Journal of Pain & Palliative Care Pharmacotherapy (J Pain Palliat Care Pharmacother)

Publications in this journal

• Article: Very-High-Dose Methadone With Minimal Toxicity and Inadequate Pain Control in a Hospice Patient With Cancer.

  Natalie M Latuga, Robert G Wahler
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  ABSTRACT: ABSTRACT A case is reported of a 48-year-old Caucasian male who was admitted to hospice care with metastatic cancer of the larynx. The patient required very high methadone doses and experienced little opioid toxicity. The pharmacodynamics and pharmacokinetics of methadone are discussed in the context of this patient experience.
  Journal of Pain & Palliative Care Pharmacotherapy 05/2013;
• Article: Care at the End-of-Life: One Chance to Get It Right.

  Perry Fine
  Journal of Pain & Palliative Care Pharmacotherapy 05/2013;
• Article: Using Haloperidol as an Antiemetic in Palliative Care: Informing Practice Through Evidence From Cancer Treatment and Postoperative Contexts.

  Samantha L McLean, Alison Blenkinsopp, Michael I Bennett
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  ABSTRACT: ABSTRACT Nausea and vomiting are common symptoms in palliative care. Haloperidol is often used as an antiemetic in this context, although direct evidence supporting this practice is limited. To evaluate the efficacy and clinical use of haloperidol as an antiemetic in nonpalliative care contexts to inform practice, the authors conducted a rapid review of (i) published evidence to supplement existing systematic reviews, and (ii) practical aspects affecting the use of haloperidol including formulations and doses that are commonly available internationally. In nausea and vomiting related to cancer treatment, haloperidol was superior to control in two small studies. In postoperative nausea and vomiting (PONV), two randomized controlledtrials found treatment with haloperidol comparable to ondansetron. In palliative care, an observational study found a complete response rate of 24% with haloperidol (one in four patients) which would be consistent with a number needed to treat (NNT) of 3 to 5 derived from PONV. There remains insufficient direct evidence to definitively support the use of haloperidol for the management of nausea and vomiting in palliative care. However, generalizing evidence from other clinical contexts may have some validity.
  Journal of Pain & Palliative Care Pharmacotherapy 04/2013;
• Article: Expanding the Framework of Assessing Adherence and Medication-Taking Behavior.

  Abdulkhaliq J Alsalman, Wally R Smith
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  ABSTRACT: ABSTRACT This analysis critiques recently published concepts of medication adherence assessment and elucidates the importance of finding new measures of adherence. Improving concepts and methods of adherence assessment is key to improving adherence outcomes. It proposes a new framework that contains more inclusive concepts and more standardized terminology. These new concepts and terms not only describe adherence and its specific measures in more detail, but also describe all medication-taking behavior. It argues for the integration of and measurement of behavior associated with specific dose times, types, or schedules. Last, it describes promising research enabled by the new framework that, if implemented, might lead to improved adherence.
  Journal of Pain & Palliative Care Pharmacotherapy 04/2013;
• Article: Through the Eyes of Child: Reflections on My Mother's Death From Cancer.

  Mary A Macy
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  ABSTRACT: ABSTRACT Before being exposed to palliative care, I had lived through 15 years of emotional suffering, beginning with my mother's relapse of leukemia. My mother died 12 years ago; however, the suffering did not end there. Palliative care helped me find meaning and purpose in my suffering. During her illness I received no explanations about what was happening to my mother, and I felt utter emotional loneliness. I received no help in coping with the uncertainties of my mother's life with cancer or of her dying process. The experience left me sad and angry. Sheltering a child from truth does not lessen fear or alleviate pain; it only causes feelings of confusion, anger, embarrassment, and shame.
  Journal of Pain & Palliative Care Pharmacotherapy 04/2013;
• Article: Analgesic Medication Errors in North Carolina Nursing Homes.

