Reduction of Opioid Side Effects by Prophylactic Measures of Palliative Care Team May Result in Improved Quality of Life
ABSTRACT In February 2002, the palliative care team was established in Ikeda Municipal Hospital to improve palliative care. We investigated changes in the incidences of side effects related to opioids, and evaluated palliative care team activities.
Regarding inpatients for whom narcotics were prescribed in our hospital in the years of 2002 (from October 1, 2002 until September 30, 2003), 2004 (from October 1, 2004 until September 30, 2005), and 2006 (from October 1, 2006 until September 30, 2007), we surveyed the rates at which laxatives or antiemetics were prescribed, frequency of defecation/its state before and after the start of narcotic therapy, frequency of nausea/vomiting, and dietary intake.
The proportions of patients in whom laxatives were simultaneously prescribed during opioid therapy in 2002, 2004, and 2006 were 43.5%, 78.7%, and 75.6%, respectively. The proportions of those in whom antiemetics were combined with opioids were 45.7%, 78.7%, and 78.0%, respectively. The incidences of constipation were 50.0%, 39.3%, and 37.8%, respectively. Those of nausea/vomiting were 30.4%, 21.3%, and 9.8%, respectively. Those of anorexia were 65.3%, 39.4%, and 15.4%, respectively.
These results suggest that palliative care team activities facilitated appropriate drug prescription during opioid therapy, reducing the appearance of side effects, with likelihood of improved quality of life.
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ABSTRACT: The aim of this study was to evaluate the effectiveness of prophylactic treatment with laxatives and antiemetics on the incidence of gastrointestinal adverse reactions such as constipation, nausea and vomiting in cancer patients who received oral opioid analgesics for the first time. A multi-institutional retrospective study was carried out, in which 619 eligible hospitalized patients receiving oral opioid analgesics for cancer pain were enrolled from 35 medical institutions. The primary endpoint was the incidence of opioid-induced side effects in patients receiving prophylactic medication. Odds ratios of the incidence of adverse reactions in the absence or presence of premedication obtained from several institutions were subjected to a meta-analysis. Among 619 patients, the incidence of constipation was significantly lower in patients receiving laxatives, including magnesium oxide, as premedication than in those without them (34% vs. 55%, odds ratio=0.432, 95% confidence interval=0.300-0.622, P<0.001). However, the incidence of nausea or vomiting was similar regardless of prophylactic medication with dopamine D2 blockers. The results of the meta-analysis revealed that prophylactic laxatives significantly reduced the incidence of constipation (overall odds ratio=0.469, 95% confidence interval=0.231-0.955, P=0.037), whereas dopamine D2 blockers were not effective in preventing opioid-induced nausea or vomiting. We showed evidence for the effectiveness of premedication with laxatives for prevention of opioid-induced constipation. However, premedication with dopamine D2 blockers was not sufficient to prevent nausea or vomiting.The Clinical journal of pain 12/2011; 28(5):373-81. DOI:10.1097/AJP.0b013e318237d626 · 2.70 Impact Factor
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ABSTRACT: Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL). This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL. This was a systematic review of palliative care journals. Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original article category was further classified according to study designs. Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. The overall reporting rate among all journals was 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting. The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.Indian Journal of Palliative Care 03/2012; 18(1):59-67. DOI:10.4103/0973-1075.97475
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ABSTRACT: Abstract Purpose: To evaluate the efficacy and safety of transdermal fentanyl (TDF) in the control of postoperative pain following photorefractive keratectomy (PRK). Methods: One hundred ninety-nine consecutive PRK cases (398 eyes) were retrospectively reviewed. For postoperative pain control, 96 patients (63 females) were treated with tramadol 37.5 mg/acetaminophen 325 mg combination tablets (2 tablets bid), 103 patients (73 females) were treated with TDF (12 μg/h). Postoperative pain intensity using the visual analog scale (VAS) during postoperative 3 days including the evening of the day of the operation and peak pain intensity, rated using the verbal descriptor scale (VDS) at postoperative 4 days, were compared between 2 groups. Overall adverse events in the 2 treatment groups were also compared. Results: The differences in mean pain intensity scores were significant between the control group and the fentanyl group (P=0.001, Repeated-measures analysis of variance). The proportion of severe pain (VAS>54 mm) was significantly lower in the fentanyl group than the control group by morning of postoperative 2 days (P<0.007). The proportion of patients who rated their peak pain intensity as "intolerable pain" was significantly higher (P=0.001) in the control group (30/96, 31.3%) than the fentanyl group (13/103, 12.6%). Total number of patients who reported adverse events was significant higher in the fentanyl group (P=0.013) than the control group. However, there were no irreversible or severe adverse events in both treatment groups and nausea was the most common (14/103, 13.6%) complaint reported in the fentanyl group. Conclusion: TDF was more effective in the control of postoperative pain after PRK than tramadol/acetaminophen and no irreversible or severe adverse effect was reported with 12 μg/h concentration. TDF could be considered as alternative regimen of analgesic method after PRK.Journal of Ocular Pharmacology and Therapeutics 07/2014; 30(9). DOI:10.1089/jop.2013.0125 · 1.42 Impact Factor