Journal of pain & palliative care pharmacotherapy
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In December 2017, my mother was diagnosed with an end-stage pancreatic cancer. In the following weeks, she had to be taken to the emergency room frequently due to worsening infections, electrolyte imbalance, and vertigo, which often led to delirium. The doctors treating her were well qualified but lacked education and training about palliative and end-of-life care issues, which was reflected in their clinical practice. ⋯ Asking for palliative care-that is, accepting that the medical treatments were not working-sounded like the antithesis of my clinical work as a doctor and my duty as a son. To my surprise, my family agreed; we refused yet another hospital admission and brought her home. She has been spending the last few months in the comfort of her home being cared for by her loving family.
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J Pain Palliat Care Pharmacother · Dec 2018
Case ReportsThe Enigma of Low-Dose Ketamine for Treatment of Opioid-Induced Hyperalgesia in the Setting of Psychosocial Suffering and Cancer-Associated Pain.
Opioid-induced hyperalgesia is a paradoxical adverse effect of opioid therapy with unclear strategies for its treatment and management. We report the successful use of low-dose ketamine infusion for the treatment of opioid-induced hyperalgesia in a 38-year-old woman presenting with psychosocial suffering and high opioid requirement secondary to pain from a poorly differentiated neuroendocrine tumor. Over the course of a month, her opioid requirement escalated to the gram level of oral morphine equivalents, upon which she was hospitalized at University of California San Diego Health for an acute on chronic pain crisis. ⋯ The infusion ultimately allowed reduction of her opioid use to a third of her original daily requirement and improved her function and ability to interact for several days. Although her pain profile became increasingly complicated by psychosocial suffering and disease progression, she did not experience the same pain event for the remainder of her hospital course. Findings from this case report demonstrate the utility of low-dose ketamine infusion in opioid-induced hyperalgesia.
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J Pain Palliat Care Pharmacother · Dec 2018
Analysis of Inpatient Hospice Pharmacist Interventions Within a Veterans Affairs Medical Center.
Clinical pharmacy interventions have been shown to improve medication therapy, prevent undesirable side effects, and improve patients' clinical outcomes in a number of settings; however, limited data exist to characterize clinical pharmacy specialist (CPS) providers' interventions in an inpatient hospice Veteran Affairs (VA) setting. The primary objective of this quality improvement (QI) project was to quantify the number and types of pharmacy interventions implemented from the Pharmacists Achieve Results with Medications Documentation (PhARMD) tool for inpatient hospice patient encounters in a VA medical center. A total of 453 interventions during 185 patient care encounters were documented by CPS providers between September 1, 2016, and December 31, 2016. ⋯ Additionally, CPS providers played a significant role in the deprescribing of medication by discontinuing drugs no longer indicated (18.3%). These results substantiate the valuable contribution to patient care that the CPS providers make in optimizing symptom management and deprescribing at end-of-life. Future studies are needed to characterize the potential cost savings of CPS provider services in the inpatient hospice setting.
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J Pain Palliat Care Pharmacother · Dec 2018
Comparison of Parenteral Opioid Dosing in Adult Sickle Cell Disease Patients With Vaso-occlusive Crisis.
Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. ⋯ Pain scores were not significantly impacted by selection of pain regimen. Our study indicates that INT and PCA treatment modalities are both effective at controlling pain in VOC; however, more patients in the INT group were characterized as having a treatment failure. Based on our results, it is reasonable to initiate PCA as the primary pain treatment strategy in SCD patients presenting in VOC.
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J Pain Palliat Care Pharmacother · Dec 2018
Implementation of a Clinical Pharmacist Service in the Hospice Setting: Financial and Clinical Impacts.
Hospice is a unique environment among all clinical fields of practice. Although every other specialty aims to work toward a curative goal or prevention of mortality, hospice completely redirects focus solely on pain and symptom management and sustaining the highest quality of life possible. ⋯ A cost savings of $427,705 was observed, and the clinical pharmacist provided a great deal of expertise to the IDG. Adding a clinical pharmacist to the IDG of other hospice organizations may prove to be a worthy investment.