  Rishi J Desai, Charrlotte E Williams, Sandra B Greene, Stephanie Pierson, Anthony J Caprio, Richard A Hansen
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  ABSTRACT: ABSTRACT The objective of this study was to characterize analgesic medication errors and to evaluate their association with patient harm. The authors conducted a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Bivariate associations between analgesic medication errors with patient factors, error-related factors, and impact on patients were tested with chi-square tests. A multivariate logistic regression model explored the relationship between type of analgesic medication errors and patient harm, controlling for patient- and error-related factors. A total of 32,176 individual medication error incidents were reported over a 2-year period in North Carolina nursing homes, 12.3% (n = 3949) of which were analgesic medication errors. Of these analgesic medication errors, opioid and nonopioid analgesics were involved in 3105 and 844 errors, respectively. Opioid errors were more likely to be wrong drug errors, wrong dose errors, and administration errors compared with nonopioid errors (P < .0001 for all comparisons). In the multivariate model, opioid errors were found to have higher odds of patient harm compared with nonopioid errors (odds ratio [OR] = 3, 95% confodence interval [CI]: 1.1-7.8). The authors conclude that opioid analgesics represent the majority of analgesic error reports, and these error reports reflect an increased likelihood of patient harm compared with nonopioid analgesics.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013;
• Article: Assessment of extended-release opioid analgesics for the treatment of chronic pain.

  Jeffrey A Gudin
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  ABSTRACT: ABSTRACT Approximately 3.8 million patients annually receive extended-release (ER) or long-acting opioid prescriptions in the outpatient setting, around half of which are written by primary care physicians. Compared with short-acting, immediate-release (IR) formulations, ER and oral long-acting opioid analgesics are associated with clinical advantages, such as extended periods of time during which drug plasma levels are within the therapeutic range, decreased peak-to-trough fluctuations, and prolonged analgesia over the dosing period. Additionally, ER opioids offer a more convenient, less frequent dosing regimen to chronic pain patients who are often taking several concomitant medications. The increased utilization of ER opioids has been accompanied by a rise in the misuse and abuse of these formulations. Certain pharmacokinetic parameters (e.g., longer time to maximum drug plasma concentration, lower maximum drug plasma concentration) may decrease the abuse potential of intact ER opioids by limiting the positive subjective and reinforcing effects relative to IR formulations. Putative abuse-deterrent formulations have also recently been introduced to impede physical manipulation of these formulations, or reduce the harm resulting from such behavior. Such formulations may represent an incremental advance to reduce non-oral forms of abuse. This article reviews the pharmacokinetic profiles and abuse-deterrent features of newer ER opioid analgesics for the treatment of moderate to severe chronic pain.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):49-61.
• Article: Safe and appropriate opioid use.

  Arthur G Lipman
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):2-3.
• Article: A Protocol to Evaluate Drug-Related Workplace Impairment.

  Gary M Reisfield, Theodore Shults, Jason Demery, Robert Dupont
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  ABSTRACT: ABSTRACT The dramatic increase in the use and abuse of prescription controlled substances, cannabis, and a rapidly evolving array of legal and illegal psychotropic drugs has led to a growing concern by employers about workplace impairment, incidents, and accidents. The Federal Workplace Drug Testing Programs, which serve as a template for most private sector programs, focus on a small group of illicit drugs, but disregard the wider spectrum of legal and illegal psychotropic drugs and prescription controlled substances. We propose a protocol for the evaluation of workplace impairment, based on comprehensive drug and alcohol testing at the time of suspected impairment, followed expeditiously by a comprehensive physician evaluation, including a focused medical history with an emphasis on controlled substance use, physical and mental status examinations, evaluation of employee adherence to prescription medication instructions, additional drug testing if indicated, use of collateral sources of information, and querying of state prescription monitoring databases. Finally, we propose suggestions for optimizing the evaluation of drug-related workplace impairment.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):43-48.
• Article: Access to opioids: a global pain management crisis.

  Rosa Buitrago
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  ABSTRACT: ABSTRACT The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):86-7.
• Article: THE HELPING PROFESSIONAL'S GUIDE TO END-OF-LIFE CARE: PRACTICAL TOOLS FOR EMOTIONAL, SOCIAL, AND SPIRITUAL SUPPORT FOR THE DYING THE HELPING PROFESSIONAL'S GUIDE TO END-OF-LIFE CARE: PRACTICAL TOOLS FOR EMOTIONAL, SOCIAL, AND SPIRITUAL SUPPORT FOR THE DYING . E. Alessandra Strada , PhD, FT, MSCP. Oakland, California, New Harbinger Publications , 2013 , Paperbound, 256 pages, ISBN: 978-1-60882-199-0 , List price: $49.95.

