Pain practice : the official journal of World Institute of Pain
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The development and implementation of a pharmacist-led patient-controlled analgesia (PCA) dosing service in a large academic institution are described. ⋯ After implementation of the pharmacist-led PCA dosing service, pharmacists at our institution provide PCA pain management services as part of our pharmacy department's standard practice.
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Oral mucositis is a common and often debilitating complication among cancer patients receiving radiation therapy to the head and neck or chemotherapy agents, or undergoing hematopoietic stem cell transplantation. Pain and decreased oral function associated with oral mucositis may persist long after the conclusion of therapy. Although most patients respond to conservative management, a subset of patients develops intractable pain with severe consequences. ⋯ We also observed that methylene blue rinse significantly reduced the total opioid requirement, as demonstrated by reductions in the patients' morphine equivalent daily dose scores after its use. Our case series suggests that 0.5% methylene blue oral rinse therapy is an effective and inexpensive modality that can be used safely to palliate intractable oral pain in patients with mucositis associated with cancer treatment. To our knowledge, this is the first report using this therapy to treat pain from oral mucositis.
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Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. ⋯ Among patients who suffer an OPR-related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.
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Evaluating the clinical efficacy of acupuncture analgesia with systematic reviews (SRs) has attracted wide interest. ⋯ The quantity and the quality of SRs regarding acupuncture analgesia have been promoted in recent years. More effort should be expended on the assessment of publication bias, the provision of detailed information about the protocol and the registration process, and the implementation of additional analyses to improve the validity of the SRs.