in acetaminophen metabolism in patients with hepatic dysfunction was conducted. ⋯ The level of certainty for dosing recommendations obtainable from reviewing the evidence is low due to a small number of studies meeting search criteria, small samples sizes, inadequate information regarding cirrhosis etiology and compensated versus uncompensated liver disease, and lack of information on patient centered health outcomes. High-quality trials are not available to support the use of decreased acetaminophen doses in compensated cirrhosis patients. Acetaminophen can be a safe analgesic in patients with compensated hepatic dysfunction after careful analysis of patient-specific factors.