Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesia issues in palliative care: bone pain, controlled release opioids, managing opioid-induced constipation and nifedipine as an analgesic.
Some recent literature relevant to analgesia in palliative care is reviewed. Reports on clinical use of bisphosphonates for bone pain in cancer, controlled release opioids, selection of laxatives for opioid-induced constipation and the calcium channel blocker nifedipine as an analgesic are described.
-
J Pain Palliat Care Pharmacother · Jan 2002
ReviewCan patients taking opioids drive safely? A structured evidence-based review.
A structured evidence-based literature review was completed to determine if there was epidemiological evidence of an association of opioid use and intoxicated driving, motor vehicle accidents (MVA) and MVA fatalities; to rate the quality of this research evidence according to Agency for Health Care Policy and Research (AHCPR) type of evidence and strength and consistency of the evidence rating scales; and according to this evidence determine whether patients taking opioids can drive safely. Relevant references were located from Medline, Psychological Abstracts, Science Citation Index and the National Library of Medicine Data Query databases by appropriate subject headings. A manual search was also performed utilizing the reference lists of the retrieved articles. ⋯ The evidence in this review indicates that opioids do not appear to be associated with intoxicated driving, MVA and MVA fatalities, and consistently indicated that opioids are not associated with MVA. Although the comparison of point prevalence rates to the point prevalence may be problematic, the results of this systematic review support the contention that patients taking opioids may be allowed to drive. As in all clinical decisions, this determination should be individualized according to clinical factors.
-
This paper introduces a new series in the Journal that will address Outcomes Research and Pharmacoeconomics in Pain & Palliative Care. The goal of the series is to provide an overview of the field of outcomes research that will be geared to clinicians, and to review the outcomes literature in the area of Pain and Palliative Care. ⋯ There are a lot of misconceptions about the field including some who look at outcomes research as not really science and not adding to our knowledge about drugs and drug use. To the contrary, outcomes research is a powerful tool, but like many others it has limitations and it is important to understand both what outcomes research is, and what it isn't.
-
J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesic issues in palliative care gastroesophageal reflux pain and chronic non-cancer pain management.
Brief literature reviews and commentary on gastroesophageal reflux disease associated pain management with rectal dosage forms and beliefs about use of opioids in non-cancer pain are presented. Relevant references including the model guidelines of the Federation of State Medical Boards of the United States on the use of opioids in non-cancer pain are cited.
-
J Pain Palliat Care Pharmacother · Jan 2002
ReviewKetamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration.
Ketamine is a parenteral anesthetic agent that provides analgesic activity at sub-anesthetic doses. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with opioid receptor activity. Controlled studies and case reports on ketamine demonstrate efficacy in neuropathic and nociceptive pain. ⋯ Use of this drug by the oral, intranasal, transdermal, rectal, and subcutaneous routes has been reported with analgesic efficacy in treating nociceptive and neuropathic pain. Ketamine also has been reported to produce opioid dose sparing and good patient acceptance. A transdermal formulation is currently under patent review in Brazil and an intranasal formulation is currently undergoing phase I/II clinical trials.