Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Sep 2014
CommentTo prescribe codeine or not to prescribe codeine?
A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.
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J Pain Palliat Care Pharmacother · Sep 2014
Historical ArticleThe "death" of lethal injection as we know it? The role of chemical execution in the American criminal justice system.
Several independent elements have recently combined to thrust United States capital punishment into a chaos. Corrections officials and policy makers have attempted to "humanize" capital punishment by evolving into a chemical execution process, and soften the outward appearance. ⋯ These disruptions are spawning new theories of legal challenges in capital punishment. This is a critical time for stakeholders and all members of a civilized society to pause and reflect on the role of capital punishment.
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J Pain Palliat Care Pharmacother · Sep 2014
Case ReportsDaily application of transdermal fentanyl patches in patients receiving hyperbaric oxygen therapy.
Hyperbaric oxygen therapy (HBOT) is a treatment for a variety of conditions, particularly nonhealing wounds. The treatment requires the inhalation of pure oxygen in a sealed chamber that is pressurized to 1.5 to 3 times that of normal atmospheric pressure. HBOT safety protocols require all transdermal products to be removed prior to entrance into the hyperbaric chamber, and many institutional policies state that removed patches are not to be reapplied. ⋯ Complicating her management was the presence of chronic pain syndrome secondary to fibromyalgia. Patient 2 was a 70-year-old female with paralysis secondary to spinal fracture who presented with a stage IV sacral pressure ulcer, who was later diagnosed with osteomyelitis. Both patients were successfully managed with daily application of fentanyl transdermal patch.
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J Pain Palliat Care Pharmacother · Sep 2014
Clinical TrialPalliative treatment for advanced biliary adenocarcinomas with combination dimethyl sulfoxide-sodium bicarbonate infusion and S-adenosyl-L-methionine.
Adenocarcinoma of the gallbladder and cholangiocarcinoma account for 4% and 3%, respectively, of all gastrointestinal cancers. Advanced biliary tract carcinoma has a very poor prognosis with all current available modalities of treatment. In this pilot open-label study, the authors investigated the efficacy and safety of a combination of dimethyl sulfoxide-sodium bicarbonate (DMSO-SB) infusion and S-adenosyl-L-methionine (ademetionine) oral supplementation as palliative pharmacotherapy in nine patients with advanced nonresectable biliary tract carcinomas (ABTCs). ⋯ Moreover, this method of treatment has led to a 6-month progression-free survival for all investigated patients. The treatment was well tolerated for all patients without major adverse reactions. Given that ABTC is a highly fatal malignancy with poor response to chemotherapy and targeted drugs, the authors consider that the combination of DMSO-SB and ademetionine deserves further research and application as a palliative care and survival-enhancing treatment for this group of patients.