Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2015
Case ReportsFentanyl tolerance in the treatment of cancer pain: a case of successful opioid switching from fentanyl to oxycodone at a reduced equivalent dose.
Opioids are not generally deemed to have an analgesic ceiling effect on cancer pain. However, there have been occasional reports of tolerance to opioid development induced by multiple doses of fentanyl. The authors report a case of suspected tolerance to the analgesic effect of opioid, in which an increasing dose of fentanyl failed to relieve the patient's cancer pain symptoms, but opioid switching to oxycodone injections enabled a dose reduction to below the equivalent dose conversion ratio. ⋯ Despite the total daily dose of fentanyl reaching 5.6 mg (equivalent to 560 mg oral morphine), the analgesic effect was inadequate; thus, an urgent adjustment was necessary. Due to the moderate dose of fentanyl, the switch to oxycodone injection was done incrementally at a daily dose equivalent to 25% of the fentanyl injection. The total dose of oxycodone was replaced approximately 53.5% of the dose of fentanyl prior to opioid switching.
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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. This article provides information to patients regarding the treatment of neuropathic pain syndrome. It narrates how a doctor might explain neuropathic pain to a patient and particularly discusses the use of anticonvulsants.
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J Pain Palliat Care Pharmacother · Jun 2015
Good state policy may not mean good pain care, but policy improvement offers hope for further progress: response to the Wahowiak article.
Lindsey Wahowiak's late-2014 article discussing the status of pain management in the United States references findings from the University of Wisconsin Pain & Policy Studies Group's (PPSG) policy evaluation reports as supporting her conclusions. This commentary clarifies that the PPSG reports do not gauge the extent of pain care in each state, but rather how they relate to the quality of policies governing such treatment. ⋯ Wahowiak's emphasis that influencing clinical pain outcomes is multifaceted and requires a multifaceted response. Importantly, policy change, along with its broad and continued communication and implementation, should be considered as only one of many crucial elements in providing quality pain management.
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J Pain Palliat Care Pharmacother · Jun 2015
Tools for "decloaking" the elephant in the room: conflict of interest, shared decision-making, and patient-centered care.
Recently, apparent failures in ethical conduct appear to have impacted the public trust of health care professionals. In particular, conflict of interest, whether actual or perceived, is hindering effective relationships between patients, clinicians, and society. Clinicians are poised to experience further damage to the goodwill and reputation of their professions if direct actions and changes to practice philosophy are not taken. ⋯ These are shared decision-making (SDM), and patient-centered care (PCC). These are more than tools; they are logical frameworks for organizing the patient-clinician relationship. It is important for all clinicians to increase their understanding of these tools and incorporate in all facets of their professional practice.
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J Pain Palliat Care Pharmacother · Jun 2015
Case ReportsImprovement in chronic low back pain in an obese patient with topiramate use.
The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. ⋯ Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences.