Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2018
Case ReportsElevated Transaminases with Topical Diclofenac: A Case Report.
Drug-induced liver injury (DILI) has been described with numerous nonsteroidal anti-inflammatory drugs (NSAIDs). Oral diclofenac has been associated with DILI more frequently than other NSAIDs and requires periodic monitoring of liver transaminases and judicious consideration of clinical signs and symptoms of hepatotoxicity. ⋯ Using a widely accepted drug reaction causality instrument, a rating of "definite" was assigned given the temporal sequence of drug exposure and transaminase changes. Further study is warranted to better guide prescribing of topical NSAIDs.
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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.
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We report the case of a 76 year old lady with metastatic breast cancer, who presented to a hospice in severe distress from uncontrolled pain despite an increase in her opioid dose, alongside generalised hypersensitivity and delirium. The clinical presentation suggested opioid-induced hyperalgesia (OIH). After reduction of the opioid dose, our patient significantly improved to the extent she was discharged home a few weeks later. This report aims to increase awareness of OIH, a clinical phenomenon which remains poorly understood and probably under recognised.
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J Pain Palliat Care Pharmacother · Jun 2018
Case ReportsOpioid-Sparing Effects of Topical Ketamine in Treating Severe Pain From Decubitus Ulcers.
Pain from pressure ulcers can severely impact a patient's quality of life. Evidence-based treatment of ulcer-related pain typically relies on systemic opioids with limiting side effects. Literature exists on the use of topical ketamine for neuropathic pain, but not for tissue injury in general and for decubitus ulcer pain specifically. ⋯ Here a case is reported of a 54-year-old female with diffuse large B-cell lymphoma who during a critical period in her illness experienced gangrene leading to chronic bilateral stage IV decubitus heel ulcers. The severe pain reported by the patient was poorly managed using high doses of systemic opioids and resulted in intermittent systemic side effects. Adding a compounded ketamine gel to her wound dressings twice daily over an interval of several months drastically reduced her opioid use and, more important, her pain, with minimal side effects.