  Lynda H Oderda
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):80-90.
• Article: Quality of life in chronic low back pain patients treated with opioids.

  Peter Kiencke, Kristina Viehmann, Jutta Kresimon, Oliver Löwenstein, Reinhard Rychlik
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  ABSTRACT: ABSTRACT A noninterventional study under real-life conditions comparing patients receiving prolonged-release oral oxycodone/naloxone with those receiving other World Health Organization (WHO) Step III opioids found patients in the oxycodone/naloxone group had greater quality of life and less low back pain after 12 months. Oxycodone/naloxone was also found to be more cost-effective in the study.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):77-9.
• Article: Personalized medicine-one size fits one: tailoring pain therapy to individuals' needs.

  Sam H Ahmedzai
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  ABSTRACT: ABSTRACT Personalized medicine can be defined as the tailoring of therapies to defined subsets of patients based on their likelihood to respond to therapy or their risk of adverse events. This medical model is more established in oncology but personalized pain therapy is showing potential promise. Pharmacogenomics is of growing relevance to the pain field, for example cytochrome P450 2D6 (CYP2D6) polymorphisms with resulting variation in degree of CYP2D6 expression may affect codeine analgesia. Research using quantitative sensory testing is seeking to identify phenotypic subgroups of neuropathic pain patients with different underlying pain mechanisms. Imaging studies have suggested that genetic, environmental, mood, and injury-specific factors combine to produce a unique cerebral pain "signature." The search for central nervous system (CNS) biomarkers for chronic pain is ongoing.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):83-5.
• Article: Samarium-(153)-lexidronam therapy for metastatic bone pain.

  Hermann Ribera
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  ABSTRACT: ABSTRACT Multidisciplinary management may offer alternative therapeutic strategies in patients. Bone-seeking radiopharmaceuticals offered alongside traditional approaches to analgesia may be useful in the treatment of metastatic bone pain. A case of metastatic bone pain in which (153)Sm-lexidronam therapy was used is presented. Minimal side effects, as well as a reduction in opioid use (via patient-controlled analgesia), were observed in this case.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):80-2.
• Article: SURGEON'S GUIDE TO POSTOPERATIVE PAIN MANAGEMENT: COLORECTAL AND ABDOMINAL SURGERY SURGEON'S GUIDE TO POSTOPERATIVE PAIN MANAGEMENT: COLORECTAL AND ABDOMINAL SURGERY . Raymond S. Sinatra , MD, PhD, Sergio Larach , MD, and Sonia Ramamoorthy , MD. West Islip, New York, Professional Communications, Inc. , 2012 , Paperbound, ix + 302 pages including index, ISBN: 978-1-932610-72-7 , List price: $24.95, Copies available from Pacira Pharmaceuticals, Inc.

  Arthur G Lipman
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):93-4.
• Article: Pilot Study of Human Recombinant Hyaluronidase-Enhanced Subcutaneous Hydration and Opioid Administration for Sickle Cell Disease Acute Pain Episodes.

  Marcelo Sandoval, Patricia Coleman, Rahim Govani, Saima Siddiqui, Knox H Todd
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  ABSTRACT: ABSTRACT The objective of this study was to determine the feasibility of protocol-driven human recombinant hyaluronidase (rHuPH20)-enhanced subcutaneous (SC) hydration and opioid administration in adults presenting to the emergency department (ED) with sickle cell disease acute pain episodes (SCDAPE). Adults with SCDAPE were given 150 U of rHuPH20 and normal saline subcutaneously. Opioids were administered SC every 15 minutes for 4 hours until numerical rating scale (NRS) pain intensity scores fell to <5, or Ramsay Sedation Scores were >4. Pain intensity and pain relief were recorded hourly. Total morphine equivalents and fluid volume, total pain relief (TOTPAR), patient- and physician-perceived global efficacy, patient-perceived global SC needle discomfort, physician-rated ease of needle placement, and adverse effects were noted. Ten patients (6 males, 4 females), mean age 32.9 years (23-56 years) completed the trial. Mean pain intensity scores fell 25% (from 9.2 to 6.9) from baseline and mean 4-hour TOTPAR score was 4 (maximum: 16). A mean total of 119 mg (70-170 mg) morphine equivalents and 846 mL (200-1650 mL) normal saline were administered. Mean patient and physician global perceived efficacy ratings were 3.4 and 4.2 (of 5). Patient global discomfort of SC needle presence was 2.7 (of 10), and ease of needle placement was physician rated at 4 (of 4; easiest). Patients experienced mild swelling and stinging at the SC site, and no infusion required discontinuation. The authors conclude that rHuPH20-enhanced subcutaneous hydration and opioid administration appear feasible from this pilot study. These results need confirmation in a controlled clinical trial.
  Journal of Pain & Palliative Care Pharmacotherapy 03/2013; 27(1):10-18.
• Article: Searching for Pain Information, Education, and Support on the Internet.

