Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2018
Intravenous Chlorpromazine for the Short-Term Treatment of Insomnia in End-Stage Cancer Patients With Difficulty in Oral Administration.
The objective of the study was to evaluate effectiveness and safety of intravenous chlorpromazine for the short-term treatment of insomnia in end-stage cancer patients. Insomnia occurs as one of distressing symptoms in 70% of end-stage cancer patients. End-stage cancer patients often have difficulty in oral administration because of disease progress. ⋯ Increased total sleep time and decreased sleep latency time were observed 3 days after the treatment (P < .001); however, no improvement in depth of sleep was achieved (P = .231). There was no adverse event except for two delirium cases. The study indicated that intravenous chlorpromazine can be applied safely and effectively for the short-term treatment of insomnia in end-stage cancer patients with difficulty in oral administration.
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J Pain Palliat Care Pharmacother · Jun 2018
The Association of Joint Pain and Dipeptidyl Peptidase-4 Inhibitor Use Among U.S. Adults With Type-2 Diabetes Mellitus.
The purpose of this study was to examine the association of dipeptidyl peptidase-4 inhibitors (DPP4Is) with joint pain in adults with type 2 diabetes mellitus (T2DM). This was a retrospective cross-sectional study design, pooling data from the 2012 and 2014 Medical Expenditure Panel Survey. The sample consisted of 4,559 T2DM patients older than 40 years with (n = 3,224) or without joint pain (n = 1,335). ⋯ Even after adjusting for other factors that may affect DPP4I use, there was not a statistically significant difference in DPP4I use among adults with T2DM with and without joint pain (AOR = 1.04; 95% CI, 0.74-1.48). Adults with public health insurance (AOR = 1.76; 95% CI, 1.01-3.04), with prescription insurance (AOR = 1.76; 95% CI, 1.02-3.03), and with a heart disease (AOR = 1.59; 95% CI, 1.18-2.15). DPP4I use was not affected by the presence of joint pain.
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J Pain Palliat Care Pharmacother · Jun 2018
Prescription Drug Monitoring Programs: Relationships Among Program Awareness, Use, and State Mandates.
The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. ⋯ Ohio pre-mandate: 64% vs. 51%; χ2 = 15.66, P < .0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2 = 12.76, P < .0001). Based on these results, mandating use may be an effective method to increase PDMP utilization.
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The authors report a case of diabetes insipidus (DI) associated with a ketamine infusion. A 42-year-old Asian man underwent an exploratory laparotomy and splenectomy who was admitted to the surgical intensive care unit (ICU) for postoperative management. Pain control was attempted with escalating dose of opioids but was inadequate, prompting the addition of a ketamine infusion. ⋯ This report suggests that the patient likely experienced a medication-induced DI, which was successfully resolved through proper identification of the causative agent, removal, and subsequent treatment with desmopressin. Causality assessment between ketamine and DI was determined using the Naranjo Adverse Drug Reaction Probability Scale-a total score of 7 was achieved and thus identified the adverse drug reaction as probable. Clinicians should be aware of the possibility that ketamine may be contributory in a patient with unexplained DI.
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J Pain Palliat Care Pharmacother · Jun 2018
A Preliminary Study of Pain Relieving Dressings for Older Adults With Chronic Leg Ulcers From the Provider's Perspective: A Qualitative Study.
Prevalence of leg ulcers increases with age due to an increase in risk factors, including immobility and venous disease. With an increasingly aging population, therefore, the number of older adults with leg ulcers is increasing. Older adults with leg ulcers experience frequent pain and discomfort, and yet pain in this population is poorly managed. ⋯ Leg ulcers are well known to be painful and often associated with social stigma. A dressing that deals with absorption issues and can help to manage pain, particularly during dressing changes (when pain is highest), would be welcomed by nurse professionals. This preliminary study provides a basis upon which future research can be based.