Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2023
Equity Reporting in Systematic Reviews of Opioid Treatment of Chronic Non-Cancer Pain with Patient-Reported Outcomes.
Chronic non-cancer pain can affect a patient's social life, ability to work, and overall quality of life (QoL). Opioid therapy is often prescribed as therapeutic treatment in chronic pain. Systematic reviews (SRs)-the pinnacle of research quality-are often used in guideline development; however, pain may differ across cultures and communities. ⋯ All other items were reported in five or less studies. Our investigation revealed a deficiency in SR's reporting of equity measures for opioid treatment of chronic non-cancer pain. Given the need to address healthcare disparities among minorities, implementing the PROGRESS-Plus framework may influence QoL and patient-centered care.
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J Pain Palliat Care Pharmacother · Mar 2023
EditorialSociety of Pain and Palliative Care Pharmacists White Paper on the Role of Opioid Stewardship Pharmacists.
Opioid stewardship is one essential function of pain and palliative care pharmacists and a critical need in the United States. In recent years, this country has been plagued by two public health emergencies: an opioid crisis and the COVID-19 pandemic, which has exacerbated the opioid epidemic through its economic and psychosocial toll. To develop an opioid stewardship program, a systematic approach is needed. ⋯ To ensure dedicated time and attention to critical opioid stewardship efforts, SPPCP recommends and endorses opioid stewardship models employing a full time, opioid stewardship pharmacist in both the inpatient and outpatient setting. Early research suggests that opioid stewardship pharmacists are pivotal to improving opioid metrics and pain care outcomes. However, further research and development in this area of practice is needed and encouraged.
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J Pain Palliat Care Pharmacother · Mar 2023
Evaluation of Pain Scales and Outcome in Critically Ill Patients of a Greek ICU.
The purpose of the study was to evaluate painful procedures in ICU patients and to investigate their effect as well as the role of analgesia in the outcome. We measured pain level and vital signs before, during and after potentially painful procedures by using the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). We analyzed the correlation of these measurements and of analgesia with the outcome. ⋯ The higher change in BPS was correlated with more days of mechanical ventilation [B (95% CI) = 3.640 (1.001-6.280), p = 0.007] and of ICU stay [B (95% CI) = 3.645 (1.035-6.254), p = 0.006]. The higher change in CPOT and the nonuse of extra analgesia were related to increased mortality [OR (95% CI) = 1.492 (1.107-2.011), p = 0.009 and OR (95% CI) = 2.626 (1.013-6.806), p = 0.047]. Increased pain in ICU patients was successfully assessed by the BPS and CPOT and correlated to worse outcomes, which the administration of extra analgesia might improve.
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J Pain Palliat Care Pharmacother · Mar 2023
Observational StudyEvaluation of Naloxone Co-Prescribing Rates for Older Adults Receiving Opioids via a Meds-to-Beds Program.
Over 10,000 older adults died from opioid overdose in 2019. Naloxone is an underutilized antidote that could prevent many opioid overdose-related deaths. There is a paucity of literature evaluating naloxone prescribing through meds-to-beds programs and in older adults. ⋯ Two patients were prescribed naloxone (1.4%), one of whom was ultimately dispensed naloxone (0.7%). Of the 65 prescribers included in our study, the incidence of naloxone co-prescribing (2/65, 3.1%) was no different from a previously-reported rate among prescribers (3/179, 1.7%), p = 0.61. Naloxone co-prescribing for older adults receiving opioid prescriptions through a meds-to-beds program was low and opportunities for program enhancement exist.
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J Pain Palliat Care Pharmacother · Mar 2023
Case Series: Synergistic Effect of Gabapentin and Adjuvant Pregabalin in Neuropathic Pain.
Gabapentin and pregabalin both exert high affinity to the α2δ subunit of the voltage-gated calcium channels which inhibits excitatory neurotransmitter release. The synergistic mechanism was described in rats given combinations of gabapentin and pregabalin. ⋯ Low dose pregabalin was added to therapeutic gabapentin to achieve appreciable pain reduction in one case and improved quality of life in another case. Further research with more enrollment and longer study duration may help elucidate the appropriate dosing and potential associated side effects.