Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2024
Prevalence of Reluctance to Prescribe Opioids Among Physicians in Oncology Departments: A Descriptive Cross-Sectional Study From Turkey.
Cancer-related pain (CrP) is a significant public health problem, and opioids are the mainstay of CrP treatment. Considering the persistent problem of inadequate treatment of cancer pain in Turkey, the study was conducted to determine the prevalence of reluctance to prescribe opioids among physicians in oncology departments. The descriptive cross-sectional study included oncology residents and residents without oncology specialization in oncology departments. ⋯ A significant positive association was found between the factor associated with reluctance to prescribe opioids and fear of opioid use disorder (β = 0.964; 95% CI = 0.362-1.566; p = .002). Reluctance to prescribe opioids was inversely related to the oncology subspecialty (β = -0.878; 95% CI = -1.54 to -0.213; p = 0.010) and education about CrP and opioid management (β = -1.707; 95% CI = -2.404 to -1.009; p = 0.01). Reluctance to prescribe opioids appears to be associated with a lack of knowledge and fear of opioid use disorder.
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J Pain Palliat Care Pharmacother · Jun 2024
Case ReportsLidocaine Infusion: An Analgesic Option for Checkpoint Inhibitor Arthritis: A Case Report.
This report describes the use of subcutaneous lidocaine infusion to manage complex pain associated with checkpoint inhibitor inflammatory arthritis. In addition, the safe administration of lidocaine in the home setting is described. A 49-year-old man with metastatic melanoma to lung, right axilla and posterior chest wall on regular pembrolizumab developed checkpoint inhibitor inflammatory arthritis. ⋯ Inflammatory pain responded well to 2 mg/kg/h lidocaine infusion over 4 days with sustained response between infusions of up to 6 wk. Resulting in improved mobility, functional status, and overall quality of life. Lidocaine infusion should be considered as an option for analgesic management of checkpoint inhibitor inflammatory arthritis in patients for whom usual treatment is ineffective, and as an opioid-sparing intervention.
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J Pain Palliat Care Pharmacother · Apr 2024
The Effect of Guided Imagery and Progressive Muscle Relaxation on Sedation in Patients Undergoing Noninvasive Mechanical Ventilation.
Mental imagery and relaxation are noninvasive methods and can easily be used by the patient. Accordingly, this study aimed to detect the effect of guided mental imagery (GI) and progressive muscle relaxation (PMR) on sedation in patients undergoing noninvasive mechanical ventilation (NIV). This clinical trial study was carried out in the Shahid Modarres Hospital in 2022 and encompassed 80 patients with COVID-19 undergoing NIV, who were assigned to two intervention and control groups. ⋯ The Quade nonparametric ANCOVA revealed the significant impact of intervention on the post values of Total score (p-value < 0.001), Tolerance (p-value < 0.001), Calmness (p-value < 0.001), Ventilator synchrony (p-value < 0.001), face relaxation (p-value < 0.001), Consciousness (p-value = 0.009) and Awakeness (p-value = 0.020). The study findings demonstrated the effectiveness of relaxation program in promoting sedation in patients undergoing NIV. Accordingly, intensive care unit (ICU) nurses at our institution are encouraged to use PMR and GI to sedation of patients under NIV.
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J Pain Palliat Care Pharmacother · Mar 2024
The Impact of a Clinical Pharmacist Practitioner on Perioperative Pain Management for Orthopedic Surgeries.
The objective of this quality improvement (QI) project was to assess the impact of an evidence based clinical pharmacist practitioner (CPP) model applied to perioperative pain management by integrating a CPP into the perioperative orthopedic surgery clinical pathway. Secondary objective was to assess the effect of CPP pain management service on surgical team satisfaction. This QI project expanded CPP pain management services for patients who were scheduled for an orthopedic surgery. ⋯ The impact of the Pain CPP on perioperative pain management was demonstrated by improvement in the Clinically Aligned Pain Assessment Tool, which was similar in patients where CPP recommendations were accepted compared to surgeon only recommended regimens (p = 0.048). Five orthopedic surgical providers responded to our satisfaction survey, 80% (n = 4/5) strongly agree that a pain management CPP should become a permanent member of the care team. Through an evidence-based CPP model we observed a reduction in quantity of opioid prescribed and morphine equivalent daily dose utilized in patients who underwent an orthopedic surgery.
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J Pain Palliat Care Pharmacother · Mar 2024
ReviewBarriers and Best Practices on the Management of Opioid Use Disorder.
Opioids refer to chemicals that agonize opioid receptors in the body resulting in analgesia and sometimes, euphoria. Opiates include morphine and codeine; semi-synthetic opioids include heroin, hydrocodone, oxycodone, and buprenorphine; and fully synthetic opioids include tramadol, fentanyl and methadone. ⋯ This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population.