Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Dec 2018
Review Practice GuidelinePatient Counseling Guidelines for the Use of Cannabis for the Treatment of Chemotherapy-Induced Nausea/Vomiting and Chronic Pain.
The use of cannabis medications has grown in recent years for the symptomatic relief of chemotherapy-induced nausea/vomiting (CINV) and chronic pain (cancer-related and non-cancer-related). As states legalize the use of cannabis, it is important for pharmacists and other health care professionals to be aware of how to counsel patients receiving prescriptions for cannabis medications. The aim of this study was to develop patient counseling guidelines for the use of cannabis products in treatment of CINV and chronic pain. ⋯ Cannabis medications have become more prevalent by approval of legislators in several states. Hence, pharmacists and health care professionals should counsel patients effectively on its use. This guideline needs to be tested to assess its utility in patients.
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J Pain Palliat Care Pharmacother · Dec 2018
Implementation of a Clinical Pharmacist Service in the Hospice Setting: Financial and Clinical Impacts.
Hospice is a unique environment among all clinical fields of practice. Although every other specialty aims to work toward a curative goal or prevention of mortality, hospice completely redirects focus solely on pain and symptom management and sustaining the highest quality of life possible. ⋯ A cost savings of $427,705 was observed, and the clinical pharmacist provided a great deal of expertise to the IDG. Adding a clinical pharmacist to the IDG of other hospice organizations may prove to be a worthy investment.
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J Pain Palliat Care Pharmacother · Dec 2018
UT Southwestern's Palliative Care Program: Measurable Patient Impact and Cost-savings.
The purpose of this analysis was to measure the impact of palliative care services on hospital charges in the 5 days prior to death-the most expensive time of a patient's life-and identify hospital service categories and patient financial classes yielding the highest savings from palliative care. The analysis population included UT Southwestern patients admitted to the hospital between October 1, 2013, and September 30, 2016. Palliative care patients were defined as any patient who received at least one completed palliative care order. ⋯ Overall, there was a significant difference in charges between those that received a palliative care consult and those that did not. The fact that the highest savings were in pharmacy and laboratory services suggests that unnecessary labs and medications are discontinued in an effort to improve patient care and quality of life while reducing costs during end-of-life care. Palliative care services ease the cost burden of end-of-life services for low-income populations.
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J Pain Palliat Care Pharmacother · Dec 2018
Case ReportsThe Enigma of Low-Dose Ketamine for Treatment of Opioid-Induced Hyperalgesia in the Setting of Psychosocial Suffering and Cancer-Associated Pain.
Opioid-induced hyperalgesia is a paradoxical adverse effect of opioid therapy with unclear strategies for its treatment and management. We report the successful use of low-dose ketamine infusion for the treatment of opioid-induced hyperalgesia in a 38-year-old woman presenting with psychosocial suffering and high opioid requirement secondary to pain from a poorly differentiated neuroendocrine tumor. Over the course of a month, her opioid requirement escalated to the gram level of oral morphine equivalents, upon which she was hospitalized at University of California San Diego Health for an acute on chronic pain crisis. ⋯ The infusion ultimately allowed reduction of her opioid use to a third of her original daily requirement and improved her function and ability to interact for several days. Although her pain profile became increasingly complicated by psychosocial suffering and disease progression, she did not experience the same pain event for the remainder of her hospital course. Findings from this case report demonstrate the utility of low-dose ketamine infusion in opioid-induced hyperalgesia.
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J Pain Palliat Care Pharmacother · Dec 2018
Comparison of Parenteral Opioid Dosing in Adult Sickle Cell Disease Patients With Vaso-occlusive Crisis.
Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. ⋯ Pain scores were not significantly impacted by selection of pain regimen. Our study indicates that INT and PCA treatment modalities are both effective at controlling pain in VOC; however, more patients in the INT group were characterized as having a treatment failure. Based on our results, it is reasonable to initiate PCA as the primary pain treatment strategy in SCD patients presenting in VOC.