Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Apr 2022
Risk Factors for the Development of Neuropsychiatric Adverse Effects in Ketamine-Treated Pain.
Ketamine use has increased recently for the management of acute and chronic pain. Ketamine can cause a variety of neuropsychiatric adverse effects, such as hallucinations, dysphoria, and nightmares. The objective of this study was to explore risk factors for the development of neuropsychiatric adverse effects in ketamine-treated pain. ⋯ Patients who had an adverse effect were numerically less likely to receive benzodiazepines (28% vs 39.7%, p = 0.153), as were patients who required discontinuation of ketamine (23.1% vs. 41.4%, p = 0.08). In patients receiving ketamine for pain, predicting who may be more likely to experience neuropsychiatric adverse effects remains difficult. Further research is warranted to determine whether benzodiazepines are safe and effective for mitigating these adverse effects in this setting.
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J Pain Palliat Care Pharmacother · Apr 2022
Predictors of Opioid Resistance: An Investigation in Cancer Pain.
Appropriate use of opioid analgesics according to the World Health Organization pain relief ladder has provided pain relief to many patients with cancer pain. However, a proportion of patients fail to achieve sufficient pain relief and develop opioid resistance. Individual risk factors may relate to opioid resistance. ⋯ Age, neuropathic pain, and alkaline phosphatase were extracted as significant factors for opioid resistance (p < 0.05). A resistance score was created from these factors and classified into binary values, the sensitivity was 80.6% and the negative predictive value was 91.6%. The findings suggest that the resistance score could be a sensitive predictor of opioid resistance before opioid initiation.
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J Pain Palliat Care Pharmacother · Apr 2022
The Efficacy of Capsaicin on Sleep Quality and Fatigue in Fibromyalgia.
Capsaicin is a topical pain reliever that has been evaluated by randomized controlled trials (RCTs) as a potential adjunctive therapy for treating unmitigated fibromyalgia. Therefore, a review of English articles using PubMed and Embase was conducted from January 1, 1990 to February 9, 2022 in order to evaluate the utility of capsaicin for improvement of sleep quality and fatigue associated with fibromyalgia. The search terms included: "fibromyalgia" and "capsaicin". ⋯ This same study also found a significant improvement in fatigue. Consequently, this existing evidence is insufficient to warrant recommending capsaicin as adjunctive therapy for improvement in sleep quality and fatigue. Future studies regarding capsaicin therapy for fibromyalgia are needed.
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J Pain Palliat Care Pharmacother · Mar 2022
Case ReportsThoracic Epidural Analgesia Use in Large Recurrent Desmoid Fibromatosis Resection: A Case Report.
We present a case report of the successful use of thoracic epidural analgesia for the surgical resection of a large recurrent desmoid tumor and forequarter amputation in an adolescent male. Spinal anesthesia has been reported for intra-operative management of desmoid tumor resection, however, there are no reported cases of thoracic epidural analgesia for this tumor. Thoracic epidural should be used with caution in this patient population due to risk of de novo tumor creation but can be useful adjuvant to multi-modal analgesia to decrease post-operative opioid requirement.
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J Pain Palliat Care Pharmacother · Mar 2022
Application Site Reactions from the Buprenorphine Transdermal Patch: A Case Series.
Buprenorphine is a partial mu-opioid agonist available as a transdermal patch for use in patients with chronic pain. Transdermal products can be associated with application site reactions (ASRs). The incidence of ASRs to the buprenorphine transdermal patch (BTP) have been described as low and seldom requiring patch discontinuation. ⋯ The strength at which an ASR emerged varied among subjects; however, all ASRs developed with BTP strengths 10 mcg/hr or higher. The dose-response relationship and prolonged onset to ASR emergence may be suggestive of an allergic delayed hypersensitivity reaction. However, in this case series three subjects demonstrated tolerability to BBF either before or after developing a skin reaction to BTP.