  Yvette Colón
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  ABSTRACT: ABSTRACT 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. The topics addressed in this issue are searching for pain information, education, support, and providers on the Internet and evaluating online information.
  Journal of Pain & Palliative Care Pharmacotherapy 02/2013;
• Article: The Role of Palliative External Beam Radiation Therapy in Boney Metastases Pain Management.

  Beilei Cai, Nancy A Nickman, David K Gaffney
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  ABSTRACT: ABSTRACT Bone is the third most common organ affected by neoplastic metastases, and about 70% of patients with breast cancer or prostate cancer that develop metastases will have osseous involvement. As part of a multi-pronged approach to pain management in these patients, external beam radio therapy (EBRT) continues to be a mainstay of treatment for metastatic bone pain. This article reviews the role of radiation therapy in palliative management strategies for patients with bone metastases, including the clinical and cost-effectiveness of single fraction (SFRT) versus multiple fraction (MFRT) EBRT in pain relief. Studies indicate that SFRT is more cost-effective than MFRT, yet both are clinically effective in pain management. Therefore, EBRT use retains an important place among analgesia, bone modifying agents, chemotherapy, and hormone therapy in improving quality of life (QoL) and reducing morbidity from metastatic bone pain.
  Journal of Pain & Palliative Care Pharmacotherapy 02/2013;
• Article: PAIN COMORBIDITIES: UNDERSTANDING AND TREATING THE COMPLEX PATIENT PAIN COMORBIDITIES: UNDERSTANDING AND TREATING THE COMPLEX PATIENT , Edited by Maria Adele Giamberardino , MD, and Troels Staehelin Jensen , MD, DMSc Seattle, Washington , IASP Press , 2012 , Softcover, 507 pages, ISBN-13: 978-0-931092-92-3 , List price: US$85.00 IASP, Member price: US$70.00.

  Lee S Simon
  Journal of Pain & Palliative Care Pharmacotherapy 02/2013;
• Article: Pain Awareness and Medication Knowledge: A Health Literacy Evaluation.

  Radhika Devraj, Christopher M Herndon, Jake Griffin
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  ABSTRACT: ABSTRACT Chronic pain is a significant burden to the US health care system. Patient-related barriers such as low health literacy can prevent optimal management of pain. This study aimed to determine the relationship between health literacy, pain awareness, and medication knowledge. Chronic pain patients visiting a family health center were administered a survey addressing the study objectives. Health literacy was measured using the Newest Vital Sign. A total of 139 chronic pain patients participated in the study. Patients with low health literacy had significantly lower overall pain medication knowledge (mean score = 63.3± 18.9 versus 74.3 ± 18.5, p <0.05), and did not know where to find health care professionals to help manage their pain. Patients with low health literacy lacked knowledge of non-medication modes of treating pain, and did not know which non-prescription medications could provide pain relief. The mean Visual Analogue Scale score for the entire sample was 51.54 mm (range = 0 - 100 mm). Pain intensity was not related to health literacy (p > 0.05). Multivariate analyses showed a significant relationship between health literacy and medication knowledge after controlling for demographics. Patients with low health literacy have poor knowledge of pain medications. Educational interventions to meet the needs of patients with low health literacy are essential to safely relieve pain.
  Journal of Pain & Palliative Care Pharmacotherapy 02/